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Emergencies in international child health.

Emergencies in the pediatric populations of third world and developing countries are of a much different sort than those to which pediatricians in developing countries are familiar. Many of these emergencies derive from conditions, situations, and etiologies that no longer represent a threat to children in developed countries: malnutrition, immunizable illnesses, infectious diseases from pathogenes easily treated or prevented, urbanization, and armed conflict. Programs directed at improving basic public health, health education, access to basic health care, and immunization have been shown to have a major and positive impact on children's health status in these countries. Because of the vastness of these health problems, a growing number of volunteer organizations offer opportunities for pediatricians to contribute to improvement and they have an impact on the health of children considerably less fortunate than those in developed countries.

Child↗

Progress toward poliomyelitis eradication--Nigeria, January 2000-March 2002.

Since 1988, when the World Health Assembly of the World Health Organization (WHO) resolved to eradicate poliomyelitis globally, the annual estimated incidence of polio has declined 99%. Nigeria is the most populous country in Africa (estimated 2000 population: 127 million) and a major poliovirus reservoir. This report summarizes the progress toward polio eradication in Nigeria during January 2000-March 2002, highlighting achievements in acute flaccid paralysis (AFP) surveillance and evidence indicating reduced poliovirus transmission. The findings underscore the importance of ensuring a rapid flow of surveillance information to guide program activities.

Humans↗

Development of a rapid autopsy program for studies of brain immunity.

Human glia are essential cellular models used for studies of neurodegenerative diseases. Fetal neuroglia are commonly used, as they can be recovered in large quantities and sustained for long periods in culture. However, fetal neuroglia may have limitations in reflecting adult diseases and additionally can pose ethical issues in translating products of abortion for research use. To address these concerns, we developed a rapid autopsy program to procure age- and disease-specific neuroglia from adult brain tissues within hours of death. The challenges in developing this initiative, reflecting experiences from 69 autopsies over 4 years, are presented.

Academic Medical Centers↗

Outcome of penicillin-nonsusceptible Streptococcus pneumoniae meningitis: a nested case-control study.

BACKGROUND: There are few data comparing the clinical features, management and outcome of penicillin-nonsusceptible (PNSP) meningitis patients with penicillin-susceptible (PSSP) meningitis patients. METHODS: We performed a retrospective, nested case-control study comparing cases with PNSP meningitis with controls with PSSP meningitis obtained from the Immunization Monitoring Program, Active (IMPACT) cross-Canada surveillance study of invasive infections. RESULTS: There were 30 PNSP meningitis cases (10.1% of total) and 45 PSSP meningitis controls from 6 centers obtained from 297 meningitis cases in the IMPACT database from 1991 through 1999. Vancomycin was used for empiric therapy in no cases and controls in 1991 to 1993 and in all cases in 1999. A third generation cephalosporin was used in 93.3% of confirmed PNSP cases, and 70.0% also received vancomycin and/or rifampin. Penicillin was used in 66.7% of confirmed PSSP cases. PNSP cases were more likely than PSSP controls to have a second lumbar puncture (odds ratio, 4.1; P= 0.01). PNSP cases were treated with intravenous antibiotics for an average of 15.6 days compared with 12.3 days for controls ( P= 0.04). Among PNSP cases, those patients who did not receive empiric vancomycin were treated with intravenous antibiotics for an average of 18.5 days compared with 12.0 days for those who did receive empiric vancomycin ( P= 0.04). The overall mortality was 5.3%, and 36.6% of survivors had >or=1 neurologic sequelae, including 19.7% with hearing loss. In multivariate statistical models, PNSP was not a risk factor for intensive care unit admission or neurologic sequelae. CONCLUSIONS: Management of suspected bacterial meningitis and confirmed meningitis in Canadian children changed in the past decade. Treatment of PNSP meningitis is significantly different from that for PSSP meningitis. These changes have occurred in response to the emergence of PNSP in Canada. Neurologic sequelae remain common after meningitis, but there are no differences between PNSP cases and PSSP cases.

Adolescent↗

Smallpox vaccine.

After an extensive worldwide eradication program, the last nonlaboratory case of smallpox occurred in 1977 in Somalia. In 1972, routine smallpox immunization was discontinued in the United States, and since 1983, vaccine production has been halted. Stockpiled vaccine has been used only for laboratory researchers working on orthopoxviruses. In recent years, there has been concern that smallpox virus stocks may be in the hands of bioterrorists, and this concern has been heightened by the terrorist attack on the World Trade Center and the Pentagon on September 11, 2001. Because most of the population is considered to be nonimmune, there is debate as to whether smallpox immunization should be resumed. This statement reviews the current status of smallpox vaccine, the adverse effects that were associated with smallpox vaccine in the past, and the major proposals for vaccine use. The statement provides the rationale for a policy based on the so-called ring vaccination strategy recommended by the Centers for Disease Control and Prevention, in which cases of smallpox are rapidly identified, infected individuals are isolated, and contacts of the infected individuals as well as their contacts are immunized immediately.

Bioterrorism↗

National vaccination coverage levels among children aged 19-35 months--United States, 1998.

Sustained high vaccination coverage levels in the United States are necessary to decrease rates of vaccine-preventable diseases. Therefore, an important component of the U.S. vaccination program is the assessment of vaccination coverage. To assist in this assessment, in 1993, the Childhood Immunization Initiative (CII) was begun to increase vaccination coverage levels among children during the first 2 years of life to > or =90% by 1996 for universally recommended childhood vaccinations and to monitor trends in vaccination coverage. Vaccination objectives also were included in the national health objectives for 2000 initiative. Except for hepatitis B vaccine, the 90% coverage goals were achieved and maintained through implementation of CII by public- and private-sector organizations and health-care providers at the national, state, and local levels.

Child, Preschool↗

A bacterial inhibitor of host programmed cell death defenses is an E3 ubiquitin ligase.

The Pseudomonas syringae protein AvrPtoB is translocated into plant cells, where it inhibits immunity-associated programmed cell death (PCD). The structure of a C-terminal domain of AvrPtoB that is essential for anti-PCD activity reveals an unexpected homology to the U-box and RING-finger components of eukaryotic E3 ubiquitin ligases, and we show that AvrPtoB has ubiquitin ligase activity. Mutation of conserved residues involved in the binding of E2 ubiquitin-conjugating enzymes abolishes this activity in vitro, as well as anti-PCD activity in tomato leaves, which dramatically decreases virulence. These results show that Pseudomonas syringae uses a mimic of host E3 ubiquitin ligases to inactivate plant defenses.

Apoptosis↗

[The expanded vaccination program in Cameroon: status of the intermediate objectives and future prospects].

The authors report the results of nine sample surveys for the evaluation of the immunization coverage program carried out in urban and rural areas in Cameroon. The halfway target of 30% is reached in urban areas and approached in rural areas. The achievement of the target (85%) will need the solution of more and more intricate problems and the participation of the whole national community.

Cameroon↗

Current Assessment of Yellow Fever and Yellow Fever Vaccine.

Yellow fever (YF) is a mosquito-borne viral illness that causes hemorrhagic fever in tropical Africa and South America. Although a very safe and efficient vaccine (17D) is available, it is underused. An estimated 200,000 people are still infected annually, and YF remains a major public health concern. This article reviews the recent data on YF epidemiology, virology, and immunity, and analyzes the rare postvaccination adverse effects that have been recently reported. YF vaccine should be included in the expanded program of immunization for children and sustained for people living in or traveling to endemic areas. A surveillance of vaccinated people also should be reinforced. New research programs should be developed to identify molecular markers of YF virus tropism and attenuation, and to understand mechanisms of host responses to virus infection.

Journal Article↗