Reference ranges for IgG, IgM and IgA in the serum of urban and rural Somalis.

In order to provide baseline data for an immuno-parasitological laboratory in Somalia, serum concentrations of IgG, IgM and IgA were determined in some key populations: healthy residents of Mogadishu (n = 157), inhabitants of the village of Daimo Samo (n = 276) and patients with malaria (n = 39) and visceral leishmaniasis (n = 26), both protozoan infections accompanied by hypergammaglobulinaemia and causing severe health problems in Somalia. Since the serum immunoglobulin concentrations in the Somali populations studied were not normally distributed, they were evaluated using medians and percentiles. Significantly higher values of IgG, IgM and IgA were demonstrated in healthy Mogadishu residents as compared to healthy Swedes. Daimo Samo villagers had significantly higher IgG and IgM values than healthy Mogadishu residents. Very high concentrations of IgG and IgM were demonstrated in sera from patients with visceral leishmaniasis. Somali patients with malaria also had marked hypergammaglobulinaemia, however, only in the IgG class. The high levels of IgG, IgM and IgA demonstrated in sera from Somalis, indicate the need for establishing local reference values and should be considered when introducing serological tests in tropical countries. Such methods are usually adopted to conditions in industrialized countries, where immunoglobulin contents of sera are lower.

Influence of storing urogenital specimens at -20 degrees C before testing by enzyme amplified immunoassay (IDEIA) to detect Chlamydia trachomatis antigen.

Urogenital specimens from 445 patients, 174 women and 271 men, were tested for antigen to Chlamydia trachomatis by an enzyme amplified immunoassay, IDEIA. The test results for specimens stored at -20 degrees C for means of 9.6 weeks (from each of the first 376 patients) and eight months (from the remaining 69) were compared with results for specimens stored at 4 degrees C and tested within five days. Of 617 specimens (one from the urethra of each patient and one from the cervices of 172 women) cultured for C trachomatis, 90 (15%) gave positive results. The IDEIA results for specimens stored at -20 degrees C were identical with those of specimens analysed without such storage in 96.4% (595/617) of all cases. No difference was seen between urethral specimens from men or women or cervical specimens or between specimens stored for 9.6 weeks compared with those stored for eight months. In 22 cases in which the IDEIA results differed, culture positive results were missed in stored as well as unstored specimens. The median absorbance value above the cut off point for a positive IDEIA result in stored specimens was no lower than in those not stored. The few differences noted probably depended on the sampling technique rather than on the way of storing the specimens.

Syphilis in women of reproductive age in Mogadishu, Somalia: serological survey.

In Mogadishu, Somalia 223 women of childbearing age, including prostitutes, were tested for serum markers for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Sera reactive in either of these tests were tested for IgM antibodies by solid phase haemadsorption assay (SPHA). Three per cent of sera from 67 pregnant women and none of those from 71 educated women gave positive results that were confirmed with the TPHA. In contrast, 58% of sera from 85 prostitutes were confirmed as being positive, 26% of which were SPHA positive, which indicated active syphilis. The proportion of TPHA positive sera increased with age among the prostitutes. As venereal syphilis is highly prevalent in prostitutes in Mogadishu, a strategy of intervention based on screening followed by treatment seems to be indispensable.

PIP: Three different groups of women were studied in a cross sectional survey conducted during July to August 1985 and in January 1986 in Mogadishu, Somalia. The survey population consisted of: 67 pregnant women (aged 16 to 40); 71 educated women volunteers, (aged 15 to 44); and 85 prostitutes (aged 14 to 48). A standardized protocol elicited data about age, occupation, pregnancies, history of syphilis, and number of clients. Blood samples were taken, and all sera were screened by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum hemagglutination assay (TPHA). The positive sera were tested for IgM antibodies by the solid phase hemadsorption assay (SPHA). Of the 67 pregnant women, two (3%) had positive VDRL test results that were confirmed by TPHA. Three (4%) of the sera from the 71 educated women were reactive in the VDRL test, but the VDRL reactions were false positive. Of the 85 prostitutes, 50 were VDRL positive; 38 of them were confirmed positive by TPHA. The remaining 12 (14%) sera were false positive VDRL reactions. Positive TPHA results in the absence of a reactive VDRL test were found in 11 (13%) of the 85 sera tested. Thus, 49 (58%) of the sera from prostitutes gave positive reactions in the TPHA. The predictive value of a positive VDRL test result was 76%. Of the 49 seropositive prostitutes, 15 (31%) had a history of syphilis, whereas of the 36 seronegative prostitutes, only four (11%) had had syphilis earlier. The positive TPHA results increased with the age of the prostitutes (p = 0.03). IgM antibodies were not detected by the SPHA in VDRL or TPHA positive sera from the pregnant or the educated women, whereas 13 (15%) of the sera from the prostitutes were SPHA positive. All sera that were negative in the VDRL test were negative in the SPHA. One of the 13 prostitutes who had IgM antibodies was pregnant at the time of the study. 45 (82%) of 55 prostitutes claimed to have had only local clients and these 55 had 1-105 sexual partners a week.

Sexually transmitted viral infections in various population groups in Mogadishu, Somalia.

The prevalence of serum antibodies to human immunodeficiency virus (HIV), herpes simplex virus (HSV), and cytomegalovirus (CMV) and of hepatitis B virus (HBV) markers was investigated in different population groups, including prostitutes, in Mogadishu, Somalia. Hepatitis B surface antigen (HBsAg) was detected in 37% of pregnant women, 4% of neonates, 22% of educated women, and 20% of prostitutes. No significant difference between the groups was observed for HBV. In contrast to figures reported from South East Asia, the prevalence of hepatitis Be antigen (HBeAg) was 18% in prostitutes and only 3% in all other HBsAg positive subjects. The prevalence of antibodies to HSV (100%) and CMV (90%) was very high, but antibodies against HIV were not detected in any of 471 sera. As the routes of transmission for HBV and HIV infections are considered to be similar, HIV will probably spread rapidly in Somalia once this virus has been introduced into the country.