Human Papilloma Virus Vaccine Awareness and Vaccination History in Patients Attending STI Clinics in Lagos and Ibadan, Nigeria.

HPV is one of the most common causes of sexually transmitted disease in both men and women worldwide. It is transmitted through vaginal, anal, and oral sex. This study provided information on the Human Papilloma Virus (HPV) vaccine awareness and vaccination history in relation to the level of antibodies to (HPV) in the population at risk in Nigeria. Patients attending STI clinics at Lagos and Ibadan were recruited and informed consent was obtained from all the participants. Using semi structured questionnaire, vaccination history, demography and past experiences of the patients were obtained. Whole blood samples were obtained and the sera screened for specific antibodies to HPV using ELISA test kits for determination of IgG to HPV by DIA PRO Diagnostic Bioprobes Milano-Italy according to the manufacturer's instruction. Of the170 samples analysed 50 (29.4%) samples were positive for HPV. Thirty (17.6%) were from females and 20 (11.7%) of them were males. Thirty-five (35%) of the 100 women participants were aware of HPV vaccine. 15(15%) women did not take the vaccine because they did not know where to get it while 20 (20%) of them could not afford it. It was also noted that there is higher prevalence among the middle-aged women. A high prevalence of HPV antibodies was observed in the study yet none of the participants had received the HPV vaccine thus the antibodies may be from infection. Implication is that the 30 women who tested positive for the HPV antibodies may be at risk of cervical cancer.

Fluconazole resistant opportunistic oro-pharyngeal Candida and non-Candida yeast-like isolates from HIV infected patients attending ARV clinics in Lagos, Nigeria.

BACKGROUND: Oro-Pharyngeal Candidiasis (OPC) continues to be considered the most common opportunistic fungal disease in HIV/AIDS patients globally. Azole antifungal agent has become important in the treatment of mucosal candidiasis in HIV patients. Presently, antifungal drug resistance is fast becoming a major problem particularly with the immune depleted population. OBJECTIVES: This study was designed to investigate the: existence of OPC, species distribution fluconazole susceptibility profile of yeast cells isolated from oral specimens of HIV/AIDS patients from Lagos Nigeria, between Oct. 2004 and June, 2005. METHODOLOGY: The venous blood samples were screened for HIV antibodies using the Cappillus HIV I and II test kit (Trinity Biotech Plc UK), and Genie II HIV I and II EIA kit (Bio-Rad France). The positive results were subsequently confirmed at the laboratory attached to each of the clinics, using the Nigerian Federal Ministry of Health approved algorithm. The samples from 213 (108 females and 105 males) HIV positive patients were plated onto SD agar. The isolates were identified by morphotyping, microscopy and speciated using germ tube test and battery of biochemical sugar fermentation and assimilation tests. Fluconazole agar diffusion susceptibility testing was carried out on each isolates. RESULTS: Seventy-four (34.7%) isolates were recovered including one person with double isolates. Only 70 (94.6%) of the isolates could be adequately speciated. Candida albicans 30 (40.5%) was the most frequently isolated species, the rest were non-albicans species, with the frequency of C. tropicalis > C. Krusei > C. glabrata and C. neoformans for species for species having up to 4 isolates. Four (30.8%) out of 13 isolates of C. tropicalis showed germ tube formation. While one C. albicans was germ-tube negative. Out of the 74 isolates tested for fluconazole sensitivity, 58 (78.4%) were sensitive, MIC d'' 8 microg/ml, 9 (12.1%) were susceptible Dose Dependent (SDD), MIC 16-32 microg/ml and 7 (9.5%) were resistant, MICs e'' 64 microg/ml. Among the C. albicans isolates, 26 (86.7%) were sensitive to fluconazole. The rank of susceptibility was C. albicans > C. tropicalis > C. Krusei for the most prevalent species. CONCLUSION: We conclude that fluconazole resistant strains of oro-pharyngeal yeast-like cells exist in about 9.5% of HIV/AIDS patients with the above stated species distribution. We therefore, highlight the need for routine antifungal susceptibility testing on HIV patients with cases of initial or repeat episodes of OPC.

Evaluation of immune response in infants with different nutritional status: vaccinated against tuberculosis, measles and poliomyelitis.

Immune response of infants vaccinated under Expanded Programme on Immunization (EPI) was evaluated for measles, poliomyelitis, and tuberculosis in Ifo/Otta area of Ogun State and Badagry area of Lagos State, Nigeria. In the prevaccination evaluation of measles antibody, 59 per cent were protected and 41 per cent were at risk in Ifo/Otta area, while 49 per cent were protected and 51 per cent were at risk in the Badagry area. After measles vaccination, 89 per cent of those evaluated seroconverted and 11 per cent did not in Ifo/Otta area, while in Badagry area, 86 per cent of those evaluated seroconverted and 14 per cent did not. For polio neutralizing antibody evaluated at post-immunization, 91 per cent seroconverted, while 9 per cent did not in Ifo/Otta area, while in Badagry area 66 per cent seroconverted and 34 per cent did not. Tuberculin test was used to evaluate the cellular response to BCG vaccination against tuberculosis. 64 per cent were found protected, while 18 per cent were at risk in both areas examined and 18 per cent dropped out. Using Gomez method to evaluate the nutritional status of the infants, 34 per cent were malnourished in Ifo/Otta area and are mostly immigrants. In Badagry area, 53 per cent were normal while 47 per cent were malnourished and most of the malnourished infants were plagued with diarrhoea, severe cough, high fever or malaria infection. Most of the malnourished in the two areas screened were between 9 and 18 months of age, which is the crucial period in the growing stage of the children.(ABSTRACT TRUNCATED AT 250 WORDS)

Trial of economical regimens of suckling mouse brain rabies vaccine for postexposure prophylaxis in Lagos, Nigeria.

The suckling mouse brain rabies vaccine, recommended for production and routine use in Nigeria from our previous study, was investigated in the present study in an effort to reduce the cost of antirabies treatment in the country. This is needed for economic reasons. Instead of seven daily doses followed by three boosters, we tried five daily doses followed by three boosters, with or without equine hyperimmune serum given on day 0 (40 IU per kg body weight). Fifty dog-bite, victims, aged 3-81 years, were placed on this regimen, 25 with serum and 25 without serum, according to the history of the case. The serum had no effect on the kinetics of antibody development and both serum and vaccine were well tolerated. The geometric mean titres (GMTs) of antirabies antibodies in the sera of recipients of vaccine alone on days 10, 28 and 90 were 3.05 equivalent units ml-1 (EU ml-1), 4.35 EU ml-1 and 2.54 EU ml-1 respectively. Among those who had received antiserum and vaccine the titres were respectively 3.19 EU ml-1, 4.35 EU ml-1 and 3.02 EU ml-1. Of the 50 subjects, 49 showed detectable antibodies by day 28, and all the 50 survived. This regimen is therefore recommended for further trial in countries where rabies is endemic but potent antirabies vaccines are scarce and expensive. Another 23 subjects, considered not to be at risk of rabies, were given a one-tenth dose, two-site intradermal inoculation of the same vaccine on days 0, 3, 7, 14, 28 and 90.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-rabies treatment of dog-bite victims in Lagos, Nigeria: trial of suckling mouse brain and fetal bovine kidney cell rabies vaccines.

Human rabies is common in Nigeria, a country known for rabies endemicity. Yet the supply of anti-rabies vaccines for human use (adult sheep brain origin, produced locally, and duck embryo and human diploid cell vaccines, imported) is grossly inadequate. This study involved controlled treatment of dog-bite victims with suckling mouse brain (SMBV) or fetal bovine kidney (FBKV) rabies vaccines in an effort to determine which type to recommend for production and use in Nigeria. Dog-bite victims treated were aged three to 74 years, with about equal numbers of males and females. Of the 136 patients, 116 (85.3%) completed at least the primo-series of vaccinations, and all have survived without any evidence of clinical rabies. Recipients of the SMBV showed local and generalized reactions in 11.1% and 2.5% of the cases, respectively. Recipients of the FBKV administered subcutaneously showed local and generalized reactions, in 12.5% and 9.4% of cases, respectively. There were no side effects attributable to the vaccine among patients who received the FBKV intramuscularly. By day 7, 26.7% of SMBV recipients and 28.6% of FBKV recipients showed antibody response, with titres of at least one Equivalent Unit ml-1. These percentages increased to 95.1 and 81.1, respectively, by day 14, and by day 20 (for SMBV recipients) or day 30 (FBKV recipients) the response was 100%. Titres dropped by day 90, but in no case to below 1 EU ml-1. We have concluded that both vaccines are equally efficacious and well tolerated. In view of the simple technology required, and the resultant lower cost, the SMBV is being recommended for production and use in Nigeria.

Cryoglobulins in Schistosoma haematobium infection.

The sera of school children with Schistosoma haematobium infection were tested for the presence of cold-insoluble immune complexes "the cryoglobulins". Two different methods were used: the standard macro-technique and the micro-adaptation technique. On using the standard macro-technique, 40 (32.8%) out of 122 schistosomiasis patients and 6 (7.5%) out of 80 control children were positive for cryoglobulins. Using the micro-adaptation technique, the corresponding numbers were 47 (38.5%) and 8 (10%), respectively. A comprehensive medical examination was carried out before treatment. After treatment with metrifonate (Bilarcil) the quantity of cryoglobulins and the number of children with cryoglobulins were significantly reduced to 12 (9.8%) when using macro-technique, and to 15 (12.3%) with micro-adaptation technique, thus suggesting a possible relationship of cryoglobulinaemia with urinary schistosomiasis. There was a significant difference in the number of sera found positive by the two techniques (X2 = 0.875, P less than 0.1).