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In a clinical trial of stabilized yellow fever vaccine from Institute Pasteur in 77 children aged seven to eight months, fever was the most significant immediate and delayed side effect. Fever occurred in 12 (15.6%) children with in 48 hours of vaccination while it occurred in 10 (12.9%) children within ten days of vaccination. Other recorded side effects were pain at innoculation site in four (5.2%) children and vomiting in one (1.3%) child. Temperature recorded in 20 of the 22 febrile episodes ranged from 37.8 degrees C to 38.6 degrees C. One of the two patients who had temperatures of 39 degrees C and above had malaria parasites in her blood film. All episodes of fever except one responded to antipyretic. There was no episode of febrile convulsion and no feature suggestive of encephalitis. Of the 20 children who had neutralization test carried out against yellow fever virus six weeks after vaccination, the test was positive in post vaccination sera of 12 (60%) children whose pre-vaccination sera were negative. Two others showed evidence of partial protection. Although the seroconversion rate of 60% is less than reported in adults and older children, the result of this study shows that yellow fever vaccine is safe and fairly effective in infants. It is our suggestion that if a larger trial confirms our findings, the vaccine may be incorporated into the expanded programme on immunization (EPI) to be given at the age of seven months after completion of diptheria, tetanus, pertussis and poliomyelitis vaccinations and before measles vaccination is due.
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PMID:Safety and efficacy of yellow fever vaccine in children less thanone-year-old. 227 33

Although the prevention of infection through immunization is a central goal of maternal-child health programs in all developing countries, it is important to recognize that the role of vaccines varies greatly from country to country, from infection to infection, and from vaccine to vaccine. Immunization strategies must be as responsive to local disease patterns, needs, and opportunities as to technological advances in the creation, production, storage, and delivery of vaccines. This paper outlines the present state of the art for vaccines against measles, pertussis, poliomyelitis, tetanus, and tuberculosis. Other childhood infections in the tropics in need of a vaccine are the enteric infections, serious bacterial infections, vertically transmitted viral infections, and parasitic infections such as malaria. Immunization technologies related to the cold chain, delivery techniques, and adjuvants are constantly improving. Gains have also been made in outcome evaluation and disease surveillance. Ultimately, the success of the immunization effort depends on community participation and awareness.
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PMID:Recent advances in immunization. 331 42

Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.
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PMID:Health and medical care in Ethiopia. 271 Jan 85

To facilitate understanding of the advances in health care in Nicaragua since 1979, this discussion examines them within a historical framework. Nicaragua was occupied by US marines almost continuously from 1909-33. In 1933, their withdrawal left in power the US backed National Guard and the 1st dictator, Anastasio Somoza Garcia. Health conditions under the Somoza regime are difficult to evaluate because lack of data and underreporting were the norm. The health care system under Somoza was administered by 23 separate agencies, including the National Social Security Institute (INSS), a national Ministry of Health, independent local health ministries, and autonomous public hospital governing boards. On July 19, 1979, the dictatorship was overthrown in a popular uprising. Somoza left behind a foreign debt of 1.6 billion dollars, which the Sandinista Front for National Liberation (FSLN) needed to honor to qualify for needed loans. Following Somoza's defeat, the new government faced the problem of how to care for the tens of thousands of persons wounded and how to distribute the aid and medical supplies coming in from other countries. The key to achieving these tasks was popular participation and organization. By the early part of 1980, the new government was addressing more directly the organization of the health care system. Unlike the fragmented services under Somoza, health care in the new Nicaragua fell under the control of a unified Ministry of Health (MINSA). In 1980, the FSLN initiated an intensive campaign against illiteracy, 100,000 young Nicaraguans, called "brigadistas," were trained and sent around the country to teach basic reading and writing. In addition, 1 out of 10 was trained in elementary health principles. They were responsible for educating others about hygiene and basic sanitation as well as distributing antimalarial medication. 5 popular Health Campaigns were waged during 1981 against polio; measles, diphtheria, pertussis, and tetanus; rabies; poor sanitation; and malaria. Since women and children make up about 75% of the population, maternal and child health is a priority. The Sandinistas' approach to diarrhea and dehydration, a major cause of morbidity and mortality in children, has been the creation of over 200 oral rehydration units. The purpose of these units, in addition to the oral replacement of an appropriate salt and glucose solution, is to educate health care workers about the prevention and treatment of diarrheal disease. The education of health care workers also has been a priority. With increased access to health services, there is a chronic shortage of supplies and personnel and capital to build new facilities. International aid has been very important to health. Diverting funds away from Nicaraguan destabilization and toward social needs here in the US would have a positive impact on health services for the people of both Nicaragua and the US.
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PMID:Health care in Nicaragua: a social and historical perspective. 659 13

Physicians counseling patients who are planning major travels should make sure that baseline immunizations (diphtheria-tetanus-pertussis, polio, measles, rubella) and any necessary boosters are current. In addition, several other immunizations may be warranted (yellow fever, typhoid, and cholera), depending on destination(s) and itinerary, and prophylaxis for malaria may be advisable. As worldwide requirements for immunization do change, the physician should verify current requirements before planning an immunization schedule for a particular patient.
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PMID:Immunization. Around the world in 80 shots. 682 57

Recent experiments in the murine system have indicated that the passive acquisition by offspring of maternal anti-malarial IgG antibodies while conferring some degree of immunity against a primary infection, paradoxically prevents the generation of acquired immunity through vaccination. Therefore, in view of earlier findings concerning the competitive effects of specific IgM and IgG antibodies, we investigated whether specific monoclonal IgM antibodies could be used to potentiate the response to a blood-stage murine malaria vaccine. We now report that small amounts of purified monoclonal anti-parasite IgM can specifically potentiate both priming and memory cell generation in response to vaccination as evidenced by survival after infection, and that the magnitude of this effect is greater than that found with a more conventional nonspecific adjuvant (Bordetella pertussis). Additionally, in offspring of immune mothers, where vaccination is ineffective for up to 8 weeks due to the presence of maternal IgG, we have found that IgM when administered with the vaccine can completely overcome this inhibition by its adjuvant effect.
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PMID:Specific monoclonal IgM is a potent adjuvant in murine malaria vaccination. 683 62

The protective immunity conferred by subcutaneous injection of outbred CD-1 mice with a killed Plasmodium yoelii (YM strain) vaccine was strongly potentiated by saponin. By adjusting the dose of antigen, the number of immunizations and the number of living parasites in the challenge infection, conditions were defined where antigen alone was non-protective but 100% protection was obtained by the addition of saponin. Inbred BALB/c, CBA/CA and C57 B1 mice were much less responsive than the CD-1 mice. The following adjuvants were compared with saponin: mineral oil emulsions (Freund's incomplete and complete adjuvants); A1(OH)3(Alhydrogel); bacteria and synthetic bacterial derivatives (Bordetella pertussis, Corynebacterium parvum and muramyl dipeptide); surface active materials (digitonin, vitamin A, Arquad 18, dimethyldioctadecyl ammonium bromide, and the polyene antibiotics, Nystatin and Amphotericin B). None of these adjuvants were as effective as saponin, although FCA, A1(OH)3 and C. parvum augmented immunity considerably. The possible reasons for the efficacy of saponin as an adjuvant for protozoal vaccines are discussed. The P. yoelli/mouse system provides a sensitive and rapid screening assay for comparison of potential adjuvants suitable for use with a malaria vaccine.
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PMID:A comparison of saponin with other adjuvants for the potentiation of protective immunity by a killed Plasmodium yoelii vaccine in the mouse. 714 65

Mice vaccinated with fixed parasitized red blood cells and Bordetella pertussis can clear an otherwise lethal Plasmodium yoelii infection in 7 days; this protection is abolished by splenectomy before vaccination. Most mice splenectomized following vaccination were able to clear their infections, although their recovery was delayed. When labelled parasitized red cells were injected into mice during an infection, splenic uptake fell from day 3 onwards while uptake by the liver increased. Lymphocytes (mainly T cells) formed the majority of the live cells extracted from livers 7 days after infection, although blasts and myeloid cells were also present. Infected livers from vaccinated mice contained most cells. Less marked increases were observed 7 days after P. berghei infection of vaccinated mice. Examination of liver tissue showed that the sinusoids contained increased numbers of cells and suggested that activation of Kupffer cells was occurring, particularly in vaccinated mice infected with P. yoelii. Homing experiments confirmed the increased trapping of various cells in livers of vaccinated mice infected with P. yoelii. These results suggest an important role for the liver in recovery from blood-stage malaria infection.
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PMID:The role of the liver in immunity to blood-stage murine malaria. 743 34

This paper opens by briefly tracing the development of vaccines from Edward Jenner's work in 1796 to the present. The proportion of deaths from communicable diseases in developed and developing countries is discussed, and it is noted that, in 1990, communicable diseases killed 575,000 people in industrialized countries and 16 million people in developing countries. In developed countries, there were no deaths from measles, malaria, tetanus, or pertussis, and only seven from diarrheal disease as compared to 1,006,000, 926,000, 505,000, 321,000, and 2,866,000, respectively, in developing countries. By the end of the century, AIDS will overshadow the communicable disease profile. Annual mortality figures from bites by rabid animals, snakes, insects, etc. are also grossly underreported. A look at the common biologicals used in developing countries shows that at least eight bacterial and eight viral vaccines are in common use globally. The origin and indications for each vaccine are tabulated. Data on anti-serum vaccines, plasma-derived preparations, and biological response modifiers (available in industrialized countries) are similarly tabulated. Consideration of the industrial production of immunogens in developing countries reveals that most production relies on outdated technology. Vaccines exhibit suboptimal performance in these settings either due to factors relating to individual vaccines or to community circumstances. Individual vaccines which exhibit inadequate potency in adverse circumstances include liquid vaccines and lyophilized vaccines and prophylactics. This situation is exacerbated by unsatisfactory vaccine administration practices, malnutrition, and cases of immunosuppression. Suboptimal performance at the community level is due to procurement procedure, the cost of vaccines, poverty, population growth, failures in the cold chain, lack of trained personnel, religion and gender bias, and political factors, such as war. A suitable remedial action plan requires integrated action at the international, national, and community levels. Such an effort would be aided by improved mortality data collection techniques and by multidisciplinary research to update indigenous manufacturing technology.
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PMID:Human immunization in developing countries: practical and theoretical problems and prospects. 788 21

Plasmodium falciparum, the parasite responsible for the most severe form of malaria, undergoes an asexual multiplication in man and a sexual one in mosquito. The asexual cycle can be reproduced in vitro. The present work reports the isolation of a small guanosine triphosphate-binding protein in Plasmodium falciparum extracts. This protein, a 21,000 M(r) Ras-like molecule, was revealed by western blotting in each stage of the intraerythrocytic asexual life cycle. Conversely, a 46,000 M(r) G alpha subunit of a heterotrimeric GTP-binding protein was found to be expressed during a short period from mature schizonts to free merozoites. In order to provide additional evidence for the presence of these GTP-binding proteins in Plasmodium falciparum cultures and also to determine the kinetics, we tested two toxins that are involved in the cellular signalling transduction. We observed that pertussis toxin increases P. falciparum growth, whereas cholera toxin induces crisis forms, and subsequent parasite death within the following 24 h.
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PMID:Evidence for expression of a Ras-like and a stage specific GTP binding homologous protein by Plasmodium falciparum. 788 4


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