Your search found 8 Results
Zika virus infection: global update on epidemiology and potentially associated clinical manifestations.
Releve Epidemiologique Hebdomadaire. 2016 Feb 19; 91(7):73-81.Add to my documents.
[Geneva, Switzerland], WHO, 2016 Feb.  p.WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it. The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.
Introduction of a new hypo-osmolar oral rehydration solution to routine use in the treatment of diarrhoeal disease: a phase IV clinical trial.
Dhaka, Bangladesh, International Centre for Diarrhoeal Disease Research, Bangladesh [ICDDR,B], Centre for Health and Population Research, . 14 p. (USAID Development Experience Clearinghouse DocID / Order No. PN-ADD-051)In May 2002, following the recommendations made at a meeting of experts held in New York in July 2001, WHO and UNICEF recommended the use of a new, low sodium, low glucose, low osmolarity oral rehydration salts (ORS) solution in place of the previous formulation for use in the treatment and prevention of dehydration due to diarrhoea in all age groups and for all causes. Although the safety data in patients with cholera, while limited, was reassuring, it was recommended that the safety of this new formulation be monitored in a post-marketing surveillance study, measuring the incidence of symptomatic (seizure/altered consciousness) hyponatraemia (serum sodium <130 mmol/L) during treatment with the new formulation of ORS. The objective was to measure the incidence of symptomatic hyponatraemia (seizure/altered consciousness) during treatment of diarrhoea with the newly recommended ORS formulation. The study was conducted at the ICDDR, B hospitals in Dhaka and in Matlab over a complete year (from December, 2002 to November 2003 in Dhaka hospital and from February, 2003 to January 2004 in Matlab hospital). In the two hospitals, a total of 53,280 patients were admitted to the rehydration ward with uncomplicated watery diarrhoea to be treated with the new ORS solution for at least for 8 hours. Patients with associated severe illnesses, or patients directly admitted to the special care unit of the hospitals were excluded from the study. During treatment in the rehydration ward, patients developing symptoms (seizure/altered consciousness) were immediately transferred to the special care unit for treatment and clinical and laboratory investigations to identify the cause of the symptoms. Patients’ records were analysed to find out if the symptoms were associated with hyponatraemia, and if the development of hyponatraemia was due to intake of the new ORS. As this study was not a controlled clinical trial, we reviewed also the records of the Dhaka hospital for the corresponding previous year (from December, 2001 to November, 2002) to compare our findings with the situation when the old ORS formulation was the only ORS solution in use. In both hospitals, a total of 53,280 patients were monitored (22,536 were less than 60 months old, 6,093 were 6 to 15 years of age, and 24,651 were more than 15 years old). In patients less than 60 months of age, on admission 51% had signs of some dehydration and 10% signs of severe dehydration. In patients 6 to 15 years old, 46% had signs of some dehydration and 46% had signs of severe dehydration. Finally, among patients older than 15 years of age, 48% had signs of some dehydration, while 45% had signs of severe dehydration. No single adult patient experienced any symptoms (seizure/altered consciousness) associated with hyponatraemia. A total of 31 patients less than 60 months of age experienced seizure/altered consciousness during treatment with the new ORS formulation. Among those, 24 presented symptoms (seizure/altered consciousness) associated with hyponatraemia (serum sodium <130 mmol/L). Overall the incidence rate of symptomatic hyponatraemia was 0.05% per year in the Dhaka hospital, and 0.03% per year in the Matlab hospital. The review of the hospital records from the Dhaka hospital showed that the incidence rate of symptomatic hyponatraemia was 0.09% per year (47 cases of symptomatic hyponatremia) for the year prior to the initiation of this study. Concerns about the safety of the new reduced osmolarity ORS centers on its use in patients with cholera especially adults. As no single adult diarrhoea patients experienced symptoms (seizure/altered consciousness) associated with hyponatraemia, this finding should be reassuring for the clinicians, policy makers and producers of ORS. In addition, the results of this study demonstrates that the occurrence of seizure/altered consciousness associated with hyponatraemia in patients treated with the new ORS formulation is rare and that the incidence rate of symptomatic hyponatremia associated to the use of the new ORS is less than the incidence rate observed with the old ORS formulation. Based on the results of this study, we can conclude that the new reduced osmolarity oral rehydration salts solution recommended by WHO and UNICEF is safe and that it can be used for the treatment of acute diarrhoea of all etiologies and in all age groups. (author's)
Rabies in endemic countries. Problems with canine carriers of the virus and the cost of safe, post-exposure prophylaxis.
BMJ. British Medical Journal. 1994 Feb 19; 308(6927):488-9.Rabies kills 25,000 people annually in India. Stray dogs are usually the disease carrier. Approximately 500,000 people receive prophylactic treatment after being bitten. In developing countries including India, there are documented cases of the responsible canine outliving its victims, which suggests a chronic excretor state for the virus. Some dogs live a month; 1 dog, which was studied at the Pasteur Institute in Coonoor, lived 3 years. Of 913 saliva samples from the dog, based on fluorescence antibody testing and animal inoculation testing, 14 were positive. This included 1 after a week of prednisolone treatment. Deaths from the bites of chronic excretors have rarely been reported in the United States. Prolonged excretion of rabies virus has been reported in the saliva of asymptomatic dogs, including 5 unvaccinated dogs in an Ethiopian study. These rare, chronic strains of canine rabies may be less virulent. However, human deaths following bites by prolonged excretors would indicate that fatal strains of rabies also have a chronic carrier state. The World Health Organization currently recommends a 10 day observation period for an animal that has bitten someone. This may be insufficient. Also, whether a bitten person should automatically be immunized in areas where rabies is endemic is in question. In developing countries, the animal often escapes and cannot be observed; people are unaware that the animal should be impounded; and inadequate laboratory facilities do not permit proper examination of killed animals. In cases of transdermal bites or scratches, and of contamination of mucous membranes by saliva, patients should immediately receive tissue culture vaccine, regardless of knowledge of the animal's condition. Since neurotissue vaccines are cheap, they are still being used in developing countries. The occurrence of serious neuroparalytic complications following immunization with neurotissue vaccine has been reported to be from 1/220 to 1/12,000. In view of this, immunization after all cases of animal bites would be dangerous. Without laboratory confirmation, the following needs to be considered: 1) the pattern of rabies in the area; 2) the animal species involved; 3) the state of the animal's health at or after the time of the bite; and 4) the site and the severity of the bite. If the new tissue culture vaccines are used, immunization on days 0, 3, 7, and 10 would probably be sufficient when the animal is an excretor. Also, the new vaccines can be given after the 10-day observation period, if the animal is a nonexcretor. If administered intradermally, which requires technical skill, the cost of treatment with the new vaccines is less.
Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study.
ARCHIVES OF CLINICAL NEUROPSYCHOLOGY. 1993 Mar-Apr; 8(2):123-35.In preparation for a World Health Organizations (WHO) study of human immunodeficiency virus-1-associated neurological and psychiatric disorders in a variety of geographic and sociocultural settings, 2 new tests of neuropsychological performance were evaluated. The goal was to identify instruments that are not only able to tap the primary functional domains affected in symptomatic HIV-1 cases but also suitable for cross-cultural use. The WHO/UCLA Auditory Verbal Learning Test (AVLT) presents subjects with a list of words with universal familiarity drawn from 5 categories (body parts, animals, tools, household objects, and vehicles), while Color Trails 1 and 2 is based on the use of numbered colored circles and universal sign language symbols. These instruments represent modifications of the previously utilized Rey AVLT and Trail Making A and B tests. Both the new instruments and the reference tests were administered to healthy or HIV-infected volunteers in 2 developed country settings (Germany and Italy) and 2 developing country sites (Thailand and Zaire). There was a significant correlation between scores on each new test and those on the reference tests, indicating that the new instruments tap the same functional domains. The variance of the z-transformed scores from test site to site was reduced for the WHO/UCLA AVLT compared to the Rey AVLT and for the Color Trails 2 compared to the Trail Making B, suggesting that the new tests are more culture-fair than their predecessors. Finally, the percentage of impaired subjects identified through the new tests was significantly higher among seropositive than seronegative subjects, indicating that these instruments are indeed sensitive to HIV-21 associated cognitive damage across different cultures.
AFRICA HEALTH. 1992 Jan; 14(2):31, 34-5.10-12 million people in the world have leprosy. India claims about 4 million of these cases. Overall at least 20% of the cases are children. In the 1940s, dapsone was the only drug used to treat leprosy. By the early 1970s, dapsone did not perform as expected and Mycobacterium leprae were beginning to exhibit resistance to dapsone. In 1982, WHO published results of its study which recommended fixed and relatively short duration regimens of multiple drug therapy (MDT) for all people with leprosy. It also listed recommendations on diagnosis, classification, and distribution of patients to either pauci or multibacillary groups. MDT depends on what type of leprosy patients have. For example, patients with multibacillary leprosy receive rifampicin, clofazimine, and dapsone whereas those with paucibacillary leprosy receive only rifampicin. In many African countries, however, MDT is not used. Yet cases of leprosy exist in 94% of Africa's countries. Moreover 37% have highly prevalent leprosy and the lowest percentage of patients on MDT (18% vs. world average of 56%). In fact, Nigeria is included in the group of 5 countries with 84% of all cases. Until the various countries in Africa can satisfy the ideal requirements for establishing a MDT program, they should begin MDT at least on a small scale. They do need, however, an adequate supply of the drugs. The other requirements include a good plan of action, laboratory facilities, transport, and referral centers. If the period of time needed to meet these requirements is long, then physicians should conduct pre MDT screenings to diagnose cases and determine who needs chemotherapy. The best way to diagnose cases is from clinical experience and paying particular attention to dermatological and neurological findings. Early identification is needed since leprosy cases are stigmatized. This article includes MDT dosages in adults and children.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1990; 68(5):671-3.A consultation on the neuropsychiatric aspects of HIV-1 infection was held at the World Health Organization (WHO) headquarters January 11-13, 1990. Of topics discussed, participants concluded that a group of conditions characterized by cognitive and motor impairment can be described. New terminology was suggested accordingly. Participants found that otherwise health HIV-1 seropositive patients were no more likely than HIV-1 seronegative patients to manifest clinically significant cognitive impairment. The serological screening of asymptomatic patients for HIV-1 in attempts to protect public safety was therefore deemed unnecessary. Hallucinations and delusions being not infrequent in AIDS and ARC patients, they may be indicative of cognitive impairment or later accompanied by symptoms pointing to diagnosis of delirium or dementia. Acute psychotic disorders outside of evidence of cognitive impairment may result as anomalies described within the text. Depressive syndrome may result outside of severe depressive episode or major depression due to recent diagnosis as HIV-1 positive and/or as the first stage of HIV-1 dementia. DIstinguishing between ARC and the above-mentioned states as the cause of this syndrome may be difficult. Consultation participants cited stress associated with HIV-1 infection or disease to be conditioned by several factors. Finally, neuropsychiatric disorders due to HIV-1 opportunistic processes were discussed. Country-level recommendations included preparing health workers for a wide range of neuropsychiatric conditions in the HIV-1 positive patient, and notifying then that otherwise healthy HIV-1 positive patients may not show clinically significant signs of cognitive impairment. Recommendations followed in urging health services to prepare for a large burden of neuropsychiatric illness in AIDS and ARC patients; governments should support services and train health workers accordingly. Pre- and post-serological testing counseling was stressed, with facility for and understanding of the special needs of HIV-1 positive patients' families and involved health staff. Research on the neurological and mental health needs of patients should be given high priority with attention given to the immediate policy and care implications. Final qualification of the difficulty involved in generalizing research findings to apply across sociocultural and geographical contexts was provided with mention in the text of a WHO multicenter study addressing this concern in its pilot phase at the time of publication. Neurological tests were designed for use in this study to be culturally nonspecific.
EPI NEWSLETTER. 1985 Jun; 7(3):1-2.The Pan American Helath Organization (PAHO) has announced a campaign to enadicate the indigenous transmission of wild polio virus from all countries of the Americas by 1990. This 5-year drive is viewed as a vital part of the broader World Health Organization Expanded program me on Immunization goal to achieve universal immunization against childhood diseases by 1990. Special vaccination strategies will be adapted to the neess of each country. suported by effective disease surveillance and control, proper laboratory support for diagnosis, and training of program managers and field epidemiologists. Program costs over the next 5 years are expected to total US$110 million, about 1/3 of which will come from donor countries. PAHO has emphasized that immunization programs should not be implemented at the expense of efforts to develop the health service infrastructure and that campaigns and national vaccination days should be viewed as ad hoc measures to be gradually replaced by routine immunization services. In the 1969-84 period, a total of 53,251 cases of polio were reported in the Americas. By 1984, 26 countries had achieved polio control.