The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Aug 2006
Comparative StudyTriclabendazole and its two main metabolites lack activity against Schistosoma mansoni in the mouse model.
Some have claimed that triclabendazole, a safe and efficacious drug for the treatment of fascioliasis, also exhibits antischistosomal properties, but results are conflicting. We assessed the effect of triclabendazole and its two main metabolites against two different strains of Schistosoma mansoni harbored in mice. Low worm burden reductions (18.6-35.9%) were observed in mice infected with an Egyptian strain of S. mansoni and treated with a single dose of 120 mg/kg 3 days before infection or single/double doses of 120-200 mg/kg 7 weeks after infection. ⋯ Administration of 400 mg/kg of either triclabendazole, triclabendazole sulphone, or triclabendazole sulfphoxide to mice infected with a Liberian strain of S. mansoni resulted in worm burden reductions < 10%. In comparison, high worm burden reductions (82-100%) were observed in S. mansoni-infected mice treated with single oral doses of 400, 500, or 500 mg/kg twice a day praziquantel, regardless of the S. mansoni strain. We conclude that triclabendazole and its main metabolites display weak and inconsistent schistosomicidal activities.
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Am. J. Trop. Med. Hyg. · Aug 2006
The costs of introducing a malaria vaccine through the expanded program on immunization in Tanzania.
This report presents an approach to costing the delivery of a malaria vaccine through the expanded program on immunization (EPI), and presents the predicted cost per dose delivered and cost per fully immunized child (FIC) in Tanzania, which are key inputs to the cost-effectiveness analysis. The costs included in the analysis are those related to the purchase of the vaccine taking into account the wastage rate; the costs of distributing and storing the vaccine at central, zonal, district, and facility level; those of managing the vaccination program; the costs of delivery at facility level (including personnel, syringes, safety boxes, and waste management); and those of additional training of EPI personnel and of social mobilization activities. ⋯ The marginal cost is approximately 5% less than the average cost. Although the vaccine price still determines most of the total delivery costs, the analysis shows that other costs are relevant and should be taken into account before marketing the vaccine and planning its inclusion into the EPI.
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Am. J. Trop. Med. Hyg. · Aug 2006
Comparative StudyMalaria prevention during pregnancy: assessing the disease burden one year after implementing a program of intermittent preventive treatment in Koupela District, Burkina Faso.
The World Health Organization recommends that pregnant women in malaria-endemic areas receive >or= 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp/SP) in the second and third trimesters of pregnancy to prevent maternal anemia, placental parasitemia, and low birth weight (LBW). In 2001, a program evaluation in Koupéla District, Burkina Faso demonstrated that despite widespread use of chloroquine chemoprophylaxis, the burden of malaria during pregnancy remained high. In 2003, the Burkina Faso Ministry of Health piloted a program of IPTp/SP (three doses) and accelerated distribution of insecticide-treated nets (ITN) to pregnant women in Koupéla District. ⋯ The proportions of women at ANCs with peripheral parasitemia and anemia were significantly lower in 2004 than in 2001 (RR = 0.53, P = 0.001 and RR = 0.78, P = 0.003, respectively). The proportions of women at DUs with peripheral and placental parasitemia were also significantly lower in 2004 than in 2001 (RR = 0.66, P < 0.0001 and RR = 0.71, P = 0.0002, respectively). These data suggest that a package of IPTp/SP and ITNs is effective in reducing the burden of malaria during pregnancy in Burkina Faso.
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Am. J. Trop. Med. Hyg. · Apr 2006
Case ReportsWound botulism acquired in the Amazonian rain forest of Ecuador.
Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. ⋯ However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.
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Am. J. Trop. Med. Hyg. · Apr 2006
Volume replacement in infants with dengue hemorrhagic fever/dengue shock syndrome.
Volume replacement was studied prospectively in 208 infants with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). The mean volume of intravenous fluid used was 110.4 mL/kg administered over a mean period of 25.8 hours. The mean volumes of intravenous fluid replacement in infants with DSS was significantly higher than in those with non-shock DHF (129.8 mL/kg versus 102.1 mL/kg; P = 0.001). ⋯ Four patients with DSS died of severe complications. Intravenous fluid replacement with special care to avoid fluid overload requires careful attention to established indications for use of colloidal solutions and blood transfusions. To improve case fatality rates, special efforts need to be directed to infants with DHF/DSS accompanied by severe complications.