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Our data suggest that for preventing tuberculosis in HIV-infected patients, a daily 2-month regimen of rifampin and pyrazinamide is similar in safety and efficacy to a daily 12-month regimen of isoniazid. This shorter regimen offers practical advantages to both patients and tuberculosis control programs.

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Control strategies had an overall impact in decreasing diarrheal mortality among children under five years of age. Additionally the country did not suffer from a decrease in tourism or economic consequences. This experience can be considered as the operationalization of a new public health system spanning multisectorial activities, involving community participation, political will and with impact on public health and economic issues.

Symptomatic and asymptomatic astrovirus infection was prospectively determined in a 3-year birth cohort of Mayan infants. Stool samples from 271 infants and 268 older siblings were tested for astrovirus, adenovirus 40/41, rotavirus and Salmonella, Shigella and Campylobacter species. Concurrent diarrhea, vomiting, fever, or anorexia were noted. Astrovirus was detected in 164 infants (61%) and 20 siblings (7%). Rotavirus (4%) and adenovirus 40/41 (13%) were isolated less frequently. Of all diarrheal episodes reported at a visit, 26% (78/305) were associated with astrovirus; 17% (78/452) of astrovirus infections were associated with diarrhea and 9% with other symptoms. Only diarrhea was associated with astrovirus infection (odds ratio, 1.4; 95% confidence interval [CI], 1.07 -1.92; P Å .01). Of infants with astrovirus, 70% shed at multiple visits over a period of 2 -17 weeks (median, 5). The point prevalence of astrovirus infection was significantly higher among infants than siblings (relative risk, 6.18; 95% CI, 3.93 -9.72; P õ .0001, x 2 ). Astrovirus was identified throughout the year, peaked in March and May, and decreased in September. In this population, astrovirus was the most common enteric pathogen isolated; symptomatic infection was prevalent among infants.Astroviruses are second only to rotaviruses as a common the incidence of asymptomatic astrovirus infection have been described in US day care center studies [2,3]; no longitudinal cause of viral gastroenteritis in infants and young children worldwide [1]. Acute astrovirus gastroenteritis induces a mild, data have been published regarding children living outside of developed countries. In addition, astroviruses may be isolated watery diarrhea that lasts for 2 -3 days and may be associated with vomiting, fever, anorexia, abdominal pain, and constitufrom stool specimens from children with gastroenteritis that contain other enteric pathogens, making determination of the tional symptoms that last up to 4 days. Protracted diarrhea and viral shedding are uncommon. Most astrovirus infections are causative pathogen difficult. As part of an oral poliovirus vaccine (OPV) immunogenicity detected in the winter months in temperate regions and in the rainy season in tropical climates, a pattern similar to that seen study [4], we collected sequential stool samples from a 3-year population-based birth cohort of rural Mayan infants and their with rotavirus infections. Symptomatic infections are primarily found in infants and young children, particularly in developing older siblings living in Chiapas, Mexico. We studied the prevalence of astrovirus, rotavirus, adenovirus 40/41, and Salmocountries, or in elderly, institutionalized populations.Most data regarding astrovirus infection have been obtained nella, Shigella, and Campylobacter species in this population and obtained information regarding the presence of common from cross-sectional rather than longitudinal studies of children with gastrointestinal symptoms. Longitudinal data regarding gastrointestinal symptoms arou...

Because measles causes an estimated 2 million deaths per year among children in developing countries, including a substantial proportion of infants less than nine months old--the age at which vaccination is recommended--there has been interest in using different strains of vaccine and higher doses to achieve immunization of younger infants. We conducted a randomized trial of three different doses of Edmonston-Zagreb and of Schwarz measles vaccines in infants to evaluate the effect of the strain and dose of vaccine on the serologic response and acute adverse reactions to vaccination. Six-month-old infants received a standard, medium, or high dose of one of the vaccines, and nine-month-old infants received a standard dose. Antibody levels were measured before and after vaccination, by means of a plaque-reduction neutralization assay, in 1061 six-month-olds and 299 nine-month-olds. Edmonston-Zagreb vaccine produced higher rates of seroconversion and seropositivity than comparable doses of Schwarz vaccine. Among the six-month-old infants, the seroconversion rate 18 weeks after vaccination with the standard dose of Edmonston-Zagreb vaccine was 92 percent, that with the medium dose was 96 to 97 percent, and that with the high dose was 98 percent; the rates for the corresponding doses of Schwarz vaccine were 66 percent, 76 percent, and 91 percent, respectively. Higher seroconversion rates were observed with an increase in the dose of either Edmonston-Zagreb (P less than 0.01) or Schwarz (P less than 0.001) vaccine. The seroconversion rates produced by high and medium doses of Edmonston-Zagreb vaccine in six-month-olds were equal to or significantly higher than the rate produced by a standard dose of Schwarz vaccine in nine-month-olds (87 percent). Clinical adverse reactions were not associated with the strain or dose of a vaccine. We conclude that Edmonston-Zagreb vaccine is more immunogenic than Schwarz vaccine in infants and can induce effective immunization against measles at six months of age.

Factors affecting immunogenicity of the first 2 doses of oral poliovirus vaccine (OPV) among unimmunized Mayan infants were prospectively evaluated. The relative impact of multiple variables, including mass or routine vaccination, concurrent enteric bacterial (salmonella, shigella, and campylobacter) and viral (adenovirus 40/41, astrovirus, nonpolio enteroviruses, and rotavirus) infections, interference among Sabin vaccine viruses, and preexisting poliovirus antibodies were studied. Sera were available from 181 infants after 2 OPV doses. Seroresponses were 86% to Sabin type 1, 97% to Sabin type 2, and 61% to Sabin type 3 vaccines. Mass versus routine vaccination and preexisting poliovirus antibodies did not affect immunogenicity. By multiple logistic regression analysis, fecal shedding of homologous Sabin strains was associated with increased seroresponses to all Sabin types, especially to Sabin type 3. Decreased OPV immunogenicity was primarily attributable to interference of Sabin type 3 by Sabin type 2. OPV formulations with higher doses of Sabin type 3 could improve immunogenicity among infants in developing countries.

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