[Neonatal tetanus in Lomé-Tokoin University Teaching Hospital. Apropos of 145 cases]. / Tétanos néonatal au CHU de Lomé-Tokoin. A propos de 145 cas.

The authors report on series of 145 cases of neonatal tetanus observed in the infectious disease ward of the University Teaching Hospital in Lomé from 1980-1988. The point of entry of infection was in all cases the umbilical cord. Neonatal tetanus is endemic in Togo with a high mortality rate of 71.03% in this series. The prevention of neonatal tetanus still poses a number of problems.

[Antitetanus immunity in mother-child pairs]. / Etude de l'immunité antitétanique dans le couple mère-enfant.

A study on tetanus toxoid immunity in mothers and their children by passive hemagglutination using "Vacci T Pasteur" was conducted in two stages: an initial study of 100 mothers and their newborns was conducted with no particular selection criteria used. Tetanus toxoid titers were measured on serum directly for the mothers and on whole blood using filter paper for the children; a second study of 100 mothers and children was conducted using defined criteria for enrollment. Blood was drawn directly from the veins of both the mother and child in this study. Titers were measured for both mother and child on serum. In both studies it was verified that the pregnant women has good vaccination coverage. However, the study of immunity levels among the newborns showed different results in the two studies. The authors discuss the reasons for these differences and formulate recommendations for an use of these tests during sero-epidemiologic studies in tropical climates.

[Can one contract S. mansoni bilharziasis in Lake Togo or its surroundings?]. / Peut-on contracter la bilharziose à S. mansoni dans le lac Togo ou ses abords?

Authors describe a case of S. mansoni intestinal schistosomiasis in a young wind-surfer. Lake Togo was suspected as a possible place of infection. An epidemiological investigation carried out on the lake and its surroundings (Sio and Hao rivers) has permitted to exclude this hypothesis.

The protective effect of BCG vaccination of the newborn against childhood tuberculosis in an African community.

The latest controlled trial of BCG vaccination in southern India showed that two vaccines failed to confer protection against pulmonary tuberculosis. This result cast serious doubt on the effectiveness of BCG vaccination of the newborn, which is widely applied in developing countries. Therefore, WHO initiated a global research study to evaluate current programmes in developing countries. Part of this study was carried out in Lomé, Togo, in which child contacts of newly detected patients were followed up with clinical and radiological examinations. All observations were recorded according to a scoring system. Concomitant observations were made to verify the comparability of the vaccinated and unvaccinated children. Of the child contacts of 352 index cases, 1421 completed the examinations. The distribution of the final score made it possible to distinguish 175 children likely to suffer from tuberculosis: 113 among the 546 unvaccinated and 62 among the 875 vaccinated children. Significant incomparability was observed in respect of intensity of exposure: the vaccination coverage was relatively low, and the risk of disease relatively high, if a parent was the index case or the child shared the bedroom of the index case (which very often coincided). The other variables studied, including age and sex, turned out to be practically irrelevant as regards comparability. The estimate of the protective effect against all types of tuberculosis combined is 61.5%, which is slightly lower than suggested by the raw data (66%). The protective effect, however, appeared to increase considerably with severity of disease. In children of 5 years and older it was lower than in the younger children. Tuberculin testing failed to reveal any sensitivity induced by BCG in the vaccinated children. The distribution of the tuberculin reactions correlated poorly with the other diagnostic findings. Small reactions were only slightly more frequent in healthy than in sick children; only the very large reactions were associated with a higher risk of disease. This confirms that the tuberculin test is of very limited diagnostic value in young children.

[Epidemiologic study of 2 foci of Schistosoma mansoni bilharziasis in Togo (Lama Kara and Kpalimé). Comparative efficacy of oltipraz (RP 35972)]. / Etude épidémiologique de deux foyers de bilharziose à Schistosoma mansoni au Togo (Lama Kara et Kpalimé). Efficacite comparée de l'oltipraz (RP 35972).

The authors note a very high prevalence of schistosomiasis mansoni in the two foci studied in Togo (Lama Kara in the North and Kpalimé in the South-West); however, the prevalence is significantly higher in Lama Kara (79.5%) than in Klonou (54.7%); this was calculated on both coprological and serological basis. The parasite burden is identical in the two foci; but, the GMRT is higher in Lama Kara than in Klonou (31.7 and 8) which might be explained by a different immunogenicity of the two strains. It is noticed schistosomiasis mansoni might be responsible for hepatosplenomegaly found in the two foci, especially in Lama Kara, which might be explained by a higher virulence in this location. The treatment by oltipraz (RP 35972) had a 91.9% success rate in Klonou (similar to our results in Paris). However, in Lama Kara, even though the drug was taken with some food--increasing its biodisponibility--, the treatment was less effective at day 180 (76.5%). The authors wonder whether the difference of oltipraz efficiency between the two foci is based on a difference of biology between the two strains of Schistosoma mansoni in Lama Kara and in Klonou.

Vibrio parahaemolyticus gastroenteritis during, the El Tor cholera epidemic in Togo (West Africa).

In the course of the El Tor cholera epidemic in Togo (West Africa), Vibrio parahaemolyticus was identified as the causative agent of a cholera-like gastroenteritis. From September 1971 to March 1973 81 cases were confirmed bacteriologically. Seventy patients developed cholera-like symptoms and at first were wrongly diagnosed as cholera cases; 6 other patients were simultaneoulsy infected with El Tor vibrios and V. parachaemolyticus. There was a markedly higher incidence in males than in females. Only sporadic cases occurred, and outbreaks and secondary cases have not been observed. It is suggested that V. parahaemolyticus might be an important agent of acute gastroenteritis on the coast of West Africa.