Seroepidemiology of hepatitis B in Nepal

To assess the prevalence of BHV infection in Nepal sera of 2,555 healthy individuals of different age groups from different parts of the country were examined for the markers of the infection. BHsAg and anti-HBs were assayed by R-PHA and PHA methods respectively and anti-HBc by ETA method. Anti-HBc was positive in 43.5 per cent of 2,555 sera of healthy individuals in Nepal. HBsAg was in 0.9 per cent (1.5 per cent in male and 0.5 per cent in female) and anti-HBs in 7.7 per cent (7 per cent in male and 8 per cent in female). The prevalence of HBsAg and anti-HBs was higher in urban than in rural areas, and the highest prevalence of these markers was noted in health care personnels (HBsAg 2.6 per cent and anti-HBs 17 per cent). HBsAg was not detectable in infants and young children, and the highest prevalence rate was observed in 6 to 15 years age group. The main mode of spread of HBV infection in Nepal was the horizontal transmission in pre-adolescent and adolescent children. HBV infection is common in Nepal but the BHsAg carrier rate is much lower than reported from other Asian countries.     

Determination of the frequency of residual tuberculous changes in the lungs and the level of contamination in urban and rural populations

The frequency of metatuberculous lesions and contamination levels were compared in 5341 urban and 5023 rural residents. It was shown that the frequency of residual tuberculous lesions in the urban (2.6 per cent) and rural (2.3 per cent) residents was the same while the frequency of posttuberculous lesions in the respiratory organs of the fluoropositive persons from the rural areas (65.3 per cent) was higher than that of the persons from the urban areas (43.7 per cent). Among the persons with x-ray signs of cured tuberculosis, positive reactions to tuberculin tests in 89.8 per cent of the urban residents and in 91.0 per cent of the rural residents were recorded. The frequency of the positive reactions to tuberculin corresponded to an increase in the number of the x-ray positive persons. The maximum increase was observed in persons at the age of 40 to 49 years.     

Seroepidemiology of brucellosis in Mexico]

Brucellosis is an important and widely distributed zoonosis in Mexican cattle which also affects an unknown proportion of the human population. This report presents the brucellosis antibody levels registered in the National Seroepidemiology Survey (NAS) in sera obtained from 66,982 healthy persons from one to 98 years of age and determined by the test of plaque microagglutination. Seroprevalences by states ranged from 0.24 per cent in Morelos to 13.5 per cent in the state of Mexico. The national mean was estimated to be 3.42 per cent. The analysis showed no statistical differences for brucellosis antibody levels by urban and rural residence and by density of family sleeping areas (three or more persons vs. one or two persons per bedroom). Adults between 20 and 39 years of age had greater seropositivity and children from one to nine years had the least. Women were most affected and had 48 per cent more seropositivity than men. According to the information obtained in the study, brucellosis in Mexico has the following characteristics: it is related to gender but not to occupation; affects persons in all age groups, social strata and is independent of size of the community of residence. Historically, brucellosis has been an endemic disease in Mexico. Recently an increasing incidence has been reported, and this is possibly due to a better national notification system.     

Juvenile paracoccidioidomycosis in urban area: report of two cases

We present two cases of juvenile form of paracoccidioidomycosis (PCM), a systemic mycosis frequently found in rural areas, whose prognosis is poor in children and young adults. They are a 14-year-old boy and a 25-year-old woman, both residents in an urban area in São Paulo – Brazil, without any history of travelling to an endemic area. They have been admitted to the hospital due to fever, weight loss and lymphadenopathy. The diagnosis was confirmed by serologic and histopathologic study. Patients have recovered after therapy with oral itraconazole and were discharged from hospital, maintaining outpatient visits. In this article, the authors discuss the unusual presentation of PCM in an urban area.     

The seroepidemiology of rubella in Mexican women. A national probability survey

A rubella seroepidemiologic survey was carried out in a rural population to better understand the epidemiology of this infections disease in Mexico. 24,331 serum samples from women between 10 and 44 years old were collected during 1987-1988 from the 32 federal states. Samples were tested for Rubella Antibodies by use of hemagglutination inhibition with a titer 1:8 bring considered as positive; 79.96 per cent (CI 95%, 7.5-80.5%) of women were seropositive, seropositivity increased with age, from 69.26 per cent in the age group of 10 to 14 years old, to 87.84 per cent in the 40-44 age group. Seropositivity rates were lower in southern states than in northern states and, higher in urban areas that rural areas (82.4 vs 76.6%); statistical significative difference in seropositivity rates were found between girls less than 14 years of age in urban areas as compared to rural areas (74.7 vs 63.6%). Seropositivity rates were related to socioeconomic status only when high status group were compared lower status group (82.5 vs 77%). In addition, we observed a significative trend of increasing seropositivity as level of school education increased. In comparison to the 1974 national survey, this seroepidemiological survey showed a decreased seropositivity for all age groups, even with an increase in the number of susceptible women, particularly in the group less than 20 years old. This study offers seroepidemiologic information about rubella at a national and regional level.     

Seroepidemiology of measles in Mexico]

Measles is an illness of universal distribution and great social impact. According to the WHO, the annual deaths due to this disease amount to more than a million children in the world. The objectives of this paper are to estimate the seroprevalence of titer of antibodies to measles in the population of 12 to 59 months of age in Mexico and identify the determinants of the immunity state. From the National Seroepidemiology Survey, 5,232 blood samples of children between 12 and 59 months of age, were analyzed, their blood samples were considered positive when the antibody titers were greater or equal to 1:4, tested by hemagglutination inhibition using sensitized erythrocytes. The National seroprevalence was 76.2 per cent. By age group, an increment in positive level was observed age increased. The seroprevalence was 56 per cent in children of 12 to 24 month and 82 per cent for children 48 to 59 month of age. The history of vaccination was obtained verbally; 62.5 per cent of seropositive didn't have vaccination history and 82.5 per cent were of those vaccinated were positive. By place of residence, at rural level (populations less than 2,500 inhabitants) 74 per cent positives, compared to 79 per cent in children of urban areas. All risk factor were significant, based on a univariate analysis, being the one with greatest risk those with negative vaccine history and children of one year of age. The efficiency of the vaccine estimation was of 63.6 per cent. Risk factors related to the vinculation of immunity protection to measles or seropositives were age, and verbal history of vaccination.     

HIV antibodies in a remote rural area in Rwanda, Central Africa: an analysis of potential risk factors for HIV seropositivity

Detection of HIV antibodies by means of an immunoenzymatic assay, an indirect immunofluorescence technique and Western blot was attempted on 375 serum samples collected in the Murunda area, a remote rural area situated in Rwanda, central Africa. Two out of 147 (1.4%) adults from a strict rural area, five out of 59 (8.5%) adults from an adjacent market place, and 49 out of 169 (30%) STD clinic attenders from the same area were HIV seropositive. In the first two groups, HIV seropositivity was associated with a history of sexually transmitted disease (STD) in the previous 2 years (P less than 0.001) and with a history of travel to a Rwandese urban centre in the previous 5 years (P less than 0.05). This study suggests that HIV seroprevalence is low in rural central Africa compared with urban centres. Risk factors for HIV seropositivity are similar in rural and urban-based adults in Rwanda, i.e. heterosexual promiscuity and STDs. Many HIV seropositive rural subjects from this study are likely to have acquired HIV infection through sexual contacts in Rwandese cities.     

Epidemiological study on the incidence of chronic lymphocytic thyroiditis in childhood (author's transl)]

An epidemiological survey on the incidence of chronic lymphocytic thyroiditis in childhood was performed in 11,353 apparently healthy school children in Chiba prefecture, Japan. The present study included 9,416 school children (4,401 boys and 5,015 girls, ages 6--18 yrs) in Chiba City and 1,937 children (744 boys and 1,193 girls, ages 16-18 yrs) in Tateyama City. The first group was selected as a representative of urban area, and the second group was selected as that of seaside area. Children having goiter were selected for testing antihyroblobulin and antimicrosomal antibodies in sera. Final diagnosis of chronic lymphocytic thyroiditis was based on histological specimens obtained by needle biopsies on the antithyroid antibody positive subjects. The overall incidence of chronic lymphocytic thyroiditis in these children with 1.7 per 1,000 children. There was a considerable sex difference in the prevalence. None of the patients were boys. In girls the incidence increased with age: ages 6-12 0.9, ages 13-15 4.6 and ages 16-18 3.1-4.2 per 1,000, respectively. The incidence in the seaside area, 2.6 per 1,000 was not significantly higher than that in the urban area, 1.8 per 1,000. Histologically, all cases were classified as focal thyroiditis.     

Studies on anthrax in food animals and persons occupationally exposed to the zoonoses in Eastern Nigeria

A total of 221 blood and 174 carcase swab samples obtained from food animals (cattle, sheep, goats, pigs and horses) slaughtered at urban and rural slaughter houses in Nsukka area were studied. 51 blood samples and 180 samples of vesicle fluid were also collected from persons occupationally exposed (butchers/skinners, meat retailers, meat inspectors, veterinarians and tanners) to these animals and their products. All the samples were studied culturally and microscopically. Confirmation of infection was by subcutaneous inoculation of guinea pigs and mice with samples of human and animal blood, carcase swabs and vesicle fluid got from suspected cutaneous lesions on the hands of persons studied in this survey. Of the blood samples obtained from food animals, 5 per cent (3/60) of cattle and 3.3 per cent (1/30) of sheep were positive. The rest of the blood samples from other animals were negative. For the carcase swab samples, 5.7 per cent (5/88) from cattle and 3.1 per cent (1/33) from sheep were positive. The rest of the carcase swabs from goats, pigs and horses were negative. Only the blood samples from butchers/skinners, 20 per cent (2/10), meat retailers, 9.1 per cent (1/11) and tanners, 11.1 per cent (1/9) were positive. Malignant pustule was confirmed in 13.3 per cent (6/45) of butchers/skinners, 10 per cent (3/30) of tanners and 6 per cent (3/50) of meat retailers. The results show that food animals and their products constitute a potential danger to those persons whose occupation necessitates handling animal products or contact with animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Segmental colonic transit time

Mean segmental transit time of radiopaque markers through the right colon, left colon and rectosigmoid areas of adults and children has been calculated from their distribution on consecutive plain films of the abdomen. Overall mean transit does not differ significantly in the large bowel between adults and children. However, there are regional differences within the colon in relation to age. Mean transit time in the right colon is 13.8 hours in adults and 7.7 in children (p<0.01). Corresponding values in the left colon are 14.1 and 8.7 hours (p<0.02) and, in the rectum, 11 and 12.4 hours (p=NS). The percentage of the mean total large bowel transit time spent in the right colon, left colon and rectosigmoid area are respectively for adults and children 33±4 and 28±3 per cent (p=NS); 39±4 and 32±4 per cent (p=NS); and 28±4 and 41±4 per cent (p<0.05), indicating a relative stagnation in the rectosigmoid area of children. These physiologic differences may have implications in diseased states. Partly supported by the following granting agencies: INSERM (CRL 77-2-185-7). CRM (Canada) (MT-3511), la sous-commission franco-québécoise pour les accords de la santé; partly supported by a grant from the research foundation of the American Society of Colon and Rectal Surgeons.     

Toxoplasmosis in Panama: a 10-year study

We studied the prevalence of Toxoplasma antibody over a 10-year period in a rural population of 326 people in Chorrera Province of Panama using the dye test. Fifty-five seroconversions were found in 108 people at risk, and 48 (87%) in children between 2 and 13 years with a mean incidence rate of 8.6% per year. Antibody prevalence rose from 25% at 5 years to 50% at 10 years of age, and increased gradually, reaching 90% by 60 years. Mean antibody levels after seroconversion were 1:6,000 in the dye test; they fell to 1:1,000 after 1 year, 1:800 after 2 years, 1:200 after 3 years, and 1:333 after 7-9 years. About 10% of antibody titers ranged between 1:4 and 1:32. Toxoplasma antibody prevalence was also studied in the metropolitan Panama City population using 590 sera collected in the fall of 1981. Age-specific incidence rates were similar in the urban and rural setting (correlation coefficient 0.71). The number of cats observed in the rural area and in the city and the degree of soil contact appeared compatible with a hypothesis of transmission by oocysts.     

Diabetes Mellitus as a Cause of Death in Sub-Saharan Africa: Results of a Community-based Study in Tanzania

The aim of this study was to determine the contribution of diabetes mellitus to all-cause mortality and diabetes mortality rates in adults 15 years and above living in one urban and two rural areas of Tanzania (Dar es Salaam, Hai and Morogoro Rural Districts). The three surveillance populations comprised 307912 persons. Prospective monitoring of all deaths between 1 June 1992 and 31 May 1995 was carried out. Cause of death was determined by verbal ‘autopsy’ conducted with relatives of the deceased. In total, 4299 deaths were recorded in children (aged <15 years) and 8054 in adults. In children there were no reported deaths associated with diabetes (due to or in children with diabetes). The adult male mortality rates associated with diabetes were 34, 30, and 15 per 100000 per year in Dar es Salaam, Hai and Morogoro Rural Districts respectively. The figures in women were 21, 18, and 4 per 100000 per year, respectively. The percentages of all adult male deaths associated with diabetes were 2.6 %, 2.1 % and 0.7 % respectively. In women the percentages were 1.7 %, 1.8 %, and 0.2 % respectively. Acute metabolic complications, infection, and stroke each accounted for approximately 30 % of all diabetic deaths. Thus diabetes mortality rates varied between the three surveillance areas, being lowest in the poorest rural area. Rates were higher in men in all areas. While care is required in the comparison of mortality rates between countries, it was noteworthy that Tanzania, a country with a low diabetes prevalence, had diabetes mortality rates which were higher than or comparable to rates in Mauritius and the United States. Most patients died from preventable causes, indicating a need for improved case-management of diabetic emergencies as well as better detection and treatment of hypertension.     

中国部分沿海地区居民碘营养状况调查结果分析

目的 了解我国沿海地区食用碘盐防治碘缺乏病是否导致居民碘摄入过量.方法 采用横断面调查方法,在我国11个沿海省份(自治区、直辖市)中,沿着海岸线从北往南选择辽宁省、上海市、浙江省及福建省4个省(市)进行调查.除上海市调查其所有辖区外,其他的3个省都分城市和农村两个层次,分别调查了5个沿海城市、5个沿海农村,以及3个内陆农村(作为对照点)的外环境水碘、居民合格碘盐食用率、居民人均盐日摄入量以及不同人群的尿碘水平.结果 在4个省(市)共采集居民饮用水水样7552份、居民户盐样7996份和不同人群(成人、哺乳妇女、孕妇和儿童)尿样9873份.除浙江省沿海城市和沿海农村合格碘盐食用率低于90％外,其他3个沿海省(市)调查地区的合格碘盐食用率均大于90％.4个省(市)成人和儿童尿碘中位数均在100～299 μg/L;哺乳妇女尿碘中位数均大于100 μg/L;上海市、浙江省沿海城市和福建省沿海农村孕妇尿碘中位数低于150μg/L.结论 沿海地区居民的碘营养状况总体水平上是适宜的,部分沿海地区孕妇碘营养不足;沿海地区应坚持食盐加碘防治碘缺乏病的措施.     

Japanese Encephalitis epidemic in Anantapur district, Andhra Pradesh (October-November, 1999).

Epidemic of Japanese Encephalitis has occurred in Andhra Pradesh during October-November, 1999 affecting 15 out of 23 districts. In total, 873 cases with 178 deaths have been recorded up to the day 29.11.99. The epidemiological investigation has been done in Anantapur district in western Andhra Pradesh, where the outbreak has started in the third week of October. In the district 47 PHC have been affected. On an average 4.5 per cent of 3175 villages have been affected. Average number of cases per affected village have been 1.5. Rural population has been primarily affected. Age groups 1-14 years including infants have been affected but nearly 86.8% of cases have been among 1-9 year age group. The overall case fatality rate has been 18.4 per cent. Clinical features have been high fever, headache, altered sensorium, convulsions and coma. A marked seasonal onset of a few cases per village and 93.75 per cent of human serum samples collected from hospitalised cases showed the evidence of J.E. virus infection indicating that the present outbreak was due to JE virus. High density of Culex vishnui complex mosquitoes has been observed in the area. All the environmental and ecological conditions, temperature, rainfall and relative humidity have been in favour of JE transmission. Analysis of the data for the last 10 years showed that the human JE cases occurred in Anantapur in September-October months, which shifted to October-November, 99. Prolonged draught conditions were observed till October. Possibly the delayed monsoon and congenial atmospheric conditions after monsoon were favourable to the vector species for extra-human cycle of transmission in 1999. Low level transmission leading to small number of cases continued during the succeeding years every September-October till the present epidemic. In all 24 PHCs and urban towns were identified with 212 cases and 39 deaths till 29.11.99.     

Spread of HIV infection in a rural area of Tanzania.

OBJECTIVE: To assess the spread of HIV into rural areas. METHODS: Since 1994 a demographic surveillance system (with 5-monthly rounds) and open adult cohort study have been established in a rural ward in Tanzania. Two sero-surveys of all resident adults aged 15-44 and 15-46 years were conducted in 1994 1995 and 1996-1997 respectively. Qualitative data were collected on mobility, bars and commercial sex. RESULTS: Attendance of the two rounds of survey was 5820 (78%) and 6413 (80%) in 1994/1995 and 1996/1997 respectively. HIV prevalence increased from 5.8% to 6.6%. HIV incidence was 0.73 and 0.84 per 100 person years among men and women respectively. HIV incidence under the age of 20 years was low among both sexes. Striking differences in HIV prevalence and incidence were observed within the small geographic area studied: HIV prevalence in the trading center was twice that in the area surrounding the trading center (within 2 km) and three to four times that in the rural villages (within 8 km of the trading center). Aggregate level data showed significant differences between the trading center and nearby rural villages in terms of sexual behavior, commercial sex workers, mobility of the population, and alcohol use. CONCLUSION: This study documents the existence of very substantial HIV prevalence and incidence differences within a small geographic rural area. The rapid decrease in HIV prevalence within a small rural area emphasizes the importance of concentrating HIV prevention efforts on high transmission areas, such as trading centers, especially in resource-poor settings. Furthermore, this has considerable implications for monitoring the spread of HIV through sentinel sites, as such sites are typically located in high transmission areas.     

Studies on the mechanical fragility of erythrocytes. I. Normal values for infants and children

1. The mechanical fragilities of incubated and nonincubated erythrocytes ofnormal newborn infants, children and adults have been determined through theuse of a simplified rotator.

2. The mean mechanical fragility of nonincubated erythrocytes was 7.1 percent for newborns, 4.0 per cent for children and adults; the mean mechanicalfragility of incubated erythrocytes was 13.4 per cent for newborns, 10.5 per centfor children and 10.8 per cent for adults.

3. The possible relationship of increased mechanical fragility of erythrocytesin the newborn to increased hemolysis in the neonatal period is suggested.

4. Possible causes of variation in the determination of mechanical fragilityof incubated erythrocytes are discussed.

Submitted on August 15, 1952 Accepted on October 16, 1952     

Seroepidemiological study of toxoplasmosis in different sections of population of Union Territory of Chandigarh

Infections with Toxoplasma gondii in humans are usually asymptomatic or in the form of mild febrile illness. Primary infection in pregnant women may result in congenital toxoplasmosis while infection in immunocompromised subjects like AIDS patients may cause potentially fatal toxoplasma encephalitis. In India, only a few studies in hospital based patients have shown prevalence of toxoplasmosis to be between 1.5 and 21%. No field study involving general population is available. The present study investigates the prevalence of toxoplasmosis in subjects from rural, urban and urban slum populations of Union Territory, Chandigarh. Serum samples from 500 subjects from each group were collected and antitoxoplasma IgM and IgG was detected by conventional micro ELISA technique using soluble Toxoplasma gondii tachyzoite antigen. Overall 5.4% subjects were positive for IgM while 4.66% showed IgG antitoxoplasma antibodies. Amongst the three groups, significantly higher number of subjects in slum area (7.8%) showed IgM antibodies as compared to urban and rural areas (4.2% each). There was no significant difference in IgG positivity between three study areas. Prevalence of T. gondii specific IgG antibodies was significantly higher amongst females of both slum (7.31%) and rural area (8.44%) as compared to the males (2.85% and 3.27% respectively) in the same areas (p<0.05) and also to females of the urban area (2.98%, p<0.05). Prevalence of IgM antibodies was significantly higher (p<0.05) in females in the slum area (10.5%) as compared to females in the urban area (2.55%). In both urban and slum areas, highest IgM seropositivity was observed in age group 6-12 years (10% and 13.3% respectively), while in the rural area the highest IgM seropositivity was seen in the age group > or = 5 years (17.7%). These data indicate that majority of children are exposed to toxoplasma before 12 years of age and particularly in rural areas higher number of subjects acquire Toxoplasma gondii infection early in childhood probably as a result of higher exposure due to farming, poor hygiene and handling of animals.     

Larvivorous fishes in controlling mosquito breeding from draw wells

Culex quinquefasciatus have been found to breed in about 29 per cent of the wells in semi-urban area and 14 per cent of the wells in rural areas of Varanasi at one time or other. Majority of such wells are used-ones. Effectiveness of Poecillia reticulata, Esomus danrica and Trichogaster fasciatus in controlling well breeding is evaluated in the present study with successful results.     

Rarity of bacterial and viral meningitis in areas of Western Greece with fewer than 2,000 inhabitants

The purpose of the present study was to compare the incidence of childhood meningitis in regions with fewer than 2,000 inhabitants (rural regions) and regions with more than 2,000 inhabitants (urban regions) in the prefecture of Achaia in Western Greece during 1991-2005. Included were all 555 children hospitalized for meningitis. The criteria for bacterial meningitis were (i) positive blood/cerebralspinal fluid (CSF) culture, Gram stain, or latex agglutination and/or (ii) increased beta-glucuronidase in CSF. In case of suspected bacterial meningitis, the following findings were considered: compatible clinical and laboratory findings, and whether or not a cure was achieved with antibiotic treatment and finally resulted in negative cultures. In cases of suspected viral meningitis, compatible clinical and laboratory findings were considered, together with observation of a cure without antibiotic treatment. Only 28 of 555 meningitis patients were from rural regions. The incidence per 10,000 children in rural and urban regions, respectively, was as follows: meningitis, 1.13 and 8.99; bacterial meningitis, 0.16 and 2.40; suspected bacterial meningitis, 0.52 and 3.00; and viral meningitis, 0.44 and 3.58. The incidence ratio for bacterial, suspected bacterial, and viral meningitis in urban versus rural regions was 14.85, 5.72, and 8.10, respectively. Only 2 of the 79 cases with a confirmed causative pathogen came from rural regions. In conclusion, compared to those living in urban regions, children living in rural regions are relatively spared from bacterial and viral meningitis.