typhoid
(Diagnosis, Diagnostics, Immunodiagnosis,
Immunodiagnostics, Pathogenesis, Vaccines
& Drugs)
Abstracts
1527. Baridalyne
N. Anand K. Pandav CS. Typhoid fever vaccines. National Medical Journal of
India. 13(2):79-80, 2000 Mar-Apr.
1528. Cuzzubbo
AJ. Vaughn DW. Nisalak A.
Solomon T. Kalayanarooj S. Aaskov
J. Dung NM. Devine PL. Comparison of PanBio Dengue Duo
IgM and IgG capture ELISA and venture technologies dengue IgM and IgG dot blot.
Journal of Clinical Virology.
16(2):135-44, 2000 Apr.
Abstract
BACKGROUND: A number of commercial ELISA for dengue diagnosis have recently become available, though direct comparison between these assays have not been published. OBJECTIVES: The Venture Technologies Dengue IgM and IgG Dot Blot assays and the PanBio Dengue Duo IgM and IgG Capture ELISA were compared. STUDY DESIGN: Paired sera from patients with dengue (n=20) and Japanese encephalitis (JE, n=10), and single sera from patients with typhoid (n=10), leptospirosis (n=10) and scrub typhus (n=10) were assayed according to the manufacturer's instructions. RESULTS: The Dot Blot IgM ELISA showed higher sensitivity than the PanBio IgM ELISA (100 vs. 95%), while the PanBio IgM ELISA showed higher specificity in JE (100 vs. 20%) and non-flavivirus infections (100 vs. 97%). Defining elevation of either IgM or IgG as a positive result, the Dot Blot and ELISA tests both showed 100% sensitivity in dengue infection, while the PanBio test showed superior specificity in JE (70 vs. 0%) and non-flavivirus infections (100 vs. 67%). CONCLUSIONS: Both assays are useful aids to the serological diagnosis of dengue infection. The clinical setting, user preference and local conditions will be important in determining which test is more appropriate.
1529. Kalhan
R. Kaur I. Singh RP. Gupta HC. Latex
agglutination test (LAT) for the diagnosis of typhoid fever. Indian Pediatrics. 36(1):65-8, 1999 Jan.
1530. Kalhan
R. Kaur I. Singh RP. Gupta HC. Rapid
diagnosis of typhoid fever. Indian Journal of Pediatrics. 65(4):561-4,
1998 Jul-Aug.
Abstract
A Reverse Passive Haemagglutination Test
(RPHA) was designed for the detection of Salmonella typhi antigen and rapid diagnosis of
typhoid fever. Two per cent fresh sheep RBC's were
coated with 32 micrograms/ml of immunoglobulin. The minimal detectable level
of the antigen was 1250 micrograms/ml. Cross reactions were observed
with the samples of patients suffering from Salmonella paratyphi A and
pseudomonas infections. The RPHA established was used for the detection of S.
typhi antigen in culture broths from 100 patients with clinically
suspected typhoid fever with culture and/or widal positive, 50 patients
with septicemia caused by bacteria other than S. typhi and 50 normal,
afebrile healthy controls. It was found that the sensitivity and
specificity of this assay was 70% and 92% respectively.
1531. Kamath
PS. Jalihal A. Chakraborty A. Differentiation of typhoid
fever from fulminant hepatic failure in patients presenting with jaundice and
encephalopathy. Mayo Clinic Proceedings.
75(5):462-6, 2000 May.
Abstract
OBJECTIVE: To determine the clinical and laboratory features that allow the early diagnosis of typhoid fever in patients who present with jaundice and encephalopathy. PATIENTS AND METHODS: This 12-month prospective study, conducted in Bangalore, India, between 1990 and 1991, evaluated the clinical and laboratory features of all patients (N=47) who presented with encephalopathy within 8 weeks of onset of jaundice. Ciprofloxacin and dexamethasone were used to treat 11 patients diagnosed on blood culture as having typhoid fever. The other 36 patients were presumed to have fulminant hepatic failure with a viral cause and were treated with supportive measures (bioartificial liver support and transplantation were not available). RESULTS: In patients with jaundice and encephalopathy, a liver span of greater than 9 cm on physical examination, thrombocytopenia, elevated alkaline phosphatase level, aspartate aminotransferase level greater than alanine aminotransferase level, and only mild prolongation of the prothrombin time suggested a diagnosis of typhoid fever. All 11 patients diagnosed as having typhoid fever had an excellent response to treatment with ciprofloxacin and dexamethasone with no mortality and with normalization of the liver test results in 2 weeks. On the other hand, 30 of the 36 patients with nontyphoid fulminant hepatic failure died. CONCLUSIONS: In patients presenting with jaundice and encephalopathy, physical examination and simple laboratory tests can help make an early diagnosis of typhoid fever. We believe that patients with a presumptive diagnosis of typhoid fever should be treated with ciprofloxacin and dexamethasone, even before the results of blood cultures are available.
1532. Olopoenia
LA. King AL. Widal agglutination test -
100 years later: still plagued by controversy.
[Review] [35 refs] Postgraduate Medical Journal. 76(892):80-4, 2000 Feb.
Abstract
We review the significance of the Widal
agglutination test in the diagnosis of typhoid fever. Over 100 years
since its introduction as a serologic means of detecting the presence of
typhoid fever, the Widal test continues to be plagued with controversies
involving the quality of the antigens used and interpretation of the result, particularly in endemic
areas. Areas of concern with clinical and
laboratory significance discussed in this review include: the
techniques of test performance, interpretation of results, limitation of the
value of the test results in endemic typhoid areas, the quality of the
antigens used, and alternative diagnostic tests.
1533. Rao
PS. Prasad SV. Arunkumar G. Shivananda PG. Salmonella typhi VI antigen co-agglutination test
for the rapid diagnosis of typhoid fever. Indian Journal of Medical
Sciences. 53(1):7-9, 1999 Jan.
Abstract
A slide Co-agglutination test for the
detection of Salmonella typhi Vi antigen in blood was evaluated for its
efficiency in rapid diagnosis of Typhoid fever. The results were compared
with conventional methods like Blood culture and Widal test. The test
showed a sensitivity of 86.67% and specificity of 88.83% when compared with
blood culture positivity or Widal titre above 160. This is a useful rapid
diagnostic test for the early diagnosis of Typhoid fever.
1534. Rathish
KC. Chandrashekar MR. Nagesha CN. An outbreak of multidrug
resistant typhoid fever in Bangalore. Indian Journal of Pediatrics. 62(4):445-8, 1995 Jul-Aug.
Abstract
Six hundred and eighty five blood cultures
from children clinically diagnosed as enteric fever yielded 176
salmonella strains showing isolation success rate of 25.7%, S. typhi
were 164 (93.2%), S. paratyphi A 5 (2.8%), S. choleraesuis 4 (2.3%) and S. typhimurium 3 (1.7%).
Antibiogram of 164 isolates of S. typhi
showed triple drug resistance (TDR) in 156 strains (95.1%) to
chloramphenicol, ampicillin and cotrimoxazole, and sensitivity of 90.2% and
95.1% to norfloxacin and ciprofloxacin respectively. Minimum
inhibitory concentrations (MIC) of chloramphenicol were between 360 mcg and 640
mcg per ml. Phage types of 38 strains of TDR S. typhi were predominantly
E1 and 0 with prevalences of 47.4% and 36.8% respectively in this region.
All children with S. typhi isolates sensitive to quinolones in Vitro
responded well to these drugs with almost no relapse and hence, the newer
generation of quinolones could be considered as the first choice in the
primary treatment of enteric fever.
1535. Thomas
RE. Preparing patients to travel abroad safely. Part 2: Updating vaccinations.
Canadian Family Physician. 46:646-52,
655-6, 2000 Mar.
Abstract
OBJECTIVE: To provide, for family physicians
without access to a travel clinic, evidence-based recommendations on
vaccinating infants and children, adults, pregnant women, and
immunocompromised patients traveling to non-Western countries. QUALITY OF EVIDENCE: Searches were undertaken of
MEDLINE from 1990 to November 1998 (372 articles); the Cochrane
Collaboration Library; publications of the
National Action Committee on Immunization and the Committee to Advise on
Tropical Medicine and Travel in Canada Communicable Disease Reports; the
Canadian Immunization Guide; and Laboratory Centre for Disease Control,
United States Centres for Disease Control, and World Health
Organization websites. Evidence-based statements, randomized controlled trials,
systematic reviews, and meta-analyses were selected. Vaccination recommendations are based on this
evidence. MAIN MESSAGE: Physicians should
complete vaccination schedules for children whose primary series is
incomplete and vaccinate unvaccinated adults. Hepatitis A is widespread, and
travelers to areas where it is endemic should be vaccinated. The elderly
should be vaccinated against influenza and pneumococcal disease. Pregnant
women should receive vaccines appropriate to their trimester.
Immunocompromised patients should be vaccinated, but BCG and live vaccines are
contraindicated. Travelers to areas where meningitis, typhoid, cholera,
Japanese encephalitis, and rabies are endemic should be vaccinated if
they are likely to be exposed. Those traveling to areas where tuberculosis
is endemic should take precautions and should have skin tests
before traveling and 2 to 4 months after return. CONCLUSIONS: Family physicians
can administer all necessary vaccinations. They can advise pregnant women
and immunocompromised people about the balance of risk of disease and
benefits of vaccination.
1955.
Greenberg SB. 'Bacilli and bullets': William Osler and the
antivaccination movement. Southern Medical Journal. 93(8):763-7, 2000 Aug.
Abstract
Public discourse concerning current
vaccination recommendations has dramatically increased. The current battle
is not new, having had a lengthy foreshadowing during the 19th and
early 20th centuries. Over a 30-year period, a concerted effort to limit the use of smallpox vaccine
grew at the very time typhoid vaccines were
being developed and advocated for widespread prevention. As a long time
advocate for widespread smallpox vaccination and a supporter of the newly
tested typhoid vaccine, Sir William Osler entered the public debate at
the beginning of World War I. Osler was asked to address the officers and
men in the British army on the need for typhoid vaccination. His speech
entitled "Bacilli and Bullets" outlined the medical reasons for getting
inoculated against typhoid. Osler's strong support for typhoid
vaccination of the British troops was met by opposition in Parliament but not by
most of the troops. Osler's arguments in support of vaccination failed
to respond to the concept of "conscientious objection," which
was central to the antivaccinationists' argument. Similar arguments are being
propounded by current antivaccination groups.
1956.
Merican I. Typhoid fever: present and future. Medical Journal of Malaysia. 52(3):299-308; quiz 309, 1997 Sep.
Abstract
Typhoid fever (TF), a systemic prolonged
febrile illness, continues to be a worldwide health problem especially in
developing countries where there is poor sanitation and poor standards of
personal hygiene. The worldwide incidence of TF is estimated to be
approximately 16 million cases annually with 7 million cases occurring annually in
SE Asia alone. More than 600,000 people die of the disease annually.
The pathogenesis of TF is beginning to be understood. The clinical
features and diagnosis of TF are well known. New diagnostic methods have yet
to gain universal acceptance. Traditional treatment with the first-line
antibiotics (i.e. chloramphenicol, ampicillin and
trimethoprim-sulphamethoxazole) though still being used in most developing
countries are gradually being replaced with shorter courses of treatment with third
generation cephalosporins or fluoroquinolones especially with the growing
incidence of multi-drug resistant S typhi strains (MDR-ST). MDR-ST
strains are particularly common in the Indian subcontinent; Pakistan and
China. The presently available vaccines are far from satisfactory in terms
of safety, efficacy and costs. Newer vaccines have been developed and are
presently undergoing clinical trials in human volunteers.
1957. Wallis TS.
Galyov EE. Molecular basis of Salmonella-induced
enteritis. Molecular Microbiology. 36(5):997-1005, 2000 Jun.
Abstract
Salmonella pathogenesis is a complex and
multifactorial phenomenon. Many genes required for full virulence in mice
have been identified, but only a few of these have been shown to be necessary
for the induction of enteritis. Likewise, at least some of the
Salmonella virulence factors affecting enteritis do not appear to be
required for infection of systemic sites in mice. This suggests that subsets of
virulence genes influence distinct aspects of Salmonella pathogenesis.
Recently, considerable progress has been made in characterizing the
virulence mechanisms influencing enteritis caused by non-typhoid
Salmonella spp. The Salmonella pathogenicity island-1-encoded type III
secretion system mediates the translocation of secreted effector proteins
into target epithelial cells. These effector proteins are key virulence
factors required for Salmonella intestinal invasion and the induction of fluid secretion and inflammatory
responses.
1958.
Wang JY.
Noriega FR. Galen JE. Barry E.
Levine MM. Constitutive expression of the Vi
polysaccharide capsular antigen in attenuated Salmonella enterica serovar typhi
oral vaccine strain CVD 909. Infection & Immunity. 68(8):4647-52, 2000 Aug.
Abstract
Live oral Ty21a and parenteral Vi
polysaccharide vaccines provide significant protection against typhoid
fever, albeit by distinct immune mechanisms. Vi stimulates serum
immunoglobulin G Vi antibodies, whereas Ty21a, which does not express Vi, elicits
humoral and cell-mediated immune responses other than Vi antibodies. Protection may be enhanced if serum Vi
antibody as well as cell-mediated and
humoral responses can be stimulated. Disappointingly, several new attenuated
Salmonella enterica serovar Typhi oral vaccines (e.g., CVD 908-htrA and Ty800)
that elicit serum O and H antibody and cell-mediated responses following
a single dose do not stimulate serum Vi antibody. Vi expression
is regulated in response to environmental signals such as osmolarity by
controlling the transcription of tviA in the viaB locus. To investigate if
Vi antibodies can be stimulated if Vi expression is rendered constitutive, we replaced
P(tviA) in serovar Typhi vaccine CVD 908-htrA with
the constitutive promoter P(tac), resulting in CVD 909. CVD 909
expresses Vi even under high-osmolarity conditions and is less
invasive for Henle 407 cells. In mice immunized with a single intranasal
dose, CVD 909 was more immunogenic than CVD 908-htrA in eliciting serum Vi
antibodies (geometric mean titer of 160 versus 49, P = 0.0007), whereas O
antibody responses were virtually identical (geometric mean titer of 87 versus
80). In mice challenged intraperitoneally with wild-type serovar
Typhi 4 weeks after a single intranasal immunization, the mortality of
those immunized with CVD 909 (3 of 8) was significantly lower than that of control
mice (10 of 10, P = 0.043) or mice given CVD 908-htrA (9 of 10,
P = 0.0065).
2476. Agunwamba JC. Analysis of socioeconomic and environmental impacts of waste stabilization pond and unrestricted wastewater irrigation: interface with maintenance. Environmental Management. 27(3):463-76, 2001 Mar.
Abstract
The effluent from the waste stabilization ponds (WSPs) of the University of Nigeria, Nsukka Campus, is used for irrigation by poor rural farmers. There has been fear that the poorly maintained WSPs and the reuse practices are contributing to environmental degradation and health hazards. In this study the environmental and socioeconomic impacts of the WSPs and reuse were evaluated based on data collected from questionnaires and the literature. The engineering and agricultural properties of soil in the irrigated and nonirrigated areas were compared. Comparison of the health status of the farmers and nonfarmers, of consumers of crops irrigated with wastewater and nonconsumers was performed using Student's t test and the z-score test. The occurrences of diarrhea, typhoid fever, and malaria among the various groups were used as indices. Analyses show that the health status of the farmers and consumers is poorer than those of nonfarmers and nonconsumers at the 5% level of significance. Vegetable cultivation using WSP effluent is a means of sustenance to the farmers and provides an affordable means of satisfying their nutritional deficiencies. However, the poorly maintained WSPs create odor and mosquito nuisances, trap and destroy livestock, and flood nearby compounds with waste debris. At both 1% and 5% levels of significance, communities around the ponds (< 300 m) suffer malaria more frequently than those who live far away (> or = 300 m). Cost-benefit analysis argues in favor of improvement of WSP management and irrigation reuse of wastewater. Dredging of the ponds, training workers and farmers, and adopting appropriate maintenance and monitoring strategies will greatly enhance the socioeconomic status of the urban poor farmers.
2477. Chiu S. Chiu CH. Lin TY. Luo CC. Jaing TH. Septic arthritis of the hip caused by Salmonella typhi. Annals of Tropical Paediatrics. 21(1):88-90, 2001 Mar.
Abstract
We describe septic arthritis of the hip in a child with typhoid fever. The aetiological diagnosis was confirmed by a positive Widal test as well as by isolation of Salmonella typhi from joint aspirate. Treatment with ceftriaxone along with surgical drainage was successful.
2478. Ebi GC. Kamalu TN. Phytochemical and antimicrobial properties of constituents of "Ogwu Odenigbo", a popular Nigerian herbal medicine for typhoid fever. Phytotherapy Research. 15(1):73-5, 2001 Feb.
Abstract
The ethylacetate-insoluble fraction of the methanol extract of "Ogwu Odenigbo" a popular Nigerian traditional herbal medicine for typhoid fever prepared from the stem bark of Cleistropholis patens Benth, (Annonaceae), was separated into 13 semi-characterized constituents by preparatory TLC. The in vitro antimicrobial activities of the 13 fractions were quantitatively and/or qualitatively assessed by the agar well diffusion method using Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhinium, Aspergillus niger and Candida albicans. The steroidal fraction was about 20 and 15 times more potent than penicillin and chloramphenicol respectively against B. subtilis, and about twice as active as penicillin G. or chloramphenicol against Klebsiella pneumoniae. The glycoside fractions 4/5, 6, 7 and the alkaloidal fraction 11 showed significant activity comparable to those of the controls against Klebsiella pneumoniae. The saponin fraction 1 was the only fraction active against Salmonella typhinium. Its activity was comparable to that of the controls against this organism. Copyright 2001 John Wiley & Sons, Ltd.
2479. Hussein MM. Mooij JM. Roujouleh HM. Hamour OA. Felemban H. Non-typhoid Salmonella septicemia and visceral leishmaniasis in a renal transplant patient. Transplantation. 71(3):479-81, 2001 Feb 15.
Abstract
BACKGROUND: We report on a renal transplant patient with recurrent attacks of fever, in which Salmonella septicemia as well as visceral leishmaniasis were diagnosed. PATIENT: The patient was a 62-year-old man with diabetic nephropathy and a living related kidney transplantation. RESULTS: Nearly 2 years after the transplantation, the patient developed recurrent attacks of fever, which were initially diagnosed as non-typhoid salmonellosis and improved after treatment. Three months later, he had relapses of fever. As the patient developed pancytopenia, a bone marrow aspiration was done, showing Leishmania parasites. The patient responded well to treatment with sodium stibogluconate. CONCLUSIONS: A high index of suspicion, together with better diagnostic assays to detect visceral leishmaniasis, is warranted in the diagnostic work-up of any fever of unknown origin in immunocompromised patients, especially in endemic areas.
2480. Singh H. Singh S. Hypoglycaemia in Salmonella typhi. Tropical Doctor. 31(1):56-7, 2001 Jan.
2481. Sood A. Midha V. Sood N. Massive hemorrhage from colonic ulcers in typhoid fever. Indian Journal of Gastroenterology. 20(2):80, 2001 Mar-Apr.
2482. Sorabjee JS. The liver in enteric fever and leptospirosis. [Review] [13 refs]Indian Journal of Gastroenterology. 20 Suppl 1:C44-6, 2001 Mar.
2483. Yeolekar ME. Gupta H. Persistent fever in a case of typhoid--an unusual cause of neuroleptic malignant syndrome. Journal of the Association of Physicians of India. 49:296, 2001 Feb.
2998.
Dunstan SJ. Ho VA. Duc CM.
Lanh MN. Phuong CX. Luxemburger C. Wain J. Dudbridge F. Peacock CS.
House D. Parry C. Hien TT.
Dougan G. Farrar J. Blackwell JM. Typhoid fever and genetic polymorphisms at the natural resistance-associated macrophage protein 1. Journal of Infectious
Diseases. 183(7):1156-60, 2001 Apr 1.
Abstract
Control of Salmonella enterica serovar Typhimurium (S. typhimurium) infection in the mouse model of typhoid fever is critically dependent on the natural resistance-associated macrophage protein 1 (Nramp1). In this study, we examined the role of genetic polymorphisms in the human homologue, NRAMP1, in resistance to typhoid fever in southern Vietnam. Patients with blood-culture-confirmed typhoid fever and healthy control subjects were genotyped for 6 polymorphic markers within and near NRAMP1 on chromosome 2q35. Four single base-pair polymorphisms (274 C/T, 469+14 G/C, 1465-85 G/A, and D543N), a (GT)(n) repeat in the promoter region of NRAMP1 and D2S1471, and a microsatellite marker approximately 130-kb downstream of NRAMP1 were examined. The allelic and genotypic frequencies for each polymorphism were compared in case patients and control subjects. No allelic association was identified between the NRAMP1 alleles and typhoid fever susceptibility. In addition, neither homozygotes nor heterozygotes for any NRAMP1 variants were at increased risk of typhoid fever.
2999.
Fierer J. Guiney DG.Diverse
virulence traits underlying different clinical outcomes of Salmonella
infection. [Review] [50 refs] Journal of Clinical Investigation. 107(7):775-80, 2001 Apr.
Abstract
Salmonella
strains have evolved to infect a wide variety of reptiles, birds, and mammals
resulting in many different syndromes ranging from colonization and chronic carriage to acute fatal disease. Adaptation to a large number of different
evolutionary niches has undoubtedly driven the high degree of phenotypic and
genotypic diversity in Salmonella strains. Differences in LPS and flagellar
structure generate the antigenic variation that is reflected in the more than
2,000 known serotypes. Moreover, variations of LPS structure affect the virulence
of the strain. The differential expression of various fimbriae by Salmonella is
likely to be due to the wide variety of mucosal surfaces that are encountered
by various strains, and the host immune response may select for a different
expression pattern. As with these surface structures, a variety of other
important virulence determinants show a variable distribution in Salmonella strains and also serve to delineate the divergence of the Salmonella lineage
from E. coli. The acquisition of the SPI-1 region may have represented the
defining genetic event in the separation of the Salmonella and E. coli
lineages. The SPI-1 cell invasion function allowed Salmonella to establish a
separate niche in epithelial cells. The mgtC locus on SPI-3 is also present in
all lineages and facilitates the adaptation of the bacteria to the low Mg2+,
low pH environment of the endosome that results from SPI-1-mediated
invasion.Subsequent acquisition of SPI-2 allowed Salmonella to manipulate the
sorting of the endosome or phagosome, altering the intracellular environment
and facilitating bacterial growth within infected cells. The ability to
disseminate from the bowel and establish extraintestinal niches is promoted by
the spv locus. Since Salmonella proliferates within macrophages and must avoid
phagocytosis by neutrophils to establish a systemic infection, the spv genes
appear to promote the macrophage phase of the disease process. Here the
polymorphism of the spv locus is clearly demonstrated, since the serovars that
cause most cases of nontyphoid bacteremia contain the spv genes. The absence of
the spv genes from S. typhi is particularly puzzling and is a strong indication
that the pathogenesis of typhoid fever is fundamentally different from that of
bacteremia due to nontyphoid Salmonella. There is currently no genetic
explanation for the phenotype of host adaptation or for the finding that only a
few serovars cause the majority of human infections. Based on recent findings
that multiple individual virulence genes have a variable distribution in
Salmonella, it is unlikely that a single locus will be found to be responsible
for these complex biological traits. Instead, a complicated combination of
genes are likely to contribute to the overall virulence phenotype.
3000.
Guerrant RL.
Kosek M. Polysaccharide conjugate typhoid vaccine. [letter; comment].
New England Journal of Medicine.
344(17):1322-3, 2001 Apr 26.
3001.
Lin FY. Ho
VA. Khiem HB. Trach DD. Bay PV. Thanh TC.
Kossaczka Z. Bryla DA. Shiloach J.
Robbins JB. Schneerson R. Szu SC. The efficacy of a Salmonella typhi
Vi conjugate vaccine in two-to-five-year-old children. [see comments]. New
England Journal of Medicine.
344(17):1263-9, 2001 Apr 26.
Abstract
BACKGROUND: Typhoid fever is common in developing countries. The licensed typhoid vaccines confer only about 70 percent immunity, do not protect young children, and are not used for routine vaccination. A newly devised conjugate of the capsular polysaccharide of Salmonella typhi, Vi, bound to nontoxic recombinant Pseudomonas aeruginosa exotoxin A (rEPA), has enhanced immunogenicity in adults and in children 5 to 14 years old and has elicited a booster response in children 2 to 4 years old. METHODS: In a double-blind, randomized trial, we evaluated the safety, immunogenicity, and efficacy of the Vi-rEPA vaccine in children two to five years old in 16 communes in Dong Thap Province, Vietnam. Each of the 11,091 children received two injections six weeks apart of either Vi-rEPA or a saline placebo. Cases of typhoid, diagnosed by the isolation of S. typhi from blood cultures after 3 or more days of fever (a temperature of 37.5 degrees C or higher), were identified by active surveillance over a period of 27 months. We estimated efficacy by comparing the attack rate of typhoid in the vaccine group with that in the placebo group. RESULTS: S. typhi was isolated from 4 of the 5525 children who were fully vaccinated with Vi-rEPA and from 47 of the 5566 children who received both injections of placebo (efficacy, 91.5 percent; 95 percent confidence interval, 77.1 to 96.6; P<0.001). Among the 771 children who received only one injection, there was 1 case of typhoid in the vaccine group and 8 cases in the placebo group. Cases were distributed evenly among all age groups and throughout the study period. No serious adverse reactions were observed. In all 36 children studied four weeks after the second injection of the vaccine, levels of serum IgG Vi antibodies had increased by a factor of 10 or more. CONCLUSIONS: The Vi-rEPA conjugate typhoid vaccine is safe and immunogenic and has more than 90 percent efficacy in children two to five years old. The antibody responses and the efficacy suggest that this vaccine should be at least as protective in persons who are more than five years old.
3002.
Shears P. Antibiotic resistance in the tropics. Epidemiology and
surveillance of antimicrobial resistance in the tropics. [Review] [27
refs] Transactions of the Royal Society
of Tropical Medicine & Hygiene.
95(2):127-30, 2001 Mar-Apr.
Abstract
Antimicrobial
resistance is threatening to undermine many of the health care improvements
achieved in the tropics in the past 2 decades. While only limited data are available, there is evidence from most tropical areas of the spread of
resistant bacterial strains in diseases from typhoid and bacillary dysentery to
tuberculosis and, as in industrialized countries, multiply resistant hospital
pathogens including methicillin-resistant Staphylococcus aureus (MRSA).
Attempts to control the spread of resistant bacteria are limited by the lack of
surveillance data at both the local and international level. For effective
surveillance programmes to be implemented, the strengthening of laboratory
services at district and national level, with a long-term commitment to
resources, training and quality control, is essential.
3003.
Webster G. Barnes E. Dusheiko G.
Franklin I. Protecting
travellers from hepatitis A. BMJ. 322(7296):1194-5, 2001 May 19.