Pinta, yaws, and venereal syphilis in Colombia.

Three treponemal infections of man have coexisted in Colombia, South America for centuries. In former years, Colombia and Mexico were the world's most highly endemic countries for pinta. Within Colombia, highest rates of infection with pinta occurred among the mestizo and Indian populations in the Andean and Caribbean departments of Huila, Tolima, Antiochia, Magdalena and Cesar. Yaws occurred primarily in rural areas along the Pacific coast among descendants of African slaves. Infectious syphilis is most often reported from the three largest urban areas, and from three other densely populated departments in the Andean region. During the 21-year period from 1954 to 1974, almost four times as many cases of pinta as yaws were reported. The incidence rates of yaws and pinta have declined almost in parallel in Colombia, even though there has been a national campaign against yaws, but not against pinta. The incidence of primary and secondary syphilis increased only slightly during the same period. The total burden of reported treponematoses (excluding tertiary and congenital syphilis) declinded by over 40 per cent, while the ratios of reported yaws, pinta and infectious syphilis rose from 1:3:4 in 1954 to 1:7:975 in 1974.

Dracunculiasis eradication: a mid-decade status report.

A campaign to eradicate dracunculiasis has been underway from the beginning of the International Drinking Water Supply and Sanitation Decade (1981-1990), since providing safe drinking water is the most effective means to prevent that disease. About 120 million persons are estimated to be at risk of the infection in Africa, and 20 million more in India and Pakistan. Both major endemic countries in Asia have begun efforts to eliminate the disease, and by the end of 1986, national anti-dracunculiasis programs were underway or planned in 8 of the 19 affected African countries. In May 1986, the World Health Assembly adopted a resolution on the elimination of dracunculiasis-the first such resolution since the successful Smallpox Eradication Program. India, which began its Guinea Worm Eradication Program in 1980, has already eliminated the disease from one of seven endemic states, and reduced the total number of cases found through active surveillance by 35% between 1983 and 1985. In Côte d'Ivoire (Ivory Coast), the only African country to conduct active surveillance for dracunculiasis so far, an aggressive combined program of rural water supply, health education, and active surveillance has reduced the disease from 4,971 cases in 1976 to 592 cases in 1985.

After smallpox eradication: yaws?

The WHO-coordinated Smallpox Eradication Program (SEP) has reduced the number of smallpox-endemic countries from 30 to 1, and now expects to complete the eradication of smallpox after a 10-year campaign. Campaigns to eradicate yaws were begun in the early 1950's with WHO and UNICEF support, and have greatly reduced the prevalence of that disease. Yaws has not yet been eradicated from any large geographic area, however, and is already resurgent in some countries. Some of the differences between the two diseases and available control measures are discussed. The thesis of this paper is that yaws programs have been deficient in failing to aggressively seek and contain yaws cases and contacts after mass treatment campaigns reduced yaws prevalence to low levels. It is further suggested that by using a modified SEP-type strategy to focus investigation and control efforts on infections yaws cases and their contacts, and by taking advantage of new methods to obtain more accurate diagnosis of yaws cases in the field, it should be possible to control yaws more effectively and efficiently, and perhaps to eradicate it. Outstanding barriers to yaws eradication are also discussed.

Fluorescent treponemal antibody absorption (FTA-ABS) tests using blood samples collected on filter paper.

One hundred and eleven (111) blood specimens were collected from patients with known or suspected syphilis by venipuncture and on a small piece of No. 3 grade filter paper. Both specimens from each patient were tested by bluorescent treponemal antibody absorption (FTA-ABS) test. Of the 62 patients whose venipuncture sera were FTA-ABS positive, filter paper blood samples were also positive in 56 (90%) and negative in 6 (10%). Complete agreement was obtained on paired specimens from 49 patients who were FTA-ABS negative. These preliminary results suggest that finger stick blood samples, collected on filter paper, could be used for FTA-ABS testing of remote rural populations--such as in areas where yaws is endemic.

Dracunculiasis eradication: target 1995.

Substantial progress has been achieved over the past 3 years by the campaign to eradicate dracunculiasis. The target of eradication by 1995 has been set by the African Regional Office of the World Health Organization and accepted by the United Nations Children's Fund (UNICEF) and the United Nations Development Program. India and Pakistan continue to reduce their cases of the disease dramatically. In Africa, Ghana and Nigeria conducted national village-by-village searches in 1988-1990 and, between them, found greater than 800,000 cases of the disease. Most African countries have now prepared national plans of action, appointed national coordinators, and intend to use UNICEF's assistance to conduct national searches by the end of 1990. An international donors' conference held in 1989 facilitated major new assistance for the initiative by UNICEF, the United Nations Development Program, the United States Agency for International Development, the Japanese International Cooperation Agency, the Peace Corps, the American Cyanamid Company, and DuPont. The World Health Organization held a meeting early in 1990 to draft criteria and recommend the process for certifying achievement of elimination of dracunculiasis in formerly endemic countries. The major remaining obstacles to eradication of dracunculiasis by 1995 are civil wars in northeastern Africa and the apathy of some national and international officials.

Dracunculiasis eradication: almost a reality.

The idea of a global campaign to eradicate dracunculiasis was first proposed by the Centers for Disease Control and Prevention in 1980, during the advent of the International Drinking Water Supply and Sanitation Decade (IDWSSD) (1981-1990). In 1981, the Steering Committee of the IDWSSD adopted eradication of dracunculiasis as a subgoal of their efforts to provide safe drinking water to unserved populations. In 1988, African ministers of health voted to eradicate dracunculiasis by the end of 1995, a target date that was endorsed by UNICEF in 1989 and the World Health Assembly in 1991. Although nine of 18 endemic countries, India (1980), Pakistan (1987), Nigeria and Cameroon (1988), Ghana (1989), and Mauritania, Benin, Burkina Faso, and Togo (1990) completed national searches for cases of the disease, only four countries, India (1983), Pakistan (1988), Ghana (1989), and Nigeria (1989), actually started eradication programs during the 1980s. The remaining 14 endemic countries began their eradication programs between 1991 and 1995. At the end of 1996, dracunculiasis had not been entirely eradicated, but its incidence had been reduced by 95%, from an estimated 3.2 million cases in 1986 to 152,805 cases in 1996. Sudan reported a total of 118,578 (78%) of the 152,805 cases of dracunculiasis reported during 1996. Insufficient funding and the civil war in Sudan continue to be the major obstacles to overcome. A primary aim of the eradication program in 1997 is to seek to ensure that all cases of dracunculiasis outside of Sudan are contained. In Sudan the challenge is to pursue all appropriate control measures in all accessible areas as vigorously as possible until political circumstances allow access to all of the remaining affected areas.

Dracunculiasis eradication: delayed, not denied.

By the end of 1998, Asia was free of dracunculiasis (Guinea worm disease), with Pakistan, India, and Yemen having interrupted transmission in 1993, 1996, and 1997, respectively. Transmission of the disease was also interrupted in Cameroon and Senegal during 1997. Chad reported only 3 cases during 1998. Dracunculiasis is now confined to only 13 countries in Africa. The overall number of cases has been reduced by more than 97% from the 3.2 million cases estimated to have occurred in 1986 to 78,557 cases reported in 1998. Because the civil war in Sudan remains the major impediment to eradication of dracunculiasis, the interim goal is to stop all transmission outside that country by the end of 2000. The most important operational need now is for national programs to improve the frequency and quality of supervision of village-based health workers in order to enhance the sensitivity of surveillance and effectiveness of case containment.

Dracunculiasis eradication: beginning of the end.

Beginning with the International Drinking Water Supply and Sanitation Decade (1981-1990), an increasingly broad coalition of international and bilateral agencies, organizations, private companies, and other institutions have joined forces to eradicate dracunculiasis (Guinea worm disease). From an estimated annual incidence of 10 million persons just before the campaign began, the remaining incidence of cases is now less than two million. More than 23,000 villages are known to be endemic. All 18 countries where the disease is still endemic have completed or begun nationwide searches to identify endemic villages, except Kenya. Dracunculiasis is nearly eradicated in Asia, where Pakistan found only 23 cases in 1992, and India found 1,081 cases. Cameroon and Senegal are close to achieving eradication in Africa, where the two formerly highest endemic countries, Nigeria and Ghana, reduced their combined total of cases from approximately 820,000 in 1989 to less than 240,000 in 1992. Much remains to be done, however, in francophone West Africa and especially in East Africa. The most serious current obstacles to eradicating dracunculiasis by 1995 are the civil war in Sudan, apathy of some national and international health officials, and inadequate funding for the campaign.

Dracunculiasis eradication: March 1994 update.

Substantial progress has been realized in the global campaign to eradicate dracunculiasis by the end of 1995 since a previous review of the subject was published in this journal a year ago. All known endemic countries are now engaged in the eradication effort, and one or more control measures are now in place in 93% of endemic villages. Despite improved surveillance for the disease, the number of reported cases of the disease has been reduced by 41% (to about 221,000), and the number of known endemic villages has been reduced by 28% (to about 16,500) in the past year. Priorities for national eradication programs in 1994 include increasing the use of vector control and intensifying the case containment strategy in endemic villages. It is still possible to achieve the eradication target of December 1995, but greatly intensified efforts this year will be required to do so.

Mobilization strategy for guinea worm eradication in Nigeria.

The transformation of dracunculiasis from an obscure and neglected rural disease to the highly visible target of a national eradication campaign in Nigeria is described in this report. This process progressed through four overlapping stages: documentation of the extent and nature of the disease as a national problem, demonstration in Nigeria that dracunculiasis could be effectively prevented by targeted provision and use of protected rural water supplies, mobilization for community participation in, and political support of, the eradication effort, and implementation of interventions nationwide. The conduct of the first national village-by-village search for cases and documentation of the adverse socioeconomic impact of the disease (e.g., on rice production) in Nigeria were the key elements used to solicit greater attention to the problem and mobilize support for its eradication. The critical role of the mass media in this effort and other benefits of this mobilization strategy are also highlighted.

The Carter Center's assistance to river blindness control programs: establishing treatment objectives and goals for monitoring ivermectin delivery systems on two continents.

Periodic mass treatment with ivermectin in endemic communities prevents eye and dermal disease due to onchocerciasis. As part of an international global partnership to control onchocerciasis, The Carter Center's Global 2000 River Blindness Program (GRBP) assists the ministries of health in ten countries to distribute ivermectin (Mectizan, donated by Merck & Co.). The GRBP priorities are to maximize ivermectin treatment coverage and related health education and training efforts, and to monitor progress through regular reporting of ivermectin treatments measured against annual treatment objectives and ultimate treatment goals (e.g., full coverage, which is defined as reaching all persons residing in at risk villages who are eligible for treatment). Since the GRBP began in 1996, more than 21.2 million ivermectin treatment encounters have been reported by assisted programs. In 1999, more than 6.6 million eligible persons at risk for onchocerciasis received treatment, which represented 96% of the 1999 annual treatment objective of 6.9 million, and 78% of the ultimate treatment goal in assisted areas.

A method of rapid assessment of the distribution and endemicity of dracunculiasis in Nigeria.

This paper describes how information was collected at a national conference in Nigeria and a map compiled to give an initial assessment of the distribution and endemicity of dracunculiasis (guinea worm disease) throughout the country. The map provided a stimulus for further studies of the status of the disease and for the consideration of national control strategies. A map created along the same lines could be used for obtaining an initial assessment of the extent and endemicity of dracunculiasis, or other diseases, in countries for which such data was not readily available.

Effect of low-impact aerobic dance on the functional fitness of elderly women.

To determine the effect of low-impact aerobic dance on sedentary elderly women (N = 53), functional fitness was measured by items from the proposed American Alliance of Health, Physical Education, Recreation, and Dance (AAHPERD) fitness test for older adults. After 12-weeks of low-impact aerobic dance, the group improved significantly on all functional fitness components except motor control/coordination, including cardiorespiratory endurance, strength/endurance, body agility, flexibility, body fat, and balance.

AIDS in minority populations in the United States.

Among ethnic minorities in the United States, blacks and Hispanics, who compose 12 percent and 7 percent of the U.S. population, respectively, constitute 24 percent and 14 percent of the cases of AIDS. Seventy-eight percent of all children with AIDS are black or Hispanic, as are 71 percent of all women with AIDS. In the black and Hispanic communities, intravenous (IV) drug abuse is associated with much of the AIDS transmission, and parenterally acquired infections are spread secondarily by sexual and perinatal transmission. Almost two-thirds of black and Hispanic persons with AIDS in the United States reside in New York, New Jersey, or Florida. Important differences in the understanding of AIDS and human immunodeficiency virus infection and control measures in minority communities must be considered in devising information and intervention programs for those communities. Programs intended specifically for minorities, especially greatly intensified prevention and treatment of IV drugs abuse, are needed to supplement programs aimed at the U.S. population in general. Combatting AIDS offers black and Hispanic populations an opportunity to greatly reduce IV drug abuse, other sexually transmitted diseases, and teenage pregnancy.

Public health measures for prevention and control of AIDS.

The grave challenge posed by the recent pandemic of acquired immunodeficiency syndrome is not the first time mankind has faced such a threat. Useful lessons may be drawn from the successful global Smallpox Eradication Program and applied to the current campaign in the areas of surveillance, strategy, operations, and evaluation. The most important epidemiologic characteristic of this new infection is the unprecedented observation that virtually all asymptomatic infected persons are infectious and will remain so indefinitely. In combatting this infection we should concentrate our efforts in the United States on preventing transmission from the estimated 1.5 million persons who are already infected. We must make the best use we can of all the tools we already have: public information, health education, counseling and serologic testing of persons at high risk, treatment and prevention of intravenous drug abuse, and serologic screening of organ and tissue donors. Adequate confidentiality of test results needs to be secured in order to promote voluntary testing as an important means of achieving behavorial change among persons who are most likely to have been exposed to the infections. Persons whose sexual or drug abuse behavior puts them at higher risk of infection are the highest priority target group. They should be sought at every opportunity, whether seen in public clinics or private practice, and advised to be tested. In order to focus on preventing sexual, parenteral, and perinatal transmission of the virus we must avoid numerous potential distractions and irrelevant issues: we don't have time for them.

Four-week supplementation with a natural dietary compound produces favorable changes in body composition.

The purpose of this study was to determine whether a natural dietary supplement produced favorable changes in body composition during a 4-week diet- and-exercise program. The active compound contains a patented combination of chromium picolinate, inulin, capsicum, L-phenylalanine, and other lipotropic nutrients. A double-blind, weight-loss intervention design was used. Participants were randomly assigned to either a diet/exercise/supplement group (n = 56) or a diet/exercise/placebo group (n = 67). Caloric intake was reduced to 1500 kcal/d and participants walked for 45 minutes, 5 days a week, to attain between 60% and 80% of predicted maximal heart rate. Analysis of covariance (ANCOVA) showed significant differences (P < .05) between groups in percent body fat, fat mass, and fat-free mass; no significant differences were found (P > .05) in body weight, body mass index, or energy intake. Independent t tests showed no significant differences (P > .05) in diet composition between groups. Results indicate that the addition of a natural dietary supplement during a 4-week diet-and-exercise weight-loss program accelerates the rate of body fat loss and helps maintain fat-free mass (lean tissue), thereby producing favorable changes in body composition.