Prevalence of and mortality from HIV type 2 in Guinea Bissau, West Africa.
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Adult↗
Biomedical subjects
W L Heyward
Publications and source records attributed to W L Heyward.
Rapid emergence of AIDS in Abidjan, Ivory Coast.
Between July and November, 1988, 1501 consecutive adult medical admissions to the two largest hospitals in Abidjan, Ivory Coast, were studied. The overall prevalence of infection with human immunodeficiency virus (HIV) types 1 and 2 was 43% in hospital A and 28% in hospital B. AIDS accounted for 19% and 9%, respectively, of medical admissions to the two hospitals, and for 33% of medical deaths in hospital A. The risk of death was significantly higher in HIV-seropositive patients with acquired immunodeficiency syndrome (AIDS) (risk ratio 2.5, 95% confidence interval [CI] 2.0-3.2) and in HIV-positive patients who did not meet the AIDS case-definition (risk ratio 1.7, 95% CI 1.3-2.3) than HIV-negative patients. The male/female ratio of the 265 cases of AIDS identified was 4.8. 50% of patients with AIDS were seropositive for HIV-1 only, 4% for HIV-2 only, and 46% reacted serologically to both viruses. The minimum incidence of AIDS in adult male and female residents of Abidjan (per million per year) is estimated at 1447 and 340 cases, respectively. AIDS in this West African city has emerged as a major public health problem.
Acquired Immunodeficiency Syndrome↗
Duration of immunogenicity and efficacy of hepatitis B vaccine in a Yupik Eskimo population.
In 1981, a hepatitis B virus vaccine demonstration project was conducted in 1630 Yupik Eskimos in southwest Alaska. Levels of antibody to hepatitis B surface antigen and markers for hepatitis B virus infection in vaccinees were monitored yearly for 5 years. After 5 years of follow-up, 19% of those who initially had an immune response to vaccine of 10 sample ratio units or greater subsequently had levels of antibody to hepatitis B surface antigen lower than 10 sample ratio units. During the 5 years after the first dose of vaccine, in three responders and one person with an antibody to hepatitis B surface antigen response lower than 10 sample ratio units, antibody to hepatitis B core antigen developed, and the level of antibody to hepatitis B surface antigen was boosted. Hepatitis B surface antigen did not develop in any subjects, and none had clinical hepatitis. In the 5 years following the demonstration project, the annual incidence of hepatitis B virus infection decreased from 50 cases per 1000 population before the vaccine trial to 0.45 per 1000.
Adolescent↗
Field testing and comparative evaluation of rapid, visually read screening assays for antibody to human immunodeficiency virus.
Five rapid, visually read assays for detection of antibody against human immunodeficiency virus (HIV) were evaluated on fresh serum samples from 4000 prospective blood donors at Mama Yemo Hospital, Kinshasa, Zaïre. The sensitivity of the assays, based on 214 specimens positive by western blot, ranged from 84.6% to 99.1%. The specificity, based on 3664 samples negative by enzyme-linked immunosorbent assay (ELISA) or western blot, ranged from 92.7% to 98.8%. Three readers scored each test result independently; disagreement about test interpretation occurred in 1.2-8.3% of the specimens. There was no correlation between assay performance and assay principle (agglutination or dot immunobinding) or antigen source (viral lysate or recombinant). Assays such as these can be readily implemented in a developing country transfusion centre, where blood screening by ELISA is not practicable.
Agglutination Tests↗
Invasive pneumococcal disease in an Alaska native population, 1980 through 1986.
From 1980 through 1986, one hundred fourteen Alaska Native patients from the Yukon-Kuskokwim Delta had community-acquired invasive pneumococcal disease confirmed by isolates of Streptococcus pneumoniae from normally sterile body sites. The annual bacteremia rates per 100,000 persons were 105 cases for all ages, 1195 cases for infants under 2 years of age, and 130 cases for adults over 59 years of age. These were six to 34 times higher than rates reported for other US populations. The most common underlying conditions in infants diagnosed before 24 months of age were previously diagnosed anemia and pneumonia, while alcoholism and anemia were most common in adults. The case-fatality rate for infants under 2 years of age was 3.2%, and the case-fatality rate for adults over 59 years of age was 30%. Serotyping of more than half the isolates identified 96% of these isolates to be present in the currently available pneumococcal polysaccharide vaccine. The pneumococcal disease rates reported herein are likely to be underestimates since most diseases that occur in this region are treated at the village level without laboratory confirmation.
Adolescent↗
Hepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up.
We analyzed the demographic, clinical, laboratory and histologic features of 13 patients who were diagnosed as having polyarteritis nodosa associated with hepatitis B virus infection over a 12-year period, 1974 to 1985. All 13 patients were Yupik Eskimos and resided in southwest Alaska, an area hyperendemic for hepatitis B virus infection. The annual incidence of hepatitis B virus-associated polyarteritis nodosa for this population is 7.7 cases per 100,000 population. All patients presented with multisystem disease, and all had biopsy or angiographic findings consistent with polyarteritis nodosa. All 13 were positive for hepatitis B surface antigen and hepatitis B e antigen at diagnosis. Two untreated patients and two of five patients who received corticosteroids died, vs. none of six who received corticosteroids plus cyclophosphamide. None of the patients who survived the initial bout of polyarteritis nodosa has relapsed after a mean follow-up of 55 months, but all have become chronic HBsAg carriers. In eight patients, clinical or serologic evidence indicated that polyarteritis nodosa followed recent hepatitis B virus infection. We concluded that hepatitis B virus-associated polyarteritis nodosa is a serious, life-threatening complication that occurs early in the course of hepatitis B virus infection, is ameliorated by immunosuppressive therapy and can be prevented by hepatitis B vaccine.
Alaska↗
Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome.
As of December 31, 1988, 82,764 cases of acquired immunodeficiency syndrome (AIDS) and more than 46,000 AIDS-related deaths had been reported in the United States. In 1987, AIDS deaths accounted for 9% of the total mortality among men 25 to 34 years of age. Projections suggest that the impact of human immunodeficiency virus (HIV) infection on morbidity and mortality in young adults and children will continue to increase, with an estimated 50,000 cases projected to be diagnosed in 1989. The mean latency period between infection and diagnosis of AIDS is estimated to be more than seven years, and 78% to 100% of persons infected with HIV are predicted to develop AIDS within 15 years of onset of infection. Rates of seroconversions have been decreasing since 1984 among cohorts of homosexual HIV-seronegative men, and the proportion of AIDS cases among homosexual men is decreasing. In contrast, the proportion of AIDS cases attributed to intravenous drug use is increasing, with 33% of AIDS cases reported in 1988 occurring among intravenous drug users, their sex partners, or children of women who are intravenous drug users or sex partners of intravenous drug users. Worldwide, the differences in the epidemiology of HIV infection and AIDS are primarily due to differences in the proportions of the modes of transmission and in the time in which HIV infection was introduced.
Acquired Immunodeficiency Syndrome↗
Further experience with the World Health Organization clinical case definition for AIDS in Uganda.
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Acquired Immunodeficiency Syndrome↗
The epidemiology of AIDS in the U.S.
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Acquired Immunodeficiency Syndrome↗
Food-borne botulism in Alaska, 1947-1985: epidemiology and clinical findings.
We reviewed records of all food-borne outbreaks of botulism in Alaska from 1947 through 1985. Fifty-nine confirmed or suspected outbreaks with 156 cases were reported. All outbreaks occurred in Alaska Natives and were associated with eating traditional Alaska Native foods. Forty-four (75%) of the outbreaks were laboratory confirmed and involved 133 persons. The overall annual incidence of confirmed or suspected botulism was 8.6 cases per 100,000 population. Seventeen persons died, an overall case-fatality rate of 11%. Type E toxin accounted for 32 (73%) laboratory-confirmed outbreaks; type A, six (14%); and type B, five (11%). Forty-one cases demonstrated botulinal toxin in one or more specimens (serum, gastric contents, or stool). Of the 41 botulinal toxin-positive persons, 38 (93%) had at least three of the commonly recognized pentad of signs or symptoms--nausea and vomiting, dysphagia, diplopia, dilated and fixed pupils, or dry mouth and throat--and 20 (49%) required respiratory assistance.
Adolescent↗
A comprehensive programme to reduce the incidence of hepatitis B virus infection and its sequelae in Alaskan natives.
In 1983, a comprehensive programme was introduced to halt the spread of hepatitis B virus (HBV) infection and to reduce mortality from hepatocellular carcinoma (HCC) in Alaskan Natives, in whom the incidence of HBV infection was high. This programme includes: serological screening of all Alaskan Natives; immunisation of susceptible persons, including all newborn babies, with hepatitis B vaccine; and testing HBsAg-positive carriers twice a year for alpha-fetoprotein (AFP) to detect HCC at an early stage. By October, 1986, over 53,000 Alaskan Natives (84% of the total Native population) had been tested for HBV serological markers and 80% of the identified susceptibles had been or were being vaccinated against HBV. After complete immunisation of 90% of the susceptibles in the area with the highest infection rates in Alaska, the annual incidence of acute symptomatic HBV infection decreased from 215 to 14 cases per 100,000 population. After the introduction of AFP screening, the 1-year-case-fatality rate for HCC fell, from 100%, to 50%.
Alaska↗
Primary liver cancer in Alaskan natives. 1980-1985.
The authors reviewed the cases of 19 Alaskan Natives (15 men, four women) with primary hepatocellular carcinoma (HCC) diagnosed during 1980-1985. Of these 19 patients, 16 were seropositive for hepatitis B surface antigen (HBsAg). Alpha-fetoprotein (AFP) was elevated in 15 patients (all were HBsAg positive). The patients ranged in age from 8 to 80 years old. Of the 19 patients, 16 were Eskimo, 13 of whom were Yupik. The annual age-adjusted (world standard) incidence of HCC for all Alaskan Natives was 9.3/100,000 for men and 2.2/100,000 for women. The tumor was resected in seven patients; six showed no recurrence of cancer 1 to 4 years after surgery. Histologic evaluation in 18 patients revealed trabecular type of HCC in 15 and acinar HCC in two others. In 16 specimens in which nontumorous liver could be studied, only six had evidence of cirrhosis; ten others showed variants of chronic persistent hepatitis.
Alaska↗
Hepatitis B virus replication and tuberculin reactivity: studies in Alaska.
In a previous study in 1982-1984 of southeast Asian refugees in Philadelphia, the authors found that hepatitis B virus carriers who reacted to a tuberculin (purified protein derivative (PPD)) skin test were more likely to be negative for the hepatitis B e antigen (HBeAg) than carriers who did not react to PPD. Because it was not known whether the PPD reactivity was due to natural infection or vaccination with bacille Calmette-Guérin (BCG), the authors conducted a further study in 1985 in Alaskan Native hepatitis B carriers, a group not vaccinated with BCG. The inverse association of HBeAg and PPD reactivity was confirmed across all age groups and was similar in magnitude to that observed in the refugee population. The host response to tubercle bacilli may inhibit the replication of hepatitis B virus. If the host response to BCG is similar, BCG vaccination may be of therapeutic value in chronic hepatitis B infection.
Adolescent↗
Pharyngeal carriage and acquisition of anticapsular antibody to Haemophilus influenzae type b in a high-risk population in southwestern Alaska.
Haemophilus influenzae type b disease in Alaskan Eskimos is characterized by greatly increased disease incidence at younger ages. This suggests that Eskimo infants have increased exposure to the disease. Exposure was studied in 1982-1983 in children less than age three years who lived in four Eskimo villages, as well as in a random sample of their family members (354 people from 132 households). During a 12-month period, up to four pharyngeal cultures and two serum specimens were obtained from each participant. Colonization with H. influenzae type b was relatively uncommon (overall 2.5% of cultures, 6.8% of individuals) and was not associated with age, sex, season, or prior incidence of disease in the village. Biotyping and outer-membrane-protein typing of H. influenzae type b isolates revealed homogeneity within villages, with differences between villages. Matched sera revealed a significant decline in H. influenzae type b capsular antibody in the course of the study year. However, pharyngeal carriage of H. influenzae type b was associated with increases in antibody for carriers and members of their households. Antibody levels were positively associated with age. Only one case of H. influenzae type b disease developed during the study. Low carriage of H. influenzae type b was coincident with low incidence of disease and declining levels of capsular antibody in these villages. Mechanisms for increased exposure which would not be reflected in high carriage rates may exist for these young children.
Adolescent↗
Prevalence of hepatitis B virus infection in Tonga: identifying high risk groups for immunization with hepatitis B vaccine.
A serological survey for evidence of hepatitis B virus (HBV) infection was conducted in the Kingdom of Tonga as the first step in developing a strategy for an immunization programme. There were 414 individuals from the general population plus 137 pregnant women included in the survey. HBsAg was found in 20% of the general population and 88% had one or more serologic markers of HBV infection. In the 5-9 year age group, 80% of the children had one or more markers of HBV, and in the 10-19 year age group, the prevalence was 96.4%, indicating that most transmission of HBV in the Tongans studied occurs in the young. Of the pregnant women studied, 15% were positive for HBsAg, and 57% of those positive for HBsAg were also positive for HBeAg. Evidence of delta virus infection was not found in any of 82 HBsAg positive sera tested. Surveillance data suggested that significant serious sequelae to HBV infection (cirrhosis and primary hepatocellular carcinoma) also occur in Tonga. Immunization of infants and children is the most effective strategy for reducing or eliminating HBV infection and its sequelae in developing countries like Tonga.
Adolescent↗
Early detection of primary hepatocellular carcinoma. Screening for primary hepatocellular carcinoma among persons infected with hepatitis B virus.
High rates of hepatitis B virus infection and primary hepatocellular carcinoma are present among Alaskan Natives. To determine if primary hepatocellular carcinoma could be detected at an early surgically resectable stage, serological screening for elevated alpha-fetoprotein levels was done semiannually among Alaskan Natives infected with hepatitis B virus. During a 26-month screening period, 3,387 alpha-fetoprotein tests were performed on 1,394 persons. Of 126 persons with elevated levels of alpha-fetoprotein (greater than 25 ng/mL), nine males were found to have primary hepatocellular carcinoma (all with alpha-fetoprotein levels greater than 350 ng/mL). Six of these nine persons were asymptomatic for primary hepatocellular carcinoma and four had small tumors (less than 6 cm) that were surgically resected. After surgery, the alpha-fetoprotein levels in all four patients fell to normal and have remained normal after a follow-up of four to 20 months (median, ten months). alpha-Fetoprotein screening proved to be an effective approach in this population in detecting primary hepatocellular carcinoma at a potentially curable stage and should be considered in other individuals or populations infected with hepatitis B virus.
Adolescent↗
Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state.
Yupik Eskimos of southwestern Alaska have the highest known prevalence of hepatitis B virus infection of any general population in the United States. Prospective serological surveys of 1,280 seronegative Yupik Eskimos, performed between 1971 and 1976, identified 189 (14.8%) who developed serological evidence of hepatitis B virus infection. Twenty-six (13.8%) developed clinical hepatitis during the interval when seroconversion occurred. The proportion of patients with clinically apparent hepatitis increased with age (P less than .01), ranging from 9.5% of infections in patients who were four years of age or less to 33.3% of infections in patients who were 30 years of age or older. Twenty-five (13.3%) of the 188 individuals who were studied became chronic carriers of hepatitis B surface antigen. The risk of becoming a carrier was inversely related to the age of the patient at the time of infection (P = .02). Among patients who were four years of age or less when infected, 28.8% became chronic carriers of hepatitis B, as compared with 7.7% of those who were 30 years of age or older.
Acute Disease↗
The long-term serological course of asymptomatic hepatitis B virus carriers and the development of primary hepatocellular carcinoma.
One hundred fifty asymptomatic patients who were carriers of hepatitis B surface antigen (HBsAg) were studied serologically for up to 11.3 years (mean, 6.1 years). Only 9 (6.0%) lost HBsAg during the study period, for a mean annual clearance rate of 1.0%. We found no difference in the clearance of HBsAg by age, but a higher percentage of females lost HBsAg than did males (P less than .02). Hepatitis B e antigen (HBeAg) was found in 102 (68.5%) of the 149 carriers of HBsAg who were tested. Carriers of HBsAg who were seropositive for HBeAg were younger than those who were seronegative for HBeAg (P less than .01). The prevalence of HBeAg was not affected by the patients' sex. The clearance of HBeAg was gradual; 9.6% of the HBsAg carriers lost HBeAg each year. Females were more likely to clear HBeAg than were males (P less than .01), and those who cleared HBeAg were older than those who did not (P less than .01). Three (2.0%) of the HBsAg carriers developed primary hepatocellular carcinoma during the study period.
Adolescent↗