Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis.

IgE antibodies (Ab) specific to galactose-α-1,3-galactose (alpha-gal) are responsible for a delayed form of anaphylaxis that occurs 3-6 hours after red meat ingestion. In a unique prospective study of seventy participants referred with a diagnosis of idiopathic anaphylaxis (IA), six (9%) were found to have IgE to alpha-gal. Upon institution of a diet free of red meat, all patients had no further episodes of anaphylaxis. Two of these individuals had indolent systemic mastocytosis (ISM). Those with ISM had more severe clinical reactions but lower specific IgE to alpha-gal and higher serum tryptase levels, reflective of the mast cell burden. The identification of alpha-gal syndrome in patients with IA supports the need for routine screening for this sensitivity as a cause of anaphylaxis, where reactions to alpha-gal are delayed and thus may be overlooked.

Early detection and response to meningococcal disease epidemics in sub-Saharan Africa: appraisal of the WHO strategy.

OBJECTIVE: To assess the sensitivity, specificity and predictive value positive of the WHO threshold strategy for detecting meningococcal disease epidemics in sub-Saharan Africa and to estimate the impact of the strategy on an epidemic at district level. METHODS: Data on meningitis cases at the district level were collected weekly from health ministries, WHO country and regional offices, and nongovernmental organizations in countries where there were epidemics of meningococcal disease in 1997. An epidemic was defined as a cumulative district attack rate of at least 100 cases per 100,000 population from January to May, the period of epidemic risk. The sensitivity, specificity and predictive value positive of the WHO threshold rate were calculated, and curves of sensitivity against (1 - specificity) were compared with alternatively defined threshold rates and epidemic sizes. The impact of the WHO strategy on a district epidemic was estimated by comparing the numbers of epidemic cases with cases estimated to have been prevented by vaccination. FINDINGS: An analysis was made of 48 198 cases reported in 174 districts in Benin, Burkina Faso, the Gambia, Ghana, Mali, Niger, and Togo. These cases were 80.3% of those reported from Africa to WHO during the 1997 epidemic period. District populations ranged from 10,298 to 573,908. The threshold rate was crossed during two consecutive weeks in 69 districts (39.7%) and there were epidemics in 66 districts (37.9%). Overall, the sensitivity of the threshold rate for predicting epidemics was 97%, the specificity was 95%, and the predictive value positive was 93%. Taken together, these values were equivalent or better than the sensitivity, specificity and predictive value positive of alternatively defined threshold rates and epidemics, and remained high regardless of district size. The estimated number of potential epidemic cases decreased by nearly 60% in the age group targeted for vaccination in one district where the guidelines were followed in a timely manner. CONCLUSION: The use of the WHO strategy was sensitive and specific for the early detection of meningococcal disease epidemics in countries of sub-Saharan Africa during 1997 and had a substantial impact on a district epidemic. Nevertheless, the burden of meningococcal disease in these countries remains formidable and additional control measures are needed.

Feeding pattern of Salminus maxillosus (Pisces, Characidae) at Cachoeira das Emas, Mogi-Guaçu River (São Paulo State, Southeast Brazil).

Diet of 364 specimens of the dourado (Salminus maxillosus) was studied monthly at Cachoeira das Emas from November/1996 to May/1998, considered the breeding ground of this and other migrant fishes of Mogi-Guaçu River. Only adults were found at this site, and diet consisted exclusively of fish, with predominance of Leporinus sp. Seasonal variation in feeding activity was highest during some months of the rainy and hot season (September-December), when fish composition and number of prey species consumed also changed. These modifications were primarily attributed to an increase in food availability at the site of study during the rainy season, once most of the migrant species, including small Characidae concentrate there at this time of year. Apparently diet shifts, prey availability and rainfall are intimately related, representing a combination of factors that may account for the observed patterns of resource exploitation.

Feeding pattern of Salminus maxillosus (Pisces, Characidae) at Cachoeira das Emas, Mogi-Guaçu River (Säo Paulo State, Southeast Brazil)

Diet of 364 specimens of the dourado (Salminus maxillosus) was studied monthly at Cachoeira das Emas from November/1996 to May/1998, considered the breeding ground of this and other migrant fishes of Mogi-Guaçu River. Only adults were found at this site, and diet consisted exclusively of fish, with predominance of Leporinus sp. Seasonal variation in feeding activity was highest during some months of the rainy and hot season (September-December), when fish composition and number of prey species consumed also changed. These modifications were primarily attributed to an increase in food availability at the site of study during the rainy season, once most of the migrant species, including small Characidae concentrate there at this time of year. Apparently diet shifts, prey availability and rainfall are intimately related, representing a combination of factors that may account for the observed patterns of resource exploitation

FluNet as a tool for global monitoring of influenza on the Web.

In collaboration with the Institut National de la Santé et de la Recherche Médicale, the World Health Organization (WHO) has developed an Internet application linking the global WHO network of influenza centers (FluNet; http://oms.b3e.jussieu.fr/flunet/). During 1997, 22 pilot centers entered data on influenza activity and viral laboratory results directly into FluNet via secured access. In addition, 54 centers sent data to WHO for entry. Four countries (the Russian Federation, Romania, Sweden, and the United Kingdom) reported widespread outbreaks of at least 4 weeks' duration. The FluNet server ran 24 hours a day without interruption. To improve management and enhance standardization of reporting, this early-alert system for the global monitoring of influenza provides international and national authorities, the public, and the media with full access to real-time epidemiological and virological information.

Re-emergence of monkeypox in Africa: a review of the past six years.

Human monkeypox was first identified in 1970 in the Democratic Republic of the Congo. Extensive studies of this zoonotic infection in the 1970s and 1980s indicated a largely sporadic disease with a minority of cases resulting from person-to-person transmission, rarely beyond two generations. In August 1996, an unusually large outbreak of human monkeypox was reported, and cases continued through 1997 with peak incidence in August 1996, March 1997 and August 1997. Preliminary results from the field investigations in 1997 suggest a new epidemiological pattern where a majority of secondary cases result from person-to-person transmission, and a clinically milder disease. But there is preliminary laboratory evidence of a simultaneous outbreak of varicella in the same geographic region which will undoubtedly modify these preliminary results. Since smallpox was eradicated and vaccinia vaccination terminated in this region, the population of susceptible individuals has grown. The use of vaccination to protect the population at risk, however, must take into account HIV prevalence and the risk of generalized vaccinia when using vaccinia vaccine in populations where HIV is known to be present.

Human monkeypox in Kasai Oriental, Zaire (1996-1997).

Monkeypox is an orthopoxvirus with enzootic circulation in the rainforests of central and western Africa; the virus can be transmitted to humans and cause a syndrome clinically similar to smallpox (e.g., pustular rash, fever, respiratory symptoms, and in

Meningococcal disease: public health burden and control.

Meningococcal disease which is increasing globally is still associated with a high mortality and persistent neurological defects, particularly among infants and young children. Sporadic meningococcal meningitis occurs throughout the world, with seasonal variations, and accounts for 10-40% of endemic bacterial meningitis. Epidemic meningitis occurs in any part of the world but the largest and most frequently recurring epidemics have been in the semi-arid area of sub-Saharan Africa where the current pandemic is associated with attack rates exceeding 500 per 100,000 population and thousands of deaths. In the Americas and Europe serogroup B is the predominant agent causing systemic disease, followed in frequency by serogroup C. Serogroup A meningococcus was historically the main cause of epidemic meningococcal disease globally and still predominates in Africa and Asia. A range of internal and external factors predispose for epidemics such as strain virulence, carriers, humoral immunity, co-infections, low humidity and drought, population movements and crowding. To respond to the current situation and the expected spread of the disease, WHO, in collaboration with its Member States and various governmental and non-governmental agencies, has developed a sustainable plan of action for preparedness and control of meningitis.

Yellow fever: a decade of reemergence.

Since the 1980s, yellow fever has reemerged across Africa and in South America. The total of 18 735 yellow fever cases and 4522 deaths reported from 1987 to 1991 represents the greatest amount of yellow fever activity reported to the World Health Organization (WHO) for any 5-year period since 1948. There is an excellent vaccine against yellow fever. At present, a high proportion of travelers to at-risk areas are reported to be immunized, reflecting widespread knowledge about the International Health Regulations. In South America, yellow fever remains an occupational hazard for forest workers, who should be immunized. However, Aedes aegypti mosquitoes are now present in urban areas in the Americas (including southern parts of the United States), and there is concern that yellow fever could erupt in explosive outbreaks. In Africa, a large proportion of cases have occurred in children. The WHO, the United Nations Children's Fund (UNICEF), and the World Bank have recommended that 33 African countries at risk for yellow fever add the vaccine to the routine Expanded Programme on Immunization; studies show that this would be highly cost-effective. To date, financing yellow fever vaccine has been a major problem for these countries, which are among the poorest in the world. For this reason, WHO has launched an appeal to raise $70 million for yellow fever control in Africa.

Tuberculosis trends in eastern Europe and the former USSR.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

[Trends in the field of tuberculous diseases in the Eastern Europe and former U.S.S.R]. / Tendentsii v oblasti tuberkulëznykh zabolevanii v Vostochnoi Evrope i v byvshem SSSR.

According to WHO questionnaire data, reports of national ministries of health, medical associations and other medical institutions, tuberculosis morbidity in the majority of the East European countries and CIS surpasses that for the West Europe. In 1990-1992 it varied from 18 to 80 cases per 100,000 people. The lowest morbidity was recorded in the Czech Republic, the highest in Roumania and Kazakhstan. In Estonia, Latvia, Lithuania, Russia and Ukraine tuberculosis morbidity tends to a slow reduction, while in Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, Roumania, Turkmenistan mortality rates constantly grow. Antituberculous therapeutic and prophylactic policy in the East Europe and CIS should be aimed at finding the resources for adequate supply of the population with antituberculous medications, introduction of WHO-recommended short course of chemotherapy. On demand, health care system should be restructured and new educational programs for specialists and the population introduced.

Safety of oral poliomyelitis vaccine: results of a WHO enquiry.

PIP: The date received from the 13 countries participating in the World Health Organization (WHO) collaborative study to obtain information on the possible risks associated with the use of oral poliomyelitis vaccine (OPV) and on measures to reduce these risks if they were shown to exist are reported for 1980-84. The data largely confirm earlier patterns and particularly those for 1975-79. 4 countries with a total population of 39 million were free from cases of acute persistent spinal paralysis (APSP) all through 1980-84; 8 countries with a population of 485 million had a low incidence of the disease; and 1 country with a population of 22.6 million continued to experience more cases than any of the others. From a total population of 547 million (1983 estimate), a total of 395 cases of APSP fulfilled the criteria for inclusion in the study, representing an annual average rate of 0.14 cases/1,000,000 population in the 5-year period. 305 of the cases were reported from 1 country. The annual rate in this country was 90 times higher than that of the other countries in the study. 10 countries used oral vaccine; 3 of them administered 20 million doses, and the remaining 7 reported the distribution of 193 million doses. Different approaches were used in the 4 countries that did not report any cases during the 1980-84 period; all these approaches were shown to be effective. Country No. 1 used mono-, bi-, and trivalent oral poliovaccines administered in short-term campaigns. Country No. 2 had a combined vaccination schedule of 3 doses of inactivated poliovaccine followed by 3 doses of oral vaccine administered throughout the year. Countries No. 6 and 12 relied exclusively on inactivated poliovaccine. Of the 8 countries reporting 90 cases of APSP during 1980-84, 6 relied exclusively on OPV. In these 6 countries, based on an estimated overall vaccine acceptance rate of 67% in the 1980-84 period, nearly 24 million children would have completed the full course of primary vaccination within their 1st 2 years of life. There were 32 recipient cases among this child population of 24 million. In sum, the primary conclusion of this study, which extended over a 15-year period, is that oral poliovaccine continues to be one of the safest vaccines in use. The risk of vaccine associated, in all but 1 participating country, was less than 1/1,000,000 vaccinees, cases due to type 3 virus being the most common in both vaccine recipients and contacts. Type 2 occurred more often in contacts than in vaccinees, and type 1 was rarely implicated.^ieng

Rubella--world impact.

Worldwide, rubella is considered a public health problem because of the risk of infection to the fetus and of subsequent congenital defects. It is not a notifiable disease in most countries, and even where it is, it is underreported, and greater than 50% of infections are clinically inapparent. The impact of rubella is therefore gauged mainly through seroepidemiologic studies. Rubella appears to be endemic worldwide except in some remote areas or islands, where explosive outbreaks may occur. In general, a large proportion of a population is infected before puberty, but approximately 20% of adults may remain susceptible. Effective vaccines against congenital rubella exist, and many countries have already begun or are considering initiating large-scale immunization programs. In the developing world, where problems compete for priority in the mobilization of meager available resources, certain factors need to be considered before such programs are launched, including the ability to effectively deliver a program, the relationship between susceptibility and the age-fertility pattern, the incidence of congenital rubella, and the cost-effectiveness of intervention.

World overview of poliomyelitis: regional patterns and trends.

Reporting of poliomyelitis at national and international levels is often incomplete, and data available are often limited to certain reporting areas or to selected health institutions and therefore do not represent the true extent of the problem. However, despite their deficiencies, the annual data available have provided valuable information of disease trends over the years. Over the past five to six years in every World Health Organization (WHO) region, only a small number of countries accounted for the majority of the cases. These countries show a high endemicity, with periodic peaks of even higher incidence. They comprise, but are not composed exclusively of, the most populous countries in their regions. In addition, a number of countries, usually reporting a small number of annual cases, experience pronounced outbreaks every few years. Poliovirus type 1 predominates in communities with low immunization coverage and a high number of reported cases, and conversely there is a preponderance of types 2 and 3 in well-immunized communities reporting only a few cases. Poliovirus type 1 still causes small outbreaks among the nonimmunized population in well-immunized communities. The data available indicate that if concerted efforts were made to secure and sustain high immunization coverage in a selected number of countries, there would be a disproportionate decrease in the number of cases at regional and global levels.

Neurological diseases associated with viral and Mycoplasma pneumoniae infections.

In 1963 the World Health Organization established a system for the collection and dissemination of information on viral infections and by 1976, laboratories in 49 countries were participating in this scheme. The present study is in two parts: part 1 is an analysis of almost 60 000 reports on neurological disease associated with viral and Mycoplasma pneumoniae infections reported during the 10-year period 1967-76. This analysis showed a steady increase in the yearly number of reports of viral neurological diseases, which closely followed the general increase in the overall reporting of virus diseases. Likewise, the seasonal pattern was similar to that seen in general for any given virus.Over 75% of the cases were in children. Over half of all viral neurological diseases were associated with enteroviruses, while the myxoviruses accounted for almost 30%. Among the myxoviruses, mumps virus was by far the most frequently reported. The polioviruses were the agents most commonly detected in cases of paralytic disease. The other enteroviruses, mumps virus, and the herpesviruses were the most frequently reported viruses in cases of aseptic meningitis or encephalitis. On the other hand, one-third to over one-half of the reports on the myxoviruses (excluding mumps and measles) related to ill-defined clinical conditions.Part 2 of the study deals in particular with viruses whose role in neurological disease is less well documented. One laboratory reported an outbreak of adenoviral aseptic meningitis in Czechoslovakia, while another described neurological disease associated with M. pneumoniae infection in Finland. Part 2 also includes a detailed appraisal of viral infections diagnosed in the Netherlands during the period 1973-76. The results are very similar to those routinely reported.