Search

OBJECTIVE: To evaluate the safety of the intradermal Copenhagen BCG vaccine in neonates at different levels of delivery and neonatal units of the Durban Functional Region and surrounding regions. METHODS: A prospective study was carried out over a two-year period between July 1997 and June 1999. All neonates who had been vaccinated with the intradermal vaccine were evaluated at immunization clinics six weeks after immunization, or earlier if adverse effects occurred. FINDINGS: In total, 9763 neonates were examined: in 95.4% the vaccination scar had healed and 1.5% had no visible scar. Adverse events occurred in 3.1%. The proportion of neonates with no visible vaccination scars decreased over the study period, as did the number with adverse events. The lowest rate of adverse events and the highest rates of healed vaccination scars were seen in the tertiary hospital and regional and district hospitals that were in close proximity to the academic centre involved in this study. CONCLUSION: In the study sites, the transition from the percutaneous to intradermal route of administration of BCG vaccine was successful and took place without incurring unacceptably high rates of adverse events. To minimize adverse events, however, it is essential to continue training health personnel involved in implementing intradermal BCG vaccination programmes.

The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival, Bulletin of the World Health Organization 2008;86:210-214. Resume Dans le contexte mondial actuel d'appauvrissement generalise, les nouvelles directives de I'OMS sur le VIH et l'alimentation du nourrisson recemment publies demandent aux pays de reexaminer leurs politiques d'alimentation du nourrisson en tenant compte d'aspects socioeconomiques plus larges. Cet elargissement de la perspective est motive par de nouveaux rapports convaincants sur l'ampleur a l'echelle mondiale du sous-developpement dans les pays en developpement. Le present article etudie ces aspects en examinant les choix en matiere d'alimentation du nourrisson faits par les meres infectees par le VIH et les programmes fournissant gratuitement du lait pour nourrisson dans un contexte mondial de pauvrete persistante. Les preuves qui s'accumulent d'une augmentation de la malnutrition, de la morbidite et de la mortalite liee a l'abstention ou a l'arret precoce de l'alimentation au sein par les meres infectees et les dangers imprevus de l'alimentation artificielle exigent une evaluation plus approfondie des mesures necessaires pour optimiser les politiques en matiere d'alimentation du nourrisson et de l'enfant et pour faire reculer la pauvrete. Les interventions fragmentaires pour augmenter les ressources qui ne compensent qu'une partie de l'appauvrissement familial (fourniture de matieres de base pour preparer des aliments pour nourrissons conformes a l'hygiene par exemple) et prennent de mauvaises decisions concernant l'alimentation du nourrisson, sont condamnees a echouer. Il n'existe pas d'alternative a la prise de mesures fondamentales pour attenuer la pauvrete. Les couts d'opportunite de tels programmes, les couts en matiere d'equite de la fourniture selective de ressources et les pertes dues aux tentations de vendre des biens en capital doivent etre soigneusement evalues. La fourniture de preparations pour nourrissons a des populations pauvres subissant une forte prevalence du VIH ne peut se justifier par des elements factuels, des considerations humanitaires, le respect des traditions locales ou des resultats economiques. L'alimentation exclusivement au sein, menacee par l'epidemie de VIH, reste la base inebranlable de la survie de l'enfant. Resumen La publicacion de las nuevas directrices de la OMS sobre el VIH y la alimentacion del lactante, en un contexto mundial de empobrecimiento generalizado, obliga a los paises a revisar sus politicas de alimentacion del lactante en relacion con algunos aspectos socioeconomicos mas amplios. Esta perspectiva mas amplia es imprescindible a la vista de la contundencia de los ultimos datos sobre la magnitud del subdesarrollo global en los paises en desarrollo. En este articulo se analizan esas cuestiones centrando la atencion en las decisiones de alimentacion de sus hijos que toman las madres infectadas por el VIH y en los programas que suministran leche artificial gratuita en un contexto mundial de pobreza persistente. La creciente evidencia de un aumento de la malnutricion, la morbilidad y la mortalidad asociadas a la evitacion o la interrupcion temprana de la lactancia materna por las madres infectadas por el VIH y los riesgos imprevisibles de las preparaciones para lactantes exigen una evaluacion mas profunda de las medidas necesarias para formular politicas optimas sobre la nutricion del lactante y del nino y para mitigar la pobreza. Las intervenciones fragmentarias de incremento de los recursos con miras a paliar solo una parte del empobrecimiento de las familias, como productos basicos para la elaboracion higienica de las preparaciones y algunas decisiones desacertadas en materia de alimentacion del lactante, estan destinadas a fracasar. No son esas alternativas que puedan suplir medidas fundamentales de mitigacion de la pobreza. Los cestos de oportunidad economicos de esos programas, la inequidad que supone proporcionar recursos a unos y no a otros, y las perdidas debidas a la tentacion de vender los bienes de capital exigen una detenida evaluacion. El suministro de preparaciones a las poblaciones pobres con alta prevalencia de infeccion por VIH no puede justificarse aduciendo la evidencia disponible, consideraciones humanitarias, el respeto de las tradiciones locales o los erectos economicos. La lactancia materna exclusiva, amenazada por la epidemia de VIH, sigue siendo un arma fundamental para la supervivencia infantil., WHO Consensus Statement on HIV and Infant Feeding The new WHO Consensus Statement on HIV and Infant Feeding (1) highlights critical issues in the continuing debate on whether the HIV [...]

A study report describes pregnancy outcomes among clade C HIV-infected and uninfected women in South Africa. Although low birth weight was associated with increased early mortality for infected and uninfected women, the risk of a baby dying in the first 6 weeks of life was not independently associated with maternal HIV infection.

Author(s): Photini Kiepiela [1]; Alasdair J. Leslie [2]; Isobella Honeyborne [1, 2]; Danni Ramduth [1]; Christina Thobakgale [1]; Senica Chetty [1]; Prinisha Rathnavalu [1]; Corey Moore [3]; Katja J. Pfafferott [...]

A safe and effective HIV-1 vaccine is urgently needed to control the worldwide AIDS epidemic. Traditional methods of vaccine development have been frustratingly slow, and it is becoming increasingly apparent that radical new approaches may be required. Computational and mathematical approaches, combined with evolutionary reasoning, may provide new insights for the design of an efficacious AIDS vaccine. Here, we used codon-based substitution models and maximum-likelihood (ML) methods to identify positively selected sites that are likely to be involved in the immune control of HIV-1. Analysis of subtypes B and C revealed widespread adaptive evolution. Positively selected amino acids were detected in all nine HIV-1 proteins, including Env. Of particular interest was the high level of positive selection within the C-terminal regions of the immediate-early regulatory proteins, Tat and Rev. Many of the amino acid replacements were associated with the emergence of novel (or alternative) myristylation and casein kinase II (CKII) phosphorylation sites. The impact of these changes on the conformation and antigenicity of Tat and Rev remains to be established. In rhesus macaques, a single CTL-associated amino substitution in Tat has been linked to escape from acute SIV infection. Understanding the relationship between host-driven positive selection and antigenic variation may lead to the development of novel vaccine strategies that preempt the escape process.

HIV-infected women may have enough virus in their breast milk to transmit the virus to their baby. In a study of 79 HIV-infected women, the greater the amount of virus in breast milk, the greater the chance of transmitting the virus to the baby.

Objective. The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. Methods. First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. Results. Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. Conclusions. Informed consent in this setting was truly informed but not truly voluntary. (Am J Public Health. 1998;88:637-640)

Objective. The effects of vitamin A supplementation on morbidity of children born to human immunodeficiency virus (HIV)-infected women were evaluated in a population where vitamin A deficiency is not endemic. Methods. A randomized, placebo-controlled trial of vitamin A supplementation was carried out in 118 offspring of HIV-infected women in Durban, South Africa. Those assigned to receive a supplement were given 50 000 IU of vitamin A at 1 and 3 months of age; 100 000 IU at 6 and 9 months; and 200 000 IU at 12 and 15 months. Morbidity in the past month was then recalled at each follow-up visit. Analysis was based on 806 child-months. Results. Among all children, the supplemented group had lower over-all morbidity than the placebo group (OR = 0.69; 95% confidence interval [CI] = 0.48, 0.99). Among the 85 children of known HIV status (28 infected, 57 uninfected), morbidity associated with diarrhea was significantly reduced in the supplemented infected children (OR = 0.51; 95% CI = 0.27, 0.99), whereas no effect of supplementation on diarrheal morbidity was noted among the uninfected children. Conclusion. In a population not generally vitamin A deficient, vitamin A supplementation for children of HIV-infected women appeared to be beneficial, reducing morbidity. The benefit was observed particularly for diarrhea among HIV-infected children. (Am J Public Health. 1995; 85:1076-1081), Vitamin A supplements may reduce the incidence and severity of infection, especially diarrheal infections, in infants of HIV-positive mothers. Vitamin A is known to strengthen immune responses. The infants of 118 HIV-positive mothers were randomly assigned to receive oral doses of vitamin A or placebo at 3-month intervals until 15 months old. HIV status was determined at 15 months. Of the 107 surviving children, 13 in the supplemented group were HIV positive versus 15 in the placebo group. Supplemented children had two-thirds the overall infection rate. Episodes of diarrhea were reduced by 29% and cases of severe diarrhea requiring hospital admission by 77%. For HIV-positive children, the incidence of diarrhea was cut in half. All hospital admissions for diarrhea were in HIV-positive children, and this was reduced by 77% in the HIV-positive group.