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.

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.

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.

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.

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)

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)

An assessment of the yellow fever vaccination campaign in Trinidad, West Indies

A study was undertaken to assess the effectiveness of a yellow fever vaccination campaign, which had been conducted in Trinidad, West Indies from November, 1978 through 1979. Evaluative tools consisted of: (i) an interview survey in a randomly selected sample of two hundred households, to determine immunization coverage and (ii) a serological study of 232 vaccines to ascertain protection conferred through use of 17D yellow fever vaccination. Results of the household survey indicate that approximately 12.53 percent of the 1149 persons interviewed had not been vaccinated against yellow fever. In most instances, no substantial reasons could be advanced by respondents for non-immunization. Based on the performance of 13 plaque reduction neutralization tests, all but one of the 232 sera examined from people with a history of immunization posessess adequate humoral immunity to yellow fever. This study has, therefore, shown that the vaccination campaign, under review, was successful in achieving satisfactory protection of immunized persons, and in drastically reducing the number of susceptibles within the population (AU)

Yellow fever activity in Trinidad: a historical review

Documentation of yellow fever in the Caribbean from as early as 1620. The disease in Trinidad is traced back to 1793, however, it is noted that no further documentation of epidemic activity was recorded until 1818, following which a number of outbreaks were reported on the island. A Table of outbreaks of yellow fever in the West Indies, 1620-1900 (Scott) is also presented

Yellow fever activity in Trinidad: a historical review

Documentation of yellow fever in the Caribbean from as early as 1620. The disease in Trinidad is traced back to 1793, however, it is noted that no further documentation of epidemic activity was recorded until 1818, following which a number of outbreaks were reported on the island. A Table of outbreaks of yellow fever in the West Indies, 1620-1900 (Scott) is also presented

An assessment of the yellow fever vaccination campaign in Trinidad, West Indies

A study was undertaken to assess the effectiveness of a yellow fever vaccination campaign, which had been conducted in Trinidad, West Indies from November, 1978 through 1979. Evaluative tools consisted of: (i) an interview survey in a randomly selected sample of two hundred households, to determine immunization coverage and (ii) a serological study of 232 vaccines to ascertain protection conferred through use of 17D yellow fever vaccination. Results of the household survey indicate that approximately 12.53 per cent of the 1149 persons interviewed had not been vaccinated against yellow fever. In most instances, no substantial reasons could be advanced by respondents for non-immunization. Based on the performance of 13 plaque reduction neutralization tests, all but one of the 232 sera examined from people with a history of immunization posessess adequate humoral immunity to yellow fever. This study has, therefore, shown that the vaccination campaign, under review, was successful in achieving satisfactory protection of immunized persons, and in drastically reducing the number of susceptibles within the population.