Incremental cost of implementing residual insecticide treatment with delthametrine on top of intensive routine Aedes aegypti control

Objectif: Les informations sur le coût de l'implémentation du traitement à insecticide résiduel (TIR) pour la lutte contre lAedes sont rares. Nous avons évalué le coût supplémentaire, en plus de celui des activités intensives conventionnelles de routine du programme de lutte contre Aedes (ACP) dans la ville de Santiago de Cuba, à Cuba. Méthodes: Nous avons mené létude d'analyse des coûts en 2011-2012, dans la perspective de lACP. Les sources des données étaient les registres de comptabilité, les registres d'activité du Centre ACP provincial et les comptes d'une étude d'implémentation du TIR dans 21 regroupements de 4 blocs de maisons en moyenne, comprenant 5.180 prémisses. Résultats: Le coût annuel des activités de routine de lACP était de 19,66 $ US par ménage. Les applications de TIR espacées de 4 mois d'intervalles, avec une couverture de 97,2 percent en moyenne et utilisant 8,5 g de deltaméthrine par an et par ménage, coûtent 3,06 $ US par ménage et par an. Le deltaméthrine constituait 66,5 percent de ce coût; le coût supplémentaire pour le déploiement du TIR constituait 15,6 percent du coût de routine totale de lACP et 27 percent du coût lié à la lutte de routine contre le stade adulte de lAedes. Conclusions: Le coût incrémental de l'implémentation du TIR est élevé. Il devrait être jaugé par rapport à l'effet incrémental sur la charge de morbidité causée par la panoplie d'agents pathogènes transmis par lAedes. Le coût pourrait être réduit si l'insecticide devenait moins cher, en limitant le nombre d'applications annuelles ou en ciblant les foyers importants de transmission(AU)

Community involvement in dengue vector control: cluster randomised trial.

OBJECTIVE: To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti, the vector of dengue, compared with a routine strategy. Design Cluster randomised trial. Setting Guantanamo, Cuba. Participants 32 circumscriptions (around 2000 inhabitants each). Interventions The circumscriptions were randomly allocated to control clusters (n=16) comprising routine Aedes control programme (entomological surveillance, source reduction, selective adulticiding, and health education) and to intervention clusters (n=16) comprising the routine Aedes control programme combined with a community based environmental management approach. MAIN OUTCOME MEASURES: The primary outcome was levels of Aedes infestation: house index (number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive for immature stages of Ae aegypti per 100 inspected houses), and the pupae per inhabitant statistic (number of Ae aegypti pupae per inhabitant). RESULTS: All clusters were subjected to the intended intervention; all completed the study protocol up to February 2006 and all were included in the analysis. At baseline the Aedes infestation levels were comparable between intervention and control clusters: house index 0.25% v 0.20%, pupae per inhabitant 0.44 x 10(-3) v 0.29 x 10(-3). At the end of the intervention these indices were significantly lower in the intervention clusters: rate ratio for house indices 0.49 (95% confidence interval 0.27 to 0.88) and rate ratio for pupae per inhabitant 0.27 (0.09 to 0.76). CONCLUSION: A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation. Trial Registration Current Controlled Trials ISRCTN88405796.

Community involvement in dengue vector control: cluster randomised trial.

OBJECTIVE: To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti, the vector of dengue, compared with a routine strategy. DESIGN: Cluster randomised trial. SETTING: Guantanamo, Cuba. PARTICIPANTS: 32 circumscriptions (around 2000 inhabitants each). INTERVENTIONS: The circumscriptions were randomly allocated to control clusters (n=16) comprising routine Aedes control programme (entomological surveillance, source reduction, selective adulticiding, and health education) and to intervention clusters (n=16) comprising the routine Aedes control programme combined with a community based environmental management approach. MAIN OUTCOME MEASURES: The primary outcome was levels of Aedes infestation: house index (number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive for immature stages of Ae aegypti per 100 inspected houses), and the pupae per inhabitant statistic (number of Ae aegypti pupae per inhabitant). RESULTS: All clusters were subjected to the intended intervention; all completed the study protocol up to February 2006 and all were included in the analysis. At baseline the Aedes infestation levels were comparable between intervention and control clusters: house index 0.25% v 0.20%, pupae per inhabitant 0.44x10(-3) v 0.29x10(-3). At the end of the intervention these indices were significantly lower in the intervention clusters: rate ratio for house indices 0.49 (95% confidence interval 0.27 to 0.88) and rate ratio for pupae per inhabitant 0.27 (0.09 to 0.76). CONCLUSION: A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN88405796.

Cost-effectiveness of a community-based approach intertwined with a vertical Aedes control program

We compared in a 5-year intervention study the cost-effectiveness of community-based environmental management intertwined with routine vertical Aedes control and of routine vertical control only. At baseline (year 2000), Aedes infestation levels and economic costs for vector control were comparable in intervention and control areas (house index, 2,23 percent versus 2,21percent and US$21 versus US$24/yr/inhabitant, respectively)... (AU)

Cost effectiveness of Aedes aegypti control programmes: participatory versus vertical.

We conducted an economic appraisal of two strategies for Aedes aegypti control: a vertical versus a community-based approach. Costs were calculated for the period 2000-2002 in three pilot areas of Santiago de Cuba where a community intervention was implemented and compared with three control areas with routine vertical programme activities. Reduction in A. aegypti foci was chosen as the measure of effectiveness. The pre-intervention number of foci (614 vs. 632) and economical costs for vector control (US$243746 vs. US$263486) were comparable in the intervention and control areas. During the intervention period (2001-2002), a 13% decrease in recurrent costs for the health system was observed. Within the control areas, these recurrent relative costs remained stable. The number of A. aegypti foci in the pilot areas and the control areas fell by 459 and 467, respectively. The community-based approach was more cost effective from a health system perspective (US$964 vs. US$1406 per focus) as well as from society perspective (US$1508 vs. US$1767 per focus).

Towards active community participation in dengue vector control: results from action research in Santiago de Cuba, Cuba.

Community participation is advocated as essential for attaining effective dengue prevention, but knowledge of how to foster this is limited. In Santiago de Cuba, multiple small task forces were created at the neighbourhood level that included all stakeholders in the control of Aedes aegypti. The task forces assessed the perceived needs and elaborated action plans to promote specific behavioural change and to reduce environmental risks through social communication strategies and intersectoral local government activities. We monitored five dimensions of the participation process and assessed behavioural and environmental results and entomological outcomes. Participation was weak to good. At the household level, uncovered water storage containers decreased from 49.3% to 2.6% between 2000 and 2002, and removing larvicide from them dropped from 45.5% to 1%. There was a reduction of 75% in the absolute number of positive containers and a significant decrease from 1.23% to 0.35% in the house index. Local task forces, in which the interests of householders as well as vector control workers are directly represented, can lead to effective government-community partnerships that resolve problems of mutual concern.

A synthetic conjugate polysaccharide vaccine against Haemophilus influenzae type b

Glycoconjugate vaccines provide effective prophylaxis against bacterial infections. To date, however, no commercial vaccine has been available in which the key carbohydrate antigens are produced synthetically. We describe the large-scale synthesis, pharmaceutical development, and clinical evaluation of a conjugate vaccine composed of a synthetic capsular polysaccharide antigen of Haemophilus influenzae type b (Hib). The vaccine was evaluated in clinical trials in Cuba and showed long-term protective antibody titers that compared favorably to licensed products prepared with the Hib polysaccharide extracted from bacteria. This demonstrates that access to synthetic complex carbohydrate-based vaccines is feasible and provides a basis for further development of similar approaches for other human pathogens(AU)

A phase I clinical trial of a multi-epitope polypeptide TAB9 combined with Montanide ISA 720 adjuvant in non-HIV-1 infected human volunteers.

A phase I clinical trial was performed to examine the safety and immunogenicity of a multi-epitope polypeptide comprising the central 15 amino acids of the V3 loop from six HIV-1 isolates. This protein called TAB9 was emulsified in Montanide ISA720 (Seppic, Paris) and administered intramuscularly at doses of 0, 0.2 and 1 mg to 24 healthy, HIV-1 seronegative adult males. Three immunisations were given at months 0, 1 and 6 in a randomised, double blind, placebo controlled clinical trial. The placebo was generally well tolerated. However, severe local reactions were observed in TAB9 vaccinated subjects after the second and third inoculations. Seven out of eight volunteers from the lower dose group showed moderate or severe local inflammation, while four out of eight subjects from the higher dose group developed granulomas and sterile abscesses. In general, the reactogenicity depended on the number of inoculations given and the dose of TAB9. Both doses were immunogenic, all immunised volunteers seroconverted and antibodies were broadly reactive against the V3 peptides included in the protein. All vaccine's sera reacted against gp120 in Western blot and 50% of them also neutralised at least one out of five laboratory isolates tested. No differences between doses were found. Anti TAB9 lymphoproliferative responses were observed, being more intense in the high dose group. Due to the strong local reactions that were found in this study, a change in the formulation will be required for further trials with this vaccine candidate in humans.

[Economic and social impact of the National Tuberculosis Control Program (NTCP) on the Cuban population]. / Impacto económico-social del Programa Nacional de Control de la Tuberculosis (PNCT) en la población Cubana.

Tuberculosis (TB) control strategies provide one of the greatest cost/effectiveness results. To assess the impact of the national TB control program on the Cuban population, the time series of new TB cases and death reports, potential years of life lost, and the numbers of beds for TB case hospitalization in the entire country during 1964-91 and 1992-96 were described by common simple calculation on the basis of estimated expected values. The reduction in new TB cases and deaths, potential years of life saved, and savings in expenditures for treatment, hospitalization, and unemployment compensation were estimated. From 1965 to 1991 new case reports were reduced by 94.6% (4% per year); 86,500 cases were avoided; 166,439 potential years of life were saved; 2,831,625 million pesos were saved on tuberculostatic drugs; 82.7 million pesos were saved on unemployment compensation under the social security system for workers with active TB. Estimated savings totaled 494,919,631.3 pesos. Nationwide intervention for TB control produced an important impact on the basis of the sociopolitical status making it possible to approach complete elimination of the disease in the future.

The epidemiological impact of antimeningococcal B vaccination in Cuba.

The incidence of invasive meningococcal disease (IMD) before (1984-1988) and after (1989-1994), a nationwide intervention with VA-MENGOC-BC vaccination started in 1989, was compared. The prevaccination period incidence density (ID> 8.8/10(5) year-person) was higher than the postvaccination ID (ID< 6.5/10(5) year-person). The percentage proportional differences from the start to the end of each period of ID in the vaccinal period was higher (87%) than the prevaccinal (37%) with significant differences among vaccinated groups (< 25 years old). A break-point (Chow test) was confirmed by the decrease in the ID between 1989 and 1990 in children under 1 year old, 5-9, 10-14, 15-19 and 50-54 years. Comparison of ID using maps showed a decrease in IMD in all municipalities during the postvaccination period. These findings support the epidemiological impact of VA-MENGOC-BC vaccination in the reduction of IMD morbidity.