A community-based study of acute respiratory infections among preschool children in Syria

A longitudinal community-based study of the epidemiology of acute respiratory infections (ARI) in children less than 5 years old was carried out in a low income peri-urban area of Syria. A total of 1030 children were followed up by weekly morbidity surveillance for a period of 24 weeks, starting September 1989. The results revealed that, on average, a child suffered 3.4 episodes of ARI per 100 child-days at risk. The average prevalence of ARI was 23 per cent of time of observation. The peak age-specific incidence occurred in children 6-12 months old for cough/cold, and in children 0-5 months for pneumonia. Male children experienced higher incidence and prevalence of ARI. The most frequently reported symptoms were nasal discharge and cough.

Effect of pneumococcal vaccine on morbidity from acute lower respiratory tract infections in Papua New Guinean children

The effect of a 14-valent pneumococcal polysaccharide vaccine on morbidity from acute lower respiratory tract infection (ALRI) was determined in a randomized double-blind controlled trial in children under the age of 5 years living in the Paupa New Guinea highlands. The vaccine did not protect against mild ALRI. Vaccine efficacy in the study as a whole was 28% for moderate/severe ALRI, which was not statistically significant though consistent with the significant effect on mortality. Children entered the trial in five separate cohorts 4 months apart. The incidence of disease and vaccine efficacy varied between cohorts and with age. There was no vaccine effect in the first cohort, which had a much higher proportion of older children. The effect was greatest and statistically significant among those groups encountering an epidemic of moderate and severe ALRI at a young age. It was therefore in children at the most vulnerable age in times of greatest incidence of disease that the vaccine had its most potent effect. It is postulated that the efficacy of pneumococcal vaccine is dependent on the predominant invading serotypes in the period after vaccination, the age at which children develop immunocompetence to specific vaccine serotypes, and the levels of naturally acquired specific immunity already present in children at the time of vaccination, and that for all of these conditions there will be a cohort effect.

Childhood diarrhoea in Sri Lanka: a case-control study of the impact of improved water sources

Between January 1987 and March 1988 a case-control study of the impact of improved water sources on childhood diarrhoea was conducted in Kurunegala District, Sri Lanka. Two thousand four hundred and fifty eight cases of diarrhoea were recruited at five of the hospitals in the district. Another 4140 children presenting at the same hospitals with complaints other than diarrhoea were recruited as controls. Data from the five hospitals suggest that children in households drawing their drinking water from handpumps suffer 46% fewer episodes of diarrhoea than children in families using unprotected traditional sources (95% c. i. 29-59%), while children in families using protected traditional wells suffer 35% fewer episodes than children in families using unprotected traditional sources (95% c. i. 27-41%). There were, however, substantial differences between the different hospitals. Among children recruited at one of the hospitals, the reduction in diarrhoea rates associated with the use of improved sources was estimated to be 93% compared with an average of 18% for the other four hospitals. In common with other case-control studies conducted in Malawi and the Philippines, little evidence of confounding of the association between diarrhoea and water supply was observed. Our results suggest that, in Sri Lanka, the use of improved water supplies, including protected traditional wells, rather than unprotected traditional sources may lead to a substantial reduction in diarrhoea morbidity among children under five years of age.

Determinants of water quality, availability and use in Kurunegala, Sri Lanka

Between January 1987 and February 1988, 4590 homes of children under five years of age were visited in three areas of Kurunegala district, Sri Lanka and data were collected on water related practices. 60% of the population used protected wells, 30% used unprotected sources and 10% used handpumps on boreholes or piped supplies. 90% of households had a source less than 1 km away. Mean water consumption was above 25 litres per capita per day and did not correlate with the distance to source. Samples of drinking water were collected and faecal coliform levels were determined in samples of stored water from 3092 households and in samples from the water sources used by 1043 of these households. The absence or presence of organisms in each sample, and the geometric mean count in samples with organisms were used as indices of contamination. Both indices changed with season and varied between areas and between types of water source. The proportion of positive source samples was uniformly high with the exception of piped supplies and handpumps. The mean count was highest for unprotected sources. There was no evidence that ground water contamination occurred in boreholes. With stored samples, boiling appeared to reduce contamination markedly. The proportion of positive stored water samples was also lower with the use of different vessels for collection and storage, with storage inside the house, and with use of a storage container other than an earthenware pot. Because surface water pollution appears to be important it is proposed that headwalls and drainage aprons be built around unprotected sources. Faecal contamination at the source may have more public health significance than contamination of stored water. In this respect public hygiene may play an important role in reducing water pollution at handpumps or protected wells.

Clinical signs and risk factors associated with pneumonia in children admitted to Goroka Hospital, Papua New Guinea

This study examined the clinical signs and symptoms in 897 children aged under 5 years presenting with pneumonia to Goroka Hospital in the highlands of Papua New Guinea between June 1982 and July 1985. The usefulness of the signs in predicting severity of disease was determined and risk factors for severe disease were identified. While cyanosis and poor feeding were the strongest predictors of death, bronchial breathing, grunting, and nasal flaring also significantly increased the risk of dying. First-born children, children under 1 year of age, females, malnourished children, and children with symptoms for more than 7 days were at increased risk of severe disease and of dying. Fever alone did not increase the risk of dying unless it was present for more than 7 days. These clinical signs of severity and risk factors may be used to improve the efficiency of health education programmes, for both health workers and mothers, aimed at reducing childhood mortality from pneumonia.

Pneumococcal vaccine prevents death from acute lower-respiratory-tract infections in Papua New Guinean children

In three double-blind placebo-controlled trials of pneumococcal capsular polysaccharide vaccines against death from acute lower-respiratory-tract infections (ALRI), children were vaccinated at 6 months to 5 years of age. The efficacy of the vaccines against ALRI as the sole cause of death was estimated at 59% in children vaccinated when younger than 5 years (p = 0.008) and 50% in children vaccinated when younger than 2 years (p = 0.043). Mortality from all causes was 19% less in the vaccinated group.

Density-dependent perception of triatomine bug bites

Pots containing different densities of Rhodnius prolixus were strapped on to the upper and lower arms and legs of six human volunteers. Analysis of the volunteers' perception of the bugs' probing activity showed a clear linear trend of perception according to bug density. Comparison with other results suggests that in humans as well as other vertebrate hosts, density dependent irritation from the bug bites and consequent disturbance and interruption of bugs' feeding could provide the mechanism by which bug development and population density is normally regulated.

The incidence of eye lesions and visual impairment in onchocerciasis in relationship to the intensity of infection

Data from follow-up surveys of onchocerciasis, conducted in the rain-forest and savanna areas of the United Cameroon Republic, are used to fit equations relating the incidence of eye lesions and visual impairment to microfilaria concentration in skin-snips. The incidence of lesions in those aged under 45 appears to be directly proportional to concentration, though the association is less clear in females over 25 in the savanna. The incidence of visual impairment appears also to be directly proportional to concentration among those under 45, but only in the savanna. Predictions of changes in incidence rates under transmission control are made, using hypothetical values for the rate of decline of infection. They are compared with reported incidence of lesions from the Onchocerciasis Control Programme: they are in good agreement for those aged under 30 years, but they understate the observed decline in older subjects.

The molluscicidal properties of Ambrosia maritima L. (Compositae). 2. Results from a field trial using dry plant material

A field trial in Egypt of the plant molluscicide, Ambrosia maritima is described. Applications of 140, 70 and 35 mg/l-1 dry, whole plant were made to irrigation canals and drains in June. The treatment effect took between 1 and 5 weeks to become fully established. The reduction in the numbers of alive Biomphalaria alexandrina snails was generally more than 90% and was virtually the same at all treatment levels and in both types of watercourse. The snail population remained at a low level for at least 3 months until September-October. The possible use of a single, annual application in April or May in controlling snails throughout the main schistosomiasis transmission season in Lower Egypt is suggested.

Dynamics of Schistosoma haematobium infection in a Gambian community. I. The pattern of human infection in the study area

The roles of some of the factors thought to be responsible for the characteristic relationship between age and the intensity and prevalence of Schistosoma haematobium infection have been investigated. In this initial report a study population in an area of intense infection is described, as are the methods used. Subsequent papers report the effect of interrupting transmission with molluscicide in part of the area and compare changes in egg count in this treated area with changes in an area where no intervention took place. These allow a consideration of age-specific rates of loss and acquisition of infection to be made. The intensity and prevalence of infection varied between villages both in the treated and untreated areas, but the relation of age to the pattern of infection was regardless of the level of infection in the villages. Over-all, the number of subjects and their pattern of infection was similar in both areas. The prevalence of infection tended to be higher in adult males than females but preliminary water contact observations suggest males are less exposed to infection. Observations over the three-year study period emphasize the extent of population movement in the study area and point to its importance in the planning of control measures.

Dynamics of schistosoma haematobium infection in a Gambian community. II. The effect on transmission of the control of Bulinus senegalensis by the use of niclosamide

Niclosamide was used to interrupt transmission of Schistosoma haematobium by Bulinus senegalensis in seasonal rainwater pools for a period of three years. Snail populations were progressively reduced to approximately 1% of the numbers in untreated pools. There was little or no evidence of acquisition of new infection by children in the area during the period of intervention. The intensity of infection in a cohort of children initially under 10 years old followed for three years fell by more than 50%, while there was a ten-fold increase in a similar group in a nearby untreated area. The mean annual cost (1982) of control per head of the population protected was pound 0.50 (US $0.89).

Dynamics of Schistosoma haematobium infection in a Gambian community. III. Acquisition and loss of infection

During a three-year period of effective control of Schistosoma haematobium transmission by molluscicide application the mean number of S. haematobium ova passed by subjects in the treated area fell in an exponential manner which suggested that the mean life span of the worm was 3.4 years. Parallel observations were made in a similar but untreated area. A comparison of the observations in these two areas suggested that in the untreated area subjects of all ages acquired infection during the course of the study. At the end of the study over 50% of the egg output in most age groups in the untreated area appeared to come from worms acquired during the preceding three years. There were substantial differences between age groups in the amount of infection acquired. Children, aged between eight and ten years at the end of the study, appeared to be passing perhaps a thousand times more ova from worms acquired during the preceding three years than were middle-aged subjects. Preliminary observations suggest that age- and sex-related differences in the pattern of water contact may not fully account for age- and sex-related differences in the rate of acquisition of infection and its prevalence. The probable significance of protective immunity in the epidemiology of schistosome infections is discussed.

The molluscicidal properties of Ambrosia maritima L. (compositae). 1. Design for a molluscicide field trial

The composite plant, Ambrosia maritima is toxic to the snail intermediate hosts of schistosomiasis. A field trial was required to confirm this activity. A preliminary survey of irrigation canals and drains was conducted using two snail sampling methods. The results have been used to indicate the minimum number of watercourses which would have to be treated and the number of sampling stations per watercourse required to establish statistical significance in a kill of snails obtained from a molluscicide treatment.

The use of infectivity titrations for measurement of the viability of Entamoeba histolytica after cryopreservation

An infectivity titration technique is described for the measurement of the viability of Entamoeba histolytica. Using this method an optimal cryopreservation technique has been developed. When amoebae from young cultures were equilibrated with 7.5% dimethylsulphoxide for 15 minutes at 37 degrees C, cooled to -100 degrees C at 1 degree C per minute, and stored in liquid nitrogen, 1 to 2% regularly survived after thawing rapidly at 37 degrees C and, on occasions, 10 to 12% survived.

Histochemical enzyme variation in Onchocerca volvulus microfilariae from rain-forest and Sudan-savanna areas of the Onchocerciasis Control Programme in West Africa

Histochemical staining methods for acid phosphatase were used to study the differences among microfilariae of various West African strains of Onchocerca volvulus in both forest and Sudan-savanna onchocerciasis zones. The results have shown statistically significant differences in the staining patterns of microfilarial populations in the two zones. In the rain-forest areas, where onchocerciasis is transmitted by Simulium yahense, S. sanctipauli, S. soubrense and S. squamosum, there were no significant differences of microfilarial staining patterns in patients, by age and sex, between the three Simulium-Onchocerca complexes studied. There was a close relationship between the "strain differences", as revealed morphoenzymatically, and the clinical picture of the disease in both the forest and the Sudan-savanna zones. The present findings are in favour of the hypothesis that there are intrinsic differences in the strains of the parasite occurring in the two areas. The application of the histochemical means of parasite characterization appears to be a useful tool in differentiating strains of O. volvulus and could contribute towards a better understanding of the epidemiology of human onchocerciasis in different bioclimatic zones where the disease is endemic.

[Microfilaruria and ocular onchocerciasis (author's transl)]

A study of the relationship between microfilaruria and onchocercal eye lesions has been carried out among 619 persons in 5 villages of North Benin. There is evidence of a significant relationship between microfilaruria and irreversible eye lesions in men aged 15-34 years. The association of microfilaruria with high numbers of microfilariae in the anterior segment of the eye occurs more in older men.

Observations on cattle schistosomiasis in the Sudan, a study in comparative medicine. II. Experimental demonstration of naturally acquired resistance to Schistosoma bovis

Epizootiological observations on Schistosoma bovis in cattle at Kosti, Sudan, showed a significant fall in age-specific prevalence and intensity with age, based on fecal egg count. To test the possibility that this is due to acquired resistance, Kosti cattle and a control group of cattle of similiar breed and age from a nonenzootic area were experimentally challenged with 70,000 S. bovis cercariae. Clinical observations showed very clearly that the Kosti cattle were able to withstand almost completely the effects of the challenge, whereas the controls developed lethal infections. Resistance was further demonstrated by clear differences between the two groups in terms of their body weights, hematological measurements, histopathological and pathophysiological responses, and worm and egg counts. The data suggested that the main basis of the resistance was a suppression of egg production by the worms from the challenge, rather than absolute prevention of their maturation. There was also evidence of a suppression of the fecundity of worms in the naturally infected Kosti cattle.

Observations on cattle schistosomiasis in the Sudan, a study in comparative medicine. III. Field testing of an irradiated Schistosoma bovis vaccine

Previous work has shown that cattle can acquire a strong resistance to Schistosoma bovis infection following repeated natural exposure. Partial resistance to a laboratory challenge with S. bovis has also been demonstrated in calves after immunization with an irradiated schistosomular or cercarial vaccine. The aim of the present study was to see whether this type of vaccine could protect calves under the very different conditions of natural exposure to S. bovis in the field. Thirty 6- to 9-month-old calves were each immunized with 10,000 irradiated S. bovis schistosomula by intramuscular injection and 8 weeks later were released into an enzootic area along with 30 unvaccinated animals. The calves were followed up for 10 months, during which period protection was evidenced by a lower mortality rate, a slower rate of acquisition of infection, and lower fecal egg counts in the vaccinated calves. Necropsy of the survivors showed 60--70% reductions in worm and tissue egg counts of the vaccinated calves as compared to those not vaccinated.

Observations on cattle schistosomiasis in the Sudan, a study in comparative medicine. I. Epizootiological observations on Schistosoma bovis in the White Nile Province

A 2-year epizootiological study was carried out on Schistosoma bovis in cattle in an enzootic area of the Sudan. The prevalence of infection, as judged by the Pitchford fecal egg counting technique, was very high, approaching 90% in 1.5-year-old animals. There was, however, a lower prevalence in older cattle, and this trend was also seen with the fecal egg counts. This suggests that the cattle gradually acquire resistance to reinfection, particularly since there seems to be little age-related variation in the amount of water contact. Monthly incidence rates, estimated from fecal examinations of initially uninfected "tracer" calves showed a marked seasonal pattern, being much higher in the hot summer months, and snail infection rates showed a similar seasonal pattern. In addition, both the monthly incidence measurements and the snail infection rates showed that transmission was much heavier in 1976 than in 1977. Epizootics such as those recorded previously in this area presumably arise from exceptionally intense transmission years.

Tanzania filariasis project: studies on microfilaraemia and selected clinical manifestations of Bancroftian filariasis

In a total of 1977 males aged 5 years and over examined in 21 cluster samples on the coast of Tanzania, the overall rate for microfilariae of Wuchereria bancrofti was 32%. Hydrocoele and elephantiasis rates were 39% and 3%, respectively. The rates and severity of these 2 clinical manifestations increased in the older age groups. Both the microfilarial density and prevalence increased rapidly in the early age groups, followed by a levelling off and then a slight fall in old age. There was no association between microfilarial densities or rates and the overall prevalence of hydrocoele, but a negative association was demonstrated between microfilaraemia and hydrocoeles and elephantiasis. A comparison between the length of residence in an endemic area and the microfilarial and clinical sign rates showed evidence for the long incubation period for W. bancrofti and for the slow development of hydrocoeles and elephantiasis.

The immune response to a meningococcal polysaccharide vaccine in an African village

The antibody response to group C meningococcal polysaccharide vaccine was studied in a Nigerian village. Household clustering of poor responders to immunization was detected. Age had a marked effect on antibody response, maximal titres being obtained only in those over the age of 10 years. Children with malaria parasitaemia had a lower antibody response than those without parasitaemia and subjects with the genotype AA had a lower antibody response than those with the genotype AS. The antibody response to the vaccine was not influenced by mild degrees of malnutrition but children with clinical marasmus or kwashiorkor were excluded from the study.

Long-term outcome after severe head injury

From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled.

Tanzania filariasis project. Survey methodology and clinical manifestations of bancroftian filariasis

In a Bancroftian filariasis survey on the coast of Tanzania microfilaria rates rose with age reaching 53% in the 60-69 year group followed by a slight fall above this age. The most important clinical manifestations were hydrocoele, funiculitis and elephantiasis, with hydrocoele presenting the most serious public health problem. Hydrocoele rates increased with age reaching 90% above the age of 70. The highest proportion of large hydrocoeles were also in the older age groups. A satisfactory methodology was established for the planning of future surveys leading to control.

Bancroftian filariasis: a comparison of microfilariae counting techniques using counting chamber, standard slide and membrane (nuclepore) filtration

Three techniques were compared for counting microfilariae of Wuchereria bancrofti in blood specimens--a standard slide method, the counting chamber technique (CCT) and a membrane filtration technique (MFCT). The CCT was much more sensitive than the slide method, the difference in sensitivity between these two methods probably being due mainly to the loss of microfilariae during the dehaemoglobinizing process prior to staining in the standard slide method. There was good correlation between the techniques when 0.1 ml of finger-prick blood was examined by the CCT and 1 ml of venous blood by the MFCT. The number of additional positives revealed by the MFCT was ten of 275 (3.6%) subjects examined. The use of venepuncture for MFCT is impractical for field surveys in East Africa whereas a microfilarial count on 0.1 ml of finger-prick blood meets most of the criteria required of a field technique. The method is simple, quantitative and acceptable to the population. The results are reproducible, can be readily checked, the technique provides a useful and practical method for obtaining prevalence information following control schemes. The finding of a relatively low prevalence of microfilariae seen by both MFCT and CCT in children aged five to nine years from a highly endemic filariasis area agrees with the results of previous East African surveys carried out by blood smear and CCT.

Morbidity in relation to the clinical forms and to intensity of infection in Schistosoma mansoni infections in the Sudan

A study of morbidity in Schistosoma mansoni infection was made in 593 Sudanese patients seen in a four-year period in Khartoum Civil Hospital. Clinical and laboratory findings were compared in three egg-count groups and in four clinical forms of the infection. Patients were divided into three levels of intensity of infection: light (up to 100 eggs/gram of stool), moderate (101--400 eggs/g) and heavy (more than 400 eggs/g). According to the presence or absence of visceral enlargement, infected subjects were divided into one of four clinical forms: intestinal, hepatic, hepatosplenic and splenic. Among the symptoms only the passage of blood in the stools was significantly related to intensity of infection, and fever was significantly related to the presence of hepatosplenic disease. Hepatomegaly and splenomegaly were significantly more frequent in the heavy infection group. Anaemia, eosinophilia, raised ESR and an increase in both serum alkaline phosphatase and serum globulins were significantly related to the intensity of infection. On the other hand, haematological and biochemical changes, as well as histopathological changes, were more marked and severe in patients with hepatosplenic disease. For comparison, the findings of 117 patients with S. haematobium infections and of 41 with dual S. mansoni/S. haematobium infections are included.

Mast cell population density, blood vessel density and histamine content in normal human skin

Mast cell population density was determined in normal skin from two regions of the arm of several healthy men and compared with blood vessel density and histamine concentration in the same sites. Mast cell and blood vessel counts were made in 1--1.5 micrometer thick plastic sections, by light microscopy and tissue-histamine concentrations were determined by automated fluorimetric analysis. Statistically significant correlations were found between mast cell counts, blood vessel counts and histamine content in skin from the upper arm but no similar correlations were obtained in the forearm. Anatomical differences between the two sites may have been the cause of this discrepancy. Wide variations in mast cell counts and blood vessel density were found in different sections from the same biopsy samples which confirms the notion that dermal mast cells are unevenly distributed. Analysis of variance of the mast cell counts showed that the variance between sections from different blocks from the same biopsy samples was greater than the variance between adjacent biopsies. There was also a marked variation in the histamine content between biopsy samples from sites only 2 cm apart in the same subject.

Further observations on immunization of sheep against Schistosoma mansoni and S. bovis using irradiation-attenuated schistosomula of homologous and heterologous species

This paper describes further characteristics of the immunization of sheep against schistosomes using live, irradiation schistosomula. Sheep immunized with a non-virulent strain of Schistosoma mattheei were protected against a more virulent strain of the same species for over a year. As there was no evidence that the irradiated parasites were able to persist this long, it was concluded that the vaccine had induced a sterile resistance. Heterologous vaccination, using irradiated S. mattheei schistosomula to immunize against S. bovis or irradiated S. mansoni schistosomula to immunize against S. mattheei, failed to induce any protection.

The significance of proteinuria and haematuria in Schistosoma haematobium infection

The intensity and prevalence of proteinuria and haematuria were studied with urinanalysis reagent strips in a Gambian community in which the intensity of infection with Schistosoma haematobium was high. The level of proteinuria present was shown to be related to the intensity of infection. Follow-up for 12 months showed that infected subjects with heavy proteinuria had a good prognosis. These findings suggest that the urinary protein in such subjects is likely to originate from lesions in the bladder and ureters and that advanced glomerular pathology is probably rare. The relationship of the levels of proteinuria and haematuria to the egg count suggests they may be parameters which could have value as indications for chemotherapy. Detailed study showed that the effect of treating all the subjects who had both 30 mg/100 ml or more of protein and at least a trace of haematuria would have been very similar to treating all those with an egg count of 200 ova/10 ml or more. Since urinalysis with reagent strips is very simple and rapid it could have a role in mass chemotherapy campaigns, particularly those aimed at the identification and treatment of heavily infected subjects.

Tanzania Filariasis Project: a provocative day test with diethylcarbamazine for the detection of microfilariae of nocturnally periodic Wuchereria bancrofti in the blood

In coastal Tanzania, an area where the microfilariae (mf) of Wuchereria bancrofti exhibit nocturnal periodicity, the administration of 2 mg diethylcarbamazine (DEC) per kg body weight in the daytime provoked mf to enter the peripheral blood. In persons on normal daily activities the daytime DEC provocative method proved to be as sensitive in detecting microfilaraemia as was the examination of night blood. Its use in routine surveys is therefore justified. Although mf densities by day and night were highly correlated (r = 0.83) they tended to be lower after provocative daytime DEC than in the corresponding night blood, except in very light infections. This method was also useful in assessing the parasitological response to mass chemotherapy with DEC, but, in comparison with the results of the night blood examinations, the sensitivity and magnitude of the counts in persons remaining positive progressively decreased as the period of DEC administration increased. A correction factor has to be calculated to take account of this, and/or additional night blood samples must be taken.The dose of 2 mg of DEC per kg body weight used was readily acceptable to the people in coastal East Africa, whose cooperation is difficult to obtain for night blood surveys. Apart from W. bancrofti, the only human filarial infection occasionally encountered in this area was Dipetalonema perstans. Because of the risk of a severe Mazzotti reaction the test is contraindicated in onchocerciasis endemic regions. Severe reactions may also occur in subjects with loaiasis.

Immunization of calves against Schistosoma bovis using irradiated cercariae of schistosomula of S. bovis

Fourteen 9-month-old zebu calves were immunized with 10000 irradiatedSchistosoma bovisschistosomula given in 1–3 intramuscular or subcutaneous doses, and 4 more calves were immunized with 10000 irradiated cercariae administered percutaneously in a single dose. Eight weeks after the beginning of the experiment these calves, together with four non-immunized controls were challenged percutaneously with 10000 normalS. boviscercariae/calf. Comparative clinical, parasitological, pathological and pathophysiological observations subsequently revealed significant differences between the vaccinated and non-vaccinated calves. The vaccinated calves showed significantly higher growth rates, and a superior body composition as indicated by their lower total body water content. The beneficial effects of vaccination were also shown by significantly lower faecal egg outputs in the vaccinated calves and by their lower tissue egg and adult worm counts. The reduced tissue egg counts were also reflected in the milder histopathological changes seen in the vaccinated calves. The vaccinated calves had significantly higher packed cell and circulating red blood cell volumes than the challenged controls, longer red blood cell half lives, and somewhat lower blood volumes and rates of red blood cell synthesis. No untoward clinical effects that could be attributed to vaccination were recorded. These results indicate that zebu cattle can be effectively protected againstS. bovisby vaccination with irradiated organisms. We are now evaluating this type of vaccine in a field trial in an enzootic area in the Sudan.

Studies on onchocerciasis in the United Cameroon Republic. IV. A four-year follow-up of six rain-forest and six savanna villages. The incidence of ocular lesions

After an interval of four years the same observers re-examined six rain-forest and six savanna villages, using the same standardized techniques. The results of these surveys have previously been reported by area, i.e. rain-forest and savanna. The present paper analyses the incidence of ocular changes by village. In the rain-forest the concentrations of microfilariae in the skin were similar in the six villages and there was, in general, little difference in the incidence and/or deterioration of ocular lesions between these villages. In the savanna the corresponding quantities were much higher in the three more heavily infected villages compared with the three less heavily infected ones. The implications of these findings for the control of blindness due to onchocerciasis in the savanna are discussed.

Infection with Schistosoma mansoni in the Gezire area of the Sudan

A survey for schistosomiasis in a village in the Gezira area of the Sudan in 1973 showed that there has probably been a great increase in the incidence of S. mansoni infection in the last 25 years. Severe morbidity was uncommon in this sample but overt infection was associated with the symptoms of bloody diarrhoea, tiredness, and possibly abdominal pain, and with a reduced level of haemoglobin. Hepatosplenomegaly was common and schistosomiasis is considered to have contributed to this, although hyperendemic malaria must also have been important in its causation.

Arbovirus infections in Sarawak: the role of the domestic pig

The possible role of pigs as arbovirus maintenance hosts and their importance as amplifier hosts was studied. Blood samples from 464 pigs of all ages collected in 1962 and 1964 were tested against 10 arboviruses. Antibodies to Japanese encephalitis and Getah viruses were particularly prevalent and their calculated monthly infection rates were 19-5% and 13-3% respectively. In 1969, 447 pigs were bled monthly throughout the year and the infection rates for Japanese encephalitis virus were calculated in pigs during the first year of life. Infection rates were not uniform throughout the year; the rate increases as the pig grew older and there was a marked seasonal increase in the infection rate in the period from November to January. This coincided with the seasonal major population peak of Culex tritaeniorhynchus following intense breeding of this mosquito prior to rice planting. It is suggested that, in Sarawak, the pig acts as a maintenance host of Japanese encephalitis in a cycle involving C. gelidus mosquitoes and also acts as an important amplifier host towards the end of the year in a cycle involving C. tritaeniorhynchus. It is further suggested that Getah virus is maintained in a similar cycle between C. tritaeniorhynchus and pigs.

Studies on onchocerciasis in the United Cameroon Republic. III. A four year follow-up of 6 rain-forest and 6 Sudan-savanna villages

After an interval of four years the same observers used the same standardized techniques to re-examine 1,016 people in 12 heavily infected rain-forest and savanna villages in Cameroon. The changes in the number of nodules and in the concentration of microfilariae in the skin and eye are described. These latter changes are correlated with the development and/or deterioration of eye lesions and visual impairment. In both the rainforest and the savanna there was a strong association between the development of eye lesions and a high concentration of microfilariae, not only in the eye but also in the skin, and more so at the shoulder than at the buttock. The importance of these findings for the prevention of blindness is discussed.