Human Immunodeficiency Virus: The Genetic Bottleneck in Mother-to-Child Transmission

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Human Immunodeficiency Virus: The Genetic Bottleneck in Mother-to-Child Transmission"

Transcription

1 Human Immunodeficiency Virus: The Genetic Bottleneck in Mother-to-Child Transmission 1

2 Abstract Human Immunodeficiency Virus (HIV) has become a global epidemic, with an estimated 2.5 million children currently living with the disease. During pregnancy, complications can arise, resulting in mother to child transmission (MTCT). The genetic bottleneck wherein the transmitted infection is a conserved, highly homogenous strain is an important pathologic theory, especially in MTCT. However, it is severely under-researched, with available data inconsistent and limited. Understanding both the antibody pressure as well as the selection of a viral strain to be transmitted could change current treatment guidelines and therapy regimes. Therefore, a review of the current literature on the genetic bottleneck in MTCT has been done to describe the research methods, results, and implications. This paper ultimately highlights the need for further research into this phenomenon. The genetic bottleneck is a target that could be used to possibly reduce HIV MTCT. However, more studies are required with larger cohorts to gather consistent data that can be used for future therapy options. 2

3 Introduction Since its initial isolation and identification, Human Immunodeficiency Virus (HIV) has been an epidemic of global proportions. What was originally thought to be a mystery disease in 1980, soon spread quickly to innocent victims through blood products, needle sticks, and labor and delivery practices. The end result was immunosupression and a cascade of previously unknown infections. 1 The World Health Organization (WHO) estimates that in 2009, 33.3 million people were living with HIV, with an additional 2.6 million people contracting new infections. 2 In 2008, 370,000 children were born with HIV, adding to the 2.5 million children under the age of fifteen currently living with the chronic disease. 3 Since the epidemic began, it is estimated that over 30 million people have died from AIDS or AIDS- related symptoms. 3 HIV infections during pregnancy pose a complex problem for the clinician and have been extensively researched. Current guidelines for managing pregnancies that are complicated with maternal HIV infection involve an extensive understanding of not only the risks of mother-tochild transmission (MTCT), but also an understanding of immune control and the use of antitetroviral Therapy (ART). CD4+ T cell counts and viral load levels must be sequentially analyzed throughout pregnancy to determine whether ART should be given to control viral load or if prophylactic medications are needed to combat the co-morbidities associated with immunosuppression. 4 Further, patient counseling must be clear concerning the pregnancy risks, including early delivery to minimize HIV transmission, the possibility of MTCT in utero, and the hazards associated with breastfeeding. 4 During the course of the pregnancy, the clinician must balance both the use of ART to reduce perinatal transmission as well as the treatment of the maternal HIV infection and possible toxicity to the developing fetus. 4 3

4 However, even with current guidelines concerning treatment and management of pregnancies complicated by HIV, there is a great deal that is not understood. Genetic analysis has determined that a genetic bottleneck often occurs wherein one genetic subtype from the maternal quasi-species infects the newborn. Research describing this bottleneck is inconclusive in determining why this bottleneck occurs. With limited information and very few groups actually dedicated to researching this concept, the results often conflict and their interpretation is uncertain. Understanding of this genetic homogeneity is crucial because it possibly provides a unique target for treatment options that previously have not been explored. To understand the importance of this genetic bottleneck, the pathogenesis of both HIV in general as well as the known mechanisms of vertical transmission must be understood. To provide information about this genetic bottleneck, this literature review describing the research methods, results, and implications will highlight both the need of further research on this topic as well as the importance of treatment options capitalizing on this phenomenon. Pathogenesis The pathogenesis of HIV is well defined, with distinct phases of the infection dependent on the immune control of the patient. Transmission is the first stage, with initial infection of HIV typically occurring through blood or mucosal secretions. 5 HIV targets several immune cell types including dendritic cells, macrophages, and CD4 T cells. 6 On a microscopic level, the gp120 envelope protein on the surface of the virus binds both the CD4 T cell receptor as well as the CCR5 chemokine receptor to makes its entrance into immune cells. While CD4 T cells are most commonly infected, any immune cell is vulnerable. Because of the variability in the type of cells infected, viruses specifically targeting macrophages are designated as R5 type while T cell tropic viruses are designated X4. 6 4

5 Rapid replication and destruction of these immune cells is the hallmark of the second phase of primary HIV infection as the virus begins to replicate within cells using their own machinery, then bursts from these cells to infect other cells. Classically, patients present with flulike symptoms two to four weeks after exposure, manifested most commonly with a fever, enlarged lymph nodes, sore throat, rash, myalgia, and headache. 6 Seroconversion soon follows within four to six weeks after exposure. 5 At the same time, cytotoxic T cells begin to control viral replication and prevent further decline in CD4 T cells. The level of viral control by a patient s immune cells significantly affects the length of the latent period, which is the next stage in HIV pathogenesis. Aside from persistent lymphadenopathy, the latent period is characterized by a lack of symptoms. 5,6 However, the lymph nodes are seeded with HIV and continue to release the virus into the blood stream, with the viral load increasing slowly and steadily. Without treatment, this latent period can last from twelve to eighteen months, but with current treatments, the latent period can be much longer, giving diagnosed patients nearly normal life expectancy. 6 As viral load continues to increase, symptoms of immunosuppression occur, defining the acquired immunity deficiency syndrome (AIDS) stage, with CD4 T cells less than 67 cells/ml. 5 Even with this definition, most patients begin to see symptoms at a CD4 T cell level of 200 cells/ml. The most common conditions characterizing AIDS includes Pneumocystis carinii pneumonia, Candida albican infection of the esophagus, and Kaposi s sarcoma lesions. 6 Without treatment, this stage leads to a painful death. Vertical Transmission of HIV Understanding HIV pathogenesis is vital in determining how vertical transmission occurs. In general, vertical transmission is divided into three groups based on the timing of 5

6 infection. Infants with a positive HIV test within the first forty-eight hours of life are considered to have been infected in utero. 7 Infants who test negative at birth but are found to be infected within two to six weeks after birth are considered cases of intrapartum or postpartum infection, typically through exposure of blood or body fluids during delivery or through ingestion of colostrum in early breastfeeding. An infection discovered within six to eight weeks of birth is usually due to breast feeding. 8 However, many of these categories are more fluid than initially thought. Studies in Malawi, Africa have shown that recent maternal infection in the middle of the pregnancy may also be correlated to in utero transmission of HIV, regardless of the mother s viral load and immunologic control at delivery. 9 These results suggest variability of vertical transmission depending on the timing of maternal infection, rather than just delivery practice or maternal viral load during pregnancy. The Genetic Bottleneck HIV has a unique ability to increase viral fitness while evading immunologic control through constant mutation. In order to understand the context of the genetic bottleneck, several research groups have described the virus harbored by the mother to determine which sub-species of virus is transmitted to the infant. Clinically, this can cause different lengths and severity of disease courses in both mother and infant infected with different viral strains. 10 In vertical transmission, specific strains of HIV have been associated with transmission, especially if the infected mother has a more heterogeneous strain in specific gene regions. Typically, gene conservation is seen in the vpu and tat regions, while the vif, vpr, and gag17 regions are typically more variable in transmitting mothers. 11 In order to determine if there is preferential transmission of specific HIV strains, a group studied the molecular sequence of the viral strains contributing to vertical transmission. They determined that the R5 genotype seems to be the predominate 6

7 infecting strain of in utero HIV infection. 12 The implications of this are important because this provides a specific target and location for treatment options in preventing MTCT. With the understanding of this context, several research groups have described the evidence of a genetic bottleneck in that only one strain of maternal virus infects a fetus, regardless of the number of mutated strains the mother carries, providing a unique mechanism where interventional strategies could be applied. 8 In a recent HIV sequence analysis study of mother-infant infected pairs, one strain of the mother s virus was seen in each infant, while 20% of the infants carried two or more strains from the mother. 13 This research group further suggested that antibody pressure does not contribute to this genetic bottleneck since the only strain able to vertically infect was not exclusively resistant to maternal antibodies. 13 However, a second research group studied mother-infant pairs in Zambia with maternal acute primary infection. 14 MTCT occurred postpartum and multiple genetic sequence time-points were analyzed to determine genetic diversity and divergence. As opposed to chronically infected mothers who transmitted the infection to their infants, this cohort showed no evidence of a genetic bottleneck in that there was no reduction of viral diversity in the transmitted virus. 14 This study, while providing important information about the genetics and mechanism of MTCT, cannot be relied on exclusively because only three mother-infant pairs were analyzed. More pairs should be analyzed if the theory of the genetic bottleneck is to be disputed. Further, the lack of evidence of the genetic bottleneck may be due to the early infection status of the mother in that the virus had not had time to evolve or mutate. Chronically infected mothers may preferentially transmit a specific viral strain because of the greater heterogeneity of their own virus. Further, they must be evaluated as their own cohort to compare with the acutely infected mothers to determine the types of virus that are transmitted. 7

8 Yet another study by the same group described six MTCT pairs in Zambia analyzed for genetic features of the envelope region that might affect the ability for HIV to transmit perinatally. 15 They determined that there was severely restricted low sequence diversity in the infected infants with few n-linked glycosylation sites compared with the non-transmitted virus. This is important since there may be some preferential transmission of these low glycosylation viruses, possibly due to maternal antibodies positively selecting the transmitting virus. Further, there might also be higher fitness of the transmitted virus, allowing for efficient replication and greater ability to evade the new immune system of the infant. 15 However, this study analyzed only a population of six mother and infant pairs. In order for these data sets to be understood in context, a larger cohort must be analyzed to determine if the genetic bottleneck is occurring. This study also analyzed only the envelope gene of HIV. While this region is typically the most variable, in order to confirm the existence of a genetic bottleneck, other variable regions must be sequenced and analyzed as well so that the genetic bottleneck can be understood in a complete context. In a larger scale study, a research group in Los Angeles, California, analyzed thirty-eight HIV infected mothers during delivery to determine if antibody pressure selected for and caused transmission of the virus to their infants. 16 By testing for antibody activity against the HIV strains present at the time of delivery, they were able to draw significant correlations based on their data. Of the mothers transmitting the virus to their fetus, most did not have antibodies that reacted with the HIV strain that was transmitted, while most of the mothers who did not transmit the virus had significant amounts of antibodies that protected the infant. Further, the viruses that did escape the maternal immunological pressure were transmitted in utero or during delivery. 16 8

9 These results do not describe the exact mechanism of MTCT. Further, delivery practices, especially in underserved urban areas of the United States, affect the transmission and infection of HIV, overwhelming any antibody pressure or positive selection due to viral escapes. This must be taken into account when analyzing these maternal viral strains and drawing conclusions from them. However, because of the larger cohort, this study adds important information about the etiology of the genetic bottleneck. While this genetic bottleneck is extremely important, little is known as to why it exists or even if the antibody pressure occurs. In this limited literature review, conflicting result were discovered and no conclusions can be made based on this research. However, this phenomenon may provide a significant target for treatment of MTCT. To date, no studies have been published concerning options for treatment in this specific scenario of viral escape. Larger scale studies with increased and diverse cohorts must be conducted to better describe the existence of this genetic bottleneck. Only then can the etiology of the genetic bottleneck including antibody pressure or viral fitness be explored. From there, treatment options and specific targets in this mechanism can be developed to help prevent or even stop MTCT in this population. Conclusion Mother to child transmission of HIV is a serious problem in many areas already endemic with HIV. Understanding the pathogenesis of not only HIV infection in the mother, but also how the virus infects the fetus is imperative for every practitioner. By using this knowledge, treatment options can be explored and proper care of the infected mother can occur so that fewer infants have to live with this infection. In resource poor areas, determining the context of this care and how to manage mothers without adequate support and resources is also crucial. Moreover, for the 9

10 laboratory researcher, this pathogenesis and mechanism of transmission uncovers important biochemical steps that can be exploited for new treatment options. Ultimately, HIV is not just a scientific study, pursued and studied only in the laboratory. It is a lethal virus that has the potential to destroy life. With modern medicine and an understanding of its pathology, clinicians and scientists, working together, can provide a quality of life that was unattainable and unthinkable just thirty years ago. 10

11 References 1. Shilts R. And the Band Played On. New York, NY: St. Martin s Press; Global Report: Global Summary of the AIDS Epidemic, The World Health Organization Web site. Accessed July 16, UNAIDS: Report on the Global AIDS Epidemic, UNICEF Child Info Web site. Accessed August 1, United States Department of Health and Human Services. Panel on treatment of HIV infected pregnant women and prevention of perinatal transmission [update: September 14, 2011]. Accessed February 8, Bartlett J. The stages and natural history of HIV infection. UpToDate Online. Waltham, MA; 2011 [update: May, 2011]. Accessed October 21, Sax P. Primary HIV-1 infection: pathogenesis; epidemiology and clinical manifestations. UpToDate Online. Waltham, MA; 2011 [update: May, 2011]. Accessed October 21, De Cock KM, Fowler MG, Mercier E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries. JAMA. 2000;283(9): Bulterys PL, Dalai SC, Katzenstein DA. Viral sequence analysis from HIV-1 infected mothers and infants: molecular evolution, diversity, and risk factors for mother-to-child transmission. Clinical Perinatology. 2010;37: Taha TE, James MM, Hoover DR, et al. Association of recent HIV infection and in-utero HIV-1 transmission. AIDS. 2011; 25(11): Huang KH, Godehals D, Carlson JM, et al. Progression to AIDS in South Africa is associated with both reverting and compensatory viral mutations. PLOS Accessed December 31, Al-husaini AM. Role of the placenta in vertical transmission of human immunodeficiency virus. Journal of Perinatology. 2009; 29: Ahmad N. Molecular mechanisms of HIV-1 mother-to-child transmission of neonatal target cells. Life Sciences. 2011;88:

12 13. Russel ES, Kweik JJ, Keys J, et al. The genetic bottleneck in vertical transmission of subtype C HIV-1 is not driven by selection of especially neutralization-resistant virus from the maternal population. Journal of Virology. 2011; 85(16): Hoffman FG, Zhang H, West JT, Lemey P, Kankasa C, Wood C. Genetic variation in mother-child acute seroconverter pairs from Zambia. AIDS. 2008; 22(7): Zhang H, Tully D, Hoffman FB, Kankasa C, Wood C. Restricted genetic diversity of HIV-1 subtype C envelope glycoprotein from perinatally infected Zambian infants. PLOS Accessed December 31, Dickover R, Garratty E, Yusim K, Miller C, Korber B, Bryson Y. Role of maternal autologous neutralizing antibody in selective perinatal transmission if Human Immunodeficiency Type 1 escape variants. Journal of Virology. 2006;80(13):

Chapter 10 Human Immuno Deficiency Virus Infection

Chapter 10 Human Immuno Deficiency Virus Infection 143 Chapter 10 Human Immuno Deficiency Virus Infection Chapter 10 Human Immuno Deficiency Virus Infection...143 HIV infection...144 Clinical Features...146 Clinical Staging of HIV infection recommended

More information

HIV-1 mother-to-child transmission and prevention: success and controversies

HIV-1 mother-to-child transmission and prevention: success and controversies 6 th Workshop on HIV Transmission Rome July 2011 HIV-1 mother-to-child transmission and prevention: success and controversies Gabriella Scarlatti San Raffaele Scientific Institute, Milan, Italy Transmission

More information

Summary of Key Findings

Summary of Key Findings Summary of Key Findings mothers2mothers Internal Programme Evaluation July 2014 Department of Programmes and Technical Support mothers2mothers An evaluation of the prevention of mother-to-child transmission

More information

FAQs HIV & AIDS. What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease.

FAQs HIV & AIDS. What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease. HIV & AIDS What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease. What does HIV stand for? Human Immunodeficiency Virus Where did HIV

More information

Chapter 21. What Are HIV and AIDS?

Chapter 21. What Are HIV and AIDS? Section 1 HIV and AIDS Today What Are HIV and AIDS? Human immunodeficiency virus (HIV) is the virus that primarily affects cells of the immune system and that causes AIDS. Acquired immune deficiency syndrome

More information

What Are HIV & AIDS? Together, we can change the course of the HIV epidemic one woman at a time.

What Are HIV & AIDS? Together, we can change the course of the HIV epidemic one woman at a time. What Are HIV & AIDS? Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject What Is HIV? HIV stands for: Human Immunodeficiency Virus HIV is the virus

More information

Service Learning. HIV/AIDS Prevention

Service Learning. HIV/AIDS Prevention Service Learning & HIV/AIDS Prevention Sponsored by: Anne Arundel County Department of Health 1 Harry S. Truman Parkway Annapolis, Maryland 21401 PHONE: 410-222-7108 FAX: 410-222-7231 Maryland Relay (TTY

More information

Sexually Transmitted Diseases

Sexually Transmitted Diseases Sexually Transmitted Diseases Chapter Fourteen 2013 McGraw-Hill Higher Education. All rights reserved. The Major Sexually Transmitted Diseases Also known as sexually transmitted infections The Major STDs

More information

Borderless Diseases By Sunny Thai

Borderless Diseases By Sunny Thai Borderless Diseases By Sunny Thai Millennium Development Goal #6 6. Combat HIV/AIDS, malaria and other borderless diseases. A. Halt and begin reversing spread of HIV by 2015. B. Achieve universal access

More information

IMMUNOLOGY OF HIV INFECTION AND AIDS. Interactions between HIV and the immune system

IMMUNOLOGY OF HIV INFECTION AND AIDS. Interactions between HIV and the immune system IMMUNOLOGY OF HIV INFECTION AND AIDS Interactions between HIV and the immune system Basic Statistics United States In the U.S. in 2010, 1.1 million people were living with HIV infection. About 50,000 people

More information

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection Module 1 Overview of HIV Infection Purpose Pre-requisite Modules Learning Objectives To provide you with the basic terms and concepts related to HIV infection. None At the end of this module, you will

More information

Guidance on supply chain planning for implementation of Prevention of Mother to Child Transmission (PMTCT) of HIV infection

Guidance on supply chain planning for implementation of Prevention of Mother to Child Transmission (PMTCT) of HIV infection Guidance on supply chain planning for implementation of Prevention of Mother to Child Transmission (PMTCT) of HIV infection 1. Objective This document outlines general principles for program and supply

More information

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral.

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. Juan Carlos Salazar, M.D. Universidad de Connecticut, EE.UU. End-1998 global estimates Children (

More information

HIV 201: What I Wish I Knew as a NEW RN

HIV 201: What I Wish I Knew as a NEW RN NORTHWEST AIDS EDUCATION AND TRAINING CENTER HIV 201: What I Wish I Knew as a NEW RN Andrea Carriedo, RN The New Hope Clinic NO CONFLICTS OF INEREST OR RELATIONSHIPS TO DISCLOSE Objectives Describe the

More information

Diseases of the Immune System Dr.Aseel Lec.4

Diseases of the Immune System Dr.Aseel Lec.4 Diseases of the Immune System Dr.Aseel Lec.4 Pathology IMMUNE DEFICIENCY DISEASES Immune deficiency diseases may be caused by inherited defects affecting immune system development, or they may result from

More information

HIV Diagnosis. HIV Diagnosis and Pathogenesis. Laboratory Diagnosis of Established HIV Infection: Antibody Detection

HIV Diagnosis. HIV Diagnosis and Pathogenesis. Laboratory Diagnosis of Established HIV Infection: Antibody Detection HIV Diagnosis HIV Diagnosis and Pathogenesis Scott M. Hammer, M.D. Consider in anyone presenting with symptoms and signs compatible with an HIV-related syndrome or in an asymptomatic person with a risk

More information

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases Zika Virus Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases What is the incubation period for Zika virus infection? Unknown but likely to be several

More information

Basic Presentation HIV/AIDS. For Use by Students, Teachers and the Public Seeking Basic Information About HIV/AIDS

Basic Presentation HIV/AIDS. For Use by Students, Teachers and the Public Seeking Basic Information About HIV/AIDS Basic Presentation HIV/AIDS For Use by Students, Teachers and the Public Seeking Basic Information About HIV/AIDS Objectives- Define and understand the difference between HIV Infection and AIDS Describe

More information

Common Infectious Diseases. Chapter 28 Lesson 2

Common Infectious Diseases. Chapter 28 Lesson 2 Common Infectious Diseases Chapter 28 Lesson 2 Respiratory Infections Respiratory tract infections are infections of the breathing passages, which range from the nose to the alveoli of the lungs. Most

More information

Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7)

Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7) Betaherpesvirinae Cytomegalovirus (HHV5/CMV) Roseolovirus (HHV6 & 7) CYTOMEGALOVIRUS CMV is thought to be amongst the oldest type of herpesvirus in evolutionary terms. CMV is the prototype of beta-herpesviruses

More information

Virology. Varicella - Zoster Virus (VZV) Lec (18) Dr. Areej A. Hussein

Virology. Varicella - Zoster Virus (VZV) Lec (18) Dr. Areej A. Hussein Lec (18) Dr. Areej A. Hussein Virology Varicella - Zoster Virus (VZV) Varicella (chicken pox) is a highly contagious disease of childhood, more than 90% of people in the United States have antibody by

More information

Exposure. What Healthcare Personnel Need to Know

Exposure. What Healthcare Personnel Need to Know Information from the Centers for Disease Control and Prevention National Center for Infectious Diseases Divison of Healthcare Quality Promotion and Division of Viral Hepatitis For additional brochures

More information

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant Foreword The rapid emergence of Zika virus as a potential causative agent for fetal

More information

Chapter 43: The Immune System

Chapter 43: The Immune System Name Period Our students consider this chapter to be a particularly challenging and important one. Expect to work your way slowly through the first three concepts. Take particular care with Concepts 43.2

More information

Understanding Zika virus disease pathogenesis

Understanding Zika virus disease pathogenesis Understanding Zika virus disease pathogenesis Michael S. Diamond, M.D., Ph.D. Washington University School of Medicine Departments of Medicine, Molecular Microbiology, Pathology & Immunology Center for

More information

Transient Hypogammaglobulinemia of Infancy. Chapter 7

Transient Hypogammaglobulinemia of Infancy. Chapter 7 Transient Hypogammaglobulinemia of Infancy Chapter 7 An unborn baby makes no IgG (antibody) and only slowly starts producing it after birth. However, starting at about the sixth month of pregnancy, the

More information

Pregnancy and Tuberculosis. Information for clinicians

Pregnancy and Tuberculosis. Information for clinicians Pregnancy and Tuberculosis Information for clinicians When to suspect Tuberculosis (TB)? Who is at risk of TB during pregnancy? Recent research suggests that new mothers are at an increased risk of TB

More information

Chapter 22. Sexually Transmitted Diseases

Chapter 22. Sexually Transmitted Diseases 1 Chapter 22 Sexually Transmitted Diseases 2 1 Outline Bacterial Infections Chlamydia Gonorrhea Syphilis Viral Infections Herpes Hepatitis Other Infections Vaginal Infections AIDS 3 Chlamydia. Bacterial

More information

Novel A/H1N1. About causing agent. Swine influenza in humans. What is it?

Novel A/H1N1. About causing agent. Swine influenza in humans. What is it? Novel A/H1N1 About causing agent What is it? It is a new strain of Influenza virus A/H1N1. There have been reports of influenza-like illness (ILI) and severe pneumonia cases in Mexico, USA and Canada.

More information

Source:

Source: Novel Influenza H1N1 Joseph C. Frantz, Ph.D. Director, Pharmaceutical Technology Sanofi Pasteur, Swiftwater, PA Lecture Outline Origins of a virus Microbiology of the virus Viruses and human disease Influenza

More information

What actually is the immune system? What is it made up of?

What actually is the immune system? What is it made up of? This is a radio interview with Ken Sell, M.D., scientific director of the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), and Co-Chairman of the NIH Working

More information

Enter this essay in the English Language Learner (for 5 years or less of English) category: _X_ Yes

Enter this essay in the English Language Learner (for 5 years or less of English) category: _X_ Yes Date: 2/24/2015 Student Name: Nikita Skiba Title of Essay: HIV/AIDS treatments Teacher s Name: Cheryl McClure School Name: International School School Address: 445 128th Ave SE Bellevue WA 98005 Enter

More information

Neonatal Herpes Simplex Infection

Neonatal Herpes Simplex Infection August 2011 Neonatal Herpes Simplex Infection Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) August 2011 August 2011

More information

CME Article Hiv Disease Surveillance

CME Article Hiv Disease Surveillance CME Article Hiv Disease Surveillance hiv disease surveillance cme Collaboration between Medicine and Public Health Sindy M. Paul, md, mph; Helene Cross, phd; Linda Dimasi, mpa; Abdel R. Ibrahim, phd; and

More information

The Polio Virus. Getting to Know Your Old Enemy. Marcia Falconer, Ph.D.

The Polio Virus. Getting to Know Your Old Enemy. Marcia Falconer, Ph.D. The Polio Virus Getting to Know Your Old Enemy Marcia Falconer, Ph.D. The Polio Virus Virus is smallest living thing that can reproduce itself Outer shell (capsid) Inner genetic material (RNA) and one

More information

Varicella and Varicella Vaccine

Varicella and Varicella Vaccine Varicella and Epidemiology and Prevention of Vaccine- Preventable Diseases Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

More information

Basics of HIV / AIDS

Basics of HIV / AIDS HIV / AIDS Workplace Intervention Programme Basics of HIV / AIDS HIV / AIDS Scenario in India and Major Trends 2.5 million estimated infections in India at the end of 2006 (Source: National AIDS Control

More information

Name: Understanding Viruses. HIV, Herpes, Influenza, small pox, chicken pox, measles, mumps, bird flu, swine flu.

Name: Understanding Viruses. HIV, Herpes, Influenza, small pox, chicken pox, measles, mumps, bird flu, swine flu. Name: Understanding Viruses Section 1 1. List as many viruses as you can. HIV, Herpes, Influenza, small pox, chicken pox, measles, mumps, bird flu, swine flu. 2. How do viruses reproduce? (aside from the

More information

Routine HIV Monitoring

Routine HIV Monitoring Routine HIV Monitoring Guideline of the HIV/AIDS Division at San Francisco General Hospital Statement of Guideline: Patients will be routinely evaluated and monitored for HIV parameters, antiretroviral

More information

Varicella Infection in the Neonate GL366

Varicella Infection in the Neonate GL366 Varicella Infection in the Neonate GL366 Approval and Authorisation Approved by Job Title Date N Pritchard Chair Neonatal Procedure and policy Oct 2009 Committee Change History Version Date Author Reason

More information

HIV/AIDS. HIV- Human Immunodeficiency Virus. AIDS immume system severely damaged

HIV/AIDS. HIV- Human Immunodeficiency Virus. AIDS immume system severely damaged HIV/AIDS HIV- Human Immunodeficiency Virus Person is infected with virus. May have no s/s (but may transmit virus) More common to have brief flu-like illness 2-6 wks after becoming infected (swollen lymph

More information

Black italics are the narration or interviews as recorded on the film. Blue are the slides and text in the film

Black italics are the narration or interviews as recorded on the film. Blue are the slides and text in the film Black italics are the narration or interviews as recorded on the film Blue are the slides and text in the film Green are the printed notes that will accompany the videos is for stopping the film to answer

More information

UNDERSTANDING AIDS. ACQUIRED a disease that a person can only catch from another person who has the disease already

UNDERSTANDING AIDS. ACQUIRED a disease that a person can only catch from another person who has the disease already Understanding AIDS 5 UNDERSTANDING AIDS What is AIDS? AIDS stands for: ACQUIRED a disease that a person can only catch from another person who has the disease already IMMUNODEFICIENCY a breakdown in the

More information

MODULE 1 FLORIDA DEPARTMENT OF HEALTH STUDY GUIDE HIV/AIDS: 101 WEMAKETHECHANGE.COM

MODULE 1 FLORIDA DEPARTMENT OF HEALTH STUDY GUIDE HIV/AIDS: 101 WEMAKETHECHANGE.COM MODULE 1 FLORIDA DEPARTMENT OF HEALTH STUDY GUIDE HIV/AIDS: 101 WEMAKETHECHANGE.COM MODULE 1 HIV/AIDS 101 DVD CORE CONTENT SUMMARY WHAT IS HIV? HIV: Human Immunodeficiency Virus H Human - virus can only

More information

HIV Laboratory Testing: a Resource for Health Professionals

HIV Laboratory Testing: a Resource for Health Professionals HIV Laboratory Testing: a Resource for Health Professionals Table of Contents Overview... 2 Window Periods and HIV Testing...2 Current HIV Testing System at Provincial Public Health Reference Laboratory...3

More information

Frequently asked questions about whooping cough (pertussis)

Frequently asked questions about whooping cough (pertussis) Frequently asked questions about whooping cough (pertussis) About whooping cough What is whooping cough? Whooping cough is a highly contagious illness caused by bacteria. It mainly affects the respiratory

More information

Blood, Lymphatic and Immune Systems

Blood, Lymphatic and Immune Systems Component 3-Terminology in Healthcare and Public Health Settings Unit 4-Blood, Lymphatic and Immune Systems This material was developed by The University of Alabama at Birmingham, funded by the Department

More information

AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system.

AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system. AIDS Definition AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system. Causes Important facts about the spread of AIDS include: AIDS

More information

Prevention of Mother to Child Transmission (MTCT) of HIV

Prevention of Mother to Child Transmission (MTCT) of HIV Prevention of Mother to Child Transmission (MTCT) of HIV Tim Farley Department of Reproductive Health and Research World Health Organization Geneva 17 September 2001 Postgraduate Course in Reproductive

More information

HIV/AIDS: General Information & Testing in the Emergency Department

HIV/AIDS: General Information & Testing in the Emergency Department What Is HIV? HIV/AIDS: General Information & Testing in the Emergency Department HIV is the common name for the Human Immunodeficiency Virus. HIV is a retrovirus. This means it can enter the body s own

More information

Figure 14.2 Overview of Innate and Adaptive Immunity

Figure 14.2 Overview of Innate and Adaptive Immunity I M M U N I T Y Innate (inborn) Immunity does not distinguish one pathogen from another Figure 14.2 Overview of Innate and Adaptive Immunity Our first line of defense includes physical and chemical barriers

More information

PATHOGENESIS OF AIDS

PATHOGENESIS OF AIDS Neal Nathanson, MD Emeritus Professor Department of Microbiology University of Pennsylvania School of Medicine 1 Definitions Structure of HIV HIV entry and cell tropism HIV-cell interactions Course of

More information

Mother s blood test to check her unborn baby s blood group

Mother s blood test to check her unborn baby s blood group Mother s blood test to check her unborn baby s blood group This leaflet explains why it is important to have a blood test to check the baby s blood group, so that only those who need it, receive anti-d

More information

HIV AND AIDS for CNA's & HHA's

HIV AND AIDS for CNA's & HHA's HIV AND AIDS for CNA's & HHA's INTRODUCTION The human immunodeficiency virus (HIV) is a virus that is transmitted through sexual contact or contact with infected blood. Infection with HIV is one of the

More information

Vaccination during pregnancy protects both mother and unborn child.

Vaccination during pregnancy protects both mother and unborn child. Grippeimpfung (Englisch) Schwangere Information for expectant mothers Flu Vaccination Vaccination during pregnancy protects both mother and unborn child. Staying healthy during pregnancy During pregnancy,

More information

FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH)

FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH) FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH) What is pertussis? General Questions About Pertussis Pertussis, or whooping cough, is a contagious illness that is spread when an infected person

More information

The Basics of Drug Resistance:

The Basics of Drug Resistance: CONTACT: Lisa Rossi +1-412-641-8940 +1-412- 916-3315 (mobile) rossil@upmc.edu The Basics of Drug Resistance: QUESTIONS AND ANSWERS HIV Drug Resistance and ARV-Based Prevention 1. What is drug resistance?

More information

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism Autism Q. What is autism? Autism is a spectrum of chronic developmental disorders. The main characteristics of autism are difficulties

More information

Measles Mumps and Rubella Vaccine Having the MMR vaccine after having a baby

Measles Mumps and Rubella Vaccine Having the MMR vaccine after having a baby Measles Mumps and Rubella Vaccine Having the MMR vaccine after having a baby Information for parents Why am I being offered the MMR vaccine? Rubella can be serious for pregnant women due to the risks

More information

Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay. June 17, 2016

Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay. June 17, 2016 Dear Health Care Provider: Fact Sheet for Health Care Providers: Interpreting Results from the Aptima Zika Virus Assay June 17, 2016 The U.S. Food and Drug Administration (FDA) has issued an Emergency

More information

X-Plain Avian Influenza or Bird Flu Reference Summary

X-Plain Avian Influenza or Bird Flu Reference Summary X-Plain Avian Influenza or Bird Flu Reference Summary Introduction Avian influenza is an infection caused by avian influenza viruses. Avian means bird and flu is an abbreviation of influenza. Avian flu

More information

Page 1. Name: 1) The diagram below represents one possible immune response that can occur in the human body.

Page 1. Name: 1) The diagram below represents one possible immune response that can occur in the human body. Name: 8931-1 - Page 1 1) The diagram below represents one possible immune response that can occur in the human body. 5) One similarity between cell receptors and antibodies is that both A) are involved

More information

Gene Therapy and Genetic Counseling. Chapter 20

Gene Therapy and Genetic Counseling. Chapter 20 Gene Therapy and Genetic Counseling Chapter 20 What is Gene Therapy? Treating a disease by replacing, manipulating or supplementing a gene The act of changing an individual s DNA sequence to fix a non-functional

More information

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges John B. Kaneene, DVM, MPH, PhD University Distinguished Professor of Epidemiology Director, Center for Comparative Epidemiology

More information

Addendum. Issue 1: Clarification of risk for infection if you get poked with a needle or cut with an instrument and the person has hepatitis B

Addendum. Issue 1: Clarification of risk for infection if you get poked with a needle or cut with an instrument and the person has hepatitis B Public Health and Primary Health Care Division Communicable Disease Control 4 th Floor, 300 Carlton St, Winnipeg, MB R3B 3M9 T 204 788-6737 F 204 948-2040 www.manitoba.ca July 4, 2012 Addendum Issue 1:

More information

How HIV Is Spread HIV INFORMATION. C o m m u n i t y A I D S R e s p o n s e. HIV Transmission Through Sexual Intercourse. How HIV Infection Occurs

How HIV Is Spread HIV INFORMATION. C o m m u n i t y A I D S R e s p o n s e. HIV Transmission Through Sexual Intercourse. How HIV Infection Occurs How HIV Is Spread How HIV Infection Occurs In order to gain entry into the body, the HIV virus needs to come into contact and bind to specific target cells with particular receptors, called CD4 receptors

More information

SWINE FLU. Table of Contents. Topic Overview. Cause. Spread of Disease. Symptoms. Incubation Period. How Is Swine Flu Diagnosed.

SWINE FLU. Table of Contents. Topic Overview. Cause. Spread of Disease. Symptoms. Incubation Period. How Is Swine Flu Diagnosed. SWINE FLU Table of Contents Topic Overview Cause Spread of Disease Symptoms Incubation Period How Is Swine Flu Diagnosed How Is It Treated Precaution WHAT IS SWINE FLU? Swine influenza (also called swine

More information

Parvovirus B19 Infection in Pregnancy

Parvovirus B19 Infection in Pregnancy Parvovirus B19 Infection in Pregnancy Information Pack Parvovirus B19 Infection in Pregnancy Information Booklet CONTENTS: THE VIRUS page 3 CLINICAL MANIFESTATIONS page 6 DIAGNOSIS page 8 PATIENT MANAGEMENT

More information

Hepatitis Vaccination Policy

Hepatitis Vaccination Policy Hepatitis Vaccination Policy Purpose To outline requirements for Hepatitis Vaccinations Scope All operational levels of Life Saving Victoria Policy Background Hepatitis is a highly infectious disease.

More information

PERINATAL HIV. AIIMS- NICU protocols 2008. Sunil Saharan 1, Rakesh Lodha 2, Ramesh Agarwal 2, Ashok Deorari 3, Vinod Paul 3 1

PERINATAL HIV. AIIMS- NICU protocols 2008. Sunil Saharan 1, Rakesh Lodha 2, Ramesh Agarwal 2, Ashok Deorari 3, Vinod Paul 3 1 PERINATAL HIV Sunil Saharan 1, Rakesh Lodha 2, Ramesh Agarwal 2, Ashok Deorari 3, Vinod Paul 3 1 Senior resident, 2 Assistant Professor, 3 Professor Division of Neonatology, Department of Pediatrics All

More information

Genetic Testing in Research & Healthcare

Genetic Testing in Research & Healthcare We Innovate Healthcare Genetic Testing in Research & Healthcare We Innovate Healthcare Genetic Testing in Research and Healthcare Human genetic testing is a growing science. It is used to study genes

More information

Blood Transfusion. There are three types of blood cells: Red blood cells. White blood cells. Platelets.

Blood Transfusion. There are three types of blood cells: Red blood cells. White blood cells. Platelets. Blood Transfusion Introduction Blood transfusions can save lives. Every second, someone in the world needs a blood transfusion. Blood transfusions can replace the blood lost from a serious injury or surgery.

More information

Promoting Family Planning

Promoting Family Planning Promoting Family Planning INTRODUCTION Voluntary family planning has been widely adopted throughout the world. More than half of all couples in the developing world now use a modern method of contraception

More information

Pregnant? There are many ways to help protect you and your baby. Immunise against: Flu (Influenza) Whooping cough (Pertussis) German measles (Rubella)

Pregnant? There are many ways to help protect you and your baby. Immunise against: Flu (Influenza) Whooping cough (Pertussis) German measles (Rubella) Pregnant? There are many ways to help protect you and your baby Immunise against: Flu (Influenza) Whooping cough (Pertussis) German measles (Rubella) mmunisation This leaflet describes the vaccinations

More information

X-Plain H1N1 Flu (Swine Flu) Reference Summary

X-Plain H1N1 Flu (Swine Flu) Reference Summary X-Plain H1N1 Flu (Swine Flu) Reference Summary Introduction H1N1 flu, also called swine flu, is a respiratory disease of pigs that has now spread to humans. Swine refers to animals such as pigs, hogs,

More information

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016

William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016 William Atkinson, MD, MPH Hepatitis B Vaccine Issues June 16, 2016 Advisory Committee on Immunization Practices (ACIP) The recommendations to be discussed are primarily those of the ACIP composed of 15

More information

INDICATIONS FOR USE OF ANTI-D IMMUNOGLOBULIN

INDICATIONS FOR USE OF ANTI-D IMMUNOGLOBULIN The Guidelines for use of Anti-D Immunoglobulin have been prepared by NZ Blood Service for use by Midwives and Medical Practitioners involved in caring for pregnancies or obstetric practice in New Zealand.

More information

Part Five Screening for Infectious diseases in pregnancy

Part Five Screening for Infectious diseases in pregnancy Patient Pathway: Screening for Communicable Diseases in Pregnancy Screening to occur as early as possible during pregnancy, but can be done at any time, as soon as a woman arrives for care Provide and

More information

Your Guide to XLP. X-linked Lymphoproliferative Disease

Your Guide to XLP. X-linked Lymphoproliferative Disease Your Guide to XLP X-linked Lymphoproliferative Disease What is XLP? XLP stands for X-linked lymphoproliferative disease. XLP is a genetic condition where the immune system doesn t work as it should. XLP

More information

Recognise phagocytes and lymphocytes under the light microscope;

Recognise phagocytes and lymphocytes under the light microscope; Immunity The immune system Vaccination Learning Objective Recognise phagocytes and lymphocytes under the light microscope; The following micrographs show as to how different types of phagocytes and lymphocytes

More information

Accent on Health Obgyn, PC HERPES Frequently Asked Questions

Accent on Health Obgyn, PC HERPES Frequently Asked Questions 1. What is herpes? 2. How common is herpes? 3. Is there a cure for herpes? 4. What is oral herpes (cold sores)? 5. How is oral herpes spread? 6. What is genital herpes? 7. How is genital herpes spread?

More information

AIMS ESSAY PRESENTATION

AIMS ESSAY PRESENTATION JAMES MALM AFRICAN INSTITUTE FOR MATHEMATICAL SCIENCES AIMS ESSAY PRESENTATION 1 Long term Dynamics of HIV disease progression with a non-sterilizing vaccine 0.1 Introduction Vaccines have been used for

More information

Microarray analysis of viral infections

Microarray analysis of viral infections Microarray analysis of viral infections Dipl. Biol. Department of Virology Bernhard Nocht Institute for Tropical Medicine Berhard Nocht Institut für Tropenmedizin Possible investigations of viral infections

More information

Important Information for Rh (D) Negative Women

Important Information for Rh (D) Negative Women Important Information for Rh (D) Negative Women Prevention of Haemolytic Disease of the Newborn A fetal blood type is jointly inherited from both parents. For this reason, a fetus may have a different

More information

NHS FORTH VALLEY. Administration of VZIG in close contact with chicken pox or shingles in a pregnant woman. Unit Clinical Governance

NHS FORTH VALLEY. Administration of VZIG in close contact with chicken pox or shingles in a pregnant woman. Unit Clinical Governance NHS FORTH VALLEY Date of First Issue 01/04/2006 Approved 05/05/2012 Current Issue Date 18/09/2012 Review Date 18/09/2016 Version 1.2 EQIA Yes 01/04/2012 Author / Contact Group Committee Final Approval

More information

Novel Influenza A (H1N1)

Novel Influenza A (H1N1) Novel Influenza A (H1N1) H1N1 Healthcare Briefings September 10, 2009 P. Bryon Backenson Director, Investigations Unit Bureau of Communicable Disease Control New York State Department of Health What is

More information

The Body s Defenses CHAPTER 24

The Body s Defenses CHAPTER 24 CHAPTER 24 The Body s Defenses PowerPoint Lectures for Essential Biology, Third Edition Neil Campbell, Jane Reece, and Eric Simon Essential Biology with Physiology, Second Edition Neil Campbell, Jane Reece,

More information

PLUS MAY EQUAL. Flu-Like Symptoms SORE THROAT, SWOLLEN GLANDS, FEVER, JOINT AND MUSCLE ACHES

PLUS MAY EQUAL. Flu-Like Symptoms SORE THROAT, SWOLLEN GLANDS, FEVER, JOINT AND MUSCLE ACHES What is acute HIV infection? Acute HIV infection is the very early stage of infection with HIV (human immunodeficiency virus), the virus that causes AIDS. This is also called primary HIV infection. Acute

More information

FAQs on Influenza A (H1N1-2009) Vaccine

FAQs on Influenza A (H1N1-2009) Vaccine FAQs on Influenza A (H1N1-2009) Vaccine 1) What is Influenza A (H1N1-2009) (swine flu) 1? Influenza A (H1N1-2009), previously known as "swine flu", is a new strain of influenza virus that spreads from

More information

Swine Influenza Special Edition Newsletter

Swine Influenza Special Edition Newsletter Swine Influenza Newsletter surrounding swine flu, so that you ll have the right facts to make smart decisions for yourself and your family. While the World Health Organization (WHO) and the Centers for

More information

Section 3. Vocabulary HIV AIDS asymptomatic stage opportunistic infection. and Health

Section 3. Vocabulary HIV AIDS asymptomatic stage opportunistic infection. and Health Section 3 HIV and AIDS Objectives Before class begins, write the objectives on the board. Have students copy the objectives into their notebooks at the start of class. 1. Focus Warm-Up Health Stats Call

More information

Sexually Transmitted Diseases. Genital herpes. Questions & Answers

Sexually Transmitted Diseases. Genital herpes. Questions & Answers Sexually Transmitted Diseases Genital herpes Questions & Answers What is genital herpes? This is a widespread sexually transmitted infection caused by the herpes simplex viruses type 2 (HSV-2) or type

More information

HIV/AIDS PAPER OUTLINE. 0.Introduction. -Definitions. 1. AIDS as a stigma. -Factors to the AIDS stigma. 2. Transmission to HIV

HIV/AIDS PAPER OUTLINE. 0.Introduction. -Definitions. 1. AIDS as a stigma. -Factors to the AIDS stigma. 2. Transmission to HIV HIV/AIDS PAPER OUTLINE 0.Introduction -Definitions 1. AIDS as a stigma -Factors to the AIDS stigma 2. Transmission to HIV - The most common ways that people get HIV 3. Where you can not get AIDS 4. Conclusion

More information

Facts. What you and the people you care about need to know about HIV/AIDS

Facts. What you and the people you care about need to know about HIV/AIDS Facts for Life What you and the people you care about need to know about HIV/AIDS What is amfar? amfar, The Foundation for AIDS Research, is dedicated to ending the global AIDS epidemic through innovative

More information

Commonly Asked Questions About Chronic Hepatitis C

Commonly Asked Questions About Chronic Hepatitis C Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral

More information

PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION

PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION Printed copies must not be considered the definitive version DOCUMENT CONTROL PROTOCOL NO. 1.03 Policy Group Infection Control Committee

More information

HIV in pregnancy: information for you. Contents. Page number

HIV in pregnancy: information for you. Contents. Page number HIV in pregnancy: information for you Published February 2005 by the RCOG Due to be reviewed in 2007 Contents Page number Key points 2 About this information 3 About HIV 4 What could it mean for my baby?

More information

Module 1: The liver and hepatitis viruses

Module 1: The liver and hepatitis viruses Module 1: The liver and hepatitis viruses Module 1: The liver and hepatitis viruses Session goal This introductory session will provide a basis for the training programme by providing an overview of the

More information

HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11

HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11 11.1 INTRODUCTION D. Zanera and I. Miteka The 2004 Malawi Demographic and Health Survey (MDHS) collected information on HIV/AIDS as well as other sexually

More information

BE SURE. BE SAFE. VACCINATE.

BE SURE. BE SAFE. VACCINATE. DON T GET OR GIVE THE FLU THIS YEAR THANK YOU Vaccination is the only protection. www.immunisation.ie BE SURE. BE SAFE. VACCINATE. FLU VACCINE 2013-2014 Healthcare workers prevent the spread of flu and

More information