Influenza outbreak in a correctional facility.

The outbreak of influenza in a corrections facility occurred during August 2000. The outbreak progressed following introduction of the disease by a member of the public to the facility. Rapid diagnosis and typing of the influenza isolates was available, although two prisoners required hospital admission due to the severity of complications at the time of diagnosis. The group demonstrated rapid transmission of the virus by the respiratory route and probably by fomites. The identified infecting virus was A/Moscow-like, an H3N2 subtype typically associated with large outbreaks. Prevention of such outbreaks will involve either achieving high rates of vaccination within the risk groups, or rapid (possibly point of care) diagnosis with the institution of antiviral therapy within 48 hours of symptoms. Influenza control within institutions is feasible using such strategies, although it requires considerable planning to have such approaches in place during winter--a time when institutional staff absenteeism is typically high.

Thabo Mbeki and the AIDS 'jury'.

This paper examines the debate regarding efforts by the South African government to control the spread of HIV infections, with particular reference to events surrounding the 13th International AIDS conference. We posit that the reaction of the medical, pharmaceutical, and media sectors to the stance by the President Mbeki on HIV control amounts to an over-simplification of a very complex issue. Empathy and sincere partnership are required to address South Africa's worsening AIDS situation.

Response to HBV vaccine in relation to vaccine dose and anti-HCV positivity: a New South Wales correctional facilities' study.

Currently, about two-thirds of inmates in NSW correctional facilities have a history of injection drug use, and about half have serological evidence of exposure to hepatitis C virus. The introduction of an accelerated hepatitis B vaccination program (0-1-2 months) in 1998, using a 20 microg/dose vaccine was necessitated by the need to vaccinate eligible inmates in this high-risk environment characterised by rapid client mobility. Since 1999, both 10 and 20 microg doses of vaccine were introduced. We found that sero-response rates were not significantly influenced by HCV antibody status, but were significantly lower in cohorts of inmates vaccinated with the 10 microg dose of vaccine.

Implementing tuberculosis control programmes in Kaduna State, Nigeria.

This paper discusses the impact of pre-payment versus free drug therapy on case-finding and treatment of tuberculosis patients. While the Kaduna State tuberculosis pilot project introduced fees mainly as a cost-recovery measure, evaluation of several cohorts revealed that while it led to a reduction in the proportion of diagnosed smear-positive patients that could afford treatment, it markedly enhanced compliance in those willing to pay. Ways to balance this trade-off are suggested.

Life after multidrug therapy: the managerial implications in leprosy control in Kaduna State, Nigeria.

Multidrug therapy (MDT) represents a most effective technology for the chemotherapy of leprosy. This has created a belief that elimination of leprosy through MDT is a possibility. However, the managerial implications of MDT are not always appreciated. This study highlights major managerial implications of MDT implementation using the Kaduna State Leprosy Control (Nigeria) as a focal point.

Stigma and socio-economic reintegration of leprosy sufferers in Nigeria.

Leprosy is the commonest cause of peripheral neuropathy in the world. This feature causes gross deformities of the face and limbs of infected individuals as well as crippling disabilities involving sight, touch and manual dexterity. Such stigmata intensified the social and economic isolation of patients. Although concerted efforts by national governments and international organisations have made leprosy cease to be a medical problem in most parts of the world, leprosy still remains a "human problem": about 30% of past or present leprosy sufferers in Nigeria are disabled and/or handicapped as a result of the disease. This paper reviews the various factors contributing to leprosy stigma in Nigeria and proposes ways of minimising it.

Effect of socio-cultural beliefs on patients' perception of leprosy. The gender factor.

A study to determine the gender factor in the effect of socio-cultural beliefs on patients' perceptions of leprosy was conducted with the participation of 293 leprosy patients in Kaduna State, Nigeria. Results indicate that, contrary to popular belief, the male model is not the single interpretative model for leprosy as far as socio-cultural aspects are concerned. These differences are analysed and appropriate suggestions made.

AIDS and tuberculosis/leprosy in Nigeria: the urbanisation factor.

A study was conducted between February and June 1994 on the influence of urbanisation on the seroprevalence of human immunodeficiency virus (HIV) amongst tuberculosis (TB) and leprosy patients in the 4 Primary Health Care Zones in Nigeria. Results indicate that 71.4% of all smear positive TB patients and 75% of all multibacillary (MB) leprosy patients that are HIV seropositive in this study are resident in the urban areas. This study emphasizes the need for careful sample selection in studies involving HIV and tuberculosis/leprosy, and for careful monitoring of the HIV/leprosy interactions.

The patient as a starting point for health education in leprosy control.

The current strategy for leprosy control remains the early diagnosis and effective treatment of leprosy patients with multi-drug therapy (MDT), together with the prevention and/or limitation of disabilities. This paper proposes patients-centred health education strategies that may help in the goal of eliminating leprosy as a public health problem by the year 2000, in leprosy endemic countries like Nigeria.