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Role Seen for Prison Officials In AIDS Fight Where homosexuality and in- travenous drugs are rife in pris- ons, there is also the threat of AIDS. What the role of prison authorities shou ld be under such circumstances has been set out in a "consensus state- ment" -the first ever-d rawn up by experts from 26 coun- tries meeting recently under the aegis of WHO. As "there may be substan- tial numbers of prison inmates w ho have a history of high-risk behaviou r, the likelihood is strong of the AIDS virus being transmitted among prisoners, " the experts state . A study of prisons in 17 nations of Western Europe, w ith a total of 270,000 in- mates, shows rates of infection ranging from 1 to 26 per cent or an average of 10 per cent. "In general, the results con- firm the expectation that in prison there is an unusually high sero-positive population in relation to the general public," say the experts who carried out the study, which was commis- sioned by the Council of Eu- rope. They add: "Prison auth- orities, therefore, have a special responsibility to inform all prisoners of the risk of infec- tion from such behaviour." In addition, the authorities should recognize the ir respon- sibi lity to minimize transmis- sion, thereby also lessening the risk to the public at large in cases where prisoners are released. But in attempting to stop the spread of AIDS, the experts de- Photo: L. Sirman Press © In prisons : An unusually high sero-positive group. 30 .... .. .... ... ... ... ...... ... ..... . .......... . •••• •• •••• ••• ••• ••• ••••••• ••• • ••••••••••••••••••••• •••• •• •••• ••• ••• ••• ••••••• ••• • ••••••••••••••••••••• ••• •• ••• ••• ••• ••• •• • ••••••••••••••• ... .. .... ... ... ... ...... ... . ... ... ... . ..... . ... .. .... ... ... ... ....... ... . ................... . ••• •• •••• ••• ••• ••• •••••• ••• • •••••••••••••••••••• ... .. ... ... ... ... .. . .............. . ••• •• •••• ••••••••••• ••••••• •• • •••••••••••••••••••• ••• •• •••• ••••••••••• ••••••• •• • ••••••••••••••••••• ... .. .... .......... ...... .. . .......... ······· Editor: Peter Ozorio Letters from US Presidents On I Loathsome Smallpox I Edward Jenner (17 49-1823). the English doctor who discov- ered the principle of vaccination, and Thomas Jefferson (1743-1826). the third President of the then brand new United States of America, were 18th century contemporaries. On hearing of Jenner's discovery, Jefferson sent his con- gratulations and then confidently predicted: " Future gener- ations wi ll on ly know by history that the loathsome smallpox has existed." That prediction has come to pass 200 years later, thanks to an international eradication campaign led by WHO and sup- ported by all countries, particularly the Soviet Union and the United States. Last 26 October, on the tenth THE WHITE HOUSE ann iversary of the last case of en- WASHINGTON October 26, 1987 demic smallpox, another U.S. President also wrote a letter of congratulations. Citing Jeffer- son's prophetic words, President Ronald Reagan penned the fol- lowing to Or Halfdan Mahler, WHO"s Director-General: "I am particularly proud of the role the United States played in this fight in partnership with WHO and other nations. "The success of the erad ication campa ign serves to re- mind us all that international cooperation is invaluable for bat- tling and solving common problems, especially those that ap- pear insurmountable." This letter, and others as wel l, recalled the event a decade ago when Somali health workers tracked down Ali Maow Maalin, then 23, who had broken out in spots. His illness turned out to be the world's last case of endemic sma llpox. The anniversary was also marked in Somalia by a little ceremony in which Maalin- described as "a living monu- ment to international cooper- ation" by Or Zdenek Jezek, chief of WHO"s smallpox eradi- cation programme-received a bouquet of roses. The cost of the eradication programme has been esti- mated at from US $200 to $300 million. The savings to countries, in terms of death and suffering prevented, in not having to vaccinate, or in not checking certi ficates at airports and seaports, are estimated at $2,500 million yearly - or, sav- ings over the past decade exceeded 125 times the cost. • clare, "prisoners should not be subjected to discriminatory practices, involuntary testing, segregation, or isolation, " un- less such measures are re- quired "for the prisoner's own well-being. " The consensus statement cal ls for blood testing, under confidentiality, only on re- quest; pre-and post-test coun- selling; education and informa- tion programmes for prisoners and for prison staff alike; and for victims, "out-patient ser- vices of the same quality as those for AIDS patients in the community." On the basis of WHO projec- tions for the coming years, " prison and health authorities wi ll need to devote consider- able additional human and fi - nancial resources for the man- agement of AIDS," the experts say. Among other highlights of their statements : • That "carefu l consideration should be given to making con- doms available, in the interest of disease prevention," as well as rehabilitation programmes for intravenous drug-users; • That "prisoners with AI DS should be considered for com- passionate early release to die in dignity and freedom . " Says Or Jonathan Mann, Di- rector of WHO"s Global Pro- gramme on AIDS, "The prob- lem of AIDS in prisons has received insufficient attention. The same principles that apply to AIDS prevention and control in society generally must be ap- plied in prisons. " • China Goes Over the Half-Way Mark More than 60 per cent of chi ldren in China under the age of one have been immunized against the six major diseases of ch ildhood, according to sur- veys carried out by the end of last year. The drive by China, the larg- est country in the developing world, to protect children be- gan in 1979. lt is part of WHO's Expanded Programme on Im- munization launched in 1974, the goal of which is to immu- nize infants by 1990 against measles the No.1 ki ller, diph- theria, pertussis and tetanus (OPT). as well as polio and tuberculosis. According to estimates for the late 1970s, China then re- ported yearly about a million cases of measles, 20,000 cases of diphtheria, 6,000 cases of pertussis (whooping cough). and 10,000 cases of polio. In 1982 it set as its goal the immunization of between 80 and 95 per cent of infants. So far, seven provinces have topped the 80 per cent mark : Beijing, Heibei, Jiangsu, Jilin, Liaoning, Shanghai and Zhe- jiang. Other provinces, how- ever, such as Guanshi and Xinjiang, in the west and there- fore remote, report immuniza- tion coverage of between 40 and 50 per cent. Photo WHO/Min . Public Health, China The goal: From 80 to 95 per cent of infants. WoRLD HEALTH, March 1988 The success of immunization programmes depends essen- tially on the "cold chain," the name given to all of the equip- ment and management tech- niques that keep vaccines cold. Vaccines lose potency if ex- posed to heat, or to light. Chief among problems that health of- ficials in hard-to-reach areas need to overcome is the lack of refrigerators. To retain potency, vaccines must be stored at temperatures below 8°C (46°F). In the case of Inner Mongo- lia, where temperatures range between -20 to + 35°C (-6 to + 95°F), officials are resorting to "underground" refrigeration to keep vaccines fresh. Vaccines are delivered to that region only in winter, then stored in underground cellars, where the year-round tempera- ture never rises above 8°C (46°F) • The High Cost Of Dog Bites For France Man's best friend, the dog, continues to bite the hand that feeds it, causing not only pain but expense. A report by the National Ref- erence Centre for Rabies in Paris, for instance, estimates the cost for treatment and pro- phylaxis at some six million francs yearly. "Yet no indige- nous cases of human rabies have been observed in France since 1968," wHo notes in its Weekly Epidemiological Re- cord (No. 47) Bites, either on bare skin or through clothes, or scratches, or just contact with suspected rabid animals brought 15,104 persons to the anti-rabies centres dur- ing 1986, the report says by way of example, adding that: "Suspected contamination by a domestic carnivore was in the majority of cases the rea- son for reporting, and for treat- ment being instituted." Of the total reporting to the centre, 8,064-53 per cent- were given anti-rabies vaccina- tion . In over half these cases animals could not be examined because they had "disap- peared," but where animals could be examined, they were found rabid in 21.8 per cent of the cases treated. "" "The only prospect of reduc- ing costs would be to find a way of tracing missing or stray animals, " WHO said in a com- ment on the French report. • WoRLD HEALTH, March 1988 Newsbriefs • A Change of Syringe as Well. Not only needles but syringes as well need to be changed each time they are used if the risk of infection being passed on is to be avoided. A common belief, however. is that a change of needle is enough, but evidence from as far back as the 7950s shows that syringe contamination does occur. There has been, particularly, the risk of hepatitis transmission, and now the risk of passing on the HIV virus that causes AIDS. Thus the recommendation of WHO's Expanded Programme on Im- munization is that a sterile needle and a sterile syringe should be used for each individual. • Calendar. Of more than ·usual noteworthiness, the 3rd Interna- tional Intensive Care Nursing Conference, to be held from 30 Au- gust to 2 September, in Montreal, Canada. The American Associ- ation of Critical Care Nurses, the world's largest organization of specialised nursing, and the Canadian Association of Critical Care Nurses are sponsors. (For details, write to · Wanda Sa/as, 7 Civic Plaza, Newport Beach, California 92660, USA) • Magnum opus. While not exactly for the coffee table at home, WHO's "Smallpox and Its Eradication" is a must for scientists, clini- cians, students of public health, and medical historians. it is also eminently for the intellectually curious layman-the kind of person intrigued to know just how a disease as old as mankind was wiped off the face of the earth. The saga, from the Pharoahs of Egypt to our times, is chroni- cled in over 7,500 pages of facts, charts, maps, plates and photos plus previously unpublished data and personal experiences. The writers are leaders in the campaign: F. Fenner. D. A. Hen- derson, I. Arita, Z. Jezek and 1.0. Ladnyi, names which themselves suggest the international effort that went into the world's most triumphant achievement in public health. Published to mark the tenth anniversary of the last case of endemic smallpox (see box, opposite page). (To order, write to: WHO, Distribution and Sales, 7277 Geneva. Price . Sw.f 250 or US $750 - ) • People. Appointed as Director of WHO's Division of Public Infor- mation and Education for Health, Mrs Ann Kern (Australia), for- merly Deputy Secretary, Commonwealth Department of Health in Canberra. She is now responsible for these units: health education, me- dia, programme support, plus World Health, and World Health Forum. • The Smallpox Success Story, Told in German. Sieger in Weiss is a documentary account by novelist Nikolai van Michalewsky of how "conquerors in white coats" - under WHO's leadership-subdued smallpox in continent after continent until the disease 's eradication in the 7970s. Copiously illustrated. (For details write to the publisher, Verlag Herder, Freiburg irn Breisgau, Federal Republic of Germany. Price : OM 34). • World Bank for Health. Once solely concerned with financing economic development, the World Bank, with its headquarters in Washington, D. C., began lending for health in the 7980s. Now its President, Barber Conable, has declared the bank is prepared to make loans for health totalling US $500 million by 7997 - doubling the total of the mid-7980s. A major interest: programmes advancing the cause of safe motherhood. In the next issue The theme chosen for the Technical Discussions to be held at the time of the World Health Assembly in Geneva this May is: "Leadership Development for Health for All." The April issue of World Health will try to define what leadership means in the context of Health for all by the year 2000. ' "< · WORLD For readers everywhere ... · .. 198~ Subscriptio~ · Rates :• ·· us$ i7 . ...