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  1. 1
    Peer Reviewed

    Third meeting of the WHO Collaborating Centres on AIDS: memorandum from a WHO meeting.

    World Health Organization [WHO]. Collaborating Centres on AIDS


    The 3rd meeting of the WHO Collaborating Centres on AIDS, held 6 June 1987, updated Centre representatives on the activities of WHO's Special Programme on AIDS and discussed technical matters such a definition, testing and diagnosis of AIDS. The special program is concentrating on the African and American regions, visiting countries, and holding workshops on topics such as training, case management and epidemiological surveillance. There will be 20 professional staff at WHO headquarters and 16 in the field. An advisory group on behavioral research met to establish social and behavioral priorities. A protocol for studies of seroprevalence is being developed. The technical topics discussed included widening the definition of AIDS cases to include wasting syndrome and dementia, as well as diagnosis of presumptive AIDS without availability of standardized tests. 3 Consensus statements were adopted, on HIV transmission, HIV infection in health workers, and on present and future status of laboratory tests for HIV. HIV should be continually isolated in various regions of the world to ensure that diagnostic tests reflect local virus strains. An agenda was proposed, including the next meeting to be held in Stockholm in June, 1988.
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  2. 2

    The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.

    World Health Organization [WHO]. Global Commission for the Certification of Smallpox Eradication

    Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)

    The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
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  3. 3

    AIDS in Africa [letter]

    Lauwers M; Ndoluvualu-Namata N; Goubau P; Desmyter J

    NEW ENGLAND JOURNAL OF MEDICINE. 1991 Mar 21; 324(12):848.

    Dr. Goodgame pleads for more openness in discussing the diagnosis of AIDS with the patient. On the other hand, he believes testing for HIV antibodies is largely unnecessary for diagnosis in Uganda, which has 1 of the highest prevalences in the world. Given, however, that the WHO clinical AIDS definition has a positive predictive value of 73% in Ugandan patients (or 83% if cough due to tuberculosis is excluded), 27% of patients in whom there is a clinical suspicion will be erroneously told they have AIDS--"dreadful and at times almost unbearable" news. In other parts of Africa with a lower prevalence this may be even less acceptable. In Gemena, northern Zaire, we evaluated the WHO clinical Aids definition, as modified by Colebunders et al., in 166 patients in 1988-1989. The positive predictive value was 61% (67% if patients with tuberculosis were excluded). This means a wrong diagnosis of AIDS in 1 of every 3 patients. The HIV seroprevalence in this population was 7.9%, as measured in a group of 340 healthy pregnant women. Another problem is the lack of sensitivity of the clinical case definition of AIDS, leading to the possible exclusion of 30-46% of African patients with HIV-related disease in the absence of testing for HIV antibodies. Many patients with AIDS would thus escape detection until they were ill enough to meet the diagnostic criteria. If a standard of care for patients with AIDS is to be achieved in Africa, as Dr. Goodgame proposes, correctly identifying the patients early in the course of the disease is necessary, and we do not believe this is possible without laboratory confirmation. We are aware of the problems that may arise when anti-HIV testing is introduced, and the questions raised (e.g. Who will be tested? What will be done when a positive result is found?) should be thoroughly discussed with the local health team before the test is introduced. In addition, screening of blood donors should have absolute priority over diagnostic testing if a choice has to be made because of the dearth of reagents. (full text)
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  4. 4
    Peer Reviewed

    Clinical features of paediatric AIDS in Uganda.

    Lambert HJ; Friesen H


    A total of 177 children seen at 2 hospitals in Kampala are described who were strongly suspected of having acquired immunodeficiency syndrome (AIDS), either on clinical grounds or because they fulfilled WHO case- definition criteria for diagnosis of pediatric AIDS. Blood was taken from the 177 children and 154 of their mothers and tested for antibody to human immunodeficiency virus (HIV) by an enzyme-linked immunoassay (ELISA). Altogether, 119 (67%) children were seropositive, but only 85 (71%) fulfilled the WHO case-definition criteria, and they were significantly older than the 34 who did not fulfill the criteria. A further 58 children were seronegative but fulfilled the WHO criteria. Of the 119 seropositive children, only 3 had a history of previous blood transfusion, but 103 (98%) of 105 mothers were HIV seropositive: consequently, their children were considered to have been infected in utero or perinatally. 13 (26%) of 49 mothers of seronegative children were seropositive. 80% of HIV-infected children were under 2 years of age at diagnosis and 23% died within 3 months of diagnosis. None of the parents was known to be an intravenous drug user, a prostitute, or bisexual. The difficulty of accurate diagnosis of AIDS presents a major problem in Africa, as the WHO clinical case-definition criteria alone are clearly not adequate. (author's)
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  5. 5

    Cost-effectiveness of screening to reduce transfusion-related AIDS in developing areas. Overheads.

    Shepard DS; Eichner J

    [Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. [14] p.

    98 countries responded to the World Health Organization (WHO) survey to gather data on screening of blood for Acquired Immune Deficiency Syndrome (AIDS) antibody. 35 of the 98 countries reported screening. Nonlaboratory means of excluding high-risk donors includes donor group selection, information and education for donor self-deferral, donor history, and physical examination. On the basis of the survey, the following conclusions were reached: screening and testing of blood virtually eliminates transfusion-related AIDS in the long run; the impact on hospital costs is evident only after 5 years; screening and testing blood reduces AIDS cases and deaths and saves money; testing and screening are worthwhile even if the test or technique is imperfect; and a model can estimate impact of improvements in utilization and accuracy of testing and screening.
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  6. 6

    Guidelines for the laboratory diagnosis of diphtheria.

    Brooks R

    [Unpublished] 1981. 27 p. (LAB/81.7)

    WHO guidelines for the laboratory diagnosis of diphtheria are described in this booklet. The guidelines cover only selected laboratory methods that have been proved reliable. The health significance of diphtheria and the importance of the laboratory in diphtheria diagnosis are emphasized, because it is a frequently misdiagnosed disease. Procedures for the isolation and identification of Corynebacterium diphtheriae are outlined. Collection and transport of throat and nasopharyngeal swab specimens, including directions for taking swabs in skin diphtheria, are described. Processing recommendations, with instructions regarding the minimum culture media required for C. diphtheriae isolation, requirements for inoculation and incubation of culture media, and primary plating of specimens is provided. Examination of cultures for the presence of beta hemolytic streptococci and time frames for examination of plates are given, with a description of the method of obtaining pure cultures. A diagram depicts the primary plating of swabs, and the cellular morphology and toxigenicity testing of C. diphtheriae are explained. Biochemical testing and biotyping guidelines for C. diphtheriae, with notes on interpretation are offered in the final section. The appendix describes various reagents and culture media, with directions for preparation and transport.
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  7. 7
    Peer Reviewed

    Evaluation of a clinical case: definition of AIDS in African children.

    Colebunders RL; Greenberg A; Nguyen-Dinh P; Francis H; Kabote N; Izaley L; Davachi F; Quinn TC; Piot P

    AIDS. 1987; 1:151-3.

    In July 1986, a provisional clinical case definition of AIDS in children, developed by the WHO for surveillance purposes in Africa, was tested on 159 patients hospitalized in the Department of Pediatrics at Mama Yemo Hospital, Kinshasa, Zaire. 21 (13%) of these children were seropositive for HIV. In this population, the clinical case definition of pediatric AIDS was found to be fairly specific (87%) but lacked sensitivity (35%). The positive predictive value for HIV seropositivity was 25%. This study suggests that it is more difficult to define AIDS clinically in children than in adults and that the utility of the proposed WHO clinical case definition for pediatric AIDs for surveillance of children's AIDS in Africa is limited. (author's)
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  8. 8
    Peer Reviewed

    Smallpox and its post-eradication surveillance.

    Jezek Z; Khodakevich LN; Wickett JF


    Since May 1980 when the 33rd World Health Assembly declared the global eradication of smallpox, WHO has been developing a comprehensive system of surveillance aimed at maintaining the world permanently free from this disease. By 1984, all countries had ceased vaccinating the general public against smallpox, and had withdrawn the requirement for smallpox vaccination certificates from international travellers. A number of countries had also discontinued the vaccinating of military personnel. Until now WHO has maintained a stock of smallpox vaccine sufficient to vaccinate 300 million persons, but considering that 10 years have elapsed since the last endemic case of smallpox, maintenance of this reserve is no longer indicated. WHO continues to monitor rumors and coordinate the investigation of suspected cases, all of which have actually been misdiagnosed chickenpox or some other skin disease, or other errors in recording or reporting. Variola virus is now kept in only 2 WHO Collaborating Centers which possess high security containment laboratories. Since the variola virus gene pool has been cloned in bacterial plasmids which provide sufficient material to solve future research and diagnostic problems, there is no need to retain stocks of viable variola virus any longer. The results of a special program for the surveillance of human monkeypox have confirmed that the disease does not pose any significant health problem. In addition to testing human and animal specimens, WHO collaborating laboratories have made progress in the analysis of DNA of orthopoxviruses and in the development of reliable serological tests. (author's modified)
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  9. 9

    AIDS: diagnosis and control [letter]

    Deinhardt F; Domok P; Smithies A; Leparski E; Bytchenko B; Mann J

    Lancet. 1987 Apr 18; 1(8538):930.

    At a meeting convened by the World Health Organization (WHO) regional office for Europe in March 1987 and attended by representatives of 27 member states, it was agreed that human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pose a major threat to the health of all nations in the world. The most effective means of reducing the transmission of the virus remains intensive, frank education for the entire population about the nature of HIV infection, its modes of transmission, and the precautionary measures available. More epidemiologic data on the distribution of HIV infection and the development of AIDS within the population are needed, but should be obtained, wherever possible, by voluntary, targeted surveys rather than through compulsory testing or mandatory reporting by name. In addition, there was recognition of the need for further improvement in diagnostic tests for HIV infection to make them simple, less expensive, and more specific. Tests are also needed to detect HIV or its antigen directly during the early period after infection. Epidemiologic models can be helpful in making short-term predictions, but cannot at present be used for the long-term since they are dependent on inaccessible or unreliable data about prevalence and shifts in life-style. Finally, there was strong support at the meeting for AIDS research to be identified as a national priority. Funding should be provided to increase the number of basic and clinical research institutes, to develop cooperation among scientists from different regions, and to establish a collaborative network for clinical trials.
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  10. 10
    Peer Reviewed

    AIDS definition for Africa.

    Van de Perre P; Nzaramba D; Ntilivamunda A; Uwimana A; Lepage P; Rouvroy D; Maurel R; Gatsinzi T; Bugingo G

    Lancet. 1987 Jul 11; 2(8550):99-100.

    The positive predictive values for HIV seropositivity are compared using WHO and US Centers for Disease Control (CDC) clinical case definitions of acquired immunodeficiency syndrome (AIDS), for cases in Rwanda, Africa. It is postulated that the article by Colebunders and co-workers should encourage clinicians and epidemiologists working in Africa to adopt the World Health Organization's provisional clinical case definition for AIDS. Although the predictive value for HIV seropositivity calculated in urban-based adults, as measured by the 2 different criteria, is comparable, (both criteria yield a 93% positive predictive value), this high % is not reached for cases of AIDS diagnosed for rural adults or urban-based children, using the WHO criteria. These data confirm the opinion of Colebunders and co-workers that regional variations in the prevalence of HIV infection can interfere with the positive predictive value for HIV seropositivity of this definition. Workers in other countries should test the validity of the WHO criteria in their own settings and evaluate the WHO case definition adapted to pediatric AIDS in Africa.
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  11. 11
    Peer Reviewed

    [The Collaborating Centers of the World Health Organization and AIDS: report of a meeting of the World Health Organization] Les Centres Collaborateurs de l'OMS et le SIDA: memorandum d'une reunion de l'OMS.

    World Health Organization [WHO]


    The World Health Organization (WHO) meeting on acquired immune deficiency syndrome (AIDS) held in Geneva in September 1985 stressed the importance of the WHO collaborating centers in the worldwide struggle against AIDS. The network of collaborating centers was established after and April 1985 WHO meeting to facilitate international cooperation in training of laboratory personnel, supplying reference reactives, evaluating diagnostic tests, and organizing activities to establish the natural history of the disease in different parts of the world. The AIDS virus is transmitted during sexual intercourse, by parenteral exposure to blood or contaminated blood products, or from the mother to the infant during the perinatal period. In the US and Western Europe, over 90% of victims are still homosexual and bisexual men, intravenous drug users, and their sexual partners, but in many developing countries heterosexuals with active sex lives are the main victims. There are no indications that the virus is spread by casual contact or by insect vectors. Health authorities of all countries should establish surveillance programs to measure the extent of AIDS infection. A precise case definition including only the most serious manifestations of the disease should be used. The US Centers for Disease Control definition has been approved for countries with appropriate diagnostic capabilities. Only immunological diagnostic methods are practical for large scale routine testing. Radioimmunological and immunoenzymatic titers are the most frequently used routine testing procedures. They are very sensitive, but because of the possibility of false positive results, confirmation using another test is needed for individuals belonging to low risk populations. The Western blot or other immunoblotting tests are most often used for confirmation. Progress in laboratory diagnosis would be furthered if international reference standards, simpler diagnostic tests, and other measures were made avaliable. Until drugs capable of preventing and treating AIDS become available, prevention will depend mainly on reduction of risks based on information and education. Cases of AIDS spread by blood transfusion can be eliminated by excluding donors belonging to high-risk groups and by testing the blood for antibodies before transfusion. Reuse of nonsterile needles and syringes should be absolutely avoided. Despite efforts to identify an effective agent for treatment of AIDS, no substance has been found as yet that supplies more than a transitory arrest of viral replication. Interferon has been shown to be effective against Kaposi's sarcoma. New antiviral agents should be careful studied in conformity with accepted protocols for drug evaluation. Numerous attempts to develop an anti-AIDS vaccine are underway. The heterogeneity of the virus poses a significant problem. Several specific recommendations for its 1986-87 program were made to further the role of the WHO as a centraL clearinghouse for AIDS information.
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  12. 12

    Guidelines for the prevention and control of infection with LAV/HTLV III.

    World Health Organization [WHO]

    [Unpublished] 1986 May. [17] p. (WHO/CDS/AIDS/86.1)

    These guidelines, prepared by WHO, address the prevention and control of the acquired immunodeficiency syndrome (AIDS) infection with lymphadenopathy associated virus/human T-lymphotropic virus Type III (LAV/HTLV-III) and are suitable for international application. The Introduction sets forth case definitions of AIDS and discusses the virus, its transmission and clinical features, laboratory methods for detection, and notification and confidentiality. The chapter on recommendations for health care workers proposes precautions for specific personnel such as laboratory staff, providers of home care, dental care personnel, and eye examiners. Also included are considerations relevant to non-health-care workers such as personal service workers and food service workers. Procedures for the handling of blood and blood products and disinfection and sterilization are set forth, and means of avoiding sexual and parenteral transmission of LAV/HTLV-III infection are suggested. Another chapter focuses on screening, diagnostic testing, and counseling of seropositive individuals. The strategies outlined are anchored in fundamental public health concepts and utilize the best available knowledge on the laboratory, clinical, and epidemiologic aspects of LAV/HTLV-III infection. The guidelines are directed toward public health authorities and health professionals who have the responsibility of adapting the general guidelines to meet the diverse requirements of different populations and settings. The document is not complete at this time; several sections are currently under development and will be made available as soon as they are finished.
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  13. 13

    Acquired immune deficiency syndrome (AIDS)--recommendations of IMAP.

    International Planned Parenthood Federation [IPPF]. International Medical Advisory Panel [IMAP]

    IPPF MEDICAL BULLETIN. 1986 Jun; 20(3):3-4.

    This statement was prepared by the IPPF Medical Department in response to requests from family planning associations for clear and accurate information about the acquired immunodeficiency syndrome (AIDS) and the precautions needed to avoid AIDS infection. It summarizes current knowledge on the epidemiology, transmission, diagnosis, symptoms, and prevention of AIDS. Transmission of human lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) occurs through sexual contact with an infected person, transfusion of infected blood or blood products, injection with a needle contaminated with the virus, or artificial insemination with infected semen. Transmission also can occur perinatally from an infected mother to her infant. At present, persons who have antibody to HTLV-III/LAV are believed to harbor the virus and are considered infectious. Recommendations for the prevention of sexually acquired AIDS include avoidance of casual sex, especially with those from high risk groups (homosexual or bisexual men, intravenous drug users, prostitutes), and condom use. Transmission by nonsexual means can be controlled by refusing to accept blood, semen, organ, or tissue donations from persons in high risk groups; avoidance of illicit use of intravenous drugs or use of nonsterile needles; awareness on the part of health workers involved in providing artificial insemination services or blood and blood products of the risk of HTLV-III/LAV infection; and screening of semen donors for antibody at the time of donation and after 3 months. In terms of prevention of perinatal transmission, it should be noted that women with HTLV-III/LAV infection who become pregnant are at increased risk of developing AIDS and have a 50% chance of transmitting infection to their infant. Women with HTLV-III/LAV infection should be advised of the need for a highly efficient type of contraception to prevent pregnancy. Since AIDS is an uncommon disease of low infectivity, family planning workers are not considered to be at greater risk than the broader population.
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  14. 14
    Peer Reviewed

    [Record of the second meeting of the WHO Collaborating Centers on AIDS] Deuxieme reunion des centres collaborateurs de l'OMS pour le SIDA: memorandum d'une reunion de l'OMS.


    Participants at the 2nd meeting of World Health Organization (WHO) collaborating centers on AIDS (acquired immune deficiency syndrome) held in Geneva in December 1985 reported on progress since the 1st meeting in September 1985 and made a number of recommendations for future action in the areas of information, education, and prevention; reference reactants and tests of anti-HTLV-III antibodies; epidemiologic evaluation; and research on vaccines and antiviral agents. It was recommended that ministries of health, education, and social services provide the public with timely and accurate information on AIDS, that physicians, nurses, and similar personnel inform the ill and the public about AIDS and its prevention, and that school age children and young people be informed about AIDS and how to avoid infection. Systems of registration of AIDS cases should be implemented in order to provide the WHO and member states with data on the international level. Standardization and availability of serologic tests is also required. Instructions for avoiding infection should be provided for health personnel and others caring for AIDS patients, for individuals providing personal services to the public, and to ensure adequate methods of disinfection. Instructions for preventing AIDS should discuss sexual and parenteral transmission as well as perinatal transmission. Specific recommendations for education and family placement for children with AIDS have already been published. Instructions should be provided for prisons and similar estabilshments. Requiring international travellers to provide certificates attesting to their AIDS-free status is not justified as a preventive measure. The significant existing demand for reference reactants including human serums with anit-HTLV-III antibodies and controls is being addressed by several institutes in different countries, but it would be premature to furnish reference reactants other than serums. The WHO collaborating centers should furnish materials for purposes of training in diagnostic techniques. Existing tests for diagnosis and confirmation should be imporved and new tests should be developed, with particular attention to simple methods appropriate for use in developing countries. It will be necessary to establish international biological standards for the HTLV-III virus, but the required specifications are not yet known. Technical cooperation and epidemiological evaluation must be planned separately, based on the different prevalence of infections and technical expertise of different countries. A clinical definition of AIDS is needed for countries lacking resources needed to apply the Centers for Disease Control/WHO definition. Surveillance methods and laboratories can be installed with WHO assistance, to help evaluate the extent of AIDS infection in different countries. Later technical cooperation in the areas of continued surveillance and laboratory capacities will depend on results of the initial evaluation in each country. Research is currently underway in several countries of possible vaccines and drugs. Careful preclinical studies should be done to evaluate the toxicity of an agent before clinical studies are conducted. Convenient animal models should be sought for future research. 3 annexes to this report specify methods of disinfection; general principles of preventing transmission of the AIDS virus through parenteral exposure or following donation of organs, sperm, or other tissue; and a proposed definition of clinical cases of AIDS.
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