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Poverty and the Millennium Development Goals

Use of Probiotics in HIV-infected Children: A Randomized Double-blind Controlled Study
HIV/AIDS is an infection characterized by immune cell dysfunction and subsequent immunodeficiency, as well as intestinal disorder. Probiotics are live microbial feed supplements that beneficially affect the host animal by improving intestinal microbial balance and promoting health benefits. The goals of this study were to determine whether the use of probiotics could improve the immune response determined by CD4 cells mm–3 counts and reduce liquid stool episodes. A randomized double-blind controlled trial with 77 HIV-infected children (2–12 years), divided into two groups: one receiving probiotics (formula containing Bifidobacterium bifidum with Streptococcus thermophilus –2.5 x 1010 colony forming units) and the other, a standard formula (control group), for 2 months. The CD4 counts (cells mm–3) were collected at the beginning and end of the study. The quality and number of stools were assessed by a questionnaire (watery to normal stool consistency). There was an increase in the mean CD4 count in the probiotics group (791 cells mm–3) and a small decrease in the control group (538 cells mm–3). The change from baseline in mean CD4 cell count was +118 cells mm–3 vs. –42 cells mm–3 for children receiving the probiotic formula and control formula, respectively (p = 0.049). A similar reduction in liquid stool consistency in both the groups (p

Pattern of Malaria-specific T-Cell Responses in a Cohort of Ugandan Children
Malaria is the leading cause of morbidity and mortality in children in Uganda. The mechanisms whereby malaria parasites are eliminated, or how they may avoid the immune response remain poorly understood. We examined malaria-specific T-cell responses in a well-characterized cohort of African children in an endemic area where malaria transmission occurs throughout the year. In studies of asymptomatic children, we found a low frequency of malaria-specific T-cell responses (15/117), and these appeared to be clustered in older children (≥4 years old). Both CD4– and CD8-mediated T-cell responses were detected against circumsporozoite surface protein (CSP) and merozoite surface protein-1 (MSP-1). The presence of these T cells did not correlate with the frequency of prior episodes of parasitemia and 5 out of the 15 responders had no documented parasitemia within 8–12 months prior to immunologic evaluation. Our data supports focusing on high-risk children in future preventive vaccination efforts to ensure the generation and maintenance of effective anti-malarial cellular immune responses.

Seroprevalence and Risk Factors for Human Papillomavirus in Taiwan
The aim of the study was to tailor a future Human papillomavirus (HPV) vaccine campaign and to help perform early primary prevention of HPV infection in Taiwan, where the incidence of cervical cancer is high. A cross-sectional survey was conducted of 826 female students, ages 10, 13, 16 and 19–22 years. A self-administered questionnaire was used to collect information on risk factors for HPV infection. Serum samples were tested for antibodies to HPV 16 capsids using a virus-like particle-based enzyme-linked immunosorbence assay. The age-adjusted odds ratio of HPV seropositivity was calculated for each risk factor by multiple logistic regression analysis. HPV 16 antibodies were detected in 13 (1.6%) of 826 participants. The HPV 16 seroprevalence was 0.35% (1/287), 0.85% (2/235), 3.2% (6/185) and 3.4% (4/119), respectively, for age groups of 10, 13, 16 and 19–22 years. In the multiple regression analysis, the history of having sexual activity was the most significant risk predictor for HPV16 seropositivity. The seroprevalence of HPV16 increased dramatically among high school seniors and university students, and was significantly associated with sexual activity. Vaccination against HPV is suggested to be undertaken in early adolescence, before 16 years of age and prior to sexual debut.

Validation of a Clinical Score for the Diagnosis of Late Onset Neonatal Septicemia in Babies Weighing 1000-2500 g
There is paucity of data about the predictive values and likelihood ratios of clinical signs of late onset nosocomial sepsis in neonates. A clinical score comprising of seven items had been derived from analysis of individual signs and had been published by this group in the Journal of Tropical Pediatrics in 2003. The current study was done to validate the score in a fresh validation cohort, to evaluate the score at 0 and 24 h after onset of clinical signs of sepsis and to evaluate the sepsis screen in combination with the clinical score. The seven clinical signs in the clinical score included grunting, abdominal distension, increased prefeed aspirates, tachycardia, hyperthermia, chest retractions and lethargy. A total of 220 episodes of sepsis among 208 babies were evaluated. The clinical score was calculated at 0 h and 24 h. A sepsis screen (micro erythrocyte sedimentation rate, C reactive protein, absolute neutrophil count and immature/total neutrophil ratio) and blood culture were performed in all subjects at enrollment. Sepsis screen was considered ‘positive’ if any two parameters were positive. The outcome of interest was ‘definite sepsis’, defined as blood culture positive. The 0-h clinical score had sensitivity, specificity, PPV, NPV, LR+ and LR– of 90, 22.5, 30.3, 85.7, 1.16 and 0.44%, respectively. The 24-h score had higher specificity (60.6%) but lower sensitivity than the 0-h score. Sepsis screen per se had a sensitivity and NPV of 48.3 and 78.3% but when combined with the 0-h clinical score, the sensitivity and NPV rose to 95 and 90.6%, respectively. The ‘clinical score’ in combination with sepsis screen result can be used by clinicians to rule out sepsis.

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