Vitamin A status of children in Sri Lanka.

A representative country-wide rural nutrition status survey determined the extent and distribution of vitamin A deficiency in Sri Lanka in children 6 through 71 months of age. Trained paramedical personnel recorded the presence or absence of selected ophthalmological signs and symptoms associated with vitamin A deficiency in 13,450 children. The results of the country-wide clinical survey indicate that a vitamin A deficiency problem of public health importance may exist in two of 15 health areas. Serum vitamin A levels were determined on 346 survey children from two of 15 health areas and compared with clinical findings for these areas. The lowest mean serum vitamin A, 26.3 microgram/100 ml, occurred in children with clinical eye findings. A high prevalence of clinical eye findings, 34%, and the low mean serum vitamin A value, 28.2 microgram/100 ml, were found in the group of chronically undernourished children--children who are less than 90% of their expected height for age. The survey results enabled planned redirection of the distribution of vitamin A capsules to preschool children in Sri Lanka to areas shown to have the highest prevalences of ophthalmological signs and symptoms and/or the highest prevalence of chronic undernutrition.

Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.

In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.

PIP: Female health visitors interviewed 1512 families in 1984 and 1566 families in 1985 dispersed among Afghan refugee camps in the provinces of the Northwest Frontier Province (NWFP), Baluchistan, and Punjab in Pakistan in Pashto, the language of most of the refugees. The refugees came to Pakistan as a result of civil war in Afghanistan. Infant mortality fell from 156-119/1000, but the difference was insignificant. The researchers believed the consistent direction of the differences to be real, however. A 3.7% increase in the percentage of children who lived to age 5 and a 9% increase in children above the standard weight for height median occurred between 1984-1985. Further 1.2% fewer children were malnourished in 1985 than 1984. Moreover no children in either year were 70% of the median. These improvements coincided with a shift from tents to permanent dwellings; more livestock, vegetable gardens, enclosed water supplies, and, in near urban camps, electricity. Despite these improvements and readily available oral rehydration salts, diarrhea still was the major cause of death, especially for 1 year old children. In addition, no change occurred in the percentage of children who had diarrhea 1 week before the interview between the 2 years. Vaccine preventable deaths increased between 1984-1985. Specifically, neonatal deaths from tetanus rose from 22-28%. Further 10 children died from measles in 1984 whereas 27 did in 1985. 24% of children in 1985 had measles. In 1985, researchers estimated previous access to immunizations by the presence of a BCG vaccine scar. 45% in NWFP and Punjab had the scar while only 26% in Baluchistan had a scar. Moreover infant mortality in Baluchistan was 2 times that of the other 2 provinces. In conclusion, relief workers should implement control measures in Afghan refugee camps that reduce neonatal and infant mortality.

Impact of multiple injections on immunization rates among vulnerable children.

BACKGROUND: In 1997, the Advisory Committee on Immunization Practices (ACIP) recommended a switch from oral polio vaccine (OPV) to inactivated polio vaccine (IPV) for the first two infant doses. The ACIP also recommended use of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) for infants. These recommendations resulted in two additional injections at the 2- and 4-month immunization visits. This study evaluates the implementation of new IPV and DTaP immunization recommendations and their impact on immunization coverage levels. METHODS: Immunization coverage was assessed in public clinics in three urban areas before and after the recommendations. One pre- and three post-recommendation cohorts were followed to 12 months of age. RESULTS: Almost all (> or = 88%) infants in the pre-recommendation cohort received OPV, DTP, and only one or two injections. Almost all (> or = 78%) infants in the post-recommendation cohorts received IPV, DTaP, and three or four injections. The percentage of infants in the post-recommendation cohorts up-to-date for immunizations at 12 months of age was slightly higher than those in the pre-recommendation cohort. CONCLUSIONS: Providers rapidly switched from OPV and DTP to IPV and DTaP. Coverage at 12 months of age was higher among IPV/DTaP recipients than among OPV/DTP recipients. Provider and parent acceptance of four injections at a visit was high. The recent pneumococcal conjugate vaccine recommendations potentially add a fifth injection at 2 and 4 months of age. Acceptance or rejection of five injections by providers and parents needs early assessment.

Outbreaks of pertussis in the United States: the Wisconsin experience.

To identify risk factors for pertussis in older age groups and to examine the effectiveness of erythromycin therapy and prophylaxis in reducing secondary spread, epidemiologic investigations of two outbreaks involving teenagers and adults were conducted. The first outbreak occurred in 1984 among residents of a facility for developmentally disabled persons (median age 17 years). Rates of culture-and/or serologically confirmed infection ranged from 6% to 91% in exposed wards (42% overall), with transmission continuing over a five-month period. Although residents age 10-19 years experienced the highest rates of infection, they were also more likely to be exposed compared with residents in other age groups. Infection rates were significantly lower on wards where erythromycin treatment and prophylaxis were initiated less than 2 weeks after onset of illness in the index case (overall attack rate = 16% vs. 75% in wards where more than 4 weeks had elapsed; p less than .0001). Early treatment with erythromycin was also effective in reducing pertussis severity. The second outbreak occurred over a six-month period among residents of a 3-county area in central Wisconsin in 1985, with adults accounting for 38% of 161 culture-positive cases. Exposure outside the home was the most important predictor of community-acquired infection (p less than .001), with adolescents being at higher risk than persons in other age groups (odds ratio 3.2; p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Current epidemiology of pertussis in the United States.

The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less than 12 months of age had the highest average annual incidence, estimated at 32 cases per 100,000. Children 1-4 years of age accounted for 25% of all cases but had an average annual incidence only 1/7th that of infants. The incidence rates for all age groups increased consistently between 1982 and 1986. The most impressive relative increases occurred among older adolescents and persons 20 years of age and older. In 1986, 10% of reported cases were in this age group compared to only 5% in 1982. Rates of hospitalization and complications such as pneumonia, seizures, and encephalopathy associated with pertussis were highest in children less than 6 months of age and declined progressively with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)