Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention.

OBJECTIVE: To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). RESULTS: Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. CONCLUSION: Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific.

A systematic review of cervical cancer incidence and mortality in the Pacific Region.

This study provides the first systematic literature review of cervical cancer incidence and mortality as well as human papillomavirus (HPV) genotype prevalence among women with cervical cancer in the Pacific Island countries and territories. The cervical cancer burden in the Pacific Region is substantial, with age standardized incidence rates ranging from 8.2 to 50.7 and age standardized mortality rate from 2.7 to 23.9 per 100,000 women per year. The HPV genotype distribution suggests that 70-80% of these cancers could be preventable by the currently available bi- or quadrivalent HPV vaccines. There are only few comprehensive studies examining the epidemiology of cervical cancer in this region and no published data have hitherto described the current cervical cancer prevention initiatives in this region.

First two autochthonous dengue virus infections in metropolitan France, September 2010.

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, southeast France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.

Telehealth and outbreak prevention and control: the foundations and advances of the Pacific Public Health Surveillance Network.

The Pacific Public Health Surveillance Network (PPHSN) of which PACNET is now an integral part was established in 1996. PACNET is an innovative technical communication facility for strategic and high priority disease outbreak detection and control. PPHSN consists of National and International agencies, networks and institutions involved in Health activities in 22 Pacific island countries. Its aim is to improve public health surveillance in the Pacific islands in a sustainable way with outbreak alert and response a current priority. This report reviews the development of PPHSN, its associated public health Laboratory network (LabNeT) and the more recent EpiNet that is a regional investigation and response service. Telehealth is also discussed in terms of what services can PPHSN currently provide and what improvements can it pursue to actively contribute to the dynamic development and welfare of Pacific communities in the twenty first century.

El Niño and the dynamics of vectorborne disease transmission.

The objective of the study was to investigate the relationship between reported incidence of dengue fever and El Niño southern oscillation (ENSO) in 14 island nations of the South Pacific. Using a mixed ecological study design, we calculated correlations between annual averages of the southern oscillation index (SOI), local temperature and rainfall, and dengue fever. We also calculated temporal correlations between monthly reports of dengue fever cases on different islands. There were positive correlations between SOI and dengue in 10 countries. In five of these (including all of the larger islands) there were also positive correlations between SOI and estimates of local temperature and/or rainfall. There were temporal correlations between monthly reports of dengue cases within two groups of countries. Climate changes associated with ENSO may trigger an increase in dengue fever transmission in larger, more populated islands where the disease is endemic. There was also evidence of propagation of infection from larger islands to smaller neighbors. Unlike the initiation of epidemics, this transfer between islands appears to be independent of interannual climate variations, pointing to the importance of modulating factors in dengue transmission such as population density and travel. In the future, models of the impact of climate change must attempt to account for these factors.

Harmonization of regional health data requirements in the South Pacific.

The South Pacific has 22 diverse countries and territories that receive various levels of assistance, training, and financial support from International, regional, and national agencies. To support various aspects of these activities, the agencies currently request health data from the Pacific Island countries and territories on systematic bases in two major fields: health program monitoring and disease surveillance. There currently is little consultation or integration between the agencies. Communication exists mostly in terms of the exchange of various types of processed information such as reports, circulars, and other publications. The Interagency Meeting on Health Information Requirements in the South Pacific took place in December 1995 in Noumea, New Caledonia, to discuss the potential for more integration and cooperation in order to ease the pressure on the data providers (the countries) and to improve the relevance, quality, and timeliness of regional health information in the Pacific. As part of the effort to deal with the problems of both the pressure on data providers and the low quality and availability of good health information, we have developed methodological tools for evaluating both health indicators and diseases subject to surveillance in order to ascertain those most suitable for public health surveillance.