PedVacc 002: A phase I/II randomized clinical trial of MVA.HIVA vaccine administered to infants born to human immunodeficiency virus type 1-positive mothers in Nairobi

Background

A safe, effective vaccine for breastfeeding infants born to HIV-1-positive mothers could complement antiretroviral therapy (ART) for prevention of mother-to-child transmission of HIV-1. To date, only a few HIV-1 vaccine candidates have been tested in infants.

Trial design

A phase I/II randomized controlled trial PedVacc 002 was conducted to determine the safety and immunogenicity of a single, low dose of MVA.HIVA vaccine delivered intramuscularly to healthy 20-week-old infants born to HIV-1-positive mothers in Nairobi, Kenya.

Methods

Pregnant HIV-1-positive women in the 2nd/3rd trimester of gestation were enrolled, provided with ART and self-selected their infant-feeding modality. Infants received nevirapine and cotrimoxazole prophylaxis. At 20 weeks of age, eligible HIV-1-negative infants were randomized to vaccine versus no-treatment arms and followed to 48 weeks of age for assessments of vaccine safety, HIV-1-specific T-cell responses and antibodies to routine childhood vaccines.

Results

Between February and November 2010, 182 mothers were screened, 104 were eligible and followed on ART during pregnancy/postpartum, of whom 73 had eligible infants at 20 weeks postpartum. Thirty-six infants were randomized to vaccine and 37 to no treatment. Eighty-four percent of infants breastfed, and retention at 48 weeks was 99%. Adverse events were rare and similar between the two arms. HIV-1-specific T-cell frequencies in interferon-γ ELISPOT assay were transiently higher in the MVA.HIVA arm (p = 0.002), but not above the threshold for a positive assay. Protective antibody levels were adequate and similar between arms for all routine childhood vaccines except HBV, where 71% of MVA.HIVA subjects compared to 92% of control subjects were protected (p = 0.05).

Conclusions

This trial tested for the first time an MVA-vectored candidate HIV-1 vaccine in HIV-1-exposed infants in Africa, demonstrating trial feasibility and vaccine safety, low immunogenicity, and compatibility with routine childhood vaccinations. These results are reassuring for use of the MVA vector in more potent prime-boost regimens.     

Decay of maternally derived measles antibody in central Turkey

The aim of this cross-sectional study was to investigate maternal antibodies in sera of infants below vaccination age and their relation to the immunity status of the mothers.The study group consisted of 184 mothers and their babies aged 0-9 months. Mothers were interviewed to obtain demographic information. Samples of sera were taken from mothers and their babies and tested for measles IgG antibodies.In our study, 174 mothers (94.6%) were immune to measles. Only 78.4% of the 0 month-old infants of seropositive mothers and 26.0% of the 4-9 month-old infants were seropositive. When correlation analysis for antibody titres was made between the seropositive mothers and their seropositive infants, positive correlation was found.It was found that the time for which infants were protected was related to maternal IgG antibody titre. It will be proper to determine the vaccination strategies considering the changing epidemiological characteristics.     

A retrospective study of childhood mortality and spontaneous abortion in HIV-1 infected women in urban Malawi.

HIV infection in pregnant women has been shown to have an adverse effect on the fetus and newborn. We undertook this study to examine the adverse effect of maternal HIV-1 infection on two outcomes of the previous pregnancy, as reported by the women: childhood mortality under the age of 3 years and spontaneous abortion. Some 6605 consecutive women who presented to a large urban hospital in Malawi for antenatal care were interviewed and tested for HIV-1 antibody. Of these 4229 (64%) were multiparous and 833 (19.7%) were seropositive for HIV-1. A history of under-3 mortality of the previous pregnancy was more common in HIV-1 seropositive than HIV-1 seronegative women (35% versus 15%, P less than 0.001). In the previous pregnancy, death of infants and children under 3 years was 77 and 119 per 1000 respectively for HIV-1 seronegative mothers, but increased to 171 and 292 per 1000 in infants and children under 3 years for HIV-1 seropositive mothers. History of child mortality was independently associated with positive HIV-1 serology, positive syphilis serology, low socioeconomic status, young age and not having married. There was no correlation between history of child mortality and reported symptoms of HIV/AIDS by infected mothers, except for history of tuberculosis which was reported more often by mothers whose child had died (4% versus 1%, P less than 0.036).(ABSTRACT TRUNCATED AT 250 WORDS)     

Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors

OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this disease.     

大连地区新生儿弓形虫感染的免疫学检测

目的探讨大连地区新生儿弓形虫感染的情况。方法采用酶联免疫吸附试验三联诊断法对93例新生儿脐带血清标本进行弓形虫感染的血清学检测。结果新生儿弓形虫各单项检测阳性率分别为循环抗原(CAg)4.3％、IgM2．2％、IgG15．1％，新生儿弓形虫平均感染率为19．4％，其中近期感染率为5．4％。结论新生儿弓形虫感染的危险性很高，应开展孕妇血清学监测及时采取措施，有效地预防先天性弓形虫感染。     

Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe

BACKGROUND: Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding mothers improves the vitamin A status of their infants, but there are no data regarding its effect on infant mortality, and data on the effect of directly supplementing infants during the first few weeks of life are conflicting. OBJECTIVE: The objective was to measure the effect on infant mortality of supplementing neonates and their HIV-negative mothers with single, large doses of vitamin A during the immediate postpartum period. DESIGN: A randomized, placebo-controlled, 2-by-2 factorial design trial was conducted in 14,110 mothers and their infants; 9208 of the mothers were HIV-negative at delivery, remained such during the postpartum year, and were retained in the current analysis. The infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A (Aa), mothers received vitamin A and infants received placebo (Ap), mothers received placebo and infants received vitamin A (Pa), and both mothers and infants received placebo (Pp). The vitamin A dose in the mothers was 400,000 IU and in the infants was 50,000 IU. The mother-infant pairs were followed to 12 mo. RESULTS: Hazard ratios (95% CI) for 12 mo mortality among infants in the maternal-supplemented and infant-supplemented groups were 1.17 (0.87, 1.58) and 1.08 (0.80, 1.46), respectively. Hazard ratios (95% CI) for the Aa, Ap, and Pa groups compared with the Pp group were 1.28 (0.83, 1.98), 1.27 (0.82, 1.97), and 1.18 (0.76, 1.83), respectively. These data indicate no overall effect. Serum retinol concentrations among a subsample of women were similar to reference norms. CONCLUSION: Postpartum maternal or neonatal vitamin A supplementation may not reduce infant mortality in infants of HIV-negative women with an apparently adequate vitamin A status.     

Hair manganese concentrations in newborns and their mothers

The study was designed to investigate the manganese (Mn) status of mothers and their offspring at delivery. Hair Mn concentrations in 31 full-term, 18 preterm and 12 newborn infants with congenital malformations and their mothers were determined by the flameless atomic absorption technique. Both in infants with congenital malformations and their mothers, hair Mn levels were significantly lower than the full-term and preterm infant-mother pairs. With the exception of mothers of infants with congenital malformations, hair Mn concentrations in mothers were significantly higher as compared with their infants. Low hair Mn concentrations of infants with congenital malformations and their mothers may possibly reflect a state of Mn deficiency in these women. These results imply that 1) Mn deficiency may play a role as one potential factor in intrauterine malformations, 2) Mn is supplied to the fetus by a homeostatic mechanism which is mainly dependent on the Mn status of the mother, 3) prenatal Mn analysis in maternal hair may prove to be a reliable indicator for the risk of intrauterine malformations.     

Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey

Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women ≥37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was ≤20 ng/mL in 233 mothers (90.3%) and ≤10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies.     

HBsAg阳性母亲与婴幼儿HBV血清标志物关系

目的了解HBsAg阳性母亲及其经乙肝高效价免疫球蛋白联合乙肝疫苗免疫的婴幼儿乙型肝炎病毒（HBV）血清标志物变化及转归情况。方法对125例HBsAg阳性母亲及其128例婴幼儿（双胎3例）进行随访调查,并分别于婴幼儿7月龄、24~36月龄应用酶联免疫吸附试验检测母亲和婴幼儿血清HBV主要标志物。结果7月龄随访83例婴幼儿,24~36月龄随访75对母子。128例婴幼儿出生时HBsAg阳性4例,随访时仅1例持续阳性,其余出生时HBsAg阴性的94例婴幼儿随访中未发现HBsAg阳转;HBsAg、HBeAg双阳性的26例母亲所产婴幼儿出生时20例HBeAg阳性,随访时除1例HBsAg为阳性的婴幼儿HBeAg仍持续阳性外,余均转阴,未见婴幼儿出现HBeAg阳转;婴幼儿抗-HBe和抗-HBc在7月龄和远期随访中逐渐阴转。结论乙肝病毒经胎盘所致的宫内感染率约为3.13%（4/128）,出生后转为慢性感染者约为25.00%（1/4）;HBeAg可通过人类胎盘从母亲传递给胎儿,但在7月龄前消失;出生于HBsAg阳性母亲的婴幼儿在婴幼儿期单独抗-HBe和（或）抗-HBc阳性,不能说明处于HBV感染状态。     

Immunogenicity of 23-valent pneumococcal polysaccharide vaccine in HIV-infected pregnant women and kinetics of passively acquired antibodies in young infants

Whether gestational immunization of HIV-infected mothers with the 23-valent pneumococcal polysaccharide vaccine (PPV) confers maternal and infant early life, passive protection is not known. We evaluated safety, immunogenicity and placental transfer of antibodies in 44 HIV-infected women. Pneumococcal IgG antibodies against serotypes 1, 3, 5, 6B, 9V, and 14 were measured in mothers (pre-vaccination and at delivery), and infants (at birth, 1, 2, 3, and 6 months). PPV was safe and immunogenic in mothers. Newborns received 46–72% of maternal antibody titers. Overall, infants had antibody levels lower than protective by 2 months of age. Alternative pneumococcal vaccination of HIV-infected pregnant women should be explored with the aim of prolonging passive protection in their infants.     

Breast-feeding patterns in Saudi Arabia

A survey was conducted on 1019 mothers in 79 primary health care centers in Saudi Arabia to determine the patterns of breast feeding. A large percentage of mothers (98%) had breastfed their infants at birth. This rate dropped to 96.5% during the first week of life. There were 635 (64.1%) mothers who started to breastfeed their babies within 6 hours of delivery. Over two-thirds (68.9%) of mothers gave supplemental liquids to infants during the first 3 days of their life. More than half fed their infants on demand rather than on schedule. A high proportion (94.4%) breastfed at night, with 88.1% feeding their infants more than once. There was no significant relationship between the duration of suckling and the mother's age or work status (p 0.05). However, a significant relationship (p 0.001) was found between the duration of suckling and the mother's literacy. More than three-quarters of mothers slept in the same bed with their infants or in the same room. A large percentage of women initiated breast feeding; however, many introduced a supplement too early, a practice that should be discouraged.     

Measles susceptibility in maternal-infant dyads—Bamako,Mali

Measles is endemic in Africa; measles mortality is highest among infants. Infant measles antibody titer at birth is related to maternal immune status. Older mothers are likelier to have had measles infection, which provides higher antibody titers than vaccine-induced immunity. We investigated the relationship between maternal age and measles susceptibility in mother-infant pairs in Mali through six months of infancy.We measured serum measles antibodies in 340 mother-infant pairs by plaque reduction neutralization test (PRNT) and calculated the proportion of mothers with protective titers (>120 mIU/mL) at delivery and the proportion of infants with protective titers at birth, and at three and six months of age. We explored associations between maternal age and measles antibodies in mothers and infants at the timepoints noted.Ten percent of Malian newborns were susceptible to measles; by six months nearly all were. Maternal and infant antibody titers were highly correlated. At delivery, 11% of mothers and 10% of newborns were susceptible to measles. By three and six months, infant susceptibility increased to 72% and 98%, respectively. Infants born to younger mothers were most susceptible at birth and three months. Time to susceptibility was 6.6 weeks in infants born to mothers with measles titer >120–<430 mIU/mL versus 15.4 weeks when mothers had titers ≥430 mIU/mL.Maternal and newborn seroprotective status were positively correlated. Improved strategies are needed to protect susceptible infants from measles infection and death. Increasing measles immunization coverage in vaccine eligible populations, including nonimmune reproductive-aged women and older children should be considered.     

Seroprevalence of HIV-1 and HIV-2 infection among children diagnosed with protein-calorie malnutrition in Nigeria.

Excessive weight loss due to protein calorie malnutrition (PCM) is a significant problem in Nigerian children. This syndrome may be difficult to differentiate from the wasting disease caused by human immunodeficiency virus type 1 (HIV-1) infection. We studied 70 children admitted to the Baptist Medical Center in Ogbomosho, Nigeria in 1990 with PCM for prevalence of antibodies to HIV-1 and HIV-2. The cohort was from low-risk mothers and had a median age of 25 months (range, 4 months-9 years) with a weight deficit of at least 20% of the theoretical weight for age. Two sera were positive for anti-HIV-1 by both ELISA and Western blot (WB). A high prevalence of samples negative for HIV-1 antibody by ELISA were repeatedly reactive (11%, 8/70) or indeterminate (46%, 32/70) by WB. None of the sera was positive for antibody to HIV-2. There was no correlation of ELISA positivity or extent of WB banding with successful recovery from malnutrition. These results indicate a relatively low but significant prevalence of HIV-1 infection in Nigerian children with PCM. The high prevalence of indeterminate reactions in WB assays for HIV-1 suggests that other procedures may be necessary for confirmatory diagnosis of HIV-1 infection in this African population.     

Assessing the feasibility of passive surveillance for maternal immunization safety utilizing archival medical records in Kinshasa,Democratic Republic of the Congo

IntroductionSince the establishment of the Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions in 2015, there has been an urgent need for field validation of pharmacovigilance feasibility in low- and middle-income countries. In this study, we assess the availability and quality of archival medical records at ten randomly selected high-traffic maternity wards in Kinshasa province, Democratic Republic of Congo (DRC).MethodsA retrospective cohort of mother-child pairs was established from all recorded births taking place at study sites between July 1, 2019 to February 28, 2020 through digitization of medical records. Adverse birth outcomes and maternal vaccination status, where available and linkable, were defined according to GAIA. Basic demographic information on mothers and newborns was also tabulated; birth outcomes were assessed for both intra-site prevalence and a pooled prevalence.ResultsA total of 7,697 mother-newborn pair records were extracted, with 37% of infants screening positive as cases of adverse outcomes. Maternal vaccination information was linkable to 67% of those cases. In total, 51% of stillbirths, 98% of preterm births, 100% of low birthweight infants, 90% of small for gestational age infants, 100% of microcephalic infants, and 0% of neonatal bloodstream infections were classifiable according to GAIA standards following initial screening. Forty percent of case mothers had some indication of tetanus vaccination prior to delivery in their medical records, but only 26% of case mothers met some level of GAIA definition for maternal vaccination during the pregnancy of interest.ConclusionsArchival birth records from delivery centers can be feasibly utilized to screen for stillbirth and maternal tetanus vaccination, and to accurately classify preterm birth, low birthweight, small for gestational age, and congenital microcephaly. Assessment of other neonatal outcomes were limited by inconsistent postpartum infant follow-up and records keeping.     

CD4~+/CD8~+T细胞比值在HIV-1母婴传播早期诊断的应用

目的应用CD4+/CD8+T细胞(CD4/CD8)比值对母婴传播婴幼儿人类免疫缺陷病毒(HIV)感染进行早期诊断,为临床应用提供依据。方法对2011-2013年HIV阳性孕妇的115例3~11个月龄婴幼儿收集抗凝全血进行CD4+T细胞和HIV-1DNA检测。结果 115例婴幼儿中,检出HIV-1DNA 5例,检出率4.34%,且CD4+/CD8+T细胞比值均1.0。115例中CD4+%均25%。在110例HIV-1DNA阴性中有2例CD4+T细胞绝对数1 500细胞/μl。5例HIV-1DNA阳性中1例CD4+T细胞绝对数1 500细胞/μl,4例CD4+T细胞绝对数1 500细胞/μl。结论婴幼儿的CD4/CD8比值1.0是诊断发生母婴传播的有效早期诊断方法。     

Voluntary newborn HIV-1 antibody testing: a successful model program for the identification of HIV-1-seropositive infants.

Harlem Hospital in New York City has one of the highest HIV-1 newborn seroprevalence rates in the United States. We report the results of a program introduced in 1993 and designed to identify HIV-1-seropositive (HIV+) newborns at birth. All new mothers, independent of risk, received HIV counseling that emphasized the medical imperative to know the infant''s HIV status as well as their own. Consent was obtained to test the infant; discarded cord blood samples were tested by enzyme-linked immunosorbent assay (ELISA), and when positive, Western Blot confirmation. We compared the number of HIV+ infants identified through voluntary testing with the number reported by the anonymous New York State Newborn HIV Seroprevalence Study. In 1993, 97.8% (91 of 93) of the number of HIV+ infants identified by the anonymous testing were identified through voluntary maternal and newborn testing programs. Eighty-five HIV+ infants were identified before nursery discharge: 50% (42/85) through newborn testing; 14% (12/85) through prenatal testing; 13% (11/85) presented to care knowing their status; 23% (20/85) were known because of a previous HIV+ child. Six additional HIV+ children were diagnosed after hospital discharge (mean age, 5.5 months; range 1.5 through 17 months); four presented with symptomatic disease. The optimal time for identification of the HIV+ pregnant woman is before or during pregnancy, but when this does not occur, voluntary newborn testing can identify many HIV+ infants who would otherwise be discharged undiagnosed from the nursery.     

四川省汉、藏和彝族农村地区母乳喂养现状及其影响因素

目的了解四川省汉、藏和彝族农村地区0~18月龄婴幼儿母乳喂养的现状及相关影响因素。方法采用多阶段抽样方法,抽取四川省2个汉族县、2个藏族县和2个彝族县农村地区0~18月龄婴幼儿及其母亲为研究对象,通过问卷调查收集母亲及婴幼儿的社会人口学特征、家庭情况、母乳喂养知识和行为等信息。运用非条件Logistic回归分析母乳喂养的相关影响因素。结果 1087名婴幼儿的早开奶率为22.45%,其中,985名6月龄及以上的婴幼儿纯母乳喂养至6月龄率为35.94%、658名12月龄及以上婴幼儿的持续母乳喂养至12月龄率为34.50%。分娩方式为顺产(OR=2.80,95%CI 1.82~4.30)、母亲的早开奶知识(OR=2.48,95%CI 1.69~3.64)是早开奶的有利因素。母亲是藏族(OR=1.56,95%CI 1.02~2.39)、家庭经济状况非常好(OR=2.70,95%CI 1.47~4.98)、母亲掌握纯母乳喂养知识(OR=1.47,95%CI 1.07~2.02)是纯母乳喂养至6月龄的有利因素。二胎及以上(OR=1.67,95%CI 1.11~2.52)、母亲掌握断奶知识(OR=3.96,95%CI 2.65~5.93)是持续母乳喂养至12月龄的有利因素。结论四川省汉、藏和彝族农村地区的母乳喂养现状不容乐观,母亲的民族、分娩方式、是否掌握相关知识、胎次及家庭经济状况均会影响婴幼儿母亲的母乳喂养行为。     

Evaluation of a universal hepatitis B vaccination program and antenatal screening for hepatitis B surface antigen: Results from a real-world study 2015–2016

Background and AimsUniversal vaccination against hepatitis B virus (HBV) in infancy was implemented in Israel in 1992. This population-based study aimed to evaluate the coverage rate and cost-benefit of the HBV vaccination program among infants in Israel and the Hepatitis B surface antigen (HBsAg) status in their mothers.MethodsUsing the database of a health maintenance organization with 2 million members, we retrospectively identified, all the infants born in 2015–2016 and their mothers. Maternal data collected included age, ethnicity, country of birth and HBsAg status during pregnancy. HBV vaccination coverage among infants was calculated. A cost-benefit analysis of the HBV vaccination program was conducted based on the actual costs of HBV infection treatments in all HBsAg positive mothers.ResultsOur cohort included 72,792 mothers who gave birth to 77,572 live infants. A total of 71,107 (97.7%) mothers were screened for HBV during pregnancy, of them 124 (0.2%), who gave birth to 132 infants were HBsAg positive. HBV vaccination coverage rates were 94%, 93% and 89%, for the first, second and third dose, respectively. Birth dose coverage of 95% among infants born to HBsAg positive mothers was significantly higher compared to HBsAg negative or unscreened mothers (p < 0.001). The percentage of HBsAg positivity among mothers who were born in Israel, the Former Soviet Union or Ethiopia, were 0.1%, 0.8% and 5%, respectively (p < 0.001). Ethnic differences were not found between HBsAg positive and HBsAg negative mothers. Calculated benefit-to-cost ratios were 1.24:1 and 4.15:1, with and without antenatal HBsAg screening, respectively.ConclusionsThe Israeli vaccination program against HBV infection is epidemiologically and economically justified. High coverage rates among infants born to HBsAg positive mothers reflect very good adherence to the vaccination program and antenatal screening. Higher HBsAg positivity rates among immigrant mothers identify a high-risk population for HBV infection.     

Enzymic evaluation of thiamin, riboflavin and pyridoxine status of parturient mothers and their newborn infants in a Mediterranean area of Spain

OBJECTIVE: To determine the biochemical status of thiamin, riboflavin and pyridoxine in parturient mothers and their newborn infants in a Mediterranean region. DESIGN: Transveral study. SETTING: St Joan University Hospital and Faculty of Medicine & Health Sciences, Universitat Rovira i Virgili, Reus, Spain. SUBJECTS: 131 healthy parturient mothers, with normal pregnancies and deliveries in St Joan University Hospital, and their newborn infants. INTERVENTIONS: Erythrocyte haemolysates were prepared from maternal blood at delivery and infants' umbilical cord blood and used to measure micronutrient status using the transketolase, glutathione reductase and aspartate aminotransferase coenzyme stimulation tests. RESULTS: Maternal and infant coenzyme activities were significantly correlated, but infant coenzyme status was better than maternal, with significantly higher basal and stimulated activity (P < 0.001) and significantly lower activation coefficients (P < 0.001). Inadequate thiamin, riboflavin or pyridoxine status occured in 38.2 62.6% (50-82) of the mothers and 3.1-37.4% (4 49) of the infants; 85.2% (46/54), 12.9% (4/31) and 24.1% (12/54) of infants born to mothers with biochemical deficiency of either thiamin, riboflavin or pyridoxine, respectively also had inadequate status. Maternal deficiencies in more than one vitamin further increased the risk of infant thiamin and pyridoxine deficiency. Maternal and infant riboflavin status were significantly correlated with fetal development (e.g. length at birth, P < 0.001). The incidence of thiamin deficiency in paturient mothers in Spain was the highest out of a 12-country comparison. CONCLUSIONS: Inadequate status for each vitamin was evident in mothers and infants. Maternal status of each individual vitamin, but especially riboflavin, was affected by maternal status of the other vitamins. Infant thiamin status was the most adversely affected by maternal deficiencies in more than one vitamin. Infant riboflavin status, however, was apparently protected from adverse maternal status.     

Socio-cultural factors influencing nutritional status of infants -- a longitudinal study

During 1985-1986 in India, health workers went to the homes of 200 infants, 1-11 months old at the time they were brought into the study, and followed them until they reached one year. The researchers aimed to evaluate the role of weaning in determining the nutritional status of infants as well as to identify the sociocultural factors affecting weaning practices in the rural area near Aligarh. 99% of the infants received a prelacteal feed, especially ghutti (94%), within 6 hours of delivery. 99% were breast fed. Breast feeding began between 6 and 72 hours of birth. Almost all mothers believed ghutti cleanses the intestines and that colostrum is harmful. They discarded the colostrum. 73.5% of infants received top diluted milk. Mothers did not feed undiluted milk to their infants because they believed it causes diarrhea. 50.5% of mothers did not give their infants semi-solid foods until after 9 months. 20.5% did not give any semi-solid or solid food at one year. They all thought that semi-solid food causes diarrhea. 62.5% of infants received family food. 15% received biscuits. 98% had poor knowledge about nutritional requirements of infants, other than that breast milk is the natural food of infants. Most mothers practiced poor hygiene. Infants less than 6 months old were significantly more likely to have normal nutrition for age than those older than 6 months old (65.5% vs. 32.4%). Nutritional status declined with age, reflecting the unhygienic weaning practices in the area. At the end of 12 months, 6.8% suffered from severe grades of malnutrition. Nutritional status was not associated with social class. Educational status of mothers and fathers was significantly associated with nutritional status. These findings show that inadequate knowledge about proper weaning, not lack of food, is the limiting factor in infant nutrition. Education about the importance of proper weaning and weaning foods imparted by grass-root level workers is needed.