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Costa Rica: achievements of a heterodox health policy
No full textCosta Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica's population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system
Aerosol immunization with NYVAC and MVA vectored vaccines is safe, simple, and immunogenic
No full textEach year, approximately five million people die worldwide from putatively vaccine-preventable mucosally transmitted diseases. With respect to mass vaccination campaigns, one strategy to cope with this formidable challenge is aerosol vaccine delivery, which offers potential safety, logistical, and cost-saving advantages over traditional vaccination routes. Additionally, aerosol vaccination may elicit pivotal mucosal immune responses that could contain or eliminate mucosally transmitted pathogens in a preventative or therapeutic vaccine context. In this current preclinical non-human primate investigation, we demonstrate the feasibility of aerosol vaccination with the recombinant poxvirus-based vaccine vectors NYVAC and MVA. Real-time in vivo scintigraphy experiments with radiolabeled, aerosol-administered NYVAC-C (Clade C, HIV-1 vaccine) and MVA-HPV vaccines revealed consistent mucosal delivery to the respiratory tract. Furthermore, aerosol delivery of the vaccines was safe, inducing no vaccine-associated pathology, in particular in the brain and lungs, and was immunogenic. Administration of a DNA-C/NYVAC-C prime/boost regime resulted in both systemic and anal-genital HIV-specific immune responses that were still detectable 5 months after immunization. Thus, aerosol vaccination with NYVAC and MVA vectored vaccines constitutes a tool for large-scale vaccine efforts against mucosally transmitted pathogens
Setting up a national reference laboratory for Buruli ulcer: the case of Benin
No full textThe definitive version is available at www3.interscience.wiley.comOBJECTIVE: To report the experience of Benin, where Buruli ulcer (BU) is endemic, in the implementation of diagnostic laboratory services. METHODS AND RESULTS: There has been a gradual introduction of biologic diagnostic activities for BU comprising (1) training of a laboratory technician in a highly experienced reference laboratory; (2) acquiring indispensable laboratory start-up materials; (3) progressive development of diagnostic laboratory activities; (4) regular external quality assessment with an experienced reference laboratory and (5) decentralization of activities to various clinical diagnostic and treatment centres for BU in Benin. CONCLUSION: Setting up a reference laboratory for BU is a continuous process, which necessitates motivated personnel and the cooperation of an experienced external reference laboratory
Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan
No full textBACKGROUND: Incidence of Entamoeba histolytica infection and clinical manifestations and treatment response of invasive amebiasis (IA) in HIV-infected patients have rarely been investigated before. METHODOLOGY/PRINCIPAL FINDINGS: At the National Taiwan University Hospital, medical records of HIV-infected patients who received a diagnosis of IA between 1994 and 2005 were reviewed. The incidence of amebiasis was investigated in serial blood and stool samples from 670 and 264 HIV-infected patients, respectively, using serological and specific amebic antigen assays. DNA extracted from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Sixty-four (5.8%) of 1,109 HIV-infected patients had 67 episodes of IA, and 89.1% of them were men having sex with men (MSM). The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/microL vs. 96 cells/microL). Forty episodes (59.7%) were liver abscesses, 52 (77.6%) colitis, and 25 (37.3%) both liver abscesses and colitis. Fever resolved after 3.5 days of metronidazole therapy (range, 1-11 days). None of the patients died. The incidence of E. histolytica infection in MSM was higher than that in other risk groups assessed by serological assays (1.99 per 100 person-years [PY] vs. 0 per 100 PY; p<0.0001) and amebic antigen assays (3.16 per 100 PY vs. 0.68 per 100 PY; p = 0.12). In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14.809; p = 0.01). Clustering of E. histolytica isolates by sequencing analyses from geographically-unrelated patients suggested person-to-person transmission. CONCLUSIONS/SIGNIFICANCE: HIV-infected MSM were at significantly higher risk of amebiasis than patients from other risk groups. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment
Leishmaniases in the Mediterranean in the era of molecular epidemiology
No full textMolecular tools are used increasingly for descriptive epidemiological studies in different Mediterranean foci of visceral and cutaneous leishmaniases. Several molecular markers with different resolution levels have been developed to address key epidemiological questions related to the (re-)emergence and spread of leishmaniases, as well as its risk factors: environmental changes, immunosuppression and treatment failure. Typing and analytical tools are improving but are not yet addressing all epidemiological issues satisfactorily. There is an urgent need for better cooperation between laboratory scientists and epidemiologists and for regional epidemiological surveillance of these infectious diseases that affect all Mediterranean countries
Pediatric HIV infection: the state of antiretroviral therapy
No full textPediatric HIV/AIDS has become less of a problem in resource-rich countries as the number of perinatal infections has reduced dramatically since the advent of antiretrovirals, resulting in the effective prevention of mother-to-child transmission. In resource-limited settings, however, pediatric HIV infection remains a colossal problem; a separate review in this same issue of Expert Review of Anti-Infective Therapy examines the international aspects of pediatric HIV/AIDS. Treatment of HIV infection in children differs from that in adults in the use of immunologic markers and owing to drug pharmacokinetics and age-related adherence issues. This review, geared for the general pediatrician or family practitioner who may see the HIV-positive child in the clinic or the hospital, summarizes the most recent pediatric data and guidelines for the testing and treatment of HIV, including the US NIH guidelines released in February 2008. Treatment-experienced patients, who should be cared for by pediatric HIV specialists, are not addressed here specifically. Adolescents, infected either perinatally or sexually, with their own unique issues, deserve a separate review
Effects of skilled care initiative on pregnancy-related mortality in rural Burkina Faso
No full textThe definitive version is available at www3.interscience.wiley.comObjective The aim of this paper is to assess to what extent a Skilled Care Initiative (SCI) was associated with pregnancy-related mortality in Ouargaye district, Burkina Faso.
Methods We used a quasi-experimental design to compare pregnancy-related mortality within the intervention district (health facility areas covered by the SCI vs. areas not covered) and between the intervention district (Ouargaye) and a comparison district (Diapaga). Population-based data were used to examine differences in pregnancy-related mortality levels, their determinants and how they related to uptake of care, as well as examining contexts and mechanisms of pregnancy-related deaths that occurred. Data analyses included descriptive statistics, univariate and multivariate regression analyses.
Results The main risk factors for pregnancy-related mortality in rural Burkina Faso were age (extreme ages of reproductive period), low coverage of antenatal care and low institutional delivery. The introduction of the SCI, as implemented within the study reference period, had no appreciable effect on pregnancy-related mortality.
Conclusion Although the SCI was conceptually well designed and implemented, structural constraints may have limited its effectiveness for reducing pregnancy-related mortality within its period of implementation. Lessons have been identified which might enable similar skilled attendance strategies to make their full potential impact on pregnancy-related mortality in remote and rural settings
Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child
No full textThe definitive version is available at www3.interscience.wiley.comobjective To assess whether implementation of a prevention of mother-to-child HIV transmission
(PMTCT) programme in Coˆ te d’Ivoire improved the quality of antenatal and delivery care services.
methods Quality of antenatal and delivery care services was assessed in five urban health facilities
before (2002–2003) and after (2005) the implementation of a PMTCT programme through review of
facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries
(n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff.
results HIV testing was never proposed at baseline and was proposed to 63% of women at the first
ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIVinfected
pregnant women received nevirapine. In addition, inter-personal communication and confidentiality
significantly improved in all health facilities. In the maternity ward, quality of obstetrical care
at admission, delivery and post-partum care globally improved in all facilities after the implementation
of the programme although some indicators remained poor, such as filling in the partograph directly
during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001)
after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly
improved in all facilities after the implementation of the programme.
conclusions Introducing comprehensive PMTCT services can improve the quality of antenatal and
delivery care in general
