[The return of diphtheria in Europe. Is the French population protected?]. / Le retour de la diphtérie en Europe. La population francaise est-elle protégée?

Following the generalized vaccination of children, the European countries achieved the elimination of diphtheria. However the huge epidemic which rages since 1990 in the New Independent States of ex-URSS, culminating in 1994-1995 (with respectively 47,802 and 50,412 notified cases), has showed that diphtheria could be still threatening. A serosurvey was carried out in France on 1,025 adult patients attending the emergency wards of three hospitals, located in different parts of this country. This study showed the insufficient immunity of adults, for lack of a routine programme for revaccination: only half of them have antibodies assuring their protection. The antitoxic immunity decreases according to age. This decline is more marked in women than in men, most of them being reimmunized during the military service. These data confirm the alarming results of similar serosurveys performed in others industrialized countries. The present risk of importing diphtheria in these countries requires a strengthening of clinical and bacteriological surveillance of all cases of infections attributable to C. diphtheriae, and could justify a revaccination programme for adult population, including a regular booster, at 10 year-interval, of a reduced dose of diphtheria toxoid (d), and/or using the combined toxoid Td in the wounded, instead of tetanus toxoid alone.

Diphtheria s European come back.

Since children have been vaccinated routinely, diphtheria has been eliminated in most European states and the recent occurrence of a large epidemic in the Newly Independent States (NIS) of the former USSR was unexpected. The resurgence of diphtheria in th

Choice of traditional or modern treatment in west Burkina Faso.

A recent survey shows that patients turn to modern medicine more than traditional medicine for most of their needs except rheumatic and neurological complaints. However, the preferences stated are influenced on the one hand by the much lower cost of traditional services, and on the other by official disapproval of animistic practices.

Haemophilus type B conjugate vaccine: postimmunization kinetics of IgM and IgG antibody responses in ten vaccinated children.

A new Haemophilus type b conjugate vaccine coupling capsular polysaccharide of Haemophilus influenzae b to tetanus toxoid is available in France and other countries. We have studied the kinetics of the immune response in ten children aged 17 to 50 months during the 4 weeks after immunization with one dose of Haemophilus type b conjugate vaccine. Eight serum samples were collected from each child at day 0 (D0), D2, D4, D7, D10, D14, D21 and D28. An ELISA method has been used to discriminate between IgM and IgG classes of anti-polyribosylribitol phosphate antibodies. A high level of IgM appeared at D7 and persisted until D28. The increase in IgG was regular and progressive from D7.

[Anti-Haemophilus influenzae b (Hib) natural immunity in children in Burkina Faso]. / Immunité naturelle anti-Haemophilus influenzae b (Hib) chez l'enfant au Burkina Faso.

BACKGROUND: Natural immunity to Haemophilus infection type b that is acquired by the mothers and passively transmitted to their newborns is not well-known in developing countries, where the frequency of Haemophilus meningitis in infancy is high. POPULATION AND METHODS: Blood samples (5 ml) were taken from 89 women at the time of delivery and from the cord of their babies. Blood samples were also taken from 290 infants and children, distributed into nine subgroups as a function of their age. Children with protein-calorie malnutrition and immune deficiency were excluded from the study. Antibodies against Haemophilus influenzae were measured by Elisa and radioimmunologic methods. Blood concentrations of 0.15 pg/ml or more were considered to be protective. RESULTS: All the blood samples of mothers and cords contained protective levels of antibodies, as did the samples from 30% of those infants aged 0-60 days (all the infants were less than 1 month). No infant in the subgroup 12-23 months had protective levels of antibodies. The incidence of Haemophilus meningitis was correlated with the absence of antibodies. CONCLUSION: Maternal immunity is gradually lost by babies during their first 2 months of life, earlier than in developed countries. Early vaccination, at 3 months of age, is mandatory.

Fluconazole. Review and situation among antifungal drugs in the treatment of opportunistic mycoses of human immuno-deficiency virus infections.

Fluconazole is a novel triazole antifungal drug chiefly used in the treatment of opportunistic mycoses in immuno-compromised patients, particularly those with the acquired immuno-deficiency syndrome (AIDS). In comparison with other antifungal drugs, fluconazole has outstanding physical and pharmacokinetic properties, such as an excellent aqueous solubility allowing a parenteral formulation, high bioavailability by the oral route, even distribution throughout the tissues, including the central nervous system and the cerebro-spinal fluid, a long half-life (permitting once daily administration), and low binding to plasma proteins. It is excreted mainly as unchanged drug in the urine. Fluconazole is a broad-spectrum antifungal agent, especially effective against Candida spp., Cryptococcus neoformans and dermatophytes. Its antifungal efficacy was mainly proved by testing in animal models, since there is no relationship between in vitro and in vivo activities. It possesses a low toxicity and it is well-tolerated. Fluconazole is currently marketed for the treatment of oropharyngeal candidiasis in immuno-compromised patients and of atrophic oral candidiasis. Its place in the treatment of opportunistic mycoses in human immuno-deficiency virus-positive patients, in particular cryptococcal meningitis, is still under investigation but is promising.

[Natural immunity to Haemophilus influenzae type b. ELISA study of the distribution of IgG, IgG1 and IgG2 in France and Africa]. / Immunité naturelle vis-à-vis d'Haemophilus influenzae b étude par méthode ELISA de la distribution des IgG, IgG1 et IgG2 en France et en Afrique.

A Haemophilus influenzae type b capsular polysaccharide-tetanus toxoid conjugate vaccine will be released for use in infants in developing and industrialized countries in the near future. This prompted a comparative study of the natural immunity of mothers and passive immunity of their newborns in France and Africa. An ELISA method capable of discriminating immunoglobulin classes and subclasses was used. Monoclonal antibodies were used to determine titers of IgG1 and IgG2 antibodies. Because capsular polyribose ribitol phosphate does not bind readily to polystyrene, the plate was coated with streptavidine which bound to biotin linked to the antigen. Antibody titers were found to be identical in French and African study groups. Both IgG1 and IgG2 antibodies were found, often with higher titers for the latter. Both subclasses were found in cord blood of French and African children.

[Role of the hospital pharmacy in the preparation of an emergency plan. Experience of the central pharmacy of Angers Regional University Hospital Center]. / Rôle d'une pharmacie hospitalière dans l'élaboration d'un plan d'urgence. Expérience de la pharmacie centrale du CHRU d'Angers.

In case of disasters, an emergency plan has been set up in Angers hospital, to conform to the law. This plan concerns many partners including the hospital Pharmacist. The two principal roles of the Pharmacist are the elaboration of a checklist of drugs, medical and hospital supplies necessary for the care of the victims and the sep up of emergency containers. The computerization of this plan will facilitate its management. Thus the Hospital Pharmacist contributes to the rationalization of a health care necessity in a constrained economic context.

[Topical ophthalmic drugs]. / Actualités sur les formes médicamenteuses ophtalmiques locales.

Although satisfactory therapeutic results are obtained with usual topical opthalmic drugs, they present some inconveniences. Particularly, their biodisponibility is often poor, requiring the use of relatively important doses, and repeated applications. In order to avoid these difficulties, different systems more or less sophisticated, such as soluble inserts, impregnated lenses, liposomes or implantable pumps, have been conceived for topical application. However, although these systems seem to present certain advantages, none of them, commercialized or not, have been quite satisfactory.

[Comparative economic evaluation of nonwoven and traditional woven textiles in operating rooms]. / Evaluation économique comparative du linge non tissé et du linge traditionnel en bloc opératoire.

The nonwoven textiles do not let oneself unconcerned, but are often considered with reserve in the operating theatre, at least for the "noble" textiles, such as the surgical drapes or the surgeon's gowns. Their part is to set barriers to prevent against microbial contamination. Now, it is proved that these nonwoven textiles qualities rise above that of the woven materials. What are the reasons for this reserve? A survey carried out in 1986 at the Angers hospital, compared with other similar studies, have shown a cost decreased by 20 per cent on an average, when the nonwoven textiles are used for a surgical operation, except the gowns. On the other hand, the cost increases by 20 per cent when nonwoven textiles gowns are also used. The features of the traditional textiles versus nonwoven ones in an operating theatre are described and show the interest of the nonwoven textiles.

[Pneumococcal vaccination of the pregnant woman in Africa and passive immunity of the child. Immunologic control by the ELISA method]. / Vaccination pneumococcique chez la femme enceinte en Afrique et immunité passive de l'enfant. Contrôle immunologique par méthode ELISA.

Thirty-seven african women (mean: 23 years old) were immunized with a pneumococcal vaccine and tetanus vaccine, in a comparative study with seventeen (mean: 24 years old) women only tetanus immunized. Immune response to pneumococcal polysaccharide was studied by ELISA. All women had antibodies before vaccination. Their kinetics in mothers and infants, did not show a significant difference between the two groups. In infants, the rate of IgG antibodies significatively decreases from the date of birth to the fourth month of life. There is no foetal immunisation as shows the total lack IgM antibodies in umbilical cord blood. These results suggest that pneumococcal vaccination pregnant women in order to protect infants till 6-9 months, is not valuable.