Update on the Geographic Distribution of the Intermediate Host Snails of Schistosoma mansoni on St. Lucia: A Step Toward Confirming the Interruption of Transmission of Human Schistosomiasis.

To provide information to guide considerations of declaring interruption of transmission of human schistosomiasis due to Schistosoma mansoni on St. Lucia, we undertook an island-wide survey in June-July 2022 to determine the presence of Biomphalaria snails, the intermediate hosts of S. mansoni, and their infection status. Snail surveys were carried out at 58 habitats to determine presence of Biomphalaria snails followed by examination of the collected snails for evidence of infection with S. mansoni. Furthermore, water samples were collected at the snail habitats and screened for presence of S. mansoni DNA using an eDNA approach. We found B. glabrata present in one habitat (Cul de Sac) where it was abundant. Specimens provisionally identified as Biomphalaria kuhniana were recovered from 10 habitats. None of the Biomphalaria specimens recovered were positive for S. mansoni. None of the eDNA water samples screened were positive for S. mansoni. Experimental exposures of both field-derived and laboratory-reared St. Lucian B. glabrata and B. kuhniana to Puerto Rican and Kenyan-derived S. mansoni strains revealed B. glabrata to be susceptible to both and B. kuhniana proved refractory from histological and snail shedding results. We conclude, given the current rarity of B. glabrata on the island and lack of evidence for the presence of S. mansoni, that transmission is unlikely to be ongoing. Coupled with negative results from recent human serological surveys, and implementation of improved sanitation and provision of safe water supplies, St. Lucia should be considered a candidate for declaration of interruption of human schistosomiasis transmission.

Perfil de carga de enfermedad por diabetes 2023: Santa Lucía

El propósito fundamental de esta serie de perfiles nacionales de la carga de enfermedad por diabetes y de enfermedad renal crónica debida a diabetes es apoyar a los países de la Región de las Américas en el seguimiento de las estrategias puestas en marcha para enfrentar la diabetes. Esta primera versión de los perfiles, que abarca el período comprendido entre el 2000 y el 2019, muestra la tendencia de la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida ajustados por discapacidad de ambas enfermedad. Se han elaborado con los últimos datos disponibles de las estimaciones mundiales de salud de la Organización Mundial de la Salud y tiene como objetivo convertirse en una herramienta útil para llevar a cabo el monitoreo de las estrategias conexas.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative

[ABSTRACT]. Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia’s Ministry of Health, with support of the Pan Ameri- can Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technol- ogy, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

[RESUMEN]. Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esencia- les, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la inter- vención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

[RESUMO]. Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-pi- loto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capaci- tação foi a base de todas as mudanças.

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Sources of microbial contamination in the watershed and coastal zone of Soufriere, St. Lucia.

The Sustainable Development Goal 6 calls for global progress by 2030 in treating domestic wastewater and providing access to adequate sanitation facilities. However, meeting these goals will be a challenge for most Small Island Developing States, including Caribbean island nations. In the nearshore zone of the Soufriere region on the Caribbean island of St. Lucia, there is a history of high levels of bacteria of fecal origin. Possible land-based sources of microbial contamination in the Soufriere Bay include discharges from the Soufriere River and transport of wastewater, including fecal material from the town of Soufriere. This area is an important tourist destination and supports a local fishery. To identify the sources of microbial contamination in Soufriere Bay, a range of monitoring methods were employed in this study. In grab samples of surface water collected from the Soufriere River, counts of total coliforms and Escherichia coli were elevated above water quality guidelines. However, the spikes in concentrations of these indicator organisms in the river did not necessarily coincide with the spikes in the levels of total coliforms and E. coli detected in samples collected on the same dates in Soufriere Bay, indicating that there are other sources of pollution in the Bay besides discharges from the river. Monitoring for chemical indicators of wastewater (i.e., caffeine, sucralose, fluconazole) in the Soufriere River indicated that there are inputs of sewage or human fecal material throughout the watershed. However, analysis of Bacteroidales 16S rRNA genetic markers for fecal bacteria originating from humans, bovine ruminants, or other warm-blooded animals indicated that the majority of microbial contamination in the river was not from humans. Monitoring for chemical indicators of wastewater using passive samplers deployed in Soufriere Bay indicated that there are two "hot spots" of contamination located offshore of economically depressed areas of the town of Soufriere. This study indicates that efforts to control contamination of Soufriere Bay by fecal microorganisms must include management of pollution originating from both sewage and domestic animals in the watershed.

Major Hospital Fire in Saint Lucia.

This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable lesion for developing countries in the Caribbean, especially since there have been four hospital fires reported in the Caribbean within the past decade.

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia.

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

Epidemiology of human leptospirosis in Saint Lucia, 2010–2017

[ABSTRACT]. Objective. To describe the epidemiology of human leptospirosis cases in Saint Lucia from 2010 to 2017 and determine whether there was a relationship between cases and rainfall and temperature. Methods. A retrospective analytical study was undertaken to describe the seasonal patterns of human leptospirosis cases reported to the Ministry of Health of Saint Lucia between 2010 and 2017. Confirmed cases of leptospirosis were analyzed according to age, sex, seasonality, and geographical distribution. Disease incidence was calculated and the association of cases with geographical distribution, rainfall, and temperature was investigated. Results. A total of 353 leptospirosis cases were reported between 2010 and 2017 and of these, 145 (40.6%) were laboratory confirmed. Cases were aged 7 to 73 years (mean 34 years; median 30 years) with a male to female ratio of 4.2:1. Six deaths were reported during the period, with an overall case fatality rate of 4.1%. There was no relationship between location (district) and incidence of leptospirosis in Saint Lucia. There was a weak correlation between rainfall and leptospirosis cases during the 8-year period (rs = 0.25, p = 0.015) but the correlation between cases and seasons was not statistically significant (dry season rs = 0.13, p = 0.42; wet season rs = 0.23, p = 0.08). There was no correlation between leptospirosis cases and temperature (rs = 0.07, p = 0.49). Conclusions. Leptospirosis has a seasonal distribution in Saint Lucia, with outbreaks during periods following increased rainfall and flooding, such as in the aftermath of tropical storms and hurricanes. Saint Lucia and other Caribbean countries should enhance surveillance for leptospirosis given the likelihood of increased flooding following frequent and intense rainfall due to climate change.

[RESUMEN]. Objetivo. Describir las características epidemiológicas de los casos de leptospirosis humana en Santa Lucía entre el año 2010 y el año 2017, y determinar si hubo un vínculo entre el número de casos, las precipitaciones y la temperatura. Métodos. Se llevó a cabo un estudio analítico retrospectivo para describir el patrón estacional de los casos de leptospirosis humana notificados al Ministerio de Salud de Santa Lucía entre el año 2010 y el año 2017. Los casos confirmados de leptospirosis se analizaron según la edad, el sexo, el carácter estacional y la distribución geográfica. Se calculó la incidencia de la enfermedad y se evaluó la relación entre el número de casos y la distribución geográfica, las precipitaciones y la temperatura. Resultados. Se notificaron 353 casos de leptospirosis entre el 2010 y el 2017, entre ellos, 145 (40,6%) casos confirmados mediante pruebas de laboratorio. Los casos se presentaron en personas de 7 a 73 años (media de 34 años; mediana de 30 años) con una razón hombre:mujer de 4,2:1. Se notificaron 6 muertes durante el mismo período y una tasa de letalidad general de 4,1%. No se encontró un vínculo entre la ubicación (distrito) y la incidencia de la leptospirosis en Santa Lucía. Se estableció una correlación débil entre las precipitaciones y el número de casos de leptospirosis durante el período de 8 años (rs = 0,25, p = 0,015); la correlación entre el número de casos y las estaciones no fue estadísticamente significativa (estación seca, rs = 0,13, p = 0,42; estación húmeda, rs = 0,23, p = 0,08). No se estableció una correlación entre el número de casos de leptospirosis y la temperatura (rs = 0,07, p = 0,49). Conclusiones. La leptospirosis presenta una distribución estacional en Santa Lucía, con brotes que surgen tras períodos de aumento de las precipitaciones e inundaciones; por ejemplo, después de tormentas y huracanes tropicales. Santa Lucía y otros países del Caribe deben mejorar la vigilancia de la leptospirosis dado que el cambio climático aumenta la probabilidad de inundaciones tras períodos de precipitaciones frecuentes e intensas.

[RESUMO]. Objetivo. Descrever a epidemiologia dos casos de leptospirose humana em Santa Lúcia de 2010 a 2017 e determinar se houve uma relação entre a ocorrência de casos e precipitação e temperatura. Métodos. Um estudo retrospectivo analítico foi realizado para descrever o padrão sazonal dos casos de leptospirose humana notificados ao Ministério da Saúde de Santa Lúcia entre 2010 e 2017. Os casos confirmados de leptospirose foram analisados por idade, sexo, sazonalidade e distribuição geográfica. A incidência da doença foi calculada e a associação entre a ocorrência de leptospirose e distribuição geográfica dos casos, precipitação e temperatura foi pesquisada. Resultados. Ao todo, 353 casos de leptospirose foram registrados entre 2010 e 2017. Destes, 145 (40,6%) tiveram confirmação laboratorial. Os casos ocorreram em indivíduos entre 7 e 73 anos de idade (média 34 anos; mediana 30 anos) com uma proporção de 4,2:1 entre os sexos masculino e feminino. Houve seis mortes durante o período estudado, com uma taxa de letalidade global de 4,1%. Não foi verificada uma relação entre localização geográfica (distrito) e incidência de leptospirose em Santa Lúcia. Foi observada uma fraca correlação entre a ocorrência de casos e precipitação no período considerado de 8 anos (rs = 0,25, p = 0,015), mas a correlação entre casos da doença e estações do ano não foi estatisticamente significativa (estação seca rs = 0,13, p = 0,42; estação chuvosa rs = 0,23, p = 0,08). Não foi verificada correlação entre leptospirose e temperatura (rs = 0,07, p = 0,49). Conclusões. A leptospirose tem distribuição sazonal em Santa Lúcia, com a ocorrência de surtos nos períodos que se seguem ao aumento da precipitação e às enchentes, como após tempestades tropicais e furacões. Santa Lúcia e os outros países do Caribe devem intensificar a vigilância da leptospirose diante da possibilidade de maior ocorrência de enchentes com as chuvas intensas e mais frequentes decorrentes da mudança climática.

Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections-Improvement and Use during SCORE.

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia.

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women's rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.

Survey of Schistosomiasis in Saint Lucia: Evidence for Interruption of Transmission.

Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8-11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8-11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission.

A new genus and five new species of Anostostomatidae from the Lesser Antilles (Orthoptera: Ensifera).

Most high volcanic islands of Lesser Antilles harbor one single genus of Anostostomatidae: Rhumosa n. gen: Rhumosa bolognei n. gen. n. sp. in Guadeloupe, Rhumosa macoucheriei n. gen. n. sp. in Dominica, Rhumosa depazei n. gen. n. sp. in Martinique, Rhumosa admiralrodneyei n. gen. n. sp. in Saint Lucia, Rhumosa captainblighei n. gen. n. sp., in Saint Vincent. These species are restricted to well preserved rainforests; species from northern islands apparently occurring at higher elevation than species of southern islands. The distribution and generic position of Rhumosa n. gen. species is discussed, as well as the generic position of Lutosa cubaensis (Haan, 1843).

MMR2 vaccination coverage and timeliness among children born in 2004 – 2009: a national survey in Saint Lucia, 2015

[ABSTRACT]. Objectives. To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods. A survey was conducted in October – November 2015 targeting children born in 2004 – 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results. Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. ‘Mothers as caregivers’ was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions. Based on the results of this survey, Saint Lucia’s national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

[RESUMEN]. Objetivos. Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos. En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados. De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones. Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

[RESUMO]. Objetivos. Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola – SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos. Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados. Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. ‘’Mães como cuidadoras’’ teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões. A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Research in epidemic and emergency situations: A model for collaboration and expediting ethics review in two Caribbean countries.

Various forms of research are essential in emergency, disaster and disease outbreak situations, but challenges exist including the long length of time it takes to get research proposals approved. Consequently, it would be very advantageous to have an acceptable model for efficient coordination and communication between and among research ethics committees/IRBs and ministries of health, and templates for expediting (done with speed and efficiency) ethical review of research proposals in emergency and epidemic situations to be used across the Caribbean and in other low and middle income countries. This project involved a literature search and the interviewing of ministry of health officials, public health practitioners, and research ethics committee/IRB members in Jamaica and St. Lucia, to obtain suggestions for the best model for efficient coordination and communication between research ethics committees (RECs), and developed a template for expediting review of research protocols in epidemic and emergency conditions.

PAHO/WHO Multi-Country Cooperation Strategy for Barbados and Eastern Caribbean Countries, 2018-2024

This Strategy for Technical Cooperation with Barbados and the Eastern Caribbean Countries reflects a medium-term vision of the work that the Pan American Health Organization [PAHO/ WHO] and the other levels of the World Health Organization will jointly undertake with the seven countries under the jurisdiction of the PWR-ECC during the period, 2018- 2024. These countries are namely - Antigua and Barbuda, Barbados, Dominica, Grenada, . St. Kitts and Nevis, St. Lucia and St. Vincent and the Grenadines. This is the second such multi-country cooperation framework with these small island states. While the first strategy focused mainly on the establishment of the structures which PAHO/WHO and the Member States had agreed on to better facilitate technical cooperation, this second strategy was developed on the basis of a health situational MESSAGE FROM THE DIRECTOR OF PAHO analysis together with consultations with senior technical officers from the Ministries of Health in the respective countries, with a view to identifying joint health priorities to be addressed in a targeted manner. I am happy to note that in the development of this strategic document, due consideration was given to existing national, sub-regional and global frameworks.