Sachregister 2000

Ohne Zusammenfassung     

Polio eradication-target 2000

Poliovirus an enterovirus is of 3 types (1, 2 & 3). The 1 poliovirus is most often the cause of paralysis. Poliomyelitis can be eradicated from human soil as man is the only reservoir of this infection and effective vaccines are also available for its control. Inactivated poliovirus vaccine (IPV) confers mainly the humoral immunity in comparison to oral polio vaccine (OPV) which gives the intestinal immunity as well. OPV has been recommended by the WHO as the vaccine of choice for global eradication of polio because of its superior ability to inhibit spread of wild polio virus, low cost and its ease of administration. 70–90% of polio cases occur in children less than 3 year of age. Each paralytic case which is the tip of an iceberg probably represents 100 to 1,000 infected persons in the community. The incidence of poliomyelitis is on the decline with 145 of 213 countries today report 0 case of polio. Central Africa & South Asia are the principal reservoirs of wild poliovirus with nearly two thirds of cases being reported from Indian subcontinent. Components of eradication strategy are: sustained high levels of immunisation, annual mass vaccination campaigns of OPV to all children under 5 years of age, establishment of extremely sensitive surveillance systems and targeted immunisation to areas and populations where poliovirus transmission is likely to persist. The task of global eradication of poliomyelitis is uphill but well within our reach. A strong will and political commitment by the Government of India is leading the nation to the goal of polio-free world by the year 2,000.     

Year 2000 health objectives

The potential effects of the report reach far into the health care community. This report could mark the beginning of an era of increased preventive health care. How the report is followed-up, however, is the key to the Year 2000 equation. Countless hours of study and countless dollars have, in the past, produced valuable reports similar to the Year 2000 report. Yet, the results of these other reports, because of lack of follow-up, are less than impressive. If the contributions of more than 7000 individuals are to translate to better health for the nation in the year 2000, follow-up measures must be enacted. This is an opportunity for action on the part of NAPNAP and all pediatric nurse practitioners.     

Measles outbreak in Dublin, 2000

BACKGROUND: An outbreak of measles occurred in Ireland between December 1999 and July 2000. The majority of cases were in north Dublin, the catchment area of The Children's University Hospital (TCUH). METHODS: Details of all of the 111 children attending the hospital with a diagnosis of measles between December 1999 and July 2000 were prospectively entered into a database. Charts were subsequently reviewed to extract epidemiologic and clinical details. National figures were obtained from the National Disease Surveillance Centre. RESULTS: In the study period 355 attended TCUH with a serologic or clinical diagnosis of measles, and 111 were admitted (47% female, 53% male). The main indications for admission were dehydration in 79%, pneumonia or pneumonitis in 47% and tracheitis in 32%. Thirteen children (11.7% of those admitted) required treatment in the intensive care unit, and in 7 of these mechanical ventilation was necessary. There were 3 deaths as a result of measles. Public health measures to curb spread of the disease included promotion of immunization for susceptible children nationally and recommending administration of measles-mumps-rubella vaccine (MMR) from the age of 6 months, in North Dublin. CONCLUSION: This outbreak of measles posed a major challenge to the hospital and the community for the first half of 2000. The national MMR immunization rate before the outbreak was gravely suboptimal at 79%, whereas the rate in North Dublin, the catchment area of TCUH, was <70%. Three children died as a result of a vaccine-preventable illness.     

The 2000 Burkitt lymphoma trial in Malawi

BACKGROUND: We previously reported 57% 12-month event free survival (EFS) in Malawian children with stage I to III Burkitt lymphoma (BL) with an intermediate dose chemotherapy protocol lasting 77 days. This protocol was shortened to 42 days and evaluated in children with stage I to IV disease for EFS and toxicity. METHODS: All Malawian children admitted to Queen Elizabeth Central Hospital, from 03/08/2000 to 12/03/2002 with confirmed BL were eligible. A fine needle aspirate, bone marrow aspirate, cerebrospinal fluid cytology, haemoglobin (Hb), white cell count (WCC), malaria smear, ELISA for HIV, and abdominal ultrasound were performed routinely. Murphy staging was used. The first dose of chemotherapy (COP1) consisted of 300 mg cyclophosphamide (CPM), 1 mg vincristine, and 60 mg prednisone given on day 1 and followed by COP2 on day 8 (only for patients with larger tumour volumes, stage III or IV disease). The vincristine dose in COP2 was 2 mg. COMP1 and 2 given on days 22 and 36 consisted of 500 mg CPM, 2 mg vincristine, 60 mg prednisone, and 2 g methotrexate. All doses were calculated per body surface area. Intrathecal methotrexate and hydrocortisone were given with COP1 and 2. RESULTS: Forty-two patients, 30 boys and 12 girls median ages 6 and 7.5 years, respectively, had Murphy stage I(n5), II(n8), III(n21), and IV(n8) disease. The face was involved in 74%, abdomen in 55%, bone marrow in 14%, kidneys in 24%, and 12% had paraplegia. Fourteen children died during or shortly after completion of chemotherapy. Three of these were disease related. Twelve patients suffered a local relapse after 57-328 days, and one a CNS relapse at 76 days. The projected EFS at 12 months is 50% in stage I, 50% in stage II, 24% in stage III, 25% in stage IV, and 33% for all patients. The cumulative mean dose of CPM was 62 mg/kg in survivors and 64 mg/kg in children who relapsed. One third of patients experienced significant marrow suppression, and infections after COMP1. CONCLUSIONS: Thirty-three percent of children are in first remission at 12 months. The morbidity and mortality of treatment was high. The high relapse rate in all stages may be due to the low cumulative dose of CPM.