Biomedical subjects
Publications and source records attributed to B Cvjetanovic.
Andrija Stampar (1888-1958) was one of the founders of the World Health Organization, Chairman of the Interim Commission, and President of the First World Health Assembly. His name is a byword to all students of public health and is familiar to readers of World Health Forum from our fortieth anniversary article about the early days of WHO (1) and the reminiscences of Szeming Sze (2).
The impact of different immunization strategies on hepatitis B infection rates in Italy over a 20 year period is simulated by the means of a simple deterministic mathematical model. The anticipated effect of vaccination of health workers only, of newborns from HBsAg+ mothers, of all newborns, of the entire population are simulated. Immunization of newborns from HBsAg+ mothers is by far the strategy with the greater effectiveness per unit cost.
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Advances in immunology, microbial genetics, molecular biology and biochemistry are opening prospects for new purified and synthetic antigens against infectious diseases, cancers of viral origin and some immunodeficiencies. Immunization programmes against major childhood diseases with commonly used vaccines gave excellent results and are leading to their virtual eradication in developed countries. However some vaccines like the one against pertussis proved to be of considerably lower effectiveness. Results achieved in developing countries are in general lagging behind due to lower immunization coverage. While in some countries immunization strategies for eradication of measles are discussed, in others it is questionable whether immunization should continue due to failures of immunization programmes. Evaluation of the effectiveness of national immunization programmes by surveillance and various other methods including the use of epidemiological models point ot the deficiencies of vaccine potency and/or stability and the inadequacy of vaccination schemes and coverages. There is a need to determine optimal immunization programmes for control and possible eradication with currently available antigens and new ones. For newly developed vaccines, ever increasing in number, but with the uncertainty of their appropriate public health use, it is essential to study their optimal and most cost-effective uses e.g., pertussis vaccination is an old unsolved problem and that against hepatitis B a new one. Better results can be obtained with current vaccines by appropriate modification of immunization programmes. Some of the proposed strategies for using recently developed vaccines are questionable and need critical examination.(ABSTRACT TRUNCATED AT 250 WORDS)
This is a preliminary report on a multistate epidemiological model without age structure constructed on the grounds of the natural history of hepatitis B. In determining twelve essential epidemiological classes and related epidemiological parameters the lack of precise definitions of certain classes and their infectiousness was an important constraint in model formulation. For this reason the distribution of some classes and their parametric values were rather arbitrarily set. As more exact information on natural history becomes available it can be directly incorporated into the present model. The computer programme of the model has been written in basic language. The model was used for the simulation of endemic and epidemic situations. It was applied for simulating the natural course of infection as well as the effects of various public health interventions, such as passive and active immunization and/or application of appropriate sanitary and hygienic measures. The model is evaluated through the above simulations of actual and hypothetical situations. The cost-effectiveness analysis of various public health interventions can also be carried out with the model. The model in its present form, in spite of some uncertainties as far as epidemiological parameters are concerned, seems to be useful in the study of hepatitis B dynamics and its epidemiological patterns and in the search for effective and cost-effective control strategies. The model needs further refinement.
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Different DPT + typhoid vaccines were produced by two laboratories and tested in the field for untoward local or systemic reactions and in the laboratory for immunogenic properties. The combined DPT and acetone-inactivated and dried typhoid antigen was found to cause more numerous and more severe local and systemic reactions than the DPT and DPT + typhoid (heat-thiomersal) vaccines. The antibody responses to all four antigens in both of the combined DPT + typhoid vaccines were very satisfactory.From the results of these studies it is concluded that quadruple DPT + typhoid vaccine is suitable for use in areas where typhoid fever is a problem and where logistic and other considerations require the use of combined vaccines.
Determination of the level of tetanus immunity in different age groups of a population is important in relation to the results of mass immunization of the population with vaccines containing tetanus toxoid.In this study, the level of tetanus antitoxin in sera from 1053 inhabitants of 6 villages in Bosnia and Herzegovina was determined by means of the passive haemagglutination test. The results show that children from 1 to 14 years of age regularly immunized with DT and DTP vaccines possessed a high level of immunity against tetanus (geometric mean antitoxin titre >/=0.8 IU/ml) and were protected against tetanus in 80-95% of cases. The adult inhabitants (men and women over 29 years of age) were not sufficiently protected against tetanus, the concentrations of antitoxin in their sera being equal to or greater than 0.01 IU/ml in less than 50% of cases.
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