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  1. 1

    Neonatal tetanus--a brief global review.

    Cook R

    In: The control of neonatal tetanus in India, edited by Indra Bhargava [and] Jotna Sokhey. New Delhi, India, Ministry of Health and Family Welfare, 1983. 16-23.

    Neonatal tetanus is relatively preventable either by the immunization of pregnant women or hygienic care of the umbilical stump. Nonetheless, the medical profession tends to place great emphasis on its treatment than prevention, and the global magnitude of the problem remains largely unknown. In many countries, few cases of neonatal tetanus reach the hospitals and the usual notification system shows only a fraction of total mortality from this disease; thus, retrospective surveys are regarded as the most practical way to arrive at reasonably accurate estimates of disease incidence. Results of these surveys suggest that between 500,000 and 1 million deaths from neonatal tetanus occur each year in the developing world (excluding China). Trials have indicated the effectiveness of a combined approach to neonatal tetanus including improved maternity care (especially through training traditional birth attendants) and immunization of future mothers with 2 doses of tetanus toxoid. The basic prerequisites for effective control seem to be 1) a primary health care network accessible to the majority of the population and 2) an awareness of the magnitude of the problem. Every opportunity should be taken to immunize women in the childbearing period of life; many pregnant women do not take advantage of prenatal care. The World Health Organization (WHO) has been involved in the prevention of neonatal tetanus since the late 1960s. To achieve its goal of virtually eliminating neonatal tetanus by the year 2000, WHO plans to 1) encourage further retrospective surveys, especially in areas where the scope of the problem is unknown, and 2) support the demonstration of a combined approach (improved maternity care and immunization) in areas with populations over 250,000.
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  2. 2

    WHO seeks global program against viral hepatitis.

    Bulletin of the Pan American Health Organization. 1983; 17(3):323.

    A World Health Organization (WHO) Consultative Group on Hepatitis met during July 1983 to draft a global program for viral hepatitis control. At this time, hepatitis viruses infects tens of millions of people every year. These viruses can be transmitted by the fecal-oral route, in blood or certain blood products, and through intimate personal contact. Of the various forms (heptitis A, hepatitis B, and hepatitis non-A, non-B) hepatitis B arouses particular concern because it can produce chronic liver disease and premature death. Currently, there are over 200 million persistent carriers of this virus, many of whom will die of chronic liver damage. Firm evidence recently shows a clear cause and effect relationship between infection with hepatitis B virus and primary liver cancer, a common cancer that claims hundreds of thousands of lives a year. The July meeting made recommendations to improve the situation. One of the most important recommendations was to strengthen national capabilities to control viral hepatitis. The group also reviewed available diagnosis and control methods and suggested areas where action by the WHO would be most effective. The group agreed that the availability of safe and effective vaccines against hepatitis B provides a unique opportunity to break the chain of transmission and to prevent acute and chronic liver disease, including primary liver cancer. There has been concern that the plasma-derived hepatitis B vaccines could contain transmissible agents that might be implicated in the acquired immune deficiency syndrome (AIDS). It was felt that much care needs to be taken in selecting plasma donors and in purifying the immunizing component of the vaccine, known as hepatitis B surface antigen, so as to ensure a very high degree of purity and freedom from all infectious agencts. No evidence exists at this time of AIDS transmission by any hepatitis B vaccine.
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  3. 3

    Possible prevention of liver cancer by vaccination.

    Bulletin of the Pan American Health Organization. 1983; 17(2):212.

    A World Health Organization (WHO) sponsored scientific meeting concludes that hepatitis B vaccine presents unique opportunities for preventing a common type of human cancer by vaccination. Should these prospects be realized, it would be the 1st time an important human cancer has been prevented in this way. The 5-day meeting, held in February 1983, brought together specialists in biostatistics, epidemiology, molecular biology, pathology, virology, and vaccine development and production from 16 countries. The topic at the meeting was liver cancer, one of the 10 most common cancers in the world and one of the most prevalent cancers in developing countries. The evidence for the implication of hepatitis B virus in the etiology of primary liver cancer is based upon epidemiologic and geographic observations of a strong association between hepatitis B infection and this form of cancer and also upon recent results of molecular biology studies showing integration of hepatitis B viral DNA into the host's genetic material. About 80% of all liver cancers are thought to occur as a result of infection with hepatitis B virus. Actual development of such cancers is believed to proceed through a series of intermediate stages, including establishment of a persistent infection with the virus, the hepatitis B carrier stage, and integration of the virus into the host genome. Worldwide, survival, and persistence of the hepatitis B virus depends on a huge reservoir of human carriers, estimated conservatively to number over 200 million. Prolonged "shedding" of the virus by a portion of these carriers and its transmission to others by various routes helps to account for the high incidence of the disease. In many parts of the world perinatal infection and infection in early life play a very important role in transmission and often lead to continuing infection. Feasibility studies conducted in recent years in several countries with 2 newly developed hepatitis B vaccines demonstrated that immunization of babies can prevent natural infection with hepatitis B virus and also can prevent development of a persistent hepatitis B infection. It seems an appropriate time to take international action to plan and initiate a number of field intervention trials with the new vaccines among populations known to have high prevalence of hepatitis B infection, the hepatitis C carrier state, and liver cancer.
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