Showing papers by "Pan American Health Organization published in 1998"

Induction of antigen-specific cytotoxic T lymphocytes in humans by a malaria DNA vaccine

Abstract: CD8+ cytotoxic T lymphocytes (CTLs) are critical for protection against intracellular pathogens but often have been difficult to induce by subunit vaccines in animals. DNA vaccines elicit protective CD8+ T cell responses. Malaria-naive volunteers who were vaccinated with plasmid DNA encoding a malaria protein developed antigen-specific, genetically restricted, CD8+ T cell-dependent CTLs. Responses were directed against all 10 peptides tested and were restricted by six human lymphocyte antigen (HLA) class I alleles. This first demonstration in healthy naive humans of the induction of CD8+ CTLs by DNA vaccines, including CTLs that were restricted by multiple HLA alleles in the same individual, provides a foundation for further human testing of this potentially revolutionary vaccine technology.

An Outbreak of Hantavirus Pulmonary Syndrome, Chile, 1997

Abstract: An outbreak of 25 cases of Andes virus-associated hantavirus pulmonary syndrome (HPS) was recognized in southern Chile from July 1997 through January 1998. In addition to the HPS patients, three persons with mild hantaviral disease and one person with asymptomatic acute infection were identified. Epidemiologic studies suggested person-to-person transmission in two of three family clusters. Ecologic studies showed very high densities of several species of sigmodontine rodents in the area.

Epidemic of pediatric deaths from acute renal failure caused by diethylene glycol poisoning

Abstract: Context.—Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin.Objective.—To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures.Design.—Case-control study, cohort study, and laboratory toxicologic evaluation.Setting.—Pediatric population of Haiti.Participants.—Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects.Main Outcome Measure.—The odds of exposure to suspected etiologic agents among cases and controls.Results.—We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG.Conclusions.—An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.

Antioxidant Supplementation and Respiratory Functions among Workers Exposed to High Levels of Ozone

Abstract: Ozone exposure has been related to adverse respiratory effects, in particular to lung function decrements. Antioxidant vitamins are free-radical scavengers and could have a protective effect against photo-oxidant exposure. To evaluate whether acute effects of ozone on lung functions could be attenuated by antioxidant vitamin supplementation, we conducted a randomized trial using a double-blind crossover design. Street workers (n = 47) of Mexico City were randomly assigned to take daily a supplement (75 mg vitamin E, 650 mg vitamin C, 15 mg beta carotene) or a placebo and were followed from March to August 1996. Pulmonary function tests were done twice a week at the end of the workday. During the follow-up, the mean 1-h maximum ozone level was 123 ppb (SD = 40). During the first phase, ozone levels were inversely associated with FVC (beta = -1.60 ml/ppb), FEV1 (beta = -2.11 ml/ppb), and FEF25-75 (beta = -4.92 ml/ppb) (p < 0.05) in the placebo group but not in the supplement group. The difference between the two groups was significant for FVC, FEV1, and FEF25-75 (p < 0.01). During the second phase, similar results were observed, but the lung function decrements in the placebo group were smaller, suggesting that the supplementation may have had a residual protective effect on the lung. These results need to be confirmed in larger supplementation studies.

Risk for transfusion-transmitted infectious diseases in Central and South America.

Abstract: We report the potential risk for an infectious disease through tainted transfusion in 10 countries of South and Central America in 1993 and in two countries of South America in 1994, as well as the cost of reagents as partial estimation of screening costs. Of the 12 countries included in the study, nine screened all donors for HIV; three screened all donors for hepatitis B virus (HBV); two screened all donors for Trypanosoma cruzi; none screened all donors for hepatitis C virus (HCV); and six screened some donors for syphilis. Estimates of the risk of acquiring HIV through blood transfusion were much lower than for acquiring HBV, HCV, or T. cruzi because of significantly higher screening and lower prevalence.rates for HIV. An index of infectious disease spread through blood transfusion was calculated for each country. The highest value was obtained for Bolivia (233 infections per 10,000 transfusions); in five other countries, it was 68 to 103 infections per 10,000. The risks were lower in Honduras (nine per 10,000), Ecuador (16 per 10,000), and Paraguay (19 per 10,000). While the real number of potentially infected units or infected persons is probably lower than our estimates because of false positives and already infected recipients, the data reinforce the need for an information system to assess the level of screening for infectious diseases in the blood supply. Since this information was collected, Chile, Colombia, Costa Rica, and Venezuela have made HCV screening mandatory; serologic testing for HCV has increased in those countries, as well as in El Salvador and Honduras. T. cruzi screening is now mandatory in Colombia, and the percentage of screened donors increased not only in Colombia, but also in Ecuador, El Salvador, and Paraguay. Laws to regulate blood transfusion practices have been enacted in Bolivia, Guatemala, and Peru. However, donor screening still needs to improve for one or more diseases in most countries.

Measles eradication: experience in the Americas.

Abstract: In 1994, the Ministers of Health from the Region of the Americas targeted measles for eradication from the Western Hemisphere by the year 2000. To achieve this goal, the Pan American Health Organization (PAHO) developed an enhanced measles eradication strategy. First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. These vaccination activities are accompanied by improvements in measles surveillance, including the laboratory testing of suspected measles cases. The implementation of the PAHO strategy has resulted in a marked reduction in measles incidence in all countries of the Americas. Indeed, in 1996 the all-time regional record low of 2109 measles cases was reported. There was a relative resurgence of measles in 1997 with over 20,000 cases, due to a large measles outbreak among infants, preschool-aged children and young adults in Sao Paulo, Brazil. Contributing factors for this outbreak included: low routine infant vaccination coverage, failure to conduct a "follow-up" campaign, presence of susceptible young adults, and the importation of measles virus, apparently from Europe. PAHO's strategy has been effective in interrupting measles virus circulation. This experience demonstrates that global measles eradication is an achievable goal using currently available measles vaccines.

The Onchocerciasis Elimination Program for the Americas: a history of partnership

Abstract: The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center. OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$ 2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela, so as to take full advantage of the Merck donation. Now halfway into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999.

Vitamin A deficiency in Latin America and the Caribbean: an overview

Abstract: Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960s; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implications of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude of VAD in countries of the Region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the Region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol < 20 micrograms/dl) in children under 5 years of age ranges between 6% in Panama and 36% in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25% of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation, with sustained high coverage rates through national immunization days in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala, and Honduras (a significant effect has been documented in Guatemala and Honduras) and is under negotiation in Bolivia, Colombia, Costa Rica (to be resumed), Ecuador, Nicaragua, and Peru; and (c) limited dietary diversification activities.

Prevalence of malaria parasitemia and accuracy of microscopic diagnosis in Haiti, October 1995

Abstract: In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1 803 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0% (range, 0.0% to 14.3%). The rate was lowest among 1- to 4-year-old children (1.6%) and highest among persons aged 15 and older (5.5%). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6%, specificity was 88.6%, and the predictive value of a positive slide was 22.2%. Microscopic diagnoses need to be improved, and adequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts targeted to the areas of highest prevalence could further diminish the effect of malaria in Haiti.

Rational use of rubella vaccine for prevention of congenital rubella syndrome in the Americas

Abstract: Rubella is a viral disease with minor morbidity and few complications unless it is contracted by a pregnant woman. Rubella infection during the first trimester of pregnancy often leads to fetal death or severe congenital defects (congenital rubella syndrome, CRS). Rubella remains endemic in many countries of Latin America and the Caribbean. It has been estimated that 20000 or more infants are perhaps born with CRS each year in Latin American and Caribbean countries. While the inclusion of rubella vaccination into routine childhood immunization will decrease rubella virus circulation among young children, it will not have immediate impact on the transmission of rubella among adults or the occurrence of CRS. A one-time mass campaign targeting both males and females 5 to 39 years of age with measles-mumps-rubella or measles-rubella vaccine followed by the use of measles-mumps-rubella vaccine in routine early childhood vaccination will prevent and control both rubella and CRS promptly. In April 1988, the Ministers of Health of the English-speaking Caribbean targeted rubella for elimination by the end of the year 2000 using the vaccination strategy outlined above. The rubella elimination experience of these countries will provide useful information for the eventual elimination of rubella virus from the Americas.

A prefilled injection device for outreach tetanus immunization by Bolivian traditional birth attendants.

Abstract: This study evaluated the performance, acceptability, and appropriateness of a new, single-use, prefilled injection device called UniJect for an outreach immunization application. Between April and June 1995, UniJect devices were used by 36 traditional birth attendants to administer tetanus toxoid injections to 2,240 pregnant women during routine, antenatal home visits in the Northern, Ichilos, and Warnes Districts of Santa Cruz, Bolivia. Because tetanus toxoid is relatively heat stable, the traditional birth attendants were able to keep the tetanus toxoid-filled UniJect devices in their homes for up to one month without refrigeration. The devices were stored, transported, and disposed of in an outreach carrier designed to reduce the risks of improper handling and disposal. Data were collected from injection recipients, traditional birth attendants, and supervisors via observation, questionnaires, and post-study interviews. The performance of the UniJect device and its acceptability among all groups was very high. The traditional birth attendants used UniJect properly and safely; there were no reports or observations of device misuse, reuse, or needle-stick. Advantages cited included the fact that the device required no assembly, offered assured sterility, and reduced vaccine wastage sometimes associated with multi-dose vials. The ability to store and transport the vaccine-filled devices without ice also greatly simplified logistics.

Protection of Mice against Plasmodium yoelii Sporozoite Challenge with P. yoelii Merozoite Surface Protein 1 DNA Vaccines

Abstract: Immunization of mice with DNA vaccines encoding the full-length form and C and N termini of Plasmodium yoelii merozoite surface protein 1 provided partial protection against sporozoite challenge and resulted in boosting of antibody titers after challenge. In C57BL/6 mice, two DNA vaccines provided protection comparable to that of recombinant protein consisting of the C terminus in Freund’s adjuvant.

Evaluation of indoor ozone concentration and predictors of indoor-outdoor ratio in Mexico City

Abstract: As part of a study on the potential adverse health effects of ozone exposure on the respiratory health of young children residing in Mexico City, we used passive ozone monitoring devices to determine microenvironmental ozone concentrations. Indoor and outdoor ozone concentrations were measured at 145 homes and at the schools of participating children. In addition, outdoor concentrations were also measured with continuous monitors at the schools and at stationary outdoor monitoring sites. At the children's homes, indoor ozone levels were 1030% of the outdoor ozone concentrations. The mean indoor-to-outdoor (I/O) ratio was 0.20 (SD = 0.18). The highest I/O ratios were observed in homes where windows were usually open during the day, and where there was carpeting or air filters. At school during class hours, the I/O ratio was higher (0.3 to 0.4) than at the children's homes, due to periodic opening of the doors and windows. Given the large disparity in ozone concentrations between different microenv...

How to do (or not to do) … The Genogram: A New Research Tool to Document Patterns of Decision-Making, Conflict and Vulnerability within Households

Abstract: The household is an important unit of analysis in health economics and public health research. In developing countries in particular, household composition may be varied and complex ^ possibly incorporating a range of close family members (including multiple partners and children from different partnerships), extended family members (including uncles, aunts, grandparents and grandchildren), and non-kin individuals (such as lodgers and servants).

Early electrocardiographic abnormalities in Trypanosoma cruzi-seropositive children

Abstract: As part of a major epidemiologic study on Chagas' disease, we compared the prevalence of electrocardiographic (ECG) abnormalities among 141 school children 7-12 years of age and seropositive for Trypanosoma cruzi, and 282 age-, sex-, and school-matched seronegative children in an endemic area in Brazil. The prevalence of ECG abnormalities was 11.3% among seropositive children and 3.5% among seronegative children (odds ratio = 3.5, 95% confidence interval [CI] = 1.5-8.4). The prevalence rate of ECG alterations was 10.7% for seropositive males versus 8.9% for seropositive females. Complete right bundle branch block (CRBBB), which is highly suggestive of Chagas' disease cardiopathy, was diagnosed in nine (6.4%) seropositive children and in only one (0.3%) seronegative child (odds ratio = 18.5, 95% CI = 2.3-146.5, attributable fraction = 58.3%). Five incident new cases of CRBBB were diagnosed after a 36-month follow-up of seropositive children who were enrolled in an independent clinical field trial. No case of frequent and/or multifocal ventricular premature beats was found in the cohort of children. The surprisingly high frequency of early ECG abnormalities, which indicates a rapid evolution from infection to disease, suggests the existence of endemic areas with a particular accelerated disease progression that was not described before. Under such conditions, a public health chemotherapy program focusing on the treatment of young seropositive children would be recommended.

Reducing automobile traffic: an urgent policy for health promotion

Abstract: In recent decades traffic injuries have become a leading cause of death and disability the world over. In congested urban areas, the noise and emissions from vehicle engines cause discomfort and disease. More than one billion people are exposed daily to harmful levels of atmospheric contamination. Because internal combustion generates carbon dioxide (CO2), the automobile is a principal contributor to the greenhouse effect, which has significantly raised the temperature of the atmosphere. Scientists anticipate that in coming decades the greenhouse effect will produce alterations in climate that are very likely to be harmful and possibly catastrophic. Meanwhile, burgeoning traffic and rural and urban highway infrastructures are already among the principal causes of environmental degradation. Urban development, because it is nearly always "planned" to accommodate automobiles rather than people, reduces the quality of life and tears the social fabric. In contrast to private automobiles, public transportation, bicycles, and walking produce little environmental contamination or injury-related morbidity and mortality. These modes of transport involve more physical activity, with its positive health effects, and avoid contributing to the greenhouse effect. The reduction of automobile traffic and substitution of alternative modes of transport are essential policies for health promotion. They should be incorporated in "healthy cities" programs and general economic policies.

Cattle response to foot‐and‐mouth disease virus nonstructural proteins as antigens within vaccines produced using different concentrations

Abstract: Four groups of ten nine‐month‐old Nelore heifers were used for this study. Each group received one of four foot‐and‐mouth disease (FMD) trivalent vaccines for the duration of the experiment. The four vaccine formulations (Normal, 2X, 4X and 8X) differed in 140S content to determine the serological reactivities to FMD virus (FMDV) nonstructural proteins 2C, 3ABC and 3D. Vaccination was by the intramuscular administration of vaccine on day 0, 180 and 360. Bleedings were done at 30 days post vaccination (dpv), 90 dpv, 30 days post revaccination (dpr), 90 dpr, and 30 days post third administration (dprr). There was a general tendency to have higher mean 3D responses with increased vaccine application but not with increased concentration of antigen. With 2C and 3ABC this tendency was not seen, neither with repeated application of vaccine nor with increased antigen concentration. All individual animal observations to 2C and 3ABC remained within three standard deviations of the average observed for naiv...

Nursing Education and International Health in the United States, Latin America, and the Caribbean

Abstract: Purpose: To identify international health activities in United States, Latin American, and Caribbean schools of nursing. In the international community, nurses face challenges similar to those in related professions, but without the benefit of a long tradition. There is little research about how nursing education and associated activities prepare nurses to deal with international health, and little information about the extent of international health activities in U.S. schools of nursing. Design: Descriptive. Method: Using a questionnaire with 16 items, a survey was conducted in 1995 on a random sample of representatives from 100 university schools of nursing in the United States plus 15 schools with known international activities (10 from the United States and 5 from Latin America and the Caribbean). Findings: International health as a program topic was found in one-third of U.S. schools of nursing. However, nursing curriculums do not integrate international health with other subjects. Also, partnerships with foreign institutions are incipient and international health activities are usually individual initiatives with little institutional support. Conclusions: For nurses to become major contributors to international health, nursing curriculum content must shift from “international nursing” to “international health.” Programs of nursing education should include study of social, economic, and political factors that affect health care systems. Schools should develop partnership agreements. Educacion en Enfermeia y Salud Internacional en los Estados Unidos, America Latina y el Caribe Proposito: Identificar las actividades de salud internacional en las escuelas de enfermeria en los Estados Unidos, America Latina, y el Caribe. Estos profesionales en la comunidad internacional, confrontan retos similares a otras profesiones relacionadas a la salud, pero sin el beneficio de una tradicion larga. Existe escasa investigacion e informacion acerca de como la educacion de la enfermeria y actividades asociadas preparan a sus profesionales para el manejo de la salud internacional, yde la extension de estas actividades en estas escuelas en los Estados Unidos. Diseno: Descriptivo. Metodologia: Se tomo una muestra representativa usando un cuestionario de 16 preguntas. Se condujo una encuesta al azar de 100 escuelas universitarias de enfermeria en los Estados Unidos y 15 escuelas con conocidas actividades internacionales (10 de los Estados Unidos y 5 de America Latina y del Caribe.) Hallazgos: Se encontro el topico de Salud Internacional en los programas de un tercio de las escuelas Estadounidenses. Sin embargo, el tema de salud internacional no esta integrado en otros cursos. Ademas, asociaciones con instituciones extranjeras estan en sus comienzos y las actividades de salud internacionalgeneralmente son iniciativas de caracter individual y cuenta con poco apoyo institucional. Conclusiones: Para que los profesionales de la enfermeria sean contribuyentes para la salud internacional, el contenido de los curriculos de enfermeria necesitan cambiarse en su enfoque de “enfermeria internacional” para un contenido de “salud internacional.” Los programas de educacion de enfermeria deben incluirestudios de los factores sociales, economicos, y politicos que afectan los sistemas de salud. Las escuelas deben desarrollar ademas asociaciones de cooperacion mutua.

Nutritional status of Haitian children, 1978-1995: deleterious consequences of political instability and international sanctions

Abstract: Results from three national surveys in Haiti suggest that the prevalence of stunting, underweight, and wasting in children fell considerably between 1978 and 1990. In the following four years, rates of stunting and underweight levelled off, while that of wasting nearly doubled. Child nutrition deteriorated dramatically during a period of intense political crisis and international sanctions that included a strictly enforced trade embargo. Human welfare should be monitored whenever international sanctions are imposed to regulate a country's behavior.

The economics of pharmaceuticals and health sector reform in the Americas

Abstract: Las crecientes presiones que enfrentan los sistemas de salud y los notables cambios economicos que han tenido lugar en muchos paises de America Latina y el Caribe hacen que sea necesario reformar los sectores de la salud y del mercado de medicamentos. Aunque las necesidades de salud y de productos farmaceuticos siguen aumentando, las politicas que liberalizan la venta y el precio de los productos y que se adoptan con el fin de revitalizar las economias a menudo provocan un aumento del gasto en productos farmaceuticos. Tales circunstancias afectan a los pobres mas que a otros grupos, lo cual agrava las desigualdades ya presentes en la sociedad. La reforma del sector sanitario, si ha de ser de optima calidad, se basa en el postulado de que el acceso a buenos servicios de salud es un derecho de todo individuo. De ello se desprenden tres objetivos: equidad en el acceso para todos, calidad y eficiencia. Cada pais debe moldear su reforma del sector de la salud segun sus prioridades y sus condiciones sociales y economicas, pero la reforma del sector farmaceutico debe incorporarse a la reforma del sector sanitario y dirigirse a que todo individuo tenga acceso a los medicamentos esenciales y a servicios de salud de calidad. El concepto de los medicamentos esenciales, promovido por la OMS mediante su Programa de Accion sobre Medicamentos Esenciales y la OPS, subraya la importancia de la disponibilidad, accesibilidad economica, calidad y uso racional de los medicamentos. Son cinco las areas fundamentales que abarca la estrategia de reforma: el papel de los sectores publico y privado; la disponibilidad de diferentes opciones para el pago de medicamentos; las politicas de fijacion de precios; las estrategias en torno a los productos genericos, y el uso racional de los medicamentos.

Emerging Diseases—What Now?

Abstract: The Pan American Health Organization (PAHO) was born in 1902 out of concern for the spread of infectious diseases. The outbreak of cholera in Hamburg in 1892 and the epidemics of yellow fever in the Americas led to the decision to establish the International Sanitary Bureau with permanent headquarters in Washington. At the conference that made this historic decision in 1902, participating countries agreed to cooperate with each other and transmit to the bureau “all data of every character relative to the sanitary conditions of their ports and territories and furnish said Bureau every opportunity and aid for a thorough and careful study and investigation of any outbreaks of pestilential disease.” All this was to be done to provide the “widest possible protection of the public health of each of the said republics and that commerce between said republics may be facilitated.”

Advances in Pharmaceutical Market Integration in Mercosur and Other Latin American Countries

Abstract: This paper reviews the developments in the pharmaceutical sector in the MERCOSUR countries which have resulted from the renewed efforts of economic integration in Latin America. MERCOSUR refers to the “Mercado Comun del Sur, “ the common market that has been under development since 1991 by Argentina, Brazil, Paraguay, and Uruguay. In MERCOSUR the underlying principles for harmonization of pharmaceutical legislation and regulations are that there is no centralized approval system (a pharmaceutical product needs to be registered at the national level before it can be marketed in a country) and that requirements and procedures for registration should be the same in all countries. By the end of 1995, the MERCOSUR countries had adopted common good manufacturing practice (GMP) guidelines for production of large parenteral solutions and an inspection guide, a common guide for inspection of production facilities of pharmaceutical products, common requirements for production facilities for pharmaceutical ingredients and raw materials, an inspection guide for raw materials’ production facilities, common guidelines on GMP and quality control of blood products, and a strategy for the transition period stretching until 1999. It is concluded that the opening of markets has already brought not only adoption of GMP standards but general movement toward clearly defined technical requirements for the registration of products. This will strengthen national regulatory systems and consumer protection. The harmonization process will strive to reach international standards, with the World Health Organization (WHO) and the International Conference on Harmonization (ICH) as references. Multinational companies will review their production policies and plant locations. National companies will review their portfolio of products looking for specific “niches” in the pharmaceutical market; and they will need to be prepared for increased competition from foreign companies. Further concentration of the domestic industry is likely to occur.

Mosaic of the AIDS epidemics in Latin America and the Caribbean.

Abstract: In Latin America and the Caribbean, the AIDS pandemic is comprised of groupings of different epidemics, varying in transmission routes and in populations affected. Primary modes of HIV transmission in Latin America, the Caribbean, and South America are outlined, and vary from type of sexual contact to intravenous drug use, depending on the subregion. Overall, the epidemic is progressing into younger, more impoverished, and more rural populations. Efforts to stem the spread of the epidemic should meet the prevention needs of marginalized and impoverished populations and be consistent with the type and characteristics of the epidemics found at the country level. Timely surveillance is a key component in alleviating the epidemic. Strategies targeting at-risk populations should empower women, educate youth, and disseminate messages.