Updated recommendations of the International Dengue Initiative expert group for CYD-TDV vaccine implementation in Latin America.

Dengue disease represents a large and growing global threat to public health, causing a significant burden to health systems of endemic countries. For countries considering vaccination as part of their Integrated Management Strategy for Prevention and Control of Dengue, the World Health Organization currently recommends the first licensed dengue vaccine, CYD-TDV for: individuals aged 9 years or above from populations with high transmission rates, based on either seroprevalence criteria or pre-vaccination screening strategies, and for persons with confirmed prior exposure to infection in moderate to lower transmission settings. This paper describes the main conclusions of the Sixth Meeting of the International Dengue Initiative (IDI) held in June 2018, following release of a new product label by the manufacturer, updated WHO-SAGE recommendations, additional scientific evidence on vaccine performance, and reports of experiences by implementing countries. Considerations were made regarding the need for improving the quality of epidemiological and surveillance data in the region to help define the convenience of either of the two vaccination strategies recommended by WHO-SAGE. Extensive discussion was dedicated to the pros and cons of implementing either of such strategies in Latin America. Although, in general, a seroprevalence-based approach was preferred in high transmission settings, when cost-effectivity is favorable pre-vaccination screening is a convenient alternative. Cost-effectiveness evaluations can assist with the decisions by public health authorities of whether to introduce a vaccine. Where implemented, vaccine introduction should be part of a public health strategy that includes the participation of multiple sectors of society, incorporating input from scientific societies, ministries of heath, and civil society, while ensuring a robust communication program.

Migration decisions, agrarian structure, and gender: the case of Ecuador.

PIP: This article briefly reviews the literature on migration in Latin America and examines migration decision making in Ecuador. Aggregate data are obtained from the 1974 census of agriculture and population for cantones. Individual level data are obtained from the 1982 census of population. Migration refers to all census persons who recorded differences in their present and previous place of residence during 1974-82. Migration is modeled as dependent upon gender, age, education, marital status, income at origin and at destination, and population pressure or agrarian reform. Logistic model findings indicate that migration decisions are influenced by individual characteristics of migrants and contextual variables. Migration varied by gender. The results confirm Todaro's hypothesis that the probability of migrating is related to income differences between place of destination and origin, but only for males. Findings suggest that females migrate for primary reasons other than economic ones. The probability of migration was greater with increased levels of education. The decision to migrate was affected by quality of life differences, such as literacy rates and levels of urbanization. The probability of migration was reduced by the effects of land reform. Population pressure had a significant effect in increasing migration. The effects of land reform differ from findings in Mexico by William E. Cole and Richard D. Sanders. Land reforms were initiated in 1964 in Ecuador, but by 1974 there was still considerable inequality in land distribution and increased population pressure. Traditional haciendas were modernized, and peasants increased their dependency on non-farm income.^ieng

Migration and circulation in Ecuador.

"This study investigates labor mobility in Ecuador as a function of the socioeconomic structure of places and personal attributes of migrants and circulators (short-term movers).... Particular attention is given to the role of agrarian change in altering established migration and circulation patterns." The author finds that "circulation may significantly alter family organization and the role of women in many Ecuadorian communities."

Policy aspects of development and individual mobility: migration and circulation from Ecuador's rural Sierra.

"Individual out-migration and out-circulation from Ecuador's rural Sierra during the period 1974-1982 are jointly examined to identify differences in each process. Personal attributes operate similarly, but place characteristics associated with development do not. Particular attention is given to land reform policies and related occurrences as forces of regional change, which in turn affect population movements. Also highlighted is the importance of place knowledge, particularly in drawing substantively informed conclusions from statistical analyses of data with broad geographic coverage."

Circulation and migration in third world settings: a comparison in Ecuador.

This study is concerned with circulation, defined as temporary and repetitive migration that lacks any declared intention of a permanent or long-lasting change in residence. "The first section of the paper reviews pertinent circulation literature. Attention then turns to describing circulation and migration patterns in Ecuador, and identifying relationships between these patterns and regional differentials in economic development, both through cartographic and statistical analyses. A summary and conclusions comprise the last section."