Showing papers in "Bulletin of The World Health Organization in 1983"

An analysis of malaria in pregnancy in Africa.

Abstract: This article summarizes information and specific evidence regarding the epidemiology of malaria in pregnancy in Africa. Malaria infection is more frequent and severe in primigravidae both during pregnancy and at the time of delivery. A study of pregnant women living under holoendemic conditions in western Kenya showed that the peak prevalence of infection in primigravidae (85.7%) and multigravidae (51.7%) occurred at 13-16 weeks gestation. There were a similar number of recoveries in both groups during the 2nd and 3rd trimesters. The loss of immunity in early pregnancy was equivalent to an 11-fold decrease in the rate of recovery from infection. The recovery seen in late pregnancy suggests that the women mount a satisfactory immune response to malaria infection reacquiring their prepregnancy immune status at about the time of delivery. The pattern of infection in pregnancy is comparable to that observed in infants and children. What the child achieves over several years the mother reachieves in 9 months; the pattern is repeated in successive pregnancies. The practical implications of this pattern of malaria in pregnancy are discussed. (authors modified)

Development of simple standard assay procedures for the characterization of snake venom.

Abstract: In accordance with the recommendations of the report of a WHO Coordination Meeting on Venoms and Antivenoms, methods have been developed for the assessment of lethal, defibrinogenating, procoagulant, haemorrhagic, and necrotizing properties of venoms, and used to study 53 venoms from 30 different species of snakes of medical importance throughout the world The venoms studied included Echis carinatus (Iran), Naja naja kaouthia (Thailand), Notechis scutatus (Australia), Trimeresurus flavoviridis (Japan), Vipera russelli (Thailand), and Crotalus atrox (USA), which comprise six of the eight venoms designated by WHO as international reference venoms (IRVs) (C atrox venom replaced C adamanteus venom, as an adequate supply of the latter was not available) The tests used were simple and should be reproducible in other laboratories throughout the world Procedures for assaying neuromuscular paralytic activity and systemic myotoxic activity have yet to be developedThe tests will be used to assay the neutralizing potency of both international standard antivenoms (raised using the IRVs) and new and currently available commercial antivenoms Such studies should result in the production of more potent antivenoms for use in both developing and developed countries, and improve the understanding and management of snake bite throughout the world

Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread

Abstract: Between 31 July and 6 October 1979, 34 cases of Ebola virus disease (22 of which were fatal) occurred among five families in a rural district of southern Sudan; the disease was introduced into four of the families from a local hospital. Chains of secondary spread within the family units, accounting for 29 cases resulted from direct physical contact with an infected person. Among all persons with such contact in the family setting, those who provided nursing care had a 5.1-fold increased risk of infection, emphasizing the importance of intimate contact in the spread of this disease. The absence of illness among persons who were exposed to cases in confined spaces, but without physical contact, confirmed previous impressions that there is no risk of airborne transmission. While the ecology of Ebola virus is unknown, the presence of anti-Ebola antibodies in the sera of 18% of persons who were unassociated with the outbreak suggests that the region is an endemic focus of Ebola virus activity.

Clinical observations on virologically confirmed fatal dengue infections in Jakarta, Indonesia

Abstract: Thirty virologically confirmed cases of dengue infection with a fatal outcome were studied clinically in Jakarta, Indonesia, from 1975 to 1978. All 4 dengue virus serotypes were isolated from fatal cases, but dengue type 3 was responsible for 21 (70%) of these isolates, compared to only 47% of isolates from all cases of dengue infection. The majority (60%) of these 30 cases were males in the 5-9-year age group. Nonspecific signs and symptoms in the fatal cases were no different from those in patients who survived dengue infection, but 70% of the patients with fatal outcome had one or more signs of encephalitis, primarily convulsions and somnolence; 3 of them developed spastic tetraparesis before death and 2 died of an illness clinically compatible with viral encephalitis. Other unexpected observations were that only 63% of the patients had classical dengue shock syndrome with haemoconcentration, thrombocytopenia and shock. A high percentage (80%) had gastrointestinal haemorrhage, and in 9 patients (30%) this was severe enough to cause shock and death. In these 9 cases, the gastrointestinal haemorrhage and haematemesis began before the onset of shock and there was no evidence of haemoconcentration or pleural effusion at any time during hospitalization. According to certain widely accepted criteria, these patients would not be diagnosed as dengue haemorrhagic fever (DHF). But as they made up nearly one-third of the confirmed fatal dengue infections in this study and had massive gastrointestinal haemorrhages with thrombocytopenia, the definition of DHF should be changed to include this type of patient. It is proposed that the disease should be more realistically classified as dengue fever with or without haemorrhage and dengue shock syndrome.

The management of snake bite.

Abstract: The present article reviews current knowledge on the epidemiology, pathophysiology, and treatment of snake bite, with particular reference to the situation in developing countries. There is little reliable information on the incidence of snake bite in many parts of the world, and epidemiological studies are needed, using enzyme-linked immunosorbent assay to identify and quantify serum levels of venom antigen and antibody. The pathophysiology and clinical features of envenoming by medically important snakes are discussed. Antivenom, if used correctly, can reverse systemic poisoning even if given days after the bite. It is therefore wise to wait for the appearance of signs of systemic poisoning before administering antivenom, rather than using it routinely. WHO has designated the Liverpool School of Tropical Medicine as a Collaborating Centre for the Control of Antivenoms, and this Centre now holds a collection of reference venoms from several important snake species. Characterization of these and of standard antivenoms should significantly improve the management of snake bite throughout the world.

Diarrhoeal disease control: reviews of potential interventions.

Abstract: Diarrheal diseases are a major cause of illness and death in young children in most developing countries with recent estimates attributing nearly 5 million deaths/year to children under 5 in developing countries excluding China Because diarrheal disease mortality can be effectively reduced at reasonable cost by oral rehydration and possibly other measures it is a priority target for primary health care programs in many countries Other interventions are needed in addition to oral rehydration to lessen the impact of probable operational constraints on oral rehydration programs to reduce mortality from chronic or dysenteric diarrheas in which oral rehydration is of limited use and to reduce diarrhea morbidity rates The Diarrhoeal Diseases Control (CDD) Programme of the World Health Organization (WHO) advocates a 4-part strategy for diarrhea control consisting of improved case management improved maternal and child health care improved use and maintenance of drinking water and sanitation facilities and improved food hygiene and detection and control of epidemics The CDD program has undertaken a systematic review of the effectiveness feasibility and cost of available antidiarrheal interventions and has developed a classification of interventions to guide the review process Each intervention will be reviewed using a standard format and assigned to 1 of 3 categories: 1) those shown to be effective feasible and affordable for which the CDD program will develop guidelines for implementation within primary health care programs and promote any additional operational research needed; 2) those believed on theoretical grounds to be effective but in which insufficient field experience has been gained will receive further field testing; and 3) those shown to be too costly ineffective or unfeasible will not be recommended by the CDD The classification of possible interventions has 4 categories: 1) case management including oral rehydration therapy at home or at a medical facility promoting appropriate feeding during diarrheal episodes and chemotherapy at home or in a medical facility; 2) increasing host resistence to infection through various programs of maternal nutrition child nutrition immunization or chemoprophylaxis; 3) reducing transmission of the pathogenic agents through control of water supply and excreta disposal personal and domestic hygiene food hygiene control of zoonotic reservoirs or fly control; and 4) controlling or preventing diarrhea epidemics

The 1980 earthquake in southern Italy: rescue of trapped victims and mortality.

Abstract: A retrospective survey was undertaken on the health effects of the 1980 earthquake in southern Italy. The study population included 3619 people living in 7 villages situated near the epicentre of the disaster. The overall casualty rate (dead and injured) was 19.7%. Nearly all the deaths (192/202) occurred among trapped people who died before they could be rescued. Eighty per cent of all the trapped people were extricated within 2 days, mostly without the use of sophisticated means. The probability of survival decreased sharply, the longer the time before extrication. The crude mortality during the 18 months following the earthquake was 19.0 per thousand among the injured people who received treatment, and 14.1 per thousand among non-injured people. After age standardization, there was no significant difference between these two figures and the expected mortality figures for the Italian population in normal times (14.4 per thousand). These results stress the importance of providing rescue activities in the first 48 hours after the impact. Strengthening the self-reliance of the community in disaster preparedness is suggested as the best way to improve the effectiveness of relief operations. In disaster-prone areas, training and education in methods of rescue should be an integral part of any primary health care programme.

Epidemic group C meningococcal meningitis in Upper Volta, 1979.

Abstract: Group C meningococci were isolated during an epidemic of meningococcal meningitis which occurred between January and May 1979 in eastern Upper Volta, an area previously associated with endemic and epidemic group A disease. A total of 539 cases of meningitis, 55 of which were fatal, were reported, giving an attack rate of 517 cases per 100 000 inhabitants. Attack rates were higher for children under 15 years of age. Clinical and bacteriological data suggested that the group C meningococci were sulfonamide-resistant. The last meningococcal epidemic in Upper Volta occurred in 1970 and was nationwide. Epidemic cycles of group A meningococcal meningitis have occurred at 10-15 year intervals in the sub-Saharan region, raising concern that the current increase in activity may presage more wide-spread disease in the next dry season.

Interventions for the control of diarrhoeal diseases among young children: measles immunization.

Abstract: The effects of measles immunization on diarrhea morbidity and mortality are reviewed using data from field studies and theoretical calculations 2 types of measles-associated diarrhea are distinguished: with-measles diarrhea which starts between 1 week prerash-onset and 4 weeks postrash-onset and postmeasles diarrhea which starts 4-26 weeks postrash-onset The etiology of these measles-associated diarrheas is unknown but some evidence points towards a frequently severe and dysenteric form of disease with Shigella playing a major role Theoretical calculations indicate that measles immunization at the age of 9-11 months with coverage of between 45-90% can avert 44-64% of measles cases 06-38% of diarrhea episodes and 6-26% of diarrhea deaths among children under age 5 The cost of measles immunization is in the range of US$2-15 (1982 prices)/child vaccinated The impact of measles immunization on diarrhea mortality may be partly additional to the impact of oral rehydration because it averts deaths that are not prevented by oral rehydration Community research is urgently needed to confirm or reject these theoretical suppositions to clarify the etiology of measles-associated diarrhea and to determine the cost-effectiveness of measles immunizations as an intervention to reduce diarrhea mortality (authors modified)

Analysis of antigenic variation in equine 2 influenza A viruses.

Abstract: Influenza outbreaks involving viruses of the H3N8 subtype (equine 2) often occur in vaccinated horses. For this reason, a series of influenza viruses of the H3N8 subtype were examined to determine if antigenic variation could be detected in isolates during the period 1963-81. Antigenic analyses with post-infection ferret sera and monoclonal antibodies showed that the haemagglutinins of recent isolates were antigenically distinguishable from the prototype A/eq/Miami/1/63 and that antigenically distinguishable groups of equine 2 viruses co-circulate in the horse population. Based on these studies, it is recommended that a recent equine strain, A/equine/Fontainebleu/1/79 or A/equine/Kentucky/1/81, serve as an additional prototype strain for this subtype.Antigenic variation in equine 2 viruses may be of epidemiological significance, yet the overall conservation of these strains makes it unlikely that vaccine failures can be attributed solely to antigenic changes in these viruses. A sufficiently potent vaccine, containing a current representative of the most prevalent equine 2 strain, may improve the protection afforded by equine vaccines.

Efficacy of inactivated poliovirus vaccine in India.

Abstract: The immunogenic efficacy of inactivated (Salk) poliovirus vaccine (IPV) was evaluated in infants in India, in view of the high frequency of vaccine failure after immunization with oral (Sabin) poliovirus vaccine (OPV). A total of 150 infants, aged 6-45 weeks, were given 3 doses of IPV, with intervals of 4 or 8 weeks between doses. The effect on the antibody response of child's age, presence of maternal antibody before immunization, and interval between doses was assessed. The overall seroconversion rates to poliovirus types 1, 2, and 3 were 99%, 89%, and 91%, respectively. Seroconversion rates to types 2 and 3, and antibody titres to types 1 and 2, were higher (i) in infants given vaccine doses at 8-week intervals and (ii) in those without detectable maternal antibody. The seroconversion rates in infants without maternal antibody, who were given IPV at 8-week intervals, were 100%, 100%, and 96.2% to poliovirus types 1, 2, and 3, respectively. Thus the immunogenic efficacy of IPV was found to be satisfactory.

Laboratory-based surveillance of influenza A(H1N1) and A(H3N2) viruses in 1980-81: antigenic and genomic analyses

Abstract: During 1981, the A/Brazil/11/78-like strains of influenza virus that had been prevalent from 1978 to 1980 were displaced by a new set of heterogeneous, but closely related, variants (reference strain, A/England/333/80). Genomic analysis revealed that these new variants were almost exclusively nonrecombinant H1N1 viruses, i.e., they contained no genes of H3N2 origin. However, a few recombinant viruses containing the new variant HA and genes of H3N2 origin were identified. Antigenic analysis of H3N2 viruses indicated that they were also heterogeneous. The majority of these virus isolates were antigenically intermediate between A/Texas/1/77 and A/Bangkok/1/79, but additional variants were detected. Genomic analysis revealed that the H3N2 viruses isolated in the winter of 1980-81 were quite similar to H3N2 viruses isolated from 1977-79 in their T1 oligonucleotide maps. No H1N1 genes were detected in H3N2 virus isolates. Comparison of pairs of oligonucleotide maps of total virus RNA indicated that a similar rate of genetic change had occurred for nonrecombinant H1N1 viruses, for recombinant H1N1 viruses, and for H3N2 viruses and that, in general, pairs of viruses exhibited increasing numbers of changes in their oligonucleotide maps as the time interval between isolation of the viruses increased.

A double-blind comparative clinical trial of mefloquine and chloroquine in symptomatic falciparum malaria

Abstract: A total of 99 male Zambian patients with symptomatic falciparum malaria were treated in a double-blind randomized manner with either mefloquine (1000 mg given in one day) or chloroquine (1500 mg given over 3 days). An S-type response was seen in all the chloroquine patients and 98% of the mefloquine group; one patient in the latter group (2%) showed an RI-type response, but the parasites obtained during the recrudescence were sensitive to both chloroquine and mefloquine in the in vitro microtest, and the patient responded satisfactorily to oral chloroquine. The rate of clearance of parasitaemia was marginally faster in the chloroquine-treated group. The rate of clearance of fever was similar in the two groups. Both drugs were well tolerated and side-effects such as nausea, vomiting, dizziness, loose stools, and pruritus were mild and transient. Pruritus was more common after chloroquine administration and dizziness more common in the mefloquine group. There were no drug-induced alterations in the haematological and biochemical profiles.

Clones of different sensitivities in drug-resistant isolates of Plasmodium falciparum.

Abstract: Clones of two Thai isolates of Plasmodium falciparum were prepared and examined for variations in drug susceptibility and electrophoretic properties of enzymes. Both isolates were found to include mixtures of genetically distinct parasites. Of particular significance was the finding that one isolate (T9), which on initial testing was resistant to chloroquine, pyrimethamine and sulfadoxine—pyrimethamine, yielded a clone of parasites markedly more sensitive to these three drugs, while five other clones resembled the original isolate in drug susceptibility.

Epidemiology of seasonal falciparum malaria in an urban area of Senegal.

Abstract: A 15-month longitudinal survey was carried out to examine entomological and parasitological aspects of human malaria transmission in Pikine, a city located in the Sudan savanna zone on the Cap Vert peninsula in the west of Senegal. The anopheline population was sampled twice weekly indoors by night human bait capture. During the same period, thick and thin blood films were collected from 296 children at 2-month intervals. Anopheles arabiensis was the only species responsible for transmission of Plasmodium falciparum. The parasite rate showed a positive correlation with both the entomological inoculation rate and the vectorial capacity. In Pikine, malaria is epidemic and probably unstable, and the population enjoys a variable degree of immunity.

Immunogenicity and side-effects of a new tetravalent meningococcal polysaccharide vaccine.

Abstract: A new tetravalent meningococcal polysaccharide vaccine containing groups A, C, W 135, and Y was administered to 40 healthy adults. The vaccine was well tolerated and bactericidal assay showed mean titre increases for the meningococcal polysaccharide groups A, C, W 135, and Y of 5.0, 7.8, 8.2, and 5.9 log2 titre steps, respectively. The immunogenicity and side-effects of the vaccine were similar to those associated with monovalent and bivalent vaccines containing group A and C meningococcal polysaccharides.

Viral etiology of acute respiratory diseases in Rio de Janeiro: first two years of a longitudinal study.

Abstract: A two-year study was undertaken to establish the incidence and possible viral etiology of acute respiratory diseases among the child population of a shanty town in Rio de Janeiro, Brazil. The results demonstrated that nearly half of all the illnesses seen were respiratory infections, 10% of them affecting the lower respiratory tract. Viruses were isolated from 20% of the throat swabs collected. Of the viruses identified, 47% were adenoviruses, 25% were enteroviruses, 9% were influenza A, 8% herpes simplex, 7% parainfluenza, 3% respiratory syncytial and 1% influenza B viruses.

Effect of two years of educational intervention on adolescent smoking (the North Karelia Youth Project).

Abstract: A two-year educational intervention programme was carried out to try to prevent the onset of smoking among 13-15-year-olds in the county of North Karelia in eastern Finland. The aim of the programme was to teach the children skills to resist social pressures towards smoking. Older students (peer leaders) were trained to conduct the programme, which was directly managed in two schools and voluntarily implemented by the staff of about half of the remaining 23 schools in the county. Both types of intervention were associated with a significant reduction in self-reported onset rates of smoking. It is concluded that this type of innovative approach, based on modern psychosocial principles, is needed to control the smoking epidemic among adolescents.

Heterogeneity of influenza B viruses.

Abstract: Antigenic analysis of influenza B strains isolated in 1981-82 from England, Japan, and the USA, using a panel of monoclonal antibodies to the haemagglutinin of B/Oregon/5/80, showed considerable heterogeneity among the isolates, the majority of which had distinct reactivity patterns Antigenically similar viruses were isolated from England, Japan, and the USA, and heterogeneity was detected among isolates from each country Further studies are needed to determine whether this marked heterogeneity reflects different cocirculating strains or antigenic drift during an epidemic The monoclonal antibodies failed to detect any difference between influenza B isolates from patients with Reye's syndrome and those circulating in the community The monoclonal antibodies, each recognizing different determinants on the haemagglutinin of B/Oregon/5/80, were pooled and compared with ferret antisera to determine if the pool could be used as a reference reagent The monoclonal antibody pool discriminated between isolates, contained no non-specific inhibitors of haemagglutination, and avoided the problems associated with differences between ferret antisera In general, viruses that were shown to be antigenically different by ferret antisera were also different with the pooled monoclonal antibodies, but further studies are required to determine the optimal mixture of antibodies that will detect epidemiologically significant differences between strains

Enzyme analysis of Schistosoma haematobium.

Abstract: Results are reported of enzyme analyses, by isoelectric focusing in polyacrylamide gels, of adult Schistosoma haematobium worms derived from 22 isolates originating from 13 countries. Polymorphisms have been identified in the glucose-6-phosphate dehydrogenase (G6PD) and phosphoglucomutase (PGM) systems. Certain forms appear to be restricted in their geographical distribution and their occurrence outside their usual areas suggests human population movements resulting in mixing of parasite strains. The possible implications of minor variations in some PGM patterns and the apparent absence of heteropolymer fractions in presumed G6PD heterozygotes are discussed. The use of the technique to detect natural multiple miracidial infections in snails is reported and discussed.

Interventions for the control of diarrhoeal diseases among young children: supplementary feeding programmes.

Abstract: The effect of supplementary feeding programs on diarrheal disease morbidity and mortality among preschool children is reviewed using data from field studies in developing countries. The supplementary feeding programs considered are those which provide food to preschool children on a continuing and communitywide basis. Nutritional rehabilitation of sick children and feeding programs in disasters and emergencies are not considered. The evidence that poor nutritional status predisposes to increased diarrheal disease incidence or that supplementary feeding programs can reduce diarrheal disease incidence is not strong. There is evidence that poor nutritional status predisposes to more severe diarrhea and to higher case fatality and that supplementary feeding programs can reduce the severity of the diarrhea and the mortality. However supplementary feeding programs entail high costs and considerable logistic and managerial complexity and it is unlikely that they are a cost-effective intervention for national diarrheal disease control programs. Prospective studies into the effect of nutritional status on the severity of etioloty-specific diarrheas and the resulting deaths are warranted. (authors modified) (summary in FRE)

A phase II clinical trial of mefloquine in Brazilian male subjects.

Abstract: Mefloquine was compared with sulfadoxine-pyrimethamine for safety and efficacy in a randomized, double-blind clinical trial in adult males from a malaria-endemic area of Brazil. A total of 99 oligosymptomatic and symptomatic volunteers with Plasmodium falciparum parasitaemia took part in the trial; 49 were given 1000 mg of mefloquine and the remainder received 1500 mg of sulfadoxine plus 75 mg of pyrimethamine, in a single oral dose.Mefloquine was 100% successful in clearing parasitaemia within 7 days; there were no recrudescences. Sulfadoxine-pyrimethamine was less successful; 35 cases showed an S-type response, 8 an RI response, 3 an RII, and 2 an RIII response. The side-effects of mefloquine were mild and transient and included headache, nausea, vomiting, dizziness, and diarrhoea. A satisfactory weight gain and rise in haemoglobin level were seen in both groups.

Haemoglobin measurement: the reliability of some simple techniques for use in a primary health care setting.

Abstract: The reliability of five simple techniques for the estimation of blood haemoglobin levels was studied under laboratory conditions. The methods tested were the Sahli technique, the Tallqvist method, and the Lovibond comparator with undiluted blood, blood diluted in Drabkin solution, and blood diluted in modified Drabkin solution. The Lovibond comparator technique using undiluted blood was satisfactory in terms of precision and accuracy, and seems suitable for the monitoring of individual patients and for screening for anaemia. The other techniques were less reliable. A detailed procedure was worked out for estimation of the number of screening errors that can be expected with each of these techniques in any epidemiological situation.

Resurgence of visceral leishmaniasis in Bangladesh

Abstract: Out of 218 suspected cases of kala-azar from different parts of Bangladesh, 59 could be confirmed; and out of 41 patients with suspected skin lesions, 6 were confirmed as post-kala-azar dermal leishmaniasis. Confirmation of diagnosis was based on the demonstration of L-D bodies in tissue specimens (spleen and liver (after puncture) or skin scrapings).The complement fixation test (CFT) and aldehyde test (AT) were positive in all but one case of kala-azar. Their usefulness in the diagnosis of the disease has been emphasized. The aldehyde test is very simple to perform and does not require any equipment or electricity; it can therefore be used as a screening test in rural areas.Failure of the organism to grow in NNN medium in 2 cases and failure to maintain organisms isolated from some other cases for more than 2-3 weeks in the culture medium indicate the possibility that different strains were involved. As the number of kala-azar cases appears to be increasing, the threat of an epidemic is real.

Replacement of intravenous therapy by oral rehydration solution in a large treatment centre for diarrhoea with dehydration.

Abstract: In this study the efficacy of oral rehydration solution (ORS) was compared with that of intravenous fluid (IVF) in the treatment of moderate and some severe cases of dehydration due to diarrhea in a treatment center in Bangladesh during 1980-81. 10379 patients with moderate and severe dehydration in 1980 and 9897 in 1981 were studied most were under age 5. Almost all uncomplicated diarrhea patients with moderate and severe dehydration admitted in 1980 were initially treated with IVF followed by ORS. The average amounts of IVF ORS and total fluid used/patient (based on a 10% sample of patients) were 1.26 0.10 and 1.36 litres respectively in 1980 and 0.65 1.16 and 1.81 litres in 1981. As of December 1980 only patients with pulselessness shock and vomiting were given IVF. In 1981 94% of severe cases of dehydration were treated with IVF plus ORS compared to 100% in 1980 (p<0.01) and 6% were treated with ORS alone compared to 0% in 1980 (p<0.01). Among moderate cases of dehydration 29% received IVF plus ORS in 1981 (92% in 1980) and 71% were successfully treated with ORS alone (8% in 1980). The percentage of patients staying for over 12 hours in the treatment center was 29.9% in 1980 and 42.1% in 1981. Among the patients staying less than 12 hours the mean duration of stay was 6.02 +or- 3.18 hours in 1980 and 6.73 +or- 3.35 hours in 1981 significant at the 0.001 level. IVF is shown to be effective in treating dehydration but costs more and presents greater risks including the introduction of septicaemic infection pyrogenic reactions embolism phlebitis thrombosis and even rupture of the veins. ORS treatment is simple safe less costly and can be taught to parents. No children treated with ORS died but some IVF patients did suggesting that only ORS therapy is fully effective. Average cost per patient in the treatment center was US$6.60 in 1980 and US$4.40 in 1981 a savings of 33.3%. Replacement of IVF by ORS led to the conclusion that developing countries should make ORS services available throughout the country in order to reduce hospital admissions and mortality. (summary in FRE)

Antigenic and amino acid sequence variations in the haemagglutinins of type A influenza viruses recently isolated from human subjects.

Abstract: Since 1978, influenza A viruses with different antigenic properties have been isolated in many countries, even though little influenza activity has been recorded. In the present paper, the antigenic properties of viruses representative of isolates from each year since 1979 are compared, and the amino acid sequences of their haemagglutinins are described in detail. The reults give an indication of the extent and nature of variation in influenza A viruses during this period.

Bacterial meningitis in Egypt: analysis of CSF isolates from hospital patients in Cairo, 1977-78.

Abstract: Bacterial meningitis remains a major cause of mortality and morbidity in many countries of the world despite effective antimicrobial therapy Studies of the etiology and some laboratory characteristics of bacterial meningitis in Egypt were conducted during 1977-1978 All patients suspected of having bacterial meningitis were studied at the time of admission to the two fever hospitals of Cairo Direct culture, serological identification of the capsular type, and countercurrent-immunoelectrophoresis of 1627 CSF specimens were done Of these, 276 had bacteria identified either by culture or Gram stain Pneumococci were the most common and the serotype distribution was similar to that reported from other parts of Africa; second were meningococci with groups C and B predominating; in third place was Haemophilus influenzae type b which caused the highest mortality and had an unusually young age distribution There were 77 bacterial isolates (22%), including 11 species, designated as "other" because there was no predominant species There were many "clear" CSF specimens that were found to contain pneumococci, meningococci or H influenzae type b, confirming the need for more comprehensive laboratory facilities for accurate diagnosis of the etiology of bacterial meningitis

Timing of antenatal tetanus immunization for effective protection of the neonate.

Abstract: The relationship between the timing of maternal tetanus toxoid immunization and the presence of protective antitoxin in placental cord blood was investigated among women admitted to the obstetrical service of the University Hospital in Kuala Lumpur Malaysia. The 1st dose was given between 13-39 weeks of gestation with a median of 29 weeks. The 2nd dose was given an average of 4 weeks later. Protection was conferred on 80% or more of newborns whose mothers received their 1st tetanus toxoid injection 60 days or more before delivery. Protective levels were seen in all cord blood samples from infants whose mothers had received their 1st injection 90 days before delivery. Similarlyprotective titers were found in 100% of cord blood samples when the 2nd maternal injection was give 60 days or more before delivery. There was no significant degree of protection when immunization was carried out less than 20 days before delivery. A single-dose schedule provided no protection when less than 70 days before delivery. Cord and maternal antiotoxin titers differed by no more than 1 2-fold dilution for almost all of the individual paired sera. A cord: maternal antitoxin ratio of 2 was more likely to occur with increasing time between the 2nd injection and delivery. Overall these findings indicate that the 1st injection of a 2-dose maternal tetanus toxoid schedule should be given at least 60 days and preferably 90 days before delivery.