Unsustainability of a measles immunisation campaign - rise in measles incidence within 2 years of the campaign

The 1990 national mass measles immunisation campaign resulted in a marked reduction in measles incidence in Natal/KwaZulu in the first 6 months after the campaign. Data from the measles ward admissions book at Clairwood Hospital were collated for the period 1 January 1989 to 31 May 1992 to assess the sustainability of the effects of the campaign. For the first 12 months after the campaign, measles admissions were consistently low. Thereafter, the number increased steadily, rising sharply to above precampaign levels 21 months after the campaign. The age distribution of measles patients indicated that the initial fall in the 10 - 12-month age group had been reversed in the second year after the campaign, suggesting that the high vaccination coverage achieved for this age group during the campaign had not been maintained. Measles admissions to Clairwood Hospital indicate that the effect of the measles imInunisation campaign has not been sustained and that urgent action is required to avert a possible epidemic.S Afr Med J 1993; 83: 322-323

Sero-epidemiology ofhepatitis A in black South African children

A cOIDInunity-based sero-epidemiological survey was undertaken to determine the age-specific prevalence rates of hepatitis A virus (HAV) infection in a representative sample of 782 urban black children aged from newborn to 13 years. Among children aged °-5 months, the prevalence ofantiHAV was 68,8% (95% confidence interval (Cl) 60,6 - 77,0%); this fell to a low of2,5% (Cl 0,1 - 4,9%) in those aged 6 - 11 months, implying the presence of maternal antibody in the first few months of life. By the age of2 years, 51,2% (Cl 45,7 - 56,7%) had anti-HAV, by age 4 the prevalence had risen to 81,4% (Cl 75,5 - 87,3%) and by age 6, the prevalence of anti-HAV was almost 100% (Cl 90,5 96,7%), reflecting the poor socio-economic and environmental conditions these children live in. The lowest prevalence of HAV infection among urban black South African children was during infancy, before the age at which the incidence rate rose sharply; e.g. lout of 5 children was already infected with HAV by its 2nd birthday. Vaccination in infancy will therefore have the biggest impact on the spread of HAV. However, before HAV vaccination in infancy is advocated, vaccine immunogenicity in infancy and the possible detrimental effect of maternal antibodies on the immunogenicity ofthe vaccine need clarification

Understanding and responding to HIV risk in young South African women: Clinical perspectives

Young women (15 - 24 years) contribute a disproportionate 24% to all new HIV infections in South Africa – more than four times that of their male peers. HIV risk in young women is driven by amplifying cycles of social, behavioural and biological vulnerability. Those most likely to acquire infection are typically from socioeconomically deprived households in high HIV-prevalence communities, have limited or no schooling, engage in transactional sex or other high-risk coping behaviours, and have a history of sexually transmitted infections (STIs) and/or pregnancy. Despite the imperative to prevent HIV acquisition in young women, there is a dearth of evidence-based interventions to do so. However, there are several steps that healthcare workers can take to improve outcomes for this key population at the individual level. These include being able to identify high HIV-risk young women, ensuring that they receive the maximum social support they are eligible for, providing reliable and non-judgemental counselling on sexual and reproductive health and relationships, delivering contraceptives and screening and treating STIs in the context of accessible, youth-friendly services

Inter-religious dialogue in schools: A pedagogical and civic unavoidability

Social and civic conflict inspired by the fundamental convictions of different religious groups seems to be rife all over the world, also in schools. One way of addressing this problem is to promote interreligious dialogue. To establish the viability of this solution, the authors take several steps. They analyze the phenomenon “religion” and discover that it is constituted of several layers or levels that have to be accounted for in the proposed inter-religious dialogue in schools. After discussing the term “dialogue” they consider several approaches to religious diversity or plurality to find a suitable basis for the proposed inter-religious dialogue in schools. Based on these analyses, the authors argue that schools (teacher-educators and learners) should be allowed to engage in inter-religious dialogue as part of their pedagogical and civic duty. This will ensure a better understanding of others and their religions, also at the deepest spiritual level. Such comprehension can contribute to the more peaceful co-existence of people in religiously pluralist societies. HTS Theological Studies Vol. 63 (2) 2007: pp. 543-56

Inter-religious dialogue in schools: A pedagogical and civic unavoidability

Social and civic conflict inspired by the fundamental convictions of different religious groups seems to be rife all over the world, also in schools. One way of addressing this problem is to promote interreligious dialogue. To establish the viability of this solution, the authors take several steps. They analyze the phenomenon “religion” and discover that it is constituted of several layers or levels that have to be accounted for in the proposed inter-religious dialogue in schools. After discussing the term “dialogue” they consider several approaches to religious diversity or plurality to find a suitable basis for the proposed inter-religious dialogue in schools. Based on these analyses, the authors argue that schools (teacher-educators and learners) should be allowed to engage in inter-religious dialogue as part of their pedagogical and civic duty. This will ensure a better understanding of others and their religions, also at the deepest spiritual level. Such comprehension can contribute to the more peaceful co-existence of people in religiously pluralist societies

Stabilizing HIV prevalence masks high HIV incidence rates amongst rural and urban women in KwaZulu-Natal, South Africa

Background: In mature generalized human immunodeficiency virus (HIV) epidemics, as survival from accessing antiretroviral treatment (ART) increases, HIV prevalence data may be suboptimal and difficult to interpret without HIV incidence rates. Objective: To determine the HIV incidence rate among rural and urban women in KwaZulu-Natal, South Africa. Methods: We conducted a prospective cohort study from March 2004 to May 2007. Volunteers were recruited from a rural family-planning clinic and an urban clinic for sexually transmitted infections. Consenting, HIV-uninfected women aged 14-30 years were enrolled. Demographic, clinical, sexual and behavioural data were collected using standardized questionnaires with HIV risk reduction counselling and HIV testing. Pelvic examinations were completed at quarterly visits. Results: The HIV prevalence at screening was 35.7% [95% confidence interval (CI) 32.7-38.8] amongst rural women and 59.3% (95% CI 56.5-62.0) amongst urban women. A total of 594/2240 (26.5%) enrolled women contributed to 602 person-years (PYs) of follow-up. The median age was 22 years [inter-quartile range 18-23 years]. HIV incidence rate was 6.5/100 PY (95% CI 4.4-9.2) amongst rural women and 6.4/100 PY (95% CI 2.6-13.2) amongst urban women. HIV incidence rate of 17.2/100 PY (95% CI 2.1-62.2) was highest amongst urban women <20 years of age and 10.2/100 PY (95% CI 4.1-20.9) amongst rural women ≥25 years of age. Conclusion: HIV incidence rates are devastatingly high in young women in rural and urban KwaZulu-Natal, despite reports of stabilized HIV prevalence observed in current surveillance data. The diffuse nature of the HIV epidemic underscores the urgent need to enhance HIV prevention and treatment modalities

APOBEC3G expression is dysregulated in primary HIV-1 infection and polymorphic variants influence CD4+ T-cell counts and plasma viral load

OBJECTIVES: In the absence of HIV-1 virion infectivity factor (Vif), cellular cytosine deaminases such as apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like 3G (APOBEC3G) inhibit the virus by inducing hypermutations on viral DNA, among other mechanisms of action. We investigated the association of APOBEC3G mRNA levels and genetic variants on HIV-1 susceptibility, and early disease pathogenesis using viral load and CD4 T-cell counts as outcomes. METHODS: Study participants were 250 South African women at high risk for HIV-1 subtype C infection. We used real-time PCR to measure the expression of APOBEC3G in HIV-negative and HIV-positive primary infection samples. APOBEC3G variants were identified by DNA re-sequencing and TaqMan genotyping. RESULTS: We found no correlation between APOBEC3G expression levels and plasma viral loads (r = 0.053, P = 0.596) or CD4 T-cell counts (r = 0.030, P = 0.762) in 32 seroconverters. APOBEC3G expression levels were higher in HIV-negative individuals as compared with HIV-positive individuals (P < 0.0001), including matched pre and postinfection samples from the same individuals (n = 13, P < 0.0001). Twenty-four single nucleotide polymorphisms, including eight novel, were identified within APOBEC3G by re-sequencing and genotyping. The H186R mutation, a codon-changing variant in exon 4, and a 3' extragenic mutation (rs35228531) were associated with high viral loads (P = 0.0097 and P < 0.0001) and decreased CD4 T-cell levels (P = 0.0081 and P < 0.0001), respectively. CONCLUSION: These data suggest that APOBEC3G transcription is rapidly downregulated upon HIV-1 infection. During primary infection, APOBEC3G expression levels in peripheral blood mononuclear cells do not correlate with viral loads or CD4 T-cell counts. Genetic variation of APOBEC3G may significantly affect early HIV-1 pathogenesis, although the mechanism remains unclear and warrants further investigation

TB treatment outcomes following directly-observed treatment at an urban outpatient specialist TB facility in South Africa.

The treatment of 450 consecutive new patients with pulmonary TB was evaluated to determine outcome following directly-observed treatment. In all,176 (39.1%) patients were cured, 23 (5.1%) completed treatment, 80 (17.8%) defaulted treatment, 24 (5.3%) died, 54 (12.0%) were lost to follow-up and 93 (20.7%) were transferred out. Increasing age was significant for death. Males were more likely to default and those with negative pretreatment sputum smears and those who were unemployed were more likely to be lost to follow-up.The overall treatment success rate remains low. Our data suggests that greater emphasis is needed to improveTB treatment success

Increasing burden of pulmonary tuberculosis in young women.

Scientific letter.No abstract available