Abstract: Concomitant infection of HIV and HBV is a single most important factor that predispose to poor clinical outcome among patients infected with HIV. This study was aimed at evaluating the CD₄⁺ T cell profile as a marker of immune response and stability in patients infected with HIV and HBV. Five hundred and seventy two HIV infected persons were screened for concomitant infection with HBV using HBV screening kit (Sketec, USA). The CD₄⁺ T cell count were also determined using cyflow cytometer (Patec, Germany) out of these number, 88 persons were positive for HBV representing 15.4%. The mean CD₄⁺ T cell count was 112.3cell/μL, which was significantly lower than the mean CD₄⁺ T cell count of 312.3cells/μL among those infected with only HIV. This indicates that HBV infection could be associated with rapid decline in CD₄⁺ T cell count in HIV infected persons.

Abstract: Background: Cameroon is endemic for malaria; however, the level of endemicity varies between the various eco-epidemiological zones. A public private partnership including many stakeholders was set up to control malaria along the Chad-Cameroon pipeline corridor. The present paper presents the baseline epidemiological data obtained in the zone prior to the implementation of control measures. Methods: A prospective study was conducted in three sites along the Chad-Cameroon pipeline including Bipindi in the forest humid zone, Meidougou in the high Guinean savanna and Dompta in the sudano-sahelian zone. A total of 2492 participants aged from 6 months to 10 years were included in the survey. Finger prick blood was taken to prepare thick and thin blood films for the determination of parasite density and identification of parasite species. Results: Malaria prevalence was 12.74% in dry season versus 55.5% in wet season in Bipindi; 2.77% against 3.6% in Meidougou and 26.8% versus 29.7% in Dompta. In wet season plasmodic index was 54.82% in Bipindi, 4.04% in Meidougou and 31.3% in Dompta site versus 13.40%; 4.09% and 28.8% during dry season. Only Plasmodium falciparum infections were detected. Splenic index in Bipindi was 52.79% in wet season versus 43.81% in dry season; 17.04% against 16.20% in Meidougou and 28.1% versus 25.8% in Dompta. Bipindi wasmeso-endemic for malaria in dry season and hyper-endemic in wet season. Meidougou was hypo-endemic and Dompta wasmeso-endemic in both seasons. Conclusion: This study along the Chad-Cameroon pipeline highlighted variations of the intensity of malaria transmission which is high and perennial in the forest humid zone, low and seasonal in the high savanna zone, moderate and perennial in the sudano-sahelian zone. These baseline results will help to evaluate the impact of control measures recommended by the Ministry of Health.

Abstract: Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) have been declining in developed nations. In low and middle-income countries, however, they continue to be a major cause of mortality and morbidity. It is estimated that RHD causes 200000-250000 premature deaths every year and is the leading cause of cardiovascular death in developing nations. This review aims to describe the background, pathogenesis and epidemiology of acute rheumatic fever and rheumatic heart disease in developing nations. The paper also highlights some of the public health measures, which can be undertaken to reduce the heavy disease burden of ARF and RHD in theses countries.

Abstract: Urinary Schistosomiasis and soil transmitted helminths (STH) infections are serious problems in developing countries owing to climatic, environmental, and behavioral factors of the people that favor transmission. A cross-sectional survey involving 1,232 people aged 5-78 years in two villages in Vingujini Sub-Location, Msambweni District of Coast Province in Kenya was conducted to determine prevalence of Schistosoma haematobium and soil transmitted helminths infections. Urine and stool samples were collected from 1,232 people in two villages in Vingujini Sub-Location. The samples were examined for eggs of Schistosoma haematobium and intestinal helminths respectively. Hematuria was determined using urine dip strips. Hemoglobin levels were determined for all participants to establish the relationship between hookworm disease and anemia. The overall occurrence of helminth infections were; 44% for Schistosoma haematobium, 29.6% for hookworm disease, 0.5% for Ascaris and 24.6% for trichuriasis (N = 1,232). Only 32.7% were free from any of the four types of parasitic infections screened. Infection with schistosome was highly correlated with Trichuris infection (r = 0.96, p = 0.006) and also highly correlated with age (f = 95.17, p > 0.01). Infections with Schistosoma haematobium (f = 95.17, p > 0.01), hookworm disease (f = 11.51, p = 0.010) and trichuriasis (f = 26.46, p > 0.01) were also age correlated. High intensities of Schistosoma haematobium were associated with hematuria (f = 639.99, p > 0.01). Prevalence of hookworm disease was not correlated with anemia, but there was a relationship between intensity of hookworm infection and anemia (r = -0.091, P< 0.01). Individuals with heavy and medium intensity of hookworm infections were more likely to suffer from anemia than individuals with low intensities or the non-infected (f = 5.5, p < 0.01). The current study has established high (44%) prevalence of urinary schistosomiasis, hookworm (29.6%) and Trichuris (24.6%) infections in Msambweni compared to national prevalence for schistosomiasis (23%), and global prevalence for hookworms (10-20%). Infections with Ascaris were low. Majority of Schistosome infected subjects were also infected with hookworms or at least one STH. The data suggests that measures of intensity are required for increasing effectiveness of current control programs and stresses the need for enhanced public health interventions against these diseases.

Abstract: Background: A local community leader informed us about sudden increase in number of cases of fever and rash in five villages of district Kangra on 14^th September 2006,. We investigated the suspected outbreak to confirm diagnosis and recommend for prevention and control. Methods: A case of rubeola was defined as occurrence of fever with rash in a child between from 3^rd September to13th January, 2007. We collected information on age, sex, date of onset, residence, signs, symptoms, vaccination and cold chain and smoking status. We described the outbreak by place, time and person characteristics. We conducted a retrospective cohort study to estimate vaccine efficacy. We ascertained the measles immunization status by interviewing the mothers and reviewing immunization cards. We confirmed diagnosis clinically, epidemiologically and serologically. Results: Sixty case patients were identified in five villages (41/60 rubeola and 11/60 confirmed epidemiologically linked unvaccinated rubella). The overall attack rate (AR) was 9%. Sex specific AR was 11% for male. Majorities of cases were >5years of age. No death/minimal complications occurred. Of 60 case-patients, 42 (70%) were vaccinated for rubeola. The AR of rubeola among unvaccinated children was 25.8% as compared to AR among vaccinated of 4.5% (Relative risk: 5.75%; 95% confidence interval: 3.48–9.51 P <0.001). We estimated general vaccine efficacy (VE) to be 83% while gender based VE for male was 84%. Eight case-patients were confirmed serologically for measles IgM antibodies, two nasopharyngeal swabs positive by PCR. Rubeola virus was genotyped D4. Only 30% (18/60) of the cases took the treatment from modern system of medicine. Conclusion: A mixed outbreak of rubeola/rubella was confirmed clinically, epidemiologically and serologically. We recommend MR vaccination at the age of 18-24 months and aggressive IEC activities to modify help seeking behavior of community, especially in the measles affected areas. Key Message: In the outbreak setting, two viruses’- rubeola and rubella were investigated simultaneously in the district Kangra of Northern India in highly immunized mountainous area for rubeola but unvaccinated for rubella. The single virus of rubella has been investigated in 2006 and officially documented in the state of Himachal Pradesh. The attack rate was highest in older age group warranting the need for MR vaccination.