(Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics, Pathogenesis, Vaccines & Drugs)


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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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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.


  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. 


  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. 


  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.


  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.


  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.


  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.


  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.


  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.



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