Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries.

OBJECTIVE: To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. METHODS: Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. RESULTS: High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. CONCLUSIONS: These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study's results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

Genital human papillomaviruses among women of reproductive age in Jamaica.

OBJECTIVE: To characterize the prevalence and distribution of genital human papillomavirus (HPV) types among women in Jamaica, and to explore risk factors associated with HPV infection. METHODS: This was a cross-sectional study that took place in April-July 2010 with 852 sexually-active women, 16-49 years of age, who had attended a selected public or private primary health clinic in one of Jamaica's four health authority regions. Sociodemographic data was collected from each participant by trained study staff. Each participant had a gynecological examination that included a clinical Pap test and a cervical sample for HPV detection and typing-performed using the Research Use Only Linear Array (LA) genotyping assay (Roche Diagnostics Corp., Indianapolis, Indiana, United States). Overall and type-specific prevalence of HPV infection was calculated for 37 HPV types included in the LA genotyping assay. RESULTS: HPV DNA was detected in 460 of the 852 women (54.0%). Oncogenic HPV was detected in 297 women (34.9%) and HPV types 16/18 were found in 86 women (10.1%). The most frequently occurring HPV types were: 16 (6.2%); 35 (6.0%); 62 and 83 (5.5%); 61 and 58 (5.4%); 84 (4.7%); 18 (4.3%); and, 66 and 81 (4.2%). HPV prevalence was highest among women who were single, young (16-19 years), and had had more than three sexual partners in their lifetime. CONCLUSIONS: These results, coupled with high rates of cervical cancer, support introducing HPV vaccines while maintaining and strengthening cervical cancer screening services. Policy decision-making that reflects these results is instrumental to establishing a comprehensive cervical cancer program in Jamaica.

HPV vaccine introduction in the Americas: a decade of progress and lessons learned.

INTRODUCTION: Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED: HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION: There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.

Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries / Prevalencia del virus del papiloma humano de alto riesgo en las mujeres de dos países del Caribe de habla inglesa / Prevalência do papilomavírus humano de alto risco em mulheres em dois países do Caribe anglófono

ABSTRACT Objective To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. Methods Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. Results High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. Conclusions These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study’s results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

RESUMEN Objetivo Caracterizar la infección por el virus del papiloma humano (VPH) de alto riesgo en una muestra de mujeres de dos países pequeños del Caribe de habla inglesa: Saint Kitts y Nevis, y San Vicente y las Granadinas. Métodos Participaron en el estudio mujeres sexualmente activas ≥ 30 años que acudieron a centros de atención primaria. Se realizó un examen ginecológico a todas las participantes y se le tomaron dos muestras cervicouterinas: 1) una muestra para efectuar la prueba de Papanicolaou y 2) células cervicouterinas exfoliadas para efectuar la prueba de ADN del VPH, mediante la prueba de detección del VPH de alto riesgo en tiempo real (HPV High Risk Screen Real-TM, Sacace). Se evaluaron los genotipos de alto riesgo del VPH en 404 mujeres en Saint Kitts y Nevis, y en 368 mujeres en San Vicente y las Granadinas. Resultados Se detectó VPH de alto riesgo en 102 de 404 mujeres (25,2%) de Saint Kitts y Nevis, y en 109 de 368 (29,6%) de San Vicente y las Granadinas. Los genotipos 52, 35, 51, 45 y 31 de VPH de alto riesgo fueron los detectados con más frecuencia en Saint Kitts y Nevis. En San Vicente y las Granadinas, los más frecuentes fueron los genotipos 45, 35, 31, 18 y 51. Se observó una relación significativa entre la edad actual y la infección por el VPH de alto riesgo en los dos países. Además, en San Vicente y las Granadinas, se halló que la multiparidad (> 3 embarazos) y los resultados anómalos de la prueba de Papanicolaou son factores de riesgo independientes de la infección por el VPH de alto riesgo. Conclusiones Estos resultados aportan datos acerca de la prevalencia del VPH en los estados insulares pequeños del Caribe y respaldan la introducción acelerada de la vacuna nonavalente contra el VPH en los dos países y en los demás países del Caribe de habla inglesa. Se recomienda aplicar los resultados de este estudio para guiar la formulación de políticas con respecto a la incorporación de las pruebas de detección del VPH como método primario de tamizaje en las mujeres mayores.

RESUMO Objetivo Caracterizar as infecções pelo papilomavírus humano (HPV) de alto risco em uma amostra de mulheres de dois países pequenos do Caribe anglófono: São Cristóvão e Nevis e São Vicente e Granadinas. Métodos Mulheres sexualmente ativas com ≥ 30 anos de idade atendidas em unidades básicas de saúde participaram do estudo. Cada participante foi submetida a exame ginecológico e coleta de duas amostras do colo do útero: (1) uma amostra para exame de Papanicolau e (2) uma amostra de citologia esfoliativa para teste de DNA do HPV, utilizando o kit HPV High Risk Screen Real-TM (Sacace). A presença de genótipos de HPV de alto risco foi avaliada em 404 mulheres em São Cristóvão e Nevis e 368 mulheres em São Vicente e Granadinas. Resultados HPV de alto risco foi detectado em 102/404 mulheres (25,2%) em São Cristóvão e Nevis e em 109/368 (29,6%) em São Vicente e Granadinas. Os genótipos 52, 35, 51, 45 e 31 do HPV foram os tipos de alto risco mais comuns em São Cristóvão e Nevis. Em São Vicente e Granadinas, os genótipos do HPV de alto risco mais comuns foram 45, 35, 31, 18 e 51. Foi constatada associação significante entre idade atual e infecção por HPV de alto risco em ambos os países. Além disso, em São Vicente e Granadinas, multiparidade (>3 gestações) e Papanicolau anormal foram fatores de risco independentes para o HPV de alto risco. Conclusões Esses resultados contribuem informações sobre a prevalência do HPV nas pequenas nações insulares do Caribe e apoiam a introdução acelerada da vacina nonavalente contra o HPV nestes dois países e no restante do Caribe anglófono. Recomenda-se o uso dos resultados deste estudo para orientar a formulação de políticas com relação à implementação do exame de HPV como modalidade primária de triagem para mulheres mais velhas.

Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries / Prevalencia del virus del papiloma humano de alto riesgo en las mujeres de dos países del Caribe de habla inglesa / Prevalência do papilo¬mavírus humano de alto risco em mulheres em dois países do Caribe anglófono

Objective. To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. Methods. Sexually active women . 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. Results. High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. Conclusions. These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study fs results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

Objetivo. Caracterizar la infección por el virus del papiloma humano (VPH) de alto riesgo en una muestra de mujeres de dos países pequeños del Caribe de habla inglesa: Saint Kitts y Nevis, y San Vicente y las Granadinas. Métodos. Participaron en el estudio mujeres sexualmente activas ≥ 30 años que acudieron a centros de atención primaria. Se realizó un examen ginecológico a todas las participantes y se le tomaron dos muestras cervicouterinas: 1) una muestra para efectuar la prueba de Papanicolaou y 2) células cervicouterinas exfoliadas para efectuar la prueba de ADN del VPH, mediante la prueba de detección del VPH de alto riesgo en tiempo real (HPV High Risk Screen Real-TM, Sacace). Se evaluaron los genotipos de alto riesgo del VPH en 404 mujeres en Saint Kitts y Nevis, y en 368 mujeres en San Vicente y las Granadinas. Resultados. Se detectó VPH de alto riesgo en 102 de 404 mujeres (25,2%) de Saint Kitts y Nevis, y en 109 de 368 (29,6%) de San Vicente y las Granadinas. Los genotipos 52, 35, 51, 45 y 31 de VPH de alto riesgo fueron los detectados con más frecuencia en Saint Kitts y Nevis. En San Vicente y las Granadinas, los más frecuentes fueron los genotipos 45, 35, 31, 18 y 51. Se observó una relación significativa entre la edad actual y la infección por el VPH de alto riesgo en los dos países. Además, en San Vicente y las Granadinas, se halló que la multiparidad (> 3 embarazos) y los resultados anómalos de la prueba de Papanicolaou son factores de riesgo independientes de la infección por el VPH de alto riesgo. Conclusiones. Estos resultados aportan datos acerca de la prevalencia del VPH en los estados insulares pequeños del Caribe y respaldan la introducción acelerada de la vacuna nonavalente contra el VPH en los dos países y en los demás países del Caribe de habla inglesa. Se recomienda aplicar los resultados de este estudio para guiar la formulación de políticas con respecto a la incorporación de las pruebas de detección del VPH como método primario de tamizaje en las mujeres mayores.

Objetivo. Caracterizar as infecções pelo papilomavírus humano (HPV) de alto risco em uma amostra de mulheres de dois países pequenos do Caribe anglófono: São Cristóvão e Nevis e São Vicente e Granadinas. Métodos. Mulheres sexualmente ativas com ≥ 30 anos de idade atendidas em unidades básicas de saúde participaram do estudo. Cada participante foi submetida a exame ginecológico e coleta de duas amostras do colo do útero: (1) uma amostra para exame de Papanicolau e (2) uma amostra de citologia esfoliativa para teste de DNA do HPV, utilizando o kit HPV High Risk Screen Real-TM (Sacace). A presença de genótipos de HPV de alto risco foi avaliada em 404 mulheres em São Cristóvão e Nevis e 368 mulheres em São Vicente e Granadinas. Resultados. HPV de alto risco foi detectado em 102/404 mulheres (25,2%) em São Cristóvão e Nevis e em 109/368 (29,6%) em São Vicente e Granadinas. Os genótipos 52, 35, 51, 45 e 31 do HPV foram os tipos de alto risco mais comuns em São Cristóvão e Nevis. Em São Vicente e Granadinas, os genótipos do HPV de alto risco mais comuns foram 45, 35, 31, 18 e 51. Foi constatada associação significante entre idade atual e infecção por HPV de alto risco em ambos os países. Além disso, em São Vicente e Granadinas, multiparidade (>3 gestações) e Papanicolau anormal foram fatores de risco independentes para o HPV de alto risco. Conclusões. Esses resultados contribuem informações sobre a prevalência do HPV nas pequenas nações insulares do Caribe e apoiam a introdução acelerada da vacina nonavalente contra o HPV nestes dois países e no restante do Caribe anglófono. Recomenda-se o uso dos resultados deste estudo para orientar a formulação de políticas com relação à implementação do exame de HPV como modalidade primária de triagem para mulheres mais velhas.

Assessing participation of women in a cervical cancer screening program in Peru.

OBJECTIVE: To assess systemic and individual factors influencing participation of women in a screening program for cervical cancer. METHODS: In November 2000, a new cervical cancer screening program was introduced in the Region of San Martin, Peru. A total of 107 683 women, ages 25-49, were eligible for screening. This report covers the initial period from program inception through 31 October 2003. We used data from the program information system to identify systemic factors and individual characteristics influencing women's participation. We conducted a three-step analysis: we assessed systemic factors at the level of micronetworks or group of health centers, we estimated the odds of being a new user (never screened or not screened in the past 5 years) according to sociodemographic characteristics, and we assessed how women learned about the availability of screening services while controlling for influential factors identified in previous analyses. RESULTS: During the 3-year period, 36 759 eligible women attended screening services, for a participation rate of 32.3%. While attendance varied by area and time period, the program attracted 12 208 new users. Health care micronetworks with available static screening services had higher participation. New users were more likely than regular users to have less education and to report low use of family-planning services. All other factors being equal, they were also more likely than regular users to hear about screening services from a health care provider. CONCLUSION: In this setting, the presence of and contact with health services played a role in increasing the participation in screening of women not previously screened or not screened in the past 5 years.

Human papillomavirus vaccine policy and delivery in Latin America and the Caribbean.

Cervical cancer caused by human papillomavirus (HPV) is a major preventable public health problem. Two vaccines are now available for primary prevention of HPV infection and their introduction offers new opportunities to enhance comprehensive cervical cancer prevention and control. Currently, HPV vaccine price is a significant barrier to rapid vaccine introduction and access. Therefore, making evidence-based decisions about whether and how to introduce HPV vaccine into the immunization schedule in the countries of Latin America and the Caribbean (LAC) requires a rigorous analysis of several factors. These include: estimates of disease burden, cost-effectiveness, operational feasibility of reaching a population of adolescent females and other key analyses that have been used in recent years to support the introduction of other vaccines, such as rotavirus and pneumococcal conjugate vaccines. Given the large number of public health priorities that are competing for limited public resources, developing and using a sound evidence base is of particular importance for vaccines, like HPV, which are currently available only at prices higher than other vaccines now in use. HPV vaccination provides the opportunity to dramatically improve women's health and partnerships must also be broad-based and effectively coordinated. This can be achieved by developing programs based on the lessons learned from vaccination strategies used to eliminate rubella and neonatal tetanus and for scaling up influenza vaccination in countries of LAC.

Determinants of human papillomavirus vaccine acceptability in Latin America and the Caribbean.

Prophylactic human papillomavirus (HPV) vaccines provide promise as a key component of future cervical cancer prevention programs in the Latin America and the Caribbean region. The successful introduction and acceptance of these vaccines will depend on a range of factors including awareness of cervical cancer as a problem, affordability of the vaccine, political will, competition with other vaccines, feasibility of vaccine delivery and acceptability of the vaccine among the range of groups who will influence uptake. While existing data about acceptability from Latin America and the Caribbean is scarce, it is clear that health policymakers, providers and the general public lack knowledge about HPV and cervical cancer. Furthermore, they would value more local epidemiologic data related to cervical cancer. Price is currently a major barrier to vaccine acceptability and a priority for advocacy. More research is required in Latin America and the Caribbean to determine what messages and strategies will work in these communities.

Genital human papillomaviruses among women of reproductive age in Jamaica / Virus de los papilomas humanos genitales en mujeres en edad reproductiva de Jamaica

OBJECTIVE: To characterize the prevalence and distribution of genital human papillomavirus (HPV) types among women in Jamaica, and to explore risk factors associated with HPV infection. METHODS: This was a cross-sectional study that took place in April-July 2010 with 852 sexually-active women, 16-49 years of age, who had attended a selected public or private primary health clinic in one of Jamaica's four health authority regions. Sociodemographic data was collected from each participant by trained study staff. Each participant had a gynecological examination that included a clinical Pap test and a cervical sample for HPV detection and typing-performed using the Research Use Only Linear Array (LA) genotyping assay (Roche Diagnostics Corp., Indianapolis, Indiana, United States). Overall and type-specific prevalence of HPV infection was calculated for 37 HPV types included in the LA genotyping assay. RESULTS: HPV DNA was detected in 460 of the 852 women (54.0%). Oncogenic HPV was detected in 297 women (34.9%) and HPV types 16/18 were found in 86 women (10.1%). The most frequently occurring HPV types were: 16 (6.2%); 35 (6.0%); 62 and 83 (5.5%); 61 and 58 (5.4%); 84 (4.7%); 18 (4.3%); and, 66 and 81 (4.2%). HPV prevalence was highest among women who were single, young (16-19 years), and had had more than three sexual partners in their lifetime. CONCLUSIONS: These results, coupled with high rates of cervical cancer, support introducing HPV vaccines while maintaining and strengthening cervical cancer screening services. Policy decisionmaking that reflects these results is instrumental to establishing a comprehensive cervical cancer program in Jamaica.

OBJETIVO: Determinar la prevalencia y la distribución de los tipos de virus de los papilomas humanos (VPH) genitales en las mujeres de Jamaica y explorar los factores de riesgo asociados con la infección por VPH. MÉTODOS: Este estudio transversal se llevó a cabo de abril a julio del 2010. Participaron 852 mujeres sexualmente activas, de 16 a 49 años de edad, que acudieron a uno de los consultorios públicos o privados de atención primaria seleccionados en cada una de las cuatro autoridades sanitarias regionales de Jamaica. Personal capacitado del estudio recopiló datos sociodemográficos de cada participante. Todas las participantes fueron sometidas a un examen ginecológico que comprendía una prueba clínica de Papanicolaou y la obtención de una muestra del cuello uterino a efectos de detectar y tipificarlos VPH mediante la prueba de genotipado Linear Array (LA) (Roche Diagnostics Corp., Indianápolis, Indiana, Estados Unidos), de uso exclusivo en investigación. Se calcularon las prevalencias global y específica de tipo de la infección por VPH para los 37 tipos de VPH incluidos en la prueba de genotipado LA. RESULTADOS: Se detectó ADN de VPH en 460 de las 852 mujeres (54,0%). Se detectaron VPH oncógenos en 297 mujeres (34,9%), y VPH de los tipos 16 y 18 en 86 mujeres (10,1%). Los tipos de VPH detectados con mayor frecuencia fueron 16 (6,2%), 35 (6,0%), 62 y 83 (5,5%), 61 y 58 (5,4%), 84 (4,7%), 18 (4,3%), y 66 y 81 (4,2%). La prevalencia de VPH fue más elevada en mujeres solteras, jóvenes (de 16 a 19 años) y que habían tenido más de tres compañeros sexuales en sus vidas. CONCLUSIONES: Estos resultados, junto a las elevadas tasas de cáncer cervicouterino, fundamentan la introducción de las vacunas contra el VPH al tiempo que se mantienen y refuerzan los servicios de tamizaje del cáncer cervicouterino. Las decisiones políticas que se adopten como consecuencia de estos resultados serán determinantes para establecer un programa integral contra el cáncer cervicouterino en Jamaica.

Economic analyses of rubella and rubella vaccines: a global review.

OBJECTIVE: To investigate whether the incorporation of rubella vaccine into immunization programmes in developing countries is economically justified. METHODS: A MEDLINE search was conducted for articles published between 1970 and 2000 that dealt with economic analyses of rubella and rubella-containing vaccines. The Eastern Mediterranean, South-East Asia, and Africa regional Index Medicus databases and the LILACS database for Latin America and the Caribbean were also searched. FINDINGS: For developed countries, five cost- benefit analyses of rubella vaccine and five of measles-mumps-rubella vaccine as well as two cost-effectiveness analyses were found. For developing countries, five cost analyses and five cost-benefit analyses were found. All the cost-benefit analyses had a benefit:cost ratio greater than 1 and the cost-effectiveness studies indicated that rubella immunization was a cost-effective means of reducing the impact of congenital rubella syndrome. However, the methodologies were not standardized. CONCLUSION: The data support the inclusion of rubella vaccine in the immunization programmes of both developing and developed countries and indicate economic benefits comparable to those associated with hepatitis B vaccine and Haemophilus influenzae type b vaccine. More studies should be carried out on costs for care and immunization using standardized methodologies and locally obtained information.

Assessing participation of women in a cervical cancer screening program in Peru / Análisis de la participación de las mujeres en un programa de tamizaje de cáncer cervicouterino en Perú

OBJECTIVE: To assess systemic and individual factors influencing participation of women in a screening program for cervical cancer. METHODS: In November 2000, a new cervical cancer screening program was introduced in the Region of San Martin, Peru. A total of 107 683 women, ages 25-49, were eligible for screening. This report covers the initial period from program inception through 31 October 2003. We used data from the program information system to identify systemic factors and individual characteristics influencing women's participation. We conducted a three-step analysis: we assessed systemic factors at the level of micronetworks or group of health centers, we estimated the odds of being a new user (never screened or not screened in the past 5 years) according to sociodemographic characteristics, and we assessed how women learned about the availability of screening services while controlling for influential factors identified in previous analyses. RESULTS: During the 3-year period, 36 759 eligible women attended screening services, for a participation rate of 32.3 percent. While attendance varied by area and time period, the program attracted 12 208 new users. Health care micronetworks with available static screening services had higher participation. New users were more likely than regular users to have less education and to report low use of family-planning services. All other factors being equal, they were also more likely than regular users to hear about screening services from a health care provider. CONCLUSION: In this setting, the presence of and contact with health services played a role in increasing the participation in screening of women not previously screened or not screened in the past 5 years.

OBJETIVOS: Evaluar los factores sistémicos e individuales que influyen en la participación de las mujeres en un programa de tamizaje de cáncer cervicouterino. MÉTODOS: En noviembre de 2000 se implementó un nuevo programa de tamizaje de cáncer cervicouterino en la región de San Martín, Perú. En total, 107 683 mujeres de 25 a 49 años eran elegibles para el tamizaje. Este informe cubre el período inicial desde el establecimiento del programa hasta el 31 de octubre de 2003. Se utilizaron los datos del sistema de información del programa para identificar los factores sistémicos y las características individuales que influían en la participación de las mujeres. Se realizó un análisis en tres etapas: se evaluaron los factores sistémicos a nivel de las microrredes o grupos de centros de salud, se estimaron las probabilidades de ser una nueva usuaria (nunca tamizada o no tamizada en los últimos 5 años) según las características sociodemográficas y se evaluó la vía por la que las mujeres habían conocido de la disponibilidad de los servicios de tamizaje, controlado por factores de influencia identificados en análisis previos. RESULTADOS: En el período de tres años, 36 759 mujeres elegibles recibieron este servicio, para una tasa de participación de 32,3 por ciento. Aunque la asistencia varió según la zona y el momento, el programa atrajo a 12 208 nuevas usuarias. Las microrredes sanitarias con servicios de tamizaje estáticos tuvieron una mayor participación. Las nuevas usuarias tenían menor nivel educacional y utilizaban menos los servicios de planificación familiar que las mujeres que se habían realizado la prueba con regularidad. Sin diferencias en el resto de los factores, las nuevas usuarias habían oído sobre los servicios de tamizaje más frecuentemente de los trabajadores sanitarios que las usuarias habituales. CONCLUSIONES: En este escenario, la presencia de servicios de salud y el contacto con ellos influyeron en el aumento de la participación...

Surveillance for rubella and congenital rubella syndrome in the Caribbean and costing the burden of disease - abstract

Subsequently to the "BIG BANG" catch up measles vaccination campaign that was conducted in the sub-region during 1991, very low rubella incidence rates (<2.0 cases per 100,000 population) were recorded during the years 1992 through 1995. Beginning in 1995, however, and continuing through 1997, sizeable outbreaks of rubella have occurred in Jamaica, Barbados, Trinidad and Tobago, Guyana, and Belize. Subregional rubella incidence rates increased to 10.3 cases per 100,000 population in 1996 and a prototype surveillance system for congenital rubella syndrome (CRS) was developed and disseminated to all CAREC member countries in 1996. Analysis of surveillance data indicates that nearly half (47.1 percent) of these reported cases were diagnosed at birth. Intrauterine growth retardation and cataracts appear to be the predominant clinical manifestations. The maternal age distribution of CRS case (18-37 years) supports the hypothesis that we have not as yet increased our rubella vaccination coverage among women of child bearing age to prevent CRS and our use of Measles-Mumps-Rubelle vaccine in infant populations has been too recent to confer any significant benefit to such women. Direct costs alone associated with the care of an infant with CRS in Trinidad and Tobago are conservatively estimated at US$20,000 annually. These as well as indirect costs are, however, eminently avoidable. The costs of an immunisation campaign would have to exceed the hundreds of thousands spent on CRS care before an immunisation effort would fail to be beneficial. Expenditure of one half of what this syndrome cost might have prevented it altogether.(AU)

Neonatal manifestation of congenital rubella following an outbreak in Trinidad

An outbreak of rubella occurred in Trinidad during 1982 and continued into 1983 when 992 cases were reported in a 17-month period. Twenty infants were diagnosed as suffering from the congenital rubella syndrome based on clinical and laboratory findings. There was a positive history of maternal rubella in 17 (85 per cent), the majority of whom were under 25 years of age. There was equal sex distribution in the affected infants; half of whom showed growth retardation. Hepatosplenomegaly was the commonest finding (90 and 80 per cent). Other findings were thrombocytopenia (55 per cent) abnormal central nervous system signs (60 per cent), congenital heart disease (55 per cent), eye defects (50 per cent), X-ray changes in the lung (35 per cent) and bones (35 per cent), purpura (25 per cent) and anaemia (40 per cent). Two of the twenty neonates died (10 per cent mortality). Positive rubella antibody titre (HAI) ranged from 1:20 to 1:320. Rubella-specific IgM was positive in seven of 15 babies (46 per cent) (AU)

Epidemiological characteristics of tetanus in Trinidad (1973 - 1975)

In the 3 years 1973-1975, 88 persons were known to have had tetanus in Trinidad. The distribution of patients by age was unusual only for those 20-49 years old, in which males predominated. Of the 88 patients, 65 reported a recent injury; 46 of these were on the foot or leg. The case-fatality ratio was 30 percent; fatal cases had notably shorter incubation periods(most, less tha n9 days). Immunization status was not known for 66 percent (58/88). Of those with known immunization status, 9 of the 19 who had never been vaccinated against tetanus died; only 1 of the other 11 died. There was no consistent seasonal pattern of occurrence of cases. The incidence of tetanus decreased from 7.5 cases/100,000 population in 1968 to less than 3/100,000 in 1973-1975. Vaccination for the groups at higher risk of developing tetanus is now being stressed throughout Trinidad. (AU)

HIV Seroprevalence trends among antenatal clinic attenders in Trinidad and Tobago - abstract

Seroepidemiological studies in selected sentinel populations are essential for monitoring changes in the prevalence of HIV (Human Immunodeficiency Virus) infection in these groups. The data that they yield are critical for the design, implementation and evaluation of preventive or control strategies and activities. Two HIV serosurveys were conducted in Trinidad and Tobago among samples of antenatal clinic attenders at government health facilities during 1990 and in 1991/1992. Seropositivity was also assessed in relation to a number of demographic factors such as age, geographic location and ethnicity. The overall seroprevalence of HIV infection as assayed by Immunofluorescence or Western Blot analyses was 0.28 and 0.62 per cent in 1990 and 1991/1992, respectively. In both serosurveys, HIV antibody positive ateenders were significantly younger than their seronegative counterparts. The increased number of clinic sites at which seropositive women were identified in 1991/1992 over 1990 strongly suggests that there was further penetration of HIV into this population. Changes in the ethnic distribution of seropositive attenders have also been observed over the intersurvey period. The results of these studies emphasize the need for reorienting our HIV prevention and control programmes to ensure that young adolescent females are not only well informed about prevention, but also actually engage in risk education behaviours. Additionally, the apparent doubling in HIV seroprevalence rates over a 12-15-month period points to the urgent need for developing clear policy guidelines for pregnant HIV-infected women as regards reproductive choices and breast feeding options (AU)