study of hepatitis B vaccine efficacy 10 years after compulsory vaccination in Egypt

This study aimed to determine the protective efficacy of hepatitis B vaccine against infection and chronic carriage in 720 children aged 10 years who were vaccinated in infancy. All children were tested for hepatitis B serologic markers including hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface antigen [anti-HBs], and antibody to hepatitis B core antigen [anti-HBc] using 3rd generation ELISA technique. Only 37.9% of vaccinated children had protective anti-HBs indicating its decay with time. Hepatitis B infection occurred in 6.8% of the vaccinated children and it induced a boosting effect on anti-HBs level. HBsAg was detected in 0.6% only of the vaqinated children. Thus we could conclude that up to 10 years, booster doses are unnecessary possibly due to protective anamnestic response to antigenic challenge. Further follow-up studies for longer duration than 10 years are needed especially during adolescence with the onset of sexual activity to monitor the vaccine efficacy in preventing chronic carriage and the possible necessity for booster doses.

Adult tetanus: unfinshed problem

As the immunization coverage of children and pregnant women widened, it is to be expected that neonatal and childhood tetanus will become rare. In Egypt, the recommendations for booster doses every 10 years in adults are poorly followed and no intervention takes place in persons above 9-10 years of age except for wound prophylaxis. The aim of this retrospective study was to describe epidemiological features of tetanus cases over the period from 1998 to 2004. Cases of non-neonatal tetanus were 238, mean annual frequency 34 +/- 3.3, most of the cases were adolescents and adults of both sexes except 4 children below 15 years, male to female ratio 4.4:1, 56.3% were farmers. Only 66% of the studied cases sustained an acute injury before onset of illness; 66.2% occurred after puncture wounds of whom 20.2% had stepped on a nail, 8.9% had an injury related to surgery or gluteal injection. Frequent sites for injury were the lower limb mainly the foot in 72.6% of cases, hand in 15.3%, head in 2.55% and teeth in 1 .3%. No data were available as regards the post-injury care of the wound, anti-tetanic prophylaxis, or the patients vaccination status. The incubation period ranged from 5-30 days and was related to severity of tetanus. Case-fatality rate was 18.9%; it increased at extremes of age and reached its maximum [62.1%] in patients =60 years. Case-fatality rate was significantly influenced by age, sex, site of injury, and duration of hospital stay but was not significantly influenced by type of tetanus or incubation period. All adult cases of tetanus were managed in the intensive care unit with assisted ventilation for 11 .8%. Thus considering expenses incurred in managing tetanus patients, it seems necessary to include booster doses in the Expanded Immunization Program, and to develop vaccination programs targeting adult males and elderly population of both sexes. Occupation may be an important consideration in the development of immunization policies

Relationship of helicobacter pylori infection with different digestive system malignant tumors

Studies have shown a close association between Helicobacter pylori infection and gastric cancer while its relationship with other digestive system tumors has not been clarified. This study evaluated whether H. pylori infection affected risk for different digestive system malignancies. Sera were tested for lgG antibodies against H. pylori using quantitative enzyme immunoassay in 222 subjects: 82 patients with digestive system malignancies including gastroduodenal, pancreatic, hepatic, and colorectal carcinomas, 82 healthy controls, and 58 patients with other malignancies [cancer controls]. H. pylori infection was noted in 58.8% of healthy controls, 73.2% of patients with digestive cancer and 82.8% of cancer controls. H. pylori infection imposed 2.8 folds increased risk for colorectal carcinoma. H. pylori infection was associated with increased but non-significant risk for developing genitourinary, bone, and breast cancers. Thus large-scale epidemiological studies to confirm the association and the possible causative role of H. pylori infection in the etiopathogenesis of various digestive and non-digestive system cancers are needed to help to develop preventive measures and appropriate interventions

Knowledge and practices about tetanus immunization among physicians in Damanhour, Beheira Governorate

In spite of the clear-cut guidelines regarding tetanus immunization, it is sometimes missed by the health personnel or given after injury without taking into consideration previous immunization status. One of the reasons could be that records are usually not available and history not reliable, but other reasons could be that physicians themselves are not aware of the correct immunization schedules in different groups or even if they know, they are not giving proper guidance to the general public. The study was planned to assess physicians knowledge about pre-exposure and post-exposure tetanus prophylaxis and their practices as regards post-injury tetanus prophylaxis. A stratified random sample was selected from physicians working in rural and urban health centers and hospitals affiliated to the Ministry of Health beside private practitioners. Data were collected through a pre-designed questionnaire for self-administration. The correct knowledge of tetanus immunization schedule in children, pregnant women, and adults was 92.2%, 84.4%, and 7.8%, respectively. Hospitals and health centers physicians had better knowledge about tetanus immunization of children and adults than private practitioners. Only 62.5% and 48.4% favoured giving tetanus toxoid after animal bites and burns which was considered unacceptable lack among physicians. As regards their post-injury practices, all of them admitted giving anti-tetanic serum as the sole tool for tetanus prophylaxis in wounds that they considered tetanus-prone without any attempt to enquire about the patient's vaccination status or to start immunization by the toxoid. The present study showed defects in physicians' knowledge and incorrect practices about tetanus prophylaxis that needs to be upgraded through in-service training, continuing medical education programs, beside posters at the work place

Effectiveness of myrrh in the treatment of Schistosoma K mansoni infection: a controlled trial

Chemotherapy is the main tool for control of schistosomiasis. Although praziquantel has high degree of efficacy and minimal side effects, yet concern was raised over possible ' low-level resistance. This necessitates search for new safe and effective drugs. The present study was implemented to evaluate the efficacy of Mirazid [oleo-resin extract of Myrrh obtained from the stem of Commiphora molmol]. 1184 recruits were parasitologically screened using Kato-Katz technique and intensity of infection was classified into light, moderate, or heavy according to WHO Guidelines. Schistosoma mansoni infection was detected in 156 recruits I [13.2%], they were equally allocated to one of three therapy groups either mirazid [600 mg] for ' 3 consecutive days, mirazid [600 mg] for 6 consecutive days, or single dose of praziquantel 40 mg/kgbw. Cure was monitored 3 and 6 weeks post-treatment by parasitological stool examination using quantitative Kato-Katz [4 slides/stool sample] and formol detergent techniques. Cure rate was [55.6%] for 3-days Mirazid, [45.8%] for 6-days Mirazid, and [94.3%] for praziquantel when assessed 6 weeks post-treatment. Results showed that cure rates decreased with increasing pre-treatment egg counts for the 3 studied treatment groups. For the uncured subjects, the percent reduction in geometric mean egg count observed 6 weeks post-treatment was [-6%] for those who received 3-days Mirazid, [39.1%] for those who received 6-days Mirazid, and [97.2%] for those who received praziquantel. Based on the findings of this study, although Mirazid is a well tolerated herbal drug with minimal side effects, yet if compared with praziquantel as an anti-schistosomal drug, it has a lower cure rate and is given in multiple doses with a compliance problem

cognitive cost of iron deficiency and parasitic infection in adolescent girls

Iron deficiency anemia in infants can cause developmental problems. However, the relationship between iron status and cognitive achievement in older children is less clear. The objective of the present work was to study the impact of iron deficiency and parasitic infection on cognitive functions and scholastic achievement of adolescent girls. The study recruited 180 adolescent girls aged 11-16 years. Two iron tests were used; haemoglobin concentration and serum ferritin. Cognitive functions were assessed using The Standardized Arabic Version of Wechsler Intelligence Scale for Children [WISC] while data on scholastic achievement was collected through school records. Stool was examined using Kato-Katz technique. The study revealed that 43.3% had anaemia of different degrees, 48.3% had decreased level [<12 micro g/l] of serum ferritin; [82.8%] of them had progressed to iron deficiency anaemia [IDA]. 22.4% of the studied sample had parasitic infection; mostly Ascaris lumbricoides [8.6%]. The mean cognitive scores of iron-deficient girls with and without anaemia were significantly lower than the control group on the studied subtests of WISC [similarity, comprehension, picture arrangement, and digit symbol tests], while parasitic infection only affected the similarity subtest. The scholastic achievement was insignificantly affected by neither iron deficiency nor parasitic infection. Thus screening for iron deficiency, particularly for those without anemia, might be warranted for high-risk groups. Furthermore, a randomized trial will be needed to evaluate the effect of iron therapy on cognitive scores