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Rural-urban migration and population growth are occurring more quickly now than ever before in history. These phenomena have resulted in overcrowded urbanization and increased densities of vectors which in turn have caused an increase in disease such as malaria and dengue and dengue hemorrhagic fever. Besides urban areas foster the breeding of mosquitoes, rats, and other pests. Further governmental services in both developed and developing countries have not been able to keep up with housing and sanitation needs. Moreover new migrants continue to move into temporary housing (slums) made of inferior materials with no services while the previous occupants improve their wages and move on to better housing. Thus little incentive exists to improve slums where sanitation is poor and disease common. In addition, many formerly rural people continue rural practices and traditions in urban areas such as patterns of water storage. Further people often try to control vectors by applying pesticides, but do so haphazardly and/or in an unsafe, uncontrolled manner. They even use empty pesticide containers for storing water or food. Besides insecticide resistance is spreading. WHO encourages governments to integrate disease control programs with primary health care, but most such integrated programs operate in developed countries. Integrated approaches include less dependence on pesticides; encouraging changes in human behavior; disseminating health messages; community participation, particularly the youth; mobilization of human and financial resources; and proper urban development, e.g., better quality housing and adequate sanitation and potable water.
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PMID:Vector-borne disease problems in rapid urbanization: new approaches to vector control. 156 73

The latest mosquito survey of the warmer regions of New Zealand (NZ) sampled 2,304 larval mosquito habitats of all major categories. While revealing no evidence of new establishments of exotic mosquitoes, it produced important data revealing the underutilization of types of habitats that could be invaded now or in the future (especially if the "greenhouse effect" eventually causes even quite small rises in average temperatures and sea levels). Although long feared additions of malaria vectors to a fauna still lacking any species of Anopheles, or of essentially tropical arbovirus vectors from neighboring countries to the north and northeast, may not materialize failing climatic amelioration, a new danger appeared at the beginning of the 1988-89 Northern Mosquito Survey when Aedes albopictus was reported for the first time from Fiji. This vector of dengue hemorrhagic fever and Ross River virus has since been spreading widely on the archipelago's main island, Viti Levu, whence much air and sea traffic reaches NZ. Information presented and discussed herein strongly supports the continuance and improvement of international aircraft disinsection and other insect quarantine measures.
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PMID:New Zealand's northern mosquito survey, 1988-89. 197 49

In this review of studies on the hemorrhagic fevers of Southern Africa carried out in the South African Institute for Medical Research, attention has been called to occurrence of meningococcal septicemia in recruits to the mining industry and South African Army, to cases of staphylococcal and streptococcal septicemia with hemorrhagic manifestations, and to the occurrence of plague which, in its septicemic form, may cause a hemorrhagic state. "Onyalai," a bleeding disease in tropical Africa, often fatal, was related to profound thrombocytopenia possibly following administration of toxic witch doctor medicine. Spirochetal diseases, and rickettsial diseases in their severe forms, are often manifested with hemorrhagic complications. Of enterovirus infections, Coxsackie B viruses occasionally caused severe hepatitis associated with bleeding, especially in newborn babies. Cases of hemorrhagic fever presenting in February-March, 1975 are described. The first outbreak was due to Marburg virus disease and the second, which included seven fatal cases, was caused by Rift Valley fever virus. In recent cases of hemorrhagic fever a variety of infective organisms have been incriminated including bacterial infections, rickettsial diseases, and virus diseases, including Herpesvirus hominis; in one patient, the hemorrhagic state was related to rubella. A boy who died in a hemorrhagic state was found to have Congo fever; another patient who died of severe bleeding from the lungs was infected with Leptospira canicola, and two patients who developed a hemorrhagic state after a safari trip in Northern Botswana were infected with Trypanosoma rhodesiense. An illness manifested by high fever and melena developed in a young man after a visit to Zimbabwe; the patient was found to have both malaria and Marburg virus disease.
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PMID:The hemorrhagic fevers of Southern Africa with special reference to studies in the South African Institute for Medical Research. 689 72

The Consultative Group of the Children's Vaccine Initiative (CVI) held its annual meeting at WHO headquarters in Geneva in November 1992. The CVI meeting provided evidence of solid progress in development of a thermostable oral poliomyelitis vaccine and a single-dose tetanus toxoid vaccine. Researchers were able to stabilize the vaccine for several days at 37 degrees Celsius; this could make a more thermostable oral poliomyelitis vaccine available to the public before the end of the decade. One research project had solved the problem of stability of microencapsulated tetanus toxoid at 37 degrees Celsius. Based on recent research, it appears that microspheres for delivery of tetanus toxoid vaccines (of different sizes and/or compositions) can induce long-lasting immunity. The Consultative Group hopes that experts will conduct the industrial development of these vaccines within 3 years. A comprehensive database of the world's capacity to produce children's vaccines is being compiled, and investment strategies will assure that affordable vaccines are available for all children of the world. For the past 13 years, WHO has supported research at the Mahidol University in Bangkok, Thailand, to develop a safe, immunogenic, live, attenuated, tetravalent vaccine against the 4 strains of dengue virus. Formal Phase 1 and Phase 2 clinical trials have proved the vaccine to be safe and immunogenic in humans, thus bringing the Dengue Vaccine Development Project to a successful conclusion. Researchers are preparing to test the vaccine under actual field conditions for its efficacy in preventing dengue and dengue hemorrhagic fever among children in endemic communities. Participants in the Ministerial Conference on Malaria held in Amsterdam, the Netherlands, in October 1992 adopted a World Declaration on the control of malaria which will serve as a blueprint for action in the 1990s for a partnership of malaria-endemic and malaria-free countries.
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PMID:Children's vaccine initiative. 818 73

Just over a year ago, the Occupational Safety and Health Administration (OSHA) issued the final bloodborne pathogens standard, "Occupational Exposure to Bloodborne Pathogens; Final Rule," which requires healthcare institutions to protect their employees from all occupational exposure to bloodborne pathogens." According to OSHA, the only criterion for applying the standard is the likelihood of exposure to blood and other potentially infectious materials (OPIMs). Thus, the standard is designed to protect all vulnerable personnel, from the clinical engineers who service contaminated equipment to the staff in clinical laboratories, patient care or treatment areas, and housekeeping and laundry services--any location where the nature of the work poses the risk of exposure to bloodborne pathogens. All department heads and employees must have access to the standard and should carefully review our analysis of the regulations and recommendations for implementing them, as presented in this special issue of Health Devices. The standard is aimed at protecting employees from occupational exposure to all bloodborne pathogens and, especially, to the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV)--the most infamous pathogens transmitted through occupational exposure to blood and body fluids. Other bloodborne diseases referenced by OSHA in the preamble to the standard include arboviral infections, babesiosis, brucellosis, Creutzfeldt-Jakob disease, hepatitis C, human T-lymphotropic virus type I, leptospirosis, malaria, relapsing fever, syphilis, and viral hemorrhagic fever. In this issue, we provide a clinical overview of HIV and HBV and the diseases they cause, as well as a brief discussion of other bloodborne pathogens; an analysis of the most significant regulations affecting hospitals; and our recommendations for compliance. The recommendations presented in this article do not exhaust the possibilities for reducing exposure and complying with the standard. We invite you to communicate your ideas and practices regarding compliance issues to the ECRI-sponsored Center for Healthcare Environmental Management (CHEM) for possible inclusion in a future update to its loose-leaf reference publication, the Healthcare Environmental Management System. We wish to acknowledge CHEM's contribution in developing this special report, which was reviewed by the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), and OSHA. Also see "CDC's Recommendations for Hepatitis B Vaccination and Postexposure Follow-up" and "A Minimal Training Syllabus" in this issue.
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PMID:OSHA's bloodborne pathogens standard: analysis and recommendations. 844 29

The sixth Spanish language symposium presented by the American Mosquito Control Association (AMCA) was held as part of the 62nd Annual Meeting in Norfolk, VA, in March 1996. The principal objective, as for the previous 5 symposia, was to promote the participation in the AMCA meeting by vector control specialists, public health workers, and academicians from Latin America. This publication includes summaries of 25 presentations that were given in Spanish by participants from 6 countries in Latin America and the USA. The symposium included the following topics: ecological and genetic studies of anopheline vectors of malaria, laboratory and field evaluations of chemical control methods for several mosquito species, ecological studies and community control of Aedes aegypti, and reports of dengue/dengue hemorrhagic fever and Venezuelan equine encephalitis epidemics that occurred in Latin America in 1995.
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PMID:Mosquito vector control and biology in Latin America--a sixth symposium. 888 26

In Indonesia, rapid economic development has led to a reduction in poverty among the 195 million inhabitants. While population increased more than 50% from 1971 to 1990, the annual growth rate, crude birth rate, and total fertility rates have declined rapidly. Life expectancy has increased from 45.7 years in 1971 to 62.7 in 1994 as crude death rates and infant and child mortality rates have declined. Causes of death have shifted from infectious to chronic diseases, but in 1992 major causes of death in children under 5 years old were preventable, and the maternal mortality rate was 425/100,000. Policies which guide the development of health care call for improvements in quality of life, adherence to humanitarian principles, use of scientifically approved traditional medicine, and provision of public health through a three-tiered system. Health care is financed by the government and the community, and managed care has been encouraged. Foreign aid has bolstered development in the health sector. Adequate sanitation has been achieved for 35% of the population, and 65% of urban and 35% of rural residents have reasonable access to clean water. Improvements in health indicators include 55% contraceptive prevalence, reduction in prevalence of anemia during pregnancy, 55.8% of pregnant women receiving prenatal care, a decrease in protein-energy malnutrition among children under five, and high vaccination coverage. Remaining public health problems include malaria, tuberculosis, dengue hemorrhagic fever, an increase in HIV/AIDS, iodine-deficiency, an increasing number of traffic fatalities, and an increasing number of smokers. New health policies have been instituted to meet these challenges as Indonesia's need for a productive and competitive labor force increases.
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PMID:Health services in Indonesia. 898 47

Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. In 1998 this mosquito-borne disease is the most important tropical infectious disease after malaria, with an estimated 100 million cases of dengue fever, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually. The reasons for this resurgence and emergence of dengue hemorrhagic fever in the waning years of the 20th century are complex and not fully understood, but demographic, societal, and public health infrastructure changes in the past 30 years have contributed greatly. This paper reviews the changing epidemiology of dengue and dengue hemorrhagic fever by geographic region, the natural history and transmission cycles, clinical diagnosis of both dengue fever and dengue hemorrhagic fever, serologic and virologic laboratory diagnoses, pathogenesis, surveillance, prevention, and control. A major challenge for public health officials in all tropical areas of the world is to develop and implement sustainable prevention and control programs that will reverse the trend of emergent dengue hemorrhagic fever.
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PMID:Dengue and dengue hemorrhagic fever. 966 79

This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure of impact, lost to dengue in Puerto Rico for the period 1984-1994. Data on the number of reported cases, cases with hemorrhagic manifestations, hospitalizations, and deaths were obtained from a surveillance system maintained at the Dengue Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (San Juan, PR). The reported cases were divided into two age groups (0-15 years old and >15 years old), and then multiplied by predetermined factors (10 for 0-15 years; 27 for >15 years) to allow for age-related under-reporting of cases. Severity of dengue was modeled by classifying cases into three groups: dengue fever, dengue with severe manifestations, and hospitalized cases. Each group was assigned a different number of days lost because of dengue-related disability. Dengue caused an average of 658 DALYs per year per million population (SE = 114, range = 145-1,519). A multivariate sensitivity analysis, which simultaneously altered the values of six input variables, produced a mean of 580 DALYs/year/million population, with a maximum average of 1,021 DALYs/year/million population, and a maximum, single-year estimate for 1994 of 2,153 DALYs/million population. The most important input was the number of days lost to classic dengue. The DALYs/year/million population lost to dengue in Puerto Rico are much greater than previous estimates concerning the impact of dengue hemorrhagic fever alone. The loss to dengue is similar to the losses per million population in the Latin American and Caribbean region attributed to any of the following diseases or disease clusters; the childhood cluster (polio, measles, pertussis, diphtheria, tetanus), meningitis, hepatitis, or malaria. The loss is also of the same order of magnitude as any one of the following: tuberculosis, sexually transmitted diseases (excluding human immunodeficiency virus), tropical cluster (e.g., Chagas' disease, leishmaniasis), or intestinal helminths. The results objectively suggest that when governments and international funding agencies allocate resources for research and control, dengue should be given a priority equal to many other infectious diseases that are generally considered more important.
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PMID:Using disability-adjusted life years to assess the economic impact of dengue in Puerto Rico: 1984-1994. 971 44

Blood samples from patients with viral hemorrhagic fever (VHF) pose a serious risk to laboratory workers. Current contingency plans for VHF samples recommend the use of heat, gamma-irradiation, or Triton X-100 to inactivate samples before handling. Malaria is the most important alternative diagnosis to be excluded in cases of suspected VHF. Interpretation of malaria smears using samples inactivated with these methods is problematic because morphology is altered. The objective of this study was to assess the impact of different inactivation methods on the performance of rapid diagnostic tests for Plasmodium falciparum. Triton X-100 and gamma-irradiation of samples preserved detection. The impact of Triton X-100 inactivation was also "blindly" evaluated using 100 blood samples from febrile travelers. Triton X-100 inactivation of samples did not significantly affect the performance of these tests. This may represent a useful strategy for excluding the diagnosis of falciparum malaria in cases of suspected VHF.
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PMID:Effects of viral hemorrhagic fever inactivation methods on the performance of rapid diagnostic tests for Plasmodium falciparum. 981 50


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