Bulletin of the World Health Organizationhttps://scielosp.org/feed/bwho/2000.v78n3/2016-01-01T00:02:00ZUnknown authorVol. 78 No. 3 - 2000WerkzeugPolio, war and peaceS0042-968620000003000012016-01-01T00:02:00Z2001-01-28T00:08:00ZBush, Kenneth
<em>Bush, Kenneth</em>;
<br/><br/>
The legacies of polio eradicationS0042-968620000003000022016-01-01T00:02:00Z2001-01-28T00:08:00ZMacedo, C. de GuerraMelgaard, B.
<em>Macedo, C. De Guerra</em>;
<em>Melgaard, B.</em>;
<br/><br/>
Disease eradication as a public health strategy: a case study of poliomyelitis eradicationS0042-968620000003000032016-01-01T00:02:00Z2001-01-28T00:08:00ZAylward, R.B.Hull, H.F.Cochi, S.L.Sutter, R.W.Olivé, J.-M.Melgaard, B.
<em>Aylward, R.b.</em>;
<em>Hull, H.f.</em>;
<em>Cochi, S.l.</em>;
<em>Sutter, R.w.</em>;
<em>Olivé, J.-M.</em>;
<em>Melgaard, B.</em>;
<br/><br/>
Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998. In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility). The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a ‘‘culture of prevention’’. The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The ‘‘technical’’ feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention and delivery strategy (oral poliovirus vaccine and national immunization days) and a sensitive and specific diagnostic tool (viral culture of specimens from acute flaccid paralysis cases). The certification of poliomyelitis eradication in the Americas in 1994 and interruption of endemic transmission in the Western Pacific since March 1997 confirm the operational feasibility of this goal. When the humanitarian, economic and consequent benefits of this initiative are measured against the costs, a strong argument is made for eradication as a valuable disease control strategy.Surveillance of patients with acute flaccid paralysis in Finland: report of a pilot studyS0042-968620000003000042016-01-01T00:02:00Z2001-01-28T00:08:00ZHovi, T.Stenvik, M.
<em>Hovi, T.</em>;
<em>Stenvik, M.</em>;
<br/><br/>
WHO recommends that surveillance of patients with acute flaccid paralysis (AFP) be used to demonstrate the eradication of wild poliovirus. In this article we report the results of a study to assess the frequency of AFP patients referred to Finnish hospitals and whether virological diagnostic coverage could be improved by repeated reminders and active feedback. For this purpose, we sent monthly questionnaires to all neurological and paediatric neurological units in Finland, requesting retrospective reporting on investigated paralytic patients with defined clinically relevant diagnoses, rather than AFP. Reminder letters included a pre-paid return envelope. Virological investigations were offered cost free. Of the 492 reporting forms sent, 415 (84%) were returned, evenly covering both the population and the study period (July 1997 to June 1998). Of the 90 patients reported, 83 were evaluable. The apparent incidences of the diagnoses covered were 1.6 per 100 000 at any age, and 1.0 per 100 000 for under-15-year-olds. Guillain-Barré syndrome was the most common diagnosis (0.80 per 100 000). The two faecal specimens required were virologically investigated in nine out of the 10 patients under 15 years of age, but in only 46% of all patients. Four adenovirus strains, but no polioviruses or other enteroviruses, were isolated. We conclude that a satisfactory monthly reporting system was readily established and that a sufficient number of patients with diagnoses resembling AFP are being referred to Finnish hospitals. Active feedback did not increase the proportion of virologically investigated patients to an acceptable level in all age groups. It is clear that other approaches must be used to quantify the circulation of poliovirus in Finland.Polio as a platform: using national immunization days to deliver vitamin A supplementsS0042-968620000003000052016-01-01T00:02:00Z2001-01-28T00:08:00ZGoodman, TraceyDalmiya, NitaBenoist, Bruno deSchultink, Werner
<em>Goodman, Tracey</em>;
<em>Dalmiya, Nita</em>;
<em>Benoist, Bruno De</em>;
<em>Schultink, Werner</em>;
<br/><br/>
In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 "in ways which strengthen national immunization programmes and health infrastructure". The successful use of polio National Immunization Days (NIDs) to deliver vitamin A is an example of how polio eradication can serve as a platform to address other problems of child health. Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000. It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency. In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs). While food fortification and dietary approaches are fundamental to combating vitamin A deficiency, the administration of vitamin A supplements during NIDs helps raise awareness, enhance technical capacity, improve assessment and establish a reporting system. Moreover, polio NIDs provide an entry point for the sustainable provision of vitamin A supplements with routine immunization services and demonstrate how immunization campaigns can be used for the delivery of other preventive health services.Excluding polio in areas of inadequate surveillance in the final stages of eradication in ChinaS0042-968620000003000062016-01-01T00:02:00Z2001-01-28T00:08:00ZHoekstra, E.J.Feng, ChaiXiao-jun, WangXing-lu, ZhangJing-jin, YuBilous, J.
<em>Hoekstra, E.j.</em>;
<em>Feng, Chai</em>;
<em>Xiao-Jun, Wang</em>;
<em>Xing-Lu, Zhang</em>;
<em>Jing-Jin, Yu</em>;
<em>Bilous, J.</em>;
<br/><br/>
In 1996, China adopted a virological classification of acute flaccid paralysis (AFP) cases for its surveillance system. Only AFP cases with wild poliovirus in stool specimens are confirmed as polio. Cases with adequate stool specimens that are negative for wild poliovirus are not counted. This paper describes a methodology to rule out poliomyelitis in AFP cases with inadequate stool specimens. National surveillance data were analysed using dot maps to detect clusters of AFP cases with high-risk factors for poliomyelitis. The surveillance system and vaccine coverage were assessed during field investigations. Four clusters of AFP cases were identified, but no poliomyelitis cases. Programmatic failures in the identified high-risk areas included low vaccination rates, poor stool specimen collection and inadequate AFP surveillance. Programme strategies were implemented to correct the identified failures. Use of this methodology provides strong evidence consistent with the absence of wild poliovirus in China.Poliomyelitis surveillance: the model used in India for polio eradicationS0042-968620000003000072016-01-01T00:02:00Z2001-01-28T00:08:00ZBanerjee, KaushikHlady, W. GaryAndrus, Jon K.Sarkar, SobhanFitzsimmons, JohnAbeykoon, Palitha
<em>Banerjee, Kaushik</em>;
<em>Hlady, W. Gary</em>;
<em>Andrus, Jon K.</em>;
<em>Sarkar, Sobhan</em>;
<em>Fitzsimmons, John</em>;
<em>Abeykoon, Palitha</em>;
<br/><br/>
Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases. The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP). In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11 533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted. Data reported at the national level are analysed and distributed weekly. Annualized rates of non-polio AFP increased from 0.22 per 100 000 children aged under 15 years in 1997 to 1.39 per 100 000 in 1999. The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999. The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999. Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.Eradication of poliomyelitis in countries affected by conflictS0042-968620000003000082016-01-01T00:02:00Z2001-01-28T00:08:00ZTangermann, R.H.Hull, H.F.Jafari, H.Nkowane, B.Everts, H.Aylward, R.B.
<em>Tangermann, R.h.</em>;
<em>Hull, H.f.</em>;
<em>Jafari, H.</em>;
<em>Nkowane, B.</em>;
<em>Everts, H.</em>;
<em>Aylward, R.b.</em>;
<br/><br/>
The global initiative to eradicate poliomyelitis is focusing on a small number of countries in Africa (Angola, Democratic Republic of the Congo, Liberia, Sierra Leone, Somalia, Sudan) and Asia (Afghanistan, Tajikistan), where progress has been hindered by armed conflict. In these countries the disintegration of health systems and difficulties of access are major obstacles to the immunization and surveillance strategies necessary for polio eradication. In such circumstances, eradication requires special endeavours, such as the negotiation of ceasefires and truces and the winning of increased direct involvement by communities. Transmission of poliovirus was interrupted during conflicts in Cambodia, Colombia, El Salvador, Peru, the Philippines, and Sri Lanka. Efforts to achieve eradication in areas of conflict have led to extra health benefits: equity in access to immunization, brought about because every child has to be reached; the revitalization and strengthening of routine immunization services through additional externally provided resources; and the establishment of disease surveillance systems. The goal of polio eradication by the end of 2000 remains attainable if supplementary immunization and surveillance can be accelerated in countries affected by conflict.Massive outbreak of poliomyelitis caused by type-3 wild poliovirus in Angola in 1999S0042-968620000003000092016-01-01T00:02:00Z2001-01-28T00:08:00ZValente, F.Otten, M.Balbina, F.Van de Weerdt, R.Chezzi, C.Eriki, P.Van-Dúnnen, J.Okwo Bele, J.-M.
<em>Valente, F.</em>;
<em>Otten, M.</em>;
<em>Balbina, F.</em>;
<em>Van De Weerdt, R.</em>;
<em>Chezzi, C.</em>;
<em>Eriki, P.</em>;
<em>Van-Dúnnen, J.</em>;
<em>Okwo Bele, J.-M.</em>;
<br/><br/>
The largest outbreak of poliomyelitis ever recorded in Africa (1093 cases) occurred from 1 March to 28 May 1999 in Luanda, Angola, and in surrounding areas. The outbreak was caused primarily by a type-3 wild poliovirus, although type-1 wild poliovirus was circulating in the outbreak area at the same time. Infected individuals ranged in age from 2 months to 22 years; 788 individuals (72%) were younger than 3 years. Of the 590 individuals whose vaccination status was known, 23% had received no vaccine and 54% had received fewer than three doses of oral poliovirus vaccine (OPV). The major factors that contributed to this outbreak were as follows: massive displacement of unvaccinated persons to urban settings; low routine OPV coverage; inaccessible populations during the previous three national immunization days (NIDs); and inadequate sanitation. This outbreak indicates the urgent need to improve accessibility to all children during NIDs and the dramatic impact that war can have by displacing persons and impeding access to routine immunizations. The period immediately after an outbreak provides an enhanced opportunity to eradicate poliomyelitis. If continuous access in all districts for acute flaccid paralysis surveillance and supplemental immunizations cannot be assured, the current war in Angola may threaten global poliomyelitis eradication.Stopping poliovirus vaccination after eradication: issues and challengesS0042-968620000003000102016-01-01T00:02:00Z2001-01-28T00:08:00ZWood, D.J.Sutter, R.W.Dowdle, W.R.
<em>Wood, D.j.</em>;
<em>Sutter, R.w.</em>;
<em>Dowdle, W.r.</em>;
<br/><br/>
Since 1988 reported polio cases worldwide have declined by about 85% and the number of known or suspected polioendemic countries has decreased from over 120 to less than 50. With eradication of poliomyelitis approaching, issues potentially affecting when and how vaccination against poliovirus can be stopped become extremely important. Because of the potential risks and benefits inherent in such a decision, the best available science, a risk-benefit analysis, contingency plans, a stock pile of poliovirus vaccines, and the endorsement by the global policy-making committees will all be needed before vaccination can be discontinued. The scientific basis for stopping polio immunization has been reviewed by WHO. This Round Table article summarizes the current state of knowledge, provides an update on the processes and timelines for certification, containment, and stopping vaccination, and highlights some of the unanswered scientific questions that will be addressed by further research. These include whether transmission of vaccine-derived poliovirus strains could be sustained so that poliomyelitis could re-emerge in a future unvaccinated population and whether prolonged excretion of vaccine-derived poliovirus from individuals with immune deficiencies could be a mechanism through which this could occur.Round table discussionS0042-968620000003000112016-01-01T00:02:00Z2001-01-28T00:08:00ZElevated levels of maternal anti-tetanus toxin antibodies do not suppress the immune response to a Haemophilus influenzae type b polyribosylphosphate-tetanus toxoid conjugate vaccineS0042-968620000003000122016-01-01T00:02:00Z2001-01-28T00:08:00ZPanpitpat, C.Thisyakorn, U.Chotpitayasunondh, T.Fürer, E.Que, J.U.Hasler, T.Cryz Jr, S.J.
<em>Panpitpat, C.</em>;
<em>Thisyakorn, U.</em>;
<em>Chotpitayasunondh, T.</em>;
<em>Fürer, E.</em>;
<em>Que, J.u.</em>;
<em>Hasler, T.</em>;
<em>Cryz Jr, S.j.</em>;
<br/><br/>
Reported are the effects of elevated levels of anti-tetanus antibodies on the safety and immune response to a Haemophilus influenzae type b polyribosylphosphate (PRP)-tetanus toxoid conjugate (PRP-T) vaccine. A group of Thai infants (n = 177) born to women immunized against tetanus during pregnancy were vaccinated with either a combined diphtheria-tetanus- pertussis (DTP) PRP-T vaccine or DTP and a PRP-conjugate vaccine using Neisseria meningitidis group B outer-membrane proteins as a carrier (PedVax HIB). Although most infants possessed high titres (>1 IU/ml) of anti-tetanus antibodies, the DTP-PRP-T combined vaccine engendered an excellent antibody response to all vaccine components. In both vaccine groups >98% of infants attained anti-PRP antibody titres >0.15 mg/ml. The geometric mean anti-PRP antibody titres were 5.41 mg/ml and 2.1 mg/ml for infants immunized with three doses of PRP-T versus two doses of PedVax HIB vaccines, respectively ( P< 0.005). Similarly, the proportion of infants who achieved titres >1 mg/ml was higher in the PRP-T group (87.8%) than in the group immunized with PedVax HIB (74.2%) (P = 0.036). A subgroup analysis showed that there was no significant difference in the anti-PRP antibody response for infants exhibiting either <1 IU of anti-tetanus antibody per millilitre or >1 IU/ml at baseline. These finding indicate that pre-existing anti-carrier antibody does not diminish the immune response to the PRP moiety. All infants possessed protective levels of anti-D and anti-T antibody levels after immunization.Randomized controlled trial of anterior-chamber intraocular lenses in Nepal: long-term follow-upS0042-968620000003000132016-01-01T00:02:00Z2001-01-28T00:08:00ZEvans, J.R.Hennig, A.Pradhan, D.Foster, A.Lagnado, R.Poulson, A.Johnson, G.J.Wormald, R.P.L.
<em>Evans, J.r.</em>;
<em>Hennig, A.</em>;
<em>Pradhan, D.</em>;
<em>Foster, A.</em>;
<em>Lagnado, R.</em>;
<em>Poulson, A.</em>;
<em>Johnson, G.j.</em>;
<em>Wormald, R.p.l.</em>;
<br/><br/>
Most of the estimated 20 million people who are blind with cataracts live in rural areas of developing countries, where expert surgical resources are scarce. We have studied the use of multiflex open-loop anterior-chamber intraocular lenses (ACIOL) in high-volume low-cost surgery. Between 1992 and 1995, a total of 2000 people attending Lahan Eye Hospital, Nepal, with bilateral cataracts reducing vision to < 6/36 were randomly allocated to receive intracapsular extraction (ICCE) with aphakic spectacles, or ICCE with an ACIOL. We re-examined the cohort (1305/2000, 65%) between November 1996 and April 1997 and report the findings in this article. There were 13 new cases of poor visual outcome (best corrected vision <6/60) arising after one year: 9 in the ACIOL group and 4 in the control group; odds ratio 2.1 (95% confidence interval, 0.59-9.55). The causes of poor outcome were as follows: ACIOL group - retinal detachment (4 cases), cystoid macular oedema (2), epiretinal membrane (1), age-related macular degeneration (1), and late endophthalmitis (1); control group - retinal detachment (2 cases), late endophthalmitis (1), and primary open-angle glaucoma with age-related macular degeneration (1). In rural areas of developing countries, well-manufactured multiflex open-loop ACIOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction.The role of son preference in reproductive behaviour in PakistanS0042-968620000003000142016-01-01T00:02:00Z2001-01-28T00:08:00ZHussain, R.Fikree, F.F.Berendes, H.W.
<em>Hussain, R.</em>;
<em>Fikree, F.f.</em>;
<em>Berendes, H.w.</em>;
<br/><br/>
The sex of surviving children is an important determinant of reproductive behaviour in South Asia in general and Pakistan in particular. This cohort study evaluates the role of the sex of children on reproductive intentions and subsequent behaviour of women in urban slums of Karachi, Pakistan. The analysis is based on two rounds of surveys conducted in 1990-91 and 1995 of a cohort of married women aged 15-49 years. The results show that pregnancies became increasingly unwanted as the number of surviving sons increased. The sex of surviving children was strongly correlated with subsequent fertility and contraceptive behaviour. However, rather than an exclusive son preference, couples strove for one or more sons and at least one surviving daughter. The policy implications of the link between overt son preference and low status of women are discussed.Rapid screening for Schistosoma mansoni in western Côte d’Ivoire using a simple school questionnaireS0042-968620000003000152016-01-01T00:02:00Z2001-01-28T00:08:00ZUtzinger, J.N’Goran, E.K.Ossey, Y.A.Booth, M.Traoré, M.Lohourignon, K.L.Allangba, A.Ahiba, L.A.Tanner, M.Lengeler, C.
<em>Utzinger, J.</em>;
<em>N’goran, E.k.</em>;
<em>Ossey, Y.a.</em>;
<em>Booth, M.</em>;
<em>Traoré, M.</em>;
<em>Lohourignon, K.l.</em>;
<em>Allangba, A.</em>;
<em>Ahiba, L.a.</em>;
<em>Tanner, M.</em>;
<em>Lengeler, C.</em>;
<br/><br/>
The distribution of schistosomiasis is focal, so if the resources available for control are to be used most effectively, they need to be directed towards the individuals and/or communities at highest risk of morbidity from schistosomiasis. Rapid and inexpensive ways of doing this are needed, such as simple school questionnaires. The present study used such questionnaires in an area of western Côte d’Ivoire where Schistosoma mansoniis endemic; correctly completed questionnaires were returned from 121 out of 134 schools (90.3%), with 12 227 children interviewed individually. The presence of S. mansoni was verified by microscopic examination in 60 randomly selected schools, where 5047 schoolchildren provided two consecutive stool samples for Kato-Katz thick smears. For all samples it was found that 54.4% of individuals were infected with S. mansoni. Moreover, individuals infected with S. mansoni reported ‘‘bloody diarrhoea’’, ‘‘blood in stools’’ and ‘‘schistosomiasis’’ significantly more often than uninfected children. At the school level, Spearman rank correlation analysis showed that the prevalence of S. mansoni significantly correlated with the prevalence of reported bloody diarrhoea (P = 0.002), reported blood in stools (P = 0.014) and reported schistosomiasis (P = 0.011). Reported bloody diarrhoea and reported blood in stools had the best diagnostic performance (sensitivity: 88.2%, specificity: 57.7%, positive predictive value: 73.2%, negative predictive value: 78.9%). The study, which is probably the largest of its kind ever undertaken in Africa, revealed a moderate diagnostic performance of questionnaires for identifying individuals and/or communities at high risk from S. mansoni.A proposal to declare neurocysticercosis an international reportable diseaseS0042-968620000003000162016-01-01T00:02:00Z2001-01-28T00:08:00ZRomán, G.Sotelo, J.Del Brutto, O.Flisser, A.Dumas, M.Wadia, N.Botero, D.Cruz, M.Garcia, H.Bittencourt, P.R.M. deTrelles, L.Arriagada, C.Lorenzana, P.Nash, T.E.Spina-França, A.
<em>Román, G.</em>;
<em>Sotelo, J.</em>;
<em>Del Brutto, O.</em>;
<em>Flisser, A.</em>;
<em>Dumas, M.</em>;
<em>Wadia, N.</em>;
<em>Botero, D.</em>;
<em>Cruz, M.</em>;
<em>Garcia, H.</em>;
<em>Bittencourt, P.r.m. De</em>;
<em>Trelles, L.</em>;
<em>Arriagada, C.</em>;
<em>Lorenzana, P.</em>;
<em>Nash, T.e.</em>;
<em>Spina-França, A.</em>;
<br/><br/>
Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation. Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious. Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis. With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease. New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries. An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs. We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health. Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns.Malaria drug resistanceS0042-968620000003000172016-01-01T00:02:00Z2001-01-28T00:08:00ZCommunity care not to blame for increased offending among the mentally illS0042-968620000003000182016-01-01T00:02:00Z2001-01-28T00:08:00ZMore partnerships to spur vaccine developmentS0042-968620000003000192016-01-01T00:02:00Z2001-01-28T00:08:00ZCommunity-based health care and development: exploring the mythsS0042-968620000003000202016-01-01T00:02:00Z2001-01-28T00:08:00ZHyder, Adnan A.
<em>Hyder, Adnan A.</em>;
<br/><br/>