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A study has been made of 3,745 Bedouin and 9,422 Jewish babies born in 1972-73 to residents of the Beersheba district of southern Israel (the Negev). Newborn infants weighing less than 1 kg were excluded. Thirty-seven percent of the Bedouin babies were born at home; their mothers tended to be older and of higher parity than those choosing to deliver in hospital. Less than 6% of Bedouin mothers had been to school, compared with 90% of the Jews; 30% were aged under 20 or over 34 years, compared with 18% of the Jews, and 23% were having their seventh or later baby, compared with 12% of the Jews. Mean birth weight of babies born in hospital was about 200 g lower in Bedouin than in Jews, and 11.4% of Bedouin and 6.5% of Jewish infants weighed less than 2.5 kg. There was little variation in complications of labor between the 1,959 Bedouin and 8,877 Jewish women delivered in Beersheba's Soroka Medical Center. The cesarean section rate was 1.8% in Bedouin and 4.3% in Jews, while in 0.3% of Bedouin and 1.4% of Jews labor was induced. Monozygous twinning rates were similar in the two ethnic groups (4.8 and 4.5 sets/1,000 deliveries, respectively) but dizygous twinning was twice as common among the Bedouin as among the Jews (13.0 vs 6.0 sets/ 1,000). Male births accounted for 0.526 and 0.512 of the total in Bedouin and Jews, respectively. Perinatal mortality rates for hospital births were 31.1 and 18.3/1,000 in Bedouin and Jews, respectively. Infant deaths among Bedouin (31.0/1,000) were underreported; the rate was 16.8/1,000 for Jewish infants. Although rates of all specific causes of death were higher in Bedouin than in Jews, patterns of mortality in subgroups based on birth weight, sex, twinning and maternal age were quite similar in the two ethnic groups. There were six reported deaths from tetanus among Bedouin babies. For the cohort of babies born in 1972, admissions to the Soroka Medical Center pediatric wards were recorded in 366 (195.5/1,000) Bedouin and 787 (174.3/1,000) Jewish babies younger than the age of one year. Bedouin admission rates were higher than those of Jews for gastroenteritis (119.1 and 64.5/1,000 respectively), infectious and parasitic diseases (29.4 and 21.9), malnutrition (25.6 and 8.0) and external causes (10.1 and 4.4). Admission rates for bronchitis and pneumonia were, however, lower among Bedouin than Jews in the first six months of life.
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PMID:Maternal, perinatal and infant health in Bedouin and Jews in southern Israel. 87 68

After an incubation period of one to two months rabies presents with non-specific prodromal symptoms and often with paraesthesiae of the bitten area. As in canine rabies there are furious and dumb forms of the disease. In man, furious rabies is characterised by hydrophobia: terror and excitation with spasms of inspiratory muscles, larynx and pharynx precipitated by attempts to drink and by a variety of other stimuli. Hydrophobia may represent an exaggerated respiratory tract irritant reflex with associated arousal potentiated by the selective destruction of brain stem inhibitory systmes. Also typical of furious rabies are intermittent episodes of excitement, hallucinations and maniacal behaviour. Focal neurological abnormalities are surprisingly uncommon. Other signs include hypersalivation, tachycardia and hyperpyrexia. Paralysis and coma supervene after a few days: survival rarely exceeds seven days. Dumb or paralytic rabies is an ascending flaccid paralysis with sphincter involvement and sensory disturbances. Death from respiratory and bulbar paralysis occurs after a longer illness than furious rabies. In a minority of cases hydrophobia develops before the terminal coma. Complications include respiratory arrest, pneumonitis, cardiac arrhythmias and interstitial myocarditis, posterior pituitary disorders, and gastrointestinal bleeding. Differential diagnoses of furious rabies include hysterical pseudo hydrophobia, tetanus, other encephalitides, delirium tremens and various other intoxications. Paralytic rabies may have to be distinguished from postvaccinal encephalomyelitis, poliomyelitis and other causes of Landry-type ascending paralysis. Intensive care has produced some promising results: life-threatening complications can be prevented but there is some evidence that the severity of the encephalitis is the ultimate barrier to survival.
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PMID:The clinical picture of rabies in man. 98 12

One of the most important aspects of preparing travelers for destinations throughout the world is providing them with immunizations. Before administering any vaccines, however, a careful health and immunization history and travel itinerary should be obtained in order to determine vaccine indications and contraindications. There are three categories of immunizations for foreign travel. The first category includes immunizations which are routinely recommended whether or not the individual is traveling. Many travelers are due for primary vaccination or boosting against tetanus-diphtheria, measles-mumps-rubella, pneumococcal pneumonia, and influenza, for example, and the pre-travel visit is an ideal time to administer these. The second category are immunizations which might be required by a country as a condition for entry; these are yellow fever and cholera. The final category contains immunizations which are recommended because there is a risk of acquiring a particular disease during travel. Typhoid fever, meningococcal disease, rabies, and hepatitis are some examples. Travelers who are pregnant or who are infected with the human immunodeficiency virus require special consideration. Provision of appropriate immunizations for foreign travel is an important aspect of preventing illness in travelers.
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PMID:Immunizations for foreign travel. 133 7

Detailed invasive haemodynamic studies were performed in 27 of 32 patients with severe tetanus. Nineteen had severe uncomplicated tetanus and eight had associated major complications, chiefly infection and pulmonary complications. The results were compared with those obtained from 15 healthy male volunteers who served as controls. There were two deaths in 32 patients (mortality 6.25 per cent). Severe tetanus without major complications was characterized by a high output hyperkinetic circulatory state with tachycardia (heart rate 131 (19.2) beats/minute), increased stroke volume index (43.1 (10.7) ml/m2), increased cardiac index (5.48 (0.94) l/min/m2) and a normal left ventricular stroke work index (60.5 (15.9) g/m/m2). Volume loading demonstrated a significant haemodynamic response and increased vascular capacitance. Even so the maximum percent rise from baseline values of these indices after volume load was significantly higher in controls (p < 0.001). Autonomic cardiovascular disturbances affected both sympathetic and parasympathetic activity. Hypertension and tachycardia alternating with hypotension and bradycardia were related to sudden fluctuations in systemic vascular resistance. Our studies suggested some degree of myocardial dysfunction in patients with severe uncomplicated tetanus. The haemodynamics of severe tetanus were masked and altered by complicating infection, pneumonia, and atelectasis.
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PMID:Haemodynamic studies during the management of severe tetanus. 144 46

A study of the prevalence of nosocomial colonisation and nosocomial infection (NI) was conducted in the paediatric respiratory intensive care unit of a large teaching hospital serving a developing community. Surveillance specimens were collected regularly from 63 consecutive patients admitted over 4 months, and also from professional staff, boarder mothers, cleaners and the unit environment. The incidence among patients of colonisation (40%) and of NI (43%) was high. The risk of dying in children with NI was appreciably increased (relative risk 2,241, confidence interval 0,591-8,503). This did not reach statistical significance, probably because so few children escaped acquiring hospital organisms. The significant risk factor for acquiring colonisation (P = 0.008) and NI (P < 0.0001) was a ward stay of more than 10 days. In addition, for acquiring NI an age of under 6 months was also predictive (P = 0.0298). The nature of the primary illness dictated the time spent in the ward; an important proportion of patients had preventable diseases, such as measles, pneumonia and tetanus, which required prolonged treatment. All children with endotracheal intubation had hospital-acquired organisms in tracheal aspirates. Eighty-two per cent of children developed positive gastric aspirates, 17% a positive urine culture and 11% a positive blood culture. Colonisation occurred rapidly; organisms initially appeared in gastric aspirates (mean 2 days), then in tracheal aspirates (mean 5 days) and urine cultures (mean 10 days). The acquired organisms, many of which were antibiotic-resistant, were almost exclusively enteric Gram-negative bacilli (GNB) and Staphylococcus aureus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nosocomial colonisation and infection in a paediatric respiratory intensive care unit. 144 9

An earlier report on the Nigerian expanded programme on immunization (EPI), covering 1974-1988, failed to demonstrate a clear-cut impact of the programme. This report attempts to determine the effectiveness of EPI in Borno State, Nigeria. We analysed trends in routine notifications for diphtheria, pertussis, tetanus, tuberculosis, measles, and pneumonia, from 1985 to 1991; data on poliomyelitis were excluded because of poor documentation, while we included data on pneumonia for comparison. We also performed a before (1983-1987) after (1988-1991) comparison in terms of the intensifications of EPI by age-specific strata amongst paediatric hospitalization for all EPI diseases at the University of Maiduguri Teaching Hospital, the sole referral hospital for childhood infectious diseases. Our results show an apparent reduction in morbidity from diphtheria, pertussis, tetanus, measles and pneumonia, and this was particularly prominent following intense vaccinations between 1988 and 1991. The reduction in these EPI diseases and pneumonia occurred despite the prevailing adverse socioeconomic conditions, and the absence of a specific control strategy for pneumonia in Nigeria. On the other hand, in spite of national BCG coverage of about 90% there has been a recent (1989-1991) increase in the registered cases of tuberculosis in infants and older children in Borno State. There is a need to intensify other intervention measures alongside EPI activities.
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PMID:The EPI in Borno State, Nigeria: impact on routine disease notifications and hospital admissions. 146 Jun 96

Swaziland is a kingdom with 800,000 inhabitants bordering on Mozambique and South Africa with about 50% of the population under 15 years of age. The experience of a nurse in a small clinic in the course of several years is recounted. Swaziland ranks 3rd in the world in alcohol abuse which often leads to wounds requiring suturing. Penicillin is given prophylactically with a paracetamol preparation for analgesia. As a rule, every injured person will get a .5 ml tetanus injection for prophylaxis. The most serious conditions of polyclinic patients are hepatitis, bilharzia, diarrhea, pellagra, pneumonia, and malnutrition. A great number of patients have sexually transmitted diseases, and the rate of AIDS infection is not known. According to 1 study 60-80% of the population in reproductive age will die of AIDS in the course of a 5-year period. The majority of people are impervious to counseling about their sexual behavior in spite of educational programs on the radio, in schools, and in work places. Condoms are not popular, since they are not considered manly. Pregnant women receive iron and multivitamin tablets in the course of pregnancy. Many pregnant women are anemic, and 70% give birth at home, the rest in a hospital or clinic. During delivery they get no analgesia, and there are few complications. The average weight of the newborn is 3.5 kg, although none of the women are under 150 cm. A little after birth all children are vaccinated with bacillus Calmette-Guerin (BCG) and polio, later with diphtheria-pertussis-tetanus (DPT) and measles.
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PMID:[Nursing under a different sky. Swaziland]. 146 29

The standard WHO cluster sampling technique was applied to 30 randomly selected villages covering a population of 89,470 and 2010 live births in Jasra Community Development Block with a population of 123,000 distributed in 123 villages and 27 subcenters. In each cluster, 67 mothers were interviewed who gave birth between March 1989 and April 1990. Immunization history of tetanus toxoid given during the antenatal period and the delivery was recorded by 2 teams. There were 49 neonatal deaths: 30 (61.2%) were caused by tetanus neonatorum, 10 (30.4%) died of high fever of undetermined etiology, 5 (10.2%) of pneumonia, 3 (6.1%) of diarrhea, and there was 1 case of death of undetermined cause. The tetanus neonatorum rate was 18.7/1000 live births. 93% of the births were assisted by family members and untrained dais, and 2.4% by trained traditional birth attendants. In 69 deliveries (3.4%), a doctor was called, while in 24 cases a multipurpose female worker assisted. 46.7% of neonates with tetanus were brought to the district hospital for treatment, the rest were either taken to private practitioners or to traditional healers. 1336 (66.5%) of 2010 mothers interviewed had not received tetanus toxoid, 359 (17.8%) had received only 1 dose of toxoid, and 315 (15.7%) had been immunized with 2 doses. The mothers of 27 (90.0%) of those 30 neonates who died of tetanus had not received a dose of toxoid during the antenatal period, whereas 3 mothers obtained only 1 dose. None of the newborn of mothers immunized with 2 doses during pregnancy contracted tetanus. 61% of the neonatal deaths were attributed to tetanus. The causes of neonatal tetanus include unhygienic cutting of the cord and lack of immunization of mothers with tetanus toxoid during pregnancy. The administration of 2 doses of antenatal tetanus toxoid and health education regarding the importance of conducting hygienic deliveries could eliminate this disease.
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PMID:Impact of universal immunization programme on the incidence of tetanus neonatorum. 150 Jan 43

From 1980 through 1989, 27,826 cases of pertussis were reported to the Centers for Disease Control, for an average annual crude incidence of 1.2 cases/100,000 population. The incidence of reported disease increased in all age groups during this period, but the increase was disproportionately large among adolescents and adults. Infants between 1 and 2 months of age were at highest risk for pertussis (average annual incidence, 62.8/100,000). Infants less than 2 months of age had the highest reported rates of pertussis-associated hospitalization (82%), pneumonia (25%), seizures (4%), encephalopathy (1%), and death (1%). Rates of complication were generally higher among unvaccinated children than among those who had received three or more doses of diphtheria-tetanus-pertussis vaccine; 64% of children 3 months to 4 years of age who had reported cases of pertussis had not been immunized appropriately for their age. Whereas control of pertussis in the United States may be further improved through increased levels of diphtheria-tetanus-pertussis vaccination among eligible infants and children, the use of acellular vaccines in adolescents and adults may also be needed to reduce the burden of pertussis in very young infants.
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PMID:Epidemiological features of pertussis in the United States, 1980-1989. 156 63

Significant levels of older-adult mortality and morbidity are associated with vaccine-preventable diseases, specifically influenza and pneumococcal disease. Even though current guidelines for this age group recommend a single vaccination against pneumococcal pneumonia, an annual influenza vaccination and a combined tetanus-diphtheria toxoid booster every 10 years after completion of a primary series, immunization levels remain extremely low. This article presents information regarding usage, efficacy and cost-effectiveness of these vaccines. Physician non-compliance and misinformation, negative patient attitudes and a shortage of effective programs for vaccine delivery account for vaccine underutilization. Recommendations from health care providers significantly affect whether a person will be immunized. Increased vaccine usage was noted in clinic-based programs that initiated organizational or administrative interventions, such as patient and physician reminders, physician-performance feedback, medical-record checklists and the use of non-physician health care staff to monitor patient vaccination status and to dispense vaccines. Providing organized education and vaccination programs in institutional and public settings may also help target the older-adult population. The future success of adult immunization will depend not only on increased professional and public awareness but also on the development of new approaches to vaccine delivery.
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PMID:Recommendations, usage and efficacy of immunizations for the elderly. 156 2


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