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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

A radioisotopic assay for acute granulomatous hypersensitivity (AGH) to lyophilized eggs of Schistosoma japonicum has been used to further examine responses to egg antigens in various inbred strains of mice. The ranking of responsiveness in mice from high (C57BL/6), intermediate (BALB/c) to low (CBA/H) was not influenced by high or low egg-sensitization regimens. However, the low responsiveness of responder mice sensitized with eggs by the intraperitoneal compared with the subcutaneous route of injection appears to be an egg dose-related phenomenon. The high AGH responsiveness of C57BL/6 mice can be increased further by sensitization with eggs in the presence of purified pertussigen from Bordetella pertussis but CBA/H mice treated identically remain low responders. The monoclonal anti-egg antibody, P.41, which produces a prominent bleb-type circumoval precipitate with eggs, has been shown to be directed against major 'immunopathologic antigen(s)' of S. japonicum eggs. Thus, C57BL/6 mice were sensitized for AGH by injection of soluble extracted egg antigen (SEA) bound to an immunoabsorbent of P.41 antibody on Sepharose. No success has been achieved in modulating AGH in C57BL/6 mice by injection of hyperimmune antisera raised against lyophilized eggs in either high or low responder mouse strains. This failure is in line with previous results using antisera as well as monoclonal anti-egg antibodies. The consistent failure to demonstrate a modulating effect of antibodies in this compared with other laboratories may be related to the use of lyophilized rather than viable eggs. The data suggest that activities of antisera in granuloma modulation in murine schistosomiasis japonica result from egg destruction or inhibition of production of immunopathologic antigens by eggs rather than through effects on immunopathologic immune responses.
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PMID:Attempts to modify lung granulomatous responses to Schistosoma japonicum eggs in low and high responder mouse strains. 665 45

A study of the immunogenicity of a recombinant hepatitis B vaccine was conducted among 385 Egyptian infants, 191 (49.6%) of whom were born to mothers with moderately active Schistosoma mansoni infection (mean egg count = 224 eggs/g of feces). All mothers were seronegative for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen. Infants were vaccinated with a 2.5-microg dose of this vaccine, given along with diphtheria, tetanus, and pertussis (DTP) vaccine, at the ages of two, four, and six months. Serum samples taken from each infant at nine months of age were tested for HBsAg, antibody to hepatitis B core antigen, and quantitatively for antibody to hepatitis B surface antigen (anti-HBs). There was no significant difference (P = 0.1) between anti-HBs titers in infants of S. mansoni-infected mothers (mean = 539 mIU/ml) and in infants of noninfected mothers (mean = 377 mIU/ml). This study shows that there was no apparent effect of maternal schistosomiasis infection on the immune response of these infants to vaccination.
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PMID:Immunogenicity of recombinant hepatitis B vaccine among infants of mothers with active schistosomiasis. 928 16

The Proceedings here reviewed are those of the meeting held in Geneva in October, 1983, which led to the establishment of the World Health Organization's Program for the Accelerated Development of New Vaccines. These papers reflect the state of the art in the development of vaccines for cholera, leprosy, pertussis, salmonella, shigella, dengue, foot-and-mouth disease, hepatitis B, herpes simplex, influenza, poliomyelitis, Chagas' disease, malaria, and schistosomiasis. The identification and isolation of epitopes and other antigenic fragments is presented, as well as considerations of mucosal immunity, antigenic determinants and antigenic variations, antigen presentation and T-cell activation, the use of anti-idiotypes as antigens, the development of recombinant viruses for use in vaccines, and the use of circumsporozoite antigens in the preparation of a malaria vaccine.
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PMID:New approaches to vaccine development. Proceedings of a meeting organized by the World Health Organization. Book review. 1222 27

This document presents an interview with Dr. Anthony Fauci on the development of a new generation of vaccines to prevent and possibly eradicate a legion of deadly diseases ranging from tuberculosis to AIDS. Infections that have caused major devastations in the world today include tuberculosis, malaria, schistosomiasis, filariasis, pneumococcal pneumonia, influenza, AIDS, and Ebola. Agencies should be making sure that the basic research base in microbiology, immunology, antimicrobials, and vaccinology is at the very highest level. The integration of research efforts between countries depends on collaboration between the investigators of home countries with foreign investigators. Among new developments in vaccinology are an acellular pertussis vaccine for pertussis/whooping cough (an extremely contagious disease that causes death), DNA immunization (a new technique applicable to all types of diseases), and transgenic plants for immunization against hepatitis, pertussis, and polio. As of now, AIDS in Western countries has declined, while in Africa and Asia its spread has accelerated. Combination therapy for AIDS has had a profound impact on the level of the virus in the body; however, the treatment is still vague. The good news with regard to AIDS is that education is having an impact; this is exemplified by the situation in Thailand, where the government together with nongovernmental organizations and the military has begun a crash education campaign regarding prostitutes and the use of condoms. Progress is being made in the search for better vaccine candidates. AIDS-like epidemics involving new diseases are bound to emerge at some future point, though, given the long-term historical trend.
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PMID:New drugs, new vaccines, new diseases. An interview with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID). 1234 52

During infection with the helminth parasite Schistosoma mansoni, Ab regulates hepatic inflammation, and local production of Ig in the liver appears to play a role in this process. Exploring the development of the B cell response during infection, we found that parasite-specific IgG1-secreting plasma cells appeared first in the hepatic and mesenteric lymph nodes (LNs) and then at later times in the spleen, liver, and bone marrow. The LN B cell population peaked between weeks 10 and 12 of infection, and then contracted at a time that coincided with the expansion of the hepatic IgG1(+) B cell compartment, suggesting that B cells migrate from LNs to liver. CXCL9 and -16 expression in the liver increased during the time frame of B cell recruitment. Expression of the CXCL16 receptor CXCR6 was increased on B cells within the hepatic LNs, but not the mesenteric LNs. CXCR3, the receptor for CXCL9, was broadly expressed on IgG1(+) B cells in LNs and liver during infection. Increased hepatic expression of CXCL9 and -16 failed to occur if the IL-10R was blocked in vivo, an intervention associated with decreased liver B cell infiltration and the development of severe disease. Hepatic LN IgG1(+) cells migrated toward CXCL9 and -16 in vitro and to the liver in a pertussis toxin-sensitive fashion. Our data suggest that the coordinated expression of CXCL9 and -16 in the liver and of CXCR6 and CXCR3 on responding B cells within the hepatic LNs underpins establishment of the hepatic B cell infiltrate during chronic schistosomiasis.
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PMID:Regulation of the development of the hepatic B cell compartment during Schistosoma mansoni infection. 2403 90