Gambian Infants Research Articles

Energy Expenditure and Physical Activity of Malnourished Gambian Infants

Energy Expenditure and Physical Activity of Malnourished Gambian Infants

TRIAL OF AN ATTENUATED BOVINE ROTAVIRUS VACCINE (RIT 4237) IN GAMBIAN INFANTS

A randomised, controlled trial of bovine rotavirus vaccine was undertaken in Gambian infants. Three doses were administered, from the age of ten weeks, concurrently with oral or killed polio vaccine. Prevaccination rotavirus neutralising antibody levels were high. 84/185 infants (45%) showed an increase in neutralising antibody titre after receiving rotavirus vaccine, compared with 20/91 (22%) unvaccinated infants. Clinical rotavirus infection was detected in 24/78 (31%) children in the rotavirus/oral polio group, 34/83 (41%) children in the placebo/oral polio group, and 23/92 (25%) children in the rotavirus/killed polio group, giving an overall vaccine efficacy of 33% (95% CI 4-53%). RIT 4237 did not appear to reduce the severity of clinical infections. Most cases (92%) were caused by rotaviruses with short RNA electropherotypes. Serological responses to rotavirus vaccination appeared unaffected by the concurrent administration of oral polio vaccine. Lower types 1 and 3 polio antibody levels were found in children who received oral polio and rotavirus vaccines but the differences were not statistically significant.

Factors affecting the integrity of the intestinal mucosa of Gambian children

The interrelationship between diarrhea, malnutrition, and small bowel integrity was investigated prospectively in 68 Gambian infants aged 0–18 mo. Profiles of growth and morbidity were recorded for 8 mo. Each month intestinal permeability was measured by the differential uptake of orally administered lactulose (L) and mannitol (M). In well infants the mean L:M ratio was 0.42 (range 0.11–1.42). This ratio was increased slightly for underweight (60–80% wt for age) infants (mean 0.52) but considerably for those with marasmus (less than 60% wt for age) (mean 1.3, p less than 0.001), for those with acute or chronic diarrhea (mean 1.0 and 2.85, respectively; p less than 0.001), or with measles (mean 1.4, p less than 0.001). Sequential studies of ward patients with malnutrition and diarrhea showed a rapid fall in L:M ratios with resolution of diarrhea. These studies suggest that damage to the small intestine may play an important part in the development of infant malnutrition in The Gambia.

IMMUNISATION OF 4-6 MONTH OLD GAMBIAN INFANTS WITH EDMONSTON-ZAGREB MEASLES VACCINE

Five different vaccination schedules were used to immunise Gambian infants aged 4-6 months against measles with the attenuated Edmonston-Zagreb strain of virus, which has a history of passage in human diploid cells. Vaccine aerosol given either by mask in a dose of 3500 or 7000 plaque-forming units (PFU) or from a plastic bag at a dose of 7000 PFU raised haemagglutinininhibiting or plaque-inhibiting measles antibody 16-24 weeks after vaccination to a titre of 1 in 8 or greater in all but 3 of the 51 children so vaccinated. All 21 infants given 11 400 PFU of vaccine intradermally in two divided doses and the 21 given 39 000 PFU of the virus subcutaneously also had satisfactory levels of measles antibody 16 weeks after vaccination. None of the vaccinated children had clinical evidence of measles in the 12 to 17 months after vaccination. The Edmonston-Zagreb vaccine, given subcutaneously or by other routes at 4-6 months, may be useful in preventing measles in infants in African cities, where 15-30% of children have measles before they are 9 months old, which is the recommended age for immunisation with the chick-cell-adapted strains of measles virus.

Congenital transfer of antibodies against malarial sporozoites detected in Gambian infants.

A survey of the antibody response to sporozoites of Plasmodium falciparum was carried out on plasma samples obtained from 20 mothers and their newborn infants living in The Gambia, West Africa. Serological assays detected antisporozoite antibodies in 90% (18/20) of the mothers, and similar titers were detected in 17/18 of their infants. The antisporozoite antibodies were gradually lost from the circulation of the babies until by approximately 6 months of age positive reactions against P. falciparum sporozoites were no longer detected. A similar pattern of acquisition and persistence of maternally-derived antisporozoite antibodies was noted in a neonatal rhesus monkey born to a female immunized with sporozoites of Plasmodium knowlesi.

Bacteriostasis of Escherichia coli by milk. VI. The in-vitro bacteriostatic property of Gambian mothers' breast milk in relation to the in-vivo protection of their infants against diarrhoeal disease.

A one-year field-study has been carried out in a diarrhoea-endemic area in West Africa to determine the relationship between the bacteriostatic activity of fresh human milk for Escherichia coli in vitro and freedom from diarrhoea of the infant recipients of the milk. The specific contribution of E. coli gastroenteritis to gastrointestinal diseases of infants in general is not known, nor is its particular role in the Gambian infants studied. During the study period, however, both enteropathogenic and toxigenic strains of E. coli were isolated. The incidence of diarrhoea in Gambian infants of seven age-groups from 2 days to 12 months was not significantly correlated with the bacteriostatic activity of milk. This was due rather to absence of diarrhoea in babies fed on low-activity milk than illness in those receiving highly bacteriostatic milk. Indeed, very active milk appeared to protect recipients almost completely, including seven babies of over 3 months of age, five of them during the rainy season, when the risk was high. Babies receiving lower-activity milk experienced more diarrhoea. In a situation where diarrhoeal disease is multifactorial, field evaluation of the protective action by one antibacterial property of milk is difficult. A better understanding of in vivo protection is important, and the factors which have to be taken into account are discussed.

The development of Malarial infection in breast-fed Gambian infants.

The development of Malarial infection in breast-fed Gambian infants.

Effects of heavy and repeated malarial infections on Gambian infants and children; effects of erythrocytic parasitization.

Effects of heavy and repeated malarial infections on Gambian infants and children; effects of erythrocytic parasitization.