Seroepidemiology of hepatitis B virus in Addis Ababa Ethiopia: transmission patterns and vaccine control

A community-based seroepidemiological survey of Addis Ababa, Ethiopia was conducted in 1994 to inform on the transmission dynamics and control of hepatitis B virus (HBV) infection. Venous blood from 4736 individuals under 50 years of age from 1262 households, selected using stratified cluster-sampling, was screened for HBV markers using commercial ELISAs. HBsAg prevalence was 7% (95% CI 6–8), higher in males (9%; 7–10) than females (5%; 4–6). HBeAg prevalence in HBsAg positives was 23% (18–29), and less than 1% of women of childbearing age were HBeAg positive. Overall HBV seroprevalence (any marker), rose steadily with age to over 70% in 40–49 year olds, indicating significant childhood and adult transmission. Estimated instantaneous incidence was 3–4/100 susceptibles/year, higher in males than females in 0–4 year olds, and peaking in early childhood and young adults. The age at which 50% had evidence of infection was around 20 years, and the herd immunity threshold is approximated at 63–77%. Addis Ababa is of intermediate-high HBV endemicity, with negligible perinatal transmission. Our main findings are the identification of a significant difference between males and females in the age-acquisition of HBV infection, and marked differences between age groups in HBV incidence rates. These results should target future research studies of underlying risk factors. Furthermore, we generate a crude estimate of the level of coverage of HBV vaccine that would be required to eliminate the virus from the study population

Graphical explanation in an expert system for Space Station Freedom rack integration

The rationale and methodology used to incorporate graphics into explanations provided by an expert system for Space Station Freedom rack integration is examined. The rack integration task is typical of a class of constraint satisfaction problems for large programs where expertise from several areas is required. Graphically oriented approaches are used to explain the conclusions made by the system, the knowledge base content, and even at more abstract levels the control strategies employed by the system. The implemented architecture combines hypermedia and inference engine capabilities. The advantages of this architecture include: closer integration of user interface, explanation system, and knowledge base; the ability to embed links to deeper knowledge underlying the compiled knowledge used in the knowledge base; and allowing for more direct control of explanation depth and duration by the user. The graphical techniques employed range from simple statis presentation of schematics to dynamic creation of a series of pictures presented motion picture style. User models control the type, amount, and order of information presented

Sero-epidemiology of rubella in the urban population of Addis Ababa Ethiopia

We conducted a community-based cluster sample survey of rubella sero-epidemiology in Addis Ababa, Ethiopia in 1994. Among 4666 individuals for whom complete data were available, rubella antibody prevalence was 91% (95% confidence interval: 90, 92). On multivariable analysis, seroprevalence was lower among individuals who were resident in Addis Ababa for 1 year or less. Approx. 50% seroprevalence was attained by age 4 years, and the estimated average age at infection was 5·2 years. The highest age-specific force of infection was estimated to occur in 5- to 9-year-olds. The early age at infection corresponded with a low estimated incidence of congenital rubella syndrome (CRS) of 0·3 per 1000 live births, equivalent to nine cases of CRS in 1994. The predicted critical level of immunity for elimination of rubella via vaccination was 85–91%, requiring 89–96% coverage with a vaccine of 95% effectiveness. Unless very high coverage of rubella vaccine could be guaranteed, the introduction of childhood vaccination could increase the incidence of CRS in Addis Ababa

A knowledge-based approach to configuration layout, justification, and documentation

The design, development, and implementation is described of a prototype expert system which could aid designers and system engineers in the placement of racks aboard modules on Space Station Freedom. This type of problem is relevant to any program with multiple constraints and requirements demanding solutions which minimize usage of limited resources. This process is generally performed by a single, highly experienced engineer who integrates all the diverse mission requirements and limitations, and develops an overall technical solution which meets program and system requirements with minimal cost, weight, volume, power, etc. This system architect performs an intellectual integration process in which the underlying design rationale is often not fully documented. This is a situation which lends itself to an expert system solution for enhanced consistency, thoroughness, documentation, and change assessment capabilities

A Knowledge-Based Approach to Configuration Layout, Justification, and Documentation

The design, development, and implementation of a prototype expert system which could aid designers and system engineers in the placement of racks aboard modules on the Space Station Freedom are described. This type of problem is relevant to any program with multiple constraints and requirements demanding solutions which minimize usage of limited resources. This process is generally performed by a single, highly experienced engineer who integrates all the diverse mission requirements and limitations, and develops an overall technical solution which meets program and system requirements with minimal cost, weight, volume, power, etc. This system architect performs an intellectual integration process in which the underlying design rationale is often not fully documented. This is a situation which lends itself to an expert system solution for enhanced consistency, thoroughness, documentation, and change assessment capabilities

Funding Shortfall for Housing Vouchers Could Have Serious Health Consequences for Children

In the fourth brief in its Policy Action series, Children's HealthWatch finds that unaffordable housing endangers the health and development of young children. Due to a federal funding shortfall, state and local housing agencies will be forced to reduce or eliminate rental assitance to thousands of families starting this month. Voucher cuts will push more families into the ranks of the "hidden homeless" -- families that move frequently, crowd into apartments that are too small, or live doubled up with other households when they cannot find affordable housing. Children in hidden homeless families are at increased risk for poor health, nutrition, and growth, as well as developmental delays. Timely Congressional action to protect the Housing Choice Voucher Program will ensure that families have stable, affordable housing essential to children's health

The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia.

We investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74-4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57-0·73) and 0·74 (95% CI 0·55-0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia

Seroepidemiology of measles in Addis Ababa, Ethiopia: implications for control through vaccination.

We undertook a representative survey of measles antibodies in Addis Ababa, Ethiopia 1994, to characterize immunity and transmission. Specific-antibody levels (IU/l) were determined by ELISA for 4654 sera from individuals aged 0-49 years (1805 < 15 years) collected by stratified household-cluster sampling. The proportion seronegative (< 100 IU/l) was 20% (95% CI: 16-25) in children 9-59 months old, declining to 9% (7-12) in 5-9 year olds, 5% (4-7) in 10-14 year olds, and < 1% in adults. The proportion of children (< 15 years old) with low-level antibody (100-255 IU/l) was 8% (7-10). Vaccination and an absence of a history of measles illness were strongly associated with low-level antibody. History of measles vaccination in 9 months to 14-year-old children was approximately 80%. We estimate a primary vaccine failure rate of 21% (12-34) and continued high measles incidence of 22 per 100 susceptibles (19-24) per annum. Our data support the introduction of campaign vaccination in the city in 1998, although higher routine vaccine coverage is required to sustain the impact. The implications of a high prevalence of low-level antibody are discussed

Physics Beyond the Standard Model

I briefly summarize the prospects for extending our understanding of physics beyond the standard model within the next five years.Comment: 9 pages, 2 figures, LaTeX. Presented at the 1999 UK Phenomenology Workshop, Durham, September 1999. To be published in Journal of Physics