Rubella transmissibility and reproduction number (Ro): A critical appraisal of the prospects for its control in Nigeria.

Rubella is a highly contagious disease of public health importance that is endemic in Nigeria. Rubella with its devastating sequel, congenital rubella syndrome, is a neglected disease with no surveillance system in place and no national incidence figure in Nigeria. This article, therefore, seeks to do reviews of rubella transmissibility, its reproduction number and the prospects for its control in Nigeria. This is a review of literatures with triangulation of findings along the objectives and the use of available secondary data to analyse the prospects of rubella control in Nigeria. Data were analysed and presented with appropriate tables and charts. A number of factors can fuel rubella transmission causing increase in reproduction number, Ro.The high birth rate, poor rubella surveillance and non-inclusion of rubella vaccines in the routine vaccination schedule among others are some of the factors working against a good outlook for rubella control in Nigeria. The Nigerian government should control the growing population, ensure a robust surveillance for rubella and incorporate rubella-containing vaccine in the immunisation schedule for infants with regular vaccination campaigns for older children and adults.

Maternal transmission of HIV infection: a crime against my child?

This paper considers whether section 20 of the Offences Against the Person Act 1861, which has been used to prosecute those who transmit the HIV virus in sexual relationships (eg, R v Konzani), could be used to prosecute women (in England and Wales) who transmit the virus to their child during pregnancy, delivery or via breast feeding. The discussion concludes that prosecution for transmission in pregnancy/delivery is unlikely. However, it is argued that there might be scope to prosecute the transmission of the virus via breast feeding in the event that there was sufficient evidence. However, this would also be subject to the Crown Prosecution Service deeming such a prosecution to be in the public interest. The paper does not seek to examine the ethical issues involved. However, it acknowledges that this issue is part of a broader debate as to whether, and if so, when, it is appropriate to criminalise the transmission of disease.

[Human immunodeficiency virus infection in children and adolescents: more of 25 years in Chile]. / Infección por virus de inmunodeficiencia humana en niños y adolescentes: Más de 25 años en Chile.

In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.

When courts intervene: public health, legal and ethical issues surrounding HIV, pregnant women, and newborn infants.

Ninety-three percent of pediatric AIDS cases are the result of perinatal HIV transmission, a disease that is almost entirely preventable with early intervention, which reduces the risk of perinatal HIV infection from 25% to <2%. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend routine HIV testing of all pregnant women and at-risk newborn infants. When pregnant women decline HIV testing and/or treatment, public health, legal, and ethical dilemmas can result. Federal courts consistently uphold a woman's right to refuse medical testing and treatment, even though it may benefit her fetus/newborn infant. Federal courts also reliably respect the rights of parents to make health care decisions for their newborn infants, which may include declining medical testing and treatment. Confusing the issue of HIV testing and treatment, however, is the fact that there is no definitive United States Supreme Court ruling on the issue. State laws and standards vary widely and serve as guiding principles for practicing clinicians, who must be vigilant of ongoing legal challenges and changes in the states in which they practice. We present a case of an HIV-positive pregnant woman who declined treatment and then testing or treatment of her newborn infant. Ultimately, the legal system intervened. Given the rarity of such cases, we use this as a primer for the practicing clinician to highlight the public health, legal, and ethical issues surrounding prenatal and newborn infant HIV testing and treatment in the United States, including summarizing key state-to-state regulatory differences.

Congenital Cytomegalovirus Prevention, Awareness and Policy Recommendations - A Scoping Study.

BACKGROUND: Congenital cytomegalovirus (cCMV) is known to cause childhood deafness, neurodevelopmental disability and death. Simple hygiene precautions are effective in reducing maternal risk of CMV infection. OBJECTIVE: To review i) awareness of CMV infection and available primary prevention strategies both in the community and amongst health professionals ii) available cCMV information sources in the literature, grey literature and published professional guidelines. METHODS: Scoping study to i) identify literature pertaining to cCMV awareness amongst parents and health professionals using MedLine and CINAHL databases via EBSCO ii) review one high income country's guidelines and recommendations regarding cCMV infection and pregnancy (example country Australia) iii) grey literature for parental information. RESULTS: Worldwide awareness of cCMV and of available prevention strategies amongst women and health professionals are poor. Findings internationally suggest at least half of maternity care health professionals do not routinely provide advice to women regarding simple hygiene precautions that can reduce their risk of infection during pregnancy. Though information resources regarding cCMV are available, they are frequently not included within general healthy pregnancy advice and require individuals to search for 'congenital cytomegalovirus'. CONCLUSION: cCMV is a preventable cause of serious congenital disability and death. Prevention opportunities are being missed because most women are not aware of cCMV or how to reduce their risk of infection in pregnancy, in part due to poor health professional awareness. New strategies to disseminate cCMV information to the community and to support health professionals to embed cCMV advice within routine pregnancy counselling is required.

Vertical HIV transmission should be excluded from criminal prosecution.

Prevention of mother-to-child transmission of HIV (PMTCT) is an important part of global and national responses to HIV and AIDS. In recent years, many countries have adopted laws to criminalise HIV transmission and exposure. Many of these laws are broadly written and have provisions that enable criminal prosecution of vertical transmission in some circumstances. Even if prosecutions have not yet materialised, the use of these laws against HIV-positive pregnant women could compound the stigma already faced by them and have a chilling effect on women's utilisation of prevention of mother-to-child transmission programmes. Although criminal laws targeting HIV transmission have often been proposed and adopted with the intent of protecting women, such laws may disadvantage women instead. Criminal laws on HIV transmission and exposure should be reviewed and revised to ensure that vertical transmission is explicitly excluded as an object of criminal prosecution. Scaling up PMTCT services and ensuring that they are affordable, accessible, welcoming and of good quality is the most effective strategy for reducing vertical transmission of HIV and should be the primary strategy in all countries.

Assessment of State Perinatal Hepatitis B Prevention Laws.

INTRODUCTION: Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health. No recent assessment of state screening and reporting laws for HBV infection has been published. METHODS: In 2014, the authors analyzed laws current through December 31, 2013 from U.S. jurisdictions (50 states and the District of Columbia) related to HBV infection and hepatitis B surface antigen screening and reporting requirements generally and for pregnant women specifically. RESULTS: All states require reporting of cases of HBV infection. Twenty-six states require pregnant women to be screened. Thirty-three states require public health reporting of HBV infections in pregnant women, but only 12 states require reporting pregnancy status of women with HBV infection. CONCLUSIONS: This assessment revealed significant variability in laws related to screening and reporting of HBV infection among pregnant women in the U.S. Implementing comprehensive HBV infection screening and reporting laws for pregnant women may facilitate identifying HBV-infected pregnant women and preventing HBV infection in their infants.

Prevention of mother-to-child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination?

OBJECTIVE: The present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20years prior to 2010. METHODS: We undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010. RESULTS: We identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization. CONCLUSION: A dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.

[Prevention of viral hepatitis B and C infections--jurisdiction and certification difficulties]. / Profilaktyka zakazen HBV i HCV a trudnosci orzecznicze.

The number of the cases for payment because of viral hepatitis B and C inflammation is significant. Because of the greater patients' notice of the disease and portal of infection, lawyer's opinion accessibility and poor economical situation of society the claims for damages seems to be more popular. The lawyers specialize in medical law. This is the reason to pay more attention to prevention of infections. Besides the hospital infections there is problem of viral hepatitis B and C infection as the occupational disease with all health and juridical consequences. These problems concern specially operative specialties therefore gynecology and obstetrics among the others. The aim of our study was to analyze jurisdiction and certification difficulties in context of occupational disease and cases for payment because of viral hepatitis B and C infections. We also try to answer the question what are possibilities to prevent infections and to defence in law suits.

Kentucky court says custody can't be denied because of HIV infection.

AIDS: A Kentucky state appeals court ruled that a parent cannot be denied child custody based solely on HIV infection. HIV infection in a parent does not alone serve as grounds for modifying a custody order. The custody motion was filed when a father learned that his ex-wife had remarried a man who tested positive for HIV. It was determined that the stepfather's HIV status would not put the children at risk for transmission.^ieng

Judge refuses to let HIV-positive mother breast feed son.

AIDS: In April 1999, Lane County Juvenile Court Judge Maurice Merten refused to surrender state control of a baby whose mother, [name removed], wants to breast feed even though she is HIV-positive. [Name removed]'s experts argued that although HIV exists, there is no real evidence that the virus causes AIDS. Other experts, however, stated that most researchers agree that HIV causes AIDS and that the chance of transmitting HIV through breast milk surpasses other risk factors, including unprotected anal sex and contaminated blood transfusions. In addition, a doctor specializing in pediatric AIDS stated that newborns are more susceptible to HIV infection than adults. The Judge ruled that [name removed] will continue to have physical custody of her son, but cannot breast feed him. A caseworker will visit the [name removed] home once a week to ensure that the baby is being bottle fed.^ieng

HIV-positive mothers risk criminal prosecution, group warns.

AIDS: The Center for Women Policy Studies is urging State legislators to specifically exempt perinatal transmission from laws that criminalize HIV transmission. In 1996, 24 States had laws making it a felony to knowingly or intentionally expose persons to HIV, and only Oklahoma and Texas explicitly forbid prosecuting women from exposing their infants or fetuses to HIV. In light of rulings that have found that fetuses are persons under the law, legislation must be tailored to protect the women from criminal prosecution.^ieng

Courts uphold HIV test for rapist, but not for child molester.

AIDS: Mandatory HIV testing of convicted sex offenders can be ordered by trial judges. In two separate California appeals court cases, the judges reached opposite conclusions regarding this testing. One court upheld the mandatory testing of a man convicted of rape. In another California case, regarding a convicted child molester, the court overturned the order to submit to mandatory testing. The appeals court said that the jury had not provided enough information to determine whether or not testing was justified.^ieng

Senate favors promoting voluntary tests for pregnant women.

AIDS: Senator Nancy Landon Kassebaum, R-Kans., has proposed legislation that would implement the Centers for Disease Control and Prevention (CDC) recommendations for universal counseling and voluntary HIV-antibody testing of pregnant women. The proposal was tacked onto the Ryan White CARE Act reauthorization bill. Under the Senator's plan, jurisdictions with a high HIV-seroprevalence rate among child-bearing women would qualify for Federal funds to promote counseling and testing. This plan is an alternative to legislation sponsored by Reps. Tom Coburn, R-Okla., and Gary Ackerman, D-NY, that would require mandatory testing of all newborns whose mothers had not been tested during pregnancy. Opponents of mandatory testing of pregnant women state that it would drive women away from important prenatal care. Coburn and Ackerman hope to amend the Ryan White reauthorization bill to force testing of all newborns. The Congressmen believe the bill will prevail in the House and be voted down in the Senate.^ieng

Canadian HIV Pregnancy Planning Guidelines: No. 278, June 2012.

OBJECTIVE: Four main clinical issues need to be considered for HIV-positive individuals and couples with respect to pregnancy planning and counselling: (1) pre-conceptional health; (2) transmission from mother to infant, which has been significantly reduced by combined antiretroviral therapy; (3) transmission between partners during conception, which requires different prevention and treatment strategies depending on the status and needs of those involved; and (4) management of infertility issues. The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist HIV-positive individuals and couples with their fertility and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible, and they take into account diverse and intersecting local/population needs and the social determinants of health. OUTCOMES: Intended outcomes are (1) reduction of risk of vertical transmission and horizontal transmission of HIV, (2) improvement of maternal and infant health outcomes in the presence of HIV, (3) reduction of the stigma associated with pregnancy and HIV, and (4) increased access to pregnancy planning and fertility services. EVIDENCE: PubMed and Medline were searched for articles published in English or French to December 20, 2010, using the following terms: "HIV" and "pregnancy" or "pregnancy planning" or "fertility" or "reproduction" or "infertility" or "parenthood" or "insemination" or "artificial insemination" or "sperm washing" or "IVF" or "ICSI" or "IUI." Other search terms included "HIV" and 'horizontal transmission" or "sexual transmission" or "serodiscordant." The following conference databases were also searched: Conference on Retroviruses and Opportunistic Infections, International AIDS Conference, International AIDS Society, Interscience Conference on Antimicrobial Agents and Chemotherapy, the Canadian Association of HIV/AIDS Research, and the Ontario HIV Treatment Network Research Conference. Finally, a hand search of key journals and conferences was performed, and references of retrieved articles were reviewed for additional citations. Subsequently, abstracts were categorized according to their primary topic (based on an outline of the guidelines) into table format with the following headings: author, title, study purpose, participants, results and general comments. Finally, experts in the field were consulted for their opinions as to whether any articles were missed. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table) and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. SPONSORS: The Society of Obstetricians and Gynecologists of Canada, Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, University of Toronto, Abbott Laboratories Canada, the Ontario HIV Treatment Network, the Canadian Institutes of Health Research, and the Canadian HIV Trials Network.

Infección por virus de inmunodeficiencia humana en niños y adolescentes: Más de 25 años en Chile / Human immunodeficiency virus infection in children and adolescents: More of 25 years in Chile

In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.

En este artículo se describe en forma resumida la patogénesis y aspectos clínicos de la infección por VIH en niños, las claves para su sospecha, las medidas preventivas para evitar su transmisión vertical, el estudio necesario para certificar o descartar la infección en lactantes y niños mayores, y las principales recomendaciones para la terapia anti-retroviral y cómo tratar y prevenir las manifestaciones de la infección por VIH. Se relata a continuación, en forma detallada, la evolución que ha experimentado en Chile la infección por VIH en pediatría, desde el primer caso pesquisado en el año 1987, producto de una transfusión sanguínea, y los primeros lactantes (mellizos) detectados en 1989, que fueran infectados en forma vertical, hasta el año 2014, con el progreso obtenido, las trabas, esperanzas y desafíos enfrentados.