What has been achieved in HIV prevention,treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries

ObjectiveIn 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an “accountability matrix”, focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.DesignWe searched peer-reviewed literature, conducted online searches, and contacted experts for ‘grey’ literature. We limited searches to documents published since December 2009 and used decision rules endorsed in earlier reviews.ResultsPolicy shifts are increasing coverage of key interventions for PWID in China, Malaysia, Vietnam and Ukraine. Increases in PWID receiving antiretroviral treatment (ART) and opioid substitution treatment (OST) in both Vietnam and China, and a shift in Malaysia from a punitive law enforcement approach to evidence-based treatment are promising developments. The USA and Russia have had no advances on PWID access to needle and syringe programmes (NSP), OST or ART. There have also been policy setbacks in these countries, with Russia reaffirming its stance against OST and closing down access to information on methadone, and the USA reinstituting its Congressional ban on Federal funding for NSPs.ConclusionsPrevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.     

利什曼原虫K26序列应用于我国利什曼原虫分离株鉴定的价值分析

目的评价利什曼原虫K26序列应用于我国利什曼原虫分离株鉴定的价值。方法收集我国不同流行区的利什曼原虫16个分离株和6个国际参照株,培养后收集前鞭毛体,提取DNA,扩增K26序列并测序,应用ClustalX2进行序列比对,从GenBank下载同源性较高的利什曼原虫分离株的K26序列,构建系统进化树,分析我国不同流行区的利什曼原虫分离株的亲缘关系。结果我国16个利什曼原虫分离株和国际参照株DD8均扩增出单一条带,而5个非杜氏利什曼原虫复合体虫株均未扩增出任何条带。序列分析结果表明,我国人源型利什曼病流行区的3个分离株801、KS-2和KS-6均扩增出920 bp片段,自然疫源型利什曼病流行区的4个分离株XJ771、JIASHI-1、JIASHI-2和JIASHI-5均扩增出491 bp片段,人犬共患型利什曼病流行区4个分离株Cy、SC6、Hebei-Lv和Shanxi-Yang均扩增出404 bp片段,皮肤利什曼病流行区的5个分离株KXG-Xu、KXG-Liu、KXG-65、KXG-918和KXG-927均扩增出449 bp片段,且各流行区内虫株间的序列一致性均为100%。各流行区之间的虫株间的序列一致性较低,为40.2%~91.4%。系统进化树分析结果显示,我国16个利什曼原虫分离株聚集成2个群3个亚群,其中KXG-Xu、KXG-Liu、KXG-65、KXG-918、KXG-927、XJ771、JIASHI-1、JIASHI-2、JIASHI-5分离株聚集为A亚群,Cy、SC6、Hebei-Lv、Shanxi-Yang与婴儿利什曼原虫聚集为B亚群,A亚群和B亚群聚集为Ⅰ群;801、KS-2和KS-6分离株与杜氏利什曼原虫聚集为C亚群,进一步与国际参照株DD8聚集为Ⅱ群。结论利什曼原虫K26序列可应用于我国利什曼原虫分离株的鉴定。     

洞庭湖区消除血吸虫病迈向新时期

湖南省在我国血吸虫病防治史上占据了特殊地位,不但是我国血吸虫病重度流行区,也是在我国血吸虫病防治工作不同阶段出成绩、出经验的省份之一。近年来,湖南省高度重视血吸虫病防治工作,加大资金投入,坚持以传染源控制为主的综合防治策略,持续推进家畜传染源控制、人群传染源控制、钉螺控制及血防机构能力建设"四大工程",取得了显著血防效益,实现了防治与科研结合、科研为现场服务的理念,从防治实践中创造了一批血防模式,为我国血吸虫病防治提供了"湖南经验"。今后仍需贯彻政府主导、部门协作的原则,坚持科学防治、联防联控、群防群控,继续强化以"以传染源控制为主、钉螺控制并重"的血吸虫病综合防治策略,保障经费投入、提高防治队伍能力建设,积极探索医防结合新模式,早日实现消除血吸虫病的目标。     

Quantification of tryptase-TIM-3 double-positive mast cells in human chronic periodontitis

ObjectivesMast cells (MCs) are implicated in the pathogenesis of allergic reactions and inflammatory conditions through the release of inflammatory mediators. So far limited attention has been given to the role of MCs in periodontitis. T cell immunoglobulin mucin domain (TIM)-3 is an immunomodulatory molecule and influences MC function. However, whether TIM-3 is expressed on MCs in the process of human periodontal disease has not been reported. Therefore, we identified MCs by toluidine blue staining and examined the expression of TIM-3 on tryptase-positive MCs in different severities of human chronic periodontitis using double-immunofluorescence staining in this study.Material and methodsA total of 83 human periodontal specimens were involved in this study, including healthy control tissues (n = 25), chronic moderate periodontitis (n = 28), and chronic severe periodontitis (n = 30). The gingival specimens were fixed in 10% buffered formalin, stained with haematoxylin and eosin for histopathology, with toluidine blue for MCs, and with double-immunofluorescence for identification of tryptase-TIM-3 double-positive MCs in gingival tissues.ResultsCompared with healthy controls, the score of gingival tissue inflammation was significantly increased in the chronic moderate periodontitis (P = 0.013) and chronic severe periodontitis (P < 0.0001), and the densities (cells/mm²) of tryptase-TIM-3 double-positive MCs were significantly increased in both the chronic moderate (P = 0.011) and severe periodontitis groups (P < 0.0001). However, compared with the chronic moderate periodontitis group, both the score of gingival tissue inflammation (P = 0.012) and the density of tryptase-TIM-3 double-positive MCs (P = 0.011) in gingival tissue were significantly increased in the severe periodontitis groups.ConclusionSignificantly increased number of tryptase-TIM-3 double-positive MCs had the similar tendency as the severity of periodontitis inflammation in human chronic periodontitis. Our data suggest that TIM-3 may have a role on MCs in human chronic periodontitis.     

National intestinal helminth survey among schoolchildren in Tajikistan: Prevalences,risk factors and perceptions

Solid evidence regarding the epidemiology of intestinal helminth infections in Tajikistan is currently lacking. As such information is essential for the evidence-based design, implementation and evaluation of control interventions, a national intestinal helminth survey was conducted with the following objectives: (i) to assess the prevalence of intestinal helminth infections among school-aged children nationally and stratified by region; (ii) to identify locally relevant risk factors for infection; and (iii) to better understand the children's knowledge and perception of intestinal helminth infections, and asses their haemoglobin status. Standard field and laboratory procedures including the Kato-Katz thick smear and tape test were employed. Complete data was obtained for 1642 children from 33 randomly selected primary schools from different parts of the country. Across the country, prevalences of E. vermicularis, A. lumbricoides, H. nana and T. trichiura were 26.5%, 16.9%, 15.5% and 2.7% respectively. The prevalence of common soil-transmitted helminth (A. lumbricoides and T. trichiura) infections was 19.4%. No hookworm infections were detected, and prevalences of various infections differed significantly between administrative districts (all P < 0.05). Hand washing after toilet usage (OR = 0.78; P = 0.047) and handling animals (OR = 0.66; P = 0.009) were identified as significant protective factors against E. vermicularis infections. H. nana infection was associated with a 2.85 g/L decrease in haemoglobin levels (P < 0.001) despite already low average haemoglobin levels. The proportions of children with knowledge about intestinal helminths and protective hygiene practices varied significantly between regions (both P < 0.001). Mass albendazole administration to school-aged children and women of child-bearing age against intestinal helminths has been conducted in Tajikistan in spring 2012, followed by mass albendazole and praziquantel distribution to school-aged children in autumn 2012. In the longer term, an integrated approach including chemotherapy, provision of safe water and proper sanitation as well as targeted health education will be necessary to achieve sustainable control.     

Indigenous Māori perspectives on urban transport patterns linked to health and wellbeing

There is a growing body of research linking urban transport systems to inequities in health. However, there is a lack of research providing evidence of the effect of transport systems on indigenous family wellbeing. We examined the connections between urban transport and the health and wellbeing of Māori, the indigenous people of New Zealand. We provide an indigenous exploration of current urban transport systems, with a particular focus on the impacts of car dependence and the need for culturally relevant travel. We interviewed nineteen Māori participants utilising qualitative research techniques underpinned by an indigenous research methodology (Kaupapa Māori). The data highlighted the importance of accessing cultural activities and sites relevant to ‘being Māori’, and issues with affordability and safety of public transport. Understanding the relationship between indigenous wellbeing and transport systems that goes further than limited discourses of inequity is essential to improving transport for indigenous wellbeing. Providing an indigenous voice in transport decision-making will make it more likely that indigenous health and wellbeing is prioritised in transport planning.     

Serum antibody response to Moraxella catarrhalis proteins in stringently defined otitis prone children

BackgroundMoraxella catarrhalis (Mcat) is a frequent pathogen of acute otitis media (AOM) in young children. Here we prospectively assessed naturally-induced serum antibodies to four Mcat vaccine candidate proteins in stringently defined otitis prone (sOP) and non-otitis prone (NOP) children age 6–36 months old following nasopharyngeal (NP) colonization, at onset of AOM and convalescence from AOM.MethodsSerum IgG and IgM antibody against recombinant Mcat proteins, oligopeptide permease A (OppA), outer membrane protein (OMP) CD, hemagglutinin (Hag), and PilA clade 2 (PilA2), were quantitated by ELISA.ResultsDuring NP colonization by Mcat all four antigens were immunogenic in both sOP and NOP children. However, sOP children had lower antibody responses than NOP children across age 6–36 months, similar to our findings for protein vaccine candidates of Streptococcus pneumoniae (Spn) and Nontypeable Haemophilus influenzae (NTHi). sOP children displayed a later and lower peak of antibody rise than NOP children for all four antigens during NP colonization of Mcat. The age-dependent increase of antibody ranked as OppA > Hag5-9 > OMP CD > PilA2 in both sOP and NOP children. Lower serum antibody levels to the Mcat antigens were measured in sOP compared to NOP children at the onset of AOM. We did not find a consistent significant increase of antibody at the convalescence phase after an AOM event.ConclusionssOP children is a highly vulnerable population that mount lower serum antibody responses to Mcat candidate vaccine proteins compared to NOP children during asymptomatic NP carriage and at onset of AOM.