text: Southern African Journal of Epidemiology and Infection - Volume 21, Issue 1, January 2006
  Volume 21, Issue 1, January 2006
  The outbreak of poliomyelitis in Namibia : editorial
  Author Barry Schoub
  Source: Southern African Journal of Epidemiology and Infection 21 (2006)
  The outbreak of poliomyelitis in Namibia in June 2006 is undoubtedly an unfortunate setback to the global polio eradication initiative. To date (8th of July 2006) 17 cases of paralytic disease of whom two died have been laboratory-confirmed as due to type 1 polio virus. The virus belongs to the SOAS genotype which is endemic in India. Analysis of the sequence homology between these isolates as well as those responsible for the outbreak of eight cases in Angola in 2005 and those of the parental Indian isolates, indicate a molecular distance equivalent to 2½ years of virus circulation. Whether the Namibian virus was imported from Angola, or whether from India is not clear. However, what the molecular clock tells us is that the virus had been circulating for upwards of 2½ years before it was manifest as the Angola epidemic last year and the Namibian outbreak this year. Rather disturbingly, this reveals significant gaps in the acute flaccid paralysis (AFP) surveillance which is used as the marker to detect circulation of polio in the population. An unusual feature of the Namibian outbreak is the age distribution of cases : with the exception of one case (aged 14 years), all but one case (a 51-year-old female) occurred in young adults (up to 39 years of age) older than the 15-year-old age used as the upper age limit for AFP surveillance. This unusual age distribution could possibly be the result of the late introduction of routine polio immunisation in Namibia and a consequent accumulation of susceptible adults. Routine polio immunisation as part of the EPI programme was only introduced into Namibia after its independence in the early nineties.
  Announcement of polio certification and laboratory containment initiative in South Africa
  Authors: N.P. Sithebe, H.N. Gumede-Moeletsi, N.M. Bida, M.J. Mphahlele, N. Ngcobo, N.E. Khomo and B.D. Schoub
  Source: Southern African Journal of Epidemiology and Infection 21, pp 3 –4 (2006)
  In 1988 the World Health Assembly resolved to eradicate poliomyelitis worldwide. Since then, the number of reported cases globally has been reduced by over 99% from an estimated 350 000 in 1988 to 1 567 cases in 2005. In the African region, significant progress towards interrupting the final chains of transmission continue as a result of routine and mass immunisation programmes using the inexpensive oral polio vaccine (OPV). Significant challenges to the programme in 2003 due to cessation of immunisation in northern Nigeria and the subsequent spread of wild poliovirus to many countries of west and central Africa have been overcome. All states of Nigeria are once again participating in polio campaigns, and the outbreaks due to importations in the neighbouring countries have been brought under control.
  Meningococcal disease in Cape Town
  Authors: H. Mahomed and N. Cameron
  Source: Southern African Journal of Epidemiology and Infection 21, pp 5 –8 (2006)
  Meningococcal disease is a significant cause of morbidity and mortality worldwide. Communities in Cape Town have suffered from large epidemics of meningococcal disease in the past. This review highlights meningococcal disease as an important cause of preventable death and disease by describing recent trends of meningococcal disease in Cape Town and briefly reviews strategies for control and prevention. Notification, mortality and laboratory records were obtained and analysed. Between 1998 and 2002 between 109 and 124 case were reported annually in Cape Town. This number dropped to 93 in 2003 and to 44 in 2004. On average, the reported incidence rate of meningococcal disease was three per 100 000 population and was predominantly due to serogroup B. It occurs sporadically and affects mainly young children. While the number of deaths has remained at between 10 and 20 per year the case fatality rate has increased from less than 10% in 1998 to 14% in 2003 and 45% in 2004. Though less common than in the past, meningococcal disease has reported a dramatic increased mortality rate in Cape Town in 2004. While it may be that deaths are being selectively reported, a higher index of suspicion, together with early treatment and appropriate chemoprophylaxis is encouraged.
  The diagnosis and management of tuberculosis in HIV-infected children
  Authors: H.S. Schaaf and M.F. Cotton
  Source: Southern African Journal of Epidemiology and Infection 21, pp 9 –13 (2006)
  Human immunodeficiency virus (HIV) infection has made the diagnosis of tuberculosis (TB) in children more complex, despite it presenting in similar ways as in HIV-uninfected children. A history of contact with an infectious source case is often the first hint of the diagnosis. Both TB and HIV cause failure to thrive. HIV is often associated with other chronic lung disease and pulmonary TB may present as acute pneumonia. Current South African National Tuberculosis Control Programme guidelines recommend a six-month rifampicin (RMP)-based treatment regimen for HIV-infected and HIV-uninfected TB cases. Alternative regimens without RMP are not recommended. Drug-drug interactions occur with antituberculosis treatment and highly active antiretroviral therapy (HAART), mainly between RMP, which induces the P450 iso-enzyme system, and the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. Current recommendations for first line HAART in children on RMP-based TB treatment are : stavudine/lamivudine/ritonavir for children less than 3 years of age, and stavudine/lamivudine/efavirenz for children older than 3 years of age. Antituberculosis drugs and antiretroviral drugs have many toxicity profiles in common. For this reason, initiation of HAART should be delayed in children with dual infection unless HIV infection is at an advanced stage.
  Sexually transmitted infections in pregnant urban South African women : socio-economic characteristics and risk factors
  Authors: G.I.J.G. Rours, R.P. Verkooyen, W.C.J. Hop, Ye Htun, F. Radebe, A.D. Rothberg, P.A. Cooper, R. De Groot, H.A. Verbrugh and R.C. Ballard
  Source: Southern African Journal of Epidemiology and Infection 21, pp 14 –19 (2006)
  The prevalence of sexually transmitted infections (STIs) was assessed in 766 apparently healthy, pregnant urban South African women presenting for delivery, and associations with demographic and socio-economic characteristics and clinical symptoms were determined. Overall, 48% of women carried one or more STI infection during their pregnancy. Infection with HIV, Treponema pallidum, Chlamydia trachomatis and Neisseria gonorrhoeae was detected in 18%, 23%, 12% and 9% of women, respectively. Predictive factors for infection included lack of antenatal care, multiple pregnancies, being unmarried, unemployed status and lack of a regular monthly income. While routine screening for HIV and syphilis is offered at most South African antenatal clinics, screening for chlamydial and gonococcal infection is not routinely performed and therefore these infections remain undetected and untreated. Elicited symptoms were not associated with infection, but differences in demographic and socio-economic characteristics offer a tool to tailor preventive, diagnostic and therapeutic strategies for the control of STIs to the individual needs of this high-risk group.
  Carriage of Chlamydia trachomatis during pregnancy : consequences for mother and infant
  Authors: G.I.J.G. Rours, W.C.J. Hop, Ye Htun, F. Radebe, A.D. Rothberg, P.A. Cooper, R. De Groot, H.A. Verbrugh, R.P. Verkooyen and R.C. Ballard
  Source: Southern African Journal of Epidemiology and Infection 21, pp 20 –25 (2006)
  Rates of transmission of Chlamydia trachomatis infection from apparently healthy, black, pregnant South African women to their newborns were studied in a setting where tetracycline eye prophylaxis is routinely provided to prevent neonatal conjunctivitis. The postnatal consequences of maternal chlamydial carriage during pregnancy were also evaluated for both mother and child. A total of 77 chlamydia-positive women and their newborns were followed-up. The chlamydial transmission rate from mother to infant was estimated to be 30%. C. trachomatis was detected in the conjunctivae of 39% and in the nasopharynx of 83% of these infants. Tetracycline eye prophylaxis appeared to prevent overt ocular, but not nasopharyngeal infection. Postnatal genitourinary symptoms and signs were found in 52% and 78% of chlamydia-positive mothers respectively with 18% developing post-partum pelvic inflammatory disease. The complex of postnatal maternal genitourinary symptoms and signs, in combination with symptoms and signs in the infant, should alert clinicians to the possibility of neonatal and maternal complications of chlamydial infection.
  Persistent undernutrition amongst preschool children
  Authors: C.C. Jinabhai, M. Taylor and K. Sullivan
  Source: Southern African Journal of Epidemiology and Infection 21, pp 26 –30 (2006)
  An investigation was undertaken in 2004 by the KwaZulu-Natal Income Dynamics Study (KIDS) which provided an opportunity to assess the nutritional status of preschool children (6 months to less than 7 years) a decade after democracy. During the past decade, Government has initiated a range of nutritional programmes to improve children&apos;s health and nutritional status. The KIDS survey investigated over 1200 households selected via census enumerator areas throughout the province. Of the 1146 children, 574 (50.1%) were boys and 572 (49.9%) girls, with a mean age of 47.0 (SD 22.6) months for boys and 44.8 (SD 22.2) months for girls. There were statistically significant gender differences for height with boys taller than girls (p=0.002). Mean weight of boys and girls was similar (p=0.87), as was BMI (p=0.17). Overall, 1.6% of children were wasted, 7.5% were underweight and 19.8% were stunted; boys were significantly more wasted than girls (p=0.007) and more underweight (p=0.002), but not stunted (p=0.2). Chi-square tests of trend over age group found a significant decrease in wasting from 1-6 years of age (p=0.03), but not for underweight (p=0.75). There was a significant decrease in overweight (p<0.0005) and in stunting (p=0.006) from 1-6 years. The persistence of an unacceptably high prevalence of under-nutrition constitutes a public health problem amongst KwaZulu-Natal children. The key finding of this study was that the prevalence of stunting among preschool children shows minimal change when compared with the 1994 SAVACG study : wasting of 0.79% (1994) vs 1.6% (2004), overweight of 4.2% (1994) vs 7.5% (2004) and stunting of 15.6% (1994) vs 19.6% (2004). In addition to nutritional programmes, other multi-factorial interventions targeting factors such as poverty, HIV/AIDS, and concomitant infections, as reflected in the UNICEF conceptual framework, are required to address persistent stunting among young children.