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  1. 1
    070831

    Report of a WHO Consultation on the Prevention of Human Immunodeficiency Virus and Hepatitis B Virus Transmission in the Health Care Setting, Geneva, 11-12 April 1991.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. [3], 8 p. (WHO/GPA/DIR/91.5)

    The transmission of both Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in health care settings causes concern among patients, health care workers, and national policymakers. This document reports recommendations from a consultative meeting on the issue organized by the World Health Organization Global Program on AIDS. The meeting was held at the request of member states to review risks of transmission of HBV and HIV in the health care setting, and to provide guidance on policies and strategies to minimize such risks. In order of declining incidence and likelihood, HBV and HIV may be transmitted from patient to patient, patient to worker, and worker to patient. The risk of infection depends on the prevalence of infected individuals in the population, the frequency of exposure to contaminated medical instruments, relative viral infectivity, and the concentration of virus in the blood. The risk of acquiring HBV from a needlestick exposure to blood of an infected patient is estimated at 7-30%, while less than 0.5% of health care workers exposed in similar fashion to HIV+ blood have become infected with HIV. General recommendations and specific measures for WHO and national authorities to adopt in the prevention of these infections are listed. Central to prevention is the adoption by health care workers of universal precautions which assume that all blood and certain bodily fluids are infectious. HBV vaccines for both health care workers and as a routine infant immunogen are recommended where appropriate. Routine and/or mandatory blood testing of workers or patients is not recommended, and is considered potentially counterproductive to AIDS control.
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  2. 2
    070850

    Towards better diagnosis.

    Payne D

    WORLD HEALTH. 1991 Sep-Oct; 12.

    A researcher with WHO's Tropical Disease Research Programme reviews techniques used to diagnose malaria. Present techniques have not improved much since a French physician 1st used a microscope in 1880 to examine blood from a sick soldier and then noticed the parasites of Plasmodium falciparum. Yet optical quality has improved and special stains can now be used to color the parasites making them more recognizable. In fact, at a magnification of 600-700 times, a scientist can identify all 4 plasmodia, the blood forms of the plasmodia, and count the plasmodia. Blood samples and a microscope allow physicians to monitor the ill person's progress after they began treatment. Yet a microscope and the needed laboratory skills and other resources are not always present in health center in a village in countries where malaria is endemic. It is here where simple and effective techniques are needed the most. 1 approach is to detect antibodies to the plasmodia, but this takes much time. In addition, antibodies are only present after an individual has been infected for a relatively long time. Thus this technique cannot detect malaria early enough to provide proper treatment. Another approach readily identifies antigens. Yet the techniques required are complicated and require a lot of time. Besides antigen techniques are not as reliable as microscopic diagnosis. Researchers are presently experimenting on simple visual methods which are quick, inexpensive, and reliable. Molecules in the plasmodia which are in a small amount of blood will either react or not react with reagents incorporated on a dipstick or card. Thus physicians can detect what plasmodia are present and estimate parasite load. Another test can inform the physicians what antimalarial to prescribe and how much and resistance of the plasmodia to the antimalarial.
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  3. 3
    069586

    The epidemiological evolution of HIV infection.

    Greco D

    ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.

    Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
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  4. 4
    069078

    What use is a clinical case definition for AIDS in Africa?

    Gilks CF

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1189-90.

    The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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  5. 5
    068455

    AIDS in India: constructive chaos?

    Chatterjee A

    HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.

    Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
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  6. 6
    066757
    Peer Reviewed

    The value of a clinical definition for epidemic KS in predicting HIV seropositivity in Africa.

    Desmond-Hellmann SD; Mbidde EK; Kizito A; Hellmann NS; Ziegler JL

    Journal of Acquired Immune Deficiency Syndromes. 1991; 4(7):647-51.

    Kaposi's sarcoma (KS) in African adults can present in both endemic (non-HIV related) and epidemic (HIV related) forms and in this paper, the authors evaluated the usefulness of a clinical case definition for epidemic KS in predicting HIV seropositivity. A total of 235 patients with KS presenting to the Uganda Cancer Institute from January 1, 1988-March 31, 1990 were evaluated with history and physical examination. Symptomatic patients underwent chest radiography and upper gastrointestinal endoscopy. 174 (80%) underwent HIV ELISA testing with Western blot confirmation. The clinical case definition had a 91% sensitivity and a 95% specificity in predicting HIV seropositivity. Oral KS was the most sensitive specific site of involvement in predicting HIV seropositivity. The clinical case definition is useful in assessing patients to determine prognosis and likelihood of responding to aggressive therapy. (author's)
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