History of nightblindness: a simple tool for xerophthalmia screening.

Among 5925 preschool-age children examined in a house to house rural field study, X1B (Bitot's spot with xerosis) and/or an history of nightblindness (XN) was presented in 325. Mean serum vitamin A levels among those with isolated XN (13.9 microgram/dl), isolated X1B (13.4 micrograms/dl), and coexistent XN/X1B (12.1 microgram/dl) were similar, and significantly below that of normal age/sex/neighborhood matched controls (17.6, 17.1, and 18.3 microgram/dl, respectively). The mean serum vitamin A level of the matched controls was significantly below that of normal, randomly sampled children from the study population as a whole (20.6 microgarm/dl). As independent screening criteria, disregarding the presence of absence of other signs, twice as many children had a history of XN as had X1B (84 and 41% of all clinically abnormal children, respectively). Of randomly sampled children 55% but only 15% of cases of XN had serum vitamin A levels above 20 microgram/dl. Of children with a history of nightblindness 97% had impaired scotopic vision on objective testing, but the mean serum vitamin A levels among test positives and negatives were identical. These results suggest a properly eleicited history of nightblindness can be almost as specific and far more sensitive an index of vitamin A deficiency and early xerophthalmia than the prescence of Bitot's spots (X1B), and that vitamin A deficiency is a clustered, neighborhood phenomenon rather than an isolated, sporadic occurrence.

Immune responses in human infections with Brugia malayi: specific cellular unresponsiveness to filarial antigens.

We evaluated the cellular immune competence of 101 subjects living in an area of South Kalimantan (Borneo) where Malayan filariasis is endemic. All patients with elephantiasis but none with other clinical stages of filariasis reacted with adult worm antigens. The majority of subjects without clinical or parasitological evidence of filariasis and approximately one-half of those with amicrofilaremic filariasis reacted with microfilarial antigens. In contrast, most patients with patent microfilaremia did not respond to microfilarial antigens. The in vitro reactivity of all patient categories to nonparasite antigens was similar to that of the distant control group. These results indicate that patent microfilaremia is associated with a state of specific cellular immune unresponsiveness and are consistent with the current hypothesis that the various clinical manifestations of filariasis result from different types of immune responses to distinct antigens associated with different developmental stages of filarial worms.

Plague in Central Java, Indonesia.

Plague in man occurred from 1968 to 1970 in mountain villages of the Boyolali Regency in Central Java. Infected fleas, infected rats, and seropositive rats were collected in villages with human plague cases. Subsequent isolations of Yersinia pestis and seropositive rodents, detected during investigations of rodent plague undertaken by the Government of Indonesia and the WHO, attested to the persistence of plague in the region from 1972 to 1974.Since 1968, the incidence of both rodent and human plague has been greatest from December to May at elevations over 1000 m. Isolations of Y. pestis were obtained from the fleas Xenopsylla cheopis and Stivalius cognatus and the rats Rattus rattus diardii and R. exulans ephippium. The major risk to man has been fleas infected with Y. pestis of unique electrophoretic phenotype. Infected fleas were collected most often in houses.Introduced in 1920, rodent plague had persisted in the Boyolali Regency for at least 54 years. The recent data support specific requirements for continued plague surveillance.

Geographic distribution of arbovirus antibodies in indigenous human populations in the Indo-Australian archipelago.

Sera from lifetime residents in 16 localities of the Indo-Australian archipelago and adjacent areas were tested for hemagglutination-inhibition antibody against four alpha-viruses (Sindbis, Getah, chikungunya, and Ross River) and for neutralizing antibody against six flaviviruses (dengue 2 and 3, Japanese encephalitis, Murray Valley encephalitis, Kunjin, and Edge Hill). Mosquito collections were carried out in some of the localities to study vector relationships to distribution of the arbovirus antibodies. Antibodies specific to Sindbis and Getah viruses were rare except in north Australia. Chikungunya virus-specific antibody was highly prevalent in localities of the Oriental zoogeographic region and Wallacea, rare in west New Guinea, and absent in north Australia. Age distribution of chikungunya antibody suggested that the antibody last occurred in most Indonesian localities about 30 years ago. Ross River virus-specific antibody was confined to localities of the Australian zoogeographic region. Antibodies reacting to dengue 2 and 3 viruses occurred in high frequency in the entire area of the archipelago. Antibodies specific to Murray Valley encephalitis and Kunjin viruses were also widespread although at a very low frequency. Japanese encephalitis virus-specific antibody was highly prevalent in areas west of Wallace's Line while it was absent in areas east of the line with the exception of Lombok. Antibody to Edge Hill virus was rare and confined to the Australian zoogeographic region. The distribution of arthropod vectors, vertebrate hosts, and of arboviruses are discussed in relation to zoogeographic divisions.

Dengue virus isolation in Indonesia, 1975-1978.

Virus isolations from dengue hemorrhagic fever patients in Indonesia are reported from 1975 to 1978. All 4 dengue serotypes were endemic in Jakarta, but dengue 3 was the predominant virus isolated. This type was also the most frequently isolated virus from patients outside Jakarta and had the widest distribution in Indonesia. The sensitivity of the mosquito inoculation technique for isolation of dengue viruses is discussed.

Human parasitoses of the Malili area, South Sulawesi (Celebes) province, Indonesia.

A biomedical survey was conducted in 9 villages in the Malili area of South Sulawesi, Indonesia. Blood specimens were examined for malaria and microfilariae; stool specimens were examined for intestinal parasites. Malaria parasitemias were rare; Plasmodium falciparum was detected in 10 and P. vivax in 11 of 985 blood smears. Malayan filariasis was endemic to all villages surveyed. The overall prevalence of detectable microfilaremias was 15%, varying from 34% in Kawata to 1% in Nuha. Microfilarial densities, expressed as MfD50 averaged 8.0 and varied from 1.1 in Timampu to 16.0 in Karabbe. Intestinal parasites were common. Although Schistosoma japonicum was not found, 97% of the examined had one or more intestinal parasites as follows: Ascaris lumbricoides (74%), Trichuris trichiura (65%), hookworm (62%), Entamoeba coli (38%), Endolimax nana (10%), Entamoeba histolytica (6%), Iodamoeba bütschlii (4%), Entamoeba hartmanni (3%), Giardia lamblia (2%) Chilomastix mesnili (1%) and Enterobius vermicularis (1%). Strongyloides stercoralis larvae and Hymenolepis nana eggs were detected once each and heterophyid-like eggs were detected twice.

A controlled field trial of plain and aluminium hydroxide-adsorbed cholera vaccines in Surabaya, Indonesia, during 1973--75.

A controlled field trial comparing the effectiveness of a plain cholera vaccine with that of a vaccine adsorbed to aluminium hydroxide was carried out in a cholera-endemic area of Indonesia during 1973-75. Tetanus toxoid adsorbed to aluminium phosphate was used as the control. In vaccinees aged 1-4 years, the adsorbed cholera vaccine provided about 88% protection for 6 months following vaccination and still provided about 50% protection between 11 and 14 months after vaccination. In the same age group, the plain vaccine provided only 53% protection during the first 6 months and no appreciable protection beyond that period. In those aged 5 years and over, both vaccines provided 50-60% protection throughout the period of observation (14 months). Neither vaccine caused any serious side effects.

Biomedical survey in Irian Jaya (West Irian), Indonesia.

A biomedical survey was conducted in several areas of Irian Jaya, Indonesia in July 1972 in association with an investigation of reports of a cholera outbreak. Stool specimens, blood smears and sera were collected and examined for evidence of parasitic as well as other infectious diseases. A total of 114 stools were examined and the most commonly found intestinal parasites were Trichuris trichiura (94%), Ascaris lumbricoides (74%), hookworm (58%), Entamoeba coli (15%), Endolimax nana (8%), Entamoeba histolytica (7), Entamoeba hartmanni (4%), Giardia lamblia (3%) and Chilomastix mesnili (3%). A total of 513 blood smears were examined and Wucheria bancrofti microfilariae were detected in 4% and malaria in 4% (Plasmodium falciparum 3%, Plasmodium vivax 2%). The malaria and filarial positive individuals lived in Beeuw, Waigeo and Arar, Sorong. These parasitic infections were not detected in people from Biak City and Sburia, Biak. Sera were collected from 357 persons and significant antibody titers were found for Entamoeba histolytica (4%) Toxoplasma gondii (7%), Influenza A2 Hong Kong 68 (65%), Influenza B Taiwan 68 (78%), Japanese encephalitis virus (87%) and Dengue 1 virus (79%).

Timor filariasis: epidemiologic and clinical features in a defined community.

The epidemiology of Timor filariasis was observed during a clinical and parasitologic survey of persons living in a remote village on the island of Flores, Southeast Indonesia. Infection and disease was distributed evenly throughout the community, which was in accord with the breeding and feeding habits of the only identified vector, Anopheles barbirostris. Although micfofilaremia rates appeared independent of host variables of age and sexes and sex, symptoms of disease were greater among males than females, and in both sexes disease rates more than doubled between the first and second decades of life. Symptoms included recurring episodes of inguinal and femoral lymphadenitis with retrograde lymphangitis and fever, abscesses of lymph glands or vessels along the path of the great sapheneous vein and its mae highest yet reported for the Timor filaria; it is a virulent parasite causing serious ill-health among the inhabitants of eastern Flores.

Absence of plague in certain mammals from Java and Kalimantan (Borneo).

Antibodies against plague were lacking in 237 wild mammal sera from Java and 103 from Kalimantan. Wild mammal spleens, 114 from Java and 18 from Kalimantan were negative for plague bacilli. A variety of mammalian species and areas was examined.

Chloroquine-resistant falciparum malaria in East Kalimantan, Indonesia.

Following the discovery of four imported chloroquine-resistant P. falciparum infections in the Province of Yogyakarta (Island of Java) sensitivity tests were carried out in the Province of East Kalimantan Island of Borneo). Twenty subjects were given 25 mg. of chloroquine base per kilogram of body weight over three days. Two infections were found resistant at the RII level and a third at the RI level with early recrudescence on day 7. In the other 17 cases followed up to day 21, six were found again with asexual parasites between day 9 and day 14 and a seventh on day 21. These results confirm the presence of chloroquine resistance in P. falciparum in East Kalimantan and, together with previous findings, suggest a widespread distribution of chloroquine-resistant falciparum malaria in this Province of Indonesia. It is particularly interesting to note that chloroquine-resistant falciparum malaria has now been detected in almost all the area of dispersion of A. balabacensis.

Febrile illnesses resulting in hospital admission: a bacteriological and serological study in Jakarta, Indonesia.

A study of 741 Indonesian patients with fever was carried out in order to determine what serious febrile illnesses are prevalent in Jakarta. All patients were hospitalized primarily because of fever and were studied by bacteriological and serological methods. Bacteremia due to Salmonella typhi (150 cases), S. enteritidis (36 cases), or both (2 cases) was common in both children and adults. One S. enteritidis isolate was chloramphenicol resistant. Serological evidence of Salmonella infection was found in 130 additional cases without bacteremia. Serological evidence of arbovirus infection (94 cases) was common in children. Malaria was found in 12 adults, most of whom were probably infected outside Jakarta. Little serological evidence was found for rickettsial, leptospiral, Brucella, Toxoplasma gondii or a number of other infections. Clinical signs and symptoms in the febrile patients studed were generally nonspecific, and laboratory results reported were very helpful in establishing more accurate diagnoses.

Japanese encephalitis virus from pigs and mosquitoes in Jakarta, Indonesia.

Japanese encephalitis virus was isolated from 11 pools of Culex tritaeniorhynchus and a single pool of C. gelidus mosquitoes at a pig-raising area near Jakarta, West Java, Indonesia, during 1972-74. Ten sentinel pigs placed in the area all developed haemagglutination-inhibition antibodies against Japanese encephalitis and the virus was isolated from the blood of 3.