Unmet needs of high-risk mothers reduce success of antiretroviral treatment in HIV-infected infants.

In the era of effective prevention of mother-to-child transmission of HIV, the same psychosocioeconomic factors that predispose to mother-to-child transmission also substantially increase the likelihood of antiretroviral therapy failure in infected infants. For HIV-infected infants to benefit from early infant diagnosis and treatment initiation, into which much funding and effort is now invested, it is vital that these unmet needs of high-risk mothers are urgently attended to. From an ongoing study of early infant diagnosis and treatment following in utero transmission in KwaZulu-Natal, South Africa, we describe four cases to highlight these challenges facing transmitting mothers that contribute to treatment failure in their infants.

Temporal association of rotavirus vaccination and genotype circulation in South Africa: Observations from 2002 to 2014.

BACKGROUND: Rotavirus vaccination has reduced diarrhoeal morbidity and mortality globally. The monovalent rotavirus vaccine was introduced into the public immunization program in South Africa (SA) in 2009 and led to approximately 50% reduction in rotavirus hospitalization in young children. The aim of this study was to investigate the rotavirus genotype distribution in SA before and after vaccine introduction. MATERIALS AND METHODS: In addition to pre-vaccine era surveillance conducted from 2002 to 2008 at Dr George Mukhari Hospital (DGM), rotavirus surveillance among children <5 years hospitalized for acute diarrhoea was established at seven sentinel sites in SA from April 2009 to December 2014. Stool specimens were screened by enzyme immunoassay and rotavirus positive specimens genotyped using standardised methods. RESULTS: At DGM, there was a significant decrease in G1 strains from pre-vaccine introduction (34%; 479/1418; 2002-2009) compared to post-vaccine introduction (22%; 37/170; 2010-2014; p for trend <.001). Similarly, there was a significant increase in non-G1P[8] strains at this site (p for trend <.001). In expanded sentinel surveillance, when adjusted for age and site, the odds of rotavirus detection in hospitalized children with diarrhoea declined significantly from 2009 (46%; 423/917) to 2014 (22%; 205/939; p<.001). The odds of G1 detection declined significantly from 2009 (53%; 224/421) to 2010-2011 (26%; 183/703; aOR=0.5; p<.001) and 2012-2014 (9%; 80/905; aOR=0.1; p<.001). Non-G1P[8] strains showed a significant increase from 2009 (33%; 139/421) to 2012-2014 (52%; 473/905; aOR=2.5; p<.001). CONCLUSIONS: Rotavirus vaccination of children was associated with temporal changes in circulating genotypes. Despite these temporal changes in circulating genotypes, the overall reduction in rotavirus disease in South Africa remains significant.

Serum trace elements in Zairian mothers and their newborns.

OBJECTIVES: Pregnant women in developing countries might be at risk of trace element deficiencies. These deficiencies could have deleterious effects on fetus. Therefore, serum trace elements were determined at delivery in Zairian mothers and their newborns. DESIGN: Prospective study. SETTING: Maternity ward of Kinshasa University Hospital (Zaire). SUBJECTS: 166 pregnant women admitted for delivery and their newborns. MAIN OUTCOME MEASURES: Zinc, copper and selenium were determined by atomic absorption spectrometry. Haematocrit, lymphocyte count, transferrin, ferritin and anthropometric indices (birth weight, length, head and arm circumferences; mother weight) were also evaluated. RESULTS: Serum selenium concentrations were high [mothers: 0.76-1.56 mumol/l (60-124 micrograms/l), newborns: 0.45-1.21 mumol/l (36-96 micrograms/l)]; zinc concentrations were low [mothers: 3.9-11.9 mumol/l (253-773 micrograms/l), newborns: 5.8-17.4 mumol/l (378-1130 micrograms/l)] and copper concentrations were in the range of previous works [mothers: 16.2-49.0 mumol/l (1020-3088 micrograms/l), newborns: 0.7-14.3 mumol/l (44-900 micrograms/l)]. Mother serum indices, age, weight and parity had little influence on newborn serum trace elements. In umbilical serum, copper was correlated to selenium (r = 0.340, P < 0.01); selenium (r = 0.310, P < 0.001) and copper (r = 0.404, P < 0.001) were correlated to transferrin. Newborn selenium (r = 0.310, P < 0.001) and copper (r = 0.257, P < 0.01) concentrations were related to head circumference. Newborn selenium concentration varied according to birth weight [< 2500 g: 0.58-0.86 mumol/l (45-67 micrograms/l); > 2500 g: 0.48-1.20 mumol/l (37-94 micrograms/l). Umbilical serum copper concentration was related to birth length (r = 0.197, P < 0.05). CONCLUSIONS: These results suggest that: (1) copper and selenium status at delivery in Zairian mothers are similar to those in developed countries, whereas zinc status is poor; (2) trace element and nutritional status in the mother and fetus are independent.

[Evaluation of vaccine coverage in children under two years of age in Kinshasa (Zaire)]. / Evaluation de la couverture vaccinale des enfants de moins de 2 ans à Kinshasa (Zaïre).

BACKGROUND: Despite efforts to make immunization against preventable diseases available to all children in Zaire, only about 33% of the children living at Kinshasa were immunized in 1986. METHODS: The compliance with the vaccination schedules was evaluated in 211 children less than 2 years of age consulting in the largest medical center of Kinshasa during one week in September 1989. Socio-demographic data on the parents and histories of infectious preventable diseases in children were also collected. RESULTS: 93% of the children were immunized against tuberculosis, 85% against diphtheria, tetanus, pertussis and poliomyelitis, 76% against measles. Compliance with the vaccination schedule was higher when the mothers were better educated, or when they worked in the public service. 25% of the children had not been immunized against measles at the age of 9 months. CONCLUSION: The vaccine schedule and the strategy must still be improved.

Iron and folate status in Zairian mothers and their newborns.

An evaluation of iron and folate status was carried out on 166 Zairian pregnant women from Kinshasa at delivery and in cord blood from their newborns. Anemia, defined as a low hematocrit value (less than 33%), was observed in 38% of pregnant women. Iron deficiency, recognized by a combination of abnormal values for serum ferritin level (less than or equal to 12 micrograms/l) and transferrin saturation (less than 16%) was present in 54% of pregnant women. Folate deficiency, defined by a red blood cell folate of less than 100 micrograms/l, was observed in 6% of cases. In anemic mothers, anemia was associated with iron deficiency in 57% of cases and with folate deficiency in 5%. Correlations between maternal and newborn iron and folate indicators were found. This study points out the necessity for developing strategies in African countries to combat nutritional anemias during pregnancy by specific measures combined with general strategies.