[Tuberculosis in 0-14 year-olds in Cuba (1994-2003)]. / Tuberculosis en niños de 0-14 años: Cuba, 1994-2003.

INTRODUCTION: Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. METHODS: Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. RESULTS: The incidence rate decreased from 0.76 x 10(5) in 1994 to 0.31 in 2003 (59.2% of the overall reduction and 6.6% of the annual average reduction). The highest rate (1.06 x 10(5)) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6%). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and 1-4 years (35.2%). CONCLUSIONS: Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease.

Tuberculosis en niños de 0-14 años: Cuba, 1994-2003 / Tuberculosis in 0-14 year-olds in Cuba (1994-2003)

Introducción La ocurrencia de tuberculosis en niños es un signo de transmisión continua de la infección. En este estudio describimos la distribución y tendencia de las tasas de incidencia de casos nuevos de tuberculosis de niños menores de 15 años de edad en Cuba. Métodos Se estimaron las tasas de incidencia y su tendencia, por provincias y grupos de edades del período 1994-2003. Se determinó la distribución porcentual, porcentaje de variación global y promedio anual de las tasas, así como las tasas y porcentajes de tuberculosis según su localización. Resultados La tasa de incidencia disminuyó de 0,76 × 105 en 1994 a 0,31 en 2003 (59,2 % reducción global y 6,6 % reducción anual como promedio). En 1995 se notificó la tasa más alta 1,06 × 105 (26 casos). En casi todas las provincias la tendencia de la incidencia fue descendente, excepto en Ciudad Habana, Sancti Spíritus, Santiago de Cuba e Isla de la Juventud. El 69,6 % de la tuberculosis infantil fue de localización pulmonar. Los grupos de edades de 10-14 años (35,6 %) y 1-4 (35,2 %) presentaron los porcentajes más altos dentro de la población infantil afectada. Conclusiones La tuberculosis es muy poco frecuente y más bien rara en menores de un año y en general presenta notificación muy baja en todo el país con una tendencia global descendente mantenida

Introduction Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. Methods Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. Results The incidence rate decreased from 0.76 × 105 in 1994 to 0.31 in 2003 (59.2 % of the overall reduction and 6.6 % of the annual average reduction). The highest rate (1.06 × 105) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6 %). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6 %) and 1-4 years (35.2 %). Conclusions Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease

Tuberculosis en niños de 0-14 años: Cuba, 1994-2003 / Tuberculosis in children 0-14 years: Cuba, 1994-2003

Introducción: La ocurrencia de tuberculosis en niños es un signo detransmisión continua de la infección. En este estudio describimosla distribución y tendencia de las tasas de incidencia de casos nuevos de tuberculosis de niños menoresde 15 años de edad en Cuba.Métodos Se estimaron las tasas de incidencia y su tendencia, porprovincias y grupos de edades del período 1994-2003. Sedeterminó la distribución porcentual, porcentaje de variaciónglobal y promedio anual de las tasas, así como las tasas y porcentajes de tuberculosis según su localización.Resultados La tasa de incidencia disminuyó de 0,76 105 en 1994 a0,31 en 2003 (59,2 por ciento reducción global y 6,6 por ciento reducción anual como promedio). En 1995 se notificó la tasa más alta1,06 105 (26 casos). En casi todas las provincias la tendencia de la incidencia fue descendente, excepto en CiudadHabana, Sancti Spíritus, Santiago de Cuba e Isla de la Juventud. El 69,6 por ciento de la tuberculosis infantil fue de localización pulmonar. Los grupos de edades de 10-14 años (35,6 por ciento) y 1-4 (35,2 por ciento) presentaron los porcentajes más altos dentro de la población infantil afectada.Conclusiones La tuberculosis es muy poco frecuente y más bien raraen menores de un año y en general presenta notificaciónmuy baja en todo el país con una tendencia global descendentemantenida(AU)

Introduction: Tuberculosis in infants and children is a sign of continuoustransmission. The present article describes the distribution and the trend in incidence rates of new tuberculosiscases in 0-15-year-olds in Cuba. Methods Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual averagerates, and rates and percentages according to classification were determined. Results The incidence rate decreased from 0.76 105 in 1994 to0.31 in 2003 (59.2 percent of the overall reduction and 6.6 percent ofthe annual average reduction). The highest rate (1.06 105) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana,Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6 percent).Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and1-4 years (35.2percent). ConclusionsTuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease(AU)

[The knowledge, attitudes and practice of population groups with respect to tuberculosis. 1994-1996]. / Conocimientos, percepciones y prácticas de grupos de población respecto a la tuberculosis. 1994-1996.

The development of successful tuberculosis control programs requires the people's involvement, hence a study was performed to identify knowledge, perceptions and practices of the population regarding occurrence, transmission, treatment and control of this disease. The focal group technique was used in 6 sets of persons aged 15 years and over from 6 municipalities of the City of Havana. These groups thought that tuberculosis had declined in the last ten years but had increased again in the last 2-3 years, that it was a contagious disease presenting symptoms such as cough, hemoptysis, loss of weight, fever. They considered it as a terrible, undesirable sickness associated with poverty and caught due to malnourishment, poor hygiene of the sick person and his/her relatives and smoking. Some thought that this disease was curable and other that it was not. Several other people believed that patients should be isolated in hospital whereas others stated that they could have a normal life at home, most preferred to be informed about the disease by TV and radio. It was concluded that a quantitative study should be performed based on these results.

[Distribution and trends of tuberculosis by age groups and municipalities in La Habana City, Cuba (1986-1998)]. / Distribución y tendencia de la tuberculosis por grupos de edades y por municipios en ciudad de La Habana, Cuba. (1986-1998).

BACKGROUND: The province of Havana City, the capital and most densely populated city in Cuba, totals around 27% of the new cases of tuberculosis. This article is for the purpose of describing the distribution and trend of the tuberculosis cases rates from 1986 to 1998, by municipalities and age groups in this province. METHOD: A calculation was made of the rates and of the total percentage of deviation of these rates, in addition to the annual average deviation both throughout two time periods and between the two (1986-1993 and 1994-1998). The trends were calculated by simple linear regression. RESULTS: Throughout the 1986-1993 period, the case rate for this province underwent a 6% increase. Throughout the 1994-1998 period, it dropped by 7.3%. The three most densely-populated cities showed a higher rate increase. Of the 15 municipalities, only La Lisa showed a drop in the rates throughout the entire period in question. The rates by ages were similar throughout all of the municipalities, being higher for individuals > 65 years of age. Six tenths (0.6%) of the cases reported involved people under 15 years of age. The infantile tuberculosis rates were very low for the time period under analysis. CONCLUSIONS: The differences among the municipalities in question make it necessary for different measures to be taken to achieve a greater impact and repercussion in Cuba. The drop in the rates detected over the last three years is indicative of the epidemic being brought under control and the national tuberculosis control program being reinstated.

[The management of tuberculosis in the Republic of Cuba]. / Manejo de la tuberculosis en la República de Cuba.

The essential aspects for the management of tuberculosis surveillance and control are described to propitiate their divulgation among to health professionals. Since 1970 there is an integrated program under way within the health services based on the localization of cases by the bacilloscopic examination and the sputum culture in symptomatic respiratory patients, the ambulatory controlled treatment, the investigation of the contacts of the notified cases, including the chemoprophylaxis with isoniacide, and the BCG vaccination to newborns. In 1995, the percentage of symptomatic patients detected at the general medicine offices was of 0.7%, whereas the percentage of the first bacilloscopy performed among the symptomatic individuals was of 78.6%, 99.5% of the detected contacts were investigated. 37.9% of the new cases were diagnosed at the primary health care level. After a decreasing trend maintained from 1979 to 1991, mortality has increased from 50 deaths (0.5 x 10(5)) in 1991 to 157 (1.4 x 10(5)) in 1995, and the incidence rose from 503 (4.7 x 10(5)) in 1991 to 1,574 (14.3 x 10(5)) in 1994, and to 1,553 (14.0 x 10(5)) in 1995, which suggests that the increase observed during the last 6 years begins to stop. The primary resistance to tuberculostatics was of 3.5% in 1992-1995, and of 11.5% in 1996. A priority integrated program of surveillance and control adjusted to the present socioeconomic conditions of the country is still going on.

Asthma mortality in Cuba during 1972-1993.

UNLABELLED: Morbi-mortality due to asthma has increased in recent years both throughout the world in Cuba. A study of mortality caused by this disease has conducted in order to describe its current trend in the country. METHOD: A time series study was conducted which included all deaths attributed to asthma in Cuba recorded in the vital statistics records of the Ministry of Public Health from 1972 to 1993. Rates, secular trends of general mortality and according to gender were estimated. The proportional mortality for the 1972-1993 period was calculated and the potential years of life lost during the 90-92 trienium were quantified. RESULTS AND DISCUSSION: A drop in these global rates occurred between 1972 and 1975, with values of 3.6; 4.1; 3.0; 2.2; respectively; possibly due to the introduction of disodic chromoglycate among other drugs and the beginning of the Asthmatic Patient Program. An later increase in mortality was observed until 1993 (5.9 x 100,000 inhabitants) which may attributed to a drop of the intensity and regularity of said program and to other internationally knowledge factors which are present in our country. The trend of general mortality rose during this period and was greater in females than in males; which means that the risk to die of this cause has increased. Proportional Mortality since 1980 (0.50%) also increased until 1993 (0.80%). Potential years of life lost due to premature death ranged from 5,646 in 1990 to 7,386 in 1992. The increase in proportional mortality and the potential years of life lost suggest that this disease should been given priority by the National Health Program as a preventable cause of death, especially in women. CONCLUSIONS: There is a rising trend of mortality among asthmatic patients during the period under consideration. Asthma is a cause of premature death in Cuba.

Prescription of antibiotics for mild acute respiratory infections in children.

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many physicians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family physicians and public education campaigns, two 1991 interventions were carried out in four health areas (designated A, B, C, and D) in the city of Havana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through December 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1,600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes occurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were initiated, antibiotics were prescribed for 26%, 20%, 11%, and 19% of the mild ARI cases occurring in areas A, B, C, and D respectively (P > 0.05). In the period immediately following the interventions, antibiotic prescription rates declined by 26% and 63% in areas A and B, while increasing by 2% and 48% in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54% (95% CI: 31-69%). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective.

[The trends by province of tuberculosis in Cuba: 1979-1993]. / Tendencias por provincias de la tuberculosis en Cuba: 1979-1993.

This study was carried out in order to describe tuberculosis trends in Cuba and its provinces between 1979 and 1993. For this purpose, reports of new cases of all forms of tuberculosis were obtained from the National Statistics Bureau of the Ministry of Public Health. In addition, tuberculosis incidence rates and their trends between 1979 and 1992 were determined. The data were analyzed by means of simple linear and exponential regression models. Finally, the percentage reductions in incidence between 1979 and 1992 were calculated and the observed changes were described in reference to the expected values derived from the regression models. The number of new tuberculosis cases reported in Cuba decreased from 1133 (11.6 per 100,000 population) in 1979 to 633 (5.8 per 100,000) in 1992 (a 44% reduction). In 1993, 788 cases were reported (7.2 per 100,000). In almost all the provinces the incidence tended to decrease between 1979 and 1992, and the average annual number of new case notifications fell between 4.0 and 5.4%, although in some, less than 3%. In 1992, the number of new case notifications in the country was 25% higher than in 1991, and the incidence rates in all the provinces were higher than expected. The incidence in La Habana, the City of Havana, Villa Clara, Cienfuegos, Ciego de Avila, Santiago de Cuba, and Guantánamo exceeded the overall national incidence. In 1993, incidence in the country was 55.6% higher than it had been in 1991 and 24.5% higher than in 1992. Incidence rose in all provinces, and especially in the City of Havana, Matanzas, and Guantánamo. Although incidence remained below 8 cases per 100,000 population between 1992 and 1993, it rose during those years, as it did in other countries. The increase appears to be attributable to the economic crisis that affects the country and to have very little connection to human immunodeficiency virus infection.

[Progress in surveillance of acute respiratory infections in the Republic of Cuba]. / Progresos en la vigilancia de las infecciones respiratorias agudas en la república de Cuba.

BACKGROUND: A process of techniques perfection of the epidemiologic surveillance of morbidity by Acute Respiratory Infections, with the purpose of obtaining a better and more appropriate description of the problem, was carried out. METHODS: A mathematical model of Fourier harmonic analysis and an Arima model was applied to the time series of weekly consulting rates for those diseases by age groups and provinces. This allowed to identify the epidemical moments, based on the prediction of expected values and an specific cut-off. RESULTS: The application of this technique made it possible and early and appropriate identification of an epidemical rise in children of less than 1 year, between July and August of 1988, with the identification of the Respiratory Syncytial Virus, as the aetiological agent. In the age-group of 5-14 years, a rise was observed in September, at the beginning of the school-year, and a smaller one between May-June of 1989. In the group age of 65 years and more, an epidemical increase took place from July to October. CONCLUSIONS: The use of these techniques provided new possibilities to make more precise and appropriate recommendations to improve epidemiological surveillance of these diseases at a national level.

[Training of epidemiology personnel in Cuba]. / Formación de personal en epidemiología en Cuba.

We describe the academic characteristics of the Master of Epidemiology Program taught at the Instituto de Medicina Tropical "Pedro Kourí", in La Habana, Cuba. We provide a description of the structure of the course along with its didactical principles, the main objectives of the different academic modules and the number and background of graduates from seven Classes. We also discuss potential work areas for graduates and short-term perspectives for their continuing education.

[Stages of the historic evolution of the antituberculosis campaign in Cuba]. / Recuento de las etapas de evolución histórica de la lucha antituberculosa en Cuba.

A brief account is provided on the main characteristics of the stages in the historical evolution of struggle against tuberculosis in Cuba. The foundations and the steps taken in tuberculosis control are noted. A synthesis of therapeutic schemes used in the last 20 years is provided and the tendency of notification of new cases in 1979-1988 is discussed. During that ten-year period there was a 38.8% reduction.

[Influenza and other acute respiratory infections. Republic of Cuba, 1989]. / Influenza y otras infecciones respiratorias agudas. República de Cuba, 1989.

Information is provided on the epidemiological situation of influenza and other acute respiratory tract diseases in Cuba during 1989. General mortality rate was 25.4 per 105 inhabitants. Global morbidity rate was 373.9 per 1,000 inhabitants. The highest morbidity rate reported corresponded to children 5-14 years old and under 1 year of age. Serologically, the viral agent proportionally most identified was influenza virus type A (H3N2).

[Methodology for the epidemiologic study on acute respiratory infections]. / Metodología para un estudio epidemiológico sobre infecciones respiratorias agudas.

The foundations and methodology for an epidemiological study on acute respiratory diseases are described. The study took place in 4 urban health areas in Havana City and 4 rural doctor's offices in Matanzas. A discussion is carried out regarding the intervention design for the staff of the health primary assistance team headed by the family doctor.

[Automated sentinel system of infectious diseases in Cuba]. / Sistema automatizado de vigilancia de las enfermedades infecciosas en Cuba.

We state that the creation of the Automated System of Epidemiological Surveillance should become an integral part of the Service of Hygiene and Epidemiology of the Republic of Cuba, which allows for the operative evaluation of the epidemiological situation in the country in order to take timely anti-epidemiological and prophylactic steps.

[Perspectives on the application of automated systems to epidemiologic surveillance in Cuba]. / Algunas perspectivas para la aplicación de sistemas automatizados a la vigilancia epidemiológica en Cuba.

A few considerations on the development of the applied automatization of epidemiologic surveillance systems in Cuba are exposed. Reference is made to aspects of the national strategy, to the lines of development of the National Health Systems, to the projections of the subsystems of epidemiologic surveillance, and to the future integrated intercommunication.

[Evaluation of an anti-influenza vaccine in a group of elderly]. / Evaluacion de la vacuna antigripal en un grupo de ancianos.

To 57 individuals of the Old People's Home in Güines and Artemisa Municipalities, without vaccinal contraindications, was administered and inactivated bivalent antigrippal vaccine with the antigenic content: A/Kiev/59/79 (H1N1) and A/Filipina/2/82 (H3N2). Trough the inhibition technique of hemagglutination in pair sera, satisfactory results (seroconversion) were obtained in more of the vaccinated individuals, for both antigens. Local reactions such as erythema and papule were observed. Nine patients were detected among the vaccinated individuals by the epidemiologic surveillance carried out a year after vaccination. The serologic study performed to five of them showed a case positive to influenza A (H3N2) and another one positive to influenza B.

[Evaluation of the anti-influenza vaccine in students from basic high school]. / Evaluación de la vacuna antigripal en escolares de secundaria básica.

The anti-influenza vaccine was applied to a group of 217 students of "Batalla del Jigüe" Secondary School which was compared to a group inoculated with the vaccine placebo with the view to evaluate the results of vaccine protection against the flue, as well as to determine its secondary effects in an adolescent population. There was a significant difference in the immunologic response in favor of the vaccine group as compared to controls for both strains of the antigenic contents of the vaccine Influenza A/Philippines/2/82 (H3N2)--A/Kiev/59/79 (H1H1). The local side effects found in the highest ratios in the group receiving the anti-influenza vaccine were papules (51.0%) and erythema (44.0%) with statistically significant differences in relation to the group receiving placebo. Fever was the general reaction most frequently found, for 8.4% 48 hours after its application among immunized students. During the subsequent epidemiologic surveillance a greater incidence of influenzal patients was found in students not receiving the anti-influenza vaccine. These results may serve as a starting point for new investigations in our environment.

[Distribution of non-tuberculous mycobacteria isolated and reported in a region of La Havana City and other western provinces from 1976 to 1982]. / Distribución de las micobacterias no tuberculosas aisladas y notificadas en una región de la Ciudad de La Habana y otras provincias occidentales entre los años 1976 y 1982.

The results of a study on the isolation and identification of non-tuberculous mycobacterial strains in a Havana City area and in other three western provinces are reported. The isolate for identification of non-tuberculous mycobacteria was more frequent in the provinces of Pinar del Rio, Havana, and Havana City than in Matanzas. The Runyon group most frequently found was number III, and the least frequent group I. The most frequent species belongs to the M. avium-intracellulare-scrofulaceum complex and M. fortuitum comes second. It was considered of interest to complete the study of the distribution of these mycobacteria in the rest of the country.