RESUMO
An epidemic of meningococcal disease occurred in Nairobi, Kenya, during 1989, outside the "meningitis belt" of sub-Saharan Africa. About 3800 cases occurred between April and November (250/100,000 population). The case-fatality rate was 9.4% among hospitalized patients. Areas that included Nairobi's largest slums had particularly high attack rates. The epidemic displayed an unusual age distribution, with high attack rates among those 20-29 years old. A vaccination campaign was conducted. By early January, the weekly case count had fallen to 25 from a high of 272 (in September). A case-control study estimated the vaccine efficacy to be 87% (95% confidence interval, 67%-95%). A model estimated that the vaccination campaign reduced the number of cases by at least 20%. Multilocus enzyme electrophoretic typing demonstrated that the strain responsible for this large epidemic is closely related to strains that caused other recent epidemics, documenting further spread of what may be a particularly virulent clonal complex of group A Neisseria meningitidis.
Assuntos
Vacinas Bacterianas , Surtos de Doenças , Infecções Meningocócicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Enzimas/análise , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Infecções Meningocócicas/líquido cefalorraquidiano , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas , Pessoa de Meia-Idade , Neisseria meningitidis/classificação , Neisseria meningitidis/enzimologia , Neisseria meningitidis/isolamento & purificação , Áreas de Pobreza , VacinaçãoRESUMO
To determine the prevalence of the HIV seropositivity in general paediatric emergency admissions at Kenyatta National Hospital; 552 children were studied systematically for four months in 1991.A clinical history was taken and physical examination conducted. The HIV status was determined by use of organ Teknika's Vironostika viral lysate assay for initial two screenings and then a Behring enzygnost anti-HIV-1 synthetic peptide assays a confirmatory assay.Seventy (12.7) of all the children studied were HIV positive; the mean age of the HIV-positive children was 17.5 months while that of the total study population was 23.5 months. HIV seropositivity was not associated with history or parenteral injections. No haemophilia patient was recruited during the study period; and of all the 18 sicklers recruited; none was HIV positive despite multiple blood transfusions. The WHO paediatric Aids Case definition criteria had moderately low sensitivity (55.7); high specificity (85.9) and low positive predictive value (36.4). This was in agreement with observations noted in other studies in East and Central Africa