Epidemia de sarampo e trabalho escravo no Grão-Pará (1748-1778) / Measles epidemic and slave work in Grão-Pará (1748-1778) / Epidemia de sarampión y trabajo esclavo en el Gran Pará (1748-1778)

O artigo apresenta o impacto populacional provocado pela epidemia de sarampo (1748-1750) na capitania do Grão-Pará e sua relação com o processo de inserção da mão de obra escrava africana. A análise é fundamentada na documentação produzida no século XVIII, levantada em diferentes arquivos brasileiros e portugueses, incluindo correspondências oficiais, crônicas, memórias, mapas populacionais e listagens de mortos pela epidemia. A documentação serial foi posta em base de dados, construída a partir das 80 listagens de mortos pelo sarampo, o que permitiu uma análise do impacto demográfico da epidemia. Concomitantemente, a contagem populacional das vilas e povoações da capitania, do terceiro quartel do século XVIII, compôs uma segunda base de dados e auxiliou na compreensão da distribuição interna de escravos africanos. O ponto de interseção entre as bases de dados é formado pelo conjunto da documentação histórica administrativa, que trata dos efeitos da epidemia e das possibilidades de solução da crise de mão de obra - ocasionada pela alta mortalidade de indígenas. O estudo procura mostrar não apenas a mortalidade causada pelo sarampo, mas também a construção de uma política para a inserção de escravos africanos na região. Para tanto abordam-se a epidemia em Belém, a importância do trabalho indígena para os colonos, o número de mortos e a distribuição da mortalidade considerando espaço e sazonalidade (meses e anos). Também se discutem a luta entre projetos para sanar a demanda de mão de obra, gerada pela alta mortalidade do sarampo, e a política de inserção de escravos africanos para combater a carência de trabalhadores, bem como a distribuição desses escravos na capitania

The paper discusses the population impact of the measles epidemic (1748-1750) in Grão-Pará (a captaincy of the Portuguese Empire, now northern Brazil) and its relation to the process of insertion of African slave labor. The analysis is based on the documentation produced in the 18th century, including official correspondence, essays, memoirs, population maps and lists of those killed by the epidemic. The serial documentation was entered into a database, created from 80 lists of those killed by measles, which allowed an analysis of the demographic impact of the disease. Concomitantly, the population count of the captaincy’s towns and villages from the third quarter of the 18th century composed a second database and facilitated understanding of the internal distribution of African slaves. The point of intersection between the databases is the set of historical administrative documents, which addresses the effects of the epidemic and the possible solutions to the labor crisis - caused by the high mortality of indigenous peoples. The study shows not just measles mortality, but also the construction of a policy for the insertion of African slaves in the region. As such, the text is divided into two parts: the first deals with the epidemic itself, its presence in the city Belém, the importance of indigenous labor for the colonists, the number of deaths and the distribution of mortality in terms of space and seasonality (months and years). The second part discusses the fundamental struggle between projects that addressed the demand for labor, the policy of insertion of African slaves as a means to combat the high mortality of measles, and the distribution of these slaves in the captaincy

En el artículo se analiza el impacto sobre la población de la epidemia de sarampión que se produjo en la capitanía del Gran Pará entre 1748-1750 y su relación con el proceso de inserción de la mano de obra de los esclavos africanos. El análisis se basa en documentación producida durante el siglo XVIII, recogida en varios archivos brasileños y portugueses, que incluye correspondencia oficial, crónicas, memorias, mapas y listados de muertos por la epidemia. La documentación serial se incluyó en una base de datos construida a partir de 80 listados de muertos por el sarampión, lo que permitió un análisis de los efectos demográficos de la epidemia. Al mismo tiempo, el recuento de la población de las ciudades y pueblos de la capitanía en el tercer cuarto del siglo XVIII compuso una segunda base de datos, y ayudó a la comprensión de la distribución interna de los esclavos africanos. El punto de intersección entre las bases de datos lo constituye el conjunto de la documentación administrativa histórica que se ocupa de los efectos de la epidemia y las posibles soluciones para la crisis de la mano de obra causada por la alta mortalidad de los indígenas. El estudio no solo se propone abordar la mortalidad causada por el sarampión, sino también la construcción de una política para la inserción de los esclavos africanos en la región. Por lo tanto, se aborda la epidemia en Belém, la importancia del trabajo indígena para los colonos, el número de muertos y la distribución de la mortalidad considerando el espacio y la estacionalidad (meses y años). También se discute la lucha entre proyectos para subsanar la demanda de mano de obra generada por la alta mortalidad causada por el sarampión, y la política de inserción de los esclavos africanos como un mecanismo para combatir la escasez de trabajadores, así como la distribución de estos esclavos en la capitanía

Measles in a tertiary institution in Bida, Niger state, Nigeria: prevalence, immunization status and mortality pattern

Measles is a highly infectious immunizable disease with potential for eradication but is still responsible for high mortality among children, particularly in developing nations like Nigeria. This study aims to determine the hospital based prevalence of measles, describe the vaccination status of children managed for measles at the Federal Medical Centre, Bida, Niger state and to identify the parental disposition to measles vaccination. This is a cross-section study carried out over a period of 18 months beginning from July 2007. All children with a diagnosis of measles made clinically and reinforced with serological test in the WHO Measles, Rubella and Yellow Fever laboratory in Maitama District Hospital, Abuja were recruited. Informed consent was obtained from the parents/ care givers. Structured questionnaire was used to obtain information and data analysis was by SPSS version 15. One hundred and nine children were managed for measles, constituting 8% of total admission over the study period. The male to female ratio was 1.2:1. Of the 109 children with measles, 90 [82%] did not receive measles vaccination. Eighty-eight [80%] of the parents or guardian felt vaccination was bad for various reasons. Of the 23 [21.1%] children whose parents or guardians were positively disposed to vaccination, one death was recorded while the remaining seven deaths were recorded among children whose parents were negatively disposed to vaccination. All the deaths were in the non-vaccinated group below 2 years of age. Measles is still a major health burden in our community. The majority of affected children were not vaccinated due to negative parental disposition. Continuous health education is required for change the disposition of the parents/ guardian and improve vaccination coverage to minimize measles associated morbidity and mortality

Measles case fatality ratio in India: A review of community based studies.

Context: Measles remains a major cause of child mortality in India. Measles case fatality ratios (CFRs) vary substantially between countries and even within the same community over time. We present a review of Indian community-based measles CFR studies conducted from 1975 to 2008. Evidence acquisition: PubMed, Cochrane Libraries, and all WHO databases were searched using a combination of terms. All community-based studies were abstracted into a database. Results: We identified 25 studies with data on 27 communities. The median CFR was 1.63 per 100 cases (Q1= 0.00 and Q3= 5.06). Studies conducted after 1994 had significantly lower CFRs (P=0.031). Studies in rural settings had significantly higher CFRs compared to urban studies (P=0.015). No differences were found by study design or outbreak/endemic setting. Conclusions: This review suggests measles CFR may be declining in India. We hypothesize that increased measles vaccination coverage is the main factor contributing to the decline. Widespread vaccination increases both the average age of infection and the proportion of total measles cases previously vaccinated. Vitamin A treatment/supplementation is also likely to have contributed. In order to further reduce measles burden in India, vaccination and vitamin A treatment/supplementation coverage should be increased and a two dose vaccine strategy should be implemented in all areas.

Two doses of measles vaccine reduce measles deaths.

Two doses of measles vaccine to children reduce measles related deaths. The first dose is delivered through the routine immunization system to infants and the 2nd dose through campaigns or routine immunization system, whichever strategy reaches the highest coverage in the country. Experience in 46 out of 47 measles priority countries has shown that measles vaccination using mass vaccination campaigns can reduce measles related deaths, even in countries where routine immunization system fails to reach an important proportion of children. The gradual adoption of this strategy by countries has resulted in 74% reduction in measles related deaths between 2000 and 2007. The 2010 goal to reduce measles mortality by 90% compared with 2000 levels is achievable if India fully implements its plans to provide a second dose measles vaccine to all children either through campaigns in low coverage areas or through routine services in high coverage areas. Full implementation of measles mortality reduction strategies in all high burden countries will make an important contribution to achieving Millennium Development Goal 4 to reduce child mortality by two thirds in 2015 as compared to 1990.

Clinical outcome in measles patients hospitalized with complications

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay [>5 days]. Pneumonia [39.7%] and diarrhoea [38.2%] were the commonest complications. Seven children died and encephalitis [57.1%] was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis

study of measles cases reported to District Headquarter hospital, Bahawalnagar

To study the measles cases reported to the hospital and measles associated diarrhea and pneumonia in children less than 15 years of age over a period of one year. Hospital-based Prospective Study was conducted at children out patient department of District Head Quarter Hospital Bahawalnagar, which is the main secondary health care facility of the district. The study period was from March, 2005, to February, 2006. Data collecting procedures were based on the questionnaires designed for clinical diagnosis of measles and complications were also recorded. Standard case definitions were used for the diagnosis of Probable Measles, Clinically Confirmed Measles, Measles Associated Diarrhea [MAD] and Measles Related Pneumonia [MRP]. Informed verbal consent was taken from the respondents. Pediatricians filled the questionnaires. All cases of measles were included and the cases that did not meet clinical case definition were excluded from the study. A total of 140 cases of measles were enrolled during the study period of one year. The maximum number of patients, [86] 61.43%, were in the months of April, May, June, July and August. Out of 140 patients, 38 were clinically confirmed of having measles while 62 were grouped as probable measles. There were more females [88] than males [52].The most affected age group was under the age of 3-years with 76 patients [54.28%], 37 [26.43%] cases in 3 to 5 years age group and 27 cases [19.28%] were above 5 years of age, while 17 cases [12.14%] were reported in 6 to 9 months of age. Only 60 cases [42.86%] were immunized against measles while 80 cases [57.14%] were not immunized. Non-immunized children were more likely to suffer from complicated measles [75 [93.75%]] than immunized children [29 [48.33%]]. Diarrhea was the most frequent complication [53.57%, n=75], followed by pneumonia [20.71%, n=29]. The largest proportion [53.33%, n=40] of cases with diarrhea occurred in June, July and August while most Pneumonia with measles cases were reported in February, May and November [55.17%, n= 16]. During follow up of the identified cases of measles, 3 children died due to its complications, two with pneumonia and one with diarrhea giving a fatality rate of 2.14%.Measles is still under reported and its complications are a problem in the region. Occurrence of measles in immunized children reflects partial immunity and / or vaccine failure

Darkness in El Dorado: human genetics on trial.

A recent book by a freelance journalist makes major accusations against genetic studies by J. V. Neel in the Amazon a generation ago. Contrary to these charges, there was no connection of Neel's work with human experiments conducted by the Rochester Manhattan project twenty years earlier, nor did the studies serve as a control for survivors of the atomic bombs in Japan. Neel was not a eugenicist. His program of measles vaccination reduced mortality, and was not in any sense an experiment. Given the passage of time and lack of supporting evidence, further investigation of these charges is pointless. However, the political climate in which human populations are studied has changed dramatically over the last generation. Unless guidelines reflect an international consensus, the benefits of population studies to human welfare and science will be jeopardized. The World Health Organization guidelines should be extended to cover current research.

Avancos na erradicaçäo do sarampo na Paraiba / Improvements in measles erradicacion in Paraiba

Em 1994, os ministros da saude dos paises da America, durante a XXIV Conferencia Sanitaria Pan-Americana da Organizacao Pan-Americana da Saude (OPAS), assumiram o compromisso de erradicar o sarampo na Regiao das Americas ate o ano 2000. Para isso, a Paraiba e demais estados brasileiros implantaram o Plano Nacional de Erradicacao do Sarampo, sob a coordenacao da Fundacao Nacional de Saude (FUNASA). Grandes avancos foram alcancados na vigilancia do sarampo com a implementacao das estrategias de vigilancia epidemiologica desse Plano: o aumento substancial das coberturas vacinais e a realizacao de campanhas periodicas de vacinacao. Ha 18 meses nenhum caso da doenca e registrado, nao sendo detectada, portanto, a circulacao do virus selvagem no estado

Scale for identification of "at risk" families for underfive deaths.

India currently has an infant mortality rate (IMR) of 73 and aims to reach 60 per 1000 live births by 2000 A.D. The "at risk" approach which has been traditionally used for Maternal and Child Health services could help to reduce costs. The main objective of the study was to identity socio-demographic "risk factors" at family level for underfive deaths and assess the validity and efficiency of a risk index scale for this purpose. A computerised database on about 71,000 individuals in 28 villages in Ballabgarh Block exists since 1987. All the underfive deaths in the study area during the period 1991-95 were compared with age and sex matched controls on socio-demographic variables. All variables which were found significant at 10% level were taken in for logistic regression. The variables found significant were used to construct a ten point scale. This scaling system was applied to all the families with an underfive child during the two year period 1996-97. Validity and efficiency of this approach was calculated. A total of 849 cases and their age and sex matched controls were studied. The variables which were significantly associated with risk of underfive deaths were: not received measles vaccine (2.19; 1.58-3.04), history of sibling death (2.03; 1.19-3.45), maternal illiteracy (1.86; 1.23-2.81), never used a contraceptive (1.59; 1.17-2.14), having more than 4 children (1.46; 1.04-2.05). About 40% of houses were labelled as high risk. The sensitivity and specificity were around 60%. The improvement in efficiency by the risk approach was 33%. Risk approach is helpful in identifying families who are at greater risk of having underfive deaths. It results in a modest increase in the efficiency of services.

Manual de vigilancia epidemiológica

Aborda en forma sencilla y resumida, los principales aspectos organizativos del sistema de Vigilancia Epidemiológica que permita una mejor organización y uniformidad de la notificación de los distintos eventos epidemiológicos, así como algunos elementos en el abordaje de las principales enfermedades y problema que afectan a la población y que sirvan por lo tantocomo una guía práctica y organizativa a todos los niveles del sistema

A erradicaçäo do sarampo e o papel do laboratório / Measles eradication and the role of the laboratory

A disponibilidade de vacinas seguras e eficazes, a existência de apenas um tipo antigênico, a estabilidade antigênica, a restriçäo da doença à populaçäo humana e a facilidade de identificaçäo clínica da maioria dos casos de sarampo, permitiram considerar o sarampo como a doença ideal para ser erradicada. Apesar dos esforços neste sentido, com início nos anos oitenta (80), o sarampo continua sendo um grave problema de saúde pública. De acordo com as estimativas da Organizaçäo Mundial da Saúde, ocorreram, no ano de 1997, mais de trinta (30) milhöes de casos e cerca de um (1) milhäo de óbitos por sarampo. Contudo, os dados indicam que a erradicaçäo do sarampo é possível e tem-se uma meta estabelecida para o período de 2005 a 2010. O laboratório tem assumido um papel fundamental nas estratégias de controle e eliminaçäo. O presente trabalho tem por objetivo discutir as diversas oportunidades de atuaçäo do laboratório, assim como as técnicas que mais se adequam a cada finalidade.

Risk factors for increased mortality in children with complications of measles

Measles is a common infectious disease of children, which may be associated with complications. This study was conducted to determine the risk factors that predispose children suffering from complications of measles to increased mortality. This was conducted in the Department of Paediatrics, Mayo Hospital, Lahore from 1st January 1998 to 31st August 1998. Eighty-four children having various complications of measles were included. Thirteen children left against medical advice leaving 71 evaluable cases. Fifty-eight cases improved and were discharged and 13 died. Mortality was proportionate in all age groups. Mortality in the girls as compared to the boys was 9 vs 4 which was not statistically significant. Mortality rate was higher in those with weight < 5th centile [P=0.12]. Measles vaccination was received by 32 percent cases but it had no impact on the case fatality. Fifty-three children had a positive history of contact with a measles patient out of which 60.36 percent had a close contact at home. This also did not have any prognostic significance. Pneumonia was the most common [67.86 percent] complication followed by encephalitis [38.1 percent], diarrhoea, febrile fits, meningitis and tuberculosis. Case fatality of measles was 18.31 percent, however all cases who expired had pneumonia either alone or with another complication. Hence severe malnutrition [weight < 5[th] centile] and pneumonia were two risk factors for increased mortality in this series of patients

Inmunizaciones básicas: estado actual y vigilancia epidemiológica en la provincia de Jujuy / Basic immunizations: present state and epidemiological surveillance in the province of Jujuy

Introducción: El propósito de las vacunas es prevenir las enfermedades infectocontagiosas y sus complicaciones. La OMS, a través del PAI (Programa ampliado de inmunizaciones), estableció la vacunación obligatoria para 6 enfermedades inmunoprevenibles. A partir de distintas fuentes de información, en este trabajo se evaluó el estado de situación de las inmunizaciones establecidas por el PAI y de la vigilancia epidemiológica de las enfermedades incluidas en él en la provincia de Jujuy. Material y métodos: Se emplearon distintas fuentes de información: 1) Encuesta cerrada realizada en padres de niños concurrentes al Hospital de Niños de Jujuy (n = 500). Los datos analizados fueron: lugar de procedencia, comprensión de la utilidad de las vacunas, cumplimientos de los esquemas de vacunación, origen de la información, lugar de vacunación y causas de esquemas incompletos; 2) Datos provinciales de cobertura, números de casos notificados y de defunciones causadas por las 6 enfermedades en niños de 0 a 14 años en el período de 1984-1994. Resultados: Los resultados indicaron que: 1) el 74 por ciento de los padres comprendía la utilidad de las vacunas; 2) el 70,8 por ciento de los niños tenían esquemas completos no observándose variaciones regionales; 3) el 27,8 por ciento de los encuestados no recibió información y en el 37 por ciento de los casos ésta provino de los agentes sanitarios; 4) en cuanto al lugar de vacunación, la proporción fue similar en el puesto de salud (48,6 por ciento) y en el hospital (46,8 por ciento); 5) entre las causas que impidieron el cumplimiento del esquema de vacunación predominó la interconcurrencia de una enfermedad inespecífica (63,1 por ciento); 6) la cobertura fue total en menores de 1 año y decreció en forma diferencial para Sabin, DPT y BCG después del año; 7) excepto para sarampión y tétanos, el número de casos notificados y de defunciones se mantuvo constante en los últimos 10 años. Conclusiones: Si bien en general existiría una adecuada vigilancia de las enfermedades del PAI, la discordancia observada para la cobertura entre los datos oficiales y por encuesta, las falencias en la información y en los programas específicos para enfermedades de importancia local (TBC y meningitis por Haemophilus influenzae) indicarían que se deben ajustar, priorizar y reprogramar las acciones de control epidemiológico de las enfermedades inmunoprevenibles en la provincia de Jujuy

Vaccine effect on the trend of measles morbidity and mortality in Egypt [1960-1985]

Since the measles vaccination program began in 1976, measles reported data for Egypt, 1960 - 1985, were analyzed to reveal trends in measles occurrence, age pattern, seasonal variation and mortality pattern. Data analysis revealed a reduction in the annual average reported cases in Egypt by about 57% after introduction of compulsory vaccination. The impact of vaccination was more evident in the urban than rural areas as the reduction was 64% in urban compared with only 3.5% in the rural Egypt. The mean age of notified measles cases has risen from 3.5 years to approximately 5 years of age over the 9 years since the program began. The mean seasonal index of measles calculated in the pre- and post-vaccination period revealed 8 weeks shift for the maximum seasonal index of measles morbidity. Data analysis showed marked reduction in the reported measles deaths and the case fatality rate after introduction of compulsory vaccination in 1976

Sarampion: determinación de anticuerpos específicos en suero de madres y sus recién nacidos, su relación y prevalencia en el tiempo / Measles: determination of specific antibodies in sera of mother and her newborn, its relations and prevalence in the time

En los países subdesarrollados, el mayor número de casos y muertes por sarampión ocurre en niños menores de 1 año, quienes deberían estar protegidos por la inmunidad pasiva (IP) adquirida de sus madres. Estudios realizados en otros países indican pérdida precoz de IP; situación similar pareciera verse en Venezuela, donde existe un aumento en la incidencia de sarampión en niños entre 6 y 9 meses, antes de la edad establecida para aplicar la vacuna antisarampionosa (VAS). Determinamos la concentración de anticuerpos contra virus del sarampión (IgG AS) en suero de madres y sus recién nacidos (RN) sanos, determinamos el transporte activo placentario del IP contra sarampión y estimamos la edad en que los RN perderían la IP, se harían susceptibles a la enfermedad y responderían a la VAS. 113 pares de madres entre 15-40 años, previamente sanas, con embarazo simple a término no complicado y partos normales y sus RN sanos, a término, y adecuados para edad gestacional (AT/AEG) que acudieron al servicio de obstetricia del "Hospital Miguel Pérez Carreño" del IVSS de Caracas durante Mayo y Junio de 1992. Variables estudiadas: 1)Edad materna, clasificación socio-económica, antecedentes maternos de sarampión y VAS, edad gestacional y peso del RN. 2)IgG AS en las muestras de sangre materna y del RN por el método de ELISA indirecto. 3)Valor de IgG-AS de los RN dividido entre el valor del IgG-AS de sus madres (IgG AS RN/M), expresión del transporte transplacentario. 4)Estimación de la persistencia de IgG AS durante el 1er año de vida. El 94 por ciento de las madres tenían valores protectores contra sarampión (IgG AS=317,55+/-148,33 AU/ml), sin correlación aparente con edad, Graffar, haber sufrido sarampión o haber recibido VAS. Si la vida de la IgG-AS es de 60 días, el 100 por ciento de estos niños no tendrían valores protectores de IgG-AS a los 8 meses y el 195 por ciento responderían a VAS. Concluimos que la adquisición de IP transplacentaria contra sarampión en la población estudiada es menor que en otros países. Estos RN pueden hacerse susceptibles precozmente al sarampión y explicaría la situación epidemiológica actual. Aparentemente pudieran responder apropiadamente a VAS antes de los 9 meses. La utilización selectiva de VAS a partir de los 6 meses de edad puede ser una alternativa de control del sarampión en nuestro país.

Sarampión en adultos: estudio clínico de 68 casos / Measles in adults: clinic study

El propósito del estudio prospectivo fue conocer el espectro clínico epidemiológico del sarampión en personas adultas hospitalizadas durante el brote que afectó al departamento de Huánuco en 1992. Se incluyó 68 pacientes, 50 por ciento para cada sexo. Un 87,6 por ciento comprendidos entre los 15 a 24 años de edad. Sólo el 27,94 por ciento fueron vacunados y un alto porcentaje(64,7 por ciento) refirió contacto previo. La mayoría de pacientes ingresaron al hospital en fase eruptiva (83,82 por ciento). La fiebre y la tos fue la caraterística común en todos los pacientes. Las complicaciones mas frecuentes fueron bronquitis 49,6 por ciento, laringitis 33,8 por ciento y neumonía aguda en 25 por ciento. Las gestantes con sarampión presentaron aborto y parto prematuro. La mortalidad fué 0 por ciento. Podemos concluir señalando que la elevada INCIDENCIA (37 por ciento) de saramión en adultos que se encontró, está en relación con múltiples factores como son: la falla para alcanzar y mantener los niveles elevados de inmunización, no vigilancia efectiva y por último el no control agresivo del brote epidémico