World Health Organ Research Articles

Current Concepts in the Management of Tuberculosis

Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acid-fast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.

The effect of infertility and assisted reproduction on first-trimester placental and fetal development

Our investigation of differences in first-trimester placentation and/or fetal biometry in pregnancies conceived spontaneously compared with those conceived through fertility treatment, and comparing less invasive fertility treatment with in vitro fertilization found no statistically significant difference in first-trimester abnormal placentation or fetal growth between pregnancies conceived spontaneously and those conceived through fertility treatment, or between the in vivo and in vitro subgroups.

Probiotics, Enteric and Diarrheal Diseases, and Global Health

Enteric and diarrheal diseases are a major worldwide cause of death among children under the age of 5. In this age group, diarrhea occurs 2.5 billion times per year [1] and causes 15% of childhood deaths.[2] Diarrheal diseases claim 59 million disability-adjusted life years (DALYs), nearly all from children in low- and middle-income countries.[3] Despite this enormous burden, these numbers fail to capture the full impact of enteric and diarrheal diseases. Early and frequent exposure to intestinal pathogens begins a cycle (Figure 1A) that affects digestion, nutrient absorption, growth, and immunity.[4] Repeated infections, with either overt diarrhea or subclinical enteropathy, produce acute and chronic undernutrition,[5] which leads to more frequent and severe infections.[6] Undernutrition contributes to 53% of childhood deaths [7] and is the leading risk factor for poor health outcomes in childhood;[8] survivors are at risk for developmental deficits in growth, fitness, and cognition that persist into adulthood with devastating consequences.[4] These consequences have a multiplicative effect on calculations of DALYs from diarrheal disease.[9] Open in a separate window Figure 1 The vicious cycle of diarrhea and undernutrition in susceptible children (A) The devastating synergy between enteric infections and undernutrition is influenced by the environment, the human genome, host nutrition, and the human microbiome. Various interventions (red boxes) may inhibit progression to the next step in the cycle, minimizing both acute and chronic morbidities. (B) Employing a spectrum of disease outcome measures would lend greater insight into the pathology underlying enteric and diarrheal diseases, while providing a more complete understanding of interventions targeting basic steps of enteric and diarrheal disease pathogenesis. Adapted with permission from Wiley: Nutrition Reviews,4 copyright 2008. http://www.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1753-4887.

“Gratuities” for donated organs: ethically indefensible

With the encouragement of more than 90 medical bodies (the Declaration of Istanbul) 1 Declaration of Istanbul. Endorsing organizations. http://www.declarationofistanbul.org/index.php?option=com_content&view=article&id=74&Itemid=56 (accessed Aug 10, 2010). Google Scholar and WHO—which in May, 2010, endorsed revised Guiding Principles that confirm the ban on payment for organs from living or deceased donors 2 World Health Assembly. Human organ and tissue transplantation. May 21, 2010. http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R22-en.pdf (accessed Aug 10, 2010). Google Scholar —several of the countries that have been the most notorious organ bazaars, 3 Shimazono Y The state of the international organ trade: a provisional picture based on integration of available information. Bull World Health Organ. 2007; 85: 955-962 Crossref PubMed Scopus (250) Google Scholar including Egypt, Pakistan, China, and the Philippines, have recently outlawed organ sales and taken steps to prevent trafficking of organs to transplant tourists. 4 Delmonico FL The implications of Istanbul Declaration on organ trafficking and transplant tourism. Curr Opin Organ Transplant. 2009; 14: 116-119 Crossref PubMed Scopus (53) Google Scholar Yet the risk to people who are poor remains, as proponents of markets for organs seek to circumvent or reverse the prohibitions.

Commentary

Commentary

Interaction between Plasmodium falciparum Apical Membrane Antigen 1 and the Rhoptry Neck Protein Complex Defines a Key Step in the Erythrocyte Invasion Process of Malaria Parasites

Invasion of host cells by apicomplexan parasites, including Plasmodium falciparum and Toxoplasma gondii, is a multistep process. Central to invasion is the formation of a tight junction, an aperture in the host cell through which the parasite pulls itself before settling into a newly formed parasitophorous vacuole. Two protein groups, derived from different secretory organelles, the micronemal protein AMA1 and the rhoptry proteins RON2, RON4, and RON5, have been shown to form part of this structure, with antibodies targeting P. falciparum AMA1 known to inhibit invasion, probably via disruption of its association with the PfRON proteins. Inhibitory AMA1-binding peptides have also been described that block P. falciparum merozoite invasion of the erythrocyte. One of these, R1, blocks invasion some time after initial attachment to the erythrocyte and reorientation of the merozoite to its apical pole. Here we show that the R1 peptide binds the PfAMA1 hydrophobic trough and demonstrate that binding to this region prevents its interaction with the PfRON complex. We show that this defined association between PfAMA1 and the PfRON complex occurs after reorientation and engagement of the actomyosin motor and argue that it precedes rhoptry release. We propose that the formation of the AMA1-RON complex is essential for secretion of the rhoptry contents, which then allows the establishment of parasite infection within the parasitophorous vacuole.

Respiratory syncytial virus in young children

Respiratory-tract infections remain the foremost cause of death in young children and are a major obstacle to achievement of Millennium Development Goal 4—to reduce under-5 mortality by two-thirds by 2015. 1 UNThe Millennium Development Goals report 2009. http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdfDate: 2009 Google Scholar , 2 Rudan I Boschi-Pinto C Biloglav Z Mulholland K Campbell H Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008; 86: 408-416 Crossref PubMed Scopus (923) Google Scholar , 3 Scott JAG Brooks WA Peiris JSM Holtzman D Mulhollan EK Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest. 2008; 118: 1291-1300 Crossref PubMed Scopus (125) Google Scholar Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory-tract infections and admissions to hospital worldwide. It is the only agent of the three major organisms that causes death from respiratory-tract infections—RSV, Streptococcus pneumoniae, and Haemophilus influenzae—for which no vaccine is available. 2 Rudan I Boschi-Pinto C Biloglav Z Mulholland K Campbell H Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008; 86: 408-416 Crossref PubMed Scopus (923) Google Scholar , 3 Scott JAG Brooks WA Peiris JSM Holtzman D Mulhollan EK Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest. 2008; 118: 1291-1300 Crossref PubMed Scopus (125) Google Scholar RSV has been prioritised for control and vaccine development by global and national health organisations for more than 20 years. 4 National Institutes of HealthThe Jordan Report: 20th anniversary. Accelerated development of vaccines. http://www3.niaid.nih.gov/topics/Malaria/PDF/jordan20_2002.pdfDate: 2002 Google Scholar , 5 Monto AS The prospects for immunizing against respiratory syncytial virus. in: Institute of Medicine Committee on Issues and Priorities for New Vaccine Development New vaccine development: establishing priorities—volume 2, diseases of importance in developing countries. National Academy Press, Washington1986: 299-308 Google Scholar Successful immunisation against RSV was predicted, in 1994, to be achieved within 10 years. 6 Murphy BR Hall SL Kulkarni AB et al. An update on approaches to the development of respiratory syncytial virus (RSV) and parainfluenza virus type 3 (PIV3) vaccines. Virus Res. 1994; 32: 13-36 Crossref PubMed Scopus (119) Google Scholar Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysisGlobally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority. Full-Text PDF

Introduction to special issue on “Trade‐Offs in Female Life Histories: Integrating Evolutionary Frameworks”

Introduction to special issue on “Trade‐Offs in Female Life Histories: Integrating Evolutionary Frameworks”

Loss of Caveolin-3 Induces a Lactogenic Microenvironment that Is Protective Against Mammary Tumor Formation

Here, we show that functional loss of a single gene is sufficient to confer constitutive milk protein production and protection against mammary tumor formation. Caveolin-3 (Cav-3), a muscle-specific caveolin-related gene, is highly expressed in muscle cells. We demonstrate that Cav-3 is also expressed in myoepithelial cells within the mammary gland. To determine whether genetic ablation of Cav-3 expression affects adult mammary gland development, we studied the phenotype(s) of Cav-3(-/-)-null mice. Interestingly, Cav-3(-/-) virgin mammary glands developed lobulo-alveolar hyperplasia, akin to the changes normally observed during pregnancy and lactation. Genome-wide expression profiling revealed up-regulation of gene transcripts associated with pregnancy/lactation, mammary stem cells, and human breast cancers, consistent with a constitutive lactogenic phenotype. Expression levels of three key transcriptional regulators of lactation, namely Elf5, Stat5a, and c-Myc, were also significantly elevated. Experiments with pregnant mice directly showed that Cav-3(-/-) mice underwent precocious lactation. Finally, using orthotopic tumor cell implantation, we demonstrated that virgin Cav-3(-/-) mice were dramatically protected against mammary tumor formation. Thus, Cav-3(-/-) mice are a novel preclinical model to study the protective effects of a lactogenic microenvironment on mammary tumor onset and progression. Our current studies have broad implications for using the lactogenic microenvironment as a paradigm to discover new therapies for the prevention and/or treatment of human breast cancers.

Preventing Premature Disability and Death Through Surgical Intervention

Preventing Premature Disability and Death Through Surgical Intervention

<p>Practical screening priorities for hearing impairment among children in developing countries</p>

Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.
 Published courtesy of: Bull World Health Organ. 1992; 70(5):645-655

Epidemic Hypertension in Sub-Saharan Africa

The article “Hypertension in Sub-Saharan Africa” by Addo et al has documented both the high prevalence of hypertension, especially in urban areas, and poor control of hypertension in sub-Saharan Africa.1 In 1992, we reported the high prevalence of hypertensive disease in a population sample from Benin, Nigeria and the strong association with higher socioeconomic class and body weight.2 Previous reports from the World Health Organization (WHO) and other groups have warned of the growing epidemic of hypertension and vascular disease and, most important, the need for both population-based approaches to reduce the epidemic, including the reduction of salt in the diet and treatment of BP using inexpensive drug therapies.3,4 There is a need for better data on the prevalence of hypertension and risk factors related to both hypertension and vascular disease in sub-Saharan Africa. The most important imperative at the present time is to effectively blunt this growing epidemic of vascular disease. This epidemic of vascular disease is following the path characteristic of many other countries and especially in the United States, with initial high rates of hypertension and vascular disease among the upper socioeconomic groups and then explosive epidemics of both hypertension and vascular disease among lower income populations, especially the black population in the United States.5 The key variables that drive the epidemics are the greater use of processed foods, higher intake of calories, decreased physical activity leading to weight gain, and the reduction of foods high in potassium.6 The epidemic, as noted, has begun in the upper social classes and in urban …

Establishing Pediatric Cardiovascular Services in the Developing World

There is increasing realization that the lack of facilities for sustainable pediatric cardiac services in the developing world results in a massive number of preventable deaths and suffering. It is estimated that 15 million children die or are crippled annually by potentially treatable or preventable cardiac diseases. Ignored for a long time, this issue is starting to be a cause of major concern to individuals, governments, and, most importantly, cardiovascular specialists who can appreciate the gravity of the problem and that the current situation is unacceptable. What then can be done to alleviate the problem, by whom, and how? In this issue of Circulation , Larrazabal et al describe the pioneering efforts of Castenada and his colleagues in Guatemala.1 This should act as a model and a source of inspiration in this field. This editorial is an attempt to outline some of the issues that relate to the problem, such as estimates of its size, and explores potential, long-lasting solutions. Article p 1882 The pediatric population constitutes a larger proportion of the community in developing countries, with ≈40% of individuals <18 years old in some countries. Children in developing countries have a significantly higher incidence and prevalence of serious cardiac diseases.2 This is contributed to by a variety of factors that include a lack of early correction of congenital cardiac abnormalities that results in accumulation of a large number of children with uncorrected anomalies who survive the neonatal period. In addition, many of these children develop more rapid deterioration in their clinical condition as a result of accelerated forms of secondary changes in the heart and other organs, such as pulmonary hypertension. Some of these changes could be the result of genetic and/or environmental factors such as pollution or infection. Furthermore, endemic “neglected” cardiac diseases such as rheumatic …

New International Measuring Stick for Defining Obesity in Non-Europeans

Body mass index (BMI) is a useful way of classifying the degree of excess weight in an individual. Defining BMI cut points at which adverse cardiovascular outcomes, diabetes mellitus, and other comorbidities are more likely to occur affords clinically relevant guidelines for patient care. Expert panels from both the National Institutes of Health and the World Health Organization1–3 have developed such cut points, which define overweight as a BMI (weight [in kilograms]/height [in meters squared]) of 25.0 to 29.9 kg/m2, mild or grade I obesity as a BMI of 30 to 34.9 kg/m2, grade II or more severe obesity as a BMI of 35 to 39.9 kg/m2, and extreme or grade III obesity as a BMI ≥40 kg/m2. Epidemiological studies focusing on persons of European descent have verified that these cut points are, indeed, associated with incremental risk for cardiovascular events and all-cause death.4–6 An awareness that appropriate BMI cut points for Asians may differ from those of Europeans has been largely based on observations that cardiovascular and metabolic risk in Asians occur at a lower BMI than in Europeans. For example, there is increasing evidence of a high prevalence of type 2 diabetes mellitus and elevated cardiovascular risk in certain Asian countries, despite an average BMI in these countries that is <25 kg/m2.7,8 Even for Asian-Americans, the prevalence of diabetes mellitus after adjustment for BMI is 60% higher than in their European counterparts.9 Article p 2111 The definition of clinically useful BMI cut points in Asian populations has been difficult, at least in part because of the limitations of previously used methodologies. Two general methodological approaches have been taken in the past to derive these BMI cut points in Asians: (1) recalculation of BMI cut …

Lepromatous Leprosy

A 27-year-old woman from the Maluku province of Indonesia presented with erythematous skin lesions that had progressed slowly during the preceding 2 years. The lesions started initially as macular discoloration of the cheeks but evolved into indurated, erythematous plaques involving the entire face, trunk, and bilateral upper and lower extremities. The patient also experienced flattening of the nasal bridge and loss of bilateral eyebrows. The lesions on the extremities were associated with numbness and swelling of the hands and feet. The patient had palpable, nodular thickening of ulnar and sural nerves and diffuse skin changes. Biopsy of the right earlobe and sural nerve showed granulomatous inflammation. Numerous acid-fast organisms were seen on Fite method and auramine-rhodamine stains, suggestive of multibacillary (lepromatous) leprosy. Electromyographic findings indicated axonal length-dependent sensorimotor peripheral neuropathy. A treatment regimen of clofazimine, dapsone, and rifampin was initiated, with a planned duration of 2 years. The patient was doing well at 2-month follow-up. Despite attempts at eradication, leprosy (Hansen disease) remains endemic in certain parts of the world, including Indonesia, India, and Brazil.1Leprosy: global target attained.Wkly Epidemiol Rec. 2001; 76: 155-156PubMed Google Scholar The causative organism is Mycobacterium leprae, an obligate intracellular parasite.2Ishii N Recent advances in the treatment of leprosy.Dermatol Online J. 2003; 9: 5PubMed Google Scholar Clinical presentations range from paucibacillary (tuberculoid) disease with less than 5 lesions to multibacillary (lepromatous) leprosy with diffuse skin involvement of the face, trunk, and extremities.3WHO Expert Committee on Leprosy World Health Organ Tech Rep Ser. 1998; 874: 1-43PubMed Google Scholar Severe involvement of facial skin results in the classic “leonine” face seen in our patient. Both sensory and motor nerve damage occur in the vicinity of tuberculoid lesions but can be more diffuse in lepromatous leprosy.4Jacobson RR Krahenbuhl JL Leprosy.Lancet. 1999; 353: 655-660Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar With treatment, the skin lesions gradually clear, mostly within the first year.

Pesticide self-poisoning: thinking outside the box

Self-poisoning with pesticides is a major global public-health problem, with estimates of 300 000 deaths a year in the Asia-Pacific region alone.1 WHO now estimates that pesticide ingestion is the most common method of suicide worldwide, and has responded by launching a global Pesticides and Health Initiative.2,3 Several approaches have been proposed to reduce the high morbidity and mortality associated with pesticide self-poisoning. These strategies include improved clinical management of poisoning, provision of counselling services for vulnerable individuals, and restricted access to toxic pesticides.4,5 Restriction of the availability of pesticides to prevent their use in impulsive acts of self-harm is emerging as a favoured approach.3,6 Suggested measures include the development of agricultural practices in which pesticide use is avoided or reduced to a minimum, national bans on highly toxic pesticides, and promotion of initiatives to store pesticides safely.6 Before one or more approaches are chosen, careful assessment will be required from a combined public-health and agricultural perspective. The pesticide industry has long argued for secure storage and use of locked boxes to prevent all forms of pesticide poisoning,7 and has started several projects testing and scaling-up the use of safe-storage boxes.8 With the active backing of industry, support for this approach has begun to gather momentum at WHO and the International Association for Suicide Prevention, with three meetings in Durban, Singapore, and Geneva.9,10 The pesticide industry's concern about this important public-health issue is welcome. However, industry-led initiatives will probably be affected by corporate priorities for shareholders and profits, and could bypass adequate consideration and assessment of alternative strategies. A second concern about the rapid scale-up and implementation of the locked-box approach is to carefully ensure that the approach will not have unplanned adverse effects. Intuitively, locked boxes are a sensible solution. However, in a pilot study in Sri Lanka, we found that many of the 172 participating households that received an inhouse storage box changed the location of pesticide storage from their fields (0·1–2 km away) to their homes. After 7 months, the number of households storing pesticides in their household increased from 54% to 98%, and only 84% locked the box. These changes could thus increase access to pesticides at times of stress. The storage box also highlighted where exactly the pesticides were stored; during our study, locked boxes were twice broken into (figure) and pesticides ingested, with one death. Another intervention of simple distribution of boxes without education or support resulted in only 30% of households locking their box.11 Figure Pesticide-storing metal box So far, no studies assessing the feasibility or effectiveness of safe pesticide-storage devices have been published. Such knowledge is needed before the practice can be widely recommended. Variation in cultural beliefs and agricultural practice in different communities and countries highlights the need for qualitative research to ensure generalisability to local circumstances and to implement appropriate modifications. Practical design issues, including ways to increase the likelihood of boxes being locked, should also be assessed before large-scale trials are undertaken. Infield storage devices or community-run stores could be more effective than the currently promoted inhouse boxes, but acceptable models have not yet been developed. With the public-health community's energy focused on safe storage, policymakers could be distracted from more immediate and longlasting solutions such as sales restrictions, product reformulation, import bans, and general reductions in agricultural pesticide use. Safe-storage interventions should be studied and assessed with other options that might not be as attractive to industry.

South Asians and Cardiovascular Risk

Case presentation: A 36-year-old nonsmoking, normotensive South Asian man presented to the emergency department of a community hospital with retrosternal chest pain of &60 minutes’ duration. His 12-lead ECG demonstrated 10 mm of ST-segment elevation in leads V2 through V6, and he received fibrinolytic therapy within 90 minutes of symptom onset. His pain resolved, but his ST segments only partially normalized; he had a peak creatine kinase of 4564 IU/L, and he showed signs of early heart failure. LDL cholesterol was 135 mg/dL, HDL 32 mg/dL, triglycerides 20 mg/dL, and total cholesterol 206 mg/dL; his body mass index (BMI) was 24 kg/m2. Cardiac catheterization demonstrated severe and diffuse triple-vessel disease, including occlusion of the proximal left anterior descending artery, as well as moderate left ventricular dysfunction. While in the hospital, he was diagnosed with new-onset type 2 diabetes mellitus and subsequently underwent uncomplicated coronary bypass surgery. South Asians are individuals whose ethnic roots originate from the Indian subcontinent, a large geographic area that includes India, Pakistan, Sri Lanka, Nepal, and Bangladesh. Collectively, South Asians represent one fifth of the global population. In North America, more than 2 million South Asians reside in the United States and almost 1 million in Canada. It is important to recognize that the term “South Asian” refers to a heterogeneous population, with important differences in diet, culture, and lifestyle among different South Asian populations and religions. Multiple studies of migrant South Asian populations have, however, confirmed a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death as compared with other ethnic groups.1–3 In an analysis of age-standardized coronary heart disease (CHD) mortality in Canada over a 15-year period, South Asians had the highest CHD mortality compared with individuals of Chinese and European descent.4 In …

The lack of Crimean-Congo hemorrhagic fever virus antibodies in healthcare workers in an endemic region

We aimed to detect antibodies against Crimean-Congo hemorrhagic fever virus (CCHFV) in healthcare workers (HCWs) in an endemic region. The study was conducted in a tertiary care hospital that had cared for CCHFV infected patients in the period 2002-2003. The sera from the HCWs were collected one month after the last admitted hospital case (October 2003), and sent to the Pasteur Institute, Lyon, France to be studied for CCHF IgM and IgG by ELISA. The total number of HCWs included in the study was 75; the median age was 30, 68% of the subjects were female, and 83% of the HCWs were at risk of exposure to the body fluids of patients. Only one HCW from the group without risk of exposure was CCHF IgG positive. The adherence rate to universal precautions was high. In conclusion, a lack of CCHFV transmission from patients to HCWs was observed. This result could be related to the high rate of compliance to the universal precautions, which are sufficient to protect against CCHFV infection.

Avian Influenza Virus Infections in Humans

Seroepidemiologic and virologic studies since 1889 suggested that human influenza pandemics were caused by H1, H2, and H3 subtypes of influenza A viruses. If not for the 1997 avian A/H5N1 outbreak in Hong Kong of China, subtype H2 is the likely candidate for the next pandemic. However, unlike previous poultry outbreaks of highly pathogenic avian influenza due to H5 that were controlled by depopulation with or without vaccination, the presently circulating A/H5N1 genotype Z virus has since been spreading from Southern China to other parts of the world. Migratory birds and, less likely, bird trafficking are believed to be globalizing the avian influenza A/H5N1 epidemic in poultry. More than 200 human cases of avian influenza virus infection due to A/H5, A/H7, and A/H9 subtypes mainly as a result of poultry-to-human transmission have been reported with a > 50% case fatality rate for A/H5N1 infections. A mutant or reassortant virus capable of efficient human-to-human transmission could trigger another influenza pandemic. The recent isolation of this virus in extrapulmonary sites of human diseases suggests that the high fatality of this infection may be more than just the result of a cytokine storm triggered by the pulmonary disease. The emergence of resistance to adamantanes (amantadine and rimantadine) and recently oseltamivir while H5N1 vaccines are still at the developmental stage of phase I clinical trial are causes for grave concern. Moreover, the to-be pandemic strain may have little cross immunogenicity to the presently tested vaccine strain. The relative importance and usefulness of airborne, droplet, or contact precautions in infection control are still uncertain. Laboratory-acquired avian influenza H7N7 has been reported, and the laboratory strains of human influenza H2N2 could also be the cause of another pandemic. The control of this impending disaster requires more research in addition to national and international preparedness at various levels. The epidemiology, virology, clinical features, laboratory diagnosis, management, and hospital infection control measures are reviewed from a clinical perspective.

Oral health of Aboriginal Australians: Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia*

Australian Dental JournalVolume 49, Issue 3 p. 151-153 Free Access Oral health of Aboriginal Australians: Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia* First published: 12 March 2008 https://doi.org/10.1111/j.1834-7819.2004.tb00067.xCitations: 22 † *Prepared by Kaye Roberts-Thomson AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Kailis DG. Dental conditions observed in Australian Aboriginal children resident in Warburton and Cundeelee mission, Western Australia. Aust Dent J 1971; 16: 44– 52. 2 Kailis DG. Prevalence of dental caries in Australian Aboriginal children resident in Carnarvon, Western Australia. Aust Dent J 1971; 16: 109– 115. 3 Davies MJ, Spencer AJ, Westwater A., et al. Dental caries among Australian Aboriginal, non-Aboriginal Australian-born, and overseas- born children. Bull World Health Organ 1997; 75: 197– 203. 4 Dental Statistics and Research Unit. Oral health of Aboriginal and Torres Strait Islander Persons. AIHW Research report no. 14. Den 108. Adelaide : The University of Adelaide, 2003. 5 Dental Statistics and Research Unit. The Child Dental Health Survey, Northern Territory, 1999. AIHW Cat No. Den 93. Adelaide : The University of Adelaide, 2002. 6 Bourke C., Baima D., Allister J., et al. Caries Experience of Aboriginal Children in South Australia 1991. J Dent Res 1999; 78: 951 (Abstract No. 67). 7 Endean C., Roberts-Thomson K., Wooley S. Anangu oral health: the status of the Indigenous population of the Anangu Pitjantjatjara lands. Aust J Rural Health 2004; 12: 99– 103. 8 Dental Statistics and Research Unit. Oral health and access to dental services among Indigenous Australians, 2000. AIHW Cat No. Den 64. Adelaide : The University of Adelaide, 2000. 9 Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis and risk of poor glycaemic control in subjects with non-insulin dependent diabetes mellitus. J Periodontol 1996; 67: 1085– 1093. 10 Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993; 16: 329– 334. Citing Literature Volume49, Issue3September 2004Pages 151-153 ReferencesRelatedInformation