ABSTRACT
Few prospective studies of mortality among children in developing countries have been published. Here we quantify and describe mortality and injury morbidity among a cohort of schoolchildren in rural Southeast Asia. Deaths among a cohort of 40,119 schoolchildren in Thailand were prospectively monitored over a two year period from January 1991. Additionally, data were collected with a questionnaire from a subset of 6,378 children asking them to recall all injuries over a one-year period. There were 40 deaths for an annual incidence of 50/100,000. Fifty percent of all deaths were due to injury; 25% to infectious diseases. Sixty percent of the injury deaths were due to motor vehicles and 35% to drowning. Sixty-six percent of the children reported one or more accidents. The leading categories of non-fatal injuries, in decreasing order, were: animal bite, puncture wound, burn, near-drowning, fall from a height. Boys experienced more injuries than girls for almost every type of injury. Injuries are replacing infectious diseases as the most important cause of deaths in developing countries. Additional public health initiatives to reduce childhood accidents may be warranted.
Subject(s)
Accident Prevention , Accidents/mortality , Adolescent , Cause of Death/trends , Child , Child, Preschool , Developing Countries , Female , Humans , Incidence , Male , Morbidity , Needs Assessment , Population Surveillance , Prospective Studies , Public Health Practice , Surveys and Questionnaires , Sex Distribution , Students/statistics & numerical data , Thailand/epidemiology , Wounds and Injuries/etiologyABSTRACT
A significant number of acute non A to E hepatitis cases are reported in Thailand every year, and the etiologies of these cases are unknown. Members of the herpesviridae family have been reported to cause either a self limited or fatal hepatitis in a small proportion of patients in other parts of the world. To determine whether herpesviruses may play a role in acute non A to E hepatitis, sera from 32 acute hepatitis patients without markers for acute hepatitis A to E virus infection were examined for IgM to herpesvirus type 2 (HSV-2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) using commercially available assays. IgM to HSV-2 was detected in four sera, IgM to CMV was detected in one serum, and IgM to EBV was detected in one serum. All of the acute non A to E hepatitis patients recovered and none had underlying conditions associated with impaired immunity. These results suggest that herpesviruses should be considered in the differential diagnosis for Thai patients with hepatitis.
Subject(s)
Acute Disease , Adolescent , Adult , Cytomegalovirus Infections/diagnosis , Female , Hepatitis, Viral, Human/diagnosis , Herpes Genitalis/diagnosis , Herpesviridae Infections/diagnosis , Herpesvirus 2, Human/immunology , Herpesvirus 4, Human/immunology , Humans , Male , Middle Aged , Serologic Tests , ThailandABSTRACT
The seropositivity rate of anti-HBs after hepatitis B vaccines, "Hepavax B", a one-dollar per dose vaccine produced by Korean Green Cross Corporation, Korea which were widely distributed and used for the first few years in the National Expanded Program on Immunization in Thailand were assessed in children who regularly came for immunization at the Well Baby Clinic at the Children's Hospital between June to December 1994. The schedule for hepatitis B immunization is at birth, 2 and 6 months of age. The seropositivity rate of anti-HBs at 6 months after the last dose were 86.3% and 87.7% at 12 months which was comparable to the seropositivity rate after other more expensive hepatitis B vaccines at 2 years (88.1%). This result should convince people that a one-dollar hepatitis B vaccine, "Hepavax" is immunogenic and expected to be as effective as other expensive hepatitis B vaccines. The marked reduce in the cost of hepatitis B vaccines will enable us to prevent and ultimately control of worldwide hepatitis B infections in the future.
Subject(s)
Costs and Cost Analysis , Hepatitis B/immunology , Hepatitis B Antibodies/immunology , Hepatitis B Vaccines/economics , Humans , Infant , Infant, Newborn , ThailandABSTRACT
To better characterize the etiology of acute non-A, B, C hepatitis, 24 sera from 50 acute hepatitis without acute markers for hepatitis A, B, and C were examined for acute markers for the hepatitis E virus (HEV), cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2), and Epstein-Barr virus. Immunoglobulin M (IgM) specific for HEV, HSV-2, and CMV was detected using ELISA and total Ig specific to EBV was determined by standard indirect immunofluorescence. IgM to CMV was not observed in sera from any of the patients; whereas, IgM to HEV was detected in sera from 2 patients and IgM to HSV-2 was detected in 5 of 24 acute hepatitis patients. In addition, high titer of antibody was found in 2 of the patients. This results indicate that HSV-2 and HEV circulate in Thailand and are responsible for a small proportion of non-A, B, C hepatitis in Thailand.
Subject(s)
Hepatitis Antibodies/immunology , Hepatitis E/etiology , Humans , ThailandABSTRACT
A sharp but short outbreak of hepatitis A occurred in a college during September and October 1992. The epidemic pattern suggested a common source. The attack rate of clinically recognizable hepatitis A was 8% all cases were HAV IgM positive. Among 31 students with minor symptoms but without jaundice 8 (26%) were also HAV IgM positive, as were 8 (10%) of 77 totally asymptomatic students tested. A case control study of eating and drinking habits of the students showed no other significant differences other than that 45 of 56 cases and 18 of 34 controls interviewed had filled their water glasses by dipping them in a overflow water reservoir. This gives an odds ratio of 3.8. The reservoir was heavily contaminated with coliform bacteria and the residual chlorine was at lower than standard concentration, whereas other water resources were clean. It is suggested that the reservoir had been contaminated with hepatitis A virus by somebody with fecally contaminated hands a couple of weeks prior to the beginning of the outbreak.
Subject(s)
Adolescent , Adult , Antibodies, Viral/blood , Case-Control Studies , Disease Outbreaks , Food Services , Hepatitis A/immunology , Hepatovirus/immunology , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Odds Ratio , Thailand , Universities , Water MicrobiologyABSTRACT
Age-specific prevalence of anti-HAV was determined for 3 groups of children whose mean ages were 12.6, 20.7 and 52.5 months. There were 41, 43 and 99 children in the respective age groups. All children were healthy, from middle to low socioeconomic families in Bangkok and vicinity. None of the children in the two younger age groups had anti-HAV antibody while 2 of 99 children in the oldest age group did. One of them resided in central Bangkok (Amphoe Dusit) and the other in Nonthaburi Province. The overall prevalence of anti-HAV in children under 5 years old was 1.1%. This demonstrates that hepatitis A transmission rates in Bangkok are very low when compared to ten years ago when prevalence rates were as high as 50-65%. From this study hepatitis A vaccine is recommended for 4-5 years old children in Bangkok. We need more epidemiologic data concerning hepatitis A transmission in Thailand before we can consider hepatitis A immunization for the whole country.