Mother-to-Child Transmission of HTLV-1 Epidemiological Aspects,Mechanisms and Determinants of Mother-to-Child Transmission

Human T-cell Lymphotropic Virus type 1 (HTLV-1) is a human retrovirus that infects at least 5–10 million people worldwide, and is the etiological agent of a lymphoproliferative malignancy; Adult T-cell Leukemia/Lymphoma (ATLL); and a chronic neuromyelopathy, HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP), as well as other inflammatory diseases such as infective dermatitis and uveitis. Besides sexual intercourse and intravenous transmission, HTLV-1 can also be transmitted from infected mother to child during prolonged breastfeeding. Some characteristics that are linked to mother-to-child transmission (MTCT) of HTLV-1, such as the role of proviral load, antibody titer of the infected mother, and duration of breastfeeding, have been elucidated; however, most of the mechanisms underlying HTLV-1 transmission during breast feeding remain largely unknown, such as the sites of infection and cellular targets as well as the role of milk factors. The present review focuses on the latest findings and current opinions and perspectives on MTCT of HTLV-1.     

The health system of El Salvador

This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.     

Phaeohyphomycosis in El Salvador caused by Exophiala spinifera

We identified Exophiala spinifera as the causal agent in a case of subcutaneous phaeohyphomycosis in El Salvador. Identification was based on the morphology of the fungus in tissue and the microscopic features of the culture obtained from the biopsy material. This case is the first of this type to be documented from Central America.     

Prevention of Mother-to-Child Transmission of HIV in Yaounde: Barrier to Care

Most HIV-infected children in Sub-Saharan Africa are born where programs for the prevention of mother-to-child transmission of HIV (PMTCT) exist but are not universally operational. The expansion of PMTCT programs in Cameroon was among the largest in francophone Africa, but despite highly variable estimates of PMTCT uptake (ranging from 20% to 66%), it is clear that not enough HIV-infected pregnant Cameroonian women benefit from treatment to prevent HIV transmission to their children. The reasons why HIV-infected women in Cameroon do not use treatments to prevent this transmission remain partially unidentified. We conducted a qualitative study of the therapeutic itineraries (treatments taken and motivations) followed by HIV-infected pregnant women in Cameroon to understand the barriers to accessing high-quality PMTCT care. Here we construct the therapeutic itinerary for HIV-infected pregnant women, and identify the barriers at each step. Lack of financial independence, personal support, and empowering information were the primary obstacles at multiple steps.     

Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment Monitoring: From Measuring Process to Impact and Elimination of Mother-to-Child Transmission of HIV

Progress towards achievement of global targets for the prevention of mother-to-child transmission of HIV (PMTCT) and paediatric HIV care and treatment is an integral part of global and national HIV and AIDS responses. This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges. A review of the development of the monitoring and reporting process since 2002–2016 was conducted using existing published literature and taking into account changes in WHO HIV treatment guidelines, global HIV goals and targets, programmatic and methodological developments, and increased need for interagency partnerships, coordination and harmonization of global monitoring and reporting mechanisms. The number and type of indicators reported increased and evolved from monitoring of existence of national policies and guidelines, service delivery sites and trained health workers and coverage of PMTCT and paediatric HIV interventions to measuring outcomes and impact in reducing new HIV infections and AIDS related deaths, including efforts to validate elimination of mother-to-child transmission of HIV. These changes were required to mirror changes in WHO and national PMTCT and HIV treatment guidelines. The number of countries reporting PMTCT coverage increased from 53 in 2003 to over 130 in 2015. National monitoring processes have also expanded in scope and the capacity to report on disaggregated data by type of ARV regimen and for paediatric HIV care and treatment has increased. Monitoring of PMTCT and paediatric HIV programmes has contributed a rich body of evidence that helped monitor how quickly countries were adopting and implementing the latest WHO HIV treatment guidelines for pregnant and breastfeeding women and children. The reported data and experiences were instrumental in shaping global policies, national programmes, and investment choices.     

Results of a national study on anti-mycobacterial drug resistance in El Salvador.

SETTING: The DOTS strategy was introduced in El Salvador in 1997 and had become fully implemented countrywide by 2001. Previously, many deficiencies were identified in the management of patients with tuberculosis (TB). OBJECTIVE: To ascertain the prevalence of Mycobacterium tuberculosis resistant to first-line drugs. DESIGN: A national prospective survey was carried out in 2001 using the standardised World Health Organization/ International Union Against Tuberculosis and Lung Disease model. RESULTS: A total of 711 cultures were analysed (59% of total smear-positive cases); 611 were never treated and 100 were previously treated patients. The study showed resistance rates to isoniazid and rifampicin, either alone or combined (multidrug resistance, MDR), of 1.3%, 1.1% and 0.3%, respectively, in never treated patients, and 12%, 13% and 7%, respectively, in previously treated patients. CONCLUSION: The low rates of MDR-TB in El Salvador are puzzling, as out-patient DOTS was introduced only recently and fixed-dose combination tablets have not been used.     

Short report: serological evidence of West Nile virus activity in El Salvador

Epizootics of encephalitis in El Salvador killed 203 equines between November 2001 and April 2003. During an investigation of the outbreaks, 18 (25%) of 73 serum samples collected from stablemates of deceased animals in 2003 had antibodies to West Nile virus. Ten of these infections were confirmed by plaque reduction neutralization tests, suggesting West Nile virus has extended its range and spread to Central America.     

Association between Nutritional Status and Severity of Dengue Infection in Children in El Salvador

Clinical observations and some studies suggest that dengue virus infection is more severe among children with better nutritional status. We examined the nutritional status of children in El Salvador and its relationship between this and the severity of dengue infection. Z-scores for weight-for-age, height-for-age, and body mass index (BMI)-for-age of children with dengue fever (66), dengue hemorrhagic fever (62), and healthy controls (74) were compared. There were no differences in weight-for-age or BMI-for-age Z-scores between the three groups. Children with dengue fever had a greater height-for-age than healthy controls but no significant differences in rates of stunting. There was no difference in height between children with dengue fever and dengue hemorrhagic fever. Excess nutrition does not appear to be a risk factor for severe forms of dengue infection in El Salvador, nor does malnutrition appear to be predictive of good outcomes.     

Externalities of Prevention of Mother-to-Child Transmission Programs: A Systematic Review

There has been considerable debate about the effects of targeted global health assistance in low- and middle-income countries on health systems, specifically HIV/AIDS funding. Recently, a handful of studies have emerged that describe the implementation of PMTCT programs, which have many theoretical links to maternal and child health. Through a systematic review of research published between January 2000 and March 2011, this paper synthesizes evidence evaluating the impact of these programs. We assessed 5,855 papers, reviewed 154, and included 21 articles. They offer evidence of beneficial synergies between PMTCT programs and both STI prevention and early childhood immunization. Other data, including information about antenatal and delivery care, family planning, and nutrition supplementation varied considerably across studies demonstrating both positive and negative effects of PMTCT. More research is needed to allow countries and funders to make informed decisions regarding allocation of limited funds to targeted versus broad categories of health care.     

Serologic and parasitologic studies of Entamoeba histolytica in El Salvador, 1974-1978

Serologic and parasitologic studies were done in El Salvador, C.A., from 1974-1978 to examine the reliability of the diagnosis of Entamoeba histolytica infection in an endemic area and to confirm the estimates of morbidity and mortality due to amebiasis. The results suggest that infection with E. histolytica is common, but the estimated prevalence is too high. Misdiagnosis occurring in hospital and public health laboratories was documented. Data collected from examining family members of persons with E. histolytica infection and disease indicate that most infections are asymptomatic, and support the hypothesis that estimates of morbidity and mortality rates are excessive.     

Correlates of Bisexual Behaviors Among Men who have Sex with Men in El Salvador

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30–5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01–9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26–0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22–0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.     

Seasonal changes in malnutrition and diarrheal disease among preschool children in El Salvador.

The nutritional status of preschool children in a rural El Salvadoran population was assessed quarterly for 1 year using height, weight and arm circumference measurements in order to define seasonal changes in malnutrition. Seasonal patterns in the incidence of reported malnutrition and diarrheal disease from the local clinic serving the study population and on the national level for EL Salvador were also assessed and were compared with field measurements. Results indicated a similar seasonal increase in both measured malnutrition and in the reported incidence of malnutrition and diarrheal disease occurring at the onset of the rainy season. The results confirm the existence and indicate the magnitude of seasonal changes in malnutrition and diarrheal disease in a preschool population.     

Association between intestinal parasitic infections and type of sanitation system in rural El Salvador

OBJECTIVE: To identify demographic, behavioural and environmental determinants of intestinal parasitic infection, evaluate the impact of a variety of dry sanitation systems on intestinal parasitic infection, and evaluate the safety of using stored biosolids in agriculture in order to guide future sanitation interventions in rural areas of El Salvador. METHODS: Interviews were conducted with 109 households in eight communities where double-vaulted and solar urine-diverting desiccating latrines, pit latrines or no latrines were used. Faecal samples from 499 individuals were tested for enteric helminths and protozoa. RESULTS: Users of solar desiccating latrines had the lowest prevalence of enteric parasite infection. Double-vault, urine-diverting desiccating latrines effectively reduced the transmission of some pathogens, but may not achieve the conditions sufficient for the complete destruction of the more environmentally persistent pathogens, Ascaris lumbricoides and Trichuris trichiura. Contact with inadequately treated latrine biosolids was associated with an increased risk of Ascaris infection. CONCLUSIONS: Solar latrines were associated with the overall lowest prevalence of enteric parasitic infections. Members of households where latrine biosolids were used in agriculture had a higher prevalence of infection than those where biosolids were buried. We therefore recommend the promotion of solar latrines in rural areas of El Salvador over other dry sanitation systems, and recommend that stored biosolids not be used in agriculture.