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Lancet Infectious Diseases. 2003 Feb; 3(2):65.A 30-year campaign has successfully ended the blight of river blindness in west Africa. This monumental achievement is the result of the Onchocerciasis Control Programme (OCP), established in 1974 under the joint auspices of the United Nations Development Programme, World Bank, WHO, and the UN Food and Agriculture Organization. (author's)
New York, New York, Global Alliance for TB Drug Development, 2002. 2 p.A Lethal Synergy: While HIV/AIDS has exploded over the last decade, TB has increased 20% rise and today TB kills one out of three AIDS patient worldwide. The two diseases represent a deadly combination, since both are more destructive together than either is alone. HIV infection is the most potent risk factor for converting latent TB into active transmissible TB - accelerating the spread of the disease - while TB bacteria help accelerate the progress of the AIDS infection in the patient. Today TB is the leading cause of death in persons who are HIV positive. (excerpt)
Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.
Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (author's)
Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis.
Tropical Medicine and International Health. 2003 Sep; 8(9):820-831.Objective: To determine the incidence of serious adverse events (SAEs) after mass treatment with ivermectin in areas co-endemic for loiasis and onchocerciasis, and to identify potential risk factors associated with the development of these SAEs, in particular encephalopathic SAEs. Methods: We retrospectively analysed SAEs reported to have occurred between 1 December 1998 and 30 November 1999 in central-southern Cameroon by chart review, interview and examination of a subset of patients. Results: The overall incidence of SAEs for the three provinces studied was 6 per 100,000. However, for Central Province alone the incidence of SAEs was 2.7 per 10,000 overall, and 1.9 per 10,000 for encephalopathic SAEs associated with Loa loa microfilaremia (PLERM). The corresponding rates for the most severely affected district within Central Province (Okola) were 10.5 per 10,000 and 9.2 per 10,000 respectively. Symptoms began within the first 24–48 h of ivermectin administration but there was a delay of approximately 48–84 h in seeking help after the onset of symptoms. First-time exposure to ivermectin was associated with development of PLERM. Conclusion: In Cameroon, the incidence of SAEs following ivermectin administration in general, and PLERM cases in particular, varies substantially by district within the areas co-endemic for loiasis and onchocerciasis. More intense surveillance and monitoring in the first 2 days after mass distribution in ivermectin-naïve populations would assist in early recognition, referral and management of these cases. The increased reporting of SAEs from Okola is unexpected and warrants further investigation. Research is urgently needed to find a reliable screening tool to exclude individuals (rather than communities) at risk of PLERM from the mass treatment program. (author's)
Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1993 May; 114(5):429-36.Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.