A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica.

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of the other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8% of 23,050 patients had GUD, men (9.3%) more often than women (4.2%; p < 0.001). In 1990/91 the prevalence rate was 12.8%, with increased rates for both men (18.2%) and women (6.8%; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8% and 7.8% of the patients; syphilis, in 12.9% and 18.8%; chancroid, in 12.4% and 13.3%; viral warts, in 5.7% and 6.3%; lymphogranuloma venereum, in 4.1% and 3.9%; and granuloma inguinale, in 3.6% and 2.3%. In men the rate for syphilis was 19% in 1990/91 and 8% in 1982/83 (p = 0.001); and for genital herpes it was 7% in 1990/91 and 17% in 1982/83 (p = 0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4% of cases in 1982/83 (particularly in men), and in 47.6% of cases in 1990/91. GUDs facilitate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by strengthening the STD/HIV control programme.

PIP: The prevalence of genital ulcer disease (GUD) was investigated in two cross-sectional studies of patients presenting to the sexually transmitted disease (STD) clinic at the Comprehensive Health Center in Kingston, Jamaica, between December 1982 and August 1983 (n = 23,050) and between November 1990 and January 1991 (n = 1001). The median age of participants was 26 years for men and 25 years for women; most were low-income inner-city residents. The prevalence of GUD rose from 6.8% (9.3% in men and 4.2% in women) in the 1982-83 survey to 12.8% (18.2% in men and 6.8% in women) in 1990-91. In 1982-83 and 1990-91, respectively, genital herpes was diagnosed in 16.8% and 7.8% of patients, syphilis in 12.9% and 18.8%, chancroid in 12.4% and 13.3%, viral warts in 5.7% and 6.3%, lymphogranuloma venereum in 4.1% and 3.9%, and granuloma inguinale in 3.6% and 2.3%. A clinical diagnosis could not be made in 44.4% of cases in 1982-83 and in 47.6% in 1990-91. Since GUDs facilitate the transmission of HIV, HIV prevention efforts must include the strengthening of STD control programs. All cases of GUD should be screened for both syphilis and HIV, with prompt treatment to reduce the period of GUD transmissibility. Jamaica has revised its national STD case management guidelines to include simplified algorithms for GUD management and strengthened STD surveillance and contact tracing. Changes in GUD prevalence over time may be a useful indicator for evaluating the impact of STD/HIV interventions.

The use of wide-mesh gauze impregnated with lambda-cyhalothrin covering wall openings in huts as a vector control method in Suriname.

An alternative vector control method, using lambda-cyhalothrin impregnated wide-mesh gauze covering openings in the walls of the houses was developed in an area in the Eastern part of the interior of Suriname. Experimental hut observations showed that Anopheles darlingi greatly reduced their biting activity (99-100%) during the first 5 months after impregnation. A model assay showed high mortality both of mosquitoes repelled by the gauze as well as of those that succeeded in getting through it. A field application test in 270 huts showed good acceptance by the population and good durability of the applied gauze. After introducing the method in the entire working area, replacing DDT residual housespraying, the malaria prevalence, of 25-37% before application dropped and stabilized at between 5 and 10% within one year. The operational costs were less than those of the previously used DDT housespraying program, due to a 50% reduction in the cost of materials used. The method using wide-mesh gauze impregnated with lambda-cyhalothrin strongly affects the behavior of An. darlingi. It is important to examine the effect of the method on malaria transmission further, since data indirectly obtained suggest substantial positive results.

PIP: Field application testing in Suriname confirmed that use of wide-mesh gauze impregnated with lambda-cyhalothrin to cover openings in the walls of Bush Negro homes represents an effective, acceptable, and low-cost vector control method. In experimental hut observations in the Eastern part of the interior of Suriname, this method reduced the biting activity of Anopheles darlingi by 99-100% in the first 5 months after impregnation. A model assay showed high mortality among mosquitoes repelled by the gauze and 100% mortality in insects that were able to cross through the mesh. A field application test in 270 huts showed good acceptance by the population, with no conflicts with local cultural customs, and excellent durability. After replacement of DDT residual house-spraying (associated with a malaria prevalence of 25-37%) with the impregnated gauze method, malaria prevalence dropped to 5-10% and material costs were halved. When the Suriname Government resumed responsibility for health care in the interior in 1992 when political strife stopped, use of this vector control method was not continued despite its demonstrated benefits.

The epidemiology of HIV-1 infection in Peru, 1986-1990.

OBJECTIVE: To determine the extent of the HIV-1 epidemic in Peru. DESIGN: Part of a national serosurvey in Peru. METHODS: Between January 1986 and December 1990, 140,976 serum samples were tested for HIV-1 antibody. RESULTS: HIV-1 antibody was found in a high percentage of serum samples provided by 4300 homosexual men (26%), 2204 male sexually transmitted disease patients (10%), 145 drug users (13%), 269 hemophiliacs (10%), and 146 unlicensed female prostitutes (10%). In addition, the prevalence of HIV-1 infection increased substantially among these groups between the beginning and end of the survey period. A low but rising prevalence of HIV-1 antibody was found during this period among serum samples provided by 83,526 blood donors and 11,101 military personnel:total period prevalence, 0.25 and 0.32%, respectively. CONCLUSION: These data indicate that HIV-1 infection is epidemic in Peru among groups at high risk of sexually and parenterally transmitted diseases, and that the risk of infection appears to be low but possibly increasing among the general population.

PIP: The findings of a national seroprevalence survey conducted in Peru during 1986-90 indicate accelerating rates of human immunodeficiency virus (HIV) among population groups at high risk of sexually transmitted diseases. Two databases were maintained: 1) January 1986-December 1988 and 2) January 1989-December 1990. Of the 140,976 survey participants, 3345 (2.4%) were HIV-positive by Western blot. 2591 participants were selected because of clinical signs suggestive of acquired immunodeficiency syndrome (AIDS); 46.7% were HIV-positive, but the prevalence increased from 19% in the 1986-88 period to 60% during 1989-90. Among the 4300 men who identified themselves as homosexual or bisexual, 26% were seropositive (8% during 1986-88 and 41% during 1989-90). HIV prevalence among 2204 men attending a sexually transmitted diseases clinic was 10.3%, with an increase from 2.0% in the first period to 19.0% in the later period. 10.4% of the 269 hemophiliacs were HIV-infected, with an increase from 8% to 36%. Among the 145 intravenous drug users, the prevalence rose from 1% during 1986-88 to 27% during 1989-90. Among 5827 registered female prostitutes, the prevalence rose from 0.3% to 0.7%; however, a 1990 analysis of 146 unregistered prostitutes revealed a rate of 9.6%. The HIV rates among 285 female and 105 male heterosexual partners of known HIV-positive persons were 50.2% and 40.0%, respectively. HIV prevalence increased from 0.8% during 1986-88 to 8.0% during 1989-90 among 1532 men and 1247 women who requested anonymous HIV testing. The prevalence among 542 male and 615 female medical personnel was 2.3%. Among 78,793 volunteer and 4733 paid blood donors, HIV prevalence was 0.2% (0.3% among paid donors). The period prevalence among 11,101 male military recruits and active duty members increased from 0.009% to 0.5%. Finally, only 0.3% of 21,595 applicants for immigration visas were HIV-positive, and there were no HIV cases among 1234 pregnant women attending antenatal clinics. Although the very low HIV prevalence among military personnel and pregnant women suggests that the virus is not yet widely disseminated within the general population, the finding that 28% of HIV-positive men were married and engaged in bisexual behavior suggests potential for heterosexual transmission in the years ahead.

Marked reduction of anemia during pregnancy over a 10-year period in Montserrat.

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90% of all women giving birth on Montserrat in 1980 and 1985, as well as 80% of those giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82% of the study women in 1980 to 23% in 1985 and 19% in 1990) and also a marked drop at three days postpartum (from 91% in 1980 to 41% in 1985 and 39% in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of the study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities.

Reduction in anaemia in pregnant women in three Caribbean countries. Possible results of different types of interventions.

PIP: The Caribbean Food and Nutrition Institute conducted a survey of anemia status of pregnant and/or lactating women in Jamaica (1982), Montserrat (1981), and St. Vincent and the Grenadines (1985). After various interventions designed to reduce the prevalence of anemia in pregnant women, follow-up surveys were conducted in the same countries five years after the initial surveys to determine whether or not the prevalence of anemia in pregnant women did indeed fall after these interventions. As of July 1984, the Jamaica Flour Mills began fortifying all baking flour and counter flour with iron (44 mg/kg) (a 70% increase in the amount of iron added), thiamine (6.3 mg/kg), riboflavin (3.9 mg/kg), and niacin (52.8 mg/kg). During the five year period following the initial survey in Montserrat, health workers had changed the type of iron administered to pregnant women, a constant supply of iron tablets was established, and the economy had improved. The changes in St. Vincent and the Grenadines were that the government provided a constant supply of iron folate (ferrous folate) tablets and there was a 1988 workshop on a manual on the control of anemia where nurses were trained in better clinic management of anemia. The prevalence of anemia (Hb 11 g/dl) in pregnant women fell from 61.6% to 53% (p 0.09) in Jamaica. It fell from 82.3% to 22.1% in Montserrat (p 0.0001). The prevalence of anemia (Hb 10 g/dl) in pregnant women fell from 25% to 14.5% (p 0.001) in St. Vincent and the Grenadines. These findings show that different interventions may have contributed to the reduction in the prevalence of anemia in pregnant women in Jamaica, Montserrat, and St. Vincent and the Grenadines.^ieng

Lessons from Cuba: mass campaign administration of trivalent oral poliovirus vaccine and seroprevalence of poliovirus neutralizing antibodies.

The immunogenicity of trivalent oral poliovirus vaccine (TOPV), which is less effective in tropical than in temperate areas, may potentially be improved in several ways, including increasing the number of doses. Little information is available on TOPV when more than 6 doses are given. The situation in Cuba provides a unique opportunity to relate the seroprevalence of neutralizing antibodies to the dose of TOPV because Cuba has not reported culture-confirmed poliomyelitis since 1973 and TOPV is only administered in twice yearly 1-week mass immunization campaigns. Sera from 2000 children nationwide were studied for neutralizing antibody among children who received 0, 2, 4, 6 and 8 doses of TOPV. These doses were administered in the period 1989-91, when TOPV (from the USSR) was being used with 500,000, 200,000, and 300,000 median tissue-culture-infecting doses (TCID50) for types 1, 2 and 3, respectively--the 5:2:3 formulation. Seroprevalence of neutralizing antibody after two TOPV doses was 91.5% for type 1, 90.8% for type 2, and 45.9% for type 3. Seroprevalence of type-3 neutralizing antibody after 6 doses remained low (73.4%), but increased to 83.5% after 8 doses (P < 0.05). Although 16.5% of the children remained unprotected for type-3 infection even after 8 doses, mass campaign immunization strategies were sufficient to eradicate the transmission of wild poliovirus in Cuba. Because the seroprevalence of type-1 neutralizing antibody was high (91.5%) after two campaign doses, additional studies using different formulations are needed to determine whether simultaneous improvement in the type-3 response to two campaign doses can be achieved.

PIP: During December 1991-January 1992 in Cuba, health workers took blood samples from a nationwide sample of 2000 children aged 0-3 who received 0, 2, 4, 6, and 8 doses of trivalent oral poliovirus vaccine (TOPV) to determine the seroprevalence of poliovirus neutralizing antibodies for types 1, 2, and 3. Specifically, researchers wanted to learn whether TOPV becomes more effective as the number of doses increases. Since 1973, Cuba has conducted two mass immunization campaigns each year in February and April. During 1970-91, Cuba used a USSR-produced poliovirus vaccine that had 500,000, 200,000, and 300,000 median tissue-culture-infecting doses for types 1, 2, and 3, respectively. Wild poliovirus has not been transmitted in Cuba since 1973 (as of August 1993), indicating that the mass immunization campaigns without routine vaccine delivery have eradicated poliomyelitis in Cuba. The seroprevalence of poliovirus neutralizing antibodies for type 1 increased significantly between 2 and 4 doses (91.5% vs. 96.5%; p = 0.05), thereafter the increases were small and insignificant. The seroprevalence of poliovirus neutralizing antibodies for type 2 increased significantly between 2 and 4 doses (90.8% vs. 97.2%), with small insignificant increases thereafter. Two doses of TOPV induced a response against poliovirus type 3 in only 45.9% of cases. At 4 doses and 8 doses, it did increase significantly from the previous dose (71.2% and 83.5%, respectively; p 0.05). Further studies using other vaccine formulations would allow persons involved in global eradication efforts to determine whether two campaign doses can improve the immunogenicity of the type 3 poliovirus while also improving that of the type 1 poliovirus.

[Changes in the contraceptive method mix during fertility decline: Latin America and the Caribbean]. / Cambios en la combinacion de metodos anticonceptivos durante la transicion de la fecundidad: America Latina y el Caribe.

"This paper reviews survey-based data regarding contraceptive prevalence and methods employed in Latin America and the Caribbean, with an emphasis on changes in the mix of methods over time. The most striking recent trend is the rise in use of female sterilization.... By contrast, use of male sterilization remains negligible in most countries. The oral contraceptive pill is by far the most popular of the temporary methods, though its prevalence has more often declined than increased in recent years. Together female sterilization and the pill make up around [two-thirds] of contraceptive practice in Latin America and the Caribbean." (SUMMARY IN ENG)