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VA-MENGOC-BC vaccine has been administered to Cuban infants since 1991 through the National Immunization Program (NIP) so it was necessary to evaluate its effects on 1-4 years-old children included in the highest risk group. To this end, a descriptive study of the morbidity and mortality from meningococal disease was carried out taking the vaccine histories of 145 cases occurred from 1991 to 1996 into account. The decreasing trend of the incidence density (ID) of meningococcal disease in all the age groups in the studied period was among the most important results, the highest decline was observed in one-year old infants with an ID of. 10.8 per 100,000 children/years at the end of the period. The percent distribution of occurrence showed a predominance of one-year old group at the beginning of the program. Implementation, and a change to 3-4 years old group at the end of the period. A high of percent of vaccinated sick children had been immunized against MD over one year ago (697.5 days as average). 35 children died during the period and the highest mortality density decline (1 per 100,000 children a year) was observed as of 1993; 2 years-old children were at highest risk of death. Seventy three percent (73.1%) of those vaccinated had been immunized for over once year. The general lethality was 24.1%, the lowest was 14.3% in one year old children. The changes occurred in meningococcal disease behaviour within this high risk group, which are attributed to the administration of vaccine as part of the NIP fully justifies the continuation of the application of this vaccine.

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We briefly sets forth the design of a surveillance system of adverse events as a part of the Vaccination Program in Cuba since it has had a world impact and thus, the real scope of such events can be known in the country. On the other hand, this system may be useful for Cuban vaccine-producing industries to prove innocousness of their products after these being licensed. Family physician and nurse program which covers 98% of the Cuban population will make the active-passive surveillance of all those persons who had been vaccinated in a territory possible. This surveillance system will be able to measure risks of adverse events by vaccine, age, number of doses, province and municipalities and by batch and manufacturer so that the causes leading to those events can be known. For this reason, it will contribute to improve the quality of services, protect the vaccination quality and upgrade the Cuban surveillance system.

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Of the 115 patients who suffered from epidemic neuropathy and received attention from March 16 de April 30, 1993, at the Center for Medical and Surgical Research (CMSR), in Havana City, 114 controls were selected at random in the community. In the univariate analysis it was found a significant association mainly with the smoking habit (odds ratio = 3.45 [95% confidence interval 1.85 to 6.35)] and with the consumption of edible fat of uncertified procedence (odds ratio = 2.77 [95% confidence interval 1.34 to 5.8]). All were ratified in the multivariate logistical regression analysis. Association (odds ratio = 8.8 [95% confidence interval 2.58 to 30.55] with the presence of antibodies against the Coxsackie virus A-9 strain 47 was also found among the 182 individuals who had serological test. It seems that the toxic factor derived from the smoking habit, together with the deficiency of some nutrients due to the changes occurred in the diet, as well as the contact with the isolated virus in one of the patients facilitated the clinical expression of this disease and therefore in the origin of the epidemics.

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56 patients were surveyed and reexamined at the Center for Medical and Surgical Research (CMSR) a year after the onset of the neuropathy epidemic. The possible factors associated with the occurrence were investigated to be studied together with the disease persistence, including the antibody titre of 33 of them, who had a previous serology against the biological agent (strain 47/IPK) isolated from the cerebrospinal fluid of a sick patient. A fourth of the patients (15 cases) were still ill. The loss of weight and the smoking habit were stressed as the factors most associated with the persistence of the clinical manifestations of epidemic neuropathy. In spite of the fact that the small number of patients who underwent the checkup limited the study, this is a basic document about the existent situation a year after the problem happened.

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With the outbreak of an epidemic neuropathy (EN) of unknown ethiology, a study of the prevalence and factors associated to the disease was carried out in the Zamora community, municipality of Marianao, Havana City. There were 11 patients identified with EN for a prevalence rate of 1.7/100. The major risk group was the one between 45 and 64 years of age, female sex, black skin. In the univaried analysis, a high prevalence ratio (PR) was found linked to beverage intake (PR = 5.32 95%; confidence intervals (CI) = 1.2-24.4), frequent drugs intake (PR = 6.59; CI = 1.8-24.6), consumption of edible of non certified fats (PR = 4.48; CI = 1.2-16.7) and the smoking habit (PR = 3.6; CI = 1.1-12.2). More than 73/100 (CI = 68.7-78.3) of the people under serologic study were infected with Coxsakie virus A-9 (strain 47) isolated from a patient still under research. It seems there are many factors like linder intake, antecedents of hemorrhagic conjunctivitis, nutritional aspects and others that, with the virus isolated were associated with this epidemiologic situation.

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Taking to consideration the low report of cholera patients and with the main knowing the reality about the introduction of Vibrio cholerae (V. cholerae) in Peru, a sample of 101 cases with acute diarrheal disease (ADD) was taken at the Distrito Villa El Salvador. They were selected by a systematic randomized sampling defined for each health care unit in the District, according to the daily average occurrence of ADD cases attended a week before the beginning of the study. All of them took part in a epidemiological survey. A sample was taken by rectal swab in order to isolate V. cholerae. 53 positive cases were found (52.2% and a confidence interval from 42.29 to 62.5%) with significant differences (p < 0.01) between the frequency in adults (67.3%) and children (34.8%). V. cholerae was isolated only in 13 (61.9%) of the 21 cases who had contact with cholera patients, for a relative risk of 1.24 (0.83 < RR < 1.85). A high positivity was also found, 21 cases (72.4%) among those who had raw food. A significant difference (p < 0.01) was observed in connection with those who had cooked food. In the multivariate logistic regression analysis it was only found a significant relationship with age and with the ingestion of raw food as regards the occurrence of cholera.

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In order to estimate morbidity by acute respiratory infections in an adult population, a study was carried out in four health areas of City of Havana, to know the real morbidity and the one assisted for this population group. A sample was selected from 10 physicians' offices at each health area, and in each one of them a random sample of 40 families was taken, that at least should include 400 elderly people of 65 years old or more. A semi-monthly visit was done to each selected family for over a year, by an interviewer trained with that purpose. Incidence rate found in adults from 15 to 64 years was of 509.5 for 1,000 years/persons, almost three times the rate reported by the inactive surveillance, and in elders of 65 years and more it was of 943.8 for 1,000 years/persons, 8.8 times the rate reported by inactive surveillance.

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BACKGROUND: A process of techniques perfection of the epidemiologic surveillance of morbidity by Acute Respiratory Infections, with the purpose of obtaining a better and more appropriate description of the problem, was carried out. METHODS: A mathematical model of Fourier harmonic analysis and an Arima model was applied to the time series of weekly consulting rates for those diseases by age groups and provinces. This allowed to identify the epidemical moments, based on the prediction of expected values and an specific cut-off. RESULTS: The application of this technique made it possible and early and appropriate identification of an epidemical rise in children of less than 1 year, between July and August of 1988, with the identification of the Respiratory Syncytial Virus, as the aetiological agent. In the age-group of 5-14 years, a rise was observed in September, at the beginning of the school-year, and a smaller one between May-June of 1989. In the group age of 65 years and more, an epidemical increase took place from July to October. CONCLUSIONS: The use of these techniques provided new possibilities to make more precise and appropriate recommendations to improve epidemiological surveillance of these diseases at a national level.

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We describe the academic characteristics of the Master of Epidemiology Program taught at the Instituto de Medicina Tropical "Pedro Kourí", in La Habana, Cuba. We provide a description of the structure of the course along with its didactical principles, the main objectives of the different academic modules and the number and background of graduates from seven Classes. We also discuss potential work areas for graduates and short-term perspectives for their continuing education.

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A study was carried out on the influenza epidemic which broke out in the 21 804-inhabitant health area of the Cristóbal Larra Polyclinic of City of Havana Province on February 29, 1988. It was found that medical consultations for acute respiratory tract infections totalled 2046 during the 30-day epidemic; 1860 of these (90.9%) were first consultations, representing about 9% of the area population. The epidemic peak was reached 22 days after the outbreak. Higher consultation rates were of patients under 5 years, and the highest consultation coefficients were registered on Mondays. The application of the Rvachov-Baroyan model for local epidemic prognosis was not effective in the health area under study.

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The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities.

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The foundations and methodology for an epidemiological study on acute respiratory diseases are described. The study took place in 4 urban health areas in Havana City and 4 rural doctor's offices in Matanzas. A discussion is carried out regarding the intervention design for the staff of the health primary assistance team headed by the family doctor.

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A discussion is carried out about the experiences with the application of rimantadine and amantadine to patients with influenza. The basic general results consisted in the fact that 2 of the 74 patients treated had a high cure percent (> 68.0%) within the first 72 hours after using the drug. No new diseased were found among the 40 contacts to whom chemoprophylaxis was applied. There were only 3.9% adverse reactions among the total number of people treated with amantadine.

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A survey was made on morbidity due to acute respiratory infections in a circumscription of the Cristobal Labra Polyclinic, from January 17 to March 2, 1987, in order to contribute some clarifications about such an important health-disease problem. The sample was made up of 75 families representing 297 inhabitants. Questioning included all family members that in the 14 days previous to the visit referred to have or to have had symptoms of acute respiratory infections. The so-called real morbidity index was reached.

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We state that the creation of the Automated System of Epidemiological Surveillance should become an integral part of the Service of Hygiene and Epidemiology of the Republic of Cuba, which allows for the operative evaluation of the epidemiological situation in the country in order to take timely anti-epidemiological and prophylactic steps.

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A study of an outbreak of acute respiratory disease was done at the "Carlos Font Pupo" Old People's Home. Las Tunas Province, where 30 diseased old individuals were detected; grippe was diagnosed to two of them. General attack rate was 8.6%. Curative treatment with amantadine was administered to 29 old patients and chemoprophylaxis to 26, for a total of 55 old individuals treated. The evolution of the patients was satisfactory and none new case was observed. Diarrhea was the only one secondary reaction observed in a patient under chemoprophylactic treatment. The need to carry on performing similar studies is pointed out.

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To 57 individuals of the Old People's Home in Güines and Artemisa Municipalities, without vaccinal contraindications, was administered and inactivated bivalent antigrippal vaccine with the antigenic content: A/Kiev/59/79 (H1N1) and A/Filipina/2/82 (H3N2). Trough the inhibition technique of hemagglutination in pair sera, satisfactory results (seroconversion) were obtained in more of the vaccinated individuals, for both antigens. Local reactions such as erythema and papule were observed. Nine patients were detected among the vaccinated individuals by the epidemiologic surveillance carried out a year after vaccination. The serologic study performed to five of them showed a case positive to influenza A (H3N2) and another one positive to influenza B.

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The anti-influenza vaccine was applied to a group of 217 students of "Batalla del Jigüe" Secondary School which was compared to a group inoculated with the vaccine placebo with the view to evaluate the results of vaccine protection against the flue, as well as to determine its secondary effects in an adolescent population. There was a significant difference in the immunologic response in favor of the vaccine group as compared to controls for both strains of the antigenic contents of the vaccine Influenza A/Philippines/2/82 (H3N2)--A/Kiev/59/79 (H1H1). The local side effects found in the highest ratios in the group receiving the anti-influenza vaccine were papules (51.0%) and erythema (44.0%) with statistically significant differences in relation to the group receiving placebo. Fever was the general reaction most frequently found, for 8.4% 48 hours after its application among immunized students. During the subsequent epidemiologic surveillance a greater incidence of influenzal patients was found in students not receiving the anti-influenza vaccine. These results may serve as a starting point for new investigations in our environment.

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