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WHO Chronicle. 1982; 36(5):179-85.The World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction supports investigations on the safety and efficacy in developing countries of oral contraceptive (OC) methods and provides advice on the best preparations or devices for particular groups and the safety of controversial products such as injectable progestins. Comparative studies on OC dosages and preparations, interaction of OCs with parasitic diseases such as malaria, timing of IUD insertion, comparison of available types of IUDs, clinical and epidemiological studies of the safety and dosage levels of long acting progestin preparations, and a comparison of surgical sterilization techniques have been carried out. High priority is given to the development of better methods of fertility control. A simplified questionnaire to determine prevalence of primary and secondary infertility, pregnancy wastage, and infant and child mortality has disclosed some very high rates of infertility, particularly in Africa. Other studies seek to standardize the protocol for diagnosis and investigation of infertility and to evaluate commonly used treatment and evaluation procedures for infertility. The Special Programme seeks to strengthen the capability of institutions in developing countries to conduct research and collaborate in projects. 250 research and visiting scientist grants were awarded in 1980-81, and 20 research training courses were organized. A major effort was made in the standardization and quality control of laboratory procedures, and 142 laboratories in 48 countries now participate.
In: National Council for International Health [NCIH]. New developments in tropical medicine. Washington, D.C., NCIH, 1982 Jan. 43-7.Schistosomiasis is a chronic trematode infection caused by 3 different schistosome species: 1) schistosoma mansoni, 2) schistosoma japonicum, and 3) schistosoma haematobium. The life span of the worms is between 3-7 years; eggs are passed in urine or feces and on reaching fresh water, hatch. The biologic principles of the life cycle have a major effect on the epidemiology of infection; the worm does not multiply in the human host, so the extent of infection is dependent on the number of cercariae that penetrate which in turn is dependent upon the human exposure to infective fresh water. Based on a recent World Health Organization survey of 103 countries, schistosomiasis is one of the most widespread parasitic infections of man; it is present in 73 countries, infecting 200 million people. As world population grows and people are more dependent on unclean water systems and poor sanitation systems, the prevalence of schistosomiasis is rising. Actual disease due to schistosomes results from the human host's inflammatory response to the many eggs that remain in the intestine near the site of oviposition. There are 3 syndromes to consider: 1) schistosome dermatitis which is not of any clinical significance, 2) acute schistosomiasis, also called Katayama Fever, which is an acute febrile illness with cough, chills, hepatomegaly, lymphadenopathy, and eosinophilia, and 3) chronic schistosomiasis, which has symptoms such as bladder calcification, terminal haematuria, occasional dysuria, ureter lesions causing hydroureters and hydronephrosis. The definitive diagnosis is made by examination of excreta or more rarely on rectal biopsy specimens. For s. mansoni in the western hemisphere the treatment is oxamniquine, 15 mg/kg in a single oral does, for s. mansoni from Africa, a dose of up to 60 mg/kg may be needed. For s. haematobium, metrifonate is usually used, 7.5 mg/kg in 3 doses separated by 2 weeks intervals, and for s. japonicum, praziquantel, 60 mg/kg in 3 equal doses in a 24-hour period. Control programs have generally relied on safe water and sanitary facilities, use of molluscicides to kill snails, and the use of chemotherapy to kill schostosomes within the human host.
WHO CHRONICLE. 1982; 36(3):87-91.This article summarizes the major findings and recommendations of the Committee on Orthopoxvirus Infections, established by the World Health Assembly to advise on posteradication policy. Although smallpox has been eradicated, there remains a need for the monitoring of vaccination practices, investigation of rumored smallpox cases, verification of virus and vaccine storage conditions, and surveillance of the other orthopoxviruses, including monkeypox. Routine vaccination for smallpox has been officially discontinued in 150 of the 158 Member States and Associate Members of the World Health Organization (WHO); Egypt and Kuwait continue to immunize, while the present status of vaccination remains unknown in 6 other countries. WHO is taking further steps to encourage all countries to cease this practice and is contracting laboratories that continue to produce smallpox vaccine to request that they cease commercial vaccine distribution. Since 1979, 124 rumors of smallpox cases from 55 countries have been investigated, most of which were misdiagnosed cases of chickenpox, measles, and other skin diseases; none has been smallpox. At present, variola virus is being stored in 4 laboratories, 3 of which are WHO collaborating centers. WHO will continue to inspect these laboratories to ensure that requirements for containment are being met. Programs for the surveillance of human monkeypox in west and central Africa are being initiated, although present data indicate that this disease is not of public health importance. The total number of known cases of human monkeypox since 1970 stands at 63. Important studies for the postsmallpox surveillance program include the development of simple and reliable screening tests for orthopoxvirus antibody and of reliable tests for antibody specific to monkeypoxvirus. Plans are underway to publish a book dealing with all aspects of the smallpox eradication campaign.
World Health Organization Technical Report Series. 1982; (674):1-75.The World Health Organization (WHO) Scientific Group on Treponemal Infections met in Geneva during October 1980 with the objective of reviewing all aspects of the treponematoses and of providing updated standards and guidelines for their diagnosis, treatment, and control. WHO has always attached great importance to the sexually transmitted diseases and to the nonvenereal endemic treponematoses, because of the heavy burden they impose on both the individual and the society. This report of the WHO Scientific Group on Treponemal Infections covers the following: epidemiological aspects (syphilis and nonvenereal treponematoses); clinical aspects; laboratory aspects (diagnosis, microcsopic tests used to identify treponemes, serological tests for the detection of antibodies in individuals with treponemal infections, and diagnosis of neurosyphilis by cerebrosponal fluid (CSF) examination); management aspects; control aspects; and research aspects. The diagnosis of a primary or secondary treponemal infection should be established by identification of the causative organisms using darkfield microscopy. A reliable nontreponemal serological test has confirmatory value in such circumstances. A combination of nontreponemal and treponemal serological tests is essential for the diagnosis of all other stages of syphilis. In clinical outposts where nonmedical health workers deliver health care, simple clinical algorithm may help to ensure that genital ulcers and other clinical manifestations of treponemal infections are treated immediately with adequate doses of suitable penicillin preparations. After nearly 40 years, penicillin remains the drug of choice in the treatment of all forms of syphilis. The following were among the recommendations made by the Scientific Group on Treponemal Infection: the following categories should be used in reporting cases of syphilis, i.e., primary and secondary infections, early latent infections, late latent infections, symptomatic late infections, congenital infections in patients under 2 years of age, and congenital infections in patients 2 years of age and older; improved teaching should have the highest priority, particular attention being directed to congenital syphilis; darkfield microscopy should be the preferred diagnostic test for infectious treponemal disease; physicians should be cautioned never to use less than the recommended dosages of penicillin; practical guidelines should be established on the efficient epidemiological analysis of the extent of syphilis, the logistics of syphilis control programs, and the indications for, and application of, various control strategies; and the highest priority should be given to the prevention of congenital syphilis.