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Vaccinating older people remains a priority in the specialty of public health. However, medical practitioners, pharmacists, carers and family members and the media need to make a special effort to inform and educate older people of the need to protect themselves against certain diseases, such as influenza, pneumococcal pneumonia and tetanus. These conditions pose particular health risks to older people in terms of the high risk of developing serious complications.
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PMID:Vaccination in older people. 1221 30

In the spring of 1992 a child health survey (Monitoring Scheme for Mortality of Children Under 5 Years of Age in China) was conducted in Henan Province among 10 representative cities and counties. The sample included the monitoring sites at Gongyi City, Mi County, and Lushi County. The sample population included 710,570 of which 55,740 were aged 0-4 years, 1473 were born in 1991, and 579 died in 1991. Child mortality was 55.58% and close to the national average. The ratio of male/female child mortality was 1:1.3. Infant mortality was 85.8% of total child mortality. 72.85% of infant mortality was newborn mortality (46.40% within the first 24 hours and 81.76% within 7 days of birth). Child mortality was higher in rural areas. 59.3% of mortality occurred while the child was at home and 28.7% on the way to medical treatment, and 24.35% did not have treatment or parents consciously decided not to seek treatment. The primary causes of death at 0-7 days were suffocation during birth, premature delivery at birth, pneumonia, neural tube defects, accidental suffocation, and newborn tetanus. Ranked causes at 0-18 days from high to low were suffocation during birth, pneumonia, premature delivery, neural tube defects, accidental suffocation, and newborn tetanus. At under 1 year the causes were pneumonia, suffocation during birth, premature delivery, accidental suffocation, neural tube defects, and congenital heart disease. At 1-4 years the primary causes were pneumonia, accidental suffocation, congenital heart diseases, other malformation, and other diseases. For mortality under 4 years of age the causes were pneumonia, congenital malformations, premature delivery, accidental suffocation, neural tube defects, and congenital heart diseases. The 1990 Summit Conference on Children's Issues in the World recommended reducing child mortality by 33% by the year 2000. This means a considerable reduction for China.
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PMID:An analysis of mortality causes of children under five years of age in 10 cities and counties in Henan Province in 1991. 1228 75

A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.
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PMID:Certain aspects of infant mortality -- a prospective study in a rural community. 1228 17

Pertussis, also known as whooping cough, is a highly contagious disease, which is most dangerous to infants less than one year old. About half of the babies reported nationally to the Centers for Disease Control and Prevention (CDC) as having the disease are hospitalized. As many as 16/100 babies reported with pertussis get pneumonia, and about 2/100 have convulsions. For those babies reported to have pertussis, about 1/500 has brain problems, some of which can become permanent, and about 1/250 will die because of complications from the disease. Serious illness is less likely in older children and adults. Pertussis vaccine is generally administered in combination with diphtheria and tetanus vaccines, known as DTP vaccine. A primary series of DTP keeps 70-90/100 children from getting pertussis, usually through the elementary school years at least. About half of the children who receive DTP vaccine will not experience any discomfort at all. Some will have minor problems such as soreness, swelling and redness where the shot was given; fever; fussiness; drowsiness; and loss of appetite lasting 1-2 days. Once per 100 to 1000 shots, moderate problems can occur: crying non-stop for 3 hours or more, fever of 105 degrees (F) or higher. For 1 shot in 1750, a child may experience a seizure (convulsions, fits, spasms, twitching, jerking, or staring spells) usually caused by fever, or collapse or fainting (becoming blue, pale, limp, and non-responsive). Very rarely, DTP causes long seizures, decreased consciousness, or coma that usually does not last. Permanent brain damage can very infrequently follow such acute brain problems. There are no tests that can tell in advance if a child will be adversely affected by the DTP vaccine. Definitely the benefits from the DTP vaccine far outweigh the risks for almost all children.
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PMID:Facts about pertussis and DTP vaccine. 1234 38

The Survival for Women and Children (SWACH) Foundation of India, based in Chandigarh, has as its first objective the improvement of mother and child survival. Some 275 women die in childbirth every day in India, and almost 7000 babies under one year die every day from common diseases such as diarrhoea, pneumonia, measles, and tetanus. More than 7 in every 10 Indian babies are born at home, their births assisted by dais or traditional birth attendants (TBAs) who are often untrained and poorly equipped. SWACH coordinates efforts of nongovernmental organizations that provide mother and child care and family planning services in several Indian states. Birth attendants and nurse-midwives are trained and health services for women and children are enhanced in several hundred villages. The foundation has helped promote innovations such as personal health record cards for mothers and infants, a color-coded weighing balance to help identify low birth weight babies, a mucus extractor to clear the breathing passages of the newborn, and a mask for use when blowing air into the lungs of babies who fail to breathe at birth. SWACH also promotes use of clean delivery kits to increase hygiene during child birth at home. The kits are assembled by women volunteers. SWACH participated in the field-testing of the World Health Organization (WHO) delivery kit and in the production of the WHO TBA training manuals. SWACH supports the education of underprivileged girls in its efforts to improve the status of women, and provides vocational training courses to adolescents in sewing, knitting, and crochet.
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PMID:The SWACH Foundation of India. 1234 3

This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey--the Person-Level File, Sample Adult File, and Sample Adult Prevention File--were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.
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PMID:Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices. 1271 69

It is a remarkable observation that virtually all bacterial toxins associated with specific clinical conditions (toxinoses) are encoded by mobile (and therefore variable) genetic elements. Remarkably, these rarely, if ever, carry determinants of antibiotic resistance. Examples are the toxins responsible for diphtheria, anthrax, tetanus, botulism, cholera, toxic shock, scarlet fever, exfoliative dermatitis, food poisoning, travelers' diarrhea, shigella dysentery, necrotizing pneumonia, and others. A recently discovered example of this phenomenon is the family of related staphylococcal pathogenicity islands encoding superantigens (SAgs). These are 15-20kb elements that occupy constant positions in the chromosomes of toxigenic strains, and are characterized by certain phage-related features, namely genes encoding integrases, helicases, and terminases, and the presence of flanking direct repeats. The prototype, SaPI1 of Staphylococcus aureus, encodes TSST-1 plus two newly described SAgs, SEK and SEL. Other members of the family encode enterotoxins B (SaPI3) and C (SaPI4), plus at least two other SAgs each. SaPI1 and SaPI2, also encoding TSST-1, are excised and induced to replicate by certain staphylococcal phages, and are then encapsidated at high efficiency into phage-like infectious particles with heads about 1/3 the size of the helper phage heads, commensurate with the sizes of the respective genomes. This results in transfer frequencies of the order of 10(8)/ml, and is presumably responsible for the spread of these elements as well as for their acquisition in the first place. In the absence of a helper phage, these two islands are highly stable; neither excision, loss, or transfer occurs at detectable frequency. Several general implications of this phenomenon will be discussed. One is that the determinants of these toxins have been imported from other species and therefore are not components of the basic genome of the extant producing organisms. This raises the question of the biological (adaptive?) roles of these toxins. Another is that the toxin-carrying units can spread among different (though probably related) species. An interesting question is that of the biological basis for the separation of toxin and resistance determinants.
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PMID:Mobile genetic elements and bacterial toxinoses: the superantigen-encoding pathogenicity islands of Staphylococcus aureus. 1272 63

A total of 868 (84.89%) patients diagnosed with tetanus were studied, out of the 1,024 tetanus patients hospitalized at Couto Maia Hospital (Salvador, Bahia, Brazil), during the period between 1986 and 1997. Of this group (n = 868), 63.5% (n = 551) were discharged, 35.4% (n = 307) died, and 1.1% (n = 10) were transferred. The average age of the deceased patients (38.73 +/- 23.31 years) was significantly greater (p < 0.0001) than the age of those who survived (29.21 +/- 20.05 years). Analyzing the variables of the logistic regression model with statistic significance (p < or = 0.25) for univariate analysis, we observed a greater association of risk for worst prognosis (death) in patients aged > or = 51 years; time of illness < 48 hours; time of incubation < 168 hours; neck rigidity; spasms; opisthotonos; body temperature > or = 37.7 degrees C; heart beat > or = 111 beats/minute; sympathetic hyperactivity and association with pneumonia. Among the group of those who survived, patients with 1 to 5 of those variables (n = 398; 76.8%) were more frequent, while among patients of the group of the deceased, 70.3% (n = 206) presented 6 to 10 of those variables, with a highly significant difference (p < 10(-8)). In conclusion, the indicators described provide early information that may guide the prognosis and medical and nurse care.
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PMID:Accidental tetanus: prognosis evaluation in a historical series at a hospital in Salvador, Bahia, Brazil. 1275 20

As the average life expectancy increases, retired people want to travel. Five to 8% of travellers in tropical areas are old persons. Immune system suffers of old age as the other organs. The number and the functions of the T-lymphocytes decrease, but the B-lymphocytes are not altered. So, the response to the vaccinations is slower and lower in the elderly. Influenza is a great cause of death rate in old people. The seroconversion, after vaccine, is 50% from 60 to 70 years old, 31% from 70 to 80 years old, and only 11% after 80 years old. But in public health, the vaccination reduced the morbidity by 25%, admission to hospital by 20%, pneumonia by 50%, and mortality by 70%. Antipoliomyelitis vaccine is useful for travellers, as the vaccines against hepatitis and typhoid fever. Pneumococcal vaccine is effective in 60%. Tetanus is fatal in at last 32% of the people above 80 years, therefore this vaccine is very important.
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PMID:Immunity and immunization in elderly. 1462 49

Tetanus is a potentially lethal disease that is preventable with appropriate vaccination. The diagnosis is made exclusively on clinical criteria, and early recognition and treatment are essential for positive outcome. Patients should be monitored in the intensive care unit immediately on diagnosis. Early intubation and mechanical ventilation have drastically reduced the mortality from tetanus. Autonomic instability is associated with a high fatality rate and therefore must be aggressively treated. Metronidazole, human tetanus immunoglobulin, and active immunization should also be initiated on presentation. Because of extremely high metabolic demands in patients with tetanus, care must be taken to provide adequate nutrition and fluids. Prevention of sequelae of long-term critical illness, such as nosocomial pneumonia and deep venous thrombosis, are also important for achieving good outcomes.
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PMID:Tetanus. 1466 67


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