Brucellosis in Arusha and Manyara Regions; Tanzania: A Challenge to Public Health

Setting: Karatu; Ngorongoro; Babati; Mbulu and Hanang districts in Arusha and Manyara regions; Tanzania. Methodology: A retrospective study was conducted in Karatu; Ngorongoro; Babati; Hanang and Mbulu districts in Arusha and Manyara regions between July and September 2002. Review of Hospital records and interview with district medical officers; hospital Incharge and clinicians were conducted.Results: Out 170;345 patients who attended hospitals in Babati; Dareda; Karatu; Hydom; Katesh; Wasso; Endulen and Mbulu hospitals in the year 2001; 619(0.36) were diagnosed as having brucellosis. It was found out that women suffer from brucellosis more than males. Out of 619 cases of brucellosis reported in the year 2001; 432 (69.8) were females and 187(30.2) were males. Most of the patients were of the age between 16-35 (46.3) i.e. after school age compared to the middle aged 36-50 (30.4). Few cases were found in the pre school age (7 years); school age (7-15) and old age (50 years) Conclusion There is a need to carry out a study that will establish the burden caused by brucellosis in the area. This should also include investigating the relationship between infection in animals and that in humans. There is also a need to investigate the burden of the disease to the community as well and not only to those who attend hospitals. Factors that favor acquisition of brucellosis to animals and subsequent transmission to humans must be explored and pointed out clearly so that the communities can be made aware of and hence minimize the chances for transmission of brucellosis

23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind; randomised and placebo controlled trial

Infection with streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults. Vaccination is recommended in the USA and europe; but there are no prospective data that show vaccine efficacy. Methods: 1392 (937 female) HIV-1-infected adults in Entebbe; Uganda; were enrolled. 697 received 23-valent pneumococcal polysaccharide vaccine and 695 received placebo. The primary end point was first event invasive pneumococcal disease. Secondary endpoints included vaccine serogroup-specific invasive disease; all (probable and definite) pneumococcal events; all-cause pneumonia; and death. Findings: First invasive events occurred in 25 individuals (24 bacteraemias; one pyomyositis); 15 in the vaccine arm and ten in the placebo arm (hazard ratio [HR] 1.47; 95CI 0.7-3.3). 22 isolates (88) were of vaccine-specific serogroups with 15 events in the vaccine in the vaccine arm compared with seven in the placebo arm (HR 2.10; 0.9-5.2). All pnwumococcal events had a similar distribution (20 vs 14; HR 1.41; 0.7-2.8) though all-cause pneumonia was significantly more frequent in the vaccine arm (40 vs 21; HR 1.89; 1.1-3.2). Mortality was unaffected by vaccination. Interpretation: 23-valent pnwumococcal polysaccharide vaccination is ineffective in HIV-1 infected Ugandan adults and probably has little; or no; public health value elsewhere in sub-Saharan Africa. Increased rates of pnwumococcal disease in vaccine recipeients may necessitate a reappraisal of this intervention in other settings