Mother-to-child transmission of human T-cell lymphotropic virus type I (HTLV-1) in Jamaica: association with antibodies to envelope glycoprotein (gp46) epitopes

To study mother-to-child transmission of HTLV-I in Jamaica, we screen antenatal patients in Kingston, Jamaica, from 1983 to 1985. Of 2,329 women, 81 (3.5 percent) were HTLV-I seropositive. Two to three years later, 36 seropositive mothers were recontacted, and blood was drawn from them and their children. All sera were tested for HTLV-I antibodies, and mother's sera were additionally tested for HTLV-I whole-virus antibody titer, syncytium-inhibition neutralizing antibody liter, and titers to six synthetic peptides from the HTLV-I envelope glycoprotein gp46. Seventeen of 74 (23 percent) [95 percent confidence interval (CI) 15-34 percent] children were seropositive. HTLV-I transmission was associated with breast-feeding duration > 6 months [relative risk (RR) 3.2; CI 0.4-22.1], maternal age > 30 years (RR 2.8; CI 1.0 - 7.8), and higher maternal whole-virus antibody titer (RR 3.3; CI 1.3 - 8.5). After controlling for higher whole-virus antibody titer, transmission remained associated with higher titer of neutralizing antibody and higher titer of antibody to the peptide sp4al, corresponding to amino acids 196 - 209 of the gp46 envelope glycoprotein. We conclude that mother-to-child transmission of HTLV-I in Jamaica is associated with longer duration of breast-feeding, older age, and higher HTLV-I antibody titer, in particular to a certain immunogenic portion of the gp46 envelope glycoprotein.(AU)

Durability of passive measles antibody in Jamaican children

Measles antibody titres were determined by haemagglutination inhibition and by neutralization in 221 sets of serum collected from delivering mothers, umbilical cords, and infants when about six months of age. Radio-immunoassay was also used to measure antibody in 120 sera. Total IgG concentration was determined in the infant sera. All mothers had measles antibody and the mean titre was high. At the time of birth, measles antibody had been further concentrated in the infant. Nevertheless, many children lost protective titres before six months of age. The rate of loss was correlated with the infant's total serum lgG so that high lgG levels at six months correlated with rapid loss of measles-specific antibody. It is suggested that in homes where sanitation is poor, antibody is made to many agents as an early age. To maintain physiological balance, homeostatic mechanisms then increase the rate of catabolism of all lgG, including that passively acquired. In keeping with its stage of sanitary development, vaccination in Jamaica can profitably be given earlier than in the United States, but it must be later than in many African countries. (AU)

Suicidal ideation and non-fatal suicide attempts in children aged 10-16 years: intrafamilial psychosocial and clinical factors - abstract

Childhood suicide is a newly emerging Caribbean problem. This report draws attention to possible risk factors and some trends which should be monitored. Suicidal ideation was identified in the records of 29 children who attended the Child Guidance Clinic, Kingston, Jamaica for a 2-year period between 1987 and 1989. Of these, 12 (41 per cent) actually made a minimum of 24 suicide attempts. The overall M : F ratio was 1 : 1.6; 2 : 1 in 10-12 year olds but 1 : 1.8 in those aged 12-15 years. Boys under 12 years demonstrated repetition of attempts and selection of potentially lethal methods, viz., hanging, jumping from heights, drug overdosage, drowning and stabbing. There were no evident differences between those attempting and those contemplating suicide. By Diagnostic and Statistical Manual III-R (DSM-III-R) criteria, major depressive episodes occurred in about one-third. In the remaining two-thirds, co-morbidity of disorders was prominent, i.e., dysthymic features occurred with or without Conduct Disorder oppositional Defiant Disorder or incomplete forms of these. Physically, abused children displayed angry (aggressive) features more frequently than depressive features. Multiple "service" to "extreme" psychosocial stressors of "enduring" and/or "acute" type were identified, using DSM-III-R criteria: poor mother-child relationship (over 90 per cent), child abuse (79 per cent), prolonged parental conflict (66 per cent), early separation experiences (average of 2 per child) and chronic illness (28 per cent). The most common triggering event was an episode of physical and/or verbal abuse in boys and sexual and/or verbal abuse in girls. There may be a complex interplay between the individual, the effects of anger and sadness, and intrafamilial stressors (AU)

Maternal infant transmission of HTLV-I in Jamaica - abstract

HTLV-I has been aetiologically linked with adult T-cell leukaemia and tropical spastic paraparesis. Studies from Japan have shown that transmission from mother to child is the principal mode of early-life infection; breast milk has been implicated as the route of this transmission. To study the frequency of, and risk factors for, maternal-infant transmission in Jamaica, we screened women attending a Kingston antenatal clinic for the presence of HTLV-I antibodies. Of 2,329 women screened, 81 (3.5 percent) were seropositive. Two to three years following screening, 35 seropositive mothers were successfully recontacted, a questionnaire was administered, and blood was collected from the mothers and the child of the original pregnancy (index child) as well as any other children. Five of 34 (15 percent) index children and 8 of 31 (26 percent) siblings were seropositive. Having a seropositive child was significantly associated with older maternal age (p<0.05) and a higher level of maternal antibody titre (p<0.05). Seropositive index children tended to breast feed for longer than seronegative index children (11 months vs 1 month; p=0.18). We conclude that HTLV-I transmission occurs in Jamaica at rates similar to those seen in Japan. Older age and measures of higher "viral load" such as elevated antibody titre are associated with transmission. Although the evidence is suggestive that transmission occurs through breast-milk, a larger study is currently underway to this tissue (AU)

Maternal and cord serum titres as predictors of the age of measles susceptibility and vaccine responsiveness in Jamaica - abstract

Wide geographic variation in the age of measles susceptibility and vaccine responsiveness provides good reason for differences in the recommended age of immunization, varying from six months in some African countries to fifteen months in the United States. We have developed a method for determining the optimal age of measles immunization, without performing formal tests of vaccine responsiveness in children of those age groups known to be suboptimal for immunization. We have measured measles neutralizing the haemagglutination-inhibiting antibody titres in Jamaica maternal and umbilical cord sera, and in infant sera taken at age five to seven months. The mean maternal neutralizing antibody titre was 7.7 log 2 units; it was concentrated to 8.2 log 2 units across the placenta. These values are the highest obtained for developing countries. The estimated half-life of passively acquired maternal measles antibody was 43 days as measured by the neutralization test and 48 days by the haemagglutination test. These half-lives were similar to those obtained from smaller groups of infants in Taiwan and New Haven, United States. The optimal age for mass measles vaccination was determined by statistical methods to be 10 to 11 months in Jamaica. In other populations, the same methodology could be used to determine the optimal ages for measles immunization (AU)

Vulvovaginitis, the gonococcus, and child abuse - abstract

Records of 424 girls under 12 years of age, who presented consecutively to University Hospital of the West Indies with a history of vaginal discharge, were kept on an on-going basis in a separate register for one year from November, 1983. The vaginal swabs showed non-specific flora in 49 percent, N. gonorrhoea in 14 percent, S. pneumoniae in 8 percent, H. influenzae Type B in 5 percent, C. albicans in 3 percent, other organisms in 13 percent, and unknown or culture negative results in 5 percent. Of the 58 children with gonorrhoea, 52 percent were under 6 years of age. Information available on 60 percent of these revealed possible sexual contact in 36 percent. Forty per cent of these were reportedly incestuous (father, brother, uncle, cousin), 30 percent involved step-father or mother's consort, and 30 percent family friends or neighbours. These figures may be underestimates. This report documents the occurrence in this age group of S. pneumoniae (not previously reported), N. gonorrhoeae, C. albicans among near-pubertal girls, T. Vaginalis in the 2 to 10 year-olds, the hidden problem of intrafamilial child abuse, and condylomata acuminata as an unusual manifestation of child abuse. Attention is drawn to vulvovaginitis in the hope that a high index of suspicion and family investigations for child abuse, gonorrhoea and incest will be encouraged; that health education for parents and schools will include information specific to perineal hygiene and sexually transmitted diseases; and that the child population, affected as it is by the increasing incidence of adult gonorrhoea, will be included in programmes for the control of this disease. The authors acknowledge with thanks the valuable assistance of the staff of their respective Departments (AU)

Some perinatal characteristics from the Netherlands Antilles - abstract

Information regarding various perinatal conditions in Curacao and Aruba (Netherlands Antilles) leading directly or indirectly to permanent brain damage of the infant is scarce. In this study, the high perinatal morality rate for Curacao (35.4 per thousand total births) is comparable to those from other (Eastern) Caribbean countries. On the other hand in Aruba with similar socio-economic conditions to Curacao, a much lower perinatal mortality rate (18.0 per thousand total births) is found. The relatively higher mean birthweight (3390 gram) in Aruba resulted in a high incidence of large-for-dates babies (14.1 percent) and a relatively low incidence of low birthweight infants (5.8 percent). Early neonatal weight loss occurring immediatley after birth is greater in "large" babies as compared to "smaller size" babies of the same gestational age. This will result in different growth patterns between these two groups of infants and may be explained by differences in body water content. The statement that increasing the mean birthweight of a population by food supplementation during pregnancy will automatically reduce the perinatal mortality and morbidity can only be made with caution (AU)

Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age

64 healthy infants, 2-3 months old, were randomly assigned to one of three vaccination groups which either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP+P (with pertussis adjuvant) vaccine in three doses at intervals of two months. Local and systemic reactions occurred most frequently after DPT vaccination and least frequently for PRP alone. Data for 60 infants from whom complete sera sets were available indicated that 70 percent of the infants who received three doses of PRP+P showed two fold or greater increases in titers of antibody to PRP with final values above the level assumed to give protection against invasive H. influenzae type b disease (>0.15 ug/ml). In contrast, less than 10 percent of infants who received PRP vaccine alone showed 2-fold or greater increases (Summary)

Oral rehydration using high and low sodium and potassium solutions in dehydrated Jamaican children with diarrhoea - abstract

The indications and pathophysiological principles underlying the use of glucose electrolyte solutions for treating diarrhoea with dehydration are well understood. The exact composition for the Caribbean is disputed, because the WHO recommended solution which contains 90mmols/L of sodium was developed for cholera and may produce hypernatremia. To establish the value of this solution in Jamaican children, we studied 84 cases of diarrhoea in children aged 5 to 18 months attending Bustamante Children's Hospital, Kingston. The children were assessed clinically and body weight, blood samples, urine and stool samples were studied at 0, 6 and 24 hours. Treatment was with oral rehydration solution given at a rate of 200 mls per hour. Cases were divided at random into two groups, one given a solution containing 90 mmols Na, the other, 60 mmols of Na. In both groups, clinical and biochemical indices improved rapidly, weight increased, serum specific gravity fell and bicarbonates rose. In the high sodium group, 5 cases developed hypernatremia at 6 hours and persistence of hyponatremia was seen in a few cases in the low sodium group. In a second study, 25 children were given standard GE solution, but the potassium was increased from 20 to 35 mmols/1 and the cases divided randomly into high and normal potassium groups. The GEsol was given as 2 volumes of solution to 1 of water. In this study the high potassium group showed no cases of hypokalemia whereas 19 - 33 percent of the low potassium group had this problem at 24 hours. It was concluded that the standard oral rehydration fluid containing 90 mmols/1 of sodium, given as 2 volumes of water to 1 of water is safe and effective in the cases seen in Jamaica and that a higher potassium concentration of 35mmols/1 would be more effective in correcting hypokalaemia than the present 20 mmol/1 solution. This regime is now standard practise in both Bustamante Children's Hospital and at the University Hospital of the West Indies and has led to dramatic reductions in hospitalization rates, use of drip sets and of intravenous therapy (AU)

Early deaths in Jamaican children with sickle cell disease

In Jamaican children with homozygous sickle cell (SS) disease diagnosed at birth two-year survival was 87 percent, compared with 95 percent in children with sickle cell-haemoglobin C (SC) disease, and 99 percent in normal controls. Death among those with SS disease occurred most often between the ages of 6 and 12 months. Principal causes were acute splenic sequestration and pneumococcal infection. Neonatal diagnosis of haemoglobinopathies must be followed by close observation if mortality is to be reduced by early diagnosis and treatment of these complications. (AU)