Second International Workshop on the Epidemiology of Cervical Cancer and Human Papillomaviruses.
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Belgium↗
Biomedical subjects
A Meheus
Publications and source records attributed to A Meheus.
Accuracy of two enzyme immunoassays and cell culture in the detection of Chlamydia trachomatis in low and high risk populations in Senegal.
Two enzyme immunoassays (EIAs), Chlamydiazyme (CZ; Abbott Laboratories) and Pathfinder (PF; Kallestadt), were compared with a cell culture technique in the detection of cervical Chlamydia trachomatis infection in 670 women in urban settings in Senegal (377 pregnant women and 293 prostitutes). Positive CZ and positive PF specimens were tested a second time using a monoclonal antibody blocking technique. True positive specimens were defined as those positive on culture or positive on EIA with confirmation of the result after blocking. Using this definition, the prevalence of genital chlamydial infection was 14.6% and 14.3% in pregnant women and prostitutes respectively. An important difference between the two populations was that the pregnant women were younger than the prostitutes, which might explain the fact that the prevalence of infection among the pregnant women was as high as that among the prostitutes, although the age-adjusted prevalence was higher among prostitutes than among pregnant women. The chlamydial detection rates of cell culture, CZ and PF were 62% (26/42), 69% (29/42) and 86% (36/42) respectively in prostitutes and 76% (42/55), 40% (22/55) and 53% (29/55) respectively in pregnant women. Agreement between the tests was 89%, 85% and 88% for culture/CZ, culture/PF and CZ/PF respectively. However, when data were adjusted for chance agreement, kappa coefficients were 0.40 for culture/CZ, 0.34 for culture/PF and 0.48 for CZ/PF. These results indicate that the accuracy of the EIAs and cell culture may vary greatly in different populations: both EIAs showed a distinctly higher detection rate than culture in prostitutes and a significantly lower detection rate in pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Heat stability of a recombinant DNA hepatitis B vaccine.
The heat stability of a recombinant DNA hepatitis B vaccine was studied in healthy adult volunteers. When compared with vaccine stored at 4 degrees C, heating of the vaccine for 1 week at 45 degrees C or for 1 month at 37 degrees C did not alter the reactogenicity or the ability of the vaccine to elicit antibody titres considered to be protective. These results have significance in situations where the cold chain is broken, as can happen in countries where proper storage and transport facilities are not always available.
Adolescent↗
The endemic treponematoses: not yet eradicated.
The endemic treponematoses which comprise yaws, endemic syphilis (bejel) and pinta constitute a group of potentially disabling and disfiguring infections which primarily afflict children in tropical and subtropical areas. Foci where these diseases are now endemic have a patchy distribution and are typically confined to underprivileged communities living in remote rural areas, with little or no access to health services and removed from the mainstream of socioeconomic development. A drastic decline in the prevalence of these infections was brought about by the implementation of mass treatment campaigns with penicillin under the technical guidance of WHO and with material support from UNICEF in the 1950s and 1960s. These worldwide campaigns against the endemic treponematoses halted disease transmission in many areas and held the promise of complete eradication if intensive surveillance could be continued for some time with the increasing involvement of the basic health services. National campaigns were so successful that relatively low priority was given to the preparation of the rural health services for this new task. The failure of many countries to integrate active control measures into the functions of the rural health services led to the gradual build-up and extension of treponemal reservoirs and the resurgence of foci of increased disease transmission particularly in communities where standards of hygiene and health care had remained low. In a number of former endemic foci only low-level transmission persisted; in a few areas disease prevalence increased dramatically to reach pre-campaign levels. The lack of technical and financial resources limited the success of renewed national control activities in the most affected areas. Today, with waning interest in these diseases confined to remote, and thus silent, population groups, and a decreasing ability of health staff to identify cases, data collected by countries need to be supplemented by information from other sources in order to arrive at a more valid assessment of the situation concerning the endemic treponematoses. Central and West Africa are most severely affected by the resurgence of the endemic treponematoses. In recent years a number of countries (e.g. Ghana, Côte d'Ivoire and Mali) have launched renewed control efforts, often combining yaws or endemic syphilis control with other public health programmes. In Central Africa itinerant pygmy groups are still highly affected by yaws and are an important source of infection for the sedentary population with which they come into contact. In Chad, Sudan and Ethiopia, there is some evidence of persistent foci of endemic treponematoses; the epidemiological situation in Southern Africa is not well established.(ABSTRACT TRUNCATED AT 400 WORDS)
Africa↗
Endemic treponematoses. Part II. Pinta and endemic syphilis.
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Africa↗
Diagnosis of STD in developing countries.
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Developing Countries↗
Prevalence and type of infertility in Gabon.
The prevalence and type of infertility based on the WHO criteria were determined in a rural and semi-rural population in south-eastern Gabon. The prevalence rate of infertility in the rural population was 5.7% for primary infertility and 20.0% for secondary infertility. In the semi-rural area, 3.0% suffered from primary infertility and 22.4% from secondary infertility. Pregnancy wastage and home delivery were risk factors for secondary infertility. An evaluation of the WHO criteria for fertility surveys was made.
Abortion, Spontaneous↗
[Epidemiology of sexually transmissible diseases in developing countries in the era of AIDS].
Recent developments in the epidemiology of sexual transmitted diseases (STD) in developing countries are reviewed. STD are very frequent in the tropics, particularly in large urban areas. They put a heavy burden on public health because they affect the economically most important age groups and because their sequellae may be fatal. Pelvic inflammatory disease and its consequences, and morbidity during pregnancy and the neonatal period are among the most important causes of mother and child morbidity. STD favour sexual transmission of HIV and may therefore explain the explosive AIDS epidemics in many developing countries. Antimicrobial resistance has made treatment of gonorrhoea and chancroid more difficult and more expensive. STD and HIV infection may be responsible for up to 17% of productive years lost to disease in certain regions. Strategies to control STD should be developed and linked with the AIDS programs. Both should be integrated in the primary health care system.
Developing Countries↗
Seroprevalence of retroviral infection in women with different fertility statuses in Gabon, western equatorial Africa.
Seroprevalence of retroviral infection (HIV-1, HTLV-1) in women with different fertility statuses was studied in Gabon (Western Equatorial Africa). The overall prevalence rate of HIV-1 was 1.4% and of HTLV-1, 6.8%. In the primary infertile women the age-adjusted prevalence rate of HIV-1 was significantly higher than in the fertile women (9.3% versus 0.7%) and in secondary infertile women (9.3% versus 2.1%). There was no difference in sero-prevalence of HTLV-1 among women with different fertility statuses, but a steady increase with age was seen. Concomitant infection with HTLV-1 and HIV-1 was observed in two women. In Gabon primary infertile women could be considered a risk group for HIV-1 infection.
Acquired Immunodeficiency Syndrome↗
Immunogenicity of a recombinant DNA hepatitis B vaccine in institutionalized patients with Down's syndrome.
Residents of institutions for the mentally handicapped, especially Down's syndrome (DS) patients, are at increased risk for exposure to hepatitis B virus (HBV). Indeed, during a serological survey of 770 mentally retarded residents in institutions in Antwerp in 1985, 32.6% of the 92 DS patients screened were HBsAg positive, compared with 7.2% of the 678 other mentally retarded (OMR) patients (p less than 0.001). Seronegative mentally handicapped individuals (275 in number including 18 DS patients) from three institutions were vaccinated with 20 micrograms of a recombinant yeast-derived hepatitis B vaccine (YDV) according to a 0, 1, 6 month schedule. Serum samples were tested at months 1, 2, 7, 12 and 24 for HBV markers by radioimmunoassay. One month after the third vaccine dose, 81.3 and 97.7% of DS and OMR patients had seroconverted, respectively, with GMTs of 516.3 and 1078.7 mIU ml-1. Two years after the start of the vaccination course, 66.7 and 96% of subjects in the two groups still had protective antibody levels (greater than or equal to 10 mIU ml-1), although GMTs had decreased to 40.1 and 166.3 mIU ml-1 in the two groups, respectively. Only one of the 18 DS patients had transient asymptomatic anti-HBc infection at month 2, no subject followed up being infected after the full vaccination course. Thus, the institutionally mentally handicapped, including DS patients are capable of responding adequately to YDV.
Adolescent↗
Syphilis intervention in pregnancy: Zambian demonstration project.
Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries, including Zambia. It is the foremost risk factor for mid-trimester abortions, stillbirths, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff. During the post-intervention phase the steps of pre-intervention phase were repeated to evaluate the impact of intervention. Overall, 8.0% of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p greater than 0.05). Fifty seven percent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 5.0), stillbirth (RR 3.6), prematurity (RR 2.6) and low birth weight (RR 7.8). The overall risk of adverse outcomes due to syphilis was 8.29 (95% confidence interval 6.53, 10.53). The new methods of health education were effective and the percentage of women who had their first prenatal visit under 16 weeks of gestation improved from 9.4 to 42.5. Although screening and treatment during intervention was suboptimal, the adverse outcomes attributable to syphilis were reduced to 28.3%; this is almost a two-third reduction when compared with 72.4% of adverse outcomes at control centres (p < less than 0.001). The intervention is culturally and politically acceptable in Zambia. The cost of each prenatal screening is US$0.60 and of averting each adverse outcome US$12. In countries with high rates of syphilis, there is an urgent need for STD control and Maternal and Child Health (MCH) programmes to pool their resources together to revitalise the prenatal care.
Adult↗
Epidemiology of sexually transmitted diseases: the global picture.
Sexually transmitted diseases (STD) are now the commonest group of notifiable infectious diseases in most countries, particularly in the age group of 15 to 50 years and in infants. Their control is important considering the high incidence of acute infections, complications and sequelae, their socioeconomic impact, and their role in increasing transmission of the human immunodeficiency virus (HIV). The worldwide incidence of major bacterial and viral STD is estimated at over 125 million cases yearly. STD are hyperendemic in many developing countries. In industrialized countries, the bacterial STD (syphilis, gonorrhoea, chancroid) declined from the peak during the Second World War till up to the late fifties, then increased during the sixties and early seventies, and they have been decreasing again from the late seventies till the present. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses and human immunodeficiency virus are now more important than the classical bacterial ones; both groups remain major health problems in most developing countries. Infection rates are similar in both women and men, but women and infants bear the major burden of complications and serious sequelae. Infertility and ectopic pregnancies are often a consequence of pelvic inflammatory disease, and are preventable. Sexually transmitted diseases in pregnant women can result in prematurity, stillbirth and neonatal infections. In many areas 1-5% of newborns are at risk of gonococcal ophthalmia neonatorum, a blinding disease; congenital syphilis causes up to 25% of perinatal mortality. Genital and anal cancers (especially cervical cancer) are associated with viral sexually transmitted diseases (genital human papillomavirus and herpes virus infections). Urethral stricture and infertility are frequent sequelae in men.
Adolescent↗
Treatment of adult gonococcal keratoconjunctivitis with oral norfloxacin.
We evaluated the efficacy of oral norfloxacin in 15 patients with culture-proven gonococcal eye disease caused by Neisseria gonorrhoeae. The first seven patients received 1,200 mg of oral norfloxacin for three consecutive days. The other eight patients were each treated with a single oral dose of 1,200 mg of norfloxacin. All control cultures were negative, and there was no progression of the corneal lesions after treatment was initiated. No adverse effects were observed. The results of this study suggested that a single dose of oral norfloxacin may be a valuable alternative to the currently recommended treatment regimens for gonococcal eye disease because it combines high efficacy and low toxicity with low cost and excellent patient compliance.
Administration, Oral↗
Protective efficacy of a recombinant deoxyribonucleic acid hepatitis B vaccine in institutionalized mentally handicapped clients.
Mentally handicapped clients in institutions are at high risk for hepatitis B virus (HBV) infection. In 1985, 770 mentally handicapped residents from four institutions in the Antwerp area were screened for HBV markers. The prevalence of hepatitis B surface antigen was 10.3 percent (range, 6.1 to 15.2 percent); 42.3 percent (range, 11.5 to 60.1 percent) had antibodies to hepatitis B surface antigen and the hepatitis B core antigen. In 1986, 275 seronegative mentally handicapped residents were vaccinated intramuscularly in the deltoid region with 20 micrograms (1.0 ml) of a recombinant deoxyribonucleic acid yeast-derived hepatitis B vaccine (Engerix-B, SmithKline Biologicals, Rixensart, Belgium) on a zero-, one-, six-month schedule. Serum samples were collected at Months 1, 2, 7, 12, and 24 and were tested for HBV markers by radioimmunoassay. The seroconversion rates for hepatitis B surface antigen antibodies were 39 percent at Month 1 (geometric mean concentration, 6.4 IU/liter), 82 percent at Month 2 (geometric mean concentration, 23.4 IU/liter), 97 percent at Month 7 (geometric mean concentration, 1,034 IU/liter), and 96 percent at Month 12 (geometric mean concentration, 269 IU/liter). Among the 214 residents evaluated at Month 12, 69 percent had hepatitis B surface antigen antibody levels greater than 100 IU/liter (geometric mean concentration, 603 IU/liter). No significant adverse reactions were observed. Within the first seven months of observation, HBV infection was detected in eight of 271 subjects (estimated annual incidence of 5 percent). During this period, none of the clients developed clinical hepatitis or showed biochemical evidence of liver damage. Between eight and 24 months, no additional HBV infections were detected. These data can be compared with an annual incidence of HBV infection of 8.7 percent in a historical cohort of mentally handicapped residents in one of the four institutions.
Adolescent↗
Epidemiology and control of gonococcal ophthalmia neonatorum.
From a public health point of view gonococcal ophthalmia neonatorum (GCON) is important as it can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries the prevalence of gonorrhoea in pregnant women is less than 1%; in developing countries the rates are between 3% and 15%, more than 50% being due to penicillinase-producing Neisseria gonorrhoeae strains (PPNG). The rate of transmission from mother to newborn is between 30% and 50%. Strategies for the control of GCON include: (1) prevention of gonococcal infection in women of childbearing age, (2) detection and treatment of gonococcal infection in pregnant women, (3) eye prophylaxis in the newborn at birth, and (4) diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective. This reduces the GCON incidence by 80% to 95% and is highly cost-effective, particularly in high-risk settings.
Adult↗
International travel and sexually transmitted diseases.
Sexually transmitted diseases (STDs) are a group of communicable diseases transferred mainly by sexual contact. Population movements are undoubtedly a major contributing factor in the spread of STDs. Owing to the ease of modern travel, larger numbers of people are moving around than ever before in peacetime. Travellers may both import and export infection, and the importance of their role in the transmission of STDs is demonstrated by the rapid worldwide spread of penicillinase-producing strains of N. gonorrhoeae (PPNG) and AIDS. While in most industrialized countries the incidence of the classic STDs (syphilis, gonorrhoea, chancroid) has decreased during the last decade, they remain hyperendemic in many developing countries due to poorly developed STD services. In many industrialized countries, the incidence of genital C. trachomatis infection now exceeds that of gonococcal infection. Chlamydial infections were previously thought to be infrequent in developing countries, but recent research has made it clear that this infection is at least as frequent as gonorrhoea. Incidence of genital herpes and genital human papilloma-virus infections (HPV) has increased dramatically during the last 20 years. Now that international travel takes place increasingly by air, it is more likely than previously for a traveller to return home within the incubation period of many STDs. Moreover, people behave differently when they travel. Tourists travel to seek adventure and new experiences, including sex. In countries where a good notification system exists, up to 30% of new cases of syphilis were found to be acquired abroad. Since PPNG appeared in 1976, these strains have spread to almost all areas of the world. During the first five years of the epidemic, most cases in Europe and the United States of America were imported. Measures for preventing STDs are the same whether the individual is travelling or not. Abstinence or sexual intercourse between two mutually-faithful uninfected partners exclusively are the only totally effective prevention strategies. The risk of infection can also be significantly reduced by adopting safe sexual practices such as the use of condoms. Prophylactic use of an antibiotic is not recommended, however.
Female↗
Seroprevalence of treponemal infection in rural and semi-rural communities in south-eastern Gabon.
A sero-epidemiological study on the prevalence of treponemal infection was performed in a representative sample of adult women in rural and semi-rural communities in south-eastern Gabon. The overall prevalence of treponemal infection was 10.1% and 9.2% in the group of pregnant women. Age-adjusted prevalence rates were significantly lower in the rural than in semi-rural area, 7.7% and 12.2% respectively (p less than 0.05). This was due to the significantly lower syphilis prevalence in the age group 15-29 years in the rural area. There was no statistically difference in age-adjusted prevalence rates in women with different fertility status or pregnancy outcome.
Adolescent↗
[Drastic spread of endemic treponematoses].
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Cross-Sectional Studies↗