RESUMO

The justification to this special issue about WHO are given, underlining the international impact of its policies and programmes in the last 50 years.

Assuntos

Assuntos

RESUMO

Bacterial meningitis is a problem for Public Health that has to be reviewed periodically. Most of the infections are due to Meningococcus, Haemophilus influenzae or Streptococcus pneumoniae. Seventy per cent of the cases are seen in children less than 5 years old; mortality ranges between 5% to 20% of the patients. Progress has been made with vaccination for Meningococcus types A and C and for H influenzae type B. In Chile, meningococcal meningitis is endemic, with epidemic bouts in the north part of the country. Currently, studies are in progress in Santiago with vaccination against H influenzae type B, in the hope that it can be extended to the rest of the country.

Assuntos

RESUMO

Chagas' disease, produced by Trypanosoma cruzi and transmitted by hematophagous triatomine bugs, exists in the Western Hemisphere from the south-western United States to central Chile and Argentina. It exists in rural and periurban sections of the northern half of Chile, with a prevalence of 16.9%. Constant rural-urban migrations have contributed to its spreading to urban sections. In order to investigate the impact of these migrations on the population susceptible of being blood donors and the probable increasing of the risk of T. cruzi transmission by blood transfusion, epidemiological surveys were carried out in donors from 22 hospitals located in the northern half of Chile. By means of an indirect hemagglutination test for Chagas' disease 16,841 blood donors were examined, arising a 2.7% of positivity, percentage that permitted to estimate that 126,477 potential blood donors infected with T. cruzi should be in the urban sections studied. These facts strengthen the need that serology for Chagas' disease must be routinely performed in endemic regions of the country, to adopt or reinforce the pertinent preventive measures.

Assuntos

RESUMO

Chile is a long and narrow country located in the south western coast of South America. Chagas' disease exists in the seven first (18 degrees 30'-34 degrees 36' South lat.) of the total of thirteen administrative regions of the country. In the 1982-1990 period a series of studies considering different epidemiological aspects of this parasitic zoonosis has been carried out with the following results: 5,601 rural of periurban dwellings were surveyed for the presence of Triatoma infestans (the most important and almost exclusive vector of Trypanosoma cruzi in Chile). 37.4% of the dwellings were infested according to the inhabitants and 29.4% were found infested according to the presence of tracks or insects captured. In 659 (17.2%) out of 3,822 T. infestans captured and examined T. cruzi was found in their abdominal contents. The most common sources of T. infestans feeding were mammals (89.0%), including man, and birds (9.5%). An indirect hemagglutination test (IHAT) for Chagas' disease, a very sensitive and specific reaction, was performed to 5,050 domestic mammals, resulting positive 7.9% of cats, 7.0% of dogs, 7.0% of goats, 4.9% of sheep and 4.1% of rabbits. 2,579 (16.9%) out of 15,418 persons were positive for the IAHT for Chagas' disease. The rates of infection were rather similar in males (17.5%) and females (16.2%) with an increase in infection rates in accordance with increase of age of individuals. The overall frequency of ECG abnormalities in positive IHAT persons was 18.7% against 8.8% in those with negative IHAT, whereas ECG abnormalities considered as suggestive of a chagasic etiology were 6.8% and 2.2% respectively. The esophageal motility in 311 persons with a positive IHAT and in 150 with a negative IHAT was found altered in 42.8% and 18.7% respectively. In the corresponding urban sectors of the 7 regions mentioned 2.7% of blood donors, 2.3% of delivering mothers, 2.6% of newborns and 0.6% of school children had positive IHAT. 646 chagasic women and 709 non-chagasic women in their reproductive span of life, and the products of the pregnancies that they had in a 6-year period were followed-up. No significant differences were found neither in the number nor in the evolution of pregnancies in both groups of mothers. Xenodiagnosis of children from chagasic mothers resulted positive in 6.3-8.9%, showing the transmission of T. cruzi by the placental route. Recently, 3 cases of congenital Chagas' disease of second generation have been demonstrated.(ABSTRACT TRUNCATED AT 400 WORDS)

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

RESUMO

The classical epidemiological picture of poliomyelitis in Chile completely changed in the 70s after the control programme had been steadily initiated in the early 60s. The technical and administrative approaches developed by the programme are presented. The epidemiological, immunological, managing and cost advantages of oral attenuated polio vaccine have proven in the Chilean experience to be highly efficacious when the vaccine is given to a community on the basis of permanent programmes with sufficient coverage. Different technical and administrative strategies in furnishing polio vaccine and the backing of the health infrastructure of the country have proved to be successful in reducing incidence to zero. The active role of the community, the steady and permanent adjustment of the programme, the integration of vaccination activities to a place of prime importance in local health services and epidemiological surveillance are all considered to be highly important in the results obtained.

Assuntos

RESUMO

Various problems and subjects related to the long Chilean experience in vaccination programmes are reported. Emphasis is placed on proper administrative and planning steps in order to obtain the right epidemiological diagnosis, to develop the infrastructure of health, to support financially, to manage resources, to train personnel, to apply techniques and to evaluate periodically. The advantages of the integration of the programme in primary services are commented on. Epidemiological evaluation and surveillance are considered highly important in the successes obtained. The particular structure of health services in Chile has played a meaningful role in meeting public health requirements for the past 25 years, specifically with respect to vaccination programmes.

Assuntos

Assuntos

RESUMO

This is a second report of epidemiological and clinical investigation, related to the arsenic health problem, unique in the world, occurring in the city of Antofagasta, Chile. The arsenic problem originates in the chronic contamination of water supply in the city during 12 years. This phenomena, investigated clinically and epidemiologically and first reported in 1971, prompted the installation of a water treatment plant. This report aims to evaluate the working efficiency of the plant. The study was carried out through the examination of arsenic content in hair and nail clipping samples of the inhabitants of Antofagasta and the determination of this element in cultivated vegetables and carbonated beverages. Also a clinical study in school children, looking for cutaneous lesions attributed to arsenicism, was made. Results are encouraging. They reveal that contamination persists but in significantly lower levels.

Assuntos

Assuntos

RESUMO

The bifurcated needle vaccination method used successfully against smallpox is a relatively simple technique that can be administered by personnel with only basic preparation and a minimum of training. This fact suggests that it could prove useful in campaigns of BCG vaccination against tuberculosis--especially for vaccination of newborns. With this end in mind, two studies were carried out in Santiago, Chile, to examine previously reported difficulties with the method and to assess its potential as an alternative to the best current method, that of intradermal inoculation. These studies indicated that previously reported variations in the results achieved by different vaccinators could be markedly reduced. However, they also found that the bifurcated needle method did not cause a sufficiently large dose of vaccine to enter the subject--even when fifteen needle strokes and a highly concentrated vaccine (160 mg per ml) were employed. It was thus concluded that although modification of the needle or other changes might ultimately yield satisfactory results, the bifurcated needle technique cannot yet be recommended for BCG vaccination of newborns.

Assuntos

RESUMO

The article gives the results of the use of two types of killed oral typhus vaccine administered to students 10 to 19 years of age in two urban areas of the Province of Santiago. Vaccine from the German Democratic Republic (GDR) was administered to 37,517 students and placebo to an equivalent control group. The period of observation was 18 months (November 1973-April 1975). The other product, from the German Federal Republic (GFR) was administered to 37,566 students, with placebo given to an equivalent control group. In this case the observation period was 7 months (October 1974-April 1975). The antigenic composition of the two vaccines is qualitatively and quantitatively different as are the characteristics of their preparation. In the field trial with the product from the GDR, the morbidity for typhoid fever in the vaccinated and control groups showed statistically significant differences, even though on the border line level. Satisfactory and highly significant results had been obtained with the product in earlier field trials. The difference observed between morbidity in the two groups in the field trial with GFR vaccine was not significant. It is emphasized in this regard that the observation period was shorter in this case, which precludes definitive conclusions. A high proportion of reliable confirmation of diagnosis of cases is evident for both field trials. The findings show the need for subjecting this type of vaccine to further and better field trials.

Assuntos

Assuntos