Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
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Emergency physicians (EPs) are increasingly participating in international medicine in regions that are chronically medically underserved. In August 1994, a ten-member emergency medicine team from the Loma Linda University School of Medicine staffed a 70-bed bush hospital in the primitive highlands of Papua New Guinea, providing both outpatient and inpatient medical care. Typhoid fever, malaria, polio, and numerous other infectious diseases were encountered. Rampant local tribal warfare resulted in regular penetrating injuries from arrows, spears, and machetes. The expedition was judged highly successful, in that 1) substantial medical service was provided to tribespeople accustomed to minimal care, 2) education was provided to local health care providers, and 3) team participants became adept at managing medical conditions uncommon in industrialized societies, and gained valuable ethical and utilitarian perspectives regarding health care delivery in underserved areas. In this article the objectives, organization, and experiences of the team members are described. This information may encourage other EPs to participate in medical expeditions to the developing world, and to provide general principles to assist in their organization and implementation.
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PMID:Emergency medicine expeditions to the developing world: the Loma Linda University experience in Papua New Guinea. 872 34

The SPf66 hybrid malaria vaccine is a polymeric, synthetic protein with amino-acid sequences derived from the pre-erythrocytic and asexual-blood-stage proteins of Plasmodium falciparum. SPf66 has already been found to have a 31% protective efficacy in Tanzanian children aged 1-5 years who lived in an area of intensive malaria transmission. A randomized, double-blind, placebo-controlled trial of SPf66 was carried out in Gambian infants. Overall, 630 children, aged 6-11 months at the time of the first dose, each received three doses of SPf66 or inactivated polio vaccine (IPV). Morbidity was monitored during the following rainy season by means of active and passive case detection. Cross-sectional surveys were carried out at the beginning and at the end of the rainy season. Analysis of efficacy was restricted to 547 of the children (316 receiving SPf66 and 231 IPV). Although the efficacy of SPf66 on the first or only clinical attack was found to be 8% when results were compared with those for the children given the placebo (IPV), the malarial vaccine had no significant effect on fever with any parasitaemia, the overall incidence of clinical attacks, packed-cell volumes, parasite prevalences or spleen rates. Compared with the present vaccine, insecticide-treated bednets appear to offer better prospects for control of malaria in Africa.
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PMID:An efficacy trial of a malaria vaccine in Gambian infants and comparison with insecticide-treated bednets. 894 81

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.
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PMID:A week in the life of a travel clinic. 933 67

150 human subjects aged 6-11 months were involved in a pilot safety and immunogenicity trial of the malaria vaccine SPf66 conducted in The Gambia in 1993. The infants were immunized with either 0.5 mg or 1.0 mg of the vaccine produced in either Colombia or the US, or with a control vaccine. Children who received SPf66 experienced more clinical attacks of malaria than did children in the control group during the first period of surveillance, with the difference in incidence between children who had received high dose Colombian vaccine and the control children being statistically significant. 127 children from the original cohort of 150 were observed during the 1995 malaria transmission season. During 18 weeks of intensive surveillance, the incidence of clinical malaria was again higher among children who had received SPf66 than among children who had received inactivated polio vaccine. The effect was most marked among children in the high dose groups, although the intergroup differences were statistically insignificant. The SPf66 vaccine may have induced an immune response which made the immunized children more susceptible to malaria. It is also possible that the increased susceptibility to malaria among children who received SPf66 was a chance event following the randomization process. No enhancement of either disease frequency or severity was found in a much larger efficacy trial of Colombian SPf66 conducted among Gambian children during a 2-year follow-up period.
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PMID:Follow-up of Gambian children recruited to a pilot safety and immunogenicity study of the malaria vaccine SPf66. 945 70

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

For over a decade we have maintained within a district of 5 million people, a system of prompt reporting of cases of childhood vaccine-preventable diseases, encephalitis, meningitis, hepatitis, and rabies; together with a sentinel laboratory surveillance of cholera, typhoid fever, malaria, HIV infection and antimicrobial-resistance patterns of selected pathogens. The system combined government and private sectors, with every hospital enrolled and participating. Reports were scanned daily on a computer for any clustering of cases. Interventions included investigations, immunisation, antimicrobial treatment, health education, and physical rehabilitation of children with paralysis. All vaccine-preventable diseases have declined markedly, whilst malaria and HIV infections have increased steadily. Annual expense was less than one US cent per head. The reasons for the success and sustainability of this model include simplicity or reporting procedure, low budget, private-sector participation, personal rapport with people in the network, regular feedback of information through a monthly bulletin, and the visible interventions consequent upon reporting. This district-level disease surveillance model is replicable in developing countries for evaluating polio eradication efforts, monitoring immunisation programmes, detecting outbreaks of old or new diseases, and for evaluating control measures.
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PMID:Disease surveillance at district level: a model for developing countries. 979 29

Travelers' immunization has 2 aims: for the traveler, to prevent the risk of contracting an endemic disease during his stay abroad; for the community to prevent the risk of importing an infectious agent yet unknown in the country. Travelling offers an opportunity to update routine immunizations: tetanus, diphtheria, poliomyelitis, hepatitis B; for young people: measles and rubella; for elderly people: influenza. Two vaccinations are compulsory: yellow fever for travelers to tropical Africa and Amazonian forest; meningococcus A + C for Mecca pilgrims. Other vaccines are recommended for travelers to specific areas: typhoid fever, hepatitis A, cholera in countries with poor hygiene; rabies for exposed travelers (expatriates, trekkers...); Japanese encephalitis for persons spending a month or longer in rural agricultural areas during the monsoon season; tickborne encephalitis for persons visiting forested areas of central Europe from may to september. Yet, most of travelers' diseases such as malaria cannot be prevented by vaccination and appropriate preventive measures (chemoprophylaxis and protection against insects) should be taken.
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PMID:[Vaccinations of the traveller]. 985 43

The declaration in 1980 that smallpox had been eradicated reawakened interest in disease eradication as a public health strategy. The smallpox programme's success derived, in part, from lessons learned from the preceding costly failure of the malaria eradication campaign. In turn, the smallpox programme offered important lessons with respect to other prospective disease control programmes, and these have been effectively applied in the two current global eradication initiatives, those against poliomyelitis and dracunculiasis. Taking this theme a step further, there are those who would now focus on the development of an inventory of diseases which might, one by one, be targeted either for eradication or elimination. This approach, while interesting, fails to recognize many of the important lessons learned and their broad implications for contemporary disease control programmes worldwide.
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PMID:Eradication: lessons from the past. 1006 68

In West Africa, the incidence of poliomyelitis has decreased in the past years thanks to intensive immunization campaigns. Nowadays intramuscular injection is the main reason for paralysis of the legs in African children as well as attendance at Rehabilitation Centres. Intramuscular injection of quinine is the most frequently reported. Faced with the lack of sterile material, health workers do not rationalize the use of intramuscular injections. Although the use of the same needle has decreased, using the same syringe for many patients, with only a rapid washing between, is still commonplace Poor septic conditions and abuse of prescriptions also contribute to the transmission of severe diseases (hepatitis, malaria, syphilis, filariasis, Ebola virus, tetanus and HIV). Paralysis due to injection is often confused with poliomyelitis and health workers are often not aware of the sequelae of injection. It seems important to prevent risk related to intramuscular injection in Africa through educating health workers and the local population. Rationalization of practises, promotion of oral therapy and alternatives to intramuscular administration should be carried out. In this respect, the intrarectal administration of an injectable solution of diluted quinine--its efficiency and pharmacokinetic having been studied over the last ten years--offers interesting opportunities.
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PMID:[Intramuscular injections in Sub-saharan African children, apropos of a frequently misunderstood pathology: the complications related to intramuscular quinine injections]. 1021 19

Antibody responses to the malaria vaccine SPf66 and to its constituent peptides were measured over a period of 2 years in Gambian children who had been immunized with SPf66 or with a control vaccine (inactivated polio vaccine). Three hundred and six of 308 children (99%) who had received three doses of SPf66 vaccine had antibodies to SPf66 at a level above that found in European controls who had not been exposed to malaria. Responses to the constituent peptides derived from 35.1, 55.1 and 83.1-kDa proteins were found in 88%, 97% and 97% of children, respectively; 26% had an antibody response to the NANP repeat peptide of circumsporozoite protein which is also included in the SPf66 vaccine. A response to SPf66 was found in 22% of children who had received the control vaccine. Antibody responses to NANP, 35.1, 55.1 and 83.1-kDa peptide were found in 3%, 33%, 49% and 33% of these children. Overall, no significant correlation was found between the level of anti-SPf66 antibody at the beginning of the malaria transmission season following vaccination and the subsequent risk of malaria. However, further analysis showed that among the control children who had acquired antibodies to SPf66 as a result of natural exposure to malaria, those with high levels of anti-SPf66 were less at risk of malaria, perhaps reflecting their greater previous exposure and thus immunity. In contrast, among children who had received three doses of SPf66, those with high antibody levels were at greater risk of have malaria during the subsequent malaria transmission season.
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PMID:Serological responses of Gambian children to immunization with the malaria vaccine SPf66. 1041 67


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