Trends in Bronchopulmonary Dysplasia Among Extremely Preterm Infants in Japan, 2003-2016.

OBJECTIVE: To investigate recent trends in bronchopulmonary dysplasia (BPD) and its risk factors among extremely preterm infants. STUDY DESIGN: Demographic and clinical data were reviewed for 19 370 infants born at 22-27 weeks of gestation registered in the affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2016. We investigated the overall survival and prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age and risk factors for developing BPD among the survivors. RESULTS: Among 19 370 infants, 2244 (11.6%) died by 36 weeks' postmenstrual age. The mortality rate decreased from 19.0% (99% CI, 15.7%-22.8%) in 2003 to 8.0% (99% CI, 6.2%-10.3%) in 2016. Among 17 126 survivors, BPD developed in 7792 (45.5%) infants, and its proportion significantly increased from 41.4% (99% CI, 36.5%-46.4%) in 2003 to 52.0% (99% CI, 48.2%-55.9%) in 2016. A multivariable analysis of the survivors showed a positive association of BPD with ≥4 weeks' supplemental oxygen or invasive ventilation, birth weight <750 g, small for gestational age, ≥4 weeks' noninvasive positive pressure ventilation, chorioamnionitis, <26 weeks' gestational age, <20 cases per year of center patient volume, or treated patent ductus arteriosus. Although the median duration of invasive ventilation was shortened, the proportions of factors associated adversely with BPD generally showed increasing trends over time. CONCLUSIONS: The mortality rate of extremely preterm infants has decreased, but the rate of BPD has increased in survivors between 2003 and 2016. Despite the decreasing duration of invasive ventilation over time, increasing rates of BPD suggest that differences in the patient population or other management strategies influence the development of BPD.

Cuba shows jump in HIV positives.

Cuba experienced a substantial increase in the number of HIV cases in 1996 due primarily to a growth of foreign tourism and an increase in prostitution, health officials said. The Juventud Rebelde newspaper said that since HIV/AIDS testing began in 1985, government-run hospitals and clinics have detected 1609 HIV-positive cases. In 1995 the total was reported at 1196, meaning that 413 new cases were detected in 1996. This compared with only 97 new cases reported during 1995. HIV infection among the island's 11 million inhabitants has remained relatively low due to a massive testing program and a public health infrastructure that provides universal and free medical treatment. Cuba was a pioneer in the use of interferon on those testing HIV-positive. Cuba produces its own interferon, which prolongs the life expectancy of patients, and also reagents for AIDS testing. There are special sanitariums for AIDS patients in most of Cuba's 12 provinces. Cuban adults who test HIV-positive are required to enter the sanitarium in a policy reminiscent of the way tuberculosis patients were tested in the US earlier in this century. Officials said the isolation of patients in sanitariums has been somewhat relaxed over past years by introducing greater flexibility in allowing persons who are considered reliable to live at home or make prolonged visits.

Decrease of measles cases in Mexico.

PIP: During November 27-December 5, 1995, in 21 states of Mexico, staff of PAHO's Special Program for Vaccines and Immunization and specialists from member countries interviewed personnel responsible for measles surveillance and reviewed thousands of daily patient records to evaluate Mexico's measles surveillance system. The personnel were well informed about case definitions and procedures. The team found only one case that fit the measles case definition. This case had not been reported to the surveillance system. Yet epidemiologists investigated 1206 suspected measles cases. The surveillance system could not identify chains of transmission for many of the suspected measles cases, suggesting that these cases were false positives or linked to undetected importations. The process for identifying and reporting cases of suspected measles was inefficient. Specifically, there were different case investigation forms for epidemiologists than for laboratories. The forms were long and requested too much clinical information, most of which was left blank. Patients often had to go through many medical consultation/examinations to make sure that they met the clinical case definition and to obtain a specimen for laboratory testing. There was no system at the local level for tracking suspected cases or once-investigated-now-discarded cases. The different levels of the health system had different databases. Ongoing training and feedback were rare. The Ministry of Health's (MOH) surveillance system did not communicate with that of other systems, e.g., Mexican Institute of Social Security. No ongoing evaluation or monitoring of the surveillance system took place. Based on the findings, the evaluation team made eight recommendations. The system should develop indicators for the quality of the surveillance system. Another identified need was integration of other institutions into MOH's surveillance system by standardizing surveillance training and sharing a common database of measles cases.^ieng

A 13-year follow-up of treatment and snail control in an area endemic for Schistosoma mansoni in Brazil: incidence of infection and reinfection.

The incidences of Schistosoma mansoni infection and reinfection were investigated in an endemic area of Brazil (Peri-Peri, State of Minas Gerais) where chemotherapy and snail control had been used for 13 years (1974-87). Two cohorts were followed: the first consisted of 584 individuals with no evidence of infection at entry (infection cohort), and the second comprised 296 individuals who were treated and did not eliminate eggs 8-12 months afterwards (reinfection cohort). The incidence of infection (per 100 person-years) decreased from 7.5 in 1974-77 to 3.6 in 1986-87, and that of reinfection from 21.3 in 1974-77 to 3.7 in 1986-87. Calendar period, age at risk, and sex were independently associated with both infection and reinfection, while a heavy S. mansoni egg count prior to treatment (> or = 500 epg (eggs per gram of stools)) was independently associated with reinfection. The geometric mean number of eggs after treatment among those reinfected (47 epg) was approximately half that among those infected for the first time (81.5 epg). Age at risk had the greatest effect on both infection and reinfection. The rate ratios of infection and reinfection were 3 to 6 times higher among individuals younger than 20 years than among those aged > or = 25 years, even after adjusting for confounders. This suggests the existence of a strong protective effect with increased age (because of biological and/or environmental factors) for both infection and reinfection.

PIP: Between 1974 and 1987 in Peri-Peri, Capim Branco Municipality, Minas Gerais State in Brazil, the schistosomiasis control program conducted a snail surveillance every 2-6 months, collected stool samples from village members annually, and administered oxamniquine to every person with Schistosoma mansoni eggs in their stool. Incidence of S. mansoni infection and reinfection steadily fell (from 7.5 to 3.6/100 person-years and from 21.3 to 3.7/100 person-years, respectively; p .001). Males were more likely to be infected or become reinfected than females (9.3 vs. 4.8, p .001 and 12.3 vs. 8, p = .025, respectively). 5-9 and 10-14 year olds had the highest incidence of S. mansoni reinfection (24.2 and 21.2 vs. 15.3 for 15-19 year olds, p .001, respectively). Infection rates were highest in 10-14 and 15-19 year olds (15 and 13.8 vs. 3.1-10.1 for 0-4 and 5-9 year olds, p .001, respectively). Reduced water contact and/or increased resistance/immunity may have accounted for lower infection and reinfection rates in people older than 20 years old. Infected people whose stool had a least 500 S. mansoni eggs/gm (epg) of stools were more likely to become reinfected faster and more frequently than people who had less than 500 epg (rate ratio, 1.7; p .001). Mean number of eggs was lower in the reinfected cohort than in the infected cohort (47 vs. 81.5 [ranges, 12-1320 vs. 12-5544]; p .001), suggesting that treatment protected against heavy reinfections. People whose egg count was at least 500 epg before treatment and were at least 25 years old did not become reinfected at a greater rate, however, further supporting the protective effect of age. These results showed that calendar period, age at risk, and sex were each associated with infection and reinfection and that a heavy egg count before treatment was independently associated only with reinfection.

AIDS in El Salvador.

The 1st case of AIDS in El Salvador was diagnosed at Rosales Hospital in San Salvador in October 1985, in a bisexual man who had recently returned from the US. Since that time there have been 110 cases at Rosales Hospital, 81% in men. Of these patients, 54% report exclusively heterosexual histories; 42% report no travel outside El Salvador, 33% report travel to the US, 12% to Honduras, and 7% to Mexico. Risk factors include multiple sexual partners in 61%, prostitution in 7%, and injected drug use in 5%. To date, 52% are known to have died, 18% are alive, and the fate of the remainder is unknown. 5 children with symptomatic HIV infection have been seen at the Benjamin Bloom National Children's Hospital. As of September 1991, 504 persons nationwide were known to be HIV-seropositive, 63% of whom lived in San Salvador. Seropositivity among blood donors at Rosales Hospital has increased from 0% in 1988, when screening began, to 0.265 in 1991.

Epidemic of caesarean sections in Brazil.

Brazil has one of the highest rates of caesarean section in the world. Patterns of caesarean sections were studied in a cohort of 5960 mothers followed from 1982 to 1986 in southern Brazil. Overall, 27.9% were delivered by caesarean section in 1982, this proportion being 30% for nulliparae, 80% for second deliveries when the first was by caesarean, and over 99% for third births when the first two were by caesarean. Socioeconomic status and requests for sterilisation by tubal ligation were important underlying factors. 9.4% of the women were sterilised during a caesarean section (3.7% in the lowest income group and 20.2% in the highest). 31% of women who had had their first child by a caesarean section and who were having a second operative delivery were sterilised. The high rates of caesarean sections and accompanying sterilisations reflect the lack of appropriate reproductive and contraceptive policies in the country.

Poliomyelitis in the Americas, 1969-1984.

PIP: The Expanded Program on Immunization (EPI) has made major advances since it was initiated in the Americas in 1977. Immunization coverage approximately doubled between 1977-84, rising from 25-30% to over 60% of the children at risk. Consequently, the incidence of the 6 EPI diseases (measles, poliomyelitis, tuberculosis, diphtheria, tetanus, and pertussis) has been greatly reduced. These achievements have been particularly marked in the case of polio. From 1969 through 1984, a total of 53,251 poliomyelitis cases were reported in the Americas. In the early years of this period, an average of 4274 cases were reported annually. Between 1981-83, the average number of cases reported per year had dropped to 1115. By 1984 only 525 cases of polio were reported in the Americas. The downward trend is clearly evident, even though improved reporting systems in recent years have resulted in larger proportions of existing cases coming to the attention of the public health authorities. All subregions in the Americas have shown a decrease in reported cases since the EPI was launched in 1977. Almost all countries have made notable progress in bringing polio under control. Between 1975-84, there was a 10-fold decrease in the number of reported polio cases, and the number of countries in the Americas reporting cases dropped from 19 to 11. In 1984 the reported incidence for the Region dropped below the goal set for 1971 in the 10-year health plan for the Americas: less than 0.1 cases/100,000 population. 26 countries had maintained incidence below this level for at least 5 years by 1984. The high degree of polio control already achieved in the Americas can be credited primarily to steadily increasing vaccination coverage of the target populations. The proportion of children under 1 year in the Americas who have received 3 doses of polio vaccine increased from about 34% in 1978 to 78% in 1984. The use of special immunization tactics has contributed significantly to the increased vaccine coverage and decreased incidence of paralytic polio. In the future, success will be measured by the absence of any cases of the disease due to wild poliovirus. The high vaccination coverages already achieved in the Americas make feasible the new goal to reduce the number of cases in the Region to zero.^ieng

Interventions for the control of diarrhoeal diseases among young children: promotion of personal and domestic hygiene.

PIP: The effects of improving personal and domestic hygiene on diarrhea morbidity are reviewed using data from studies in hospitals, day care centers, and communities. There is evidence that low educational attainment and certain religious customs predispose to diarrhea, presumably because of behavioral factors. The specific hygiene related behavior that has een most studied is handwashing. Hospital studies suggest that enteric infections can spread via contaminated hands and that hands can be decontaminated by washing with soap and water. 3 studies from Bangladesh, US, and Guatemala on the impact of hygiene education programs on diarrhea are reviewed in detail. Reductions in diarrhea incidence rates of between 14-48% were documented in these studies. Little is known of the impact of hygiene education programs on diarrheas of specific etiology or of their impact on diarrhea mortality. Information is lacking on the optimal design of such programs, on costs, and on their dependence on preexisting levels of sanitary facilities. The available evidence suggests that hygiene education programs may be a cost effective intervention for diarrhea morbidity reduction. Research is necessary to fill the current gaps in understanding and to clarfiy the operational aspects of these programs. (author's modified)^ieng

Residual paralytic poliomyelitis in a tropical region of Brazil, 1969-1977: prevalence surveys in different age groups as indicators of changing incidence.

The magnitude of the problem of paralytic poliomyelitis in recent years in the tropical Federal District of Brazil was estimated in 1980 by determining the prevalence of residual paralytic poliomyelitis in 10,007 schoolchildren born in 1969-1970 and in 10,794 schoolchildren born in 1973-1974. About 98% of these children attended school in the Federal District. The rate of residual paralytic poliomyelitis of 5.4 per 1000 children born in 1969-1970 was 2.3 times higher than the rate of 2.3 per 1000 born in 1973-1974, which may be related to increasing vaccination of children under one year of age. Paralysis appeared before four years of age in 96.5% of these children. These prevalence rates indicate a minimal average annual incidence of acute persisting paralytic poliomyelitis of 187 cases per million total population during the period 1969-1973 and of 80 per million total population during the period 1973-1977 compared with an average annual incidence of 135 reported persisting and non-persisting paralytic cases per million total population in the United States in the prevaccine era and of four persisting cases per 100 million during 1973-1978.