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  1. 101

    A major challenge. Entrepreneurship characterizes the work of the Soviet Family Health Association.

    Manuilova IA

    INTEGRATION. 1991 Sep; (29):4-5.

    The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
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  2. 102

    USAID steps up anti-AIDS program.

    USAID HIGHLIGHTS. 1991 Fall; 8(3):1-4.

    This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.
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  3. 103

    International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. [2], 64 p.

    The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
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  4. 104

    Report of a technical advisory meeting on research on AIDS and tuberculosis, Geneva, 2-4 August 1988.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1989. 21 p. (WHO/GPA/BMR/89.3)

    A technical advisory meeting on research on AIDS and tuberculosis was held to review and prioritize ongoing and planned research in the field, suggesting essential studies and study design. Studies in need of international collaboration, as well as subjects not covered by ongoing and planned research were considered, with attention given to recommending frameworks for development. The final major objective of the meeting was to determine key areas of TB programs requiring strengthening to facilitate such research, and to suggest developmental steps for improvement. The report provides opening background information of tuberculosis, AIDS, and the relationship between the 2, then launches into a discussion of urgently needed research. Epidemiological, diagnostic, clinical presentation, prevention, and treatment studies are called for under this section heading, each sub-section providing objectives, justification, and specific research questions. Design examples for selected research studies constitute an annex following the main body of text. When planning for action on suggested research, the report acknowledges the need for resources, organizational structures, detailed plans and timetables, and collaborative arrangements. 7 areas in which WHO could provide assistance are offered, followed by discussion of strengthening tuberculosis control capacity in WHO, and at the country and local levels. Selection of research sites is considered at the close of the text.
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  5. 105

    Report of the Meeting on Strategies for the Evaluation and Implementation of Laboratory Diagnosis of HIV Infection, Geneva, 31 August - 2 September 1988.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1989. 6 p. (WHO/GPA/BMR/89.2)

    A World Health Organization (WHO) meeting was held to review strategies for WHO activities in the laboratory diagnosis of HIV infection, and to propose feasible, practical ways of implementing recommendations from the Stockholm, 1987, meeting on "criteria for evaluation and standardization of diagnostic tests for detection of HIV antibody." The meeting commended efforts made over the previous 8 months by the WHO global program on AIDS in evaluating new test systems, training laboratory workers, and monitoring test performance. The paper reports recommendations regarding choice of test, training, quality control procedures, and research.
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  6. 106

    Report of the Meeting on Research Priorities Relating to Women and HIV / AIDS, Geneva, 19-20 November 1990.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. 13 p. (GPA/DIR/91.2)

    A meeting of international experts was held to identify gaps in knowledge essential to design and implement AIDS prevention and control programs as they relate to women. Fundamental to successful research efforts are the need for increased access of women to training and participation in research, new consideration of the neglect of gender specificity in existing research, and the need for such research to contribute to the empowerment of women. Specific research needs in epidemiology, behavioral research, and social and economic aspects of HIV/AIDS were identified, ranked according to their potential for contributing to the prevention and control of AIDS, relevance for developing countries, and feasibility. 12 specific research questions are posed in the report, and cover issues such as the determinants of HIV transmission, contraceptive method impact, diagnosis and treatment of STDs in women, social and economic support, women's empowerment, and the risks of female health care provider HIV infection. Additionally, HIV infection natural history differences between men and women are compared, followed by consideration of psychosocial stress, monitoring, HIV and pregnancy, and research protocol development. Background, key issues, reports of the working groups, and recommendations are included in the report.
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  7. 107
    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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  8. 108

    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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  9. 109
    Peer Reviewed

    Neuropsychiatric aspects of HIV-1 infection.


    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.
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  10. 110
    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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  11. 111
    Peer Reviewed

    Histologic types of breast carcinoma in relation to international variation and breast cancer risk factors. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

    Stalsberg H; Thomas DB; Noonan EA

    INTERNATIONAL JOURNAL OF CANCER. 1989 Sep 15; 44(3):399-409.

    Associations between breast cancer risk factors and histologic types of invasive breast carcinoma were studied in 2728 patients. Lobular and tubular carcinomas occurred with increased relative frequency in most high risk groups. The proportion of these types increased with age to a maximum at 45-49 years and decreased in the following decade. Significantly increased proportions of lobular and tubular carcinomas were also associated with high risk countries, prior benign breast biopsy, bilateral breast cancer, concurrent mammary dysplasia, high age at 1st livebirth, never-pregnant patients compared to those with a 1st livebirth before age 20, private pay status, and length of education. Nonsignificant increases were associated with family history of breast cancer, less than 5 livebirths, less than 25 months total breastfeeding, use of oral contraceptives or IUD, and high occupational class. As a general trend, the higher the overall relative risk, the higher the proportion of lobular and tubular carcinomas. The occurrence of other histologic types also increased breast cancer risk, but to a smaller degree than for lobular/tubular carcinomas. It is suggested that all hormonally related, socioeconomic, and geographic risk factors enter their effect by selectively increasing the number of lobular cells at risk. Family history of breast cancer and age over 49 years did not follow the general trend of parallel increases in the proportion of lobular/tubular carcinomas and breast cancer risk, and may operate through other mechanisms. (author's)
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  12. 112

    Further experience with the World Health Organization clinical case definition for AIDS in Uganda [letter]

    Wabwire-Mangen F; Serwadda D; Sewankambo NK; Mugerwa RD; Shiff CJ; Vlahov D; Heyward WL; Quinn TC

    AIDS. 1989 Jul; 3(7):462-3.

    The diagnostic value of the World Health Organization's (WHO's) clinical case definition for acquired immunodeficiency syndrome (AIDS) was reassessed in 99 patients aged 16 years and above who presented to the Internal Medicine ward of Uganda's Mulago Hospital in August-December 1987. The 39 cases met the WHO clinical case definition of AIDS with at least 2 major and 1 minor signs; the control group was comprised of 60 consecutive admissions to the emergency ward who did not fulfill the WHO case definition. Blood samples from each study participant were tested for antibodies to human immunodeficiency virus (HIV)-1 through use of the Organon-Teknika enzyme-linked immunosorbent assay (ELISA) and the DuPont Western blot tests. 85% of the cases and 30% of controls were seropositive for HIV-1. Thus, the WHO clinical case definition had a sensitivity of 65%, a specificity of 88%, and a positive predictive value for HIV-1 seropositivity of 85%. Similar values have been recorded in other centers in Uganda and in Zaire. Various modifications of the case definition were explored; however, none resulted in any significant overall improvements in its diagnostic value. It was concluded that the WHO clinical case definition for AIDS is adequate in central African populations and its continued use is recommended.
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  13. 113

    Can midwives be trained to insert IUDS? Results from Turkey.

    Dervisoglu AA

    ENTRE NOUS. 1988 Oct; (12):10-2.

    Beginning in the 1960s, the Turkish government placed a emphasis on the importance of family planning in an effort to improve maternal and child health (MCH) services. While the IUD has proven adequate for women in Turkey, insertion and proper use have created problems. The IUD program has had difficulty in gaining the acceptance of male physicians in Turkey, and because there are few female physicians in the country, a problem with implementation of the program arose. 1 solution suggested that non-physician personnel learn to insert the IUD and be able to examine IUD patients. Assistant nurse-midwives were surveyed in a 3-phase project carried out by the staff of the Department of Public Health of Hacettepe University in Ankara with WHO. In the 1st phase, a training method was created with competence comparison of the assistant midwives to physicians following in the 2nd phase. The 3rd phase of the project studied the use of non-physician services throughout the country. It was found that assistant nurse-midwives were equally capable of IUD insertions and check-ups and that IUD services can now reach rural areas of the country beyond the range of traditional medical services.
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  14. 114

    Consultation on AIDS and the workplace.

    World Health Organization [WHO]. Global Programme on AIDS

    AIDS ACTION. 1988 Dec; (5):3-4.

    The 1988 Consultation on Acquired Immunodeficiency Syndrome (AIDS) and the Workplace, organized by the World Health Organization (WHO), addressed 3 issues: 1) risk factors associated with human immunodeficiency virus (HIV) infection in the workplace, 2) the response of businesses and workers to the AIDS epidemic, and 3) use of the workplace for AIDS education. There is no evidence to suggest that HIV can be transmitted by casual, person-to-person contact in the workplace. The central policy issue for businesses concerns protection of the human rights of workers with HIV infection. Most workers with HIV/AIDS want to continue working as long as they are able to, and they should be enabled to contribute their creativity and productivity in a supportive occupational setting. Consistent policies and procedures should be developed at national and enterprise levels before HIV-related questions arise in the workplace. Such policies should be communicated to all concerned, continually reviewed in the light of scientific and epidemiologic evidence, monitored for their successful implementation, and evaluated for their effectiveness. Pre-employment HIV/AIDS screening, whether for assessment of fitness to work or for insurance purposes, should not be required and raises serious concerns about discrimination. Moreover, there should be no obligation on the worker's part to inform his or her employer if HIV infection develops. Information and educational activities at the workplace are essential to create the climate of collective responsibility and mutual understanding required to protect individuals with HIV or AIDS from stigmatization and discrimination by co-workers, employers or clients, and unions.
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  15. 115
    Peer Reviewed

    Evaluation of the WHO clinical case definition for AIDS in rural Zaire.

    De Cock KM; Colebunders R; Francis H; Nzilambi N; Laga M; Ryder RW; Bondjobo M; McCormick JB; Piot P

    AIDS. 1988 Jun; 2(3):219-21.

    In many areas of Africa where AIDS is endemic, facilities for laboratory diagnosis are too limited to reliably diagnose opportunistic infections. Therefore, the World Health Organization defined a clinical case definition of AIDS in which 2 major signs and at least 1 minor sign must be present to diagnose AIDS. The major signs are: weight loss greater than 10%, diarrhea for more than 1 month, and prolonged fever for more than 1 month. The minor signs are: persistent cough for more than 1 month, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic disseminated herpes simplex, and generalized lymphadenopathy. (The presence of Kaposi's sarcoma or cryptococcal meningitis are sufficient by themselves for a diagnosis of AIDS.) 72 patients in 4 hospitals in Equateur Province of Zaire were used to test the reliability of the clinical case definition. 21 (29%) of the patients were HIV seropositive, and 22 (32%) fulfilled the clinical criteria. From these data the sensitivity of the case definition was 52%, specificity was 78%, positive predictive value was 50%, and negative predictive value was 80%. Since positive predictive value rises with prevalence and HIV infection is maximal in the 20-40 age group, restricting the case definition to this age group would increase its predictive value. Exclusion of patients with tuberculosis would reduce the number of false positive results.
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  16. 116

    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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  17. 117

    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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  18. 118

    Report of the WHO Meeting on Criteria for HIV Screening Programmes, Geneva, 20-21 May 1987.

    World Health Organization [WHO]. Special Programme on AIDS

    [Unpublished] 1987. 12 p. (WHO/SPA/GLO/87.2)

    The usefulness of proposed screening programs for human immunodeficiency virus (HIV) infection must be weighed carefully against potential harmful effects. Because of complex social and ethical issues and the lack of any specific intervention against acquired immunodeficiency syndrome (AIDS), screening programs may be intrusive and divert resources from educational programs. 21 participants from 17 countries attended a special meeting in May 1987 convened by the WHO Special Program on AIDS to discuss criteria for HIV screening programs. There was general consensus among participants that readily accessible counseling and testing for antibody to HIV, provided on a voluntary basis, are more likely to result in behavior changes that reduce the spread of AIDS than are mandatory screening initiatives. There was also agreement that mandatory screening of targeted populations is less likely than a voluntary approach to reach effectively those persons whose behavior can be influenced to reduce the risk of infection. To facilitate awareness of the complexities inherent in mandatory screening of at risk populations such as drug abusers and prostitutes, this report includes a list of criteria that must be considered and resolved in the planning process. These criteria are: what is the rationale of the proposed program, what population is to be screened, what test method is to be used, where is the laboratory testing to be done, what is the intended disposition of data obtained from testing, what plan will be used for communicating results to the person tested, how is counseling to be accomplished, what is the social impact of screening, and what legal and ethical considerations are raised by the proposed screening program?
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  19. 119
    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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  20. 120
    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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  21. 121

    Business travel in Asia: blood tests required?

    Karel S

    CONSUMER MARKETS ABROAD. 1988 Mar; 7(3):1, 13.

    Travellers to Asian countries face growing hostility as potential carriers of acquired immunodeficiency syndrome (AIDS). Visitors who plan to stay in China, India, the Philippines, or South Korea for more than 1 year must prove that they are AIDS-free. In addition, all foreign students who enter China and India must carry documents indicating that they tested negative for the AIDS virus. The upcoming Olympics poses a special health problem for South Korea, which has not so far required AIDS testing for short-term visitors. A World Health Organization consultation on AIDS infection and international travel has raised questions about the feasibility of an AIDS screening program. The estimated direct cost per traveller for AIDS testing would be US$10-20. Even if all foreign travellers were to be screened, 2 problems could still allow AIDS to enter these countries: black marketing of false health certificates and failing to test foreign nationals who have been abroad. Moreover, a restrictive screening policy for international travellers could result in a decline in tourism and international commerce. Business people who intend to travel to Asia for extended periods of time are advised to check with embassies before their departure to find out what AIDS-related clearances may be required.
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  22. 122

    Standards for affiliated services adopted by PPWP's National Medical Committee.

    Planned Parenthood-World Population

    New York, New York, PPWP, 1966. 6 p.

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  23. 123

    HIV-1 seroprevalence and AIDS diagnostic criteria in Central African Republic [letter]

    Georges AJ; Martin PM; Gonzalez JP; Salaun D; Mathiot CC; Grezenguet G; Georges-Courbot MC

    Lancet. 1987 Dec 5; 2(8571):1332-3.

    Serological surveys and recording of acquired immunodeficiency syndrome (AIDS) cases have been conducted in Bangui since 1985 to monitor the spread of HIV-1 in the Central African Republic. 2.1% in 1985, 3.8% in 1986, and 7.8% of sera in the completed period of 1987 had antibodies to HIV-1--a striking increase. The expected number of new cases of AIDS from January 1986 to March 1987 was calculated to be 734. During that period only 99 cases of AIDS defined by Centers for Disease Control (CDC) criteria were reported to the authors' Bangui institute. However 587 cases (including the 99) were recorded using WHO Bangui workshop criteria. Thus the provisional clinical case definition of AIDS developed in Bangui detected 80% of predicted cases compared with only 13.5% when CDC criteria were used. These differences could at least partly explain the small number of AIDS cases reported from certain countries with high HIV seroprevalence rates.
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  24. 124

    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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  25. 125
    Peer Reviewed

    Evaluation of a clinical case-definition of acquired immunodeficiency syndrome in Africa.

    Colebunders R; Mann JM; Francis H; Bila K; Izaley L; Kakonde N; Kabasele K; Ifoto L; Nzilambi N; Quinn TC

    Lancet. 1987 Feb 28; 1(8531):492-4.

    A provisional clinical case definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organization (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. According to this definition, the diagnosis of AIDS requires the existence of at least 2 of the major signs (weight loss greater than 10% of body weight, chronic diarrhea for more than 1 month) in association with at least 1 minor sign (persistent cough for more than 1 month, general pruritic dermatitis, recurrent herpes zpster, oopharyngeal candidiasis, chronic progressive and disseminated herpes simplex infection, general lymphadenopathy) in the absence of other known causes of immunosuppression. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. Among the major symptoms and signs of the case definition, chronic diarrhea was the most specific. Of the 12 HIV-seronegative patients meeting the criteria of the AIDS case difinition, 6 had tuberculosis and 3 had suspected tuberculosis. Tuberculosis is the most common differential diagnosis problem in the design of a clinical case definition of African AIDS. When the criteria of persistent cough for longer than 1 month or general lymphadenopathy were not used for patients with proven tuberculosis, the WHO clinical definition was 93% specific, 55% sensitive, and had a positive predictive value for HIV seroprevalence and disease expression require that similar evaluations be carried out in other regions.
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