The Journal of infectious diseases
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In 1997, the Eastern Mediterranean Region (EMR) of the World Health Organization adopted a resolution to eliminate measles by 2010. Of the 23 EMR member countries, 18 are polio-free and are building on this success to eliminate measles. The 5 countries where polio remains endemic are prioritizing polio eradication and working to improve measles control. ⋯ More than 50 million children have been immunized in these supplemental activities. However, in Afghanistan, Sudan, Somalia, Djibouti, and Pakistan, where 34% of the EMR population live, routine vaccination coverage for measles remains below 60% and measles deaths are estimated at 81,000 annually among children <5 years old. Significant resources must be allocated to these last 5 countries to achieve regional measles elimination by 2010.
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Despite achieving and sustaining global measles vaccination coverage of about 80% over the past decade, worldwide measles remains the fifth leading cause of mortality among children aged <5 years. In May 2002, the United Nations Special Session on Children endorsed the goal of reducing measles deaths by half by 2005. ⋯ Substantial progress in measles control has also been achieved in the WHO Western Pacific Region, in seven southern African countries, and in selected countries in WHO European, Eastern Mediterranean, and Southeast Asian regions. The ongoing measles disease burden and availability of safe and effective measles mortality reduction strategies make a compelling case to complete the unfinished agenda of measles immunization.
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Randomized Controlled Trial Clinical Trial
Blocking of responses to endotoxin by E5564 in healthy volunteers with experimental endotoxemia.
E5564 is a second-generation synthetic analogue of the lipid A component of endotoxin (lipopolysaccharide [LPS]). The ability of E5564 to block the toxic activity of LPS was assessed in a double-blind, placebo-controlled study. A bolus infusion of endotoxin (4 ng/kg) was administered to healthy subjects to induce a mild transient syndrome similar to clinical sepsis. ⋯ In doses of > or = 100 microg, E5564 acted as an LPS antagonist and completely eliminated these signs. E5564 also blocked or ameliorated LPS-induced fever, chills, headache, myalgia, and tachycardia (P<.01). These results demonstrate that E5564 blocks the effects of LPS in a human model of clinical sepsis and indicate its potential in the treatment and/or prevention of clinical sepsis.
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The timely evaluation of new drugs that can be used to shorten tuberculosis (TB) treatment will require surrogate markers for relapse. This study examined bactericidal activity against intracellular Mycobacterium tuberculosis in whole blood culture (whole blood bactericidal activity; WBA) during TB treatment. ⋯ Cumulative WBA throughout treatment was greater in subjects whose sputum cultures converted to negative by the eighth week of treatment than in those for whom conversion was delayed (mean, -365 vs. -250 log(10) cfu-days; P=.04) and correlated with the rate of decrease of sputum colony-forming unit counts during the first 4 weeks of treatment (P=.018), both of which are indicative of prognosis. These findings indicate that measurement of WBA may have a role in assessing the sterilizing activity of new anti-TB drugs.