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Biomedical subjects

R J Biellik

Publications and source records attributed to R J Biellik.

At least 19 recordsLinked to original sources
PubMed2004

An assessment of safe injection practices in health facilities in Swaziland.

OBJECTIVES: To determine the magnitude and causes of unsafe injection practices in Swaziland. DESIGN: A safe injection practices questionnaire was administered and injection practice was observed. SETTING: A selected variety of health facilities in Swaziland. SUBJECTS: Health workers in each facility. OUTCOME MEASURES: Unsafe injection and collection for disposal practices. RESULTS: All injections observed involved disposable syringes. Although all injections were given at the correct site, using the correct dosage and equipment, unsafe injection technique was observed. Needles were changed on the same syringe at 8 facilities (31%) and syringes and needles were reused at 2 facilities (8%). Recapping of needles after use occurred at 8 facilities (31%). More than one-quarter of nurses reported having pricked their finger in the previous 6 months; in almost half of these cases this was after administration of an injection. Seven nurses (25%) recalled seeing a case of an abscess or a mild adverse event following an injection in the previous 12 months. Interviewers observed used syringes and needles being placed in a safe container in three-quarters of facilities. Almost all respondents reported that syringes and needles were buried or burned. CONCLUSIONS: Auto-disable syringes should be used for all routine and supplemental vaccination. The increased cost of auto-disable syringes represents only a small increase in the national Expanded Programme on Immunisation (EPI) budget.

Attitude of Health Personnel↗
PubMed2003

Missed opportunities for vaccination in health facilities in Swaziland.

OBJECTIVES: To determine whether potential exists to increase vaccination coverage in Swaziland by reducing missed opportunities. DESIGN: The standard World Health Organisation Expanded Programme on Immunisation (WHO EPI) protocol for assessing missed opportunities for vaccination was used to conduct this study. It involved client exit interviews and review of health cards. SETTING: Selected variety of health facilities in Swaziland. SUBJECTS: Children less than 2 years of age and women of child-bearing age exiting each facility. OUTCOME MEASURES: Children and women eligible for vaccination exiting sampled health facilities. RESULTS: Fifty-four per cent of eligible children less than 2 years of age were missed for vaccination. This constitutes 26% of all children less than 2 years old leaving the facilities studied. Almost 100% of eligible women of childbearing age were missed for vaccination, constituting 88% of women leaving the study facilities. The distribution of the proportion of missed opportunities varied considerably between regions and health facility types. Missed opportunities occurred more frequently among those children requiring the first dose of all antigens and this may be linked to the high proportion of children missed for vaccination who did not possess a health card. Missed opportunities were more likely to occur in facilities providing integrated services. CONCLUSIONS: The frequent attendance at health facilities of the target group presents a valuable opportunity to increase vaccination coverage through avoidance of missed opportunities. All regions need to set vaccination coverage targets and develop plans to increase coverage, which should include strategies to ensure that all health workers routinely screen all clients for eligibility and vaccinate as required.

Adolescent↗
PubMed1998

[Strategies for minimizing nosocomial transmission of measles].

Because of the highly contagious nature of measles before the onset of rash, nosocomial transmission will remain a threat until the disease is eradicated. However, a number of strategies can minimize its nosocomial spread. It is therefore vital to maximize awareness among health care staff that an individual with measles can enter a health facility at any time and that a continual risk of the nosocomial transmission of measles exists. The present review makes two groups of recommendations: those which are generally applicable to all countries, and certain additional recommendations which may be suitable only for industrialized countries.

Child↗
PubMed1997

Overview of poliomyelitis in the African Region and current regional plan of action.

The African Region of the World Health Organization includes a diverse membership of 48 countries and territories that has made substantial progress toward controlling poliomyelitis. The coverage with three doses of oral poliovirus vaccine among 1-year-old children reached 58% in 1995, a substantial increase from 49% in 1993, and the incidence of poliomyelitis decreased from 5126 cases in 1980 to 1597 in 1995. To interrupt poliovirus circulation, 29 countries planned to conduct either national immunization days (25 countries) or subnational immunization days (4 countries) during 1996. To ensure the success of these efforts, high-level political commitment has been obtained in many countries, and the campaign to "Kick polio out of Africa" is supported by some of the most respected African politicians. Provided the necessary resources can be obtained from internal and external sources, the African Region may be able to achieve the eradication of poliomyelitis by the year 2000 or shortly thereafter.

Africa↗
PubMed1997

Current status of polio eradication in Southern Africa.

During the 1990s, poliomyelitis transmission in 11 mainland and island nations of southern Africa appeared relatively low. However, the implementation of specific strategies recommended by the World Health Organization for eradicating polio in southern Africa began only in 1994. In 1995, oral poliovirus vaccine coverage (three doses) among infants was > or = 75% in all but 4 countries. National immunization days (NIDs) to control polio outbreaks were carried out in Namibia in 1994 and 1995. Angola, Botswana, and South Africa carried out subnational NIDs in 1995. All countries in southern Africa except Madagascar planned NIDs in 1996. Epidemiologic surveillance of acute flaccid paralysis (AFP) and laboratory surveillance of wild poliovirus was launched after nationwide training workshops in 7 mainland countries and is planned in the remaining countries by the end of 1996. Analysis of recommended performance indicators of AFP surveillance shows that substantial progress was made during 1994-1995, and the prospects for the certification of polio-free status in southern Africa on target appear good.

Adolescent↗
PubMed1997

Poliomyelitis in Angola: current status and implications for poliovirus eradication in Southern Africa.

As part of emergency assistance to the Ministry of Health (MOH), national surveillance data for poliomyelitis and charts of cases at the national rehabilitation hospital were reviewed. Poliomyelitis patients admitted to Angola's main pediatric hospital were examined. A mean of 86 cases of poliomyelitis/year were reported in Angola during 1989-1994. Review of records from non-MOH sources uncovered another 74 cases, primarily from areas outside governmental control. Hospital chart reviews revealed that 80% of the cases were children <3 years of age, mainly unvaccinated. Molecular analyses of isolates from cases in Luanda and at the Angola-Namibia border suggest that these isolates are closely related and that > or = 2 strains of wild poliovirus type 1 are circulating currently in Angola. This investigation confirms that poliomyelitis has remained endemic in Angola since independence in 1975. It affects primarily young and unvaccinated children. Control of poliomyelitis in Angola is essential to expand the polio-free zone in southern Africa.

Africa, Southern↗
PubMed1997

Polio outbreaks in Namibia, 1993-1995: lessons learned.

In 1993, a nationwide outbreak of 53 cases of paralytic poliomyelitis occurred in Namibia. The World Health Organization-recommended supplemental vaccination strategy of national immunization days (NIDs), providing two doses of oral polio vaccine (OPV) to all children <5 years, was implemented to control the epidemic. A second focal outbreak of 16 confirmed polio cases occurred during 1994-1995 in northeast Namibia. "Mopping-up" vaccination was implemented to control the second outbreak, followed by NIDs. Both epidemics appeared to be associated with wild poliovirus importation from Angola, where polio is endemic. Although supplemental vaccination measures achieved suboptimal OPV coverage, surveillance of acute flaccid paralysis has not detected wild poliovirus in Namibia since April 1995. Future NIDs should aim to ensure OPV coverage >90% in each round of NIDs in each district. Nevertheless, the risk of new poliovirus importations will continue until efforts in Angola to increase routine coverage with three doses of OPV and extend supplemental vaccination activities can be implemented.

Adolescent↗
PubMed1997

Strategies for minimizing nosocomial measles transmission.

As a result of the highly contagious nature of measles before the onset of rash, nosocomial transmission will remain a threat until the disease is eradicated. However, a number of strategies can minimize its nosocomial spread. It is therefore vital to maximize awareness among health care staff that an individual with measles can enter a health facility at any time and that a continual risk of the nosocomial transmission of measles exists. The present review makes two groups of recommendations: those which are generally applicable to all countries, and certain additional recommendations which may be suitable only for industrialized countries.

Child↗
PubMed1996

Measles vaccine efficacy in Masvingo district, Zimbabwe.

OBJECTIVE: To carry out a survey in Masvingo District to determine the efficacy of measles vaccine. DESIGN: A retrospective study, using existing health care facility records and interviews with care givers. SETTING: Using the standard WHO-EPI cluster sampling methodology, 30 clusters were randomly selected in Masvingo District. SUBJECTS: 14 or more children in each of the 30 clusters were selected. MAIN OUTCOME MEASURES: Occurrence of measles or lack of it among the children aged 12 to 23 months, age at vaccination, status, the age at which the child had measles and availability of a health card. RESULTS: In Masvingo District from 1987 to 1994, measles incidence remained very high, though mortality drastically declined. Using field survey data measles vaccine efficacy was estimated at 78.3pc (95pc CI 54.1; 89.8). Vaccine coverage was estimated to be 75pc. CONCLUSION: The efficacy results fall at the lower end, but within the normal limits, of those expected for measles vaccine as used in Zimbabwe. Steps to increase vaccine coverage are of the highest priority.

Humans↗
PubMed1992

Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease.

Poliomyelitis caused by wild poliovirus has been virtually nonexistent in the United States since 1980, and vaccine-associated paralytic poliomyelitis (VAPP) has emerged as the predominant form of the disease. We reviewed national surveillance data on poliomyelitis for 1960-1989 to assess the changing risks of wild-virus, vaccine-associated, and imported paralytic disease; we also sought to characterize the epidemiology of poliomyelitis for the period 1980-1989. The risk of VAPP has remained exceedingly low but stable since the mid-1960s, with approximately 1 case occurring per 2.5 million doses of oral poliovirus vaccine (OPV) distributed during 1980-1989. Since 1980 no indigenous cases of wild-virus disease, 80 cases of VAPP, and five cases of imported disease have been reported in the United States. Three distinct groups are at risk of vaccine-associated disease: recipients of OPV (usually infants receiving their first dose), persons in contact with OPV recipients (mostly unvaccinated or inadequately vaccinated adults), and immunologically abnormal individuals. Overall, 93% of cases in OPV recipients and 76% of vaccine-associated cases have been related to administration of the first or second dose of OPV. Our findings suggest that adoption of a sequential vaccination schedule (inactivated poliovirus vaccine followed by OPV) would be effective in decreasing the risk of VAPP while retaining the proven public health benefits of OPV.

Humans↗
PubMed1992

Poliomyelitis case confirmation: characteristics for use by national eradication programmes.

Highly sensitive case definitions were first introduced by national poliomyelitis eradication programmes to avoid missing true cases of the disease, though false-positive diagnostic errors could still occur owing to low specificity. Extensive data from all 1620 cases of acute, flaccid paralysis reported in Brazil during 1987-88 provided an opportunity to study the characteristics of confirmed poliomyelitis cases and epidemiologically to evaluate potential case definitions that maximized both sensitivity and specificity. Cases that had been confirmed by wild poliomyelitis virus isolation were compared with those that had been rejected (non-polio cases). To guarantee the consistency of clinical, epidemiological and laboratory investigations, only cases less than 10 years of age that had been investigated within 15 days of the onset and with complete laboratory specimens were included. No single practical case definition combining both high sensitivity and high specificity emerged from the study. However, the results showed that poliomyelitis endemic countries with limited resources should give priority to the investigation of cases in less than 5-year-olds, cases with prodromal fever, cases without involvement in all four limbs, cases without progression greater than 3 days after the onset, and cases occurring in areas where poliomyelitis had recently been confirmed. In countries without laboratory resources, cases of acute, flaccid paralysis with initial involvement in one or both lower limbs and residual neurological sequelae at 60 days should be confirmed. Countries that are close to eradication may selectively reject any cases lacking laboratory confirmation, despite adequate specimen collection, if they do not have initial involvement in one or both lower limbs and residual neurological sequelae at 60 days.

Brazil↗
PubMed1989

A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases.

An epidemiologic classification of paralytic poliomyelitis cases (ECPPC) has been in use in the United States since 1976. In 1985, this classification system was reviewed because of recent changes in the epidemiology of paralytic poliomyelitis and improved laboratory capability to definitively characterize poliovirus strains. An alternative classification system was devised, the epidemiologic and laboratory classification of paralytic polio cases (ELCPPC), that incorporated virus isolation and strain characterization with epidemiologic information. Reported paralytic poliomyelitis cases for 1980-86 were classified by both the ECPPC and the ELCPPC classification systems. The new ELCPPC system classified 91 per cent of the reported cases as vaccine-associated, while the ECPPC system classified only 71 per cent of the reported cases as vaccine-associated. The proposed classification system provides more specific and useful information particularly concerning vaccine-associated paralytic poliomyelitis.

Epidemiologic Methods↗
PubMed1988

Risk factors for community- and household-acquired pertussis during a large-scale outbreak in central Wisconsin.

To identify risk factors associated with community- and household-acquired pertussis, we studied 61 households (HHs) with members with culture-positive illnesses and compared their characteristics with 58 neighborhood control-HHs and 62 randomly selected control-HHs. Case-HHs were more likely than either control group to have members 12-18 y of age (P less than .01); these individuals accounted for 34% of all primary cases. A history of exposure outside the home was the most important predictor of community-acquired infection (P less than .001), with adolescents being at higher risk than other age-groups (odds ratio, 3.2; P less than .001). After known exposure to a culture-positive case in the same HH, the risk of illness was unrelated to age; lengthy delays in initiating erythromycin therapy and prophylaxis were the only factors associated with secondary spread (P less than .01). The risk of pertussis may be related more to the likelihood of exposure than to age-related increases in susceptibility, and the risk can be reduced with appropriate use of erythromycin.

Adolescent↗
PubMed1988

Immunoblot analysis of humoral immune responses following infection with Bordetella pertussis or immunization with diphtheria-tetanus-pertussis vaccine.

To help develop better diagnostic tests for pertussis, we examined the serologic response to whole-cell proteins of Bordetella pertussis after natural infection or vaccination with diphtheria-tetanus-pertussis vaccine. Serum specimens collected during a pertussis outbreak investigation and from uninfected persons were used in Western blot (immunoblot) analyses to determine the presence of immunoglobulin G (IgG) and IgA antibodies to specific B. pertussis proteins. IgG antibodies to proteins of molecular masses 220 and 210 kilodaltons (kDa) were detected in 14 of 18 serum samples obtained from patients with culture-confirmed pertussis greater than or equal to 40 days after the onset of coughing. IgA antibodies were detected in 15 of the 18 samples. Of 19 serum samples obtained from patients who had not been ill with pertussis, 6 contained IgG antibodies to these proteins and 1 contained IgA antibodies. The two proteins bound antiserum specific for filamentous hemagglutinin and comigrated with purified filamentous hemagglutinin. IgG antibodies to two additional protein bands of molecular masses 84 and 75 kDa were associated with previous vaccination. Antibody to the 84-kDa protein was detected in 15 of 17 vaccinated, never-infected persons, and antibody to the 75-kDa protein was detected in 16 of the 17. None of 11 nonvaccinated, never-infected persons tested had antibodies to either protein. All seven fully vaccinated persons with culture-documented infection had antibodies to both proteins. Antibodies to the 84-kDa protein were detected in 6 of 22 nonvaccinated and infected persons, and antibodies to the 75-kDa protein were detected in 8 of the 22. Use of Western blot analysis in this study allowed us to distinguish antibody responses to infection and immunization.

Adolescent↗
PubMed1988

Sensitivity and specificity of clinical case definitions for pertussis.

We evaluated the diagnostic performance of 15 clinical case definitions for pertussis in 233 patients who developed acute respiratory illness during community outbreaks in Wisconsin and Delaware. Using results from culture (Regan-Lowe media) and serology (Ig-class-specific ELISA) as diagnostic standards, cough for greater than or equal to 14 days was both sensitive (84 per cent-92 per cent) and specific (63 percent-90 per cent) in identifying patients with pertussis. This definition may be useful in monitoring pertussis outbreaks and for investigating contacts of culture-positive cases.

Adolescent↗
PubMed1988

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)

Adolescent↗
PubMed1983

Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981.

The civil chaos created by a combination of drought and hostilities in the Ogaden region of southern Ethiopia during the past five years has caused the majority of the indigenous, principally nomadic population to flee the area and seek refuge either in Somali refugee camps or in Ethiopian shelters for displaced persons. This paper compares the provision of basic food rations, selective feeding programs, primary health care, and preventive health measures between the two groups. During 1980-1981 Somalia received more international assistance per capita than Ethiopia. Large numbers of Western personnel provided health and nutrition services in Somali refugee camps, whereas no foreigners were involved in Ethiopian shelters. These disparities were largely due to inadequate publicity concerning the problems Ethiopia faces, partly resulting from real and perceived political limitations related to the Soviet presence in that country. Refugee needs in Somalia have been publicized far more adequately, partly due to that country's alignment with the West. The Ethiopians nevertheless demonstrated greater efficiency in assisting their disaster victims; camp services comparable to those in Somalia were available despite greater logistic difficulties and fewer donated resources. The effectiveness of relief operations in Somalia was reduced by political constraints on governmental agencies.

Adolescent↗