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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A number of newly-developed vaccines are available nowadays, whilst others, which are well-established, have been improved. The collection of epidemiological data, however, is equally important in assessing and providing insight into prophylactic measures. The beneficial effects and risks of vaccination may be calculated by special formulae. Changes in the effect of vaccines can be detected by constant reevaluation of the epidemiological situation by means of these formulae. Another possibility lies in the calculation of the borderline number of complications of a certain disease when the risks of the sequelae of the disease or of the vaccination are about equal. Examples of valuable and recommendable vaccinations are vaccination against measles, poliomyelitis, tetanus and tick-borne encephalitis. A follow-up of the case mortality of whooping-cough in Austria over the past 15 years and a consideration of the fatal complications of vacinnation, as quoted by Ehrengut, reveals that the risks of the disease balanced the risks of vaccination with usual vaccines, already in 1971 (1976 with WHO data). A beneficial effect of BCG vaccination is still present, but the influence on mortality figures is very slight only. However, the benefit of BCG may lie in the prevention of deaths from leukaemia observed by some authors. Paraspecific effects of some vaccinations are mentioned. Finally, cost-benefit calculations for Austria are presented in the case of vaccination against measles and mumps, which appear to be highly recommendable, not only from the medical, but also the economic point of view.
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PMID:[Modern trends in vaccination policy: evaluation of benefits, risks and cost (author's transl)]. 10 58

This paper is a description of a vaccination programme against the most frequent communicable diseases among children: measles, tuberculosis, diphtheria, tetanus, whooping-cough and poliomyelitis. The programme is to be carried out in three different climate zones (town, forest and savanna) and over a period of six years. The project is supported by US-AID and UNICEF.
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PMID:[A broad program of vaccination in the Ivory Coast]. 22 14

A retrospective study to investigate infant mortality was conducted in one of the poorest rural areas in Mali. The study was conducted through questionnaires, and was made among 811 women in 11 different villages. 3204 live births were recorded; 615 newborns, however, died before 1 year of life, i.e. an infant mortality rate of almost 250/1000. Main causes of mortality were obstetrical factors, tetanus, malaria, several types of pneumopathies, toxicoses, and nutrition disorders. Symptoms were the same in all villages, convulsions, cough, fever, and diarrhea. Action to improve the socioeconomic development of the area, set up a working national health structure, and a program of control of communicable diseases should be the first concern of local leaders and of national authorities.
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PMID:[An example of the application of factorial analysis of correspondences to infant mortality and its prevention in a rural area of West Africa]. 46 54

The vaccination status was investigated in 1482 patients between the ages of 1 and 14 years admitted to hospital with scarlet fever. Most of the patients were vaccinated against tuberculosis (97.7%), diphtheria, tetanus and whooping-cough (95.3%) and poliomyelitis (94.1%), relatively few against measles (21.1%) and very few indeed against mumps (0.7%) and tick-borne encephalitis (1.9%). The booster vaccination against tetanus and diphtheria had been omitted in more than 40%. Although the beneficial results of vaccination against tuberculosis, diphtheria-pertussis-tetanus and poliomyelitis remained more or less the same, the tendency towards vaccination did not spread as might have been anticipated. On the contrary, the extent of vaccination decreased, especially during the past years. In the same way the tendency towards vaccination against measles showed a sudden slowing down after a period of rapid increase. This implies that vaccination of children does not tend towards perfection. The vaccination rates differ widely between foreign children living in Vienna and natives. Although the foreigners show a similar vaccination distribution pattern as the natives, the numbers of unvaccinated children are much higher.
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PMID:[Vaccination status of children in the Vienna area (author's transl)]. 74 51

In developing countries, diagnoses of diseases associated with deaths in children are frequently derived from retrospective maternal interviews. To determine the validity of this methodology, and to define sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers using structured questionnaires, with selected physician diagnoses for 164 deaths among hospitalized children on the Philippine island of Cebu. The 164 decreased children had 256 physician diagnoses of acute lower respiratory infections (ALRI) (100), diarrhoeas (92), measles (48), and neonatal tetanus cases (16). Forty-three per cent of children had multiple illnesses. An algorithm for tetanus (age at death less than or equal to 30 days with convulsion or spasm) was 100% sensitive, but specificity could not be estimated due to the small number of comparison neonatal deaths. An algorithm for measles (age greater than or equal to 120 days, with rash and fever for at least three days) had 98% sensitivity and 90% specificity. Diagnosis of ALRI was more difficult, cough and dyspnoea alone yielding 86% sensitivity but low specificity, whereas prolonged cough and dyspnoea provided 93% specificity but low sensitivity (41%). Diarrhoea diagnoses based on frequent loose or liquid stools had high sensitivity (78-84%) and specificity (79%), irrespective of whether the child died with diarrhoea alone or in combination with other illnesses. However, maternal reports of moderate/severe dehydration had low specificity. We conclude that, in this setting, verbal autopsies can diagnose major illnesses contributing to death in children with acceptable sensitivity and specificity.
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PMID:Validation of postmortem interviews to ascertain selected causes of death in children. 237 51

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

Although the death rates from neonatal tetanus have been lowered and the death rates from childhood diarrhoea are becoming lower in India and Indonesia, death rates from pneumonia have not yet begun to fall. Pneumonia has become the greatest killer of children and the most important cause of preventable death. The reason for this relative rise in significance may lie in the failure to realize that the majority of the most acute cases of respiratory illness are not viral but rather bacterial infections which rapidly respond to appropriate antibiotic therapy. This paper reviews recent research on the aetiology of pneumonia; it examines age distribution and regional variation in morbidity and mortality; and it concludes by suggesting appropriate pneumonia treatment and case management guidelines. The essential priority is to make procaine penicillin available to children presenting with cough and a respiratory rate over 50 breaths per minute. This alone would substantially reduce the number of child deaths in India and Indonesia.
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PMID:Management of pneumonia in India and Indonesia. 268 22

To help develop better diagnostic tests for pertussis, we examined the serologic response to whole-cell proteins of Bordetella pertussis after natural infection or vaccination with diphtheria-tetanus-pertussis vaccine. Serum specimens collected during a pertussis outbreak investigation and from uninfected persons were used in Western blot (immunoblot) analyses to determine the presence of immunoglobulin G (IgG) and IgA antibodies to specific B. pertussis proteins. IgG antibodies to proteins of molecular masses 220 and 210 kilodaltons (kDa) were detected in 14 of 18 serum samples obtained from patients with culture-confirmed pertussis greater than or equal to 40 days after the onset of coughing. IgA antibodies were detected in 15 of the 18 samples. Of 19 serum samples obtained from patients who had not been ill with pertussis, 6 contained IgG antibodies to these proteins and 1 contained IgA antibodies. The two proteins bound antiserum specific for filamentous hemagglutinin and comigrated with purified filamentous hemagglutinin. IgG antibodies to two additional protein bands of molecular masses 84 and 75 kDa were associated with previous vaccination. Antibody to the 84-kDa protein was detected in 15 of 17 vaccinated, never-infected persons, and antibody to the 75-kDa protein was detected in 16 of the 17. None of 11 nonvaccinated, never-infected persons tested had antibodies to either protein. All seven fully vaccinated persons with culture-documented infection had antibodies to both proteins. Antibodies to the 84-kDa protein were detected in 6 of 22 nonvaccinated and infected persons, and antibodies to the 75-kDa protein were detected in 8 of the 22. Use of Western blot analysis in this study allowed us to distinguish antibody responses to infection and immunization.
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PMID:Immunoblot analysis of humoral immune responses following infection with Bordetella pertussis or immunization with diphtheria-tetanus-pertussis vaccine. 290 Aug 46

177 children between 1 and 3 years (74 well-nourished, 55 suspected of protein/calorie deficiency, 48 under nourished) were vaccinated (tuberculosis, diphtheria, tetanus, whooping-cough, polio); one month after the third dose of DTWC polio, we proceeded to apply the Merieux multitest and to check for intradermal reaction to the tuberculin: This study has shown that the Merieux multitest gives results comparable to the classical intradermal method with tuberculin. The multitest makes it possible to explore simultaneously seven different antigens under perfectly comparable conditions from the standpoint of precision and standardization (diphtheria, tetanus, tuberculin, Streptococcus, Proteus, Trichophyton and Candida). This exploration has shown that there is no significant difference in terms of the nutritional condition of the children. Well-nourished children, under-nourished children and children suspected of a deficiency react in the same manner to antigenic attractions whether vaccinal or spontaneous. This study would seem to suggest, therefore, that the nutritional conditions of a child need not to be taken into account when administering a vaccine.
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PMID:[Immune response as a function of the nutritional status in young children 1 to 3 years of age in the south of Ivory Coast]. 299 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


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