Opportunities to improve prevention and services for HIV-infected women in nonurban Alabama and Mississippi

OBJECTIVE

The intent of this study was to identify opportunities for improving the effectiveness of HIV prevention before nonurban (rural and small-city resident) Southern women are infected and the medical and social services offered to them after they are infected.

METHODS

At several HIV clinics in nonurban Alabama and Mississippi, women with HIV infection (who reside in small cities and towns outside of Birmingham) were identified and interviewed about the period during which they probably acquired HIV and about their needs and the services provided after they were found to be infected with HIV.

RESULTS

Before they were infected, these 211 young (mean age, 33 years), mainly African-American (67%) women often reported being seen at HIV testing sites (37%) and, among drug users, at drug treatment facilities (30%), where they presumably received counseling to prevent becoming infected. Once infected, many (21%) said they were not directed to HIV treatment sites, half (50%) were sexually active in the month before they were interviewed, many (13%) sought treatment of sexually transmitted diseases in the 12 months before the interview, and many (36%) reported unmet needs for HIV treatment related to having no insurance or Medicaid.

CONCLUSIONS

Prevention and treatment of HIV for nonurban Southern women are not fully effective. Given the continued sexual activity of these women, more focus on preventing transmission from persons who are already infected is warranted.

Human diploid cell rabies vaccine purified by zonal centrifugation: a controlled study of antibody response and side effects following primary and booster pre-exposure immunizations

Systemic allergic reactions following booster immunizations have complicated rabies pre-exposure prophylaxis with the human diploid cell rabies vaccine licensed in the US (conventional HDCV). We conducted two studies comparing an HDCV purified by zonal centrifugation to conventional HDCV. In a study of primary pre-exposure immunization, volunteers received one of four regimens: three 1.0-ml intramuscular (i.m.) or 0.1-ml intradermal (i.d.) doses of conventional or purified HDCV over 28 days. Although volunteers vaccinated i.m. had significantly greater rabies neutralizing antibody titres (VNA) 49 days, 91 days and 26 months after immunization began than volunteers vaccinated i.d. (p less than 0.005-p less than 0.05), there were no significant differences between vaccines. In a study of booster immunizations, 77 volunteers immunized with conventional HDCV 2 years earlier received a 0.1-ml i.d. booster with either conventional or purified HDCV. VNA was significantly greater with the conventional HDCV on days 7 and 28 after booster, but not on day 365. A moderate or severe reaction was reported by 5 (13%) of the 40 persons who received boosters with conventional HDCV, versus none of 37 who received the purified HDCV (p = 0.03). Purified HDCV appears to be preferable to conventional HDCV for booster vaccination.

Rabies surveillance, United States, 1988

The primary purpose of the annual report on rabies surveillance is to assist local and state public health officials in the planning of rabies control programs and to guide health professionals in evaluating the need for rabies postexposure prophylaxis in patients who are exposed to animals that may be rabid. In 1988, a total of 4,724 cases of animal rabies were reported by 47 states, the District of Columbia, and Puerto Rico, similar to the total (4,729) for 1987. No human cases of rabies were reported. The South Atlantic, South Central, North Central, and Middle Atlantic states reported 81% of the cases. Pennsylvania, Texas, California, Maryland, and Virginia each reported over 300 rabid animals. Delaware (61 cases), New Mexico (15), Alaska (34), Connecticut (8), and South Carolina (127) each reported an increase in animal rabies cases greater than or equal to 100% in 1988 compared with 1987. Smaller but significant increases also were reported from Florida (66% increase), Pennsylvania (68%), and Georgia (40%). Eighty-eight percent of rabies cases were in wild animals, and 12% were in domestic animals. Skunks, raccoons, and bats accounted for 82% of all rabid animals. Cats became the most commonly reported domestic species for the first time since reporting to CDC began in 1960. The most effective methods of reducing the number of people exposed to rabies are to educate the public to avoid unfamiliar, especially wild, animals and to vaccinate susceptible pets against rabies. Rabies vaccination programs should target cats as well as dogs. Two cases of imported canine rabies emphasized the need to educate travelers of the risk of canine rabies in developing countries. Caution should be used when pets are imported from these countries.

Microneutralization test for rabies virus based on an enzyme immunoassay

We have developed an enzyme immunoassay for rabies virus by using acetone-fixed infected cell cultures as the antigen. This test was used to demonstrate virus-neutralizing antibodies in human and animal sera and was as sensitive as and easier to perform than the rapid fluorescent-focus inhibition technique.

Rabies preexposure prophylaxis with human diploid cell rabies vaccine: a dose-response study

Recent studies suggest that human diploid cell rabies vaccine (HDCV) may not always produce acceptable titers after intradermal (id) preexposure prophylaxis. To stimulate accidental deviation from the recommended route of administration and to determine the immunogenicity of smaller-than-recommended doses of HDCV, we injected each of 154 persons either intramuscularly (im) with 100%, 10%, or 3% of the standard im dose of vaccine or id with 10%, 3% or 1% of the standard im dose. Seroconversion (titers of antibody greater than or equal to 1:11) was found in all subjects at 49 and 90 days after vaccination. Titers were higher for subjects receiving 100% of the recommended dose im than for those receiving 10% of this dose id (P less than .01); these titers in turn were higher than those from persons receiving smaller doses (P less than .05). Persons receiving 10% or 3% of the standard im dose had lower titers on day 49 than did those receiving the same dose id (P less than .05).

A case-control study of the clinical diagnosis and course of Lassa fever

A prospective case-control study of Lassa fever was established in Sierra Leone to measure the frequency and case-fatality ratio of Lassa fever among febrile hospital admissions and to better delineate the clinical diagnosis and course of this disease. Lassa fever was responsible for 10%-16% of all adult medical admissions and for approximately 30% of adult deaths in the two hospitals studied. The case-fatality ratio for 441 hospitalized patients was 16.5%. We found the best predictor of Lassa fever to be the combination of fever, pharyngitis, retrosternal pain, and proteinuria (predictive value together, .81); of outcome, the best predictor was the combination of fever, sore throat, and vomiting (relative risk of death, 5.5). Complications included mucosal bleeding (17%), bilateral or unilateral eighth-nerve deafness (4%), and pleural (3%) or pericardial (2%) effusion. Lassa fever is endemic in this area and is a more-common cause of hospital admission and death than has previously been described; this disease must be considered when diagnosing febrile illness in West Africa.

Thyroid-stimulating immunoglobulins in neonatal Graves's disease

Two patients with neonatal Graves's disease are reported. One of them had a delayed onset because of suppression of the fetal thyroid gland by antithyroid drug taken by the mother during pregnancy. Thyroid-stimulating immunoglobulins (TSAb), measured by a receptor assay, were present in both babies when they were thyrotoxic, and also in their mothers. TSAb were undetectable in both babies 1 year after birth. This strongly supports a pathogenetic role of TSAb in this condition through transplacental transfer of maternal TSAb.