Adolescence: The age of Proteus

This article focuses on adolescents as a group, who are exposed to major changes in their near future, with the key transformation being the epidemiological transition from the age of infectious and nutritional problems to that of the non-communicable  disorders (NCDs). The major NCDs are: obesity, diabetes, maternal, newborn and child, hypertension and mental health disorders. We also discuss allergies, exposure to pollutants, indoor open stoves, and behavioural factors, such as lack of exercise,  unhealthy diet, substance abuse, injuries and violence, and sexually transmitted  diseases, which contribute to a risky environment. We particularly emphasise the continuum from birth to old age, during which early events may produce lifelong diseases, and which requires serious attention with regard to preventive measures during the earliest period of susceptibility. Some indicators of disease can serve as diagnostic markers and help healthcare workers to avoid complications and manage a disorder efficiently

Loss of maternal measles antibody in black South African infants in the first year of life implications for age of vaccination

In order to investigate the feasibility of measles vaccination before the age of 9 months the duration of passive immunity against measles was estimated by conducting a longitudinal study of measles antibody levels in 20 black neonates delivered at term. Measles serum antibody (lgG) was measured by enzyme-linked immunosorbent assay in the mother at childbirth and on consecutive samples taken from the infants from birth until 9 months of age. Protective measles antibody level was defined as > 200 mlU. Unprotective levels were found in 88% (95% confidence interval (Cl) 81 - 99%) of 6-month-old infants, while at 9 months all were susceptible. The mean antibody level was 192 mlU (Cl 104 - 348%) at 4 months; 34 mlU (Cl 15 - 73%) at 6 months and 13 mlU (Cl 6-24%) at 9 months of age. Our data support the recent World Health Organisation recommendation to immunise children in developing countries at 6 months with the 'high titre' Edmonston-Zagreb measles vaccine, since most infants in our study had lost passive immunity against measles by this age

Is Option B+ the best choice?

The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+.Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence.S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8

Immunogenicity and safety of a live attenuated varicella vaccine in healthy Indian children aged 9 - 24 months

Objectives. To investigate the safety of live attenuated varicella vaccine (aka strain) and the optimal virus titre/ dose required for immunogenicity in healthy South African children.Design. Double-blind randomised clinical study using two different lots of varicella vaccine, each at two different titres. Subjects were randomly allocated to groups 1, 2, 3 and 4 to receive vaccine containing a mean virus titre of 104,5, 103,1, 103,9 and 102,7 PFUs per dose respectively. Clinical signs and symptoms were followed up for 42 days post-vaccination. Specific varicella antibodies were measured by an indirect immunofluorescence method in sera obtained on day 0 and day 42.Setting. City Health Clinic, Chatsworth, Durban.Participants. A total of 200 healthy 9 - 24-month-old children were vaccinated, of whom 189 (44,5%) completed the study.Main outcome measures. Pre- and post-vaccination varicella antibody levels. Adverse events following varicella vaccination..Results. The vaccine was safe and well tolerated. No local symptoms were reported. Skin reactions were specifically solicited in this study: 21 reactions were reported in 8,5% (17/200) of children. Vesicles were reported in 2 vaccines (,,;: 10 vesicles in both cases). One serious adverse event was reported: hospitalisation for bronchopneumonia on day 16 post-vaccination which resolved without sequelae. Around day 42 postvaccination (range 35 - 63 days) all the 176 initially seronegative subjects had seroconverted for varicella antibodies. Post-vaccination geometric mean titres (GMTs) were 104,1, 66,2, 69,5 and 77,0 for groups 1 - 4 respectively. Six subjects who were initially seropositive maintained or increased their titres post-vaccination; 3 of the 6 showed a booster response (a ;:;, 4-fold increase from the pre-vaccination titre).Conclusions. Varicella vaccine was found to be safe, immunogenic and well tolerated. No difference in seroconversion rates or GMTs, either between groups receiving the two vaccine lots or between groups receiving the different titres of each lot, was shown

Cohort Profile: Mamanengane or the Africa Centre Vertical Transmission Study

How did the study come about? From the mid-1990s, the success of antiretroviral prophylaxis to reduce HIV RNA viral load in plasma and avoidance of breastfeeding provided the real possibility that mother-to-child transmission (MTCT) of HIV-1 could be markedly reduced, 1 with an implicit understanding that these measures could be effectively applied to all HIV-infected women in developing countries. 2,3 The latter constitute the overwhelming majority of HIV-positive pregnancies resulting in approximately half a million new infant infections annually. 4 However, the inappropriate use of formula milks amongst impoverished populations resulted in major adverse effects; without the nutritiona

Messages about dual contraception in areas of high HIV prevalence are not heeded

Background. Dual protection is recommended for prevention of unwanted pregnancies and protection against sexually transmitted infections, including HIV. It is critical for HIV-negative women to prevent seroconversion and HIV transmission to their infants during pregnancy and breastfeeding. Methods. Women were followed up after delivery, monthly for the first 9 months and then 3-monthly to 24 months, in a cohort study investigating postnatal HIV transmission. Study nurses discussed family planning, including condom use, at each visit. Contraceptive methods used since the last visit were recorded. All women knew their HIV status, and most women breastfed for a minimum of 6 months. Results. Among 1 137 HIV-positive and 1 220 HIV-negative women the most common contraceptive method was the hormonal injectable; few women used condoms alone or as dual contraception (0 - 3 months 6.8%; 7 - 12 months 16.3%; 19 - 24 months 14.4%). Compared with uninfected women, HIV-positive women were more likely to use condoms in years 1 and 2 after delivery (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 1.38 - 2.14,