Introduction of human papillomavirus vaccines into developing countries - international strategies for funding and procurement.

This paper explores different international vaccine financing and procurement strategies used by the Pan American Health Organization, United Nation's Children's Fund, the Global Alliance for Vaccines and Immunization, the Gulf Cooperation Model, and the Advanced Market Commitments. The aim is to identify lessons learned to help ensure equitable distribution of life-saving vaccines for cervical cancer prevention, with particular emphasis on sustainability. A critical first step in the cascade of activities necessary for Human papillomavirus (HPV) vaccine introduction should be the creation of an informed policy decision making process that is grounded in the best available information at a national level.

PATH's approach to product introduction in developing countries.

Health interventions developed for wealthy nations are difficult to introduce in developing countries due to a lack of sufficient technological, financial, political, or infrastructural resources. Increasingly, however, product developers are creating new technologies that meet the needs of low-resource settings. Experience has shown that many activities must be undertaken to prepare health systems to accept and embrace new, improved, or under-utilized health technologies.

Chapter 25: Education, training, and communication for HPV vaccines.

As human papillomavirus (HPV) vaccines come to market, they will face education and training challenges similar to those of other new vaccines, along with HPV-specific issues. Recent studies document stark knowledge gaps about HPV at all levels--among policy makers, healthcare providers, parents, and teens--in both the industrialized and developing worlds. Pharmaceutical companies, public health advocates, medical trainers, and health educators need to understand their diverse audiences and respond appropriately to the needs of each.

Chapter 15: HPV vaccine use in the developing world.

Human papillomavirus (HPV)-related morbidity and mortality from cervical cancer primarily occurs in the developing world, where, unfortunately, access to vaccines in general, and expensive newer vaccines in particular, is often more limited than in the industrialized world. In addition, secondary prevention methods such as HPV screening, Pap testing, or visual inspection are uncommon in the developing world. The HPV vaccine will be first introduced into the industrialized countries and it will then, over the course of time, become used in the developing countries.

Advocating for cervical cancer prevention.

Cervical cancer is a significant health problem among women in developing countries. Contributing to the cervical cancer health burden in many countries is a lack of understanding and political will to address the problem. Broad-based advocacy efforts that draw on research and program findings from developing-country settings are key to gaining program and policy support, as are cost-effectiveness analyses based on these findings.

Misoprostol use in developing countries: results from a multicountry study.

Objective: To identify information and service delivery needs for obstetric/gynecologic uses of misoprostol in developing countries.

Methods: The study included a survey of reproductive health providers in 23 countries and a qualitative study of misoprostol use in four developing countries. Researchers used purposive sampling methods for the survey and qualitative study and conducted a descriptive statistical analysis of survey data and computer-assisted text-based content analysis of qualitative data.

Cervical dysplasia treatment: key issues for developing countries.

Many developing countries face serious obstacles that have hindered establishment of successful cervical cancer control programs. Various countries are now seeking to strengthen cytology services and identify simple low-cost screening strategies; but any real gains in reducing cervical cancer incidence and mortality will also require effective treatment of women with preinvasive disease. Despite a trend toward conservative outpatient approaches for treating cervical dysplasia in industrialized countries, clinicians in many developing countries still rely primarily on invasive inpatient methods such as cone biopsy and hysterectomy.

Antimicrobic susceptibility testing. A personal perspective.

The development of antimicrobic susceptibility testing is outlined with particular reference to standardization of procedures and organizational developments that have led to substantially improved performance. Special problems continue to be posed by increased proportions of opportunistic pathogens and newly recognized mechanisms of resistance, and these require updating. The role of automated procedures and technical problems in MBC and serum bactericidal testing are considered.

Development of resistance to cephalosporins in clinical strains of Citrobacter spp.

The predominant beta-lactam antibiogram of Citrobacter freundii resembles that of Enterobacter cloacae in demonstrating resistance to cephalothin and cefoxitin with susceptibility to the newer cephalosporins. Four representative strains of C. freundii were reversibly induced to high-level beta-lactamase production by cefoxitin, and mutants with stable, high-level production were selected with cefamandole.

Determination of minimum bactericidal concentrations of oxacillin for Staphylococcus aureus: influence and significance of technical factors.

The minimum bactericidal concentration of oxacillin for Staphylococcus aureus was shown to be considerably influenced by technical and definitional factors, particularly by the survival of some organisms on the walls of test tubes and by the growth phase of the inoculum. Attention to technical detail greatly improved reproducibility, and log-phase cultures of all strains showed greater than 99.9% killing in 24 h, at or close to the minimum inhibitory concentration, including eight strains described as tolerant.

Mutational enzymatic resistance of Enterobacter species to beta-lactam antibiotics.

Mutants with enhanced beta-lactam resistance were selected from strains of Enterobacter cloacae and E. aerogenes by using three antibiotics. High-level beta-lactamase-producing mutants had similar degrees of increased resistance, enzyme substrate profiles, and isoelectric (pI) values irrespective of the selective agent.

Population education in the schools.

Formal population education is designed to teach children in school about basic population issues and, in many cases, to encourage them eventually to have smaller families. Some programs include specific units on human reproduction and family planning, while others do not. National population education programs began during the 1970s in about a dozen countries, mainly in Asia.

Clinical laboratory evaluation of the Abbott MS-2 automated antimicrobial susceptibility testing system: report of a collaborative study.

The MS-2 system (Abbott Diagnostics, Division of Abbott Laboratories, Dallas, Tex.) was evaluated for its efficacy in determining the susceptibilities of both clinical and selected challenge (nonfastidious, facultative, and aerobic) isolates. The MS-2 results were compared with standard Kirby-Bauer disk diffusion and microdilution results by using fresh clinical isolates.

In-vitro activities of cefamandole and cephalothin against 1,881 clinical isolates. A multi-center study.

By use of an agardilution technic, 1,881 clinical isolates were tested against cefamandole and cephalothin. The isolates represented 18 genera, recovered in five geographically separate centers within the United States. The majority of strains were susceptible (MICs less than or equal to 8 micrograms/ml) to both drugs.

In vitro response of Enterobacter to ampicillin.

Three strains of Enterobacter were studied for their response to ampicillin. They exhibited a basic level of resistance that depended on the medium used and high-level mutational resistance at a frequency of 10(-5) to 10(-7). Two classes of mutants were selected, one of which showed markedly enhanced antibiotic inactivation as indicated by a biological assay and the other of which resembled the wild type in this regard.