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OBJETIVO: La tuberculosis es un importante problema mundial de salud que recibe una atención priorizada del Sistema de Salud Cubano. Lo objetivo del trabajo es describir el comportamiento de los indicadores del Programa de Control de Tuberculosis cubano. MÉTODOS: A partir de una revisión de los documentos de la vigilancia de la tuberculosis en los registros del Centro Provincial de Higiene y Epidemiología se expone la infraestructura sanitaria, las estrategias del Programa de Control en la ciudad, se describen las tasas de incidencia, indicadores de localización, diagnóstico y manejo de casos. RESULTADOS: Se hallaron 8 sintomáticos respiratorios por cada mil consultantes de medicina general; la tasa de incidencia de tunerculosis en todas sus formas descendió de 16,4 (1995) a 12,0x105 habitantes (1999); la tuberculosis pulmonar descendió de 15,1 a 10,45 habitantes mientras la tuberculosis extrapulmonar ascendió de 1,3 a 1,6 x 105 habitantes, en igual período. Del total de los casos nuevos, el 40-50% fueron identificados en los policlínicos, el 67% fueron diagnosticados por baciloscopías, el 15,2% por cultivos, el 13.8% sólo por evidencias clínicas y radiológicas; el 0,9% y el 1,5%, respectivamente, fueron diagnosticados por biopsia o hallazgos de necropsia. Los grupos de 15-64 años incrementaron su incidencia en 1996-1997 y disminuyeron en 1998-1999; los casos >64 años de edad disminuyeron progresivamente de 1995 a 1999; en general, la tasa de incidencia de casos disminuyó. La demora promedio entre primeros síntomas y diagnóstico mejoró de 42 días en 1995 a 28,6 en 1999. CONCLUSIONES: La reversión de la tendencia de la notificación de casos nuevos parece haberse detenido en 1996. La situación de los indicadores de tuberculosis revelan cambios satisfactorios en el período analizado.

Fundamento: Para la eliminación de la tuberculosis es necesario vigilar su incidencia a nivel local, por ser éste el de acceso de los enfermos a los servicios de salud. El objetivo de este trabajo es describir la distribución y la tendencia de las tasas de incidencia, por áreas de salud y por grupos de edades, de la tuberculosis en el municipio Marianao, de Ciudad de la Habana, durante los periodos 1990-1994 y 1995-2000. Métodos: La serie temporal de las tasas de incidencia de 1990-1994 y 1995-2000 se analizó mediante una técnica de alisamiento exponencial con dos parámetros. Se estimó el porcentaje total y promedio anual de variación. Se hizo la estratificación de las áreas de salud. Resultados: En 1990-1994 la tasa aumentó de 11,1 a 25,8 por 105 habitantes, (33% incremento anual), siendo más notable en las áreas de los Policlínicos Finlay y Portuondo (incremento anual promedio de 112,7% y 36,2% respectivamente). Tomando en cuenta que en 1995 se realizó un refuerzo del programa de control, de 1995 al 2000 las tasas descendieron en 47,6% en el municipio; las áreas de Finlay y Portuondo disminuyeron sus tasas en 79,9% y 39,7% respectivamente, mientras que en el área del Policlínico González Coro se incrementó un 58,3% y el 27 de noviembre no mostró variación importante. El grupo de 60 años de edad y más fue en el que predominó el aumento, con un 49,8% del total y sólo hubo un caso en menores de 15 años en el periodo. Durante el mismo, sólo se diagnosticaron seis casos de tuberculosis/ Virus de le inmunodeficiencia humana. El área 27 de noviembre resultó la única ubicada en el nivel insatisfactorio, según la estratificación realizada. Conclusiones: La tendencia de la tuberculosis en el municipio Marianao durante el periodo estudiado fue inicialmente ascendente y luego descendente. La enfermedad predominó en las personas adultas mayores.

Fundamento: La provincia Ciudad de la Habana, capital de Cuba y con la mayor densidad poblacional, aporta alrededor del 27% de los casos nuevos de tuberculosis. El presente artículo propone describir la distribución y tendencia de las tasas de incidencia de tuberculosis (1986-1998) por municipios y edades en la provincia Ciudad de la Habana. Método: Se calcularon las tasas y el porcentaje de variación total de las tasas, así como el promedio anual de variación en dos etapas y entre ellas (1986-93 y 1994-98). Las tendencias se calcularon mediante regresión lineal simple. Resultados: De 1986 a 1993 la tasa de incidencia provincial ascendió un 6%. De 1994 a 1998 decreció en 7.3%. Los 3 municipios con mayor densidad poblacional mostraron mayor incremento en las tasas. De los 15 municipios sólo en el de La Lisa disminuyeron las tasas durante todo el período. Las tasas por edades fueron similares en todos los municipios, más altas en sujetos ³65 años. El 0.6% de los casos notificados correspondían a personas menores de 15 años. Las tasas de tuberculosis infantil fueron muy bajas en el período estudiado. Conclusiones: Las diferencias en los municipios requieren de acciones diferenciadas para lograr mayor impacto y repercusión en el país. El descenso de las tasas observado en los últimos 3 años denota el control de la epidemia y la recuperación del programa nacional de control de la tuberculosis.

Introduction: the studies on population's knowledge and perceptions of infectious diseases contribute to develop more effective communication processes., Objective: to evaluate the knowledge and the perception of the residents in Habana Vieja municipality about tuberculosis, and to identify the ways for obtaining information about aspects of this disease., Methods: a cross-sectional study was carried out. A questionnaire was applied on a sample of 86 persons from five health areas of the municipality. A descriptive analysis was made. Odds ratios were calculated to determine association between ways for obtaining information and knowledge on the existence of the disease, symptoms and transmission forms., Results: the respondents know about tuberculosis as a disease, its symptoms, and its presence in Cuba, but the percentages corresponding to the truly significant symptoms are low, including incorrect identifications of towel, comb and mosquitoes as transmission ways of the disease. Television, radio and friends were the most mentioned sources of information., Conclusions: the population from Habana Vieja municipality knows about the existence of TB. However, specific knowledge about symptoms of the disease and ways of transmissions are insufficient. Changing this situation requires the strengthening of the role of the mass media role and the development of local communication strategies suited to local characteristics.

Objectives: To describe the variation and the trend of new tuberculosis case reports in Havana from 1995 to 2010, as well as their projection and occurrence for 2011-2013., Methods: A time series study was conducted, and the annual total and mean variation percentages of rates by clinical and bacteriological categories, age, municipal distribution and TB/HIV co-infection were analyzed. Estimation of projections by using two-parameter exponential smoothing techniques was made., Results: The rate of new reported TB cases decreased from 16.8 in 1995 to 9.5 per 100 000 inhabitants in 2010 (43.5% and 2.9% of annual total variation and mean variation respectively). The rate declined by 80% in the municipalities and in 15-64 and > or = 65 years age groups. Habana Vieja and Centro Habana municipalities kept the highest rates throughout the whole period. TB/HIV coinfection notification increased from 3 out of 369 (0.8%) cases in 1995 to 37 out of 202 (18.3%) cases in 2010. A slight increase was estimated for the 2011-2013 period (9.5; 10.0; 10.5 per 100 000 population respectively) in addition to continuous rise of the number of cases with TB/HIV co-infection., Conclusions: The TB trend showed a steady decline in Havana from 1995 to 2010, with substantial reduction in the study period, except for TB/HIV co-infection in which the number of cases increases. The TB case report rates are within the expected values, although slightly above the predictions.

Objectives: to evaluate the feasibility and immediate effect of an enabling intervention to improve the active screening of respiratory symptomatic patients in groups at risk of suffering tuberculosis and the quality of filling in lab records., Methods: a quasi-experimental-designed intervention study was conducted in two health areas of Boyeros municipality (Salvador Allende polyclinics and Federico Capdevila polyclinics). Two other areas were selected as controls in "10 de Octubre" municipality ("Turcios Lima" polyclinics and "Puente Uceda" polyclinics). Family physicians and nurses were then trained to identify patients with respiratory symptoms in the risk groups during home visits, finally sputum tests were indicated. A new model for lab recording was used. After 2 months, the ratio of detected respiratory symptomatic cases was estimated. The relative risk (95 % CI) was found. The percentage by type of screening, risk group and number of empty, misplaced and wrongly filled in items in the new model was calculated., Results: after the intervention, the capabilities of physicians and nurses for detecting respiratory symptomatic patients in "Salvador Allende" health area was almost 2.5 times higher than before (RR= 2.4320) and in "Federico Capdevila" health area was almost 2 times higher (RR = 1.8112). Over 80 % of this improvement was due to active screening carried out almost completely (90 %) in risk groups. There were no misplaced or wrongly filled data, just empty items under 0.5%., Conclusions: the enabling intervention proved to be immediate and effective in order to raise the active screening of respiratory symptomatic patients in risk groups and to improve the quality of filling in lab records.

Introduction: tuberculosis is still one of the most serious health problems in many countries and one important aspect is the effective screening of respiratory symptomatic TB suspects., Objectives: to evaluate the feasibility in the administration of rapid epidemiological surveys for some aspects of sputum smears collection and quality in respiratory symptomatic TB suspects., Methods: a previously expert-validated questionnaire was administered to people with respiratory symptoms from January to February 2006 in ten municipalities of Ciudad de la Habana province. For the selection of the respiratory symptomatic suspects, a three-phase cluster sampling was performed., Results: the survey was well accepted by the study population which provided the requested data. Cough persisted for 15,3 days; 87,1% of sputum smears were taken early in the morning and 80% of the studied people considered it as good., Conclusions: these findings are acceptable and important for TB surveillance and control in this province and show the usefulness of these surveys.

Objective: The diagnosis of tuberculosis in patients with negative acid-fast bacillus smears poses a challenge to both clinicians and public health authorities. In an attempt to aid diagnosis in such cases, an expert committee was established in Ciudad de La Habana, Cuba in 1995. The aim of this study was to describe the progress of the committee's work and the corresponding results for the period 1996 through 2003., Patients and Methods: For each patient studied by the commission, we analyzed the following data: patient's residence and referring center, tentative diagnosis proposed by the attending physician, history of antibiotic treatment, and final diagnosis made by the commission., Results: Of the 1703 patients studied, 84.8% were from La Habana, 48.4% were 55 years or older, and 63.8% were men. Between 2001 and 2003, 11.3% of patients were already on antituberculosis treatment when their case was studied by the commission. The corresponding percentage for 1996 through 2000 was 16.9% (P=.001). Active tuberculosis was confirmed in 43.1% of a total of 918 patients with full test results during the period 1996 through 2000 and in 52.2% of a total of 619 patients (52.2%) during the period 2001 through 2003 (P< .001). Of 344 patients with suspected pulmonary tuberculosis and negative acid-fast bacillus smears between 2001 and 2003, 128 (37.2%) were diagnosed with active tuberculosis., Conclusions: These findings indicate that the work of the commission is viable, sustainable, and useful for preventing overdiagnosis and inappropriate treatment, and that it also serves an educational purpose.

Introduction: Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba., Methods: Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined., Results: The incidence rate decreased from 0.76 x 10(5) in 1994 to 0.31 in 2003 (59.2% of the overall reduction and 6.6% of the annual average reduction). The highest rate (1.06 x 10(5)) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6%). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and 1-4 years (35.2%)., Conclusions: Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease.

The percentage increase or reduction of the number of cases of tuberculosis and the incidence rates in the periods 1992-1994 and 1994-2002 were estimated. Of the total of 11,216 cases, 9737 (86.8%) were pulmonary tuberculosis, among them 30.5% with negative smear. Only 1 279 cases (13.1%) of smear-negative culture-positive pulmonary tuberculosis were registered. 13.2% cases had extra pulmonary tuberculosis. There was an increase from 7.2 to 14.7 per 10(5) inhabitants that accounted for 24.1% in the global rate of tuberculosis incidence of 1994 compared with 1993, and of 53% in comparison with 1992 (5.8 to 14.7 per 10(5) inhabitants). A sustained reduction of 48.3% (6% per year) was observed from 1994 to 2002, but the proportions of the case categories were relatively stable. An important growth of the number and the rate of cases with smear-negative pulmonary tuberculosis reported in the period 1992-1994 and a sustained decrease between 1995 and 2002 very possibly associated with the strengthening of the control measures were noticed.

Objective: Tuberculosis is a worldwide health problem getting a prioritized attention by the Cuban National Health System. To describe the main indicators of the Cuban Tuberculosis Control Program., Methods: Based on surveillance data from the Provincial Center of Hygiene and Epidemiology, the health care network and strategies of the tuberculosis control program were reviewed; incidence rates, case finding indicators, diagnosis and case management were described., Results: Eight subjects with respiratory symptoms were found per 1,000 attending general medical care services. The incidence rates of all tuberculosis types declined from 16.4 in 1995 to 12.0 x 10(5) people in 1999. Pulmonary tuberculosis incidence rate was reduced from 15.1 in1995 to 10.4 x 10(5) in 1999, whereas extrapulmonary tuberculosis had an increment from 1.3 to 1.6 x 10(5) in the same period. Of all new cases, 40-50 % were diagnosed at multispecialty clinics, 67.6% were diagnosed by positive smears, 15.2 % by positive cultures, 13.8 % by clinical and X-rays evidences only; and 0.9 % and 1.5 % were respectively diagnosed by biopsy and necropsy. There was an increase in the incidence rate in the age group 15-64 years in 1996 and 1997 but it declined again in 1998 and 1999. The age group 64 years and over showed a rate reduction from 1995 to 1999. In general, incidence rates diminished in the overall period. The average delay between onset of symptoms and diagnosis improved from 42 days in 1995 to 28.6 days in 1999., Conclusions: There seems to be a halt in reporting trends of new cases in 1996. Tuberculosis indicators reveal satisfactory changes in the study period.

Background: For the elimination of tuberculosis (TB) is necessary the surveillance of the incidence rate at the local level, as this is the first level of access to the health service. This study is aimed at providing a description of the spread and trend of the tuberculosis incidence rates in Marianao Municipality, Habana City by healthcare areas and age groups throughout the 1990-2000 period., Methods: The time series for the 1990-1994 and 1995-2000 incidence rates were analyzed employing a two parameter exponential smoothing method. The total percentage and annual average of variation was estimated. The healthcare areas were stratified., Results: In 1990-1994, the rate rose from 11.1 to 25.8 per 105 inhabitants (33% of increase by year), having been most noticeable in Carlos J. Finlay and Portuondo health areas (respectively annual average 112.7% y 36.2% increases). Taking into account that the control program was strengthened in 1995, the rates dropped by 47.6% in this municipality during the 1995-2000 period. The Finlay and Portuondo areas respectively lowered their rates by 79.9% y 39.7% while the Gonzalez Coro area showed a 58.3% rise and 27 de Noviembre area had no major change. The age and above 60 group had the higher percentage of cases, recording 49.8% of the total and only one case among children under age 15 for the period. During this same period, only six cases of tuberculosis/human inmunodeficiency virus were diagnosed. The 27 de Noviembre area was the only one found to be at the unsatisfactory level according to the stratification., Conclusions: An initially upward trend, followed by a downward trend in tuberculosis was found to exist in the Marianao Municipality throughout the period studied. This disease was predominant among older adults.

Background: The province of Havana City, the capital and most densely populated city in Cuba, totals around 27% of the new cases of tuberculosis. This article is for the purpose of describing the distribution and trend of the tuberculosis cases rates from 1986 to 1998, by municipalities and age groups in this province., Method: A calculation was made of the rates and of the total percentage of deviation of these rates, in addition to the annual average deviation both throughout two time periods and between the two (1986-1993 and 1994-1998). The trends were calculated by simple linear regression., Results: Throughout the 1986-1993 period, the case rate for this province underwent a 6% increase. Throughout the 1994-1998 period, it dropped by 7.3%. The three most densely-populated cities showed a higher rate increase. Of the 15 municipalities, only La Lisa showed a drop in the rates throughout the entire period in question. The rates by ages were similar throughout all of the municipalities, being higher for individuals > 65 years of age. Six tenths (0.6%) of the cases reported involved people under 15 years of age. The infantile tuberculosis rates were very low for the time period under analysis., Conclusions: The differences among the municipalities in question make it necessary for different measures to be taken to achieve a greater impact and repercussion in Cuba. The drop in the rates detected over the last three years is indicative of the epidemic being brought under control and the national tuberculosis control program being reinstated.

The development of successful tuberculosis control programs requires the people's involvement, hence a study was performed to identify knowledge, perceptions and practices of the population regarding occurrence, transmission, treatment and control of this disease. The focal group technique was used in 6 sets of persons aged 15 years and over from 6 municipalities of the City of Havana. These groups thought that tuberculosis had declined in the last ten years but had increased again in the last 2-3 years, that it was a contagious disease presenting symptoms such as cough, hemoptysis, loss of weight, fever. They considered it as a terrible, undesirable sickness associated with poverty and caught due to malnourishment, poor hygiene of the sick person and his/her relatives and smoking. Some thought that this disease was curable and other that it was not. Several other people believed that patients should be isolated in hospital whereas others stated that they could have a normal life at home, most preferred to be informed about the disease by TV and radio. It was concluded that a quantitative study should be performed based on these results.

The essential aspects for the management of tuberculosis surveillance and control are described to propitiate their divulgation among to health professionals. Since 1970 there is an integrated program under way within the health services based on the localization of cases by the bacilloscopic examination and the sputum culture in symptomatic respiratory patients, the ambulatory controlled treatment, the investigation of the contacts of the notified cases, including the chemoprophylaxis with isoniacide, and the BCG vaccination to newborns. In 1995, the percentage of symptomatic patients detected at the general medicine offices was of 0.7%, whereas the percentage of the first bacilloscopy performed among the symptomatic individuals was of 78.6%, 99.5% of the detected contacts were investigated. 37.9% of the new cases were diagnosed at the primary health care level. After a decreasing trend maintained from 1979 to 1991, mortality has increased from 50 deaths (0.5 x 10(5)) in 1991 to 157 (1.4 x 10(5)) in 1995, and the incidence rose from 503 (4.7 x 10(5)) in 1991 to 1,574 (14.3 x 10(5)) in 1994, and to 1,553 (14.0 x 10(5)) in 1995, which suggests that the increase observed during the last 6 years begins to stop. The primary resistance to tuberculostatics was of 3.5% in 1992-1995, and of 11.5% in 1996. A priority integrated program of surveillance and control adjusted to the present socioeconomic conditions of the country is still going on.

Unlabelled: Morbi-mortality due to asthma has increased in recent years both throughout the world in Cuba. A study of mortality caused by this disease has conducted in order to describe its current trend in the country., Method: A time series study was conducted which included all deaths attributed to asthma in Cuba recorded in the vital statistics records of the Ministry of Public Health from 1972 to 1993. Rates, secular trends of general mortality and according to gender were estimated. The proportional mortality for the 1972-1993 period was calculated and the potential years of life lost during the 90-92 trienium were quantified., Results and Discussion: A drop in these global rates occurred between 1972 and 1975, with values of 3.6; 4.1; 3.0; 2.2; respectively; possibly due to the introduction of disodic chromoglycate among other drugs and the beginning of the Asthmatic Patient Program. An later increase in mortality was observed until 1993 (5.9 x 100,000 inhabitants) which may attributed to a drop of the intensity and regularity of said program and to other internationally knowledge factors which are present in our country. The trend of general mortality rose during this period and was greater in females than in males; which means that the risk to die of this cause has increased. Proportional Mortality since 1980 (0.50%) also increased until 1993 (0.80%). Potential years of life lost due to premature death ranged from 5,646 in 1990 to 7,386 in 1992. The increase in proportional mortality and the potential years of life lost suggest that this disease should been given priority by the National Health Program as a preventable cause of death, especially in women., Conclusions: There is a rising trend of mortality among asthmatic patients during the period under consideration. Asthma is a cause of premature death in Cuba.

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many physicians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family physicians and public education campaigns, two 1991 interventions were carried out in four health areas (designated A, B, C, and D) in the city of Havana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through December 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1,600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes occurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were initiated, antibiotics were prescribed for 26%, 20%, 11%, and 19% of the mild ARI cases occurring in areas A, B, C, and D respectively (P > 0.05). In the period immediately following the interventions, antibiotic prescription rates declined by 26% and 63% in areas A and B, while increasing by 2% and 48% in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54% (95% CI: 31-69%). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective.

This study was carried out in order to describe tuberculosis trends in Cuba and its provinces between 1979 and 1993. For this purpose, reports of new cases of all forms of tuberculosis were obtained from the National Statistics Bureau of the Ministry of Public Health. In addition, tuberculosis incidence rates and their trends between 1979 and 1992 were determined. The data were analyzed by means of simple linear and exponential regression models. Finally, the percentage reductions in incidence between 1979 and 1992 were calculated and the observed changes were described in reference to the expected values derived from the regression models. The number of new tuberculosis cases reported in Cuba decreased from 1133 (11.6 per 100,000 population) in 1979 to 633 (5.8 per 100,000) in 1992 (a 44% reduction). In 1993, 788 cases were reported (7.2 per 100,000). In almost all the provinces the incidence tended to decrease between 1979 and 1992, and the average annual number of new case notifications fell between 4.0 and 5.4%, although in some, less than 3%. In 1992, the number of new case notifications in the country was 25% higher than in 1991, and the incidence rates in all the provinces were higher than expected. The incidence in La Habana, the City of Havana, Villa Clara, Cienfuegos, Ciego de Avila, Santiago de Cuba, and Guantánamo exceeded the overall national incidence. In 1993, incidence in the country was 55.6% higher than it had been in 1991 and 24.5% higher than in 1992. Incidence rose in all provinces, and especially in the City of Havana, Matanzas, and Guantánamo. Although incidence remained below 8 cases per 100,000 population between 1992 and 1993, it rose during those years, as it did in other countries. The increase appears to be attributable to the economic crisis that affects the country and to have very little connection to human immunodeficiency virus infection.

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.

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.

A brief account is provided on the main characteristics of the stages in the historical evolution of struggle against tuberculosis in Cuba. The foundations and the steps taken in tuberculosis control are noted. A synthesis of therapeutic schemes used in the last 20 years is provided and the tendency of notification of new cases in 1979-1988 is discussed. During that ten-year period there was a 38.8% reduction.

Information is provided on the epidemiological situation of influenza and other acute respiratory tract diseases in Cuba during 1989. General mortality rate was 25.4 per 105 inhabitants. Global morbidity rate was 373.9 per 1,000 inhabitants. The highest morbidity rate reported corresponded to children 5-14 years old and under 1 year of age. Serologically, the viral agent proportionally most identified was influenza virus type A (H3N2).

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.

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.

A few considerations on the development of the applied automatization of epidemiologic surveillance systems in Cuba are exposed. Reference is made to aspects of the national strategy, to the lines of development of the National Health Systems, to the projections of the subsystems of epidemiologic surveillance, and to the future integrated intercommunication.

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.

The results of a study on the isolation and identification of non-tuberculous mycobacterial strains in a Havana City area and in other three western provinces are reported. The isolate for identification of non-tuberculous mycobacteria was more frequent in the provinces of Pinar del Rio, Havana, and Havana City than in Matanzas. The Runyon group most frequently found was number III, and the least frequent group I. The most frequent species belongs to the M. avium-intracellulare-scrofulaceum complex and M. fortuitum comes second. It was considered of interest to complete the study of the distribution of these mycobacteria in the rest of the country.

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.