Avian influenza protection knowledge, awareness, and behaviors in a high-risk population in Suphan Buri Province, Thailand

Avian influenza (Al) had outbreaks in Thailand from January 2004 to December 2005, which resulted in 22 human cases, and 14 deaths. Three confirmed cases were reported in Suphan Buri Province in 2004, one of whom died. A cross-sectional study aimed to investigate knowledge, attitudes, and practices about AI in Song Phi Nong District of Suphan Buri Province. Most of the respondents had moderate levels of knowledge. Most of their attitudes towards and practices of the prevention and control of AI were also appropriate. However, the peoples' knowledge about major signs and symptoms of AI was limited. The study suggested that those who had received information from media had better attitudes towards and practices of AI prevention and control, compared with those who had not received information from media. Therefore, the media played an important role in improving knowledge, attitudes, and behaviors; but for the better protection from AI, continuing health education will be necessary in Thailand.     

Risk factors for tuberculosis infection among household contacts in Bangkok, Thailand

A cross-sectional study was conducted to determine the prevalence of tuberculosis infection and risk factors for tuberculosis infection among household contacts aged less than 15 years in Bangkok, Thailand, between August 2002 and September 2003. During the study period, 342 index cases with sputum smear positive pulmonary tuberculosis patients were recruited into the study and their 500 household contacts aged under 15 years were identified. The prevalence of tuberculosis infection among household contacts was found to be 47.80% (95%CI = 43.41-52.19). In multivariate analysis, a generalized estimating equation (GEE) was used to determine the risk factors for tuberculosis infection among household contacts. The results indicated that the risk of tuberculosis infection was significantly associated with close contact (adjusted OR = 3.31, 95%CI = 1.46-7.45), exposure to female index case (adjusted OR = 2.75, 95%CI = 1.25-6.08), exposure to mother with tuberculosis (adjusted OR = 3.82, 95%CI = 1.44-10.14), exposure to father with tuberculosis (adjusted OR = 2.55, 95%CI = 1.19-5.46), exposure to index case with cavitation on chest radiograph (adjusted OR = 4.43, 95%CI = 2.43-8.05), exposure to index case with 3+ sputum smear grade (adjusted OR = 3.85, 95%CI = 1.92-7.70), and living in crowded household (adjusted OR = 2.63, 95%CI = 1.18-5.85). The distribution of tuberculosis infection and risk factors among contact cases are significant for health care staff in strengthening and implementing tuberculosis control programs in Thailand.     

Lack of increased HIV risk behavior among injection drug users participating in the AIDSVAX B/E HIV vaccine trial in Bangkok, Thailand

OBJECTIVE: To determine whether HIV vaccine trial participation leads to increased risk behavior through beliefs about vaccine protection against infection. METHODS: Changes in risk behavior were evaluated among 2545 injection drug users participating in the AIDSVAX B/E vaccine trial in Bangkok, enrolled from March 1999 to August 2000. Demographic characteristics, beliefs and risk behavior were assessed at baseline and every 6 months thereafter. Risk-reduction counseling was provided at every study visit. Generalized estimation-equation logistic regression analysis was used to study trends in risk behavior and associated factors. RESULTS: Participants were 93.4% male, their median age was 26 years, and 67.2% had at least secondary education. At baseline, 61.3% were receiving methadone detoxification and 20.9% were receiving methadone maintenance. From baseline to the 12-month follow-up visit, injection drug use decreased from 93.8% to 66.5% (P < 0.001) and needle sharing from 33.0% to 17.5% (P < 0.001). Multivariate analyses showed earlier follow-up time (at baseline and 6 months) and believing the vaccine to be efficacious associated with more-frequent injecting; younger age and lower education associated with less-frequent injecting. Earlier follow-up time (at baseline), younger age, and injection of methamphetamine and midazolam were associated with more-frequent needle sharing; methadone treatment and injecting less than weekly were associated with less-frequent needle sharing. CONCLUSIONS: Injection drug use and needle sharing decreased during the first 12 months of the trial. No increases in risk behavior in relation to beliefs about vaccine protection against HIV infection could be identified.     

Hepatitis B among pregnant women attending health care facilities in rural Bangladesh

This study assessed hepatitis B prevalence among pregnant women attending health care facilities in rural Bangladesh. Blood samples were collected from 480 participants. HBsAg was positive in 0.4% of subjects, anti-HBc was positive in 21.5% and anti-HBs was positive in 8.5% of subjects. HBsAg was more prevalent among the older age group. Hepatitis B has a low prevalence among pregnant women in rural Bangladesh. Existing hepatitis B vaccination schedule in the Expanded Program on Immunization (EPI) to vaccinate the children in rural Bangladesh is appropriate.     

Monitoring and evaluation of a model demonstration project for the control of cervical cancer in Nakhon Phanom province, Thailand

Cancer of the uterine cervix is the second most common cancer in females in the world with about half a million new patients per year. Since the introduction by Papanicolaou of cervical smear screening, the incidence of cervical cancer has declined in many developed countries. The decrease in the incidence of and mortality from cervical cancer is mainly due to the organized mass screening using Pap smear programmes. Uterine cervical cancer is the leading cancer among women in Thailand with age-standardized incidence rates of 24.7 per 100,000 in 1999. Most cases present at advanced stages with poor prognoses of survival and cure. In the present study, cervical cancer screening programme with cervical cytology was organized for Nakhon Phanom province, Thailand. The specific objectives were: 1) to evaluate the reduction in incidence and mortality from cervical cancer in the province by means of an organised low-intensity cervical cytology programme. 2) to demonstrate the different aspects of programme implementation as a potential model for nationwide implementation. The screening activities were integrated in the existing health care system. Organized screening for women in the target population (aged 35-54 years) at 5-year intervals was free of charge. Sample taking was done by trained nurses (midwives) and primary health care personnel in the local health care centers. Sample quality was under continuous controlled by the cytology laboratories and pathologists. Confirmation and treatment were integrated into the normal health care routines. The screening results of the programme, including histologically confirmed diagnosis, were registered at the National Cancer Institute using PapReg and CanReg 4 programmes. A population-based cancer registry in Nakhon Phanom province was also set up in 1997. In the period 1999-2002, 32,632 women aged 35-54 years were screened. Women with low-grade lesions returned for routine follow-up smears. High-grade preinvasive disease was further evaluated by repeating Pap smear, conization or biopsy and subsequent treatment through surgical removal or ablation. This organized low-intensity cervical cytology programme showed a considerable increase in early carcinoma in situ and CIN II -III cases and should reduce incidence of and mortality from cervical cancer in Nakhon Phanom province in the future. Screening with the Papanicolaou smear plus adequate follow-up diagnosis and therapy can achieve major reductions in both incidence and mortality rates.     

Sexual behaviors of alcohol drinkers and non-drinkers among adolescents and young adults in Nha Trang, Vietnam

A cross-sectional quantitative survey was conducted during August to November 2005 with 880 youths (16-24 years-old), including 412 males and 468 females in Nha Trang city, Vietnam. It aimed to examine the association between alcohol use and sexual behaviors by gender difference. The data revealed that the majority of respondents (65.9%) had consumed alcohol, 25.8% had sexual touching with boy/girl friends, and 10.1% of respondents had engaged in sexual experiences including vaginal sex, anal sex, and/or oral sex. Young men were significantly more likely to drink than young women were (p < 0.001), and alcohol use was significantly associated with engagement in sexual experiences (p < 0.001). There was a strong significant different between sexual touching and alcohol drinking among males (p < 0.001) and females (p < 0.001). Forty percent of young men who did not use condom in last sex and 45% of young men who had multiple sex partners were drinkers compared to 4.8% and 1.6% of non-drinkers, respectively. These significant findings will be baseline data for integrating and adapting into intervention programs for alcohol and HIV among Vietnamese youth.     

Sexual behavior and HIV infection among pregnant hilltribe women in northern Thailand

A case-control study was carried out to determine factors associated with HIV infection among pregnant hilltribe women who attended the antenatal clinics of six hospitals in northern Thailand (Mae Suai, Wieng Pa Pao, Mae Sai, Mae Chan, Wieng Kaen, Mae Fa Luang, and Chiang Rai hospitals) between 1 January 2005- 31 May 2007. Data were collected using questionnaires and analysis was by univariate (p-value = 0.100) and multivariate analysis (p-value = 0.050) in the model of unconditional multiple logistic regression. The ratio of cases to controls was 1:4. The sample consisted of 255 subjects; 51 cases and 204 controls. The mean age of the women was 26.9 years (min = 15, max = 52, and SD 7.3). The majority of the women were Lahu (49.8%) or Akha (36.9%). Nearly half the women were Christian (48.2%), followed by Buddhist (42.4%). Most of the women were not educated (60.4%). The largest group for family income was 10,000-49,999 baht/year (62.6%). After controlling for family income, family debt, education, occupation and household members, the findings showed that the "not married to debut partner" group were at greater risk than the "married to debut partner" group by 6.6 times (OR(adj) = 6.6, 95% CI = 2.9-14.9). The "use of alcohol" group were at higher risk by 4.5 times (OR(adj) = 4.5, 95% CI = 2.0-10.3) compared to the no alcohol use group, and a history of genital ulcer group had an increased risk of 6.3 times (OR(adj) = 6.3, 95% CI = 1.2-31.1) the chance of having HIV infection compared to no history of genital ulcers in pregnant hilltribe women.     

Increased risk of preterm birth among non- smoking, non- alcohol drinking women with maternal periodontitis

The aim of this case-control study was to examine the association between periodontitis and preterm birth among non-smoking, non-alcohol drinking women. The cases were 130 women who delivered a live singleton newborn before 37 weeks gestation. A random sample of 260 women who delivered a normal child on the same day as the cases were selected as controls. Periodontal examinations were performed during 24-hour period postpartum at bedside. Other related information was collected by structured questionnaire and medical records. Multiple logistic regression analysis was performed controlling for age, ethnicity, place of residence, education, occupation, income, pre-pregnancy body mass index (BMI), weight gain, antenatal care (ANC), parity, systematic infections, genitourinary infections, antibiotics used, and history of periodontal treatment. Periodontitis (defined as presence of at least 4 teeth having > or = 1 site with a probing depth (PD) > or = 4 mm, clinical attachment loss (CAL) > or = 3 mm and bleeding on probing (BOP) after 10 seconds at the same site) was diagnosed in 33.9% of cases and 10.4% of controls. Periodontitis was significantly associated with preterm birth (adjusted OR = 4.47, 95%Cl= 2.43, 8.20). These findings suggest that periodontitis may increase the risk of preterm delivery even among women who do not smoke or drink.     

Phase I/II study of a candidate vaccine designed against the B and E subtypes of HIV-1

A phase I/II trial of a candidate vaccine to prevent HIV infection was carried out in Bangkok, Thailand, testing AIDSVAX B/E (VaxGen, Inc., Brisbane, CA), a bivalent subunit vaccine prepared by combining recombinant gp120 from a subtype B virus (HIV-1MN) with gp120 from a subtype E virus (HIV-1A244) in alum adjuvant. The studies provide human data on the immunogenicity of various dose combination of non-subtype B vaccine antigens. The results suggest that AIDSVAX B/E is safe and immunogenic in humans. The optimal dose for humans in developing countries was 300 microg of each antigen (B and E). Clade E responses were measurably increased by immunizing with gp120 B/E over B alone. Using the B/E combination did not interfere with the response to either clade. Antibodies to AIDSVAX B/E were able to bind to oligomeric gp120 on the surface of cells infected with primary isolates of HIV-1.