While there is concern that children with HIV infections may have decreased immune responses or experience adverse effects from immunization, the present state of knowledge finds that the benefits of immunization outweigh the risks. In 1987, the World Health Organization recommended that asymptomatic individuals with HIV infections should receive all of the Expanded Program of Immunization antigens according to schedule. Symptomatic individuals should not receive BCG. In Uganda, BCG is administered at birth or shortly thereafter, which should minimize adverse effects in HIV-infected infants. HIV-positive adults with symptoms should receive inactivated vaccines.
African Sleeping Sickness is endemic in 37 countries of sub-Saharan Africa. Recent estimates suggest that 50 million people are at risk of acquiring the disease and 25,000 new cases are recorded every year. African Sleeping Sickness is caused by protozoan organisms belonging to the genus Trypanosoma which are transmitted cyclically by tsetse flies. The trypanosomes are limited in the early stage to the blood stream from which they later move to the central nervous system. The disease is very hard to diagnose and treat. Clinical manifestations are highly variable and unspecific, and parasitological diagnosis is difficult because of the frequently low and fluctuating parasitemia. Most of the available serological tests can only detect the presence of antibodies to trypanosomes and therefore only indicate exposure to trypanosomes rather than active infection. Clinical, parasitological, and serological diagnosis are discussed. Treatment of the disease remains dependent upon the use of Suramin and Pentamidine for early stage cases and Mel B for late stage cases when the central nervous system changes occur. Through compassionate clinical trials, however, eflornithine, formerly known as DFMO, was recently found to be an effective therapeutic agent against gambiense sleeping sickness. The drug acts by irreversibly blocking the action of ornithine decarboxylase, which catalyzes an essential step in polyamine synthesis, and stops the growth of trypanosomes. A multicenter conventional clinical trial is being arranged before it is made commercially available.
Health care workers must take care to not become infected with HIV, Hepatitis B, and other blood-borne pathogens through the course of their routine medical work. Health care workers should therefore assume that the blood and body fluids of all patients may be infected with HIV, Hepatitis B, and other blood-borne pathogens, and take universal precautions accordingly. Skin and mucus membrane exposure should be avoided with blood and other body fluids containing visible blood, semen, vaginal fluids, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. Universal precautions do not, however, apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomit unless they contain visible blood. The risk of HIV transmission from these latter fluids and materials is extremely low or non-existent. Protective barriers such as gloves, gowns, masks, and protective eyewear reduce the risk of exposure of health care workers' skin or mucus membranes to these potentially infective materials. Although saliva has not been implicated in HIV transmission, mouthpieces, resuscitation bags, or other ventilation devices should be available in operating theaters, intensive care units, labor suites, and other areas where they could be called upon to minimize the need for emergency mouth-to-mouth resuscitation and the potential of infection. Finally, infection control measures will be established in accordance with the need for personal and environmental hygiene, sterilization and high-level disinfection, disinfection, and the disposal of infected waste.
