Meeting the urgent need for rabies education in Haiti.

The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4 years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies.

Immunologic testing and immunotherapy in recurrent spontaneous abortion.

One hundred sixty-one couples with clinical histories of unexplained recurrent spontaneous abortions were analyzed in part for human leukocyte antigens, antibodies to paternal lymphocytes, and mixed lymphocyte culture reactions. All sera with antipaternal antibodies were investigated on a cell panel and absorbed with various tissues and heparin to help define antigenic specificities, and the couples were categorized as primary or secondary aborters. Primary but not secondary aborters were found to share more human leukocyte antigens with their mates than did 103 control fertile couples. Lymphocytotoxins were rarely identified in primary but were commonly present in secondary aborter sera. Results of mixed lymphocyte culture reactions with primary aborting couples showed an intrinsic cellular inability for the wives to recognize their husbands' cells. Secondary aborting couples' mixed lymphocyte culture reactions also were depressed but as a result of an inhibiting substance in the wives' sera. Thirty-three primary aborting women were treated by immunotherapy with leukocyte infusions as a prophylactic source of trophoblast-lymphocyte cross reactive antigen stimulation to immunologically protect their pregnancies. Eighty-nine percent of primary aborting patients delivered successfully. Six secondary aborting women were treated with heparin therapy; two of these delivered normal infants, two are pregnant, and two have aborted. Clinical implications for immunologic testing and immunotherapy in pregnancy failures are discussed.