Ready or not--intrapartum prevention of perinatal HIV transmission in Illinois

OBJECTIVES

The overall readiness of Illinois birthing hospitals to comply with the 2003 Illinois HIV Perinatal Prevention Act and prevent perinatal HIV transmission, and the hospital characteristics that predict readiness were examined.

METHODS

Nurse Managers of all 137 Illinois birthing hospitals were surveyed regarding current labor and delivery (L&D) practices for HIV status identification, documentation, testing and zidovudine (AZT) availability in March 2004. Bivariate and multivariable regression analysis was performed.

RESULTS

All 137 hospitals returned the surveys. Almost forty seven percent of Illinois birthing hospitals had adequate maternal HIV status documentation on arrival in L&D, 72.3% documented prenatal HIV results in the L&D chart, 65.7% documented prenatal HIV in the newborn chart, 38.7% ordered HIV tests on L&D if no prenatal HIV status was available, and 61.3% had AZT available. Only 17 hospitals (12.4%) met requirements for overall readiness to prevent perinatal HIV transmission. Sixteen hospitals (11.6%) met a minimal level of readiness (prenatal HIV status documentation and AZT availability).

CONCLUSIONS

Despite passage of legislation to increase perinatal HIV testing and reduce transmission, Illinois birthing hospitals had an overall low level of readiness to implement the intrapartum interventions that are an essential part of eradicating pediatric HIV infection. Perinatal reduction protocols and implementation guidelines would improve the overall readiness of Illinois birthing hospitals to prevent perinatal HIV transmission.

Epidemiological profile of 806 Italian children with hepatitis C virus infection over a 15-year period

BACKGROUND/AIMS

To evaluate the epidemiological profile of Italian children with hepatitis C virus (HCV) infection over a 15-year period.

METHODS

Fifteen tertiary care centers, belonging to a national Observatory established in 1998, retrospectively/prospectively recruited 806 consecutive HCV-infected, otherwise healthy, children seen from 1990 to 2004.

RESULTS

Seven hundred and sixty four were Italian and 42 from foreign countries. Newly-diagnosed cases declined from 332 in 1995-1999 to 196 in 2000-2004, while the proportion of foreign children rose from 3% to 13%. Transfusion-transmitted infection disappeared after 1992. Maternal infection (with drug abuse in 63% of cases in the North) has become the most important mode of HCV diffusion throughout Italy and the exclusive source for all children infected in 2000-2004. The prevalence of HCV genotypes 3 and 4 increased and that of genotype 1b decreased significantly (p<0.02). Male/female ratio was significantly (p<0.001) lower among vertically infected (0.6) than in transfused children (1.3).

CONCLUSIONS

The number of children with newly-diagnosed HCV infection is declining in Italy and most post-transfusion cases are now young adults. Thus foreign children could significantly contribute to the reservoir of pediatric infection in years to come. New infections result from maternal transmission and seem to privilege females and genotypes 3 and 4.

The effectiveness of state and national policy on the implementation of perinatal HIV prevention interventions

OBJECTIVES

The 1994 and 1995 US Public Health Service Guidelines regarding HIV testing and treatment for pregnant women and the resulting 1995 California law mandating an HIV test and treatment offer to every pregnant woman aim to reduce perinatal HIV transmission. However, the effectiveness of such policies after implementation is often unclear. We analyzed the association between these policies and offers of HIV tests and treatment to HIV-infected women in California.

METHODS

Data from active, population-based surveillance of 496 HIV-infected women and their infants, collected from 1987 to 2002, were analyzed to compare rates of offers of HIV tests and treatment before and after 1996.

RESULTS

We found significant increases in offers of HIV tests (P<.001) and offers of treatment (P<.001) when we compared women who delivered between 1987 and 1995 with those who delivered between 1996 and 2002. Receipt of prenatal care was the major predictor of both test and treatment offer. A significant shift in reported HIV risk factors was also evident between the 2 groups.

CONCLUSIONS

Our findings of increased offers of HIV tests and treatment to HIV-infected pregnant women suggest that the national guidelines and the 1996 California law improved health care for these women, which may lessen the risk of perinatal HIV transmission.

Reproductive health of adolescent girls perinatally infected with HIV

OBJECTIVES

We sought to describe the reproductive health of adolescent girls perinatally infected with HIV.

METHODS

We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C.

RESULTS

Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention.

CONCLUSIONS

Pregnancy rates were lower and cervical abnormalities were higher than among non-HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.

Estimating the number of vertically HIV-infected children eligible for antiretroviral treatment in resource-limited settings

BACKGROUND

With the gradual roll-out of antiretroviral therapy (ART) to delay progression of HIV disease in children in programmes across sub-Saharan Africa and resource-limited settings elsewhere, reliable information on the number of vertically infected children eligible for such treatment is urgently required.

METHODS

We present a model to estimate the number of vertically HIV-infected children by age who have progressed to moderate to severe disease (MSD) and as such are eligible for ART on the basis of clinical disease, allowing for: antenatal HIV prevalence, use of interventions to prevent mother-to-child transmission (PMTCT), infant feeding policies and availability of co-trimoxazole to prevent opportunistic infections that may hasten the onset of serious disease. The model assumptions were informed by published evidence and expert opinion; rates of progression to serious disease were inferred from mortality of infected and uninfected children of HIV-infected mothers; and mortality among children treated with ART was based on a study of treated children in Abidjan. To allow widespread use the model has been developed using the Excel spreadsheet software.

RESULTS

With South Africa as a hypothetical example, published antenatal prevalence and demographic data, and assuming PMTCT coverage with single dose nevirapine of 11%, all exposed and infected children receive co-trimoxazole, and various infant feeding policy scenarios, estimated numbers of children eligible for ART are presented.

CONCLUSIONS

This model is easy to implement and flexible and can be used in ART programmes at national and local level.

[Neonatal sepsis in the era of antenatal antibiotic prophylaxis]

The aim of this study was to compare incidence, bacteriology and associated mortality of neonatal sepsis in a neonatal unit, after (2001-2004) and before (1995-1996) implementation of universal screening for prevention of Group B Streptococcus diseases. Early onset sepsis incidence decreased from 2.5 to 1 per 1000 live births (p=0.03), with a decrease in the proportion of Group B Streptococcus cases from a 54% to 11% (p<0.01). In late onset sepsis, coagulase-negative Staphylococci continued to be the predominant pathogen (49% of cases), and Candida albicans emerged as the second etiologic agent in the postscreening period. Sepsis associated mortality was low in both periods (2.2%).

Modeling Maternal-Infant HIV Transmission in the Presence of Breastfeeding with an Imperfect Test

An important public health question is to determine the probabilities of perinatal HIV transmission and when it occurs, whether antepartum, intrapartum, or postpartum through breastfeeding. However, this is a difficult problem because the presence of HIV infection in an infant can only be ascertained through viral assays in the postpartum period. We propose a model that simultaneously estimates the risks of antepartum, intrapartum, and postpartum transmissions together with the sensitivity of the screening tests for HIV infection. The model allows estimating of infectivity through breast milk during postpartum periods. The methods are illustrated on a South African randomized clinical trial of extended AZT versus a short course of nevirapine in infants whose mothers had no access to antenatal antiretroviral therapy.

A final size relation for epidemic models

A final size relation is derived for a general class of epidemic mod els, including models with multiple susceptible classes. The derivation depends on an explicit formula for the basic reproduction number of a general class of disease transmission models, which is extended to calculate the basic reproduction number in models with vertical transmission. Applications are given to specific models for influenza and SARS.

Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study

BACKGROUND

Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding.

METHODS

2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors.

FINDINGS

1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122-174 days). 14.1% (95% CI 12.0-16.4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19.5% (17.0-22.4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per muL (adjusted hazard ratio [HR] 3.79; 2.35-6.12) and birthweight less than 2500 g (1.81, 1.07-3.06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4.04% (2.29-5.76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10.87, 1.51-78.00, p=0.018), as were infants who at 12 weeks received both breastmilk and formula milk (1.82, 0.98-3.36, p=0.057). Cumulative 3-month mortality in exclusively breastfed infants was 6.1% (4.74-7.92) versus 15.1% (7.63-28.73) in infants given replacement feeds (HR 2.06, 1.00-4.27, p=0.051).

INTERPRETATION

The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.

Disease progression in children with vertically-acquired HIV infection in sub-Saharan Africa: reviewing the need for HIV treatment

Approximately 700,000 children become newly infected with HIV annually, mainly through mother-to-child transmission (MTCT), making paediatric HIV a leading cause of morbidity and mortality worldwide. The substantial interest in preventing MTCT (PMTCT) has generated information on rates of transmission and associated factors, but there is a lack of information on disease progression and mortality in vertically-infected children, especially from resource-poor settings. Peer-review journals with titles or abstracts containing reference to the review's themes were selected using widely available search engines. We review relevant literature on mortality in children born to HIV infected mothers; morbidity and mortality associated with paediatric HIV infections; eligibility to and efficacy of antiretroviral therapy (ART). Child mortality is independently associated with maternal HIV status and maternal death, with paediatric infection resulting in approximately 4 fold increase in mortality by age 2 years. Morbidities seen in infected children were similar to those seen in uninfected children, although the rates and recurrences of illness were greater. There is some evidence that progression to AIDS may be more rapid in resource poor settings, although data on this are very limited. PMTCT and paediatric ART have been shown to be highly successful in resource-limited settings, but are not universally applied. Further efforts to increase coverage of both PMTCT and paediatric ART could substantially reduce the numbers of children becoming infected and improve survival of those infected. Additionally, improvements in health infrastructures could improve care provision, not only through improved detection and monitoring but also through treatment of co-morbidities and nutritional support.

Cambios en la transmisión vertical del virus de la inmunodeficiencia humana: comparación de los años 1994 y 2004

BACKGROUND AND OBJECTIVE

Vertical transmission (VT) is the main route of human immunodeficiency virus (HIV) infection in children. Since the publication of PACTG 076 study in 1994, several preventive methods against the vertical transmission of the HIV have been developed. In this study, we compare the clinical and epidemiological profile of HIV-infected pregnant women and the VT rate in the years 1994 and 2004.

PATIENTS AND METHOD

We looked at maternal, obstetric and pediatric variables of HIV-infected women and their children, born in 1994 and 2004, who were followed in Hospital La Paz.

RESULTS

We included 40 mother-infant couples in 1994 and 35 couples in 2004. The HIV vertical transmission rate was 35% in 1994 and 0% in 2004. We did not find changes in Hepatitis C virus (HCV) vertical transmission. In 1994, HIV-infected mothers had a more advanced HIV-disease and the major route of HIV-transmission was the intravenous drug use. Vaginal delivery was more frequent and rupture of membranes was longer than in 2004. The main route of maternal HIV infection in 2004 was sexual contact. In this same year, the use of combination antiretroviral therapy, even during pregnancy, was generalized, the elective cesarean section was the most frequent form of delivery, and every newborn received zidovudine.

CONCLUSIONS

In the last decade, there have been important epidemiological changes in HIV-infected mothers in our society. The administration of antiretroviral therapy during pregnancy and to the newborn, as well as other obstetric strategies, can prevent HIV vertical transmission. Nevertheless, we did not find any change in the risk of HCV vertical transmission.

Transmission of West Nile virus through human breast milk seems to be rare

INTRODUCTION

In September 2002, possible transmission of West Nile virus via human milk was reported for the first time.

METHODS

Since 2003, the Centers for Disease Control and Prevention collected reports of maternal or infant West Nile virus illness during the breastfeeding period. All of the reported instances were reviewed. In addition, milk samples from women infected during pregnancy were tested for West Nile virus RNA and West Nile virus-specific antibodies.

RESULTS

Six infants were reported to have breastfed from mothers with West Nile virus fever. Five of the 6 infants had no illness or detectable antibodies to West Nile virus in serum after onset of maternal illness. One infant who was not tested and developed a rash was otherwise well 1 week after onset of maternal illness. In addition, 2 infants were reported to have developed West Nile virus illness while breastfeeding; preceding maternal illness was not documented. Two breastfed infants whose mothers acquired West Nile virus fever in the last week of pregnancy developed West Nile virus-specific antibodies; both infant infections could have been congenitally acquired. Of 45 milk samples from women infected with West Nile virus during pregnancy, 2 had West Nile virus RNA, and 14 had immunoglobin M antibodies to West Nile virus.

CONCLUSIONS

Of 10 reported instances since 2003 of maternal or infant West Nile virus illness while breastfeeding, transmission of West Nile virus through human milk could neither be ruled out nor confirmed for 5 cases; in 5 others, serologic tests indicated no vertical transmission. Transmission of West Nile virus through breastfeeding seems to be rare, but more information is needed.

The Role of Vertical Transmission and Health Care-Related Factors in HIV Infection of Children

OBJECTIVES

To determine the probable route of transmission of HIV to children aged 12 years or younger in a rural area of Uganda from 1999 through 2000 and to examine associations between HIV infection and health care-related variables.

METHODS

The HIV infections status for 6991 children was determined from 1 round of an ongoing population surveillance system, and the reported numbers of injections in the past year and blood transfusions were determined for 5922 of these children based on a medical questionnaire. Data from the surveillance system and from an additional survey were used to assess the potential for vertical infection from a mother to her child.

RESULTS

The HIV prevalence among children was 0.4%. Of 23 definite and 4 probable cases of HIV infection in children, vertical transmission was not possible for 1 case, not likely for another case, and possibly not vertical for another case. The population-attributable fraction for vertical transmission was between 90% and 94%. Large numbers of injections in the past year and ever having a blood transfusion were only associated with HIV infection in children exposed to vertical transmission.

CONCLUSIONS

Up to 10% of HIV infections in children in the study area were not attributable to vertical transmission, and thus were possibly attributable to iatrogenic transmission. Associations seen between health care-related variables and HIV were likely to be attributable to treatment for AIDS-related illness in children infected vertically.

Community-based familial study of Helicobacter pylori infection among healthy Japanese Brazilians

BACKGROUND

The present study of Helicobacter pylori infection was conducted in family units of Japanese Brazilians living in São Paulo city. The authors attempted to determine the seroprevalence of H. pylori infection within family units of Japanese Brazilians and to identify risk factors associated with intrafamilial transmission.

METHODS

The seroprevalence was determined in 1037 healthy and asymptomatic volunteer subjects aged 0-69 years (530 adults and 507 children) of 265 families. Demographic data and details of living conditions were obtained from each family.

RESULTS

H. pylori seropositive infection was found in 39.2% of the parents and 9.3% of the children. A reduced risk of H. pylori infection was found for girls (odds ratio [OR] 0.45; 95% confidence interval [CI], 0.23-0.86). The prevalence of infection was 3.5% for children with uninfected parents; 9.9% (OR, 2.51; 95% CI, 0.95-6.61) for those with a seronegative mother and a seropositive father; 14.9% (OR, 4.93; 95% CI, 1.86-13.06) for those with a seropositive mother and a seronegative father; and 16.0% (OR, 5.29; 95% CI, 1.98-14.14) for those with seropositive parents. On multivariate analysis, the use of a pacifier, and mother's symptoms of nausea and vomiting were significantly associated with the risk of H. pylori infection for children, and the child having her/his own room was significantly associated with a reduced risk. Income was not associated with H. pylori infection in children and was inversely associated in parents.

CONCLUSION

The prevalence of H. pylori infection in family units of Japanese Brazilians supports the hypothesis of a predominant role for mother-child transmission of H. pylori infection, mainly through contact with regurgitated gastric juice in the mother's mouth.

HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa

HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed.

HIV and pregnancy: considerations for nursing practice

This article describes current nursing practice for pregnant women with HIV. In the United States, the number of new cases of HIV continues to rise in women of childbearing age. Women often learn of their HIV status when a pregnancy involves them in the healthcare delivery system. Since the manifestation of the disease in 1981, there have been significant advances in treatment, and now, among pregnant women testing positive for HIV, the risk of perinatal transmission can be decreased to 1% with pharmacologic intervention. Yet, HIV disease poses many new challenges to the woman testing positive who is considering pregnancy or who is already pregnant. The progression of the symptoms of AIDS is similar to the common symptoms of pregnancy; the HIV medications may also cause these symptoms. Adherence to the HIV medication regime is necessary for ongoing viral suppression, for missed doses can initiate drug resistance and the whole categories of antiretroviral drugs may become ineffective. Additionally, the HIV stigma continues to impact those infected and interferes with the access to healthcare. HIV poses a major challenge for the nurse caring for the childbearing woman.

[Mother-to-infant HCV transmission--rate and course of HCV infection in children]

OBJECT

to establish the rate and course of HCV infection in infants born to HCV infected mothers and to determine abilities of prevention.

METHODS

155 children born to HCV infected mothers were observed from birth until age 18-48 months. Serum of infants was tested for HCV-RNA (RT-PCR, Amplicor v 2.0 Roche), for anti-HCV (EIA v. 2) and ALT activity. Infants were classified as HCV infected if their serum was found to be positive for HCV-RNA at least twice during first year of life. In 11 mothers and their newborns serum and PBMC from venous blood and from the umbilical cord were collected during delivery and examined-using nested RT-PCR.

RESULTS

The overall HCV vertical infection rate was 11%. Transmission occurred more frequently in children with intrapartum exposure to maternal blood by percutaneus inoculation. None of the infected infants had clinical symptoms of hepatitis. ALT abnormal activity was detected in 43% of infected children. HCV-RNA was detected in mothers' serum and PBMC collected during delivery in 9 (9/11) samples. HCV-RNA was detected in samples from umbilical cord in serum in 7 (7/11) and in PBMC in 4 (4/11) cases.

CONCLUSIONS

The risk of HCV vertical infection in present study was high. Intrapartum percutaneus exposure to maternal blood increased transmission rates. Further investigation to determine the effectiveness of antiviral therapy in prevention of mother-to-infant HCV transmission should be performed. The role of PBMC in mother-to-child HCV transmission should be investigated.

An apparent paradox of horizontal and vertical disease transmission

The question as to how the ratio of horizontal to vertical transmission depends on the coefficient of horizontal transmission is investigated in host-parasite models with one or two parasite strains. In an apparent paradox, this ratio decreases as the coefficient is increased provided that the ratio is taken at the equilibrium at which both host and parasite persist. Moreover, a completely vertically transmitted parasite strain that would go extinct on its own can coexist with a more harmful horizontally transmitted strain by protecting the host against it.

The pattern of paediatric HIV/AIDS as seen at the National Hospital Abuja Nigeria

BACKGROUND

Paediatric HIV/AIDS has become a significant cause of mortality and morbidity in our environment.

OBJECTIVES

The objective of this paper is to determine the mode of transmission, clinical presentations and outcome of hospital admissions in children with Paediatric HIV/AIDS at the National Hospital Abuja Nigeria.

METHODS

A retrospective study of children with Paediatric HIV/AIDS admitted into the hospital from January December 2000 was done. Screening for HIV infection was based on clinical criteria as recommended by WHO except in 3 children with previously diagnosed HIV seropositivity. One positive ELISA and one positive Western Blot assay diagnosed HIV seropositivity.

RESULTS

Forty-three HIV positive children aged six weeks to nine years (mean 16.5 months, SD 26.32) were admitted into the Paediatric unit (exclusive of the newborn unit) of the hospital, accounting for 5.7% of all admissions into the unit. There were 35 infants (81.4%). There were 18 males and 25 females (male: female ratio 1:0.72). The presumed modes of transmission were mother to child transmission 40(93.02%), blood transfusion 2 (4.6%) and an unidentified route 1 (2.3%). All parents were in the reproductive age group and there were 6 discordant couples identified (mother HIV positive, father HIV negative). Common presenting symptoms were fever 16 (37.2.8%), diarrhoea 13 (30.2%), difficult/fast breathing 12 (27.9%) and vomiting 8 (18.6%), while clinical signs were crepitations in the lungs 27 (62.7%), pallor 22 (51.2%), oral thrush 20 (46.5%), hepatomegaly 18 (41.9%), and dehydration 16 (37.2%). Admitting diagnoses were pneumonia 26 (60.5%), septicaemia 4 (9.3%), diarrhoea with dehydration, intestinal obstruction and malnutrition 2 (4.7%) each. There were 14 deaths (mortality rate 32.6%); accounting for 28.57% of total deaths in the paediatric unit during the period. Thirteen (13) (92.8%) deaths occurred in children aged 2 years old and below. The greatest contributors to mortality were pneumonia 10 (71.4%) and septicaemia 2 (14.3%). Poor nutritional status was associated (p<0.05) with increased mortality.

CONCLUSION

The findings indicate that paediatric HIVAIDS occurs predominantly by mother to child transmission and constitutes a significant cause of childhood morbidity and mortality at the National Hospital Abuja Nigeria. We recommend intensification of efforts to implement the existing prevention of mother to child transmission programme and further evaluation ofpneumonia in HIV positive children.

COMPARATIVE EFFECT OF NEOSPORA CANINUM INFECTION IN BALB/c MICE AT THREE DIFFERENT GESTATION PERIODS

Neospora caninum has been recognized as a major cause of infectious bovine abortion worldwide. In the present study, the effect of N. caninum infection in mice at the 3 gestation periods (first, second, and third period) was investigated. In dams, tissue distribution of N. caninum was evaluated by nested polymerase chain reaction. In the progeny, fetal mortality, stillbirth, litter size, neonatal mortality/morbidity, vertical transmission, and parasite burden in neonatal tissues were evaluated. Pregnant BALB/c mice were infected subcutaneously with 2 x 10(6) NC-1 tachyzoites on days 0, 7, or 14 of gestation. Dams from each group were sequentially killed during gestation and postpartum (PP). Pups were killed on days 1 and 7 PP. Infection on day 0 of gestation produced a high vertical transmission rate, although no changes in fetal mortality, stillbirth, and littermate size were observed. The highest level of vertical transmission, together with an increase in fetal mortality and stillbirth and a decrease in litter size, were observed when infection was done on day 7 of gestation. Finally, infection on day 14 of gestation produced the lowest vertical transmission. Furthermore, infection at any time during gestation compromised the postnatal development of pups, because neonates from infected dams showed less body weight and a delay in the hair development.

HIV-infected children in Croatia--medical care versus ethical and social issues

The era of pediatric HIV-infection in Croatia began in 1987 when the first child from an HIV-infected mother was born. The authors present some medical data of children diagnosed as HIV-infected or observed because of maternal HIV-infection in Croatia until the end of 2005. Although the number of HN-infected children in Croatia is still relatively small, in the last two decades the Croatian society was confronted with many ethical and social issues regarding HIV-infection and discrimination. There were many obstacles in providing proper care and integrating HIV-infected children in the Croatian society. Stigmatisation, fear and lack of knowledge were major contributors. For the first time, the integration of an HIV-infected child with revealed HIV-status into school was described. Changes in attitudes towards HIV-infected people can only be achieved through planned permanent educational programs.