Integration of hepatitis B vaccination into the expanded programme on immunization in Chonburi and Chiangmai provinces, Thailand.

Hepatitis B (HB) immunization was introduced as part of the expanded programme on immunization (EPI) in two provinces in Thailand and evaluated over a four year period. Three doses of HB vaccine were offered to 60,980 newborns at birth, 2 and 6 months of age. The overall coverage for complete HB immunization was 90.4%. Serosurveys of randomly selected children under the age of 5 years were undertaken before and at the end of the project. Levels of HBsAg positivity were reduced by 85%, and there was a corresponding 70% increase in protective immunity. These findings demonstrate that HB immunization can be successfully integrated into EPI without adverse effect on coverage rates of other antigens, and results in a marked reduction in the rate of chronic carriage of HB virus in preschool age children.

Study on the management of diarrhea in young children at community level in Thailand.

An evaluating study was carried out among 15,466 children from households randomized from 30 clusters from twelve provinces of twelve regions of Thailand. Results of this study revealed 5.13 per cent of incidence-rate of diarrhea among young children aged under five years with an average of annual prevalence of 1.3 per child. The overall mortality-rate and diarrhea associated death were 51.7 per 100,000 and 6.5 per 100,000 respectively. The utilization of ORS was 25.6 per cent while the using-rate of sugar salt solution (SSS) and the use of recommended home fluids were 2.8 and 33.8 per cent respectively. As for treatment, the intravenous therapy was 6.2 per cent and the use of different types of drugs varied from 18.0 to 21.3 per cent. Only 23.7 per cent of parents could correctly prepare the ORS. The authors have made recommendations for the strengthening of community health education aiming at better promotion of ORS and other home care practices for diarrhea as important measures for lowering mortality together with relating preventive interventions.

PIP: The impact of Thailand's diarrheal disease control program on children under 5 years of age was evaluated in a survey of 15,466 young children from 30 randomly selected clusters in 12 provinces. A total of 733 children (5.13%) had experienced a diarrhea episode in the 2 weeks preceding the survey, with an average annual diarrhea prevalence of 1.3 episodes per child. 34% of sick children were under 12 months of age. 8 children died from diarrhea (mortality rate, 51.7/100,000). 25.6% of children with diarrhea were treated with oral rehydration solution (ORS), 2.8% were given a sugar-salt solution, and 33.8% received home fluids such as rice water. 84.3% of mothers breast fed their child during the diarrhea episode and 71.3% continued other forms of feeding; however, only 8.2% increased the child's fluid intake. Observation revealed that only 23.7% of mothers were preparing the ORS correctly. 58.6% of children received antidiarrheal drugs or antibiotics. Confirmation of these findings requires a larger sample size and collection of data during both the dry and rainy seasons.

Intradermal simulated rabies postexposure prophylaxis using purified chick embryo rabies vaccine.

The antibody responses of 65 volunteers receiving an i.d. regimen (0.1 ml given at two sites on days 0, 3, 7 and 0.1 ml given at one site on days 30 and 90) were compared with the control group of 35 volunteers receiving the standard i.m. regimen. By day 14, seroconversion was observed in all vaccinees in both groups. Geometric Mean Titers remained higher than 0.5 IU/ml throughout the study period. At the end of the observation period on day 365, antibodies persisted in all subjects. The multisite i.d. PCEC regimen has been proved as immunogenic as the standard i.m. regimen. Both regimens were well tolerated. Thus, it would be the effective and cheapest available rabies post-exposure treatment using tissue culture vaccine.

A comparative study on the efficacy of albendazole and mebendazole in the treatment of ascariasis, hookworm infection and trichuriasis.

A comparative study of the efficacy of albendazole and mebendazole was carried out in Pattani Province in the southern part of Thailand. One hundred and ninety-six patients with single or multiple infections with Ascaris, hookworm, and Trichuris were randomized into 4 groups for different treatments. Stool examination by Kato-Katz technique were done before and on day 14 after treatment. Results of the study showed that (1) a single dose of 300 mg mebendazole (locally produced) resulted in cure rates of 50%, 0% and 0% and egg reduction rates of 87.3%, -15.3%, and 28.3%, for ascariasis, hookworm infection and Trichuris respectively; (2) a single dose of 300 mg mebendazole (original) resulted in cure rates of 100.0%, 9.1%, and 43.3%, and egg reduction rates of 100.0%, 72.0%, and 77.9%, for Ascaris, hookworm, and Trichuris respectively; (3) a single dose 500 mg mebendazole (original) resulted in cure rates of 100.0%, 30.2%, and 70.3%, and egg reduction rates of 100.0%, 70.4% and 89.9%, for Ascaris, hookworm, and Trichuris respectively and (4) a single dose of 400 mg albendazole (original) resulted in cure rates of 100.0%, 84.3%, and 67.4%, and egg reduction rates of 100.0%, 96.0% and 87.0%, for Ascaris, hookworm, and Trichuris respectively. Both mebendazole and albendazole are safe and no side effects were observed. The results of this study suggested that albendazole is the preferred benzimidazole derivative for mass treatment of multiple infections with Ascaris, hookworm, and Trichuris.

Intradermal simulated rabies postexposure prophylaxis using purified chick embryo rabies vaccine.

The antibody responses of 65 volunteers receiving an i.d. regimen (0.1 ml given at two different sites on days 0, 3, 7 and 0.1 ml given at one site on days 30 and 90) were compared with a control group of 35 volunteers receiving the standard i.m. regimen. By day 14, seroconversion was observed in all vaccinees in both groups. Geometric mean titers remained higher than 0.5 IU/ml throughout the study period. At the end of the observation period on day 365, antibodies persisted in all subjects. The multisite i.d. PCEC regimen has been proved as immunogenic as the standard i.m. regimen. Both regimens were well tolerated. Thus, it would be the effective and cheapest available rabies postexposure treatment using tissue culture vaccine.