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Research programs in developing countries show no priorities. The World Health Organization (WHO) has promoted primary health care (PHC) and the experience of the developed countries and the developing countries is the same namely that the health improvement was due to a reduction of deaths from infectious diseases. The direct reasons for this are: 1) increased resistance; and 2) reduced exposure. Indirect influences include fertility control and advances in primary and secondary education. Economic prosperity is not always essential. Equity of access to the health determinants was important, as was the social and political will to bring about health improvements. Food is a major influence on health. People must have enough to eat. Many countries do not have enough food. Supplies are insufficient to provide everyone with an adequate diet. Several countries which do produce enough food for their populations cannot meet unstable world prices. The food available is often unevenly distributed, between countries and within them. In 1987, 50% of the children of the world were protected against tetanus, poliomyelitis, whopping cough, diphtheria, tuberculosis, and measles; 10 years earlier, it had been 5%. By the year 2000, poliomyelitis should be eradicated; deaths from neonatal tetanus should disappear, and measles mortality should be reduced by 95%. Diarrhea is serious in children. Attempts are being made to treat it with oral rehydration therapy (ORT). It is also necessary to prevent transmission of germs that cause diarrhea. In Africa, before 1950, the population growth rate was over 1% per year. Today is it 3%, on average. Many epidemic plagues have lost their demographic import. UN estimates show that world population, now 5 billion, will be 6 billion by 2000, 8 billion by 2025, and 10 billion when it stabilized in 2100. A consequence of demographic trends is the movement of people, not only from 1 country to another, but from rural to urban areas within a country. The setting of population goals is a sensitive issue.
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PMID:The road to health. 263 16

Within three years we have observed three patients with parotitis after measles-mumps-vaccination, one child with idiopathic thrombocytopenic purpura, one with meningitis, and one patient with a preexisting severe cerebral damage died of central vasomotor and breath regulation dysfunction 20 days after the vaccination. Their case histories are described here, and the literature dealing with this question is reviewed. The following incidences of side effects may have to be accepted: "vaccination measles" (fever, rash, conjunctivitis, coughing) 5%, parotid swelling 1%. Furthermore, there are reports and observations on 38 patients who have developed ITP after vaccination, and on 8 other children who developed meningitis. From their lumbar liquor, mumps- or vaccine mumps viruses have been cultured. There are, as yet, no markers that would permit a typing of these viruses. Parents will have to be informed of these possible side effects and observations. In addition to that further information is not necessary on other very rare observations with as yet not established causal relationship with the vaccination. The measles-mumps-vaccination correctly is regarded as to be of low risk. Its usefulness is apparent when the frequency of side effects discussed here is compared to the incidence of grave complications of wild measles and mumps infections.
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PMID:[Side effects and complications of measles-mumps vaccination]. 268 12

This report is of a case of giant cell interstitial pneumonia (GIP) diagnosed by transbronchial lung biopsy (TBLB) and treated effectively with corticosteroid. The patient was a 61-year-old man with cough, dyspnea and findings of diffuse reticular opacities on chest X-ray. In the microscopic section of a biopsied specimen, varied forms of giant cells were observed, some with a cannibalistic appearance. Numerous giant cells and some lymphocytes were also observed in the bronchoalveolar lavage fluid. The possibility of measles pneumonia was ruled out by a negative serum antibody test and the absence of inclusion bodies in the giant cells. The patient had neither a past history of exposure to heavy metals nor to organic dusts. A distinct improvement was obtained with 30 mg of prednisolone administered daily for two weeks and then tapered off gradually.
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PMID:A case of giant cell interstitial pneumonia. 271 33

Among the acquired or congenital valvular dysfunctions that require conservative valvuloplastic surgical intervention or valvular replacement, the rheumatic valve disease is reported in a limited number of cases among the developed countries, while it is frequent in those with precarious socio-economic conditions. In these countries there are many cases of rheumatic valve diseases during childhood, quickly leading to serious health conditions to require valve replacement during second and third childhood. On the contrary, in the more developed countries, congenital valvular disease prevail by far. The child who underwent valve replacement, once dismissed from cardio-surgical centre, must be nursed domiciliary by his family pediatrician. This assistance consists in a strict supervision for a precocious identification of valvular prosthesis dysfunctions and possible embolic and hemorrhagic complications and in supplying anticoagulant therapy. For this purpose it is important to refer to a well equipped cardiological centre. Besides these fundamental tasks there are others - equally important - directed to preserve health: curing each pathological extracardiac event, intercurrent or recurrent; preventing, with or without compulsory vaccinations, infectious childhood's diseases; preventing especially bacterial endocarditis as the most frequent cause of prosthesis pathology. This work pays particular attention to bacterial endocarditis (prophylaxis and cure). Thromboembolism and anticoagulant therapy (with the list of coumarin drug interventions) have also been dealt. Moreover we have reported brief indications on the prevention and/or cure of diseases for which vaccination is not compulsory, such as: measles, chicken-pox, whooping-cough, typhus, influenza. Our script ends with good suggestions on nourishment and physical activity.
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PMID:[The pediatrician faced with the child with a valvular prosthesis]. 282 34

In a randomised trial, infants living in a large village in The Gambia were immunised either at 4 months of age with 40,000 plaque forming units (PFU) of the Edmonston-Zagreb (EZ) measles vaccine or at the usual age of 9 months with 6000 TCID50 of a conventional Schwarz measles vaccine. Measles developed in 2 of 119 children who received the EZ vaccine, in 1 before and in the other after 9 months of age. In the Schwarz group measles developed in 7 of 120 children--in 5 before and in 2 after 9 months of age. Serological responses measured at 5 months after vaccination and at 18 months of age were satisfactory in both groups although in the Schwarz group levels were on average 2-fold higher than in the EZ group. The frequencies of fever, cough, vomiting, and diarrhoea were no higher in the EZ vaccinees in the 3 weeks following vaccination than in age-matched non-immunised controls. Long-term morbidity as assessed by clinic attendances and weight at 18 months of age was much the same in the two groups. The EZ measles vaccine is thus safe and clinically and serologically effective when used in a high dose to immunise young Gambian infants.
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PMID:Trial of high-dose Edmonston-Zagreb measles vaccine in the Gambia: antibody response and side-effects. 290 64

In 1985, 69 secondary cases, all in one generation, occurred in an Illinois high school after exposure to a vigorously coughing index case. The school's 1,873 students had a pre-outbreak vaccination level of 99.7% by school records. The authors studied the mode of transmission and the risk factors for disease in this unusual outbreak. There were no school assemblies and little or no air recirculation during the schooldays that exposure occurred. Contact interviews were completed with 58 secondary cases (84%); only 11 secondary cases (19%) of these may have had exposure to the index case in the classrooms, buses, or out of school. With the use of the Reed-Frost epidemic model, only 22-65% of the secondary cases were likely to have had at least one person-to-person contact with the index case during class exchanges, suggesting that this mode of transmission alone could not explain this outbreak. A comparison of the first 45 cases and 90 matched controls suggested that cases were less likely than controls to have provider-verifiable school vaccination records (odds ratio (OR) = 8.1) and more likely to have been vaccinated at less than age 12 months (OR = 8.6) or at age 12-14 months (OR = 7.0). Despite high vaccination levels, explosive measles outbreaks may occur in secondary schools due to 1) airborne measles transmission, 2) high contact rates, 3) inaccurate school vaccination records, or 4) inadequate immunity from vaccinations at younger ages.
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PMID:An explosive point-source measles outbreak in a highly vaccinated population. Modes of transmission and risk factors for disease. 291 58

Infant and early childhood mortality in Senegal's Sine-Saloum region was investigated through use o f data from a 1982-83 family health survey. The survey involved interviews with 1894 married women 15-44 years of age living in extended family residential units in rural areas. Given evidence of substantial underreporting of early deaths, at least among children born before 1980, an adjustment factor was applied to the survey data. Infant mortality was estimated to be about 113/1000 live births and mortality before age 5 years was 263/1000. Strong mortality differentials, particularly after infancy, were noted according to the 2 socioeconomic variables included in the analysis: type of house and father's occupation. The probability of dying at ages 1-4 years was 50% higher among children living in traditional homes than among those in modern homes as well as among children whose fathers' were engaged in primary sector occupations (farming, livestock, fishing). Infant mortality showed no sex differential, while mortality at ages 1-4 years was 18% higher among females. Diarrheal and respiratory diseases were the 2 leading causes of death, killing at least 15% of all children by 5 years of age. Tetanus was an important cause of death during infancy, while measles and malaria were significant causes only after the 1st birthday. For all causes of death, the effect of socioeconomic status is higher in early childhood than in infancy, presumably because of the protective effect of breastfeeding. 82% of children who died had fever during their terminal illness, 51% had diarrhea, 39% had a cough, and 14% a rash. At least some mortality in this area might be prevented through treatment of these symptoms. However, calculating the degree to which particular interventions such as oral rehydration for diarrhea would reduce mortality is a complex task, requiring knowledge of replacement mortality, effectiveness of interventions, and the numbers of mothers who would utilize them.
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PMID:Infant and early childhood mortality in the Sine-Saloum region of Senegal. 319 59

An unusual outbreak of measles occurred in 1982 in a pediatrician's office in Muskegon, Mich. Three children, who had arrived at the office 60 to 75 minutes after a child with measles had departed, developed measles. Using a model based on airborne transmission, it is estimated that the index patient was producing 144 units of infection (quanta) per minute while in the office. Characteristics such as coughing, increased warm air recirculation, and low relative humidity may have increased the likelihood of transmission. Adequate immunization of all patients and staff, respiratory isolation and prompt care of all suspected cases, and adequate fresh-air ventilation should decrease the risk of airborne transmission of measles in this setting. Airborne transmission may occur more often than previously suspected, a possibility that should be considered when evaluating current measles control strategies.
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PMID:Airborne transmission of measles in a physician's office. 397 36

In February 1981, a measles outbreak occurred in a pediatric practice in DeKalb County, GA. The source case, a 12-year-old boy vaccinated against measles at 11 1/2 months of age, was in the office for one hour on the second day of rash, primarily in a single examining room. On examination, he was noted to be coughing vigorously. Seven secondary cases of measles occurred due to exposure in the office. Four children had transient contact with the source patient as he entered or exited through the waiting room; only one of the four had face-to-face contact within 1 m of the source patient. The three other children who contracted measles were never in the same room with the source patient; one of the three arrived at the office one hour after the source patient had left. The risk of measles for unvaccinated infants (attack rate 80%, 4/5) was 10.8 times the risk for vaccinated children (attack rate 7%, 2/27) (P = .022, Fisher exact test, two-tailed). Airflow studies demonstrated that droplet nuclei generated in the examining room used by the source patient were dispersed throughout the entire office suite. Airborne spread of measles from a vigorously coughing child was the most likely mode of transmission. The outbreak supports the fact that measles virus when it becomes airborne can survive at least one hour. The rarity of reports of similar outbreaks suggests that airborne spread is unusual. Modern office design with tight insulation and a substantial proportion of recirculated ventilation may predispose to airborne transmission.
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PMID:Measles outbreak in a pediatric practice: airborne transmission in an office setting. 398

This paper describes the results of a study of live attenuated measles vaccines (one in a series of WHO-sponsored field trials) carried out in children 6-33 months old at an orphanage in Quebec City. The Enders Edmonston B vaccine alone and the same vaccine administered with gamma-globulin were compared with the Schwarz further-attenuated vaccine. The over-all seroconversion rates were found to be 96.9%, 98.1% and 98.8% respectively. Severe clinical reactions, except for high fever, were not observed in any of the groups. Rectal temperatures over 103 degrees F (39.5 degrees C) were noted in 16.2% of the children given Schwarz vaccine, in 59.2% of the children receiving the Enders Edmonston B vaccine alone and in 27.8% of the children inoculated with the Enders Edmonston B vaccine plus gamma-globulin. The high incidence of mild pharyngitis following inoculation of these vaccines was not observed in the group of children who had received vaccine plus gamma-globulin. No significant differences were noted in the frequency of other symptoms, such as cough, coryza, conjunctivitis and diarrhoea, between vaccinated and control groups.
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PMID:Studies on attenuated measles-virus vaccines in Canada. 529 4


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