396 PAHO BULLETIN l vol. 19, no. 4, 198.5
Vaccination of a population not attending pact of CRS and the other outcomes of rubella school poses many logistic problems. A multifa- infection during pregnancy, virtually any effort ceted approach that involves both the public and that can hasten the elimination of CRS should private sectors will be needed. Furthermore, in- be undertaken.
formation that may help identify select groups at increased risk of not being vaccinated will
have to be sought as a guide to vaccination ef- Saurce: United States Centers for Disease Control, Mar- forts. However, considering the economic im- bidity and Mortality Weekly Report 34(5), 1985.
COMMUNICABLE DISEASES IN THE CARIBBEAN, 1983 Changes in the communicable disease situa-
tion in 27 countries and territories’ of the Carib- bean (including the mainland countries of Belize, French Guiana, Guyana, Suriname, and Ven- ezuela) are highlighted in the annual review for 1983 conducted by the Surveillance Unit of the Caribbean Epidemiology Center (CAREC). At the time the review was compiled in March 1984, reporting for nine countries was incom- plete. Therefore, estimates were made for those countries on the basis of data available for shorter periods. The review compares the 1983 figures with those for 1982 and, in most cases, for 198 1. In addition, the report presented here makes use of additional information contained in earlier CAREC annual reviews and reports made di- rectly to the World Health Organization. Diseases Subject to the International Health Regulations
No reports of cholera, plague, or yellow fever were received during 1983. Neither cholera nor plague has ever been reported from the Carib- bean. The last four cases of yellow fever in that region were reported from Venezuela in 1980; the last epidemic involved some 18 cases of jungle yellow fever in Trinidad and Tobago in
1979.
‘Hereafter the term “country” should be taken to include the term “territory,” where appropriate.
Diseases Covered by the Expanded Program on Immunization
Poliomyelitis
Poliomyelitis was reported only from Haiti and the Dominican Republic. The rate per 100,000 population in Haiti was 2.1, triple the 1982 rate and 12 times that prevailing in the adjacent Dominican Republic in 1983. However, the Dominican Republic had a provisional rate of 1.7 in 1982. Since 1976, nine countries have reported cases; but rates have only exceeded 1 .O per 100,000 during that period in a few in- stances-once in Belize, Jamaica, and the Turks and Caicos Islands; twice in Haiti; and three times in the Dominican Republic.
Coverage of children less than one year old with trivalent oral polio vaccine (three doses or more) was only 7% in Haiti and 39% in the Dominican Republic. In fact, coverage reached 90% in more than one country only in 1982, and has been maintained at that level since then in only three-Antigua and Barbuda, the Cayman Islands, and St. Christopher/Nevis. In five countries, coverage actually declined in
1983 as compared to 1982. Diphtheria
l ABSTRACTS AND REPORTS 397
the 1982 rate of 2.3, but was eight times greater than the 1981 rate.
Overall, diphtheria attack rates have shown a marked decline throughout the Caribbean since 1978, a decline that has apparently been unre- lated to immunization coverage. For example, the rate of reported cases in Barbados fell from 117 in 1977 to 4.9 in 1979 and zero in 1983, while immunization coverage of children less than one year old with three or more doses of DPT vaccine remained at around 60%. Aside from Barbados, only Suriname and the Domini- can Republic have reported rates of more than
1 .O since 1978, and their coverage has only been around 30% (until 1982, when Suriname’s coverage doubled). Only three countries achieved or exceeded 90% DPT coverage in both 1982 and 1983~these being Dominica, Mont- set-rat, and St. ChristopherYNevis .
Pertussis
Pertussis was reported by 11 of the 27 coun- tries, with the highest rates being reported in Venezuela (20) and Dominica (14)-rates simi- lar to those countries’ 1982 figures. The rate in Haiti, 24 in 1982, fell to 8.7 in 1983. The Turks and Caicos Islands and Saint Lucia had epidemics in 198 1, with rates of 370 and 390, respectively; but otherwise the rates continued to remain below 10 in most countries, as they have since reporting began in 1980. (Coverage with DPT vaccine was 7 1% in Venezuela, while in Domi- nica it was 93%, a level that has been maintained for three years.)
Tetanus
Tetanus cases were reported by 13 countries, while 11 others reported no cases; no reports were received from Suriname, Venezuela, or the U.S. Virgin Islands. The highest case rates were reported in Haiti (3.4), Barbados (2.4), and the Dominican Republic (1.9). These rates were all similar to those reported in 1982. No country has reported a rate higher than eight in any year since 1976. Neonatal tetanus is not reported separately.
Tuberculosis
Tuberculosis cases were reported by 23 coun- tries (three reported no cases, and no report was received from Venezuela). Rates of over 50 cases per 100,000 were reported by the Turks and Caicos Islands, Belize, and the Dominican Re- public. However, the numerical increase in cases in the Turks and Caicos Islands was only from two to five (estimated). Except for Dominica, the 11 countries with populations of 100,000 or less (1980 census) all had some years between 1976 and 1983 with either no cases or only one. (Dominica had rates ranging from 6.3 to 35, representing five to 26 cases.) The larger coun- tries had rates ranging from a low of 1.2 (Bar- bados in 1981) to 104 (Haiti in 1976). Eight countries that did not immunize against tubercu- losis had attack rates ranging from zero to 37 during the period 1976- 1983. No overall upward or downward trend was observed in the case-rate data reported for this eight-year period.
Only 11 countries included BCG immuniza- tion in their 1983 vaccination programs, and two of these only vaccinated children above four years of age. Coverage in the six countries re- porting BCG vaccination of children under one year old ranged from 69% to 109%, an improve- ment over the range of 27-78% reported in 1982. Reported coverages were 50%) 75.2%, and 52% in the Turks and Caicos Islands, Belize, and the Dominican Republic, respectively, in 1982. (The reported coverage increased to 98% in the Turks and Caicos Islands in 1983.) Bermuda and Grenada, two countries that do not include BCG immunization in their programs, had marked increases in their case rates in 1983. Measles
398 PAHO BULLETIN l vol. 19, no. 4, 1985
ing from 5.3 to 29 over that period, as compared can Republic (five cases) and Venezuela (10 with rates in the range of 42-150 in the adjacent cases). In the past, Haiti had reported between Dominican Republic and 80-260 in Venezuela. one and four cases a year. No other countries . St. Christopher/Nevis does not immunize reported cases, although the potential is there, against measles. In the Turks and Caicos Islands, since rabies is endemic in mongooses in Grenada vaccination coverage for children under one year and in bats throughout the Caribbean.
old was 80% in 1983, but only 5.5% in 1982, Ten countries reported dengue, and there has which explains how a large epidemic (an esti- been at least a doubling in the number of dengue mated 100 cases in a population of only 7,700) cases since 1982 in Haiti, Jamaica, and Trinidad was possible. Coverage was 66% in the Bahamas and Tobago. Dengue virus type 4 continued to (virtually the same as in 1982), but 95% of the be the dominant strain. There have been no re- measles cases there occurred in children 5-14 ports of dengue hemorrhagic fever in the region years of age, and a survey showed that in that since four suspect cases occurring in adult males age group only about 28% had records of vacci- in Suriname in 1982. House indexes of Aedes nation. A campaign was therefore undertaken aegypti larvae, which measure the vector poten- in government primary schools. Proof of previous tial of a locality for dengue and urban yellow vaccination or consent for vaccination was ob- fever, ranged from less than 0.1% in Cuba to tained for 71% of these children, and 83% of 65% in Antigua in 1983; the latter figure repre- the susceptibles among them were eventually sents an increase of almost 40% from the previous
immunized. year.
I Immunization coverage has exceeded 90% in only one country (the Cayman Islands in 1982), and only six countries had coverages of 70% or more in 1983. St. Christopher/Nevis and Trinidad and Tobago are the only two of the 27 reporting countries that did not immunize against measles. The former has had recurring epidemics every three to four years since 1976, while the latter has had case rates fluctuating between 33 and 330 since that time.
There were no reported cases of the equine encephalitides in man in 1983.
Leptospiroses cases, including the first re- ported cases in Dominica and Montserrat, were reported from 12 countries. The recorded rates ranged from 0.5 in Martinique to an estimated 12 in Barbados (which had a rate of 26 in 1981), but reporting was limited by a lack of diagnostic facilities. A serosurvey of 541 schoolchildren for antibodies to nine serotypes in 1980 showed almost 10% positive.
Vector-borne Diseases
Enteric Diseases Indigenous malaria was reported from six
countries, with case rates ranging from an esti- mated 23 in Haiti to 2,900 in Belize. Ten coun- tries reported cases imported from elsewhere in the Americas, Africa, or India.
Schistosomiasis was reported only from Saint Lucia and Suriname, with rates of 14 and 58, respectively. Montserrat has not reported any cases since 1979, but S. mansoni eggs were found in stool speciinens from there and from Antigua in 1981.*
The highest rates of typhoid were reported in Dominica (44), Haiti (estimated 29), and the Dominican Republic (estimated 26). All other countries with cases had reported rates of four or less.
Rabies in man was reported from the Domini-
*See World Health Organization, Weekly Epidemiological
Four countries reported cases of ciguatera poisoning, with the highest case rates occurring in the Cayman Islands (43) and Martinique (41).
The highest rates of food-borne diseases were 260 in Bermuda and 170 in the Cayman Islands; elsewhere, the rates were 30 or below.
The highest reported rate of gastroenteritis cases was an estimated 950 in Cuba, St. Vincent
. ABSTRACTS AND REPORTS 399
Viral Diseases
Viral hepatitis had its maximum recorded at- tack rates in Dominica (140) and Grenada (1 IO).
Influenza rates ranged from 2.5 in Dominica to 3,500 in Suriname. This wide range, without laboratory confirmation in most cases, suggests that acute, noninfluenza respiratory illness may have been included in some reports. The 198 1 epidemic of acute hemorrhagic conjunctivitis (“red eyes”), which affected 10 countries, was over by 1983, and only Grenada and Trinidad and Tobago reported cases.
Rubella was reported by most countries, with the highest rate being recorded in St. Vincent and the Grenadines (130). The 1982 epidemic in Grenada (which produced a rate of 640) was followed by 20 cases of congenital rubella syn- drome in 1983, seven of them fatal.3
Mumps is not a reportable disease for CAREC, but mumps virus was isolated from 11 patients hospitalized in Trinidad for meningitis and ence- phalitis.
Other Diseases
The highest rates of gonococcal infections were reported from the Turks and Caicos Islands and the Cayman Islands (where the estimated rates were 2,600 and 2,200, respectively); and the lowest were reported from Guadeloupe (a rate of 14).
Syphilis rates ranged from an estimated 3.9 in Antigua and Barbuda to an estimated 3,800 in Montserrat.
Meningococcal infections were reported from nine countries, the number of recorded cases ranging from one to 11 except on Cuba, where an estimated 8.50 cases were reported.
%e World Health Organization, Weekly Epidemiological Record 59(11):79-80, 1984.
The prevalence rate of leprosy, among the 11 countries reporting cases, ranged from 13 in Bar- bados to 160 in Saint Lucia and 200 in the Turks and Caicos Islands.
l l l
Note: Comparison of 1983 reported diphtheria and measles attack rates in Haiti and the Domini- can Republic, which have populations of similar size and share the same island, shows that the rates in Haiti were less than one-third as great as those in the Dominican Republic, although DPT and measles immunization coverage in Haiti was much lower. This suggests consider- able underreporting of these two diseases in Haiti.
It would be interesting to know the age distri- bution of subjects with pertussis in Dominica and tetanus in Barbados, since those countries have relatively high attack rates for these dis- eases in the face of reasonably good vaccine coverage. The explanation for this could be that the cases occurred in children born before vac- cination coverage reached its current levels. The tetanus rate in Barbados in each of the years 1981-1983, when DPT immunization coverage was 59% or more, points to a total of 18 affected subjects, many of whom may not have been new- borns.
Only four countries (Barbados, Cuba, Gre- nada, and Guyana) had house indexes of Ae. aegypti larvae below the 5% level generally con- sidered to represent the point below which epidemic transmission is unlikely to occur.
Source; Caribbean Epidemiology Center, Review of Communicable Diseases in the Caribbean, 1983, as reported in the World Health Organization Weekly Epidemiological Record 60(30):229-232, 1985.
T-LYMPHOTROPIC RETROVIRUSES OF NON-HUMAN PRIMATES
