ABSTRACT
Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Employment , Physical Fitness , Socioeconomic Factors , Cohort Studies , Cross-Sectional Studies , Finland , Health Behavior , London , Prospective Studies , Social EnvironmentABSTRACT
Background: 10-valent pneumococcal vaccine (PCV-10) was introduced in 2011 to the National Immunization Program in Chile. It was administered in 4 doses, but in 2012 it was modified to a 3 dose program. This article shows the results of the Laboratory Surveillance System for Streptococcus pneumoniae isolated of invasive disease from 2007 to 2012 and compares the incidence of invasive pneumococcal disease (IPD) by age groups in the prevaccinal (2007-2010) and postvaccinal period (2012). Methods: Descriptive study of S. pneumoniae surveillance in invasive diseases cases confirmed at the National Reference Laboratory of the Institute of Public Health of Chile from 2007 to 2012. Results: Global incidence of laboratory confirmed IPD cases decreased 27.8% from 2007 to 2012 and showed a lower risk for IPD in 2012 compared with 2007. Incidence in children aged 1 year or less decreased from 56.1 to 16.3 per 100,000 and from 42.0 to 19.9 per 100,000 in children aged 12 to 23 months in the same period. Highest decreases were observed in IPD cases caused by serotypes 4 (100%), 19F (93.3%), 23F (90.9%), 14 (81.1%), 6B (70%), 18C (58.3%) and 1(81.8%) in children aged 2 years or less. Conclusion: Surveillance System detects S.pneumoniae isolated from invasive diseases, contributing with information about laboratory confirmed IPD trends, prevalent serotypes and replacement effects. These results can be used as evidence in healthcare decision making for pneumococcal vaccines.
Introducción: La vacuna neumocóccica 10 valente fue incorporada al Programa Nacional de Inmunizaciones (PNI) desde enero de 2011 para lactantes mediante un esquema de cuatro dosis, y desde 2012, con un esquema de tres dosis. El objetivo de esta publicación es dar a conocer el resultado de la vigilancia de laboratorio de Streptococcus pneumoniae aislado de enfermedad invasora (ENI) desde el año 2007 al 2012 y comparar la incidencia de esta enfermedad según grupos de edades en un período prevacunal (2007-2010) con el postvacunal (2012). Materiales y Métodos: Estudio descriptivo de los resultados de la vigilancia de S. pneumoniae en los casos de ENI confirmados microbiológicamente en Chile, en el Laboratorio Biomédico Nacional de Referencia del Instituto de Salud Pública de Chile (ISP) durante los años 2007 a 2012. Resultados: La evolución de la incidencia global de S. pneumoniae en casos de ENI muestra un menor riesgo en los años estudiados (OR 2011 vs 2007-2010: 0,82 (IC 95%: 0,75-0,89); OR 2012 vs 2007-2010: 0,76 (IC 95%: 0,70-0,82)). En niños bajo un año de edad, la incidencia disminuyó desde 56,1 a 16,3 por 100.000 y en niños de 12 meses a 23 meses desde 42,0 a 19,9 por 100.000, en el mismo período. Los mayores porcentajes de disminución en los menores de 2 años se observaron en los casos de ENI producidos por los serotipos 4 (100%), 19F (93,3%), 23F (90,9%), 14 (81,1%), 6B (70%), 18C (58,3%) y 1(81,8%). Conclusión: El sistema de vigilancia permite detectar cepas de S. pneumoniae aisladas de enfermedad invasora en nuestro país, lo que aporta información respecto de la tendencia de la ENI confirmada microbiológicamente en Chile, los serotipos prevalentes y el posible efecto de reemplazo de ellos descrito en otros países, aportando a la autoridad de salud una herramienta adicional para la toma de decisiones respecto del tipo de vacuna a usar en el PNI con la mejor evidencia disponible.
Subject(s)
Adolescent , Aged , Child , Child, Preschool , Humans , Infant , Middle Aged , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines/administration & dosage , Streptococcus pneumoniae , Chile/epidemiology , Incidence , Population Surveillance , Pneumococcal Infections/diagnosis , Pneumococcal Infections/microbiology , Pneumococcal Infections/prevention & controlABSTRACT
Background: Laboratory surveillance of Invasive Meningococcal Disease (IMD) is performed by the Institute of Public Health of Chile. It confirms identification, classifies in serogroups and analyzes the genetic profiles of Neisseria meningitidis isolates from laboratories throughout the country. Aim: To show the results of this surveillance from 2006 to 2012. Methods: A descriptive data analysis of the confirmed cases of IMD and serological characterization, susceptibility and genetic profiles of the isolates. The analysis was disaggregated by serogroup, age and region. Results: From 2006 to 2012, 486 isolates of N. meningitidis were confirmed. In 2011 a rise in IMD rates was observed due to an increase in W serogroup cases, mainly affecting children aged 5 years or less. Serogroup W became the most prevalent during 2012 (58.3%), replacing the historically prevalent serogroup B. Predominating strains belonged to ST-32 complex/ET-5 complex (40, 4% of strains) and ST-41/44 complex/ Lineage 3 (45, 9% of strains). Conclusions: Laboratory surveillance has allowed the early detection of increasing IMD caused by serogroup W, which is emergent in Chile. This information has reinforced the daily monitoring of new cases, in collaboration with all the clinical laboratories of the country.
Introducción: La vigilancia de laboratorio de enfermedad meningocócica invasora (EMI) que realiza el Instituto de Salud Pública de Chile, confirma, seroagrupa y estudia el perfil genético de las cepas de Neisseria meningitidis provenientes de los laboratorios del país. Objetivo: En este artículo se muestra los resultados de esta vigilancia entre los años 2006 a 2012. Materiales y Métodos: Se realizó un análisis descriptivo de los casos confirmados de EMI, caracterización serológica, el análisis de susceptibilidad antimicrobiana y el estudio de subtipo genético de la cepa. El análisis se desagregó por serogrupo, edad y región. Resultados: En el período 2006-2012 fue confirmado un total de 486 cepas de N. meningitidis. A partir del año 2011 se observó un alza en la tasa de EMI dado por el número de casos del serogrupo W, afectando principalmente a niños bajo 5 años de edad. El W se transformó en el serogrupo prevalente el año 2012 (58,3%), desplazando al serogrupo B, el cual históricamente había sido prevalente. Predominaron principalmente las cepas pertenecientes al complejo clonal ST-32 complex/ET-5 complex (40,4% de las muestras) y el ST-41/44 complex/Lineage 3 (45,9% de las muestras). Conclusiones: El sistema de vigilancia de laboratorio ha permitido la identificación del serogrupo W, emergente en Chile. Esta información nos ha obligado a estar en permanente alerta y monitoreo de casos diarios, mediante la participación activa de todos los laboratorios clínicos del país.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Middle Aged , Young Adult , Meningococcal Infections/epidemiology , Neisseria meningitidis , Population Surveillance , Anti-Bacterial Agents/pharmacology , Bacterial Typing Techniques , Chile/epidemiology , Epidemiological Monitoring , Genotype , Incidence , Microbial Sensitivity Tests , Meningococcal Infections/microbiology , Neisseria meningitidis/drug effects , Neisseria meningitidis/geneticsABSTRACT
Background: Leptospirosis is a zoonosis endemic in some regions in Chile. Since its inclusion into the list of notifiable diseases, the Chilean Ministry of Health was able to maintain an adequate surveillance of leptospirosis. Nonetheless, some cases are not reported due to subclinical disease or nonspecific symptoms. Objectives: Determine the national prevalence of leptospirosis and assess the epidemiological characteristics of seropositive individuals. Methods: Secondary data analysis of the National Health Survey, 2003. Results: National prevalence was 0.4%. Low socioeconomical status and female gender were characteristics, which were more frequently found in sero-positive cases. The most common serovars were icterohaemorrhagiae, bratislava and pomona. Conclusion: We present the first epidemiological analysis of leptospirosis on a national level in Chile. Thus, the study contributes to the knowledge the epidemiological situation of this disease in Chile.
Introducción: La leptospirosis es una zoonosis endémica en ciertas regiones de Chile. Desde que se incorporó esta enfermedad en la lista de las Enfermedades de Notificación Obligatoria (ENO) se ha logrado mantener una adecuada vigilancia. Sin embargo, existen casos subclínicos y con manifestaciones inespecíficas que no son reportados. Objetivo: Determinar la prevalencia nacional de leptospirosis y conocer características epidemiológicas de individuos seropositivos. Material y Métodos: Análisis de datos secundarios obtenidos en la Encuesta Nacional de Enfermedades Prioritarias, 2003. Resultados: La prevalencia nacional de leptospirosis fue 0,4%. Las características que se identificaron con mayor frecuencia en el grupo de personas positivas fueron nivel socio-económico bajo y sexo femenino. Los serovares más frecuentes fueron icterohaemorrhagiae, bratislava y pomona. Conclusión: Este es el primer trabajo de prevalencia nacional de leptospirosis realizado en Chile. Este estudio aporta al diagnóstico de situación de esta patología en nuestro país.