Predicting the long-term impact of rotavirus vaccination in 112 countries from 2006 to 2034: A transmission modeling analysis.

Rotavirus vaccination has been shown to reduce rotavirus burden in many countries, but the long-term magnitude of vaccine impacts is unclear, particularly in low-income countries. We use a transmission model to estimate the long-term impact of rotavirus vaccination on deaths and disability adjusted life years (DALYs) from 2006 to 2034 for 112 low- and middle-income countries. We also explore the predicted effectiveness of a one- vs two- dose series and the relative contribution of direct vs indirect effects to overall impacts. To validate the model, we compare predicted percent reductions in severe rotavirus cases with the percent reduction in rotavirus positivity among gastroenteritis hospital admissions for 10 countries with pre- and post-vaccine introduction data. We estimate that vaccination would reduce deaths from rotavirus by 49.1 % (95 % UI: 46.6-54.3 %) by 2034 under realistic coverage scenarios, compared to a scenario without vaccination. Most of this benefit is due to direct benefit to vaccinated individuals (explaining 69-97 % of the overall impact), but indirect protection also appears to enhance impacts. We find that a one-dose schedule would only be about 57 % as effective as a two-dose schedule 12 years after vaccine introduction. Our model closely reproduced observed reductions in rotavirus positivity in the first few years after vaccine introduction in select countries. Rotavirus vaccination is likely to have a substantial impact on rotavirus gastroenteritis and its mortality burden. To sustain this benefit, the complete series of doses is needed.

[Chylous ascites, a revealing sign of peritoneal tuberculosis in an 11-month-old infant]. / Ascite chyleuse révélatrice d'une tuberculose péritonéale chez un nourrisson de 11 mois.

Chylous ascites is rare in children. We report on a case of chylous ascites in an 1-month-old infant in Togo. The infant had been appropriately vaccinated, had normal growth and psychomotor development, and he was living in a rural area. He had fever that had started 3 months earlier and persisted despite various treatments with antimalarials and antibiotics. Then progressively abdominal pain with abdominal distension developed, while lactescent ascites was discovered after puncture. The patient was referred to the Lomé teaching hospital for advanced management. Intradermic reaction to tuberculin (IRD) was positive (16 mm). Chylous ascites liquid analysis revealed apparently lymphocytic pleocytosis. Culture on special milieu allowed isolation of Mycobacterium tuberculosis. The clinical course was favorable with antituberculosis treatment. Peritoneal tuberculosis should be suspected in endemic areas in the case of a persistent fever with abdominal bloating and effusion, whatever the patient's age and the nature of ascites liquid.

[Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]. / Traitement antirétroviral des enfants infectés par le VIH/sida à Lomé (Togo): premiers résultats.

UNLABELLED: Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.

[Ambulatory management of sickle cell disease: evaluation of the first year follow up of patients in the pediatric department of Lomé (Togo)]. / Prise en charge ambulatoire des drépanocytaires: évaluation de la première année de suivi des patients dans le service de pédiatrie de Lomé (Togo).

BACKGROUND: This study is an evaluation of the first year ambulatory follow up of patients from the sickle-cell care centre of the paediatric ward of the teaching hospital in Lomé-Tokoin. PATIENTS AND METHODS: Togo is situated in the epicentre of the Benin haplotype. A total of 132 patients (109 SS, 22 SC and 1 S beta zero thal) followed up during one year from their admission date (period of 1st January 1996 to 31st December 1997). 132 patients were included in the study. RESULTS: The patients' age varied, for the majority, between 2 months and 15 years, but a few adults (15%) were included in the study. Information was collected from the hospital files and health cards, which unfortunately did not have specific entrees for sickle cell disease. Clinical features revealed that the frequency of tooth decay and chronic persistent splenomegaly was low when compared to the rates in central Africa (Bantu haplotype). Laboratory findings lead to the conclusion that some analysis are relevant such as the dosage of the G6PD activity (24.1% of patients were deficient), parasitologic analysis of faeces (positive in 22.5%), retinal fluoro-angiography (32.2% of ocular lesions), and cardiologic check-up. On the other hand, scanning of biliary tracts and systematic X-rays of the hips seems to be secondary. Some positive results were noticed by the scanning of biliary tracts without any therapeutic decisions in non-symptomatic patients; no case of osteonecrosis was detected by the X-rays. The mean haemoglobin level was 7.4 +/- 1.4 g/dl for the SS and 10.7 +/- 2.4 g/dl for the SC. The mean MCV were 91.3 +/- 10.1 fl and 82.1 +/- 7.7 fl, respectively. Specific vaccinations were not well performed because of their high cost. CONCLUSION: In order to carry on and improve the ambulatory management of patients with sickle cell disease, it is important in low income countries, such as Togo, to target the necessary laboratory tests for an initial and annual check-up. Solidarity networks for patients should be promoted and effective involvement of the health authorities ensured.

[Intracavernous injections of etilefrin: its efficacy in the treatment of priapism in sickle cell patients]. / Injections intracaverneuses d'étiléfrine: efficacité dans le traitement curatif des épisodes de priapisme chez le drépanocytaire.

OBJECTIVE: To date, the treatment of priapism in sickle-cell patients has relied on measures aimed at lowering blood viscosity and acidosis and reducing the level of circulating hemoglobin S (hyperhydration, alkalinization, or exsanguinotransfusion...) Surgical cavernous-venous shunt may be proposed if conservative treatment fails. We examined the efficacy of intracavernous etilefrin injections. PATIENTS AND METHODS: From January 1996 through October 1997 (20 months) we performed 35 consecutive intracavernous injections of an alphastimulant, etilefrin in 7 sickle-cell patients (6 SS, 1 AS) who had experienced one or several episodes of low-flow priapism lasting 2 to 28 hours. RESULTS: Involution of the tumefaction was rapidly achieved in all cases. Tolerance was satisfactory, although some post-injection undesirable effects were reported by certain patients: moderate transient pain (2-5 min) in the retrosternal area, or intense pain in the penis (more intense than the priapism) which lasted 10 to 30 minutes. This work confirmed the earlier reported efficacy of intracavernous injections of etilefrin and suggests that the autonomous nervous system plays an important role in the genesis of this condition in sickle-cell patients. Patients should be informed about the observed undesirable effects which have not been reported previously in the literature. CONCLUSION: Etilefrin can be proposed as first line treatment for priapism in sickle-cell patients (at least in cases lasting less than 24 h). The pathogenic mechanism could involve neuromuscular dysfunction.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.