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Prevention and control of enterohaemorrhagic Escherichia coli (EHEC) infections: memorandum from a WHO meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1998; 76(3):245-55.This memorandum was developed at a World Health Organization Consultation on Prevention and Control of Escherichia coli (EHEC) Infections, held in Geneva, Switzerland, April 28 to May 1, 1997. Since EHEC O157:H7 was recognized as a human pathogen in 1982, it has been a steadily increasing cause of food-borne illness worldwide. In view of the magnitude and severity of recent outbreaks of food-borne diseases caused by EHEC O157:H7, there is an urgent need for public health and environmental health agencies, farmers, animal producers, food processors and caterers, and researchers to collaborate to reduce or eliminate the health impact of this hazard. The memorandum presents a global overview of EHEC infections, then addresses surveillance of EHEC infections, outbreak identification, and control measures. Recommended prevention and control measures include: use of potable water in food production, presentation of clean animals at slaughter, improved hygiene throughout the slaughter process, appropriate use of food processing measures, thorough cooking of food, and education of food handlers and others on the principles and application of food hygiene.
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1986 Jan; 35(1):1-2.A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.
The Population Council's research program on infant and child mortality in Southeast Asia: a case study of the relationship between contamination of infant weaning foods, household food handling practices, morbidity, and growth faltering in a rural Thai population.
Bangkok, Thailand, Population Council, Regional Office for South and East Asia, 1986 Aug. 24 p. (Population Council Regional Research Papers. South and East Asia)This booklet describes the overall plan of the research program on infant and child mortality in Southeast Asia, sponsored by the Population Council, the Ford Foundation, the Australian Development Assistance Bureau, and the Canadian International Development Research Center. The objectives are to gain scientific knowledge about the socioeconomic, behavioral and medical factors in mortality; to increase awareness through networking and publication; and to evaluate the effectiveness of interventions at the household and community levels. It is assumed that a small number of simple techniques will prevent over half of child deaths. Applied social science or operations research will be used primarily, rather than clinical or demographic studies. Statistical sociological correlations between a variety of environmental characteristics and mortality as the dependent variable will point to determinants of mortality. The 5 chief determinants are: maternal factors, environmental contamination, nutrient deficiencies, injury, and personal illness controls. The concerns reflected in the projects funded so far include: to focus on some combination of determinants of child survival; to focus on a specific location; to use multiple approaches to data collection; to produce results that can be applied as interventions. As an example, the study on the relationship of contamination of infant weaning foods to morbidity and infant growth in a rural Thai population is summarized.