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Genotype-specific in vitro amplification of sequences of the wild type 3 polioviruses from Mexico and Guatemala.

The extensive nucleotide sequence heterogeneity among independent genotypes of wild polioviruses permits the systematic design of genotype-specific molecular reagents. We have prepared two sets of polymerase chain reaction (PCR) primer pairs specific for the genotype of wild poliovirus type 3 recently endemic to Mexico and Guatemala. Nucleotide sequences of a representative wild type 3 virus isolated in Mexico in 1989 differed from the corresponding Sabin 3 (Leon 12 a1b) sequences at 167 of 900 positions within the VP1 region. From the sequence data, wild virus-specific primer pairs were designed to complement regions of high mismatch (greater than 33%) with Sabin 3 templates. Primer binding sites were spaced along the genome so that the predicted amplification products (142 bp and 163 bp) could be easily resolved electrophoretically from the products generated with our Sabin strain-specific primers (Sabin 1: 97 bp; Sabin 2: 71 bp; Sabin 3: 53 bp). RNAs of all wild type 3 poliovirus isolates from Mexico and Guatemala obtained over a 13-year period (1977-1990) served as efficient templates for amplification of the 142-bp and 163-bp products. Genomic templates derived from vaccine-related polioviruses and most heterologous wild polioviruses were inactive under equivalent reaction conditions. Amplifications generating a 114-bp product with a broadly reacting primer pair, matching highly conserved sequences in the 5'-noncoding region, provided a positive control for the presence in samples of poliovirus (or enterovirus) RNAs. Selective amplification of wild Mexico-Guatemala type 3 poliovirus sequences was obtained with either primer set in reactions containing large stoichiometric excesses (up to 10(6)-fold) of vaccine-related RNAs. We have used wild genotype-specific PCR primer sets to facilitate identification of wild polioviruses present in both clinical and environmental samples.

Amino Acid Sequence

Disease-surveillance and decision-making after the 1976 Guatemala earthquake.

In the first 3 weeks after the 1976 earthquake in Guatemala a system for collecting, analysing, and disseminating information of medical importance was instituted in the disaster area. Data on cases of selected diseases, number of available hospital beds, and medical supplies were collected, and reported epidemics were investigated. The system functioned well despite the limited numbers of trained personnel. Collection and analysis were quick enough for data to be used immediately in decision-making. No epidemics of communicable diseases were observed in the affected area. The number of dog bites in Guatemala City increased but no cases of rabies were reported. The success of the surveillance system in Guatemala suggests that immediate use of epidemiological methods should be an integral part of disaster relief.

Animals

Search for epizootic-like Venezuelan encephalitis virus at enzootic habitats in Guatemala during 1969-1971.

Seventy-four strains of Venezuelan encephalitis (VE) virus recovered from sentinel hamsters or mosquitoes at enzootic habitats in Guatemala in the two years following the 1969 epidemic-equine epizootic were examined for ability to produce small plaques in Vero African green monkey kidney cell cultures, like isolates obtained during the epizootic. (a) One strain recovered from a sentinel hamster in late October 1969 at an enzootic habitat near the epicenter of the hemagglutination-inhibition (HI) and equine-virulence properties like epizootic virus; this strain retained its small plaque characteristic after inoculation and recovery from bloods of three horses. (b) None of the other 73 strains produced uniformly small plaques, but 31 formed a few small plaques among large ones. Virions from small plaques of five strains were cloned twice in Vero cell cultures. Four clones produced uniformly small plaques after one more passage in Vero cells; three had hemagglutination-pH properties compatible with epizootic virus or intermediate between epizootic and enzootic virus, but HI tests with these three hemagglutinins or with antibody to the fourth cloned strain showed them to be like Central American enzootic virus. One of three cloned strains tested in horses produced encephalitis and death in one of four horses; another strain produced encephalitis with recovery in one of two horses. (c) Thus these small Vero plaque clones resembled Central American enzootic strains of VE virus in HI and equine-virulence tests, and the small Vero plaque characteristic was not a satisfactory marker for consistently isolating equine-virulent, epizootic VE virions. Nevertheless, this technic led to recognition of one epizootic strain isolated at an enzootic habitat in Guatemala at the end of 1969 outbreak. Whether this strain was there before the outbreak or subsequently penetrated the habitat is uncertain. During the next two years, this strain did not become dominant in that enzootic focus.

Animals

Search for persistent epizootic Venezuelan encephalitis virus in Guatemala, El Salvador and Nicaragua during 1970-1975.

Evidence was sought during 1970-1975 of persistence of equine-virulent Venezuelan encephalitis (VE) virus in regions of Central America that were heavily involved in the epidemic-equine epizootic of 1969. (a) Four sentinel horses were exposed in an arid, upland region of the Atlantic drainage of Guatemala during August-October 1970, but no horse became infected. (b) The epicenter region of the 1969 outbreak, in southwestern Guatemala and southwestern El Salvador, was studied during July 1970-February 1974; no antibody developed in sentinel horses, sentinel hamsters did not die, mosquitoes yielded no virus, wild rats had no detectable VE virus HI antibody. Unexplained decreases in populations of wild terrestrial mammals possibly limited maintenance of VE virus. However, mosquitoes were plentiful and present in the same species composition found at a focus of enzootic VE virus about 35 km northwest of the epicenter region. (c) In studies at two Guatemalan ranches near the epicenter, where horses died in 1969, VE viruse infected sentinel horses along one of three lakes on one ranch during the wet season of 1972 but not during the dry or wet seasons of 1973; the titers of neutralizing antibodies in these four horses were higher against an enzootic strain of VE virus than against an epizootic strain. During 1970 and 1971, VE virus was isolated from sentinel hamsters exposed at a marsh on the other ranch, but Vero plaque characteristics were those of enzootic VE virus. (d) The only epizootic activity of VE virus discovered in Central America in 1970-1975 occurred in Nicaragua between April and June 1972. Several hundred horses died, and N antibody, like that engendered by epizootic virus, was found in two young, unvaccinated horses. Whether this represented persistence of epizootic VE virus or reintroduction of virus is unknown.

Adolescent

Onchocerciasis in San Vicente Pacaya, Guatemala.

An epidemiological survey for onchocerciasis was carried out in the San Vicente Pacaya area of Guatemala. A total of 2,153 inhabitants were examined by a single skin snip, and 664 (30.8%) were positive for microfilariae. Slit lamp examination of the anterior chamber of the eye revealed microfilariae in 6.2%; the positive rate for microfilariae in the anterior chamber was proportional to the microfilarial density in the skin. The altitude-dependent character of onchocercal infection was shown in this mountainous area, suggesting that transmission occurs principally between 600 and 1,300 m. Of, 1,217 persons examined simultaneously by skin snip and by palpation for nodules, 587 were positive by one or both methods; 101 infections were detected by onchocercal nodules only and these were usually in children or persons living in areas of low endemicity. It was concluded that both the skin snip and a search for nodules are required for accurately determining the prevalence of onchocerciasis in Guatemala.

Adolescent

Onchocerciasis in Guatemala. III. Daytime periodicity of microfilariae in skin.

Periodicity of microfilariae of Onchocerca volvulus in the skin was not believed to exist until investigators in Africa recently demonstrated diurnal periodicity. Interestingly, this maximal density of microfilariae in the skin has been shown to coincide with the peak biting time of the Simulium vector. The current study was performed as part of other studies in Guatemala. Maximal density of microfilariae in the skin was at 1000 hours or shortly therafter. This peak is earlier than reported in Africa. The most active feeding period of Simulium ochraceum, believed to be the principal vector in Guatemala, had been previously shown to be from 0800 to 1000 hours. The current report lends support to other findings indicating that Onchocerca volvulus microlilariae have a diurnal periodicity. In addition, the occurrence of peak vector biting time at the same time as maximal numbers of microfilariae in the skin strengthens a hypothesis that these synchronous cycles have a biological significance.

Adolescent

[An endemic area of sporotrichosis in Guatemala].

An endemic area of sporotrichosis is described in the Lake of Ayarza District, South Guatemala, where 53 patients have been observed within 3 years. In 45.3% of the cases, the infection appeared after handling fish. The disease was more frequently observed in man (83%) and in patients less than 30 years of age. The most frequent clinical type was the ascending lymphocutaneous sporotrichosis of the limbs. Some cases of ulcerative or verrucous lesions were seen. Almost all the patients cured rapidly either by potassium iodide (46 patients) or spontaneously, or after application of local heat (4 patients). Intradermal tests were performed in healthy population in the endemic area and, for comparison, in Guatemala City. Whole yeast cell antigens of Sporothrix schenckii and Ceratocystis stenoceras were used in these tests. Skin tests to both antigens were more frequently positive in the endemic area; the highest frequency was obtained with the antigen of C. stenoceras. A serological study was performed in 26 patients. The fluorescent antibody staining technique was more sensitive than yeast cell and latex particles agglutinations. C. stenoceras was isolated from bark of some trees, especially Eucalyptus, in the environment, but not S. schenckii.

Agglutination

[Programs for supervised professional practice and for rural oral health promoters in Guatemala].

The experiences of the programs of Supervised Professional Practice and for Rural Oral Health Promoters conducted by the School of Dentistry of San Carlos University in Guatemala are described. The first of these programs was designed to have students practice the profession during an eight-month academic period in hinterland towns under periodical supervision by their professors, and the second resulted as an unexpected offshoot during the initial stages of the program of Supervised Professional Practice in a northwestern district of Guatemala. The history and progress of both programs are described, some results are presented, and the salient features of university-community interaction, as exemplified by these programs, are discussed in terms of a theoretical model designed by one of the authors.

Community Dentistry

Seasonal pattern in the rate of growth in height of children living in Guatemala.

Monthly increments of height for a sample of 164 Guatemala City school children are analyzed for the presence of a seasonal pattern in rates of growth. It is found that pre and post adolescent children follow a seasonal pattern of growth but adolescent children do not. It is suggested that the results are due to an effect of seasonal changes in ultraviolet light availability and the synthesis of vitamin D3 as mediated by the level of maturation of each child.

Adolescent

Monthly changes in the gain and loss of growth in weight of children living in Guatemala.

Monthly increments of weight growth for a sample of 246 Guatemala City private school children are analyzed for the presence of a seasonal pattern in rates of growth. Neither a seasonal pattern nor any other periodic rhythm is found. It is observed that a significantly greater number of children aged 5.0 to 6.9 years experience their minimum annual growth rate during the dry season, with up to 60% of them losing or not gaining weight in any one month. Patterns of diet, exercise and disease cannot explain this trend. A possible association between minimum weight growth and maximum growth in height is discussed.

Adolescent

Variations regarding susto causality among the Cakchiquel of Guatemala.

George Foster's model of 'personalistic' and 'naturalistic' disease theories is employed in the present analysis of fright-sickness among Cakchiquel villagers in highland Guatemala. Field data from Panajachel and San Antonio Aguas Calientes suggest that pronounced intrasocietal competition favors personalistic interpretation, with sorcery cited as the ultimate source, rather than naturalistic interpretation, which emphasizes chance or destiny. Village differences in subsistence echology and internal competition apparently underlie variations in both the social function and assumed etiology of fright-sickness.

Ethnicity

Contamination of human milk with chlorinated pesticides in Guatemala and in El Salvador.

In Central America huge amounts of persistent organochlorine pesticides are being used. This paper presents data on organochlorine residues in human milk. The samples studied were collected from areas with different spraying patterns. The results show very high contamination rates with organochlorine pesticides, especially with DDT. The highest levels were found in cotton-growing areas. Compared with residue levels in areas where cotton is not grown the difference was found to be statistically significant. Many of the quoted values are among the highest reported for the Western World. However, very high residue levels were also found even in Guatemala City, suggesting that other than agricultural uses of pesticides are important contamination sources. It is believed that these high levels of pesticide residues in human milk reflect a high contamination among the population in general.

El Salvador

Maternal alpha-2-macroglobulin levels and fetal growth in Guatemala.

Maternal serum alpha-2-macroglobulin (alpha 2M) levels were measured at the time of delivery in 244 women in the central highlands of Guatemala. Significantly higher alpha 2M levels were found in thin women and in poor women. In multiple regression analysis controlling for gestational age, race, sex, maternal triceps skinfold thickness and socioeconomic status, high alpha 2M levels were significantly associated with decreased birthweight. These findings agree with those in a predominantly black population in the United States and extend the relationship between alpha 2M and decreased birthweight to a developing country.

Biomarkers

The relationship of family size and spacing to the growth of preschool Mayan children in Guatemala.

The height of preschool Mayan children is analyzed with respect to family size and the spacing of their siblings, controlling for parental heights and weights. Data on 643 cases were abstracted from the records of two previous longitudinal studies on the health of children under age five years living in the highlands of Guatemala. Height at age three years is estimated from the linear regression equations fitted for each child to measurements of height repeated at three-month intervals from ages one to four years. Family size is expressed in terms of birth rank, live siblings, and the number of dependent and independent family members. Family spacing is measured as birth intervals, i.e., the number of months between the birth of the index child and his previous and subsequent siblings. Most previous studies have reported that height decreases as family size increases. This study shows that Mayan children from both small and large families are taller than those from middle-sized families. Evidence is presented to support the hypothesis that children in large families are relatively tall because their early-born siblings contribute to the family fortunes. Birth intervals are positively correlated with height. The findings are discussed in terms of their implications for family planning.

Birth Order

Onchocerciasis in Guatemala. I. Epidermiological studies of microfilaruria.

Microfilariae of Onchocerca volvulus were detected in the urine of 65 residents of three coffee plantations near Yepocapa, Guatemala. In this area the prevalence of microfilaruria is estimated to be between 17% and 30% of the population 10 years of age and older. Almost all of the people examined had clinical manifestations of onchocerciasis and 80% of them had microfilariae in skin snips. The frequency of microfilaruria is associated with the number of microfilariae in the skin. Within each age group those who had lived longer on the coffee plantations were more likely to have microfilariae in a skin snip and more likely to have microfilariae in their urine. The presence of subcutaneous nodules or history of prior nodulectomy did not reduce the incidence of microfilaruria nor did the presence of subcutaneous nodules increase the incidence of microfilariae in the urine.

Adolescent

Ecologic studies of Venezuelan encephalitis virus and isolations of Nepuyo and Patois viruses during 1968-1973 at a marsh habitat near the epicenter of the 1969 outbreak in Guatemala.

Ecologic studies of Venezuelan encephalitis (VE) virus at a marsh habitat near the epicenter of the 1969 outbreak in Guatemala revealed that the virus was enzootic there. VE virus was isolated yearly during 1968-1973 from sentinel hamsters exposed during the rainy seasons and from mosquitoes collected during July and August 1970. Hamsters yielded 41 strains of VE virus and virus was detected within 2 km of the edge of the marsh, in its interior, and at its western extreme 18 km from the central study site at La Avellana. One strain of virus came from a hamster that died in the dry season of January 1970. Culex mosquitoes yielded 20 strains of VE virus and Mansonia and Aedes one each. Culex (Melanoconion) and Aedes taeniorhynchus were most prevalent near the marsh. Hemagglutination-inhitibion (HI) and neutralization antibody tests of sera showed that wild terrestrial mammals (opossums and rodents), humans, and dogs, but not wild birds, were frequently infected. Seven of 16 susceptible residents of villages at the edge of the marsh developed antibodies without symptoms during an 18-month period between September 1971 and February 1973. Only 1 of 5 sentinel rabbits, and none of 30 sentinel chickens developed VE HI antibody during August-September 1971, a period when virus activity was readily detected by the use of sentinel hamsters. Five strains of group C arbovirus (one identified as Nepuyo) were recovered from sentinel hamsters during 1968 to 1970, and one strain of Nepuyo virus was isolated from the blood of a person with a febrile illness during 1972. Two strains of Patois group arboviruses were isolated from Culex mosquitoes during 1970.

Adolescent

Studies of possible movement of Venezuelan encephalitis virus from an enzootic focus in Guatemala during 1971-1974.

During the wet seasons of 1972 and possibly 1971, sentinel horses became infected by Venezuelan encephalitis (VE) virus in a temporally and geographically progressive manner inland from an enzootic marsh focus of virus on the Pacific couast of southeastern Guatemala. During the wet seasons of 1972 and 1973, VE virus was detected by sentinel horses (and a sentinel hamster in 1972) in a small woods 10 km north of the marsh, but virus was undetectable there during the dry seasons of 1973 and 1974 and the wet season of 1974. Culex (Melanoconion) mosquitoes were found in this woods and at the marsh during August 1973. These observations are compatible with movement of VE virus from the marsh habitat during some wet seasons. However, virus activity in this region adjacent to the marsh was quantitatively unpredictable on a yearly basis and occurred in only very focal habitats during 1971 to 1974. Mechanisms of VE virus movement from the marsh are currently unknown, but bats are under study as a likely possibility.

Animals

Knowledge and beliefs about malaria on the Pacific coastal plain of Guatemala.

Surveys of residents of the Pacific coast of Guatemala revealed a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Although mosquitoes are known to play an important role in malaria transmission and are thought to become infected by biting individuals with malaria, 75% of people interviewed believe that the mosquitoes can also acquire infections from contaminated water or by biting snakes and frogs. Furthermore, most residents believe that malaria can be acquired in other ways, such as by bathing too frequently or by drinking unboiled water. Although self-treatment of malaria with oral and injectable drugs purchased at stores and pharmacies is very common, less than 10% of the respondents were aware of the correct curative dose of chloroquine. Chloroquine injections are preferred to tablets and believed to be approximately three times as potent as tablets of the same concentration. Nearly two-thirds of the interviewees believed that pregnant and lactating women with malaria should avoid the use of chloroquine because it may cause a spontaneous abortion or dry up breast milk. Similar surveys of National Malaria Service workers and village malaria workers revealed higher levels of knowledge, although the village workers had many misconceptions about malaria transmission. An educational campaign directed at correcting some of these misconceptions should result in more appropriate self-treatment of malaria and greater acceptance by residents of personal protection methods and vector control and drug treatment programs.

Adult