For Peer Review Only

Total Page:16

File Type:pdf, Size:1020Kb

For Peer Review Only BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from The Cost-Effectiveness of HPV-Based Cervical Cancer Screening in the Public Health System in Nicaragua ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2016-015048 Article Type: Research Date Submitted by the Author: 04-Nov-2016 Complete List of Authors: Campos, Nicole; Harvard T.H. Chan School of Public Health, Health Policy and Management Mvundura, Mercy; PATH, Devices and Tools Program Jeronimo, Jose; PATH, Reproductive Global Health Program Holme, Francesca; PATH, Reproductive Health Global Program Vodicka, Elisabeth; University of Washington, School of Pharmacy Kim, Jane; Harvard School of Public Health, Health Policy and Management <b>Primary Subject Health economics Heading</b>: Global health, Health economics, Health policy, Obstetrics and Secondary Subject Heading: gynaecology, Public health Keywords: HEALTH ECONOMICS, Epidemiology < ONCOLOGY, PUBLIC HEALTH http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 56 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from 1 2 3 1 The Cost-Effectiveness of HPV-Based Cervical Cancer Screening in the Public Health System in 4 5 2 Nicaragua 6 3 Nicole G. Campos, PhD, a Mercy Mvundura, PhD,b Jose Jeronimo, MD,c Francesca Holme, MPH,c Elisabeth 7 8 d a 9 4 Vodicka, MHA, Jane J. Kim, PhD 10 11 5 12 13 6 a Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 14 15 For peer review only 16 7 Boston, Massachusetts, USA 17 18 8 b PATH, Devices and Tools Program, P.O. Box 900922, Seattle, Washington, USA 19 20 9 c PATH, Reproductive Health Global Program, P.O. Box 900922, Seattle, Washington, USA 21 22 d 23 10 University of Washington, School of Pharmacy, Seattle, Washington, USA 24 25 11 Corresponding author: Nicole G. Campos, 718 Huntington Avenue, Boston, MA 02115; e-mail: 26 27 12 [email protected]; phone: 617-432-2019; fax: 617-432-0190 28 29 30 13 Word count (abstract): 300 31 32 33 14 Word count (text): 4,068 http://bmjopen.bmj.com/ 34 35 36 15 37 38 16 39 40 41 on September 26, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 56 BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from 1 2 3 17 Abstract 4 5 18 Objectives: To evaluate the cost-effectiveness of HPV DNA testing (versus Pap-based screening) for 6 7 8 19 cervical cancer screening in Nicaragua. 9 10 20 Design: A previously developed Monte Carlo simulation model of the natural history of HPV infection 11 12 21 and cervical cancer was calibrated to epidemiologic data from Nicaragua. Cost data inputs were derived 13 14 22 using a micro-costing approach in Carazo, Chontales, and Chinandega departments; test performance 15 For peer review only 16 17 23 data were from a demonstration project in Masaya department. 18 19 24 Setting: Nicaragua’s public health sector facilities. 20 21 25 Participants: Women aged 30 to 59 years. 22 23 24 26 Interventions: Screening strategies included 1) Pap testing every 3 years, with referral to colposcopy for 25 26 27 women with an ASCUS+ result (“Pap”); 2) HPV testing every 5 years, with referral to cryotherapy for 27 28 28 HPV-positive eligible women (HPV screen-and-treat, or “HPV-ST”); 3) HPV testing every 5 years, with 29 30 31 29 referral to triage with visual inspection with acetic acid (VIA) for HPV-positive women (“HPV-VIA”); and 32 33 30 4) HPV testing every 5 years, with referral to Pap testing for HPV-positive women (“HPV-Pap”). http://bmjopen.bmj.com/ 34 35 31 Outcome measures: Reduction in lifetime risk of cancer; incremental cost-effectiveness ratios (ICER; 36 37 32 2015 US$ per year of life saved [YLS]). 38 39 40 33 Results: HPV-based screening strategies were more effective than Pap testing. HPV-ST was the least 41 on September 26, 2021 by guest. Protected copyright. 42 34 costly and most effective strategy, reducing lifetime cancer risk by 29.5% and outperforming HPV-VIA, 43 44 35 HPV-Pap, and Pap only, which reduced cancer risk by 19.4%, 12.2%, and 10.8%, respectively. With an 45 46 47 36 ICER of US$320/YLS, HPV-ST every 5 years would be very cost-effective using a threshold based on 48 49 37 Nicaragua’s per capita GDP of US$2,090. Findings were robust across sensitivity analyses on test 50 51 38 performance, coverage, compliance, and cost parameters. 52 53 54 55 56 57 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 56 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from 1 2 3 39 Conclusions: HPV testing is very cost-effective compared to Pap testing in Nicaragua, due to higher test 4 5 6 40 sensitivity and the relatively lower number of visits required. Increasing compliance with recommended 7 8 41 follow-up will further improve the health benefits and value for public health dollars. 9 10 42 11 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 on September 26, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 3 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 56 BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from 1 2 3 43 Strengths and limitations of this study: 4 5 6 44 • Using implementation data from the Scale-Up project— which aims to facilitate 7 8 45 institutionalization of HPV testing at the national level in Guatemala, Honduras, and Nicaragua— 9 10 46 we estimated the cost-effectiveness of HPV testing in Nicaragua’s public health system. 11 12 13 47 • The screening algorithms, as modeled, reflect the prototypical structure of a screening episode 14 15 48 and the typeFor of facility peer at which visits usuallyreview take place, but doonly not capture variation due to 16 17 49 geography or health facility capacity. 18 19 20 50 • While we adopted a micro-costing approach to leverage data from implementation in 21 22 51 Nicaragua, individual-level data for each woman were not available; furthermore, we did not 23 24 52 have cost data associated with HPV self-collection in community settings, where most self- 25 26 27 53 collection takes place. 28 29 54 • Despite these limitations, extensive sensitivity analyses on cost and screening assumptions 30 31 55 indicate that HPV-ST is robustly the most efficient strategy. 32 33 http://bmjopen.bmj.com/ 56 34 35 36 57 Funding statement: This work was supported by the Bill & Melinda Gates Foundation. 37 38 39 58 Disclaimer: The findings and conclusions contained within are those of the authors and do not 40 41 on September 26, 2021 by guest. Protected copyright. 42 59 necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. The funders had no role 43 44 60 in study design; data collection, analysis, and interpretation; preparation of the manuscript; or decision 45 46 61 to submit the article for publication. 47 48 49 62 Competing interests disclosed: All authors have completed the ICMJE uniform disclosure form at 50 51 52 63 www.icmje.org/coi_disclosure.pdf and declare financial support from the Bill and Melinda Gates 53 54 64 Foundation for the submitted work; JJ was the director of the START-UP demonstration projects and 55 56 57 58 59 60 4 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 56 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017. Downloaded from 1 2 3 65 received all tests used in the study as a donation from Qiagen; no other relationships or activities that 4 5 6 66 could appear to have influenced the submitted work. 7 8 67 Contributors: All authors developed the analysis plan and interpreted the data. NC, MM, JJ, FH, and JK 9 10 68 conceptualized the study. MM, JJ, FH, and EV collected implementation data. NC conducted data 11 12 13 69 analysis and wrote the first draft of the report and revised subsequent drafts. JJ was the principal 14 15 70 investigator of theFor START-UP andpeer Scale-Up projects. review JK was the principal only investigator overseeing 16 17 71 microsimulation model development. All authors contributed to and approved the final report. 18 19 72 Data sharing statement: A supplementary appendix is available. 20 21 22 23 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 on September 26, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 5 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 56 BMJ Open: first published as 10.1136/bmjopen-2016-015048 on 15 June 2017.
Recommended publications
  • Infected Areas As at 11 May 1995 Zones Infectées Au 11 Mai 1995
    WEEKLY EPIDEMIOLOGICAL RECORD, Ho. It, 12 MAY 1995 • RELEVÉ ÉPIDÉMIOLOGIQUE HEBDOMADAIRE, N‘ H , 12 MAI 1995 M adagascar (4 May 1995).1 The number of influenza M adagascar (4 mai 1995).1 Le nombre d’isolements de virus A(H3N2) virus isolates increased during February and grippaux A(H3N2) s’est accru en février et en mars. Un accrois­ March. At that time there was a noticeable increase in sement marqué des syndromes grippaux a alors été observé parmi influenza-like illness among the general population in la population générale à Antananarivo. Des virus grippaux Antananarivo. Influenza A(H3N2) viruses continued to be A(H3N2) ont continué à être isolés en avril, de même que quel­ isolated in April along with a few of H1N1 subtype. ques virus appartenant au sous-type H1N1. Norway (3 May 1995).2 The notifications of influenza-like Norvège (3 mai 1995).2 Les notifications de syndrome grippal ont illness reached a peak in the last week of March and had atteint un pic la dernière semaine de mars et sont retombées à 89 declined to 89 per 100 000 population in the week ending pour 100 000 habitants au cours de la semaine qui s’est achevée le 23 April. At that time, 7 counties, mainly in the south-east 23 avril. Sept comtés, principalement dans le sud-est et l’ouest du and the west, reported incidence rates above 100 per pays, signalaient alors des taux d ’incidence dépassant 100 pour 100 000 and in the following week, 4 counties reported 100 000, et la semaine suivante 4 comtés ont déclaré des taux au- rates above 100.
    [Show full text]
  • WEEKLY EPIDEMIOLOGICAL RECORD RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE 15 SEPTEMBER 1995 ● 70Th YEAR 70E ANNÉE ● 15 SEPTEMBRE 1995
    WEEKLY EPIDEMIOLOGICAL RECORD, No. 37, 15 SEPTEMBER 1995 • RELEVÉ ÉPIDÉMIOLOGIQUE HEBDOMADAIRE, No 37, 15 SEPTEMBRE 1995 1995, 70, 261-268 No. 37 World Health Organization, Geneva Organisation mondiale de la Santé, Genève WEEKLY EPIDEMIOLOGICAL RECORD RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE 15 SEPTEMBER 1995 c 70th YEAR 70e ANNÉE c 15 SEPTEMBRE 1995 CONTENTS SOMMAIRE Expanded Programme on Immunization – Programme élargi de vaccination – Lot Quality Assurance Evaluation de la couverture vaccinale par la méthode dite de Lot survey to assess immunization coverage, Quality Assurance (échantillonnage par lots pour l'assurance de la qualité), Burkina Faso 261 Burkina Faso 261 Human rabies in the Americas 264 La rage humaine dans les Amériques 264 Influenza 266 Grippe 266 List of infected areas 266 Liste des zones infectées 266 Diseases subject to the Regulations 268 Maladies soumises au Règlement 268 Expanded Programme on Immunization (EPI) Programme élargi de vaccination (PEV) Lot Quality Assurance survey to assess immunization coverage Evaluation de la couverture vaccinale par la méthode dite de Lot Quality Assurance (échantillonnage par lots pour l'assurance de la qualité) Burkina Faso. In January 1994, national and provincial Burkina Faso. En janvier 1994, les autorités nationales et provin- public health authorities, in collaboration with WHO, con- ciales de santé publique, en collaboration avec l’OMS, ont mené ducted a field survey to evaluate immunization coverage une étude sur le terrain pour évaluer la couverture vaccinale des for children 12-23 months of age in the city of Bobo enfants de 12 à 23 mois dans la ville de Bobo Dioulasso. L’étude a Dioulasso. The survey was carried out using the method of utilisé la méthode dite de Lot Quality Assurance (LQA) plutôt que Lot Quality Assurance (LQA) rather than the 30-cluster la méthode des 30 grappes plus couramment utilisée par les pro- survey method which has traditionally been used by immu- grammes de vaccination.
    [Show full text]
  • Latin American Regional Office
    Latin AmericanHONDURAS | 1 Regional Office Newsletter Winter 2020 TABLE OF CONTENTS GUATEMALA 3 First Mesoamerican Meeting on Masculinities 3 Agroecology in Guatemala 4 HONDURAS 5 “I want my life back.” 5 Behind the Scenes 7 NICARAGUA 9 Bertha Madrigal 9 Nohelia Calderon 10 1. Dialogue of Knowledge, Justice and Masculinities Panelists: Jesús Ricardo Sandoval Izaguirre of the Judicial Branch of the Federation Headquarters Monterrey Nuevo León (Mexico), Pedro Rolando Ixchiu García of the Judicial Branch (Guatemala) and Ezequiel González Díaz of the Office of the Attorney General of El Salvador (El Salvador). Photo ©Pepe Orozco 2. Jessy Sandoval, Harlem Padilla, Angélica Rivera, Ivethe Sánchez with the hashtag used in the presentation of the Research on Trafficking, Honduras. Photo ©Ana Judith Aguilar/Calidad de Vida 3. Nohelia Calderon, in her field, which she farms together with her husband. Photo ©Luis Sánchez Corea Graphic Design ©Giulia Vuillermoz/Trócaire. Tegucigalpa, Honduras - January 2020 Latin America Regional Office Newsletter - January 2020 Authors: Ana Maria Alvarez Medrano, Alejandra Guillot Ontanon, Gabriela Flores, Giulia Vuillermoz, Lucia Medina Photographers: Pepe Orozco, Alejandra Guillot Ontanon/Trócaire, Giulia Vuillermoz/Trócaire, Ana Judith Aguilar/ACDV, Luis Sánchez Corea Graphic Design: Giulia Vuillermoz, Trócaire Tegucigalpa, January 2020 GUATEMALA | 3 First experiences, expectations Mesoamerican Meeting on and challenges Masculinities The First Mesoamerican Meeting on Masculinities, Experiences, Expectations and Challenges was held in the departmental capital of the Department of Sololá, Guatemala, from June 26 to 28, 2019, at the facilities of the Centro Cultural Sotz´il Jay (Aldea El Tablón). Women and men (55 men and 52 women), indigenous and mestizo, from ten countries participated: Austria, Bolivia, Canada, Colombia, Costa Rica, El Salvador, Guatemala, Holland, Honduras, Mexico and Nicaragua, including 15 members of Trocaire’s counterparts from Honduras, Nicaragua and Guatemala.
    [Show full text]
  • World Bank Document
    Document of The World Bank Public Disclosure Authorized Report No: ICR2858 IMPLEMENTATION COMPLETION AND RESULTS REPORT (IDA-36650, IDA-3665A, IDA-46800) ON A CREDIT Public Disclosure Authorized IN THE AMOUNT OF SDR 32.50 MILLION (US$42.60 MILLION EQUIVALENT) TO THE REPUBLIC OF NICARAGUA FOR A LAND ADMINISTRATION PROJECT (PRODEP) Public Disclosure Authorized October 20, 2013 Sustainable Development Department Public Disclosure Authorized Central America Country Management Unit Latin America and Caribbean Region CURRENCY EQUIVALENTS (Exchange Rate Effective October 20, 2013) Currency Unit = Cordoba C 24.90 = US$ 1 US$ 1.53 = SDR 1 FISCAL YEAR January 1 - December 31 ABBREVIATIONS AND ACRONYMS ACR Alternative conflict resolution mechanisms ATLMP Agricultural Technology and Land Management Project CIP Comité Interinstitucional del Proyecto (Project Inter-Institutional Committee) CONADETI Comisión Nacional para la Demarcación y Titulación (National Commission for Demarcation and Titling of Indigenous Territories) CPS Country Partnership Strategy CTO Comité Técnico Operativo (Project Operational Technical Committee) CSJ Corte Suprema de Justicia (Nicaraguan Supreme Justice Court) DIRAC Dirección de Resolución Alternativa de Conflictos (Nicaraguan Directorate for Alternative Conflict Resolution under CSJ) DNR Dirección Nacional de Registros (National Directorate of Registries) EA Environmental Assessment EMP Environmental Management Plan FAO Food and Agriculture Organization GPS Global Positioning System ICB International Competitive Bidding
    [Show full text]
  • NICARAGUA Sistema De Información Para El Food Security Situation Seguimiento De La Seguridad Alimentaria Y Nutricional May 2006
    Prepared in conjunction with SISSAN NICARAGUA Sistema de Información para el Food Security Situation Seguimiento de la Seguridad Alimentaria y Nutricional May 2006 Alert Levels No Alert Watch Warning Emergency Summary and implications CONTENTS Summary and implications ....................... 1 The beginning of the agricultural cycle is one of the most important activities in the Seasonal calendar ..................................... 1 country in terms of food security. Agriculture provides 21 percent of Nicaragua's gross Current hazards......................................... 1 domestic product, guarantees employment for 38 percent of the economically active Rainy season............................................. 1 population (equivalent to 2 million people) according to the most recent census of the Agricultural production ............................ 2 Nicaraguan Institute of Statistics and Census, and provides more than 40 percent of Prices ........................................................ 3 national exports. The timely beginning of rains is the main factor enabling agricultural Health situation......................................... 3 activities to develop according to expectations, and access to productive means such as seeds and fertilizers is also important. Seasonal calendar Current hazards • High costs of seeds, fertilizers and pesticides, which limit subsistence farmers’ access to these inputs. • Increase in fuel prices, which have generated increases in the prices of transportation, food and other products. • Increase in morbidity due to diarrheic and respiratory diseases that are most prevalent during the beginning of the rainy period. Rainy season Forecasts by the Nicaraguan Institute of Land Studies (INETER) indicate that the rainy period will be established throughout the country in the third dekad of May. An irregular distribution of rains is foreseen in the country, due to variations in both the beginning of the rainy period and the expected precipitation volumes (see Map 1).
    [Show full text]
  • A Cross-Sectional Epidemiological Study of Domestic Animals Related to Human
    1 A cross-sectional epidemiological study of domestic animals related to human 2 leptospirosis cases in Nicaragua 3 Authors 4 Byron J. Floresa, Tania Pérez-Sánchezb, Héctor Fuertesb, Jessica Sheleby-Eliasa, José 5 Luis Múzquizb, William Jiróna, Christianne Duttmanna, Nabil Halaihelb. 6 7 a Department of Animal Health, School of Veterinary Medicine, Universidad Nacional 8 Autónoma de Nicaragua-León, Carretera a la Ceiba 1 Km al Este, León, Nicaragua. 9 b Department of Animal Pathology, Faculty of Veterinary Sciences. Universidad de 10 Zaragoza, Miguel Servet 177, 50013, Zaragoza, Spain. 11 12 Please address any correspondence to Dr. Byron José Flores Somarriba at 13 [email protected] 14 15 16 17 18 Abbreviations 19 Domestic animals (DA), Ministry of Health (MINSA, from its Spanish acronym), Pan 20 American Health Organization (PAHO), Microscopic Agglutination Test (MAT), 21 confidence intervals (CI) and Chi square test (X2). 22 1 23 ABSTRACT 24 Leptospirosis is one of the most extended zoonosis worldwide and humans become 25 infected most commonly through contact with the urine of carrier animals, either 26 directly or via contaminated water or soil. The aim in this study was to analyse the 27 epidemiological behaviour of Leptospira spp., from domestic animals around the sites 28 of human leptospirosis cases in Nicaragua, from 2007 through 2013. We report the 29 results of a cross-sectional epidemiological study with a non-probability sampling of 30 blood (n=3050) and urine (n=299) from Domestic Animals (DA) around the sites of 31 human leptospirosis cases in Nicaragua. We analysed data obtained through 32 Microscopic Agglutination Test (MAT), in-vitro culture, real time PCR and sequencing 33 of lfb1 locus.
    [Show full text]
  • Interoceanic Canals and World Seaborne Trade: Past, Present and Future
    ARSOM-KAOW The Royal Academy for Overseas Sciences Permanent InternationalAssociation for Navigation Congresses Port of The World Association for Waterbome A Antwerp Transport lnfrastructure International Colloquium INTEROCEANIC CANALS AND WORLD SEABORNE TRADE: PAST, PRESENT AND FUTURE (Brussels, 7-9 June 2012) Guest Editors: J. CHARLIER, C. DE MEYER & H. PAELINCK Financially supported by FONDATION beis po Sefacil tnrs LOCIBT10UC • PonTUA!AC • MARlfl"'C LA Ulf.ITil CHUCHUDE The Belgian Science Policy Office Fondation Sefacil Fonds de la Recherche Scientifique 2015 ACADEMIE ROYALE KONINKLIJKE ACADEMIE DES VOOR SCIENCES o'ÜUTRE-MER ÛVERZEESE WETENSCHAPPEN Avenue Louise 231 Louizalaan 231 B-1050 Bruxelles (Belgique) B-1050 Brussel (België) Tél. 02.538.02.1 1 Tel. 02.538.02. 11 Fax 02.539.23.53 Fax 02.539.23.53 E-mail: [email protected] E-mail: [email protected] Web: www.kaowarsom.be Web: www.kaowarsom.be ISBN 978-90-756-5257-4 D/2015/0 149/4 CONTENTS J. CHARLIER, C. DE MEYER & H. PAELINCK. - Introduction ........ 5 lnteroceanic Canals in Context G. CAUDE. - Le röle de l'AIPCN dans la conception des projets majeurs d'infrastructure de navigation maritime et fluviale et dans l'orientation de ses travaux au bénéfice des pays émergents. 13 C. DUCRUET. - The Polarization of Global Container Flows by Inter- oceanic Canals. 27 P. DRANK.IER. - Connecting China Overseas through the Marine Arc­ tic: Le gal lmplications and Geopolitical Considerations for Arctic Shipping..................... 45 D. DE LAME. - Connected by Oceans, Parted by Land............ 61 S. A. RrcH. - "Shiver Me Timbers ! "No Cedar Ships in the Medieval Mediterranean? . 69 The Suez Canal in between the Gibraltar and Malacca Straits N.
    [Show full text]
  • United Nations Security Council Official Records
    , UNITED NATIONS SECURITY COUNCIL OFFICIAL RECORDS THIRTY-NINTH YEAR MEETING: 30 MARCH 1984 NEW YORK. CONTENTS Page Provisional agenda (S/Agenda/2525) . 1 Adoption of the agenda ,....,........................................... 1 Letter dated 29 March 1984 from the Permanent Representative of Nicaragua to the United Nations addressed to the President of the Security Council (S/16449). 1 WV.2525 NOTE Symbols of United Nations documents are composed of capital letters com- bined with figures. Mention .of such a symbol indicates a reference to a United ‘. ’ Nations document. ” Documents of the Security Council (symbol S/. .) are normally published in quarterly Supplements of the Official Records of the Security Council. The date of. the document indicates the supplement in which it appears. or in which information about it is given. The resolutions of the Security Council, numbered in accordance with a system adopted in 1964, are published in yearly volumes of Resolutions and Decisions of the Security Council. The new system, which has ‘been applied retroactively to resolutions adopted before 1 January 1965, became fully operative on that date. .i ,. ,‘., .. : . L : i, 8 .‘. ‘, _ . ‘ ‘ 2525th MEETING Held in New York on Friday, 30 March 1984, at 3.30 p.m. President: Mr. Javier ARIAS STELLA (Peru). to express to you our congratulations on your assump- tion of the presidency of the Council for the month of Present: The representatives of the following States: March. On this occasion we should like to thank you for China, Egypt, France, India, Malta, Netherlands, the diligent manner in which you have convened this Nicaragua, Pakistan, Peru, Ukrainian Soviet Socialist meeting.
    [Show full text]
  • International Health Regulations / Règlement
    INTERNATIONAL HEALTH REGULATIONS / RÈGLEMENT SANITAIRE INTERNATIONAL Notifications of diseases received from 8 to 14 June 2001 / Notifications de maladies reçues du 8 au 14 juin 2001 Cases / Deaths Yellow fever / Fièvre jaune Cas / Décès Americas / Amériques Peru/Pérou 7.VI 82 Newly infected areas from 8 to 14 June 2001 / Zones nouvellement infectées entre le 8 et le 14 juin 2001 For criteria used in compiling this list, see No. 23, 2001, p. 180. X/ Les critères appliqués pour la compilation de cette liste sont publiés dans le No 23, 2001, p. 180.X Yellow fever / Fièvre jaune Americas / Amériques Peru/Pérou Loreto Department Iquitos District Puinahua District San Pablo District Areas removed from the infected area list between 8 and 14 June 2001 / Zones supprimées de la liste des zones infectées entre le 8 et le 14 juin 2001 For criteria used in compiling this list, see No. 23, 2001, p. 180. X/ Les critères appliqués pour la compilation de cette liste sont publiés dans le No 23, 2001, p. 180.X Cholera / Choléra Americas / Amériques Belize French Guiana / Guyane française Panama All infected areas / Toutes les zones infectées All infected areas / Toutes les zones infectées All infected areas / Toutes les zones infectées Bolivia / Bolivie Guyana / Guyane Suriname All infected areas / Toutes les zones infectées All infected areas / Toutes les zones infectées All infected areas / Toutes les zones infectées Colombia / Colombie Honduras Venezuela All infected areas / Toutes les zones infectées All infected areas / Toutes les zones infectées
    [Show full text]
  • Nicaragua: Floods
    Operation DREF n° MDRNI002 Nicaragua: GLIDE n° FL-2010-000106-NIC Floods 3 June 2010 The International Federation of Red Cross and Red Crescent (IFRC) Disaster Relief Emergency Fund (DREF) is a source of un-earmarked money created by the Federation in 1985 to ensure that immediate financial support is available for Red Cross and Red Crescent emergency response. The DREF is a vital part of the International Federation’s disaster response system and increases the ability of National Societies to respond to disasters. 36,248 Swiss francs (USD 31,341 US dollars /25,642 euro) has been allocated from the IFRC’s Disaster Relief Emergency Fund (DREF) to support the Nicaraguan Red Cross (NRC) in delivering immediate assistance to some 150 families, approximately 750 beneficiaries. Un- earmarked funds to replenish the DREF are encouraged. Summary: Nicaragua has been affected by heavy rains from the tropical storm Agatha. Five departments have been affected with León, Chinandega and Managua reporting major damages. The Nicaraguan Red Cross has carried out evacuations in the affected municipalities of the departments of León, Chinandega and Managua to collective centres established by the Ministry of Education in coordination with the National System for Prevention, Mitigation and Response to Disasters. The Quezalguaque bridge has been affected by the floods. Source: Nicaraguan Red Cross. This operation is expected to be implemented over three months, and will therefore be completed by 31 August 2010; a Final Report will be made available three months after the end of the operation (30 November). <Click here for the DREF budget; here for a map of the affected areas; and here for contact details> The Situation Since 26 May 2010, the Western Pacific Region of Nicaragua has been affected by intermittent rain with occasional moderate intensity as a result of the tropical depression Agatha.
    [Show full text]
  • Infected Areas As at !7 Mardi 1994 . 1 Zones Infectées »» 17 M<Irs 1994
    WEEKLY EPIDEMIOLOGICAL RECORD, No, 11, I S MARCH 1994 • RELEVÉ ÉPIDÉMIOLOGIQUE HEBDOMADAIRE, N *11, ISM ARS-1W 4. ... Russian Federation and Republics of th e fb n n e r. Fédération de Russie et républiques de l’ex-URSS (3 mars U SSR (3 Match 1994).1 Influenza activity continued to -1994).1 L’activité grippale a continué à s’accroître et a atteint des increase and reached epidemic levels in 20 of the 35 cities. : niveaux épidémiques dans 20 des 35 villes Élisant rapport à la fin reporting at the end of February. Highest levels were re­ février. Les.niveaux les plus élevés ont été notifiés à Minsk (2,4% de ported in Minsk (2.4% of the population affected),: : la. population touchée), N -N ovgorod (1,8%), Smolensk (-1,5%); N. Novgorod (1.8%), Smolensk (1.5%), Kemerovo and Kemerovo et Kiev (1,6%), Lvov et Voronej (1,4%). Toutefois, Kiev (1.6%), Lvov and Voronezh (1.4%). However, , - 19 villes ont signalé une légère baisse. Depuis la fin décembre 1993; 19 cities reported a slight decrease. Since the end of De- • / 18 virus grippaux ont été étudiés par le Centre de la grippe à Saint- cember 1993,18 influenza viruses have been investigated by- Pétersbourg? 5, étaient des virus A(H3N2), 2 des virus A(H1N1) et the Influenza Centre in Saint Petersburg; 5 were influenza 11 des virus B. AÇH3N2), 2 influenza AÇH1N1) and 11 influenza B. 1 See No. 9.1994, p. 67. ‘ Voir N“ 9,1994, p. 67. ' Epidemiology and intervention in public health Epidémiologie et intervention en santé publique Diploma in Applied Research, Bordeoyx-Touc, October 1994- - , Diplôme d'Etudés.
    [Show full text]
  • Infected Areas As at 6 September 2001 Zones Infectées Au 6
    Infected areas as at 6 September 2001 For criteria used in compiling this list, see p. 280. - Newly reported areas X Zones infectées au 6 septembre 2001 Les critères appliqués pour la compilation de cette liste, voir p. 280. - Nouvelles zones signalées X • • Bujumbura Province Ashanti Region Maputo City Province Plague Peste America Amérique Bujumbura Arrondissement Central Region Catembe District Bolivia • Bolivie Bururi Province Eastern Region Inhaça District La Paz Department Makamba Arrondissement Upper East Region Maputo Province Africa • Afrique Franz Tamayo Province Rumonge Arrondissement Volta Reg ion Boane District Sud Yungas Province Gitega Province Western Region Magude District Dem. Rep. of Congo Valle Grande Province Gitega Arrondissement Guinea • Guinée Manhica District Rép. dém. du Congo Makamba Province Maputo City Brazil • Brésil Conakry Province Haut Zaïre Province Nyanza-lac Commune Marracuene District Bahia State Forécariah Préfecture Ituri Sub-Region Cameroon • Cameroun Matola OTM District Mahagi Administrative Zone Biritinga Municipio Guinea-Bissau Moamba District Candeal Municipio Province de lExtrême-Nord Guinée-Bissau Ressano Garcia District Madagascar Central Municipio Diamare Département Sabie District Logone-et-Chari Département Bissau District Antananarivo Province Conceição Municipio Xinavane District Feira de Santana Municipio Mayo-Danai Département Biombo District Ambohidratrimo S. Préf. Gabu District Nampula Province Iraquara Municipio Mayo-Sava Département Niassa Province Antananarivo-Avaradrano S. Préf.
    [Show full text]