Role of virus-induced neuropeptides in the brain in the pathogenesis of rabies

Rabies virus (RABV) infection is characterized by the rapid neuronal spread of RABV into the CNS before a protective immune response is raised. Therefore, a typical feature of RABV infection is the paucity of inflammatory reactions in the brain. Here we examined whether the induction of immunosuppressive neuropeptides, in particular CGRP, may contribute to the ability of RABV to evade immune responses. RABV infection of mice caused a strong induction of calcitonin gene-related peptide (CGRP) in neurons and fibres in the neocortex as well as in the dentate gyrus and CA1 region of the hippocampus although RABV did not infect neurons in which CGRP expression was upregulated. Neuropeptide Y (NPY) or vasoactive intestinal peptide (VIP) expressing neurons also were not infected by RABV. In contrast, somatostatin neurons were infected by RABV. There was evidence for an RABV-induced increase of VIP and somatostatin but not of NPY. To test how CGRP expression is related to TNFalpha-induced enhancement of CNS innate and adaptive immunity during RABV infection, we used recombinant RABVs that contained either an active (SPBN-TNFalpha(+)) or an inactive (SPBN-TNFalpha(-)) TNFalpha gene. As compared to SPBN-TNFalpha(-), infection with SPBN-TNFalpha(+) attenuated the induction of CGRP but simultaneously enhanced induction of the invariant chain of MHC II, microglial activation and T cell infiltration. In conclusion, distinct neuropeptidergic neurons in the brain are remarkably spared from RABV infection suggesting a pivotal role of neuropeptides during CNS virus infection. Given the inhibitory effect of CGRP on antigen presentation, we propose that the strong RABV-induced upregulation of CGRP in the brain may contribute to the mechanism by which RABV escapes immune detection. Targeting the expression of neuropeptides, in particular CGRP, that are induced during RABV infection may open a new avenue for therapeutic intervention in human rabies.

[Care for the elderly with frequent falls: the fall clinic in Zeeuws-Vlaanderen, the Netherlands]

A fall-clinic forms part of the fall-prevention program in Zeeuws-Vlaanderen. In this paper it is explained how elderly who are prone to falling are examined in the fall-clinic to find the underlying cause of their fall problem. The complete examination is termed the fall-risk analysis (FRA). In a six year period 121 elderly visited the fall-clinic. On average they were 78 +/- 8 years of age (mean +/- standarddeviation) and 76% was female. An insufficient muscle force of the hip flexors was the most prominent limitation that could be related to the increased fall risk. Based on the FRA on average 4.3 +/- 1.7 actions were proposed, where a referral to a specialist or physical therapist was most frequently proposed. The fall-clinic is integrated into existing structures of the Dutch health care services. Additional attention is given to case finding by means of district-nurses and family physicians. In this way a highly qualitative health care chain is being created for the falling elderly.

Effect of conformational aspects on the movement of the equine back

The relationship between structure and function is important in the judgement of the horse. Twenty sound riding horses walked and trotted on a treadmill. The movement of the backs of each of the horses was measured using a commercially available movement analysis system. Morphometric, spatiotemporal and kinematic information were correlated to investigate the effect of conformation on movement. Taller and heavier horses seem to have longer thoracic and lumbar backs, and are wider at the pelvis. Horses with longer strides extended and flexed their backs in the caudal saddle region to a greater extent at the walk, but not the trot. Horses with greater angle of L5 tend to extend and flex this region of the back more. At the walk and trot, a long thoracic back results in greater lumbar lateral bending. A negative relationship was found between the curvature of mid-thoracic back and the amount of lateral bending of L1 and L3 and axial rotation of the pelvis at the trot. There are clear relationships between back conformation and movement that may be important to the orthopaedic health of the horse. Further understanding of the relationships between conformation, movement and injury may provide an objective basis for the evaluation of future performance and soundness.

Repeatability of back kinematics in horses during treadmill locomotion

We tested the hypothesis that repeatability of a standardised protocol for quantifying back kinematics is sufficiently high not to prevent its use in the clinical evaluation of horses with back problems. We investigated the extent to which differences between laboratories may affect the results when a standardised protocol is used. As a clinical tool, movement analysis techniques are helpful for the objective and quantitative assessment of kinematics. Knowledge about the repeatability of the kinematic data is very important. The present study investigates the repeatability of back kinematics in 10 sound horses over 5 successive days and in 2 laboratories (5 horses at each location). Measurements were performed on the treadmill during the walk and the trot. The between-stride, between-day and between-horse repeatability were determined. A high degree of between-stride and between-day repeatability was observed in the spatiotemporal parameters and in the time-angle diagrams of thoracic and lumbar vertebrae, the sacrum and the hindlimb during both the walk and trot. Much more variability was found between horses, with the highest degree of dissimilarity in the lateral bending rotation of the L1 vertebra. For range of motion values, the between-day coefficient of variability was <14% and the between-horse coefficient of variability was up to 4 times higher. Small differences were found in range of motion values between the 2 laboratories. It is concluded that an analysis of back kinematics in the horse can provide highly repeatable data, warranting clinical use.

Silver-haired bat rabies virus variant does not induce apoptosis in the brain of experimentally infected mice

To examine whether induction of apoptosis plays a role in the pathogenesis of street rabies, we compared the distribution of viral antigens, histopathology, and the induction of apoptosis in the brain of mice infected with a street rabies virus (silver-haired bat rabies virus, SHBRV) and with a mouse-adapted laboratory rabies virus strain (challenge virus standard, CVS-24). Inflammation was identified in the meninges, but not in the parenchyma of the brain of mice infected with either CVS-24 or SHBRV. Necrosis was present in numerous cortical, hippocampal, and Purkinje neurons in CVS-24-infected mice, but only minimal necrosis was identified in mice infected with SHBRV. Likewise, extensive terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end-labeling (TUNEL) staining was observed in the brain of mice infected with CVS-24 but little or none in the brain of mice infected with SHBRV. Rabies virus antigens were distributed similarly in the CNS infected with either virus. However, the expression of the glycoprotein (G) is more widespread and the staining of G is generally stronger in CVS- than SHBRV-infected mice, whereas the expression of rabies virus nucleoprotein (N) is similar in mice infected with either CVS or SHBRV. The positive TUNEL staining thus correlates with the high level of G expression in CVS-infected mouse brain. Northern blot hybridization revealed that the ratio between the N and G transcripts is similar in brains infected with either virus, indicating that the reduced expression of G protein is not caused by reduced transcription in SHBRV-infected animals. Taken together, these observations suggest that apoptosis is not an essential pathogenic mechanism for the outcome of a street rabies virus infection and that other pathologic processes may contribute to the profound neuronal dysfunction characteristic of street rabies.

Overexpression of cytochrome C by a recombinant rabies virus attenuates pathogenicity and enhances antiviral immunity

The pathogenicity of individual rabies virus strains appears to correlate inversely with the extent of apoptotic cell death they induce and with the expression of rabies virus glycoprotein, a major inducer of an antiviral immune response. To determine whether the induction of apoptosis by rabies virus contributes to a decreased pathogenicity by stimulating antiviral immunity, we have analyzed these parameters in tissue cultures and in mice infected with a recombinant rabies virus construct that expresses the proapoptotic protein cytochrome c. The extent of apoptosis was strongly increased in primary neuron cultures infected with the recombinant virus carrying the active cytochrome c gene [SPBN-Cyto c(+)], compared with cells infected with the recombinant virus containing the inactive cytochrome c gene [SPBN-Cyto c(-)]. Mortality in mice infected intranasally with SPBN-Cyto c(+) was substantially lower than in SPBN-Cyto c(-)-infected mice. Furthermore, virus-neutralizing antibody (VNA) titers were significantly higher in mice immunized with SPBN-Cyto c(+) at the same dose. The VNA titers induced by these recombinant viruses paralleled their protective activities against a lethal rabies virus challenge infection, with SPBN-Cyto c(+) revealing an effective dose 20 times lower than that of SPBN-Cyto c(-). The strong increase in immunogenicity, coupled with the marked reduction in pathogenicity, identifies the SPBN-Cyto c(+) construct as a candidate for a live rabies virus vaccine.

Nutritional status and dietary intakes of children aged 2-5 years and their caregivers in a rural South African community

The objective of this study was to determine the nutritional status regarding vitamin A, iron and anthropometric indices and dietary intakes of children aged 2-5 years and their caregivers in a rural South African community. Micronutrient, haematological, anthropometric and dietary indicators were used to assess nutritional status during a cross-sectional survey. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. The subjects were children aged 2-5 years (n = 164), and their caregivers (n = 137). Of the preschool children, 50% had a low vitamin A status (serum retinol < 20 micrograms/dL), 54% were anaemic (Hb < 11 micrograms/dL), 33% had depleted iron stores (serum ferritin levels < 10 micrograms/L), and 21% were stunted (Z-score for height-for-age < -2SD). Of the caregivers, 30% had a low vitamin A status (serum retinol < 30 micrograms/dL), 44% were anaemic (Hb < 11 micrograms/dL), 19% had depleted iron stores (serum ferritin levels < 12 micrograms/L), and 40% and 26% were overweight (BMI > or = 24 and < 30) and obese (BMI > or = 30), respectively. The children and caregivers consumed a cereal-based diet, with phutu (a stiff porridge made with maize meal), rice and bread as staple foods. Quantitative dietary analysis showed that the dietary intakes were high in carbohydrates (approximately 70% of total energy), while fat intake was within the prudent dietary guideline of 30% of total energy intake. Median dietary intakes were below 50% of the RDA for calcium, zinc (children only), vitamin A, riboflavin, niacin (children only) and vitamin B12. These preschool children and their caregivers consumed a high carbohydrate diet deficient in most of the essential micronutrients. The poor quality of the diet was reflected in a poor vitamin A and iron status, and one-fifth of the children showed linear growth retardation. Nutrition education and intervention programmes should address micronutrient deficiencies, with the focus not only on quantity, but also quality of the diet.

The effect of a biscuit with red palm oil as a source of beta-carotene on the vitamin A status of primary school children: a comparison with beta-carotene from a synthetic source in a randomised controlled trial

OBJECTIVE

To determine the effect of a biscuit with red palm oil as a source of beta-carotene on the vitamin A status of primary school children and to compare this with the effect of a biscuit with beta-carotene from a synthetic source.

DESIGN

Randomised controlled trial.

SETTING

A rural community in KwaZulu-Natal, South Africa.

SUBJECTS

A total of 437 primary school children, aged 5--11 y; 400 completed the study.

INTERVENTION

Subjects were randomly assigned to one of three groups, receiving, respectively: (i) a placebo biscuit; (ii) a biscuit with synthetic beta-carotene as a vitamin A fortificant (SB); (iii) a biscuit with red palm oil as a source of beta-carotene (PB); SB and PB supplied 30% of the RDA for vitamin A per serving of three biscuits. Biscuits were distributed daily during the school week; vitamin A status was assessed at baseline and after 3 months.

RESULTS

There was a significant improvement in serum retinol compared to the control group in both the SB and PB groups (P<0.005); the treatment effect for the two groups was equivalent (difference in treatment effect 0.62 microg/dl, with a 90% CI -0.33--1.57).

CONCLUSIONS

A biscuit with red palm oil as a source of beta-carotene is as effective as a biscuit with synthetic beta-carotene in improving the vitamin A status of primary school children. The additional qualities of red palm oil (ie no trans fatty acids; rich source of antioxidants) make it an excellent alternative fortificant for addressing vitamin A deficiency.

Perceptions of infant cereals and dietary intakes of children aged 4-24 months in a rural South African community

The objectives of this study were to determine (1) mothers' perceptions on infant cereals, and (2) dietary intakes of children aged 4-24 months in a rural South African community. All mothers/caregivers of preschool children who attended community-based growth monitoring posts during January-March 2000 were interviewed. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. Mothers/caretakers (n = 119) of children aged 5 years and under were interviewed to determine perceptions on infant cereals, and to collect retrospective data on complementary feeding practices. Dietary intakes of children aged 4-24 months (n = 50) were determined by 24 h recall. Retrospective data for the 119 children represented in the survey showed that (1) an infant cereal was given as first solid food to 50% of the children; (2) 81% of children had received an infant cereal at some stage, usually at an early age; (3) half of the children had not received any infant cereal after the age of 6 months; (4) the duration for the use of infant cereals was short (on average 3 months); and (5) feeding of an infant cereal was stopped for more than half of the children because the child did not want to eat it any more (disliked it). Most mothers had a positive attitude towards the use of infant cereals, recognizing the health benefits. The cost of the products is high compared to the amount of money spent to feed the household. For children aged 4-24 months of age, the quantities of infant cereal used was inadequate (approximately a quarter of the recommended portion size) and total dietary intakes were below 67% of the recommended levels for calcium, iron, zinc, niacin, vitamin B6 and vitamin B12. It was found that the concept of infant cereals is well accepted and the health benefits thereof are recognized in this rural community. Although these products are available in the area, intakes of children aged 4-24 months were below recommended levels for most of the micronutrients. The availability of culturally acceptable fortified products which are affordable for people in the lower socioeconomic sector is needed.

High level expression of a human rabies virus-neutralizing monoclonal antibody by a rhabdovirus-based vector

Humans exposed to rabies virus must be promptly treated by passive immunization with anti-rabies antibody and active immunization with rabies vaccine. Currently, antibody prepared from pooled human serum or from immunized horses is utilized. However, neither of these reagents are readily available, entirely safe, or consistent in their biological activity. An ideal reagent would consist of a panel of human monoclonal antibodies. Such antibodies are now available, their only drawback being the cost of production. Using recombinant technology, we constructed a rabies virus-based vector which expresses high levels (approximately 60 pg/cell) of rabies virus-neutralizing human monoclonal antibody. The vector is a modified vaccine strain of rabies virus in which the rabies virus glycoprotein has been replaced with a chimeric vesicular stomatitis virus glycoprotein, and both heavy and light chain genes encoding a human monoclonal antibody have been inserted. This recombinant virus can infect a variety of mammalian cell lines and is non-cytolytic, allowing the use of cell culture technology routinely employed to produce rabies vaccines.

Basic three-dimensional kinematics of the vertebral column of horses trotting on a treadmill

OBJECTIVE

To determine movements of the vertebral column of horses during normal locomotion.

ANIMALS

5 young Dutch Warmblood horses that did not have signs of back problems or lameness.

PROCEDURE

Kinematics of 8 vertebrae (T6, T10, T13, T17, L1, L3, L5, and S3) and both tuber coxae were determined, using bone-fixated markers. Measurements were recorded when the horses were trotting on a treadmill at a constant speed of 4.0 m/s.

RESULTS

Flexion-extension and axial rotation were characterized by a double sinusoidal pattern of motion during 1 stride cycle, whereas lateral bending was characterized by 1 peak and 1 trough. Ranges of motion for all vertebrae were: flexion-extension, 2.8 degrees to 4.9 degrees; lateral bending, 1.9 degrees to 3.6 degrees; axial rotation, 4.6 to 5.8 degrees, except for T10 and T13, where the amount of axial rotation decreased to 3.1 degrees and 3.3 degrees, respectively.

CONCLUSION AND CLINICAL RELEVANCE

During locomotion, 3 types of rotations are evident in the thoracolumbar vertebrae. Regional differences are observed in the shape and timing of the rotations. These differences are related to actions of the limbs. The method described here for direct measurement of vertebral column motion provides insights into the complex movements of the thoracolumbar portion of the vertebral column in trotting horses. Information on normal kinematics is a prerequisite for a better understanding of abnormal function of the vertebral column in horses.

Red palm oil as a source of beta-carotene in a school biscuit used to address vitamin A deficiency in primary school children

The effect of a biscuit with red palm oil as a source of beta-carotene was compared with the effect of a biscuit with beta-carotene from a synthetic source on the vitamin A status of primary school children in a randomised controlled trial. Children aged 5-11 years (n = 265) were randomly assigned to one of three groups: (1) placebo biscuit; (2) biscuit with synthetic beta-carotene as a vitamin A fortificant; and (3) biscuit with red palm oil as a source of beta-carotene. The two non-placebo biscuits were designed to provide 34% of the RDA for vitamin A per serving (4 x 15 g biscuits). The biscuits were distributed daily during the school week and compliance was closely monitored and recorded. Children were assessed at baseline and after 6 months of intervention. Mean serum retinol in all three groups increased significantly compared to baseline (P < 0.0001). The prevalence of low serum retinol levels (< 20 micrograms/dL) dropped from 50 to 24.4% in the control group, from 48.2 to 16.9% in the synthetic beta-carotene group, and from 50.6 to 22.8% in the red palm oil group. There was no significant treatment effect compared to the control group in either the synthetic beta-carotene or red palm oil group. The increase in the control group was probably due to a school feeding scheme (providing 33% of the RDA for vitamin A) introduced during the latter part of the study. Our results were thus confounded and the 'true' effect of the red palm oil biscuit on vitamin A status could not be established. The study has, however, shown that red palm oil can be incorporated in a biscuit and that the end product with regard to taste and appearance was well accepted by the school children. A follow-up study in a school where there is no school feeding is indicated.

Three-dimensional kinematics of the equine spine during canter

Most research on equine kinematics has previously been performed in the walking and/or trotting animal. This is also true for the few studies on the kinematics of the equine back. These studies have, for the major part, focused on the flexion-extension movement in the sagittal plane. However, vertebrae can rotate in 3 dimensions. This study was designed to determine all 3 rotations in various segments of the vertebral column of a cantering horse. Five Dutch Warmblood horses were measured during treadmill canter (7.3 m/s). Steinmann pins were inserted into the dorsal spinous processes of 8 thoracic (T), lumbar (L) and sacral (S) vertebrae and into both tubera coxae. A set of 4 markers was rigidly attached to each pin. The marker data were used to calculate a rotation matrix that was subsequently decomposed into 3 orthogonal rotations (flexion/extension [FE]; lateral bending [LB] and axial rotation [AR]). For the 3 rotations the variability between the horses was low for FE, slightly larger for AR and largest for LB. The maximal range of motion (mean +/- s.d.) for FE, LB and AR was 15.8 +/- 1.3 degrees, 5.2 +/- 0.7 degrees and 7.8 +/- 1.2 degrees, respectively. With respect to relative angles, the largest FE motion was found between L5 and S3 with values for the range of motion up to 8.6 degrees. Simultaneous rotation of successive vertebrae was observed particularly during the single support and suspension phases in the stride cycle, which increases spinal stability. For all rotations, a close correlation was observed between the timing of the vertebral rotations and the pro- and retraction of the limbs.

Factors associated with low serum retinol levels in children aged 6-24 months in a rural South African community

OBJECTIVE

: To identify risk factors for variation in serum retinol levels in children younger than 2 years of age in a rural South African community.

DESIGN

: Children (n = 97), 6-24 months of age, were divided into two groups according to their serum retinol levels, using 20 microg dl-1 as the cut-off point. The chi-square test, Fischer exact two-tailed test and analysis of variance were used to identify related variables which were significantly different between the two groups. To evaluate simultaneously the association between several potential risk factors and low serum retinol levels, a multiple regression model for categorical data was developed which included potential risk factors that were statistically significant in the bivariate analysis as the independent variables, and either low or normal vitamin A status as the dependent variable.

RESULTS

: There was an association between serum retinol levels and: (i) the place of birth (hospital vs. home deliveries); (ii) the attitude of the care-giver towards family life; and (iii) the health status of the child. Although not included in the multiple variable model because of small numbers, all children who had a previous episode of measles, all underweight children, and all children of widowed care-givers were in the low serum retinol group.

CONCLUSIONS

: The care-giver's attitude towards family life was positively associated with the child's vitamin A status, while home deliveries were associated with a low vitamin A status.

Breastfeeding and complementary feeding practices in a Swaziland population

Before construction of the Maguga Dam near Pigs Peak in Swaziland commenced, a baseline cross-sectional study was conducted to assess the nutritional status of the population a part of a health status survey. In this article we report the breastfeeding and complementary feeding practices of children younger than two years of age. The study population consisted of people living in three areas, which are likely to be affected by the construction of the Maguga Dam in Swaziland, and two areas approximately 150km away, which were selected because of socio-economic and demographic similarities. The initiation rate of breastfeeding was high, and most of the children were breastfeed for at least 12 months. Sixty percent of infants were introduced to solid foods at the age of 4-6 months. Maize meal porridge was the solid food introduced first to more than 80% of the infants. Approximately two months lapsed before the next solid food was introduced. Although only a small percentage (9.4%) of the mothers used formula milk, less than half of these mothers followed the correct mixing proportions (one scoop formula on 25ml water). When breast milk and solid foods were given during the same feeding session, approximately one third of the mothers gave breast milk first and then the solid foods. This study showed that the initiation and duration of breastfeeding are not a problem in this population residing in Swaziland. The complementary feeding practices of concern were the age of introducing solid foods (28.2% before 4 months and 11.8% after 6 months), the lapse of 2 months before the next solid food was introduced, and the order of feeding breast milk and solids, and the incorrect mixing of formula milk.

The effect of rounding-off age on the calculated prevalence of anthropometric indices of malnutrition in children aged 2-5 years

For children, two of the anthropometric indices used to assess nutritional status, weight-for-age and height-for-age, depend on the accurate estimation of the child's age. The effect of using age as either last attained year or as last attained year rounded up with half a year in the calculation of prevalence of malnutrition was looked at, using data of children (n= 208), aged between 2 and 5 years,living in the vicinity of the planned Maguga Dam, near Piggs Peak in Swaziland. Date of birth was not known for 41.3% of the children. For children whose date of birth was not known, using age as either last attained year or last attained year rounded up with half a year in the calculation of anthropometric indices profoundly affected the estimated prevalence of malnutrition in the population. The magnitude of malnutrition was lower when age was taken as last attained year. To ensure correct interpretation and use of anthropometric data it is imperative that the methods used to calculate ages are correctly specified and recorded in all documents.

Basic three-dimensional kinematics of the vertebral column of horses walking on a treadmill

OBJECTIVE

To determine kinematic movements of the vertebral column of horses during normal locomotion.

ANIMALS

5 Dutch Warmblood horses without apparent lameness or problems associated with the vertebral column.

PROCEDURE

Kinematics of 8 vertebrae (T6, T10, T13, T17, L1, L3, L5, and S3) and both tuber coxae were determined, using bone-fixated markers. Horses were recorded while walking on a treadmill at a constant speed of 1.6 m/s.

RESULTS

Flexion-extension was characterized by 2 periods of extension and flexion during 1 stride cycle, whereas lateral bending and axial rotation were characterized by 1 peak and 1 trough. The range of motion for flexion-extension was fairly constant for vertebrae caudal to T10 (approximately 7 degrees). For lateral bending, the cranial thoracic vertebrae and segments in the pelvic region had the maximal amount of motion, with values of up to 5.6 degrees. For vertebrae between T17 and L5, the amount of lateral bending decreased to <4 degrees The amount of axial rotation increased gradually from 4 degrees for T6 to 13 degrees for the tuber coxae.

CONCLUSIONS

This direct measurement method provides 3-dimensional kinematic data for flexion-extension, lateral bending, and axial rotation of the thoracolumbar portion of the vertebral column of horses walking on a treadmill. Regional differences were observed in the magnitude and pattern of the rotations. Understanding of the normal kinematics of the vertebral column in healthy horses is a prerequisite for a better understanding of abnormal function.

Smoking and alcohol use during pregnancy affects preterm infants' docosahexaenoic acid (DHA) status

This study investigated the effect of alcohol consumption and smoking during pregnancy on the fatty acid composition of the infants. A total of 40 very-low-birth-weight (VLBW) infants, weighing between 750 and 1500 g, were enrolled in the study after being hospitalized and ventilated for respiratory distress syndrome (RDS). Maternal and infant demographic information was recorded. Questions regarding maternal smoking (none, < 10 and > or = 10 cigarettes/d) and alcohol consumption (none, occasionally, moderate and severe) were recorded. Erythrocyte membrane (EMB; n = 40) total fatty acid analyses were performed at birth (baseline) and on days 14 and 28 postnatally. During pregnancy, 42% of mothers consumed alcohol and 50% smoked. At birth, infants of mothers who smoked and consumed alcohol during pregnancy, had significantly higher blood docosahexaenoic acid (DHA; p < 0.05) than infants of mothers who abstained from both alcohol and smoking. The consequences of this finding remain unknown.

[An outbreak of Pontiac fever among children and adults following a whirlpool bath]

We investigated an outbreak of fever most likely due to a contaminated whirlpool among nine adults and six children visiting a holiday home. The outbreak was characterized by a high attack rate, short incubation periods, influenza-like symptoms and rapid recoveries typical of Pontiac fever. The children, however, experienced less characteristic symptoms and no sequelae compared to the adults. Evidence and presumptive evidence of Legionella (L) infection was found in eleven cases; in one case by isolation of L. pneumophila serogroup 1, in two cases by positive test for Legionella by PCR and in eleven cases with seroconversion. In contrast, two adult non-users of the whirlpool had no symptoms and no serological evidence of infection. This investigation demonstrates differences between adults and children in the clinical picture of Pontiac fever, furthermore it shows that culture and PCR of tracheal aspirate for legionellae can be used in a hospital setting for rapid diagnosis although their sensitivities are low.

Nutritional status and dietary practices of 4-24-month-old children from a rural South African community

OBJECTIVES

To assess the nutritional status and dietary practices of 4-24-month-old children (under-twos) in a rural South African community.

DESIGN

Cross-sectional survey.

SETTING

A low socioeconomic rural African community (Ndunakazi), approximately 60 km north-west of Durban, KwaZulu-Natal, South Africa.

SUBJECTS

Children (n = 115), 4-24 months old who attended growth monitoring posts in the area.

RESULTS

Of these under-twos, 37.3% had low vitamin A status (serum retinol < 20 microg dl(-1)), 65.2% were anaemic, 43.2% had serum ferritin levels < 10 microg l(-1) (an indicator of low iron stores) and 15.3% were stunted. Breastfeeding was initiated by 99% of mothers. At the time of the survey, 80% of infants in the 4-12-month-old category and 56.9% of children in the 12-24-month-old category were being breastfed. Solid foods were introduced at 3.6 +/- 0.8 months. Food intake reflected a high intake of carbohydrate-rich foods, and irregular intakes of fruit and vegetables, especially those rich in vitamin A. Foods of animal origin were not consumed regularly. Of these under-twos, 15.9% experienced an episode of diarrhoea during 2 weeks prior to the survey.

CONCLUSION

These under-twos had a poor vitamin A and iron status. Nutrition education, intervention programmes and feeding schemes should address micronutrient deficiencies, with the focus on the quality of the diet, rather than quantity.

Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial

BACKGROUND

Deficiencies of iron, iodine, and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren.

OBJECTIVE

The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children.

DESIGN

Micronutrient status was assessed in 115 children aged 6-11 y before and after consumption of biscuits (fortified with iron, iodine, and beta-carotene) for 43 wk over a 12-mo period and was compared with that in a control group (n = 113) who consumed nonfortified biscuits. Cognitive function, growth, and morbidity were assessed as secondary outcomes.

RESULTS

There was a significant between-group treatment effect on serum retinol, serum ferritin, serum iron, transferrin saturation, and urinary iodine (P <0.0001) and in hemoglobin and hematocrit (P <0.05). The prevalence of low serum retinol concentrations (<0.70 micromol/L) decreased from 39.1% to 12.2%, of low serum ferritin concentrations (<20 microg/L) from 27.8% to 13.9%, of anemia (hemoglobin <120 g/L) from 29.6% to 15.6%, and of low urinary iodine concentrations (<100 microg/L) from 97.5% to 5.4%. There was a significant between-group treatment effect (P <0.05) in cognitive function with the digit span forward task (short-term memory). Fewer school days were missed in the intervention than in the control group because of respiratory- (P = 0.097) and diarrhea-related (P = 0.013) illnesses. The intervention had no effect on anthropometric status [corrected].

CONCLUSIONS

Fortified biscuits resulted in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [corrected].