Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana.

OBJECTIVES: To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana. METHODS: Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression. RESULTS: Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Guérin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socio-economic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators. CONCLUSIONS: Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.

On Ideas as Actors: How Ideas about Yellow Fever Causality Shaped Public Health Policy Responses in 19th-Century Galveston.

This article uses debates regarding yellow fever causality among leading healers in 19th-century Galveston, Texas, U.S., as a means of exploring the extent to which ideas are social actors. That is, the analysis demonstrates that ideas about yellow fever causality shaped contemporaneous public health policy responses to yellow fever outbreaks in 19th-century Galveston. The article contributes to the growing literature documenting that contagionist and anticontagionist views were often assimilated, and also supports the historiography showing that the predisposing/exciting causes dichotomy is a more robust intellectual framework for understanding 19th-century attributions of disease causality.

[Ocular manifestations of emerging arboviruses: Dengue fever, Chikungunya, Zika virus, West Nile virus, and yellow fever (French translation of the article)]. / Manifestations oculaires des arboviroses émergentes : dengue, chikungunya, infection à virus Zika, fièvre du Nil occidental et fièvre jaune.

Arboviruses are viral diseases transmitted by mosquitoes and tics bites. They are a major cause of morbidity and sometimes mortality. Their expansion is constant and due in part to climate change and globalization. Mostly found in tropical regions, arboviruses are sometimes the source of epidemics in Europe. Recently, the Chikungunya virus and the Zika virus were responsible for very large epidemics impacting populations that had never been in contact with those viruses. There are currently no effective antiviral treatments or vaccines. Ocular manifestations due to those infections are thus more frequent and increasingly better described. They are sometimes, as with Zika, complicated by a congenital ocular syndrome. The goal of this review is to describe the ophthalmological manifestations of Dengue fever, Chikungunya virus, Zika virus, West Nile virus, and yellow fever.

Detecção de risco para o avanço da febre amarela em municípios de Pernambuco, Brasil / Risk detection of yellow fever spread in counties of Pernambuco, Brazil.

O vírus amarílico, causador da febre amarela tem se dispersado no território brasileiro nas últimas décadas. Surtos de febre amarela selvática foram reportados em diversas regiões do país, inclusive em regiões sem recomendação de vacinação, com reflexo imediato no cenário epizoótico e epidemiológico do país. A região Nordeste é uma exceção, pois não apresenta casos comprovados de infecção no ciclo silvestre da doença em seus estados, em sua grande maioria. O estado de Pernambuco, historicamente apresentou casos confirmados do ciclo silvestre e urbano a mais de 100 anos atrás, e esse hiato epidemiológico, em teoria, coloca o estado fora da zona de risco de contágio com a doença. Na intenção de prevenir uma reemergência da febre amarela no estado, o estudo propõe a identificação de variáveis importantes para disseminação da doença, detectando assim, municípios com maior risco na Região Metropolitana do Recife, e propondo, desse modo, o direcionamento dos esforços da vigilância ambiental para essas áreas. Variáveis como, ocorrência de primatas, sensibilidade a infecção em primatas, imunidade da população humana, regime de chuvas e temperatura, assistência médica, foram identificadas como importantes. Quadro municípios apresentaram o maior valor de risco para disseminação da febre amarela no estado, são estes: Água Preta, Ipojuca, Recife e Tamandaré. Após avaliação da informação obtida neste trabalho, a vigilância do estado pode direcionar os esforços no monitoramento e ação para prevenção de uma futura epidemia.

Importation et destin de la première théorie des germes au Mexique: développement des premières recherches sur la fièvre jaune dans les années 1880 / Importation and destination of the first germ theory in Mexico: development of the first researches into yellow fever in the 1880s

Ce travail s'inscrit dans le cadre de la discussion du transfert de connaissances entre l'Occident et l'Amérique latine, le Mexique en particulier. Nous essayerons de montrer les enjeux internationaux et locaux qui ont encouragé l'importation de la théorie des germes au Mexique pendant les années 1880. Par ailleurs, on montrera quelles ont été les difficultés conceptuelles et matérielles pour incorporer la théorie des germes et les techniques bactériologiques encore en train de se bâtir en Europe. Au moyen de deux exemples, on essayera de mettre en évidence les intentions politiques des médecins mexicains, à l'origine de l'étude des maladies infectieuses au Mexique.

This article aims to contribute to discussions about knowledge transfer between the West and Latin America, especially Mexico. We seek to show the international and local efforts to foster the importation of germ theory during the 1880s. We also highlight the conceptual and material hurdles which stood in the way of the incorporation of this theory and bacteriology techniques at a time when they were still being developed in Europe. Two examples are given as evidence of the political motivations of Mexican physicians in studying infectious diseases in that country.

O doutor Audouard em Barcelona (1821) e a repercussão de sua tese sobre a febre amarela no Brasil / Dr Audouard in Barcelona (1821) and the repercussion of his thesis on yellow fever in Brazil

O artigo pretende analisar parte dos trabalhos do médico militar francês Mathieu François Maxime Audouard, que observara a epidemia de febre amarela em Barcelona em 1821. Audouard passaria a acusar o tráfico negreiro como principal causa da doença. Embora suas idéias fossem controversas e nem sempre aceitas pelos médicos de diferentes partes do mundo, elas apresentaram repercussão entre aqueles engajados no fim do tráfico e no movimento contra a escravidão da primeira metade do século XIX. Um caso de particular interesse para análise é a recepção de seus trabalhos no Brasil, frente ao momento de fim do tráfico negreiro no país, e a concomitância com a chegada da grande epidemia de febre amarela.

Cet article a pour objet l'analyse des travaux du médecin militaire français Maxime Mathieu François Audouard sur l'épidémie de fièvre jaune à Barcelone en 1821. Audouard accusait la traite négrière d'être une des principales causes de la maladie. Bien que ses idées étaient discutées et n'ont pas toujours été soutenues par les médecins de diverses parties du monde, elles ont été bien reçues par ceux qui s'engageaient pour la fin de la traite et par le mouvement anti-esclavagiste de la première moitié du XIXe siècle. La réception de ses travaux au Brésil au moment de la fin de la traite négrière et de l'irruption simultanée de la grande épidémie de fièvre jaune est un cas particulièrement intéressant pour notre analyse.

This article consists of an analysis written by the French military physician Mathieu François Maxime Audouard, who witnessed the epidemic of yellow fever in Barcelona, in 1821. Audouard held that the slave trade was the main cause of this malady. Although his ideas were controversial and not always accepted by doctors in different parts of the world, they had repercussions on those who supported the end of the slave trade and the movement against slavery in the first half of the 19th century. One particular case for analysis is the reception of his works in Brazil when the international slave trade was abolished in the country, a fact that occurred concomitantly with the outbreak of the great yellow fever epidemic.