JPRS-TEP-89-012

10 JUfcrY 1989

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Epidemiology

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Epidemiology

JPRS-TEP-89-012 CONTENTS 10 JULY 1989

SUB-SAHARAN AFRICA

INTER-AFRICAN AFFAIRS

Drug Epidemic Seen as New Threat to Africa

[Serge Mathias Tomondji; Cotonou EHUZU, 25 Apr 89] 1

MAURITIUS

AIDS Cases Reported Low [D. Dhooharika; Port Louis LE MAURICIEN, 21 Apr 89] 2

MOZAMBIQUE

Spread of Measles Worries Nampula Governor [Maputo NOTICIAS, 21 Apr 89] 2

TB Treatment Extended to More Provinces [Maputo NOTICIAS, 21 Apr 89] 3

Cholera Kills 112 in Benguela Province [Maputo NOTICIAS, 20 Apr89] 4

NIGERIA

Guinea-Worm Disease Ravages Several States

[Bala Dan Abu, Abdulrazaq Magaji; Ikeja NEWSWATCH, 1 May 89] 4

SEYCHELLES

Large Number of AIDS Cases Reported [Victoria SEYCHELLES NATION, 23 Apr 89] 6

SOUTH AFRICA

First Drug Abuser With AIDS Detected [Johannesburg THE STAR, 25 May 89] 6

Second Strain of AIDS Virus Found [Arthur Kemp; Johannesburg THE CITIZEN, 25 May 89] 6

TANZANIA

Concerted Efforts Against AIDS Urged

[Ichikaeli Maw; Dar-es-Salaam SUNDAY NEWS, 30 Apr 89] 7

CHINA

AIDS Antibody Found in Imported Serum [Beijing XINHUA, 11 May 89] 8

Epidemic Disease Deaths in Decline [Hong Kong HONG KONG STANDARD, 12 Apr 89] 8

Hepatitis Outbreak in China Worsens 8

Near Epidemic in Wuhan [Hong Kong SOUTH CHINA MORNING POST, 12 May 89] 8

Hospitals at Capacity [Beijing XINHUA, 11 May 89] 9

Improved, Less Expensive Hepatitis Vaccine Reported

[Mary Ann Benitez.Hong Kong SOUTH CHINA MORNING POST, 13 May 89] 9

Penicillin Production Line for Animals [Beijing XINHUA, 10 May 89] '. 9

EAST ASIA

HONG KONG

Laboratory Drops AIDS-Test Charge [Denise Wong; HONG KONG STANDARD, 29 Mar 89] 10

Free Infant Inoculations Given [Hong Kong HONG KONG STANDARD, 19 Apr 89] 10
JPRS-TEP-89-012

10 JULY 1989

THAILAND

AIDS Carriers Number 7,000 [Bangkok THE NATION, 26 Apr 89] 11

87 AIDS Carriers Discovered in Lampang Province 11

LATIN AMERICA

BRAZIL

AIDS Cases Rising Among Children Under 15

[Valeria Padrao; Rio de Janeiro O GLOBO, 30 Apr 89] 12

Meningitis Epidemic in Sao Paulo Reported 13

Increased Incidence [Sao Paulo O ESTADO DE SAO PAULO, 4 May 89] 13

Disease Process Not Understood [Sao Paulo ESTADO DE SAO PA ULO, 6 May 89] 13

CHILE

Confirmed AIDS Cases Total 139 [Santiago Television, 23 May 89] 14

NEAR EAST & SOUTH ASIA

BANGLADESH

Specialist Gives Statistics on Cancer in Bangladesh

[Dhaka THE BANGLADESH OBSERVER, 23 Apr 89] 15

Reported 'Chickenpox' Cases Said To Include Smallpox

[Dhaka THE BANGLADESH OBSERVER, 29 Mar 89] 15

Inadequacy of Health Care Facilities Deplored [Dhaka THE NEW NATION, 4 Apr 89] 15

Problems of High Incidence of Diabetes Discussed

[Dhaka THE BANGLADESH OBSERVER, 24 Apr 89] 16

High Mortality in Reported Diarrhea Suggests Cholera [Dhaka THE NEW NATION, 24 Apr 89] ... 16

INDIA

Diagnostic Problems With Early TB Take Heavy Toll [New Delhi PATRIOT, 3 Apr 89] 17

High Prevalence of Infectious Leprosy in Bombay [Bombay THE TIMES OF INDIA, 31 Mar 89] .17

Malaria on Rise Despite Efforts [S. C. Bindhani; Calcutta THE STATESMAN, 28 Mar 89] 18

Minister Asks Guidelines on Prevention of Meningitis

[Bombay THE TIMES OF INDIA, 12 Apr 89] 19

Mystery Disease Spreading in Bihar Identified

[Faizan Ahmad; Calcutta THE TELEGRAPH, 8 Apr] 19

SOVIET UNION

Transmission of Human Immunodeficiency Virus Through Breast Feeding and Heterosexual Contact

[V. V. Pokrovskiy, K. L. Servetskiy; ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGIII

IMMUNOBIOLOGII, No 12, Dec 88] 21

WEST EUROPE

CANADA

AIDS Insurance Liabilities, Experimental Lung Medicine 24

Insurance Firms' Liability Reporting

[Alan Toulin; Ottawa THE OTTAWA CITIZEN, 10 May 89] 24

Offer of Antibiotic Mist [Kelly Toughill; Toronto THE SA TURDA Y STAR, 20 May 89] 24

Leukemia Incidence Found Higher Near Four Nuclear Plants

[Jane Wilson; Ottawa THE OTTAWA CITIZEN, 12 May 89] 24

Ontario Launching Program To Combat Rabies

[Bob Mitchell; Toronto THE TORONTO STAR, 12 May 89] 25
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10 JULY 1989 3

Gypsy Moth Caterpillar Widespread in Southern Ontario

[Chi Carmody; Toronto THE TORONTO STAR, 17 May 89] 26

FINLAND

Health Minister on AIDS Situation [Helsinki HELSINGIN SANOMAT, 4 May 89] 26

ITALY

Turin Offering Free Needles in Effort To Control Spread of AIDS

[Pier Giorgio Betti; Milan LVNITA, 20 Apr 89] 26

NORWAY

Number of New HIV Cases Continues To Decline

[Hilde Harbo; Oslo AFTENPOSTEN, 8 Mar 89] 27

Bureau of Health To Halt Illegal HIV Registration

[Hilde Harbo; Oslo AFTENPOSTEN, 6 Apr 89] 28

UNITED KINGDOM

Top Industrialists To Serve on Health Service Board

[Peter Pallot; London THE DAILY TELEGRAPH, 23 May 89] 28

Health Service Reported Underfunded for Past 9 Years

[David Fletcher; THE DAILY TELEGRAPH, 9 May 89] 29

Signs Indicate Deadly Seal Virus Returning

[Robert Bedlow; THE DAILY TELEGRAPH, 22 May 89] - 30
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10 JULY 1989 SUB-SAHARAN AFRICA

INTER-AFRICAN AFFAIRS

Drug Epidemic Seen as New Threat to Africa

54000080 Cotonou EHUZU in French 25 Apr 89 p 5

[Article by Serge Mathias Tomondji]

[Text] From cannabis and hashish to opium, heroin,

cocaine and crack, drugs in this day and age are a

danger—a threat—to Africa.

It is important to combine efforts to eradicate this

scourge, which is gaining ground on our continent.

The fight against narcotics in our country is a continuous

task being worked at by all officials concerned with the

problem. The special cooperation between German and

Beninese police and the drug seizures by the Narcotics

Squad are eloquent illustrations of the fact that both

sides are aware of this scourge.

Beninese remember the police haul that resulted in the

seizure of 107 kilograms of drugs and a large ring of

traffickers. That was on 11 October 1988. But as far back

as 15 June, 11 kilograms of Indian hemp had been

discovered by the Public Security Forces in an apartment

belonging to a 31-year-old tile layer. Those seizures are

very modest when one considers the extent of drug

trafficking by various international rings.

Not long ago, a Nigerian was arrested by narcotics police

at the Port-Bouet Airport in Ivory Coast with 1.4 kilograms of pure cocaine worth 44 million CFA francs in

his possession. And 690 kilograms of Indian hemp were

seized by police in Douala, Cameroon. All those events

show us that there is a fresh upsurge ofthe drug traffic in

Africa. There is no doubt that this phenomenon constitutes one more misfortune and a considerable danger for

Africa, which is already having to face the problems of

famine and internal warfare on the continent.

In French airports, a particularly close watch is kept on

Africans and especially Nigerians, who regrettably have

become famous in the art of drug trafficking. Nowadays,

African smugglers are past masters in the art of

"moving" drugs from one point on the planet to another;

they have nothing to learn from their European or South

American "forerunners." Several Africans have been

arrested in France (mainly at the Roissy and Orly

Airports) with a few kilograms of dope. This is due to the

fact that the means of combating them are in a very

embryonic stage. They therefore find it easy to organize

networks. It is estimated that 100 kilograms of heroin

were seized from Nigerian nationals in 1985, compared

to 30 kilograms in 1984. According to an official in the

Central Office for Repression of the Illicit Narcotics

Traffic (OCRTIS), "most of the heroin entering France

comes through Lagos," where a number of smugglers

reside. The drug, most of which comes from India,

Pakistan, or the Golden Triangle (Thailand, Burma, and

Laos), is secretly repackaged in Nigeria into 100-kilogram or 200-kilogram bags which smugglers then undertake to "move" in exchange for the payment of 50,000 or

100,000 CFA francs.

Nigeria is not the only place where drug trafficking goes

on. Abidjan and Lome are following in Lagos' footsteps

and also sending smugglers to Paris, Geneva, Rome, and

elsewhere. It should be noted that the traffickers manage

to secure the complicity of deputies, diplomats, and

other influential people in escaping vigilance and even

inspection by police and customs. According to Interpol,

40 kilograms of opium, 87 kilograms of heroin, 787

kilograms of cannabis, and 400,000 tablets of psychotropic substances were seized from African diplomats and

military all over the world in 1985 and 1986.

Senegal and Ivory Coast in Antidrug Struggle

In Senegal, a dose of 1 gram of heroin costs 30,000 CFA

francs, the equivalent ofthe minimum wage. The lure of

gain has thus led several criminal gangs to take up that

kind of trafficking. The dismantling of those rings has

brought to light, among other examples, a gang made up

of Senegalese, Ghanaians, Lebanese, and—to put the

icing on the cake—business executives, hotel managers,

and people above all suspicion. But what is more disturbing is the destructive effect of certain drugs such as

barbiturates, amphetamines, LSD, and so on, which

affect the nervous system and lungs, cause people to take

leave of their senses, and in some cases even lead to

madness. As an example, the court in Thies last year

sentenced a drug addict who had beaten his own mother

in an exceptionally violent manner and then grabbed an

iron bar with which to maul his own family. In response

to the extent of the phenomenon, legal authorities in

Senegal have stiffened the penalties: traffickers are now

subject to imprisonment for from 2 to 10 years and a fine

of up to 500,000 CFA francs. It is nonetheless essential

to stress permanent vigilance, because Dakar, with its

reputation for being a hub ofinternational trafficking, is

not far from becoming a city of drug addicts.

In Ivory Coast, the establishment in 1981 of the Police

Directorate for Narcotics and Drugs (DPSD), which

works in cooperation with the Gendarmerie, the police,

Customs, and the Ministry of Water and Forest

Resources, has made it possible to reduce drug trafficking. Seizures of cannabis, which is grown in that country,

have stabilized at around 1,800 kilograms per year over

the past 3 years. The number of planted fields dropped

from 13 in 1984 to 8 in 1985, 4 in 1986, and 1 in 1987.

In 1985, police seized 16 kilograms of heroin and 8

kilograms of cocaine. In 1987, the figures were 2.3

kilograms of heroin and 2 grams of cocaine. The number

of tablets of psychotropic substances has dropped from

600,000 in 1985 to 200,000 over the past 3 years. The

general trend in drug trafficking is therefore down in

Ivory Coast thanks to three forms of action carried out

by the CILAD (Ivorian Committee for Combating Drug
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10 JULY 1989 SUB-SAHARAN AFRICA

Abuse): prevention, drug rehabilitation, and the repression oftraffickers and consumers. It should also be noted

that a real campaign for informing and educating the

population with the help of the schools and the mass

media has been undertaken. International cooperation

(notably with Interpol and the UN Fund for Combating

Drug Abuse), the upcoming establishment of regional

DPSD branches, and the establishment of a brigade of

"drug-sniffing dogs" should result in an intensification

of the fight against drug trafficking and "slow down the

appetites of lovers of easy money in Ivory Coast."

Coca Planted in Africa by Missionaries

Coca, the plant whose leaves yield cocaine, grew in

Africa in the late 19th and early 20th centuries. It was the

French missionary fathers coming to bring the Gospel

who were the gardeners. A few coca seeds in their

suitcases were enough to start plantations in Gabon,

Congo, Togo, Nigeria, Cameroon, Ghana, Guinea, and

elsewhere.

It was a French chemist, Angelo Mariani, who in 1863

invented a coca-based wine that was supposed to give

strength and long life. "Grass" is found everywhere

under various names: "gue" in Benin and Togo,

"yamba" or "lopito" in Senegal, "nguedj" in Ivory

Coast, "kif" in the Maghreb, and so on. Cannabis is a

favorite with students who are trying to keep up the pace

during examinations as well as with all those who think

they need a stimulant in order to function or to "forget

their worries."

As a component of underdevelopment and a source of

income, cannabis is grown both for consumption and for

export.

Are there solutions that will bury this new threat to

Africa for good? Awareness, repression, and education

are not enough in themselves. The ideal would be to

combat the evil at its root—that is, by managing to

convince all the peasants who grow this crop that "cannabis is not the crop of the future."

MAURITIUS

AIDS Cases Reported Low

34190233z Port Louis LE MAURICIEN in French

21 Apr 89 p 9

[Article by D. Dhooharika: "AIDS Prevalence Rate Still

Low in Mauritius]

[Text] "Mauritius is in a privileged position, for the

prevalence rate of AIDS is still low. But that doesn't

mean we should lean back and relax. We must continue

to educate the population on the risks of sexually transmitted diseases, including AIDS." That was the statement made Wednesday by the minister of health, Mr

Jugdish Goburdhun, at the opening of a seminar on

AIDS in the MIE [expansion unknown] conference

room.

At the outset, Mr Jugdish Goburdhun declared that the

risk of being infected with the AIDS virus still exists in

Mauritius, since we are a tourist country. According to

him, programs to monitor and prevent AIDS by stressing

a country-wide informational and educational campaign

will have to be established.

"The best weapon against AIDS is health education. We

are going to pursue our national educational campaign

with the help of WHO experts and a medical team to

monitor AIDS," he said.

The health minister believes the people's participation

and better dissemination ofinformation across the country would help control sexually transmitted diseases.

Medical personnel and members of the public are taking

part in this seminar presided by Dr Chan Kam, dermatologist and project manager of the anti-AIDS program.

MOZAMBIQUE

Spread of Measles Worries Nampula Governor

54000079c Maputo NOTICIAS in Portuguese

21 Apr 89 p 1

[Text] A measles epidemic has already caused the death

of tens of citizens in the districts of Moma and Morrupula in Nampula Province. According to the governor of

the province, Jacob Jeremias Nyambir, many of the

victims are persons who spent much time in the hands of

the bandits and were liberated by our forces or by the

apparently humanitarian initiative of the bandits themselves. In Morrupula, at least 18 persons died as of the

end ofthe month, while in the other district, the number

of victims has not yet been determined.

Meanwhile, the governor of the province acknowledges

that other districts, such as Ribaue and Maiema, that is,

those bordering north Zambezia Province, may also be

suffering the effects of the disease.

As far as is known, before the measles epidemic

expanded to the districts that separate the provinces of

Nampula and Zambezia, it had already caused tens of

deaths in the Upper Zambeze, thus the fear of the

Nampula Province government authorities of the possible expansion ofthat disease to other as yet unidentified

regions.

In the districts where the disease has already been

detected, a large number of the people [affected], especially young children, are people who were held captive

by the armed bandits and who were either liberated by
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10 JULY 1989 SUB-SAHARAN AFRICA

our forces in the course of military operations or managed to get away from the bandits themselves, or else the

bandits themselves decided to liberate so many people at

one time owing to the serious food crisis.

According to the governor of Nampula Province, the

measles epidemic in the zones cited is also affecting a

good number of people who had remained under the

control ofthe district government until that time, owing

to contact with the affected people.

To illustrate the seriousness of the situation, our interviewee pointed out that, in Moma District alone (south

of Nampula Province), from the end of last year to the

end of the first 2 months of this year, more than 25,000

citizens have been freed from the captivity of the armed

bandits—the majority of those people with weakened

bellies due to hunger. Some of them are carriers of the

most varied types of disease.

Although vaccines against the disease are being administered to persons whom it is possible to reach in terms of

security, the truth is that the death rate due to measles

has not stabilized.

In terms of existing and updated information, the provincial government is not in a position to determine the

exact situation, both as to the evolution of the disease

and its degree of stabilization, due in large measure to

deficiencies in the channels of information.

There are no communications channels in any of the

districts of Nampula Province, either by radio, telephone, or mail service and, according to the governor of

the province, the people are not accustomed to using

couriers, so that a situation such as the case of measles

becomes known only after it has claimed a large number

of victims.

As an example, Jacob Jeremias Nyambir said that the

bridge over the Lalaua River collapsed on the 3d of last

month but the provincial government did not learn of

the incident until the 23d, that is, 20 days later.

This means that the delayed arrival of the information

may have affected 45,000 persons who inhabit the zone.

Another example cited by our source pertained to the

specter of hunger that has already decimated nearly

5,400 persons in Memba district.

According to Governor Jacob Nyambir, the Catholic

priests who operate in the zone presented the situation in

terms of numbers of hunger victims on 10 February, but

it did not come to the attention of the province until 2

weeks later, exactly the 25th of the same month.

This means that the information channel does not function, and even some of the persons who carry in the

information do not have the necessary awareness and

breadth that will enable them to evaluate the impact of a

given piece of information in their possession, or what

its repercussion may be, said a source connected with the

Department of Natural Disasters at the provincial level.

Meanwhile, it is feared that other types of diseases, while

not fatal, may be affecting other tens of persons owing to

the difficulty of access to certain regions ofthe province

as a consequence of the armed bandits.

TB Treatment Extended to More Provinces

54000079b Maputo NOTICIAS in Portuguese

21 Apr 89 p 3

[Text] The treatment of tuberculosis through the use of

the short-duration system is going to be extended this

year to another 10 districts of the various provinces of

the country. That fact was announced in Maputo

recently at the end ofthe National Seminar on Tuberculosis which, for a period of a week analyzed the work

carried out in the past year in the framework of the

tuberculosis control program and studied ways of

extending the use of the short-duration treatment to the

rural zones.

Speaking at the closing session, Dr Martinho Djedje

pointed out that, with the introduction of the use of the

short-duration treatment, beginning the latter half ofthis

year, in the aforementioned districts there will be the

possibility of greater supervision of the patients, particularly those who are in the displaced centers. He considered that, as a result ofthe application ofthat system in

some health units, there already has been a 12 percent

reduction in the number of abandonments throughout

the country.

In a communique presented at the end of the meeting,

the provincial supervisors maintained that these results

could improve more if that extension of the use of the

treatment to the rural zones were accompanied by

intense education work among the patients and the

community in general, as well as among the health

workers themselves.

Speaking at the opening session of the meeting, the

national director of health referred to the need for health

agents in the sanitation units first to overcome some

traditional prejudices—to the effect that tuberculosis is

incurable—and to be able to explain to the patients and

to convince them ofthe possibility oftreating the disease

when the advance of the doctors is strictly followed.

Discussing the work carried out during the past year in

the area of the National Tuberculosis Control Program,

the document presented on that occasion stated that

generally satisfactory results were achieved notwithstanding some difficulties in its execution.
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10 JULY 1989 SUB-SAHARAN AFRICA

Prominent among the difficulties indicated are the lack

of access to some districts due to the criminal actions of

the armed bandits, the limited diagnostic capability, and

some of the laboratories of the health units, among

others.

The National Tuberculosis Control Program has been in

place in our country since 1985 and has the financial

support of the Norwegian International Development

Agency (NORAD), which makes available annually 7

million kroner, about $ 1 million.

During the closing session, the tuberculosis provincial

supervisors paid tribute to Dr Liisa Parkkali, a Norwegian consultant in the program, for the work she has been

carrying out in our country.

On that occasion, she considered the program now being

conducted in Mozambique to be one ofthe best in Africa

that is being financed by NORAD.

Cholera Kills 112 in Benguela Province

54000079a Maputo NOT1CIAS in Portuguese

20 Apr 89 p 5

[Text] The ANGOP News Agency reported yesterday

that cholera has killed 112 persons in Benguela Province

as of 11 April, out of a total of 2,023 persons afflicted

with the disease.

Citing sources it termed reliable, the agency reported

that Benguela Municipality has the greatest incidence of

persona afflicted with the disease, about 1,515 cases, 59

of whom have died.

The zones of that municipality most affected include

the surrounding districts, owing to inadequate health

conditions.

This new outbreak of cholera is affecting the municipalities of Benguela, Lobito, Baia Farta, and Cubal, as well

as Catumbela commune.

NIGERIA

Guinea-Worm Disease Ravages Several States

54000081 Ikeja NEWSWATCH in English

1 May 89 pp 17-18

[Article by Bala Dan Abu and Abdulrazaq Magaji]

[Text] Sumaila Usman, 42, a prominent farmer and

former politician, lives in Tungan Mallam village in

Niger State. Oba Ayinde, 30, son of a popular farmer,

lives in Bayegun village in Ifelodun local government

area of Kwara State. Both men, complete strangers to

each other and living hundreds of miles apart, are

agonizing over a common problem: the fear that they

may never be able to walk properly again as a result of

guinea-worm attacks. Usman is nursing multiple wounds

from guinea-worm attack and runs the risk of being

paralyzed unless urgent medical help gets to him. Ayinde

is already partially paralyzed as a result of guinea-worm

affliction but hopes to recover and walk well again.

The fate ofthese two is the fate of many people in nearly

all the states of the federation. Among most rural communities, the pain of guinea-worm affliction is palpable,

with the risk of contacting the disease looming even

larger by the day due to declining access to good drinking

water.

Nigeria is inexorably emerging as the worst example of a

guinea-worm ravaged country in the world. Two years

ago, the World Health Organization, WHO, in a report

on the state of guinea-worm in the world, labelled

Nigeria as the "world's headquarters" of the disease. It

was not for the fun of it. Out of the world's 140 million

victims. Nigeria accounts for three million (about 2

percent), the highest by any single country.

In Kwara State, all the 12 local governments have cases

of guinea-worm with Asa, Moro, Ifelodun, Borgu and

Oyin sporting the highest records. In Bayegun, NEWSWATCH learnt during a visit that almost half of the

village's more than 1,000 inhabitants are victims. Out of

the 139 towns and villages in Oyin, only 19 are guineaworm free. The rest have sordid tales about the menace

of the disease to tell.

Cross River State is another guinea-worm zone. About

5,000 villagers were reported early this year to have fled

their homes in north and south Ukelle in Ogoja local

government. The villagers, according to a report in the

January 24 edition of Daily Champion, had to leave

when it dawned on them that their only source of

drinking water was contaminated with guinea-worm

larvae-carrying fleas. The paper also reported that

"several hundreds of indigenous, including children,"

had contacted the disease before the people fled the

villages.

The experience with the disease in other states is no less

discomforting. Niger State's 15,000 guinea-worm victims are distributed unevenly in 150 villages. This means

that a substantial part of the state is guinea-worm

infested zone. Of the 24 local governments in Oyo, only

Ilesha and Oshogbo are relatively free. The Sokoto

State's case is more serious. In 1987, several villages in

Maguru district had to abandon their homes due to

widespread attacks. In Benue State, where the disease

began to attract attention in 1982, figures of victims had

steadily grown from 2,000 in that year to 6,000 in 1983

and 10,000 last year. Ondo, Anambra and Imo states

have the highest concentration of guinea-worm victims.

They jointly account for about 75 percent of the country's three million victims, according to experts on the

disease.

The common problem in most of the guinea-worm

afflicted zones in the country is the absence of good

drinking water. In most of these villages, ponds and
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10 JULY 1989 SUB-SAHARAN AFRICA

streams are the only source of water for the people.

Guinea-worm, according to experts, is spread by water

fleas which contain guinea-worm larvae called cyclopes.

The larvae are introduced into the human body through

contaminated water taken orally. The larvae later

develop into long tape-like worms. Affected patients

suffer from blisters, usually in the legs, as well as fever

and weakness of the body.

Guinea-worm has not only left in its trail permanent scars

on its numerous victims across the country and disabled

many, effort to contain it has also inflicted deadly wounds

on the treasury of some states. Anambra is the highest

investor in the crusade to eradicate the disease. Between

1985 and last year, the state spent six million naira on the

control of the disease. Part of the money was provided by

non-governmental agencies. However, its achievement

falls far below the huge financial commitment. The state is

still plagued with the disease. Niger State spent more than

a million naira last year on its programme for the eradication of the disease in the state. The vote was increased to

three million naira in the present budget. Musa Inuwa, the

state's commissioner for health who spoke to NEWSWATCH, said public enlightenment was a critical aspect

of the eradication programme and would be given

deserved attention.

Akwa Ibom State, which now has very little guinea-worm

problems, also voted N40,000 last year for the sustenance of public enlightenment programme and for the

training of para-medical staff to assist victims. Jones

Etuk, chief medical officer and chairman of the guineaworm eradication committee in the state, told NEWSWATCH that the committee "will not rest on its oars

since several of its neighboring states are still grappling

with the disease." Oyo State spent N60,000 on the

eradication programme last year and there are indications that it would spend more this year.

Last year, the federal government, apparently alarmed

by the growing cases of guinea-worm in the country,

launched a programme aimed at completely eradicating

the disease. Under the programme, the government is to

assist affected states to eradicate it by 1995. Last year,

the federal ministry of health provided N30.000 to

Benue, Kano, Ogun, Oyo and Rivers states to fight the

disease. In addition to direct federal government spending under its programme of guinea-worm eradication, it

has received both moral and financial support from

some concerned international agencies tö enhance the

battle to contain the disease. In 1988, the Japanese

government, through the Japanese International Cooperation Agency, JICA, donated N20 million to Nigeria in

support of the "war against guinea-worm." In addition,

JICA is to continue support with annual financial contributions until the disease is finally wiped out.

Other international bodies that have pledged to assist

Nigeria are the Rotary Foundation; Bank of Credit and

Commerce International, BCCI; Sasakawa/Global

2,000, an international voluntary organization jointly set

up by Jimmy Carter, former American president, and

Ryoichi Sasakawa, a Japanese shipping magnate; and

United Nations International Children Emergency

Fund, UNICEF. Carter visited Nigeria early last year to

assess Nigeria's critical areas of need in the guinea-worm

eradication programme.

Even as the nation addressed the issue of guinea-worm

eradication through financial assistance to affected

states, victims in most of the villages visited by NEWSWATCH in the past two weeks continued to be denied

modern medical attention. In most places, the complaints were the same: lack of medical facilities. In

Kwara, Oyo and Ogun states, there were no government

medical teams to attend to victims. Most of the victims

were seen applying palm oil, one of the few known local

treatments believed to be effective in inducing the

worms out of the victim's body.

Given the level of internal and external concern that

Nigeria's guinea-worm problem has generated and the

amount of external assistance promised, there are hopes

that the country may one day become free ofthe disease.

What is not certain is the extent to which the 1995 date

will be realistic. There are fears even among officials of

the National Committee on Eradication of GuineaWorm, NIGEP, that the rural populace might have to

cope with guinea-worm beyond 1995. The pessimism is

borne out ofthe cost of providing good drinking water to

Nigeria's vast rural areas as well as the urban centers

where pipe-borne water facilities have steadily declined

in the past 10 years.

Lola Sadiq, national coordinator ofNIGEP, last November, painted a graphic picture of the enormity of work

that has to be done before the eradication of guineaworm could be achieved. She said eradication through

the provision of potable water was capital intensive and

"government alone cannot bear the cost." She argued

that it would cost the government a fortune to lay pipes

from Iju water works to places like Maroko and Ajegunle, for example, and that the cost of the venture

would be unimaginable ifit is to be extended to cover the

entire country.

Much ofthe optimism about the 1995 date is built on the

rural water programme under the Directorate of Food,

Roads and Rural Infrastructures, DFRRI, and the UNsponsored rural water scheme in Imo, Gongola, Kwara,

Cross River, Niger and Anambra states under which

2,000 bore-holes were to be sunk. While the latter

programme was ä remarkable success, the DFRRI water

scheme, one of the best funded of its type in the history

of Nigeria, has remained a painful story of dashed

dreams. "If good drinking water is the solution to

guinea-worm," said a source in Lagos last week, "then

Nigeria is still a long way from the promised land."
JPRS-TEP-89-012

10 JULY 1989 SUB-SAHARAN AFRICA

SEYCHELLES

Large Number of AIDS Cases Reported

34190233y Victoria SEYCHELLES NATION in French

23 Apr 89 p 3

[Text] Twenty-seven cases of AIDS have been declared

in Reunion, where the number of seropositive individuals hovers between 1,000 and 2,000.

To take stock of the situation, the World Health Organization (WHO) sent one of its members, Mrs Guerma

Teguest, to the island at the end of March.

Mrs Teguest considers the epidemiological situation in

Reunion alarming compared to other islands in the

Indian Ocean. Indeed, the number of declared cases

greatly outstrips that of neighboring countries. In Mauritius, for instance, three cases have been recorded; in

Comoros, only two (one of whom was a foreigner).

According to Mrs Teguest, Reunion's sorry record could

have two causes: the lack of communication between

parents and children for one, and poor public education

for another.

She noted, during a school meeting on AIDS information, that sex was still a taboo subject. According to Mrs

Teguest, parents and children had trouble talking. She

added, however, that this modesty was not peculiar to

Reunion. This is so despite the increasing success in

dispelling myths about AIDS.

According to Mrs Teguest, AIDS information in

Reunion has not been adapted to Reunionese reality.

Indeed, she believes information must not be transmitted solely through the media, for the message is not

getting through. Here Mrs Teguest is alluding to the

problem of illiteracy. Information agencies must go out

in the field and establish dialogue with all segments of

Reunionese society.

The World Health Organization drafts plans to combat

AIDS for all countries. Mrs Teguest has drawn up a list

of activities for Reunion that could be financed by

WHO.

In concrete terms, these activities might consist of AIDS

information, education, and prevention campaigns in

the island and training for trainers.

SOUTH AFRICA

First Drug Abuser With AIDS Detected

54000086a Johannesburg THE STAR in English

25 May 89 p 9

[Text] The first case of AIDS in an intravenous drug

abuser has been detected in South Africa, Professor

Barry Schoub, director of the Medical Research Council's AIDS Research Unit, said yesterday.

Professor Schoub said this was of great concern to local

health authorities as studies in the United States had

shown that the disease spread very quickly in the intravenous drug abuse community.

Intravenous drug abusers often share the same needles,

drawing a small amount of their own blood into the

needle then mixing it with the drug before injecting it

back into themselves. This needle is then passed on to

the next person and quantities of contaminated blood

with it.

The AIDS virus is also contracted through sexual contact

and from a mother to her unborn child during pregnancy.

Professor Schoub said there had also been a disquieting

increase in the spread of the disease among heterosexuals, particularly black women, of whom there were

slightly more AIDS cases than among men. Heterosexual

spread had also been detected in the white population.

The disease previously followed a homosexual pattern.

More than 200 AIDS cases have been identified in South

Africa so far.

Second Strain of AIDS Virus Found

54000086b Johannesburg THE CITIZEN in English

25 May 89 p 12

[Article by Arthur Kemp]

[Text] A second strain of the AIDS virus, called HIV-2

has been detected in South Africa for the first time,

Professor Barry Schoub, director of the AIDS Virus

Research Unit, disclosed yesterday.

Speaking at a press conference held to mark the tabling

in Parliament of the Medical Research Council's 1988

annual report, Prof Schoub said the new strain was not

necessarily detected in tests for the original strain, now

called HIV-l.

"A further complication to the expansion of the heterosexual (AIDS) epidemic has been the detection of HIV-2

infections." Prof Schoub said.

"The HIV-2 virus differs in some respects from HIV-1."

He said the first HIV-2 case had been detected in a Black

who had never been further north than Southern

Mozambique. A spokesman for the research unit had

said later that the first HIV-2 case had been reported in

West Africa during 1988.

Prof Schoub said the HIV-2 virus had a "close resemblance to the simian immunodeficiency virus (SIV)"

carried by African green monkeys.
JPRS-TEP-89-012

10 JULY 1989 SUB-SAHARAN AFRICA

"Analysis ofdata on AIDS cases reported to the advisory

group on AIDS has revealed a disquieting increase

among heterosexuals, at this stage predominantly in the

Black community.

"The absence of HIV positive South Africans among

sexually transmitted disease clinic attenders in last year's

report contrast with the 1,14 percent and 0,87 percent

prevalence among Black female and male attenders

respectively by April 1989," he said.

Also speaking at the press conference was the president

of the MRC, Dr Flip van Heerden, who said the MRC's

highlights for the previous year had been the establishment of the Research Institute for Environmental Diseases, which looked at the effects of pollution in the air,

water and food.

"There was also the discovery of a new mycotoxin in

maize which appears to be linked to oesophageal cancer,

as well as a study on the health effects ofthe urbanisation

of Blacks in South Africa and the continuing AIDS

research," Dr Van Heerden said.

TANZANIA

Concerted Efforts Against AIDS Urged

54000083 Dar-es-Salaam SUNDAY NEWS in English

30 Apr 89 p 1

[Article by Ichikaeli Maro]

[Text] Party Secretary-General Ndugu Rashidi Kawawa,

has underscored the need for concerted efforts to mobilise people, particularly in rural areas, on the seriousness

of AIDS and how to prevent the disease.

Ndugu Kawawa said the task of mobilising people

against the disease had not been fully realised. He said

the Party, through its organs at all levels, should help

solve the AIDS problem which, he said, has spread

throughout the country.

The Party Secretary-General was talking to members of

a team appointed by the Ministry of Health recently to

review progress of the National AIDS Control Programme (NACP) launched a year ago.

The 17-man team has been divided into five groups

which were sent to the regions to assess the progress of

the programme.

The teams were despatched to Kilimanjaro Region

(Rombo District), Kagera Region (Muleba), Mbeya

Region (Ileje), Mtwara Region (Mtwara Rural District)

and Dar es Salaam.

The team, according to its leader, Doctor Harun

Matarya, was given two weeks to complete its assignment and submit the report to the Minister for Health.

He said the report would include the activities of the

programme since it was established and make further

recommendations for appropriate action.

Talking to Dar es Salaam members of the team who

called at his office to get view of the Party on the AIDS

situation in the country, Ndugu Kawawa said the Party

was concerned with the masses who, he said, have not

been fully mobilised to tackle the problem.

He urged health experts to ensure that adequate information on the disease is made available to the masses to

make them understand the seriousness of the disease so

that they could actively participate in the campaign

against it.

"We must give people true figures because hiding them

does not help. People must be told the truth on the

seriousness of AIDS", he stressed.
JPRS-TEP-89-012

10 JULY 1989 CHINA 8

AIDS Antibody Found in Imported Serum

OW1105225989 Beijing XINHUA in English

1340 GMT 11 May 89

[Text]The Shenzhen Port Public Health Quarantine Station has discovered AIDS virus Antibody in imported

serum products for second time in less than a half

month.

An official of the station said the first one was found on

April 24, when the station was asked to examine an

imported box of gamma globulin produced in Spain.

The official said when the station inspected international

parcels via Hong Kong to China on May 5, they found

four boxes of gamma globulin.

A selective examination on one ofthem showed positive

reaction of AIDS virus antibody.

The official said a reexamination by the Guangdong

Provincial Research Institute for the prevention and

treatment of epidemic diseases also proved the result.

The official noted that the gamma globulin of franbulin

brand produced in France will be confisticated and

destroyed.

Epidemic Disease Deaths in Decline

54004018 Hong Kong HONG KONG STANDARD

in English 12 Apr 89 p 2

[Passage in italics as published]

[Text] China recorded a drop in deaths from epidemic

diseases last year, but saw a sharp rise in cases of

venereal disease, a senior health official has said.

Public Health Ministry official Mr Dai Zhicheng said

16,000 Chinese died last year from 24 different types of

epidemic disease, including bubonic plague, typhoid and

dysentery, the official China Daily reported yesterday.

Although the number of recorded deaths was down 18

percent, the ministry believed the actual number of cases

was far higher, said Mr Dai, because as many as 40 to 50

percent of the cases in rural areas went unreported.

Mr Dai said reported cases of venereal disease soared to

56,090 in 1988, compared to a total of 140,648 in the

previous eight years.

China claimed to have eliminated VD in the 1960s, but

Chinese say gonorrhoea, syphilis and other venereal

diseases have reappeared in recent years because of

increased contacts with the outside world, particularly in

coastal cities.

Mr Dai, director of the Epidemic Prevention Department, said 335 people died oftyphoid, 2,039 of hepatitis

and 89 of cholera in 1988, all increases from the previous

year.

Reported cases of diphtheria, whooping cough, measles,

polio, malaria and rabies declined, he said.

At the end of the year China had 5.7 million cases of

tuberculosis and 55,240 cases of leprosy, Mr Dai said.

He blamed the increase in some epidemic diseases on

poor sanitation, saying only 2.4 percent of domestic

sewage was treated and only 30 percent of drinking water

in rural areas had attained state-set standards.

One-fourth of the food on sale did not meet hygienic

standards, he said.

Mr Dai also said China still had a high incidence of

occupational diseases such as pneumoconiosis.

Hepatitis Outbreak in China Worsens

Near Epidemic in Wuhan

54004022 Hong Kong SOUTH CHINA MORNING

POST in English 12 May 89 p 13

[An outbreak of hepatitis in the central city of Wuhan is

nearing epidemic proportions and has forced hospitals to

turn warehouses into temporary wards, an official report

said yesterday.

Five thousand cases of hepatitis of both the A and B

variety have been reported in Wuhan during the first

four months of the year, up more than 10 per cent from

last year, the New China News Agency (NCNA) said. At

the Wuhan Hospital for Infectious Diseases, all but 17 of

the hospital's 354 in-patients are hepatitis victims, it

said.

NCNA said most patients are children. It said public

health officials attributed the outbreak to poor food

hygiene.

"The city department responsible for the administration

offood peddlers is reportedly in a state of chaos," NCNA

said. "Food vendors were either dirty or thought only of

making money and simply ignored Health Department

regulations".

Wuhan is an industrial city about 1,110 kilometers south

of Beijing along the Yangtze River.
JPRS-TEP-89-012

10 JULY 1989 CHINA

Hospitals at Capacity

OW1105031289 Beijing XINHUA in English

0043 GMT 11 May 89

[Text] The incidence of hepatitis in the central Chinese

city of Wuhan, Hubei Province, is rising to epidemic

proportions this year, according to its department of

public health.

By the end of April, 5,000 cases ofthe disease (more than

10 percent more than last year) had been diagnosed.

All 953 beds for infectious disease patients in the city's

16 largest hospitals are now filled and temporary beds

have been set up to meet the growing number of patients.

A total of 1,011 patients suffering from hepatitis have

now been hospitalized.

At the Wuhan Hospital for Infectious Diseases, warehouses and emergency halls have been turned into temporary wards. Three hundred and thirty-seven of the

hospital's 354 in-patients are now suffering from the

disease.

Statistics show that most of the patients are youngsters.

The incidence ofthe disease in the city's downtown area

is higher than that of the suburbs. The cases of hepatitis

A are almost equal to those of hepatitis B.

Public health investigators have proven that the outbreak of hepatitis in Wuhan has been caused mainly by

unhygenically prepared food.

The city department responsible for the administration

of food pedlars is reportedly in a state of chaos. Food

vendors were either dirty or thought only of making

money and simply ignored health department regulations on the preparation of food.

In addition, many examinations by health inspectors

were incompetently carried out and produced no real

results, the department now admits.

Improved, Less Expensive Hepatitis Vaccine Reported

54004023 Hong Kong SOUTH CHINA MORNING

POST in English 13 May 89 p 3

[Article by Mary Ann Benitez]

[Text] A new hepatitis B vaccine will cut by half the cost

of Hong Kong's childhood immunization program

against this deadly virus.

The yeast-based vaccine contains half of the five microgram dosage available. Manufacturers have been able to

improve its potency.

A visiting chemist, who heads the Market Development

(Vaccines) of the US-based Merck, Sharp and Dohme

company, Elinor Fagan said: "Since we've made the

vaccine more potent, we can cut back the dose for infants

and children. Ifthe dose goes down in half, of course the

price is reduced by 50 per cent."

The vaccine is an improved version of the company's

recombinant hepatitis B vaccine which was the first

licensed synthetic vaccine in the world.

It is awaiting approval from the regulatory Food and

Drug Administration before it can be marketed in Hong

Kong and other countries within the year.

Clinical trials involving babies in Singapore, Taiwan,

New Zealand, the Philippines and Thailand have shown

the half-dose vaccine to be just as effective. As before,

three doses of the vaccine are needed for a complete

course.

If it is approved for use in the Government's program,

Hong Kong need spend only halfthe $55.5 million a year

to vaccinate about 60,000 babies in public hospitals.

It has yet to expand the program to pre-schoolers—cost

being a major deciding factor.

Private clinics will also be able to make the cheaper

vaccine available. At present each dose costs $110.

Mrs Fagan said it was not possible to bring down the cost

of the hepatitis B vaccine any further because of the

technology involved in preparing it.

"We have brought down the cost significantly since it

was introduced in 1986 by increasing demand. But it's

never going to be as cheap as the polio vaccine which

costs just 78 cents," she said.

The price of the vaccine has been a major stumbling

block for expansion of immunization programs in most

Asian countries where up to 20 per cent of the population are chronic carriers of the hepatitis B virus.

Penicillin Production Line for Animals

owl005041989 Beijing XINHUA in English

0036 GMT 10 May 89

[Text] Construction has begun on what will become

China's largest production line for penicillin used in

treating animals in Shijiazhuang City, capital of north

China's Hebei Province.

The production line will produce 121,000 liters of penicillin for animals a year, after completion.
JPRS-TEP-89-012

10 JULY 1989 EAST ASIA 10

HONG KONG

Laboratory Drops AIDS-Test Charge

54004017 Hong Kong HONG KONG STANDARD

in English 29 Mar 89 p 2

[Article by Denise Wong]

Since the Government started its AIDS surveillance

programme in 1985, 141 out of 120,247 people tested,

have been confirmed as AIDS virus carriers.

These include 53 hemophiliacs, 15 persons attending

social hygiene clinics, 41 patients from Government

hospitals and clinics, and 32 cases transferred from

private doctors or subvented organizations.

[Text] The Government Laboratory will drop the $250

charge for confirming the results of AIDS tests referred

to it by private doctors from Saturday.

Meanwhile two more men were found to be AIDS virus

carriers last month. One of them has since developed

full-blown symptoms. Of the 20 reported sufferers who

have developed full symptoms 12 have died.

Dr Yeoh Eng-kiong, head of the AIDS Scientific Committee, said yesterday the waiving of the charge for

referred specimens, was to encourage more referrals and

reduce the patient's worries.

"We will also have a better idea of the number of

infected people in Hong Kong," said Dr Yeoh.

At present, the Enzyme-linked Immunosorbent Assay

(ELISA) test is used to screen blood specimens for the

AIDS virus antibody.

Dr Yeoh said the accuracy of the test was close to 100

percent but there was a slim chance of a false result.

Mistaken results might be due to technical errors or

reaction to the virus used in the ELISA tests, he

explained.

A more accurate test, such as the Western Bloc method used

in the Government laboratory, is used for confirmation.

Some private laboratories might lack the expertise or

equipment to conduct these further tests, said Dr Yeoh.

Among the 1,737 specimens referred from private and

subvented organizations to the Government Laboratory

in the past four years, 32 cases were confirmed.

Dr Yeoh said most of the early specimens referred were

for preliminary tests, as the AIDS virus test only became

available in the private sector recently. Most referrals

now were for confirmation.

He said they accepted referrals from private doctors but

not private laboratories to ensure infected people had

proper counselling from their doctors.

The two people tested positive for AIDS last month are

Chinese men who acquired the disease through heterosexual contacts.

Free Infant Inoculations Given

54004019 Hong Kong HONG KONG STANDARD

in English 19 Apr 89 p 3

[Text] Free inoculations of a combined vaccine against

mumps, measles and rubella will be given to 70,000

infants from early next year.

Director of Health Dr Lee Shiu-hung said yesterday this was

to improve health conditions, although the three communicable diseases were not widespread in the territory.

He said that at present, immunisation against rubella

was given to girls aged between 11 and 14 to prevent

transmission of the disease through pregnancy.

The introduction of the combined vaccine, to be used in

Hongkong for the first time, to all infants could further

reduce outbreaks of the diseases, he said.

Dr Lee said the cost for the exercise was yet to be worked

out.

A promotion campaign would be launched to educate

parents on the need for inoculations, he said.

In other moves, a series ofmeasures would be introduced

to improve general out-patient clinic services and a

special standing committee has been set up to improve

clinic services, Dr Lee said.

Starting today, a pilot scheme will start at four general

out-patient clinics to provide medical records for individual patients.

Eight additional clerical staff will be required to handle

the system.

Dr Lee said if the scheme proved successful, it would be

introduced to all other clinics.

"We may employ experts to study ways of improving the

record system. The ultimate aim is to computerise it so

that records can be used in various clinics and hospitals," he said.

A block appointment system, introduced to 43 general

out-patient clinics since last year, has proved effective in

reducing the waiting time for patients, Dr Lee said.
JPRS-TEP-89-012

10 JULY 1989 11 EAST ASIA

He said difficulties recruiting and retaining medical staff

would be a problem in implementing the planned expansion of services.

Among the department's new projects are eight family

health service centres to be built in the next five years.

One will be opened in Yuen Long this year.

The first Oral Health Education Unit will be opened next

week.

And two new school dental clinics will start operation

this year at Sha Tin and Tuen Mun, while two more are

in the pipeline.

Adding to the existing three child assessment centres, a

new one at Sha Tin will start this year, and two more are

in the pipeline.

THAILAND

AIDS Carriers Number 7,000

53004390e Bangkok THE NATION

in English 26 Apr 89 p 2

[Excerpts] In Klong Toey slum, where AIDS may have

already saturated the drug addict community, slum

leaders will push for the government to formulate a

"comprehensive drug policy," a slum worker said yesterday, [passage omitted]

The official number of AIDS carriers has risen to about

7,000, Dr Akhom Sornsuchat, the prime minister's

adviser on social and political affairs, said over the

weekend.

Most of the reported carriers are intravenous drug

addicts.

87 AIDS Carriers Discovered in Lampang Province

BK2805072389 Bangkok Domestic Service in Thai 1300

GMT27 May 89

[Statement by Nopphadon Sombun, Lampang provincial health officer, to unidentified Radio Thailand correspondent—date, place not given; recorded]

[Excerpt] In Lampang, we have discovered 87 Acquired

Immune Deficiency Syndrome [AIDS] carriers; 44 of

whom are prostitutes, 12 are drug addicts, and the

remainder are homosexuals and those using the services

of the prostitutes, [passage omitted]
JPRS-TEP-89-012

10 JULY 1989 LATIN AMERICA 12

BRAZIL

AIDS Cases Rising Among Children Under 15

54002039a Rio de Janeiro O GLOBO in Portuguese

30 Apr 89 p 13

[Article by Valeria Padrao]

[Text] The profile of AIDS transmission among children

under 15 years of age has undergone a drastic change.

The majority of children currently suffering from

AIDS—84—were infected while still in gestation or

during childbirth from mothers who carried the disease.

Previously, receiving a blood transfusion or contaminated blood derivatives was the principal means of

contracting the disease. This change has been observed

by the Ministry of Health, which has statistics available

showing that in 1984 there were just 8 children affected.

This year, there are 215 of them.

Lair Guerra de Macedo Rodrigues, the director of the

National AIDS and Sexually Transmitted Disease Division of the Ministry of Health, explains that the change

in the profile of children's AIDS derives basically from

two factors: the existence of greater monitoring of the

blood supply, and the use of injectable drugs among

women of childbearing age.

In 1984, the first year AIDS was recorded in children,

only men were infected as a result of injectable drug use.

Today, there are 182 women and 501 men ill for this

reason. This means that for every seven men suffering

from AIDS, there is one woman ill as the result of drug

use. In 1986, the proportion was 28 men to 1 woman.

Lair stresses that the rise in the percentage of mothers

infected through injectable drug use is the only factor

that can explain the increase in AIDS cases through

perinatal transmission. She explains that it takes at least

15 months to determine if the babies of AIDS mothers

are infected or not, because only after such a period is it

possible to distinguish the antibodies produced by the

child from those transmitted by the mother.

According to Lair, knowledge about methods of transmission has motivated the population to demand a

higher standard of quality in the blood supply in Brazil,

which could reduce the number of people infected

through blood transfusions.

Statistics from the ministry show that up to the beginning ofthis month [April 1989], authorities had recorded

61 cases of hemophiliacs being infected and 53 cases of

recipients of blood transfusions being infected. During

April, for example, just one case of AIDS among hemophiliac children and two cases of perinatal transmission

were recorded.

The Ministry of Health reports that the situation with

regard to monitoring the blood supply in Brazil has not

yet reached the optimum level. There arc states where

the blood supply is under rigorous monitoring, such as in

the cases of Sao Paulo, Ceara, Mato Grosso, Mato

Grosso do Sul, Rio Grande do Sul, etc. However, there

are other states, such as Rio de Janeiro, where the project

has not made headway.

Forms of Contagion

The number of cases of children under 15 years of age who

carry the AIDS virus between 1980 and 1989 and the most

common form of transmission.

Transmitted by Cases Perccn

Hemophilia 61 28.4

Drug Use 6 2.8

Blood Recipient 53 24.7

Perinatal 84 39.1

Unspecified 11 5.1

Total 215 100.0

Incidence in Each State

State Year

'84 '85 '86 '87 '89

Total

Sao Paulo wins the sad trophy for children under 15 infected with the AIDS virus (129). Rio, with 36 cases recorded, is in second place.

SP

RJ

RS

PE

DF

CE

GO

SC

MG

ES

MA

RN

1 6 14 37 62 9 129

7 7 3 8 11 0 36

0 1 1 0 8 1 11

0 0 0 3 3 0 6

0 0 1 3 1 0 5

0 0 2 0 3 0 5

0 0 1 1 2 0 4

0 0 0 0 4 0 4

0 0 0 0 0 3 3

0 0 0 3 0 0 3

0 0 2 0 0 0 2

0 0 0 0 2 0 2
JPRS-TEP-89-012

10 JULY 1989 13 LATIN AMERICA

Incidence in Each State

State Year Total

'84 '85 '86 '87 •89

MS 0 2 0 0 0 0 2

BA 0 0 0 1 0 0 1

PR 0 0 0 1 0 0 1

MT 0 0 0 0 1 0 1

Totals 8 16 24 57 97 13 215

Meningitis Epidemic in Sao Paulo Reported

Increased Incidence

54002039b Sao Paulo O ESTADO DE SAO PAULO

in Portuguese 4 May 89 p 17

[Text] Meningococcal meningitis has once again reached

epidemic proportions in Greater Sao Paulo, after a truce

ofjust 3 months during which it was held under control

at the endemic level. In March, the Epidemiological

Watch Center of the State Secretariat of Health was

surprised by a new increase in the number of cases,

frustrating public health experts, who were expecting a

continuation of incidences within the parameters laid

down by the World Health Organization, that is, around

35 cases per month in the population of metropolitan

regions.

The meningitis responsible for the current epidemic—

and for the one that was prevalent from June to November oflast year, with the reporting of up to 72 cases in the

month of August—is of the B-4 type, which is milder

than types A and C, the latter of which was the cause of

the greatest outbreak in the country's history in 1974. "A

scenario of recurrence is taking place," explains the

director of the Epidemiological Watch Center, Wagner

Augusto Costa. Compared to the first 4 months of last

year (113 cases), the increase this year has not been very

acute (150 cases).

The problem is that in March, meningitis surpassed the

maximum margin of endemic disease: With 45 cases

reported, the epidemic stage was reached, and was

repeated in April, with another 39 cases reported. Still in

comparison with the same period of 1988, the number of

deaths was greater, rising from 18 last year to 23 now. At

Emilio Ribas Hospital, three wards are reserved for

patients with the disease, which is caused by a bacteria

that is transmitted aerially. The symptoms—high fever

and stiffness in the neck—are similar to those of a bad

cold.

The Epidemiological Watch Center was not expecting an

increase in cases until June, when cold weather favors

transmission. In all the cases already detected, the Secretariat of Health is taking the conventional precautions.

The patient is isolated and given antibiotics and penicillin. People who live with the patient also receive antibiotics for 2 days.

Vaccine

The Epidemiological Watch Center has admitted that

the vaccine developed by Cuban scientists to immunize

the population against B-9 meningitis, which is common

in Cuba, is effective against the B-4 type which is

attacking Greater Sao Paulo. The 50,000 doses donated

by the Cuban Government last year were not released for

use until September, when the epidemic was already

declining. Just last week, the Sao Paulo Secretariat of

Health began to use these doses of vaccine, choosing

children in orphanages as their public targets. According

to Wagner Costa, 17,000 children will be vaccinated,

with each receiving three doses. A 6-week interval is

necessary between the first and the second dose. The

third is applied after 2 months.

Disease Process Not Understood

54002039b Sao Paulo O ESTADO DE SAO PAULO

in Portuguese 6 May 89 p 11

[Text] The meningitis-B epidemic which is affecting Sao

Paulo for the second year in a row, and since January has

already stricken 119 people in the state, constitutes, in

addition to a tragedy for the victims' families, an enormous medical mystery. Epidemiologists in Brazil and

overseas are unable to explain why the disease appears.

Therefore, they do not know exactly how to prevent it

either.

"The bacteria that cause meningitis lodge in the human

body and are transmitted through the air, through speech

or cough, for example. So it is not possible to detect

rigorously a cause for the appearance of the epidemic,"

acknowledges hygienic physician Julio Cesar Alves. His

perplexity is shared by other infectious-disease specialists, for whom it is not possible to determine the cause of

the appearance of meningococcal meningitis, especially

type B. "There is no explanation," admits Professor Calil

Kairalla Farhat, author of various papers on infectious

diseases and chairman of the Department of Pediatric

Infectology of the Sao Paulo School of Medicine.

In the United States, it has been many years since there

were problems of a meningitis-B epidemic, and therefore, little is known about this disease. Dr Moto Ho, a

specialist in infectious diseases at Pittsburgh's Presbyterian Hospital, said to O ESTADO DE SAO PAULO: "It

is something that has to do with the socioeconomic

development of a country." He said that in the United
JPRS-TEP-89-012

10 JULY 1989 14 LATIN AMERICA

States "weaker viruses exist, but few infect. There are

many carriers; but with the lack of crowding and better

hygienic conditions, the disease is not transmitted. So we

have carriers, but we do not have an epidemic. In 1

month, the maximum that we see in cities such as

Pittsburgh is 10 cases, or even fewer."

American doctors do not understand the disease very

well. At the moment, research is being done to develop a

vaccine against meningitis-B such as already exists for

types A and C. "There is not much that can be done. In

Africa, there are epidemics even of meningitis from

group A. It is something of socioeconomic origin," Ho

speculates. He acknowledges that the most that can be

done is to take antibiotics preventively, and only under

medical supervision.

The doctors at Presbyterian Hospital say that meningitis-B is the most potent strain ofmeningitis. But after the

disease practically vanished in the United States, medical interest in it disappeared. "The reasons that this type

of epidemic occurs are still obscure. Many people are

carriers of the virus for years, but they only acquire the

disease after a long time," Ho adds.

The specialist in infectious diseases says that the climate

is also a factor in aggravating the disease: "In the

wintertime, the organism's resistance falls. Doors and

windows are kept closed, and although many of the

people who have the bacteria do not get sick, they

transmit it to others."

In Sao Paulo, the spread of type B meningitis is still

considered to be of small numeric proportions, but it

tends to increase in the wintertime. Between March and

April oflast year, 63 cases ofthe disease were recorded at

Emilio Ribas Hospital. During the same period this year,

that number grew to 90 cases. According to Calil Farhat,

head of the second inpatient unit at Emilio Ribas, the

group at greatest risk is children, especially those who arc

less than 1 year old. In spite of the fact that there arc no

preventive measures against the disease in Brazil, pediatricians say that it can be cured if it is diagnosed early.

CHILE

Confirmed AIDS Cases Total 139

PY2305190489 Santiago Television Nacional de Chile

Network in Spanish 1800 GMT 23 May 89

[Summary] Health Under Secretary Dr Augusto Schuster

has said that 139 AIDS cases have been confirmed in

Chile. He said that clinical AIDS cases are gradually

increasing as a result of the great number of AIDS carriers.
JPRS-TEP-89-012

10 JULY 1989 NEAR EAST & SOUTH ASIA 15

BANGLADESH

Specialist Gives Statistics on Cancer in Bangladesh

54500106 Dhaka THE BANGLADESH OBSERVER

in English 23 Apr 89 p 1

[Text] Over two lakh people fall prey to cancer every year

in Bangladesh and two-thirds of them die in despair

without proper treatment, reports UNB.

One among the four affected males, most of them

smokers, is a patient of throat or oral cavity cancer and

26 per cent of the female patients suffer from uterine

cancer.

World Health Organization (WHO), however, estimates

at more than eight lakhs cancer patients in Bangladesh,

most of them are not aware of the fatal disease.

Director ofthe Cancer Institute of Bangladesh Dr Abdul

Hye told UNB that one-fifth ofthe total cancer patients,

both male and female were attacked with throat cancer.

Sixteen per cent of male patients in the country suffered

from lung cancer while 15 per cent of the total male

patients came to the doctors with breast cancer, he

added.

He said, "mortality rate caused by oral, throat and lung

cancers could be curbed by 40 per cent only by preventing tobacco consumption."

A cancer expert Dr Hye said mortality rate in leukemia,

the blood cancer, was eight per cent for the male patients

and five per cent for female which, he said, was lower

than other countries of the world.

While talking about the female patients he said uterine

cancer was "easily preventable and curable if it is

detected at an early stage."

Dr Hye advised the multi-parental mothers to get regular

PAP Test from local health care unit to detect uterine

cancer.

He regretted that cancer study in Bangladesh was in a

snail's pace due to inadequate financial and technical

support. There was no chemotherapy treatment in the

health care units and radiotherapy treatment was available only in the five medical colleges.

Moreover, he pointed out, the study of cancer hampered

due to ill-maintenance of birth and death records which

was most essential for study of cancer.

In a recent survey made by the Cancer Institute, Dr Hye

informed that 15 per cent of the total deaths laid in the

Banani Graveyard were cancer patients while it was only

one per cent of those laid in Azimpur Graveyard.

Reported 'Chickenpox' Cases Said To Include Smallpox

54500105 Dhaka THE BANGLADESH OBSERVER

in English 29 Mar 89 p 5

[Text] Reports of outbreak of Chickenpox in parts ofthe

city such as Badda, Kalachandpur have made it necessary for us to write on this subject for the second time in

a week. Reports from the government source being

scanty so far, the general public are yet to be properly

informed about the disease and its spread. Going by past

experience, the period from mid-March to before the

onset of the monsoon is one for epidemics like chicken

and small pox to break out often in virulent form.

Certainly by shutting our eyes to it and opening them

only after the pestilence has carried off hundreds of

thousands is a gross failure of public responsibility. We

write to draw the attention of the relevant public health

agencies to take immediate steps towards containing the

spread of the disease into the relatively unaffected areas

contiguous to the already affected ones. By the way,

reported cases also include some of small pox, and

Dhaka is peculiarly prone to this epidemic.

Preventive steps should begin with mass vaccination

which has been conspicuous for some years by its

absence, special cleaning campaigns, apart from mosquito eradication, must be launched with immediate

effect. We had in our earlier comments on Dhaka's

sanitation expressed our apprehension about the outbreak ofsuch diseases owing to the existing low standard

ofthe city's health and sanitation, and negligence of duty

on the part of those responsible for it.

Water which is most vital to maintaining a state of

immunity to such health perils has to be taken special

care of by the WASA and a regular supply of pure

drinking water ensured on a viable basis. Cleaning ofthe

city cannot wait any longer if the minimum that the

taxpayer is entitled to is to be delivered by the city

maintenance authorities.

Inadequacy of Health Care Facilities Deplored

54500104 Dhaka THE NEW NATION in English

4 Apr 89 pp 1, 8

[Text] Despite government's repeated assertion that it

would provide "health for all by the year 2000" the

overall scenario in the health sector presents a rather

gloomy look.

The medicare facilities now available under Government management in the urban and rural areas can cover

only 40 per cent of the total population of the country,

according to a Health Ministry source.

There are approximately 1800 medical centers throughout the country which roughly provide 30,000 beds.

Thirty thousand beds for a population of over 11 crore

people make a very poor bed population ratio.
JPRS-TEP-89-012

10 JULY 1989 16 NEAR EAST & SOUTH ASIA

The government under the present Third Five-Year Plan

period had envisaged upgrading about 380 rural charitable dispensaries at a cost of Tk 22 crore.

The coming fiscal year will be the terminal year of the

Third Five Year Plan and so far only 160 charitable

dispensaries have been upgraded at a cost of Taka 4.20

crore.

The Asian Development Bank had also committed funds

for the upgradation of 150 charitable dispensaries but

only 45 have been upgraded. The Asian Development

Bank had agreed to provide a sum of Tk 12 crore for the

project.

Unfortunately the entire allocation will lapse mainly due

to inability of the concerned agency to implement the

scheme.

Inaugurating a six-day training workshop on Diabetic

service delivery integrated with primary health care in

Dhaka on Saturday morning the DPM said that Bangladesh had now 15 to 20 lakh diabetic patients and their

number was on the increase.

He said that because of the disease profile in Bangladesh

the treatment of diabetes should be integrated with the

primary health care. He pointed out that only the Diabetic Center located in the capital city of Dhaka could

not cope with the huge number of patients spread all

over the country.

Prof Matin laid emphasis on imparting training to the

doctors and health workers working in the village levels.

He said such training would enable the doctors and field

health workers to help diabetic patients know about the

initial things to do.

The government had also taken in hand a scheme to set

up 50 rural health complexes. The scheme failed to take

off the ground due to failure of the donor agencies to

make available the required funds. The government has,

however, taken 15 such complexes for completion.

A private medical practitioner told New Nation that

Government could easily ease the pressure at least in the

urban centers by inducing private sector entrepreneurs

to set up more modern clinics. He said, the best way to

do so was to exempt the medical equipment from heavy

taxes and duties.

Even best hospitals in the capital, the IPGMAR and

Suhrawardy cardiovascular hospital do not have the

latest equipment to treat the patients.

Apart from that both the hospitals remain overcrowded.

The emergency cases often do not receive the attention

they deserve.

The emergency room at the Suhrawardy Hospital presents a pitiable sight. There are too many patients and

too little space to accommodate the ever increasing

number of patients.

Problems of High Incidence of Diabetes Discussed

54500103 Dhaka THE BANGLADESH OBSERVER

in English 24 Apr 89 p 3

[Text] Deputy Prime Minister In-charge of Health Prof

M.A. Matin said in Dhaka on Saturday that the government was contemplating to train field level health and

family planning workers all over the country on diabetes

so that people would get primary services from them

before, going to clinics, reports BSS [Bangladesh News

Agency].

Presided over by National Professor Dr Mohammad

Ibrahim, the inaugural session of the workshop was

addressed by Dr A.R. Khan, Dr Manwara Binte Rahman

and Dr Hazera Mahtab.

The Deputy Prime Minister said that at present Bangladesh had one health workers for every 4000 people and

every' union had three family planning workers who

would be given training on diabetic diseases.

Explaining the government's health policy he said that

the present government under the leadership of President Ershad was committed to ensuring the availability

of essential drugs to every' citizen.

The workshop is being participated by 33 doctors from

the union and upazila levels including two from Army

Medical Corps.

High Mortality in Reported Diarrhea Suggests Cholera

54500102 Dhaka THE NEW NATION in English

24 Apr 89 p 5

[Text] The situation in the southern districts of the

country following the outbreak of diarrhea has reportedly worsened. Thousands have been afflicted with diarrheal diseases in the southern districts including Khulna,

Satkhira, Bagerhat and Perojpur. A Bengali daily of

Dhaka quoting government sources reports that the toll

exceeds five hundred. More than four thousand have

been attacked by the water-borne diseases. The report

further says that due to non-availability of medicines

treatment is hampered. In the wake of the current dry

spell the scarcity of pure drinking water has become

more acute which is said to be one of the causes of the

present outbreak. It has been apprehended that unless

remedial actions are promptly taken, the situation may

worsen further.
JPRS-TEP-89-012

10 JULY 1989 17 NEAR EAST & SOUTH ASIA

The high incidence of mortality indicates that the "diarrheal diseases" includes cases of cholera. If so enlightening the public about the true nature of the outbreak will

always be helpful. Misleading euphemisms may have

their uses but not in an area of vital public concern.

As for treatment, the medications for diarrheal diseases,

even for the severer types, are rather simple. Oral and

intravenous saline is the general ("broad-spectrum")

treatment. Ifsuch simple and essential medicines (which

are also inexpensive) are not available then the authorities really owe the people an explanation. In recent years

we have learnt much about the construction of health

centers in the interior and it has even been said that a

nucleus of health service will be set up in every union

during the coming years. We had also learned that as

many as nine medical graduates have been posted in

each rural health complex. This health infra-structure is

no doubt inadequate for providing universal health care

but they are expected to cope with the outbreak of

diarrhea. These rural medical teams should be fully

mobilized and if necessary supplemented by reinforcements from cities to contain the outbreak. At the same

time public consciousness about the prevention and

treatment of diarrheal diseases should be raised and the

mass media should be mobilized for providing education

to the rural people on the matter. The local bodies should

play their part in helping to make available potable

drinking water to the people and disseminating knowledge about making water germ-free through boiling.

INDIA

Diagnostic Problems With Early TB Take Heavy Toll

54500098 New Delhi PATRIOT in English 3 Apr 89 p 8

[Text] Lack of a reliable method to detect tuberculosis in

its early stages is taking a heavy toll of lives in India,

reports UNI [United News of India].

Every year, nearly 500,000 people die of this disease,

also found to be one of the "concomitant infections" in

AIDS patients.

The number of tuberculosis patients in the country at

any one time has been estimated to be at least 9 to 10

million one fourth of which (two million) is likely to be

infectious.

Tuberculosis is a communicable disease oflong standing,

successfully controlled by most developed countries,

where interest in the disease has resurfaced because ofits

AIDS link.

Medical researchers consider that development of a

reliable method for early diagnosis of active tuberculosis

is an essential pre-requisite for its management and

control in India.

According to a bulletin of the Indian Council of Medical

Research (ICMR), besides clinical diagnosis, sputum

examination and mass miniature radiography are the

methods available at present, supplemented by 'tuberculin' testing in certain cases.

Sputum examination for detection of Acid Fast Bacilli

(AFB) is an inexpensive and reliable method.

However, in some patients, in spite of a very suggestive

clinical course and supportive radiological findings,

'AFB' cannot be detected in the sputum.

Mass miniature radiography is useful but has low sensitivity and specificity, the bulletin says.

Therefore, there is an urgent need for a reliable laboratory test for the rapid and specific diagnosis of tuberculosis in patients in whom radiography or sputum examination are unable to give clear cut results.

Researchers say a reliable, sensitive test should aim at

detecting specific antibodies against 'mycobacterium

tuberculosis' antigens.

In India, the major work in this area including immunodiagnosis is being carried out at the Tuberculosis

Research Centre, Madras.

High Prevalence of Infectious Leprosy in Bombay

54500099 Bombay THE TIMES OF INDIA in English

31 Mar 89 p 5

[Text] There are nearly 12,000 cases ofinfectious leprosy

prevailing in Greater Bombay without the victims exhibiting any external signs ofthe scourge, ProfA.R.K. Pillai,

a long-time crusader in combating leprosy, said here

today.

He said the total number of those who suffered from

both the infectious and non-infectious varieties of the

disease was between 82,000 to 100,000 in Greater Bombay with the prevalence rate in the city's slums as high as

11.9 per 1,000 against the national medium of 5.7 per

1,000 cases.

Prof Pillai was addressing newsmen on the Indian Leprosy Foundation's disbursement of funds for rehabilitation projects in the country, particularly to those in

Bombay and other parts of Maharashtra.

Out of a total ofRs 16.23 lakh grants given to projects for

the year 1988-89, he said Maharashtra's share was Rs

1.95 lakhs for three major ones located in Pune—the

Pune district Leprosy Committee, the Sevadhan Trust

Tribal Rural Leprosy Eradication Scheme and the

Anand Gram Society—and seven in Bombay.

Among the seven charities which were recipients of the

foundation's assistance were—the Bombay Leprosy

Project, the Lok Seva Sangam, the Maharashtra Lokhita
JPRS-TEP-89-012

10 JULY 1989 18 NEAR EAST & SOUTH ASIA

Seva Mandal, the Vimala Dermatological Centre, the

Acworth Leprosy Hospital Society, the Hind Kusht Nivaran

Sangh and the Indian Association of Leprologists.

The maximum collection of funds accounting for nearly

three-thirds of the total of Rs 41 lakhs garnered from all

sources since the establishment of the foundation in

1984 was from the student community. This year out of

the Rs 16.23 lakhs given out as grants, students had

contributed nearly Rs 12 lakhs, Prof. Pillai said.

Since the introduction of the multi-drug therapy, the

incidence of the disease had been checked substantially

through for every three leprosy patients in the world one

is an Indian—2 million leprosy patients in the world

against 4 million in India.

The multi-drug therapy, consisting of rifampicin, chlofozinine and dapsone, had been tried out in five districts

among which Wardha in Maharashtra, Visakhapatnam

in Andhra Pradesh and Purulia in West Bengal.

The results of the use of this therapy were so good that

the bacilli was "mutilated" and fragmented" within a

week reducing the prevalence rate in 1982 from 10 to 12

cases per 1,000 to 2 cases per 1,000 after its introduction.

Prof Pillai claimed that a complete cure had been

achieved without leprosy patients reporting relapses for

those undergoing treatment for a duration of six months

to two years.

Giving a state-wise break-up of the prevalence of the

disease, he said the highest sufferers were 730,000 in

Tamil Nadu, 6256,000 in Andhra Pradesh, 430,000 in

Uttar Pradesh, 420,000 in West Bengal, 410,000 in Bihar

and 400,000 in Maharashtra.

The infectious variety accounted for 20 per cent of the

120,000 sufferers in the world and the non-infectious 80

per cent of the balance.

The infectious leprosy patients did not show any manifestations of the disease except what are described as

"nodules" on the earlobes or chin and copper-hued and

shiny skin.

Prof Pillai discounted the popularly held theory that the

numerous beggar patients were afflicted with the infectious variety because of their clawed hands and ulcerous

skin. On the contrary, the leprosy they suffered from was

of the non-infectious variety and there was no cause for

fear if charitably-inclined people sometimes touched any

part of their anatomy.

The foundation is a frontline voluntary agency committed to leprosy eradication and extends financial assistance, technical inputs and managerial skills to voluntary

leprosy projects and works for greater self-reliance.

Malaria on Rise Despite Efforts

54500100 Calcutta THE STATESMAN in English

28 Mar 89 p 4

[Article by S. C. Bindhani in Rourkela]

[Text] The incidence of malaria in India had tremendously reduced around the mid-'60s owing to the extensive use of DDT to check mosquitoes and chloroquinc to

check malaria parasites. But malaria cases arc recently

on the rise again with a vengeance despite 40 percent of

the country's health budget being spent in malaria control programmes.

The factors that have led to the resurgence ofthis disease

are many: Resistance of mosquitoes to insecticides such

as DDT, HCH and malathion: human resistance in the

form of refusal to the intradomiciliary spraying of insecticides: growing chloroquine resistance in the malaria

parasite: delayed treatment of malaria cases, leading to

increased chances of malaria transmission from a carrier

to the healthy person; lack of awareness in the communities about the causes and prevention of malaria;

unplanned development of roads and buildings, particularly in the urban areas and faulty irrigation and

drainage systems posing serious waterlogging problems;

lack of inter-departmental coordination; inadequate

equipment and trained malaria staff in the health departments; deforestation and conversion of forest land into

agricultural land; intense-labour migration due to the

fast industrialization and urbanization process.

The Malaria Research Centre has been functioning in

Rourkela since July 1988. The area is well known for the

high number of deaths from malaria reported in the

adjoining rural areas each year. The magnitude of the

problem in this area can be gauged from the fact that 50

per cent to 70 per cent of the fever cases were found to

have malaria in a pilot study launched by the MRC

Rourkela in the nearby Bisra Block villages.

Of the total number of malaria cases recorded in Orissa,

80 per cent to 90 per cent are of the malignant type and,

if not treated in time, may cause death. Of the total

number of deaths due to malaria in India, almost 50 per

cent occur in Orissa. In several remote villages located in

forests a very high proportion of the children was found

by the MRC to have enlarged spleens due to malaria.

More alarming is the fact that in a population sample,

about 14 per cent of the people apparently looking

normal had malarial infection in their blood. Scientists

attribute this to the high immunity in the population

which is a direct result of high malaria endemicity in the

entire State of Orissa.

The people were found to be afflicted with three species

of malaria parasites, viz, plasmodium falciparum, plasmodium vivax and plasmodium malariae. In most parts
JPRS-TEP-89-012

10 JULY 1989 19 NEAR EAST & SOUTH ASIA

of the country, the first two species of malaria parasites

are common, whereas plasmodium malariae is a rare

species and persists in blood for many years.

The community-bases bio-environmental controlstrategy being implemented by the MRC in Rourkela is

environmentally safe as it does not encourage the use of

insecticides and has second collateral benefits. Under the

programme, health education is provided in the villages

and schools by showing immature stages of mosquitoes,

charts, use of audio-visual aids and holding group discussions where emphasis is laid on the causes and

prevention of malaria.

In each study village, the centre has its own resident

health worker who visits from door to door, screens fever

cases and prepares blood smears. After a presumptive

treatment, all the slides are collected in the MRC laboratory on the same day and, after examination of these

smears, treatment is provided promptly, free of cost.

Where the patients do not respond to the chloroquine

drug, better alternative drugs are administered in order

to ensure complete treatment.

The centre, since inception, has treated more than 2,000

malaria cases in 30 villages under the study. Besides

routine screening and treatment of malaria cases, the

scientists ofthe centre are engaged in research on various

aspects related to the epidemiology of the disease.

The centre also has a specialized team that controls

mosquitoes breeding in and around the villages through

different methods. These include elimination of small

breeding places permanently by filling them up with soil,

management of waste water by constructing soak pits

with the help of locally available material, cleaning the

margins of water bodies and by introducing mosquito

larva-eating fish in all water bodies, such as ponds, used

wells and streams. The MRC has identified 27 locally

available larvivorous fishes to employ them in biological

control of mosquitoes. These fishes are being reared in

the village hatcheries.

Unused wells which support heavy mosquito breeding

are being covered with empanded polystyrene beads (an

inert material), which act as a physical barrier between

mosquito and water. These anti-mosquito measures

have helped check the mosquito menace to a large

extent.

Minister Asks Guidelines on Prevention of Meningitis

54500101 Bombay THE TIMES OF INDIA in English

12 Apr 89 p 7

[Text] The minister of state for health and family welfare, Miss Saroj Kharpade, today said guidelines had

been issued to the concerned states and Union territories

on prevention of meningococal meningitis which

claimed 2,289 lives in 1988.

Replying to a calling attention notice raised by Mr V.

Kishore Chandra Deo (Congress) and others in the Lok

Sabha on the reported meningitis deaths in Andhra

Pradesh, Bihar and Madhya Pradesh, Miss Kharpade said

the situation was being monitored by the government.

The Centre was providing all assistance to combat the

disease which was more prevalent among the poorer

sections living in unhygienic conditions. The disease

spread from the nose and throat of an infected person,

she added.

Vaccination had no role to play in controlling the epidemic. The director-general of health services had a

meeting with the officers of the affected states and

guidelines had been issued to them to control the epidemic, she added.

Mystery Disease Spreading in Bihar Identified

54500097 Calcutta THE TELEGRAPH in English

8 Apr 89p4

[Article by Faizan Ahmad:

Spreading"]

'Killer Disease in Bihar

[Text] The first death occurred on 7 March in a remote

village in Singhbhum. Sixty-three-old Delehe Koee died

mysteriously. The death went unnoticed.

After 2 days, three more persons died suddenly in the

tribal area. By 19 March, the toll rose to 15. Only then

did district health officials and the administration come

to know that an epidemic was stalking the tribal villages

in Singhbhum. After that, reports of deaths started

pouring in from other tribal districts—Gumla, Ranchi

and Sahebgunj.

The toll has since risen to 180. Expert medical teams sent

from Patna, Ranchi and Jamshedpur are still grappling

with the killer disease which is spreading unchecked as

these traditionally backward areas are not equipped with

infrastructure needed to deal with the situation.

The disease was initially diagnosed as viral fever, meningitis, encephalitis and even malaria. The symptoms are

headache, cough, shivering, pain especially in the bone

joints. The patient is racked with high fever and goes

into coma. The result—death. The tribals call the disease

a "prakop."

According to latest official figures, the disease has ravaged at least 12 villages, including Simra, Gangda, Hatpuria and Reyam in Manoharpur block in Kolhan area.

Government sources claimed that the spread ofthe killer

disease was checked in Tonto-block of Singhbhum by a

team of doctors from Mahatma Gandhi Medical College

Hospital in Jamshedpur.
JPRS-TEP-89-012

10 JULY 1989 20 NEAR EAST & SOUTH ASIA

The disease assumed alarming proportions in Paharia

village in Sahebgunj district. The toll is still not known.

The director-in-chief of health services, Dr Mohib

Ahmed, who, along with the state-health minister, Mr

Dilkeshwar Ram, flew to the affected villages on 4 April,

said the government has assessed the situation and had

taken all possible measures to control it. He said the

director-general of health services in New Delhi had

been requested to sent teams of virologists to curb the

epidemic.

Notwithstanding the assertion of the Singhbhum deputy

commissioner, Mr Shashi Kant Sharma, that contaminated water was not the primary cause ofthe disease, the

people and medical experts believe it to be the main

source. The civil surgeon of Singhbhum, Dr H.B.Sahay,

ruled out the possibility of contaminated water being the

cause of the epidemic.

Disease Identified

The killer disease which has resulted in the deaths of 180

tribals has been identified.

Dr Paran Ranjan Prasad of the Rajender Medical College, Ranchi, said the disease was caused by the bite of

insects with meningococcal, pneumonococcal or staphylococcal bacteria. The disease takes form of an epidemic

when a person is bitten by an insect infected with

meningococcal bacteria. Otherwise, it is curable. He

claimed that the disease occurred every year mainly due

to insect bites.

Dr Prasad claimed that the disease could be cured with

sulpha drugs or any antibiotic. He said 56 out of 58

patients admitted to the RMCH had been cured. He said

nearly 2 decades ago the disease had assumed an epidemic form in Sao Paulo, Brazil.
JPRS-TEP-89-012

10 JULY 1989 SOVIET UNION 21

UDC 616-092:612.017.1.064]-

022.7:578.828.6]-022.363-036.2-078.333

Transmission of Human Immunodeficiency Virus

Through Breast Feeding and Heterosexual

Contact

54001018b Moscow ZHURNAL MIKROBIOLOGII,

EPIDEMIOLOGUIIMMUNOBIOLOGII in Russian

No 12, Dec 88 (manuscript received 12 Apr 88) pp 59-62

[Article by V. V. Pokrovskiy and K. L. Servetskiy,

Central Scientific Research Institute of Epidemiology,

USSR Ministry of Health, Moscow]

[Text] In our previous report,' we described a case of

importation into the USSR of infection caused by

human immunodeficiency virus (HIV), with observation

of transmission of the virus through homosexual and

heterosexual contacts from a man to a woman and upon

transfusion of blood from a mother to her fetus. In this

article we report on two new cases of penetration of

infection caused by HIV into the USSR, which were

associated with transmission of HIV from a woman to

her infant through breast feeding and from a woman to a

man through heterosexual contact.

Material and Methods

A routine screening of blood donors and foreigners

studying in the USSR revealed two men with HIV

antibodies. An epidemiological investigation of both

cases was conducted by means ofspecial questionnaires.

The sera of identified contacts was tested for HIV

antibodies with the Antigen and Organon test systems,

with verification by the immunoblotting system of the

Dupont Firm.

Results and Discussion

The first epidemic chain (see the figure, a) started with a

28-year-old student from Zaire (No 1 in the figure, a),

who had been studying in the USSR since 1984. In 1986

and the spring of 1987, no HIV antibodies were found in

this student with the Vektor test system. When questioned, he reported about 10 sex partners in the USSR

(N0S 2—10); it was possible to test 5 of the female

partners, and HIV antibodies were found in three of

them. Two of them (Nos 3 and 4) were prostitutes and

informed us that their contacts were exclusively with

foreigners. Both had a brief period of vaginal intercourse

with No 1. Female No 2 had lived with No 1 since 1985.

Before that time, she had had one sex partner from

Chad, who returned to his country in 1984. Like the two

other women with HIV antibodies, she reported exclusively vaginal intercourse with No 1 and had observed

frequent injury to the labia and vagina, as well as

intercourse during menses.

It can be assumed that No 1 was infected in the USSR by

No 3 in 1986; however, this woman states that she had

had no contacts before him with Africans, and that when

involved with foreigners from other countries she always

protected herself with condoms at their insistence. (It is

noteworthy that No 3 used no protection when having

intercourse with foreign students since she assumed that

they had been tested for AIDS.) Five of her partners (Nos

17-21, three from Zaire and two from Tanzania) had no

HIV antibodies according to local laboratory results,

which, however, are presently being verified, since No 3

herself had been tested twice in 1987, and the results had

been negative.

No 2, while working as a nurse in May 1987, had

donated blood for a direct transfusion to a parturient

(No 11) due to poor healing of postoperative suture

following a cesarean section. (The blood transfusion was

made without testing for HIV antibodies.) Blood was

transfused on the 14th postoperative day. The recipient

became ill 1.5 months after the transfusion, with elevated temperature, sore throat and macular eruptions on

the trunk for 3 days, which can be evaluated as the

primary manifest form of infection caused by HIV. Ten

months after the transfusion, she, as well as her infant

born two weeks before it (No 12), demonstrated HIV

antibodies. The second donor (No 15) and the father of

an infant (No 13), who was the only sex partner of the

mother, and their first 6-year-old child (No 14) demonstrated no HIV antibodies. Most probably, the infant

was infected through breast feeding, the possibility of

which had already been mentioned.2The infant nursed

regularly up to the age of 3 months. At the early stage,

which coincided with the time of the transfusion, the

mother noticed cracks in her nipple, but they did not

bleed.

Thereafter, the infant had frequent colds. When tested at

the age of 10 months, pneumonia was diagnosed, and the

child responded to the usual therapy, during which

marked lymphocytosis was observed. All groups of

lymph nodes, particularly the paratracheal, splenic and

hepatic ones, were markedly enlarged. (A clinical

description will be published).

It is not of fundamental significance whether the virus

was present in maternal blood or milk, since a woman's

blood can penetrate into milk at any time. Apparently,

along with prohibition of breast feeding by mothers with

HIV antibodies, milk donors should be screened ands

and the long-known principle of "one donor—one recipient" needs to be applied.

The second detected epidemic chain (see b ofthe figure)

started with a 30-year-old man who was found to carry

HIV antibodies (No 1 in b of the figure) when he first

tried to donate blood. He reported four female sex

partners, three of whom (Nos 2, 3, 4) demonstrated no

HIV antibodies when tested. There was, however, not

enough information about the fourth woman (No 5). A

report that she had HIV antibodies detected when she
JPRS-TEP-89-012

10 JULY 1989 22 SOVIET UNION

(a) ^.@®0 0 0

I

0--^Z_^0i££^qg

D2)

? ? ? /7 /fl /5 20

(b)

Epidemiological chains of HIV infection. Numerals near the lines indicate the month (if known) and year of contact

Key: a—first chain, b—second chain. White circle—woman without HIV antibodies. Blackened circle—woman with

HIV antibodies. White square—man without HIV antibodies. Blackened square—man with HIV antibodies. Small

squares and circles—children. White circles and squares with number and question mark—identified but untested

contacts; with question mark alone—unidentified and untested contact. Solid line—sexual contact. Perpendicular to

solid line—birth ofinfant from that contact. Dashed line with arrow—blood transfusion. Dot-and-dash line—syringe

shared by drug users. Dotted line—breast feeding.

was tested because her new husband had gonorrhea was

received unexpectedly from another city. Her husband

(No 6) also had HIV antibodies, while his other female

partners (Nos 10 and 11) had none.

When gathering the epidemiological history of No 5, it

was learned that one month prior to meeting No 1 she

had injected drugs regularly intravenously with the same

unsterilized syringe used by her girlfriend (No 7), who

was engaged in prostitution with foreigners in order to

obtain money for the drugs. Concurrently, No 5 had

sexual relations and used drugs with a seaman from

Greece (No 8) who had repeatedly wondered whether she

was afraid of getting AIDS. Although we have still not

been able to test Nos 7 and 8, one of them was probably

the source ofinfection, since the others, including earlier

contacts (Nos 9-13), had no HIV antibodies, according

to results from local laboratories. The unquestionable

infection of two men (Nos 1 and 6) by No 5 is obviously

related to the fact that from 1985 to the time she was

screened at the clinic of the Central Scientific Research

Institute of Epidemiology in February 1988 she had

persistent erosion of the cervix, for which reason there

were frequent hemorrhages, one of which following
JPRS-TEP-89-012

10 JULY 1989 23 SOVIET UNION

intercourse with No 1 even led to hospitalization. There

were also instances of intercourse coinciding with the

start of menses. Anal intercourse was not practiced by

any of the demonstrated seropositive individuals.

Prior to this case, we did not have in our own practice

any direct evidence of infection of men by women

through intercourse, but during the period of the

described epidemiological investigation, a male citizen

ofYugoslavia, 20 years of age, with HIV antibodies came

to see us and stated definitely that he was infected

through sexual contact with a known female HIV carrier,

who was a drug addict. Although, according to our data,

not counting this source ofinfection, only one out ofthe

eight women with HIV antibodies from the USSR who

had had sexual relations with men had infected her sex

partners, this is no doubt quite sufficient for heterosexual transmission of HIV in the USSR on a level that

maintains an epidemic process.

The described events have great import in terms of the

organization ofthe system of epidemiological inspection

of HIV infection. The first case is a typical demonstration of errors in the organization of screening for HIV

antibodies. The fact that no HIV antibodies had been

previously demonstrated in Nos 1 and 3 from the first

chain, who had been tested twice, is definitely indicative

of flaws in the test system produced by the Vektor

Scientific Production Association. The direct blood

transfusion from No 2 without an appropriate check was

an obvious violation of the system of epidemiological

inspection.

Conversely, in the second chain, the existing system of

epidemiological inspection proved to be quite effective:

two dangerous sources of infection were identified—a

donor upon his first attempt to give blood and a female

drug addict, in the course ofroutine screening ofpatients

with venereal disease.

This study also enabled us to find several social phenomena responsible for the features of the spread of HIV in

the USSR.

For example, the fact that No 3 from the first chain had

contacts only with foreigners, and No 4, only with foreigners from Africa could raise some doubt. However,

according to our observations, "servicing" one group of

foreigners, for example Latin Americans, is typical of

prostitutes, since they operate in a system of established

contacts (Nos 3 and 4 attributed the lack of contact with

Soviet citizens to absence of financial incentive).

Since the described events occurred in the same city, in

the same period and in the same environment, it can be

stated with adequate probability that No 7 from the

second chain is one ofthe unidentified girlfriends of No

1 from the first chain.

Another important distinction of our study is that, for

the first time, HIV has been found to have penetrated the

environment of drug addicts in the USSR, which worsens the poor epidemiological prognosis.

In general, it must be stated that active heterosexual

introduction of HIV into the USSR is continuing.

Conclusions

1. Cases have been found of HIV transmission by an

infected woman to her infant through breast feeding and

to men through vaginal intercourse with infected

women.

2. In the USSR, there is a danger of spread of HIV

through heterosexual contact.

3. The possibility of the spread of HIV through breast

milk must be prevented by checking milk donors and

nursing women for HIV antibodies. Testing of all pregnant women at the last stage of pregnancy can be

proposed as a general measure.

4. Rigid rules must be adopted for checking the test

systems that are used for serological detection of infection caused by HIV.

Bibliography

1. Pokrovskiy, V. V., Yankina, Z. K., and Pokrovskiy, V.

V., ZHURN. MIKROBIOL., 1987, No 12, pp 8-11.

2. Ziegler, J. B., Cooper, D. A., Johnson, R. O., and

Gold, J., LANCET, 1985, Vol 1, pp 896-898.

COPYRIGHT: "Zhurnal mikrobiologii, epidemiologii i

immunobiologii", 1988
JPRS-TEP-89-012

10 JULY 1989 WEST EUROPE 24

CANADA

AIDS Insurance Liabilities, Experimental Lung

Medicine

Insurance Firms' Liability Reporting

54200058 Ottawa THE OTTAWA CITIZEN in English

10 May 89 p A3

[Article by Alan Toulin]

[Text] Canadian insurance companies for the first time

are being asked by federal regulators to report on the

liabilities they may potentially face because of AIDS.

Robert Hammond, superintendent of insurance, said

insurers are being asked to file liability or risk profiles

that take into account the impact of AIDS on their

business.

"This is the first time we've asked them actuarially to

deal with the subject of AIDS," Hammond told the

parliamentary finance committee. Insurance companies

are required to provide regulators with a risk profile that

outlines future liabilities due to payment of insurance

contracts. The reports help regulators determine the

financial soundness ofinsurance companies based on the

potential claims they might have in the future.

The standards for determining the impact of AIDS are

based on a draft proposal from the Canadian Institute of

Actuaries made public last November. The draft principles on developing actuarial standards for measuring the

impact ofAIDS will eventually become standards for the

insurance industry, Hammond said.

But he added that insurance industry regulators will not deal

with the questions of human rights and other civil rights

issues surrounding AIDS and the insurance industry.

The question of insuring AIDS victims or requiring

people to be tested for AIDS to obtain insurance have

not yet been resolved by the industry or by government.

These questions, Hammond said, are matters of contract

between the companies and their clients and as such are

in the jurisdiction of provincial governments.

Offer of Antibiotic Mist

54200058 Toronto THE SATURDAYSTAR in English

20 May 89 p A6

[Article by Kelly Toughill: "Downtown Clinic Offers

New AIDS Treatment"]

[Excerpts] A major new treatment centre designed to

administer an experimental lung medicine to people

infected with the AIDS virus has opened in downtown

Toronto.

Just a few months ago, people with AIDS who wanted to

take a drug called aerosolized pentamidine, an inhaled

antibiotic mist, had to buy the compound in the United

States, then find an expensive machine needed to properly dispense it.

Today, the experimental treatment is offered free at a

Sherbourne St. medical centre.

The new clinic was organized by Toronto doctors who

treat AIDS patients. The clinic was given more than

$500,000 by the province and is part of a package of new

AIDS-related programs to be announced soon by the

Ontario Health Ministry.

"This is the first time that physicians in this city have

come together to provide treatment for patients with

AIDS," said Dr. Philip Berger, a clinic organizer.

'Important Step'

[Passage omitted] Pentamidine has been used intravenously for several years to treat a form of pneumonia

that is the most common killer of people with AIDS. But

many studies show that ifthe drug is regularly inhaled, it

can prevent the pneumonia from ever developing. In

order to turn it into a mist that can be inhaled, the drug

is fed through an expensive machine.

Only the intravenous form of the drug has been fully

approved by federal health officials, but doctors arc

allowed to prescribe the inhaled form ofthe drug at their

own discretion.

More than 570 people in Metro have been diagnosed

with AIDS and another 3,000 are known to be carrying

the virus that causes the disease. The clinic is expected to

regularly serve about 1,000 patients, Berger said.

Leukemia Incidence Found Higher Near Four

Nuclear Plants

54200057 Ottawa THE OTTAWA CITIZEN in English

12 May 89 p A3

[Article by Jane Wilson]

[Text] A study of leukemia among prc-school children

born near Ontario nuclear facilities has found a highcrthan-expected number of cases at four sites.

But because the numbers studied are small and there is a

high margin of error, the Atomic Energy Control Board

has ordered a second, broader study.

The research was spurred by a British study which

showed a nine-fold increase in the risk of leukemia for

children born to mothers living near a nuclear fuel

reprocessing plant. The Ontario research has ruled out a

similar effect at all but the Bruce nuclear plant on Lake

Huron, said epidemiologist Dr. Aileen Clarke, who

headed the one-year study.
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10 JULY 1989 25 WEST EUROPE

The study was commissioned by the AECB and carried

out by Clarke, head of epidemiology at the Ontario

Cancer Treatment and Research Foundation.

The study covered the period 1950 to 1986 and involved

families living within a 25-kilometre radius ofthe plants

or mines.

Results showed the incidence of leukemia around the

Chalk River nuclear laboratories was lower than

expected, one case when 3.2 were expected and one

death compared to an expected 2.7.

Statistically, the Bruce nuclear power development

showed the highest risk, 3.5 times the expected level of

deaths, based on two recorded leukemia deaths, when

0.6 were expected. However, Clarke noted, a larger

sample could have produced a ratio offrom 0.4 deaths to

a high of 12.6. Four cases were diagnosed, compared to

an expected 1.6, since the plant's opening in 1967.

At the Pickering nuclear plant east of Toronto, the study

uncovered 50 cases of childhood leukemia, when the

researchers expected 41. There were 17 deaths, when

averages showed there should be 12.4.

Around the Elliot Lake uranium mines and mills, one

case was diagnosed and two deaths recorded, while

researchers expected 2.4 cases and 1.8 deaths, Clarke

said.

At the Port Hope uranium conversion facility, nine cases

were diagnosed instead of an expected 5.2. There were

seven deaths, although 4.7 were expected.

More work is needed to understand the implications of

the figures and narrow the margin of error in the study,

Clarke said.

The second phase will double the size of the study by

including children up to age 14. It is slated for completion in March 1990.

In Ontario in 1986, 12 children under five died of

leukemia and 62 cases were diagnosed.

The research was prompted by several studies showing

clusters of childhood leukemia cases around nuclear fuel

reprocessing facilities in England and Scotland.

Clusters of leukemia are not uncommon, said Dr. T.W.

Anderson of the University of British Columbia, one of

the research team.

Ontario Launching Program To Combat Rabies

54200059 Toronto THE TORONTO STAR in English

12 May 89 p A3

[Article by Bob Mitchell: "Foxes and Skunks Target of

$1.8 Million War on Rabies"]

[Text] Ontario is about to launch a $1.85 million plan to

stamp out rabies.

Foxes and skunks are prime targets in a three-phase

program announced yesterday.

"There are more cases ofrabies in southern Ontario than

any other place in North America," said Natural

Resources Minister Vice Kerrio. "This is a serious situation that must be eradicated."

Nearly 4,000 Ontario residents receive anti-rabies vaccine

every year in the province. Last year, more than 30,000

cases of possible human contact were investigated.

Dr. Rich Rosatte of the wildlife research section of the

ministry said Metro gets about 700 to 800 rabid foxes

and 400 to 500 rabid skunks every year.

"The valley areas of Metro are prime homes for foxes,

with the Don Valley being a hotbed," Rosatte said.

"There were 25 cases of rabid foxes alone in the Don

Valley area in 1988."

In Phase 1, bait containing rabies vaccine will be distributed in areas of Metro where foxes live or have been

seen. People are asked to telephone the rabies research

unit at 832-7154 if they see a fox or know where a fox's

den is located.

"There are about 3,000 to 4,000 skunks and another

1,000 foxes living in Metro," said Rosatte.

"But foxes are the Number 1 carriers of rabies."

Ministry research indicates rabies will likely die out if a

majority of foxes in an area can be vaccinated.

In Phase 2, ministry biologists will immunize skunks in

a 60-square-kilometre area of Scarborough.

The skunks will be trapped, injected with the vaccine

and released between July 4 and Nov. 3 in an area from

Highway 401 to Lake Ontario, bounded by Markham

Rd. on the east and Victoria Park Ave. on the west.

And from Oct. 1-12, ministry biologists will drop vaccine-laced bait from low-flying aircraft over a triangular

rural section of eastern Ontario from Napanee north to

Pembroke, east to Cornwall and west along the shoreline

of the St. Lawrence River and Lake Ontario.
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10 JULY 1989 26 WEST EUROPE

If successful, the project will create a rabies-free zone in

this area, which will be expanded westward in the future.

The oral vaccine was originally tested and used in

Switzerland in 1976 but while it is effected on foxes, it is

not work with skunks.[as printed]

Because the fox-baiting programs are still in the experimental stage, officials advise pet owners to have their

pets properly vaccinated against rabies.

"Forest tent caterpillars are pretty choosy. They'll stay

where their food source is. The gypsy moth (caterpillar)

would strip the tomato plant in your backyard," said

Bruce Ferguson, Huronia District forest management

supervisor.

Gypsy moth caterpillar infestations have caused additional problems for ministry officials because they arc

not native to North America and have few natural

predators in southern Ontario. Aerial spraying has been

introduced.

Gypsy Moth Caterpillar Widespread in Southern

Ontario

54200060 Toronto THE TORONTO STAR in English

17May89pA7

[Article by Chi Carmody]

[Text] Natural Resources Ministry officials say they're

fighting a losing battle against the gypsy moth caterpillar

and this year's infestation will be the most widespread

ever.

"They're everywhere they were last year and have been

moving eastward," said ministry pesticide co-ordinator

Jim McCreadie.

He said first-time aerial spraying of a virus harmful to

the caterpillars have been scheduled for the Carp Hills

area of Ottawa-Carleton and Backus Woods in Simcoe

next month. These are additions to the annual spraying

program conducted in Niagara, Rice Lake, Gananoque,

Tweed and Arnprior.

Ministry statistics show that gypsy moth caterpillars

defoliated the equivalent of 30,000 hectares (74,129

acres) of woodland across southern Ontario in 1988, up

from 13,000 hectares (32,123 acres) the previous year.

Less Acute

McCreadie said the area defoliated this year will probably equal that in 1988, but added the severity of the

defoliation should be less acute than last year.

Provincial entomologist Joe Churcher said a gypsy moth

caterpillar can eat a square metre of leaves every day.

"Their favorites are oak and maple leaves, but when

those aren't around they'll eat just about any kind of

foliage," Churcher said.

Because of their indiscriminate appetite, gypsy moth

caterpillars are more of a problem than the more commonly known forest ant caterpillars, which depend

largely on aspen and poplar leaves.

FINLAND

Health Minister on AIDS Situation

54002496 Helsinki HELS1NG1N SANOMAT in Finnish

4 May 89 p A8

[Text] Social and Health Affairs Minister Helena Pesola

(Conservative Party) said Friday at the ministerial meeting

held in London that there is no reason for panic in Finland

because of the AIDS situation. Pesola told her minister

colleagues that the numbers of both those with AIDS and

those infected with the HIV virus have increased significantly slower in Finland than the overall average for

Europe. Over the last 5 years, in Finland there have been

found 249 individuals infected with the HIV virus, of

which 209 were Finns. During this period, 42 Finns have

been hospitalized because of AIDS. "The low number of

cases is partly due to the circumstance that there are only

a few intravenous drug users in Finland, and also because

there are few prostitutes. Also, Finland has conducted a

frank and long-running education and informational

campaign," said Pesola. According to her, the danger is not

yet past, however, and preventing AIDS demands continuous efforts, at the same time as attempts must be made to

halt narcotics use.

ITALY

Turin Offering Free Needles in Effort To Control

Spread of AIDS

54002491 Milan L'VNITA in Italian 20 Apr 89 p 9

[Article by Pier Giorgio Betti: "Free Needles Offered To

Combat AIDS"; first paragraph is L'UNITA introduction]

[Text] Drug addicts of Local Health Unit 28 ofthe Turin

commune of Settimo will be able to receive a new needle

by turning in a used one. This "exchange" initiative, the

first of its kind in Italy and an offspring of a similar

program in the Netherlands, was taken by the public

health service "to reduce the risks of infection by AIDS

and hepatitis." Opinions are for the most part favorable,

but there are those who are clearly opposed.

Turin—Someone spoke of "provocation," but Dr Renzo

Rolando, 31, psychologist and coordinator of the drug

addiction team of the Settimo commune in Turin and
JPRS-TEP-89-012

10 JULY 1989 27 WEST EUROPE

supporter of the "clean injection" experiment is of the

opposite opinion. "Nonsense, there's nothing provocative about it. It would only be provocative if a public

health service were not trying to protect the health ofthe

people. In the face of the tragic dimensions of the

problem, we have two priorities: limiting the number of

deaths and containing the spread ofAIDS, hepatitis, and

related illnesses. We deal with the consequences. The

rest—the controversy over whether or not drug addicts

should be punished and the ready availability of drugs—

does not concern us."

"Project Sanifix" (or clean injection) came about after a

trip that Rolando, Dr Ciccio Caccavari, and other members of the team made to Amsterdam and Rotterdam to

study the "strategy" used by Dutch health officials to try

to confront the drug emergency. According to Dr

Rolando, the "exchange" idea, which has been used for 4

years, has had more than encouraging results. "With

respect to the trend ofthe previous period, the number of

AIDS cases fell by 60 percent. This is also certainly due

to the fact that smoking heroin is more common in the

Netherlands than injecting it. At any rate, the significant

fact is that 71 percent ofthe drug addicts who exchanged

needles then decreased their use of heroin or even

stopped altogether."

A sterile needle eliminates a channel of infection. And

the drug addict who comes to ask for one in some ways

makes contact with the health service, thus partially

opening the door that could lead to information and

dissuasion tactics. The Dutch experience seemed interesting, and they decided to try it in the jurisdiction of

Local Health Unit 28, which, in addition to Settimo,

includes the communes of Volpiano, San Benigno, and

Leini, for a total of about 80,000 inhabitants. Each

commune will have its own "exchange point," which will

be open from 0730 to 2400 hours. This is when pharmacies are closed, and the use of drugs and therefore

needles greatly increases. Among the possible positive

effects, managers ofthe team and the Local Health Unit

also cite the elimination of the minor risk of people

inadvertently pricking themselves with infected needles

that have been thrown to the ground.

"Project Sanifix" has the unconditional approval of

Maria Gallo, health official for the Christian Association

of Italian Workers. "The project should be supported

because it's a logical means of prevention and reduces

the danger of needles tossed away in gardens or streets."

For investigating magistrate Maurizio Laudi, the initiative taken in the Settimo commune of Turin has two

sides. "On a completely negative front such as the

current drug crisis, it could help to control the spread of

the infection. Despite its bad aspects, in other words, it

could have some benefit. But what is disturbing is the

fact that the public institution has chosen to intervene—

through no fault ofthe doctors in the Settimo commune,

naturally—by distributing clean needles, when, in fact,

much stronger and forceful preventive measures are

necessary. It's a little like admitting defeat."

The opinion of Don Paolo Fini of the Turin reception

center is quite clear-cut and negative. "I don't believe in

the clean injection. Certainly, it's necessary to educate,

especially from the sanitation viewpoint, but the fact

that it is the health service that should be freeing youth

from drug addition, distributing the needles seems contradictory to me. At the very least, an equal commitment

should be made within the organization of the department for drug addicts."

For Adriana Ceci (PCI) [Italian Communist Party], vice

president of the Chamber's Social Affairs Commission,

"the offer to exchange needles is useful ifit enables us to

talk with drug addicts and brings them to the public

service, which should be adequately prepared."

NORWAY

Number of New HIV Cases Continues To Decline

54002487 Oslo AFTENPOSTEN in Norwegian

8 Mar 89 p 60

[Article by Hilde Harbo: "Every Fourth Adult Has Been

Tested for HIV"]

[Text] Every fourth adult Norwegian has now been

tested for HIV. On a global basis, only the other Nordic

countries can be compared to Norway when it comes to

the percentage of the population tested.

Each month fewer new persons are found to be HIVpositive than in 1987, even though 50 percent more tests

are performed monthly than a year ago. Roughly 15 new

cases are now discovered each month, a drop of 25

percent since 1987.

"Despite these figures, we don't know for certain

whether the spread of the disease is abating. I say this

because there's still a lot of uncertain data and because

we don't know when these persons were infected, only

when the infection was discovered," says Oivind Nilsen,

chief adviser to the National Institute of Public Health,

to AFTENPOSTEN.

He points out that even though approximately 2,000

persons in Norway are assumed to be infected with HIV,

only 771 ofthem have been found, despite this intensive

testing. To make up for this, health authorities will

launch a major campaign in April to motivate people to

get themselves tested. The campaign will be directed

especially at high-risk groups—homosexuals and drug

abusers—as well as heterosexuals who have been at risk.

The reason Norway ranks number one in the statistics

for HIV testing is that we were the first to offer the test

of all pregnant women. Over 115,000 women who either

were pregnant or sought an abortion have been tested so
JPRS-TEP-89-012

10 JULY 1989 28 WEST EUROPE

far, and only nine were found to be HIV-positive. An

additional 25,000 conscripts and 130,000 blood donors

have been tested. Altogether, nearly 570,000 Norwegians

have been tested, about 25 percent of the population

between 20 and 65 years of age.

Last year Norway was the only West European country

to experience a decline in the number of new AIDS cases.

While 35 persons were diagnosed in 1987 as having

AIDS, the figure dropped to 30 in 1988. Homosexual

men as a group dropped the most, from 27 new cases in

1987 to 19 in 1988.

"We don't think the downward trend will last. This year

we expect the number of new AIDS cases to rise again to

somewhere between 40 and 60," says Oivind Nilsen,

who continues:

"Many ofthose who got AIDS before 1988 were sexually

active homosexuals who had been infected in the epidemic's first phase in the late 1970's and early 1980's.

After this group was infected, it took a while before the

disease began to spread to less sexually active homosexual men, intravenous drug users, and heterosexuals. The

'pause' in dissemination ofthe disease is probably what's

being reflected in the decreased AIDS figures."

"In the years to come, the incubation period before the

disease erupts will end in more and more infected

persons, and then the figures will increase again. In

particular, we anticipate a big increase among drug

abusers."

Bureau of Health To Halt Illegal HIV Registration

54002488 Oslo AFTENPOSTEN in Norwegian

6 Apr 89 p 3

[Article by Hilde Harbo: "Illegal HIV Registration"]

[Text] The Bureau of Health is clamping down on the

illegal registration of children who are born to HIVpositive mothers. Several birth reports have been discovered in which the mother's HIV infection is mentioned.

Birth reports are filled out at the hospital and sent by

district doctors to the Medical Registry of Births in

Bergen. Only the National Institute of Public Health is

entitled to register persons infected with HIV, and persons thus registered are guaranteed anonymity.

Cases in which HIV infection is mentioned in birth

reports therefore violate both the anonymity principle

and the rights of those entitled to keep records of such

infections.

Today in Norway there are roughly 20 children who were

born to mothers infected with HIV. So far, only two of these

children have been shown to be infected with HIV, because

it takes time before any infection can be established.

In 12,000 copies of a circular sent to all physicians,

midwives, district doctors, and hospitals in this country,

the Bureau of Health makes it clear that the mother's

HIV status is not to be included in birth reports.

"We look askance at the inclusion of such sensitive

information in an unauthorized register. We're very

strict about compliance with the principle of absolute

anonymity concerning information about HIV infections," says Johs. Wiik, department director in the

Bureau of Health.

He points out that priority has been given to dispatch of

the circular.

"We acted as soon as we were told by the Oslo district

doctor that the results of mother's HIV tests were mentioned in some birth reports. It's important to see to it

that this practice doesn't continue," he says.

UNITED KINGDOM

Top Industrialists To Serve on Health Service Board

54500107 London THE DAILY TELEGRAPH in

English 23 May 89 p 4

[Article by Peter Pallot, Health Services Staff]

[Excerpt] Four leading industrialists with reputations for

tough decision-making have been recruited to help in

running the Health Service. Mr Clarke, Health Secretary,

has appointed them to take unpaid jobs on the NHS

policy board, a powerful new body charged with deciding

what the NHS should be able to achieve.

Deputy chairman of the board will be Sir Roy Griffiths,

62, deputy chairman of Sainsbury's, who has been an

adviser to Mrs. Thatcher on health policy since 1983.

He is joined by Sir Graham Day, 56, who as chairman of

the sold-off Rover Group and Cadbury Schweppcs

already splits his time between cars and chocolate.

Also appointed is Sir Kenneth Durham, chairman of the

L2 billion-turnover Woolworth stores chain, which

became Kingfisher Holdings earlier this year in the face

of bitter opposition from shareholders.

Sir Kenneth, 65, who is also deputy chairman of British

Aerospace, gave a warning recently that Britain would

become a Third World country if it did not put more

cash into training scientists.

The fourth director to be appointed from industry is Sir

Robert Scholey, 67, chairman of British Steel, which last

December was privatized for L2.5 billion in a flotation

more than three times oversubscribed.
JPRS-TEP-89-012

10 JULY 1989 29 WEST EUROPE

The businessmen, who are among the highest-paid figures in Britain, will not be claiming expenses for attending monthly meetings.

Mr Clarke emphasized at a press conference yesterday to

announce the 13 members of the board that experience

in privatization among three ofthe non-executive directors was not significant.

The NHS was destined to remain a public utility but "the

biggest and most complicated service in the country"

would benefit from the expertise of directors able to run

large companies.

When Roy Griffiths was brought in to NHS management, political opponents had made capital out of the

idea of a supermarket boss running a caring service, Mr

Clarke said.

"But there are no people in the service any longer who

reject the notion of the input of someone with management expertise," he continued.

"The NHS will never be a business. It does need to be

more business-like in the way it spends L26 billion each

year and employs over one million people ifit is going to

deliver up-to-date, friendly and effective treatment to 55

million potential patients."

Mr Duncan Nichol, a member of the policy board, is

chairman of the executive.

The changes, the biggest in the NHS's 40 years, would

devolve power to local level where managers, doctors

and nurses would make decisions, said Mr Clarke.

There are five members of the policy board with direct

involvement in patient care and one woman, Mrs Julia

Cumberlege, chairman, South-west Thames regional

health authority.

Health Service Reported Underfunded for Past 9 Years

54500113 London THE DAILY TELEGRAPH

in English 9 May 89 p 4

[Article by David Fletcher]

[Text] The Health Service has been underfunded by

more than L3 billion over the past nine years, the

National Association of Health Authorities says today.

The underfunding is based on the difference between

what authorities have spent and increases needed to cope

with medical advances and Government policies.

Its figures assume an extra one per cent a year is needed

to pay for medical advances such as hip transplants or

heart surgery and between 0.4 per cent and 1.3 per cent

a year on the health needs of the elderly.

On this basis, the association estimates underfunding

this year amounts to L490 million although it could be

more depending on inflation.

It points out that inflation, already seven per cent, is now

two per cent higher than the provision made to health

authorities by the Government.

For every one per cent increase in inflation, health

authorities will have to find an additional LI30 million

from their budgets to maintain services.

Mr Philip Hunt, director of the association, said underfunding was the main cause ofdifficulties faced by health

authorities in the last few years yet little was said about

it in the Government's White Paper on the future of the

health service.

"It is vital for the Government to recognize and understand this history offinancial pressures on health authorities ifthe reforms proposed in the White Paper are to be

successful for the benefit of patients."

The association's calculations are likely to embarrass the

Government in the midst of controversy over its health

service reforms.

Mr Clarke, Health Secretary, told the Conservative Medical Society on Saturday: "In my judgement, the growth

in money going into the service is probably at the limit of

the capacity of the service to absorb it."

MrJohn Appleby, association senior policy analyst, said:

"Where is Mr Clarke's evidence for saving this? Health

authorities would easily be able to spend more money."

—A campaign against quacks and bogus practitioners of

alternative medicine was announced by doctors yesterday when they disclosed that cancer patients have

died needlessly because they put their trust in alternative therapies.

More than 200 doctors have formed Quackbusters, a

campaign against health fraud, in a backlash against the

growing popularity of alternative forms of treatment

including osteopathy, homeopathy, aroma therapy and

various forms of unproven dietary treatment.

Dr Michael Baum, Professor ofSurgery at King's College

Hospital, London, said: "There are hundreds of patients

who have been persuaded that they should be treated by

alternative practitioners and some have died as a result

of it.

"There is a powerful lobby for alternative therapies but

some of us feel it is time to stand up and be counted."
JPRS-TEP-89-012

10 JULY 1989 30 WEST EUROPE

Signs Indicate Deadly Seal Virus Returning

54500108 London THE DAILY TELEGRAPH

in English 22 May 89 p 7

[Article by Robert Bedlow]

[Text] Fears are growing that the deadly virus which

wiped out thousands of seals in the North Sea last year

has returned.

Patrols looking for dead seals have been set up around

the Wash after a carcass was found floating in the sea at

Blakeney Point, Norfolk, at the weekend, the second in

the week.

A third common seal was found dying by holiday makers

on the beach at nearby Hunstanton.

All carried the familiar symptom of a nasal discharge

which suggests a fresh outbreak of the killer virus.

The only comfort for experts is that fishermen off the

Norfolk coast have reported seeing seals "alive and well"

and wearing orange tags which means they have been

treated and survived.

Last year 17,500 North Sea seals were killed by the

distemper virus, including two-thirds ofthe seal population in the Wash.

The bodies of two grey seals have been found on the

Farne Islands, off Northumberland, and a dead grey and

a common seal were seen floating, dead, off St Andrews,

Scotland.

"A fresh tragedy could happen," said one expert. "We

are within weeks of the pupping season."

Today the RSPCA seal unit at Docking, Norfolk, is to

put up notices on the beaches, warning: "Seals are

dangerous. Leave them alone. Keep children and dogs

away from sick or dead seals."

Miss Allison Hutchinson, the unit's head nurse, said

there had been no confirmation "so far" that the seals

found dead and dying in Norfolk had died of the virus."

She warned: "Scientists predict it is going to happen

again all over this year. Obviously we are worried."

Mr Joe Reed, warden at Blakeney Point, owned by the

National Trust, said he had recently counted 252 seals

compared with 700 at this time last year.

He said: "I would like to think we are not going to have

another carnage this summer. Some seals should have

immunity to it. I would be very surprised ifthey were all

wiped out.

"The testing period will be in the pupping season next

month when the seals are on the sand-banks and could

cross-infect each other."
ö 72161

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