Evaluation of an intervention program in the control of an urban outbreak of shigellosis.

Community-wide outbreaks of shigellosis are a persistent public health problem. We evaluated the effect of a household-based intervention program on the control of an urban outbreak of S. sonnei gastroenteritis. During the intervention we attempted to contact all households with culture-confirmed S. sonnei and provide education in methods to prevent spread of Shigella. Subsequently we conducted a survey of intervention (n = 43) and nonintervention (n = 33) households. We also conducted a serosurvey of children three to five years of age. The number of new cases of S. sonnei infection declined steadily over several months after the intervention began. Members of the intervention households were more knowledgeable about handwashing (rate ratio [RR] 4.7, 95% confidence interval [CI] = 2.1-10.8) and others methods of S. sonnei transmission and control than members of nonintervention households. However, intervention households had higher attack rates of Shigella-associated diarrhea in susceptible household members (RR 1.4, 95% CI = 1.0-2.0). During the intervention we were able to contact only 25% of households by the eighth day after onset of diarrhea in the index case, when 90% of intrahousehold transmission of Shigella had already occurred. Two months after the outbreak ended, 42% of children in the outbreak community had elevated antibody titers against S. sonnei; an additional 19% had borderline elevated titers. The intervention program improved knowledge but may have occurred too late to prevent intrahousehold transmission of Shigella. Exhaustion of susceptible hosts, rather than the education program, likely accounted for the decline in shigellosis cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of imported cases of falciparum malaria in France with halofantrine.

Halofantrine is a 9-phenanthrenemethanol which is effective against multi-drug resistant strains of Plasmodium falciparum. It has been shown to be highly effective and extremely well tolerated in the treatment of imported cases of falciparum malaria in France. A total of 1,500 mg administered in three 500 mg doses at six-hour intervals results in a 100% cure rate in semi-immune subjects. This dosage should be repeated after 14 days to obtain the same cure rate in non-immune patients. Minor clinical side effects included epigastric pains, nausea and, in one case, a skin rash.

[Cowden's disease or the multiple hamartoma syndrome]. / La maladie de Cowden ou syndrome des hamartomes multiples.

Cowden's disease, also called multiple hamartoma syndrome, is a clinical entity characterized by hamartomatous tumours of endodermal, mesodermal and ectodermal origin. Although extremely rare, the disease must be known to all internists. A case of Cowden's disease in a 36-year old male patient is reported. The authors insist on the high incidence of digestive disorders and the risk of malignant degeneration of mammary and thyroid tumours. They also describe the cutaneous and mucosal lesions characteristic of the disease.

[Towards eradication of poliomyelitis in Vietnam and the western Pacific region, 1993]. / Vers l'éradication de la poliomyélite au Viêt-nam et dans la région du Pacifique occidental, 1993.

In 1988, the World Health Assembly established the goal of global eradication of poliomyelitis by the year 2000, and the Western Pacific Region (WPR) of WHO established the goal of regional eradication by 1995. Countries in the WPR with endemic poliomyelitis include China, Viet Nam, Cambodia, Laos, and the Philippines. Each country has a national plan of action for eradication, based on three main strategies: maintenance of high coverage with three doses of OPV through routine immunization; supplemental immunization with OPV, including annual National Immunization Days (NIDs); and surveillance of acute flaccid paralysis cases, including isolation of polioviruses in stool specimens. The number of confirmed poliomyelitis cases reported to WHO decreased from 2,635 cases in 1991 to 1,226 cases in 1993, mostly reflecting the decrease in China where supplemental immunization started in 1990 in high-incidence provinces. In six provinces in Viet Nam where immunization days took place in 1992, confirmed cases dropped from 168 in 1992 to 42 in 1993. China, the Philippines, Viet Nam and Laos have conducted NIDs in 1993-1994, with two doses of OPV administered to more than 100 millions children under 5 years of age. NIDs will be repeated in 1994 and 1995, and are planned in Cambodia in January-February 1995. NIDs receive strong support from national governments, and financial assistance from Rotary International, Unicef, the governments of Australia, Japan and Canada, and the US CDC. The apparent elimination of wild polioviruses from the Americas, and the substantial progress already made in the WPR, demonstrate the feasibility of eradicating polio in the WPR and other regions of the world.

[Legionnaires' disease: 21 cases observed over 2.5 years in a Parisian respiratory intensive care unit]. / La maladie des légionnaires: 21 cas observés en 2 ans et demi dans une unité parisienne de soins intensifs respiratoires.

The incidence of Legionnaire's disease is probably underestimated in France. Its clinical presentation is very suggestive, especially after the failure of a 48 hour therapeutic trial of beta-lactams, when a pneumococcal infection is initially suspected. This one sign is sufficient to orient the diagnostic survey and constitutes an indication for a therapeutic trial of macrolides for at least 72 hours. In fact, the delay in the diagnosis appears to be the determinant factor in the fatal outcome of the disease.

[Treatment with halofantrine of Plasmodium falciparum malaria imported into France]. / Traitement par l'halofantrine du paludisme à Plasmodium falciparum importé en France.

Halofantrine is a 9-phenanthrene-methanol effective against multiresistant strains of Plasmodium falciparum. It is extremely effective and well-tolerated in treating cases of malaria imported into France. 1,500 mg in 3 doses at 8 hour intervals produced 100% cure rate in semi-immune patients. This dosage could be repeated after 14 days in order to obtain the same cure rate in non-immune patients. Side-effects are minor and include epigastric pain, nausea and one case of skin rash.

Immunogenicity of a supplemental dose of oral versus inactivated poliovirus vaccine.

In many developing countries, the immunogenicity of three doses of live, attenuated, oral poliovirus vaccine (OPV) is lower than that in industrialised countries. We evaluated serum neutralising antibody responses in 368 children aged 6 months and 346 children aged 9 months in Côte d'Ivoire who had previously received three doses of OPV at 2, 3, and 4 months of age, and who were then randomised to receive a supplemental dose of OPV or enhanced-potency inactivated poliovirus vaccine (IPV) at the time of measles vaccination. Although both vaccines increased seroconversion to all three poliovirus types, antibody responses were greater in the IPV group. Among children with no detectable antibody at baseline, IPV was 2 to 14 times more likely than OPV to induce seroconversion (type 1, 80% vs 40% at 6 months [p < 0.001] and 81% vs 14% at 9 months [p < 0.001]; type 3, 76% vs 22% at 6 months [p < 0.001], and 67% vs 5% at 9 months [p < 0.001]. Among children with detectable antibody at baseline, IPV was 1.4 to 7 times more likely than OPV to elicit 4-fold or more rises in antibody titre (p < 0.01). Geometric mean titres (GMTs) to all three poliovirus types were also consistently higher among IPV recipients than in OPV recipients when measured 4-6 weeks and 13-17 months after vaccination. Administration of a supplemental dose of IPV or OPV, which requires no additional visits or changes in the existing immunisation schedule, might improve protection against paralytic poliomyelitis in communities with suboptimum seroconversion rates after three doses of OPV.