YELLOW FEVER VACCINATION IN MALAYA BY SUBCUTANEOUS INJECTION AND MULTIPLE PUNCTURE. HAEMAGGLUTININ-INHIBITING ANTIBODY RESPONSES IN PERSONS WITH AND WITHOUT PRE-EXISTING ANTIBODY.
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In view of the risk of introduction of yellow fever into South-East Asia, comparative studies have been made of yellow fever vaccination in Malayan volunteers with a high prevalence of antibody to related viruses and in volunteers without related antibody. In a previous paper the neutralizing antibody responses of these volunteers were reported. The present paper describes the haemagglutinin-inhibiting (HI) antibody responses of the same groups of volunteers and discusses the relationship of these responses to the neutralizing antibody responses.The HI responses to yellow fever following vaccination closely paralleled the neutralizing antibody responses whether vaccination was subcutaneous or by multiple puncture. Volunteers with a high level of YF HI antibody due to infection with other group B viruses were found to be less likely to show a significant YF HI response than those without antibody. 90% of HI responses could be detected by the 21st day after vaccination.As with neutralizing antibody responses, volunteers given vaccine doses of 50-500 mouse intracerebral LD(50) subcutaneously gave greater responses than those given higher doses. (+info)
THE MALARIA PARASITE RATE AND INTERRUPTION OF TRANSMISSION.
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Present methods for assessment of the attack phase of malaria eradication are inadequate, particularly lacking any objective parasitological criteria of success. On the basis of previous observations and development of theory, the authors first postulate that the effects of complete interruption of transmission should, ideally, include a regular progressive decrease of falciparum parasite rates in the ratios of 1: 0.4 in 6 months, 1: 0.16 in 12 months and 1: 0.026 in 24 months. Analysis of a series of programmes in which complete interruption of transmission is known to have been achieved shows that this postulate is valid, and that it is not materially upset by strain differences of parasites or by differences in the ages of the subjects examined. Vivax rates appear to fall at approximately the same rate; the rarity of data for vivax malaria makes firm conclusions unsure, but the postulate can be extended to rates which are predominantly due to falciparum infection but include some admixture of other species. A second, arbitrary, postulate is made that the slowest acceptable rate of fall in 12 months should be in a ratio not less than 1: 0.22, which would secure ultimate eradication in about one-third more time than the ideal fall; on this basis statistical standards are set up for assurance of confidence that the minimum rate is exceeded. Slower rates of fall are then related to reproduction rates causing them, the findings being illustrated graphically and by mathematical theory. (+info)
Tropical chronic pancreatitis.
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Tropical chronic pancreatitis (TCP) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. The classical triad of TCP consists of abdominal pain, steatorrhoea, and diabetes. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes (FCPD) which is thus a later stage of TCP. Some of the distinctive features of TCP are younger age at onset, presence of large intraductal calculi, more aggressive course of the disease, and a high susceptibility to pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis of TCP and in non-calcific cases ductal dilation on endoscopic retrograde cholangiopancreatography, computed tomography, or ultrasound helps to identify the disease. Diabetes is usually quite severe and of the insulin requiring type, but ketosis is rare. Microvascular complications of diabetes occur as frequently as in type 2 diabetes but macrovascular complications are uncommon. Pancreatic enzyme supplements are used for relief of abdominal pain and reducing the symptoms related to steatorrhoea. Early diagnosis and better control of the endocrine and exocrine dysfunction could help to ensure better survival and improve the prognosis and quality of life of TCP patients. (+info)
Tropical pediatrics: 2002 to 2015.
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It also presents the challenges that confront children in the tropics and their effects on the health of these children. These challenges include the technology divide, economic disparity, ecological changes, urbanization and industrialization, globalization, political instability, population explosion, and gender inequality. The paper paints a scenario of tropical pediatrics into the year 2015. Problems brought about by both underdevelopment and modernization, with urbanization and industrialization, will persist. Infectious diseases will continue to be the leading causes of deaths. The paper presents some significant achievements in the fight against tropical diseases and tries to predict what future progress will contribute to the alleviation of such diseases. The paper also outlines the commitment of the International Society of Tropical Pediatrics (ISTP) to improve the state of tropical pediatrics in the next 15 years. (+info)
Combating tropical infectious diseases: report of the Disease Control Priorities in Developing Countries Project.
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Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century. (+info)
Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence.
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OBJECTIVE: To assess the current international representation of members of editorial and advisory boards and authors in the leading peer reviewed literature on tropical medicine. DESIGN: Systematic review. MAIN OUTCOME MEASURES: Country affiliations, as classified by the human development index, of editorial and advisory board members of all tropical medicine journals referenced by the Institute of Scientific Information (ISI) as of late 2003 and of all contributing authors of full articles published in the six leading journals on tropical medicine in 2000-2. RESULTS: Sixteen (5.1%) of the 315 editorial and advisory board members from the 12 ISI referenced journals on tropical medicine are affiliated to countries with a low human development index and 223 (70.8%) to countries with a high index. Examination of the 2384 full articles published in 2000-2 in the six highest ranking tropical medicine journals showed that 48.1% of contributing authors are affiliated to countries with a high human development index, whereas the percentage of authors from countries with a low index was 13.7%. Articles written exclusively by authors from low ranked countries accounted for 5.0%. Our data indicate that research collaborations between a country with a high human development index and one that has either a medium or a low index are common and account for 26.5% and 16.1% of all full articles, respectively. CONCLUSION: Current collaborations should be transformed into research partnerships, with the goals of mutual learning and institutional capacity strengthening in the developing world. (+info)
Establishing the Diploma in Tropical Medicine and Hygiene (DTM&H) course in the Sultanate of Oman.
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Until 1997, there was no formal teaching in tropical medicine in Arabian Peninsular countries, although many tropical diseases (for example, malaria, schistosomiasis, leishmaniasis, filariasis), are endemic in the region. A six month, part time Diploma in Tropical Medicine and Hygiene (DTM&H) course was established in the Sultan Qaboos University, Muscat, Sultanate of Oman, in 1997, for small groups of Omani doctors wishing to sit the annual DTM&H examination in London. To date, 21 doctors have been successful, and the Royal College of Physicians of London has accredited the Tropical Medicine School in Oman as an appropriate training centre for the examination. Since over 20 doctors apply each year for the six available places in the course, a full time DTM&H course for larger groups of doctors, from Oman and regional countries, is under consideration. (+info)
Integrating evidence based medicine into routine clinical practice: seven years' experience at the Hospital for Tropical Diseases, London.
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PROBLEM: Introduction and evaluation of evidence based medicine (EBM) into routine hospital practice. STRATEGY FOR CHANGE: Routine EBM meetings introduced in 1997. DESIGN: Review of outcomes of meetings from 1997 to 2004, focusing on their effect on clinical practice. SETTING: Referral centre for tropical and domestic infectious diseases. KEY MEASURE FOR IMPROVEMENT: Outcome of meetings, classified as resulting in a change in practice; confirmation or clarification of existing practice; identification of a need for more evidence; and outcome unclear. EFFECTS OF CHANGE: Examples include a change from inpatient to day case treatment of New World cutaneous leishmaniasis; development of guidelines on the treatment of coinfection with visceral leishmaniasis and HIV; and identification of the need for more data on the efficacy and toxicity of atovaquone-proguanil (Malarone) compared with quinine plus sulfadoxine-pyrimethamine (Fansidar) in the treatment of uncomplicated falciparum malaria, which resulted in a clinical trial being set up. LESSONS LEARNT: Incorporation of EBM meetings into our routine practice has resulted in treatment guidelines being more closely based on published evidence and improvements to care of patients. Written summaries of the meetings are important to facilitate change. (+info)