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Biomedical subjects

J G Breman

Publications and source records attributed to J G Breman.

At least 55 records · Page 3Linked to original sources
PubMed1988

Response of children with Plasmodium falciparum to chloroquine and development of a national malaria treatment policy in Zaire.

In vivo sensitivity of Plasmodium falciparum to chloroquine was evaluated in 4 of 9 regions of Zaire in 1985 to develop a national strategy for treatment of malaria. Children less than 5 years of age were treated with either a single dose of chloroquine base, 10 mg/kg, or a dose of 25 mg/kg given over 3 d. A modified 7-day World Health Organization in vivo test was used with follow-up 2, 3 and 7 d after the start of treatment. 339 children were studied. In Bwamanda 92% of children were aparasitaemic 7 days after chloroquine, 10 mg/kg, but in Kinshasa only 44% were free of parasites after 25 mg/kg chloroquine. The mean drop in parasite density among those who did not clear parasites by day 7 was greater than 98% of the initial value. Although the parasite density decreased markedly, the failure of most subjects to become aparasitaemic indicated a marked decrease in parasite sensitivity since 1983. Only one child of 51 who were initially febrile remained febrile, although 14 (28%) of these had resistant parasites. The decrease in parasitaemia and temperature, even among children with resistant strains, led the Ministry of Health to recommend 25 mg/kg chloroquine as first line treatment for fever/malaria in their national malaria control plan. The plan includes drug sensitivity surveillance and a referral system for patients who do not respond to chloroquine treatment.

Animals↗
PubMed1988

Malaria infection in pregnant women in Zaire: the effects and the potential for intervention.

In five maternity centres in urban and rural Zaire we evaluated the maternal prevalence of Plasmodium falciparum parasitaemia and recorded fever, the frequency of abortions and stillbirths, newborn birth weights and the feasibility of delivering antimalarial chemoprophylaxis. Women in their first and second pregnancy, compared to others (greater than or equal to third pregnancies), had a higher frequency of parasitaemia (38 v. 15%, respectively, P less than 0.001), higher parasite densities (geometric mean densities 927 per mm3 v. 277 per mm3, respectively, P = 0.01), higher rates of stillbirths and low birth weight babies (24% v. 6.4%, P less than 0.001). On average, pregnant women first attended prenatal clinics in the sixth to seventh month of gestation and made three to four visits before delivery. In these areas of Zaire, antimalarial interventions during pregnancy would have the largest impact if they were targeted to women in their first and second pregnancy. In the study areas, maternal attitudes and prenatal care-seeking behaviours do not appear to be barriers to providing an antimalarial intervention.

Abortion, Spontaneous↗
PubMed1988

Combating severe malaria in African children.

An initiative to reduce childhood mortality due to malaria, diarrhoea and vaccine-preventable diseases, called the Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (CCCD) project, was started in 1982 and is now operating in 13 African countries, 12 of which are endemic for malaria. The project's malaria control strategy relies on the use of drugs, mainly chloroquine, to prevent severe illness and death in children less than 5 years of age; chemoprophylaxis for pregnant women is also advised to prevent low birth weight in newborns. The strategy is based on WHO recommendations which focus on improved diagnosis and treatment of cases and chemoprophylaxis for pregnant women.In 9 out of the 13 CCCD countries the sensitivity of Plasmodium falciparum to chloroquine in children was investigated and a drug sensitivity surveillance network was established. In areas with chloroquine-resistant P. falciparum, treatment with chloroquine was found to decrease the temperature in febrile children and to greatly reduce the parasite density, thus preventing severe illness and possible death. Baseline surveys in 6 countries have shown a wide range of treatment practices, e.g., use of chloroquine in various doses without standard guidelines and the excessive use of quinine and chloroquine injections in some health units. As pregnant women are often not taking chemoprophylaxis, research has been started on alternative approaches to drug treatment to prevent the adverse effects of malaria on the fetus.Only 4 of the 12 malarious countries had malaria control units when their CCCD programme began and these were concerned mainly with vector control issues; 11 of 12 countries now have such units and a written CCCD malaria plan. These countries have now integrated malaria control activities into primary health care and have begun to implement standardized treatment and prevention practices that are described in their national CCCD malaria plans.

Adolescent↗
PubMed1987

Single-dose chloroquine therapy for Plasmodium falciparum in children in Togo, West Africa.

Chloroquine, in a single dose of 10 mg of base/kg, was given orally to Togolese children less than 5 years of age as primary therapy for Plasmodium falciparum malaria. A simplified World Health Organization in vivo method was used, as was a sequential analysis procedure for determining if the drug trial was a success or failure. A total of 178 children in 3 regions were treated; 174 (98%) responded successfully, which required a greater than or equal to 75% reduction in parasites by day 2 and elimination of parasites by day 7. All 4 failures had low blood levels of chloroquine and desethylchloroquine at day 7. A single dose of chloroquine for treating malaria can be considered for those areas of Africa where the efficacy of such therapy is documented, and where an antimalarial drug sensitivity monitoring system is operating.

Administration, Oral↗
PubMed1987

Assessment of a synthetic DNA probe for Plasmodium falciparum in African blood specimens.

Synthetic DNA oligomers homologous to 21-base long repetitive sequences of Plasmodium falciparum DNA were labeled with 32P using T4 kinase, and were hybridized with purified DNA and with processed blood samples from Africa. The sequence PFR1, its antiparallel oligomer PFR1R, and PFR1 covalently attached to biotin hybridized similarly to P. falciparum DNA. One-microliter aliquots of blood from Zaire spotted on prewet nylon filters and hybridized with PFR1 gave detectable autoradiogram signals from samples with parasitemias as low as 1,000 parasites/mm3. Blood lysis and protein digestion followed by alkylation allowed dot-blot processing of larger aliquots of blood. After hybridization with PFR 1 and autoradiography, 26 samples were scored positive visually, compared with 34 scored positive by microscopy. The effective sensitivity for processed 10-microliter samples was about 500 parasites/mm3. Signals from hybridized probes were quantitated by liquid scintillation counting and densitometry, and were proportional to the amounts of purified P. falciparum DNA applied to the filter. Autoradiogram signals also were roughly proportional (correlation coefficient, r = 0.77) to the number of parasites/mm3 of blood from field samples as determined by microscopic examination.

Animals↗
PubMed1985

Chloroquine-resistant falciparum malaria in northern Malawi.

An American Peace Corps volunteer contracted chloroquine-resistant Plasmodium falciparum malaria while serving in Malawi and taking regular chloroquine prophylaxis. Resistance was confirmed by in vitro testing of his parasites for chloroquine and pyrimethamine. The possibility of Fansidar-resistant falciparum malaria was also suggested in this case. American expatriates residing in or traveling to Malawi are advised to either take both chloroquine and Fansidar, or alternatively amodiaquine or doxycycline alone. Any breakthrough of slide-proven falciparum malaria in these individuals should be seriously suspected to be chloroquine- and Fansidar-resistant malaria, and should be treated with quinine and tetracycline.

Adult↗
PubMed1984

Guillain-Barré syndrome and its relationship to swine influenza vaccination in Michigan, 1976-1977.

Active surveillance to detect all patients with Guillain-Barré syndrome who had had onset of illness from July 1, 1976 through April 30, 1977 was undertaken in Michigan after indications that the syndrome might be associated with the National Influenza Immunization Program of 1976-1977. Hospital record room librarians, neurologists, and neurosurgeons reported the greatest number of cases; coded hospital discharge records were the best means of ascertaining case occurrence. This differed from national surveillance, which relied essentially on reports that neurologists and other clinicians sent to state epidemiologists and then to the Centers for Disease Control; hospital discharge lists were not systemically reviewed nationally. A total of 79 of the Michigan cases were in persons who had not received swine influenza vaccine, while 46 cases were in persons who had received it. For unvaccinated adults, the incidence of Guillain-Barré syndrome during the 10-month surveillance period was 0.36 cases per 10(6) person-weeks; for adults with onset within six weeks of vaccination, it was 2.31 cases per 10(6) person-weeks. After six weeks post-vaccination, the rate decreased to 0.17 cases per 10(6) person-weeks. The attributable risk for acquiring Guillain-Barré syndrome within six weeks after receiving swine influenza vaccine was 11.70 cases per 10(6) persons vaccinated.

Adolescent↗
PubMed1981

The primary serological response to a single dose of adsorbed tetanus toxoid, high concentration type.

Single-dose immunization against tetanus was studied in 511 previously non-immunized residents of rural villages in Upper Volta. Males and females were equally represented and a wide age range was covered. A single dose of adsorbed tetanus toxoid containing 17.5 Lf units of toxoid and 3.86 mg of aluminium phosphate per 0.5 ml dose was used. Blood samples were taken 7 days, 2 months, and 12 months after immunization, and serum antitoxin titres were determined by neutralization titrations in mice. Adverse reactions were negligible. Only 2 participants gave evidence of prior immunization by developing detectable antitoxin titres after 7 days; they were eliminated from the study. After 12 months, 59% of the participants had antitoxin titres of >/=0.01 IU/ml, a titre usually considered protective. The mean titre and the proportion of those protected decreased substantially with increasing age; overall, females gave somewhat greater serological responses than males. Mean titre increased by 25% between 2 months and 1 year after immunization; the increase was greater in females than in males. In children under 6 years of age, 100% of females and 82% of males had protective titres after 1 year.

Adolescent↗
PubMed1980

The confirmation and maintenance of smallpox eradication.

In December 1979, an independent scientific commission certified global eradication of smallpox. This conclusion was accepted at the 33d World Health Assembly of the World Health Organization (WHO) in May 1980. After WHO's intensified eradication program began in 1967, special certification procedures were used in 35 countries where the disease had been endemic and in 44 others at special risk. Six laboratories are known to retain variola virus; efforts have been made to ensure strict containment of these strains. There is no evidence that smallpox will recur as an endemic disease. Nevertheless, WHO will promote surveillance of smallpox-like disease and selected laboratory research on certain orthopoxviruses. These efforts will maintain confidence that smallpox has been eradicated and confirm that there are no animal reservoirs of variola virus. A more complete understanding of the orthopoxviruses, including monkeypox virus, should also be obtained.

Child↗
PubMed1980

Human monkeypox, 1970-79.

Increasing attention has been given to human monkeypox since the achievement of global smallpox eradication. Monkeypox, which was first described in Central Africa in 1970, resembles smallpox clinically but differs from it epidemiologically. Forty-seven cases of human monkeypox have occurred since 1970 in 5 Central and West African countries; 38 of these cases have been reported from Zaire. The evolution of the illness and the sequelae of monkeypox and smallpox are the same; monkeypox has a case-fatality rate of about 17%. Children below 10 years of age comprise 83% of the cases. All cases have occurred in tropical rainforest areas and clustering of cases has been observed in certain zones within countries and within families. Person-to-person spread may have occurred in 4 cases; the secondary attack rate among susceptible, very close family members was 7.5% (3 cases/40 contacts) and among all susceptible contacts was 3.3% (4 cases/123 contacts)-much lower than the 25-40% secondary attack rate that occurs with smallpox. Although the low transmission rate and the low frequency of disease indicate that monkeypox is not a public health problem, more data are needed.Whilst many animals near human monkeypox cases have been demonstrated to have orthopoxvirus antibodies, the natural reservoir(s) and the vector(s) of monkeypox virus are unknown. Studies are in progress to identify the natural cycle of monkeypox virus and to define better the clinical and epidemiological features of this disease.

Adolescent↗
PubMed1979

Ocular findings in botulism type B.

In April 1977, fifty-nine persons became ill with type B botulism in a large, common-source outbreak. A combination of signs and symptoms that should make the clinician strongly suspect botulism was derived from the histories and ocular findings of these persons. Certain signs of third cranial nerve dysfunction reliably predicted in which patients ventilatory insufficiency would develop.

Botulism↗
PubMed1979

Evaluation of smallpox vaccination policy.

During 1978 and 1979 the Global Commission for the Certification of Smallpox Eradication will proceed with verification of smallpox eradication in 31 countries. If current surveillance activities do not discover any further cases before the end of 1979, the world will be declared smallpox free. However, the recent occurrence of two laboratory associated smallpox cases in Birmingham, England, revealed that the stocks of variola virus held in at least 12 laboratories in the world pose a real danger to the achievement of smallpox eradication and efforts are being made to reduce the number of laboratories retaining the virus to not more than 4-all WHO collaborating centres-by 1980. Scientific data indicate the unlikelihood of smallpox recurring once it has been eradicated from the human population, although further confirmatory studies are continuing. If the Global Commission verifies the eradication of smallpox, continuation of smallpox vaccination will be unjustifiable in view of its severe complications, however infrequent, and the expected global savings that would result from the termination of vaccination programmes.

Animals↗
PubMed1978

Botulism type B: epidemiologic aspects of an extensive outbreak.

Between March 31 and April 6, 1977, 59 individuals developed type B botulism. All ill persons had eaten at the same Mexican restaurant and all had consumed a hot sauce made with improperly home-canned jalapeno peppers, either by adding it to their food, or by eating a nacho that had had hot sauce used in its preparation. There was a highly significant association between illness and consumption of hot sauce when a comparison was made between ill persons and well controls: 4% of all restaurant patrons eating at the restaurant during the outbreak period became ill with botulism; however, approximately two-thirds of those actually exposed to the toxic hot sauce became ill. Disease severity was statistically correlated with incubation periods. No differences in disease severity were found between persons of different age groups. The full clinical spectrum (mild symptomatology with neurologic findings through life-threatening ventilatory paralysis) of type B botulism was documented.

Adolescent↗
PubMed1978

Smallpox eradication: progress and problems.

In 1958, the Eleventh World Health Assembly, on the proposal of the USSR, approved a resolution for world-wide smallpox eradication. In that year alone the disease occurred in 59 countries, and in addition many other areas experienced imported cases. When the intensified eradication programme began in 1967, there were 33 countries with endemic smallpox and two more countries subsequently became endemic. These 33 countries had a population of over 1,200,000,000 and were located in four of the six WHO regions. The most important endemic area was in Asia, but the disease was also endemic in South America and in Africa, south of the Sahara. The intensified campaign quickly narrowed the endemic area. In April 1971, the last case was reported from Brazil, the stronghold of the disease in the Western Hemisphere. By 1973, with the exception of those in the Horn of Africa, smallpox transmission was interrupted in all African countries. The last case in Asia occurred in Bangladesh where variola major made its last stand. The last known case of smallpox in the world was reported from Somalia on 27 October 1977. If no more cases are discovered it will be possible, in two years from that date, to certify that smallpox has been eradicated from all areas of the world, and Member States of the World Health Organization will be able to celebrate an unprecedented victory for preventive medicine. The complete eradication of smallpox is not only the liberation of the world from one of its most dangerous diseases, but also provides an example of what can be achieved when countries throughout the world join together with a common aim.

Africa↗
PubMed1977

Human poxvirus disease after smallpox eradication.

A 5-year-old boy living in a small camp in the rural Ivory Coast had a disease resembling smallpox. This occurred 4 years after smallpox had been eradicated from the Ivory Coast and 1.5 years after the last case of smallpox was detected in West and Central Africa. Clinical, serological, and epidemiological evidence indicated this disease was probably monkeypox, a poxvirus of the variola/vaccina subgroup. A serologic survey of poxvirus antibodies in the wild animal population detected neutralizing antibodies in rodents, larger mammals, primates, and birds. The laboratory and ecological characteristics of poxviruses require further elucidation, especially those which have been found in animals near human monkeypox cases.

Adolescent↗