Current Trend in Health Care: MMR Vaccines

• 
  Brittany Core
  

Nothing is more heartbreaking than a young life that has been taken by the infection of a killer disease. Diseases kill children every year. Many diseases are bacteria, inhaled by the victim, infecting several areas of the body. The bacteria lives and grows while its victim dies. Other diseases are caused by viruses; a non-living infection that attacks the immune system and other living cells. Children are much more vulnerable to disease because of their weak immune systems. They’re weak because they have not lived life long enough to build immunities for such infections. However, in medicine, there are always risks. So, parents argue that vaccinations should not be mandatory for children.

For many years, immunizations have continued to keep the spread of disease low. They have lowered the amount of deaths and saved lives. On the other hand, what if it was against families’ religion or they say their child is a “tough one” and they can handle the severe symptoms of disease? Those are the arguments made by people who believe that vaccines should not be mandatory for children. Are those arguments strong enough to counter all the children’s lives that have been saved by intelligent medicine? Unless America wants to unleash the beast of infectious killers, vaccinations for children should be mandatory to keep it from spreading and eventually killing. Research shows that the benefits of vaccination outweigh the risks because vaccines can prevent serious illness and disease in individuals, vaccinations can also prevent widespread outbreaks of diseases in populations and the side effect of vaccinations, though occasionally serious, are very rare.

In 1912, measles became a nationally notifiable disease in the United States, requiring U.S. healthcare providers and laboratories to report all diagnosed cases (Measles History, 2014). In the first decade of reporting, an average of 6,000 measles-related deaths were reported each year (Measles History, 2014). In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age (Measles History, 2014). It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles (Measles History, 2014).

In 1954, John F. Enders and Dr. Thomas C. Peebles collected blood samples from several ill students during a measles outbreak in Boston, Massachusetts (Measles History, 2014). They wanted to isolate the measles virus in the student’s blood and create a measles vaccine. They succeeded in isolating measles in 13-year-old David Edmonston’s blood (Measles History, 2014). In 1963, John Enders and colleagues transformed their Edmonston-B strain of measles virus into a vaccine and licensed it in the United States (Measles History, 2014). In 1968, an improved and even weaker measles vaccine, developed by Maurice Hilleman and colleagues, began to be distributed (Measles History, 2014). This vaccine, called the Edmonston-Enders (formerly “Moraten”) strain has been the only measles vaccine used in the United States since 1968 (Measles History, 2014).

The MMR shot protects your child from measles, a potentially serious disease (and also protects against mumps and rubella), prevents your child from getting an uncomfortable rash and high fever from measles, keeps your child from missing school or childcare and keeps you from missing work to care for your sick child (Vaccine and Immunizations, 2015). The measles, mumps, and rubella vaccine is recommended for children 12 months to 12 years old (MMR, 2013). Children should receive the first dose of mumps-containing vaccine at 12-15 months and the second dose at 4-6 years (Mumps Vaccination, 2012). All adults born during or after 1957 should have documentation of one dose (Mumps Vaccination, 2012). Adults at higher risk, such as university students, health care personnel, and international travelers, and persons with potential mumps outbreak exposure should have documentation of two doses of mumps vaccine or other proof of immunity to mumps (Mumps Vaccination, 2012). Pregnant women and persons with an impaired immune system should not receive the MMR vaccine (Mumps Vaccination, 2012). It is a single shot, often given at the same doctor visit as the varicella or chickenpox vaccine (MMR, 2013). Measles can be dangerous, especially for babies and young children (Vaccine and Immunizations, 2015). For some children, measles can lead to pneumonia, lifelong brain damage, deafness and death (Vaccine and Immunizations, 2015).

Measles is a respiratory disease caused by a virus. The virus lives in the mucus in the nose and throat of an infected person (Measles, n.d). Measles remains a common disease in many countries throughout the world, including some developed countries in Europe and Asia (Measles, n.d). While the disease is almost gone from the United States, measles still kills nearly 200,000 people each year globally (Measles, n.d). However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications (Measles, n.d). Measles virus causes rash, cough, runny nose, eye irritation, and fever (MMR Vaccine (Measles, Mumps, Rubella), 2015). It can lead to ear infection, pneumonia, seizures (jerking and staring), brain damage, and death (MMR Vaccine (Measles, Mumps, Rubella), 2015). Pregnant women can give birth prematurely or have a low-birth-weight baby (Measles, n.d).

Mumps is a contagious disease that is caused by the mumps virus. The mumps virus affects the saliva glands, located between the ear and jaw, and may cause puffy cheeks and swollen glands (MMR, 2013). Mumps virus causes fever, headache, muscle pain, loss of appetite, and swollen glands (MMR, 2013). It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries, and rarely sterility (MMR, 2013). Most people who have mumps will be protected (immune) from getting mumps again (Mumps Vaccine, 2006). There is a small percent of people though, who could get infected again with mumps and have a milder illness (Mumps Vaccine, 2006).

Rubella, also known as German measles or three day measles is an infectious viral disease, but don’t confuse rubella with measles, which is sometimes called rubeola (MMR, 2013). The two illnesses share similar features, including a characteristic red rash, but they are caused by different viruses (MMR, 2013). Rubella virus lives in the mucus in the nose and throat of infected persons (MMR, 2013). Rubella is usually spread to others through sneezing or coughing. In young children, rubella is usually mild, with few symptoms. They may have a mild rash, whichusually starts on the face and then spreads to the neck, chest, arms, and legs, and it lasts for about three days (MMR, 2013). A child with rubella might also have a slight fever or other symptoms like a cold. Adults are more likely to experience headache, pink eye, and general discomfort one to five days before the rash appears (MMR, 2013). Adults also tend to have more complications, including sore, swollen joints, and, less commonly, arthritis, especially in women (MMR, 2013). A brain infection called encephalitis is a rare, but serious, complication affecting adults with rubella (MMR, 2013). However, the most serious consequence from rubella infection is the harm it can cause to a pregnant woman’s unborn baby (MMR, 2013).

Measles spreads when a person infected with the measles virus breathes, coughs, or sneezes (Vaccine and Immunizations, 2015). It is very contagious. A person can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone, and you can catch measles from an infected person even before they have a measles rash (Vaccine and Immunizations, 2015). Almost everyone who has not had the MMR shot will get measles if they are exposed to the measles virus (Vaccine and Immunizations, 2015). Measles, mumps, and rubella (MMR) vaccine can protect children and adult from all three of these diseases. Thanks to successful vaccination programs these diseases are much less common in the U.S. than they used to be, but if we stopped vaccinating they would return (MMR, 2013).

Between 2000 and 2007, the number of measles cases reached a record low, with only 37 cases being reported in 2004 (Medical News Today, 2015). Last year saw the highest number of reported measles cases in the US since the virus had been declared eliminated (Medical News Today, 2015). There were 23 measles outbreaks in 2014 causing 644 people to become infected (Medical News Today, 2015). According to the CDC, the majority of these cases were brought into the country by travelers from the Philippines (Medical News Today, 2015). Where a large outbreak of the virus was occurring at the time and most of the people who became infected in the US were part of unvaccinated Amish communities in Ohio, but while last year’s statistics seem bad, this years are set to be even worse (Medical News Today, 2015). Last month alone saw 102 measles cases reported over 14 US states, including California, Texas and Washington (Medical News Today, 2015). The majority of these cases are thought to have stemmed from Disneyland, CA, where a number of people reported developing the virus after visiting the amusement part in mid-December (Medical News Today, 2015).

If you don’t have insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children Program may be able to help (CDC, 2015). The Vaccines for Children (VFC) program provides vaccines for children who are uninsured, Medicaid-eligible, or American Indian/Alaska Native (CDC, 2015). No federal vaccination laws exist, but all 50 states require certain vaccinations for children entering public schools (State Laws: Vaccines and Requirements, 2014). Vaccination coverage in America has been historically high as a result of school requirements, caregiver intervention with vulnerable populations, and seasonal influenza-shot drives, but it still falls short (MMR, 2013).

Physicians or other providers must provide the current Vaccine Information Statement (VIS) each time they administer a vaccine covered under the National Vaccine Injury or purchased through the Centers for Disease Control and Prevention grant (Kimmel & Wolfe, 2005). They must record in each patient’s medical record the date of administration, the vaccine manufacturer, the lot number, and the name and business address of the provider, along with the edition of the VIS that was given and the date on which the vaccine was administered (Kimmel & Wolfe, 2005).

An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance (Leask, Kinnersley, Jackson, Cheater, Bedford & Rowles, 2012). Conversely, poor communication can contribute to rejection of vaccinations or dissatisfaction with care and health professionals have a central role in maintaining education (Leask et al., 2012). These concerns will likely increase as vaccination schedules inevitably become more complex, and parents have increased access to varied information through the internet and social media (Leask et al., 2012). In recognition of the need to support health professionals in this challenging communication task conducted in usually public trust in vaccination; this includes addressing parents’ vaccine concerns (Leask et al., 2012).

There are several reasons why parents are choosing not to vaccinate their children. Parents who decided not to give their child MMR were concerned that the vaccine might cause a reaction in their child (Immunizations, n.d). Most children who have the MMR vaccine do not have any problems with it, or if reactions do occur they are usually mild (Immunizations, n.d). Parents were concerned that the long-term effects of the combined MMR vaccine were not known (Immunizations, n.d). Other reasons given for deciding not to go ahead with MMR were concern about the ingredients of the vaccines and that live vaccines were used and that these would be too much for a child’s body to cope with (Immunizations, n.d). A very small number of parents personally believed that immunity derived from actually having the disease was more effective than the immunity obtained from vaccines (Immunizations, n.d).

There is no scientific evidence that MMR vaccine causes autism. The suggestion that MMR vaccine might lead to autism had its origins in research by Andrew Wakefield, a gastroenterologist, in the United Kingdom (DPH, 2013). In 1998, Wakefield and colleagues published an article in The Lancet claiming that the measles vaccine virus in MMR caused inflammatory bowel disease, allowing harmful proteins to enter the bloodstream and damage the brain (DPH, 2013). The validity of this finding was later called into question when it could not be reproduced by oth­er researchers (DPH, 2013). In addition, the findings were further discredited when an investigation found that Wakefield did not disclose he was being funded for his research by lawyers seeking evidence to use against vaccine manufacturers (DPH, 2013). Wakefield was permanently barred from practicing medicine in the United Kingdom (DPH, 2013).

There will always be some cases of measles in the US, as it can still be brought into the country by individuals from other countries who have not been vaccinated. The CDC says the MMR vaccine is safe, and one dose of the vaccine is around 93% effective at preventing measles, while two doses is approximately 97% effective (Medical News Today, 2015). Immunization is the only

effective way

of protection for children against these diseases because children’s immune systems are defenseless against them because they are not fully developed yet, and once infected in most cases there is no cure or at least a very low chance of one.

References

Center for Disease Control (2015, February 5). Retrieved March 18, 2015, from

http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html

DPH: Infectious Diseases. (n.d.). Retrieved March 22, 2015

http://www.ct.gov/dph/cwp/view.asp?a=3136&q=397352

Immunization. (n.d.). Retrieved March 18, 2015, from

http://www.healthtalk.org/peoples-experiences/pregnancy-children/immunisation/deciding-not-give-my-child-mmr-measles-mumps-and-rubella

Kimmel, S. R., & Wolfe, R. M. (2005). Communicating the benefits and risks of vaccines.

The Journal of Family Practice

,

54

(1 Suppl), S51-S57

State Vaccines and requirements. (2014, December 12). Retrieved March 22, 2015, from

http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html

Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communication with parents about vaccination: a framework for health professionals.

BMC Pediatrics,

12154. doi:10.1186/1471-2431-12-154

Measles History. (2014, November 3). Retrieved March 18, 2015, from

http://www.cdc.gov/measles/about/history.html

Medical News Today (2015, February 5). Retrieved March 18, 2015, from

http://www.medicalnewstoday.com/articles/289060.php

MMR (Measles, Mumps, & Rubella) Vaccine. (2013, June 18). Retrieved March 18, 2015, from

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html

MMR Vaccine Does Not Cause Autism Examine the Evidence! Retrieved March 19, 2015, from

http://www.immunize.org/catg.d/p4026.pdf

Mumps Vaccine. (2006, October 16). Retrieved March 22, 2015, from

http://www.cdc.gov/vaccines/vpd-vac/mumps/vac-faqs.htm

Mumps Vaccination. (2012, July 2). Retrieved March 22, 2015, from

http://www.cdc.gov/mumps/vaccination.html

Vaccine and Immunizations. (2015, February 5). Retrieved March 22, 2015, from

http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html

Measles. (n.d.). Retrieved March 22, 2015, from

http://www.vaccines.gov/diseases/measles/index.html

MMR Vaccine (Measles, Mumps, and Rubella): MedlinePlus Drug Information. (n.d.). Retrieved March 22, 2015, from

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601176.html

The balance of responsibility for healthcare between society and the family – societal versus family responsibilities

“Responsibility for health: personal, social, and environmental

”

INTRODUCTION:

The Family is the basic or functional unit of a society. In making healthcare policy society and family plays a great part in implementation. Responsibility starts within each member of the family with the proper guidance of parents. Preventive efforts regarding healthcare issues must be practice by parents. A good example of which is by teaching their children at the very early age the three basic food groups (go, grow and glow) and proper hand washing, in such a way that each child will be guided accordingly regarding the proper diet to prevent illness and diseases. As a child goes to school he/she becomes a member of the society, a good practice of healthcare can be shared between peers. As they grow much older this good practice and views regarding healthcare becomes more profound and evident they becomes more responsible towards health and to the society. In my personal point of view responsibility for health is as basic as food, taking good care of one self is the fundamental responsibility an individual in becoming a better member of a society. The society has the responsibility of providing proper health services to the family and to a certain individual. An example of which is a good access in healthcare insurances, Equality in healthcare services on all facilities in government and private alike. The right for information regarding laws, provisions and policies should be properly disseminated. Access to rural or community health involving different business, healthcare, and transport sectors to address any healthcare issues.

One of the most important obligations of society is ensuring that each and every one has access to health care. This has been the main focus of health care policies all over the world. While this has been the most important, it is also vital that societies promote health in many other ways.

Society plays a great role in making sure that everyone has access to optimal health care and there are a lot of means by which this will be successful. One very common and effective way is by means of education and training. By means of education, people may be able to know more about ways on how to promote health and how to prevent certain diseases. Education is an effective tool to spread out information not just about the social issues but more importantly, about health. Through education, we may be able to enlighten people about the most important health issues that we have now. Some of these issues include sanitation, pollution, food and drug safety and disease prevention. Much attention should be focused on ways on how to promote health besides access to health care. These include environment and public health and health research.

In today’s modern age, there are numerous technological advances which affect our daily living. Whether we like to admit it or not, our lives are easier now because of these technological advances. They help us get to places faster and aid us with everyday activities so that we may be able to do them with more ease but as they say, there is always downside to everything. These advances may be the reason why there are several people who are becoming lazier when it comes to doing chores at home or at work. People nowadays tend to depend largely on technology to do simple things which they can do themselves. Simple things like walking when going to nearby places or picking something up from a store.

Lifestyle plays a huge role in some of the most fatal illnesses that exist now. According to Ralph Neas the total expenditures on health care in the United States represented 17 percent of the gross national product in 2010 and are projected to reach 20 percent by the end of this decade. The United States spends 141 percent more on health care than other economically advanced nations; furthermore, according to Centers for Disease Control and Prevention, although smoking has declined steadily there since the 1960s, smoking- related medical expenses are still about US$75.5 billion per year. Obesity, which has been climbing in the past two decades, accounts for about US$75 billion in healthcare costs there each year, moreover, alcoholism and drug addiction in the USA account for annual healthcare costs of about US$22.5 billion and US$12 billion, respectively. Federal government spending on healthcare relating to HIV/AIDS is over US$13 billion per year. This goes to show that health education is important and that people needs to be informed thoroughly on how to improve health and prevent diseases from spreading. It is also sensible to allot sufficient budget on health research and find means on how to prevent and if possible, to completely eradicate such diseases.

The balance of responsibility for healthcare between society and the family – societal versus family responsibilities encompasses different aspects in healthcare. It needs the involvement of all stakeholders. A families views and attitudes towards healthcare has a great impact in a society. A good example is in the Philippines, the Department of social welfare and development (DSWD) together with the Department of Interior and Local Government (DILG) and some None-Government organization groups Spear headed a program/Scheme Pantawid Pamilyang Pangkabuhayan or( 4Ps). The main purposes of the program is Hunger Mitigation, Prevention of Maternal and infant deaths by giving financial assistance to the families under poverty line with conditionality’s.

The conditions:

1. Pregnant Household Member/s should visit their local health center to avail of pre- and post-natal care starting from the first trimester of pregnancy.
2. Children 0-5 Years Old – members of the household who are 0–5 years old shall visit the health center and avail of Immunization/vaccination, weight monitoring, and management of childhood disease.
3. Children aged 6–14 years old should receive deworming pills twice a year

Education conditionalities.

1. Children aged 3–5 years old enrolled in Day Care Program or pre-school program and maintain a class attendance rate of at least 85% per month (still subject to evaluation/study).
2. Children aged 6–14 years old enrolled in elementary and secondary schools and maintain a class attendance rate of at least 85% per month.

Other conditionalities.

1. Parents should attend Family Development Sessions at least once a month.
2. Participate in community activities to promote and strengthen the implementation of the program.

The first task is to identify the families who will be eligible and be the beneficiary of the program by doing surveys in the rural areas. First they disseminate the information from national down to local government units, barangays and families. After which they inform and award the families legible for the said program. Together with the Department of Health Philippines and Department of Education they create programs. The DOH launches the Immunization program visiting families house to house and immunizing children 8y/o and below. Each family also receives financial assistance.

According to WHO 1992, healthcare issues regarding the environment addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.

While it is sensible to place sole responsibility to an individual to take care of their health, there are several objections to it as well. One argument is that it is unfair to hold someone completely responsible for their own health especially if that person does not have a sound mind or is under the influence of drugs. Another is that it would be exceedingly difficult to implement a system that holds individuals responsible for their own health, since diseases and disabilities result from a complex interaction of genetic and environmental factors. Although it is completely rational that an individual must be able to maintain their health, the responsibility should not be placed solely on them. Whichever the case may be, the society must always help promote health and prevent illness. Although access to health care is extremely vital, society should also focus on creating means on how to promote health. They say, prevention is better than cure and it is true in so many ways. Prevention is more cost-effective and is more medically efficacious rather than finding means of treatment. For instance, it is more cost-effective to prevent certain serious illness rather than undergoing surgery or chemotherapy in the long run. The government should be able to provide its people their needs and with regards to health care, this includes monitoring of disease, urban planning and should be able to guarantee food and drug safety.

Family on the other hand, is considered to be the basic unit of a community and is therefore a great factor in an individual’s attempt to health promotion and disease prevention. It is through family that a person first learns everything which is why family greatly affects the choices made by an individual. Most often than not, a person confides with a family member in decision making may it be with finances, work related problems and health issues as well. If a person is unable to decide, a family member, usually the elder or the head of the family steps in to make the decision for them.

For instance, in New Zealand, since there are numerous rest homes, it is the obligation of the family or one of the family members to decide what is best for their loved ones who are residing at these rest homes especially if their loved ones cannot decide for themselves or is not able to comprehend some of the information given to them.

CONCLUSION:

Health care access is one of the most important factors to consider in terms of societal issues with regards to health care but it is also with utmost importance that the society is able to promote health through education and research as well. Much importance should be placed not just on health care access but more so on strategies for health promotion especially on environmental and public health and health research. Government action is also vital and should be able to provide the needs of its people especially if it’s already out of their control like monitoring of disease and urban planning.

Family is the basic unit of community and is considered to be the basis of one’s decision with just about anything. May it be financial or health issues, families play a huge role in an individual’s choice.

REFERENCE:

• Centers for Disease Control and Prevention (CDC). Smoking costs nation $150 billion each year in health costs, lost productivity. Press Release. Retrieved from
  
  http://www.cdc.gov/media/pressrel/r020412.htm
  
• Centers for Disease Control and Prevention (CDC). Obesity costs states billions in medical expenses. Press Release. Retrieved from
  
  http://www.cdc.gov/media/pressrel/r040121.htm
  
• Resnik D.B. July 2006. Responsibility for Health: Personal, Social and Environmental. J Med Ethics. Aug 2007; 33(8): 444–445. Retrieved from
  
  http://www.ncbi.nlm.nih.gov/pmc/issues/174348/
  
• Neas, Ralph. (May 2011). Our Ailing Health. Politico. Retrieved from
  
  http://www.politico.com/news/stories/0511/55775.html
  
• World Health Organisation. (1992). Environmental Healthcare. Retrieved from
  
  http://www.who.int/topics/environmental_health/en/
  
• World Health Organisation. (1999). Population Issues. Retrieved from
  
  http://www.who.int/en/
  
• Department of Social Welfare and Development. Pantawid Pamilyang Pilipino Program (4Ps). Retrieved from
  
  http://pantawid.dswd.gov.ph/
  

Assessment of Dental caries experience, Periodontal Status and Oral Mucosal Lesions among HIV seropositives with and without Anti-Retroviral Therapy (ART): A Cross-sectional study

Objective:

To assess the dental caries experience, Periodontal Status and oral mucosal lesions among patients with and without Anti-Retroviral Therapy (ART).

Basic Research Design:

A Cross-sectional study.

Clinical settings:

A rehabilitative centre for HIV/AIDS.

Participants:

Individuals with HIV/AIDS above the age group of 15 years.

Main Outcome Measures:

Dental caries experience, Periodontal Status and Oral Mucosal Lesions among individuals with and without ART.

Results:

The results shows that 15.4% of the individuals were males, 84.6% of them were females, and 86.2% were on ART. There was no significant difference in the DMFT score among subjects with and without ART (Median=3). According to Community Periodontal Index of Treatment Needs (CPITN), Calculus was seen in 42.9% and 55.6% of the subjects with and without ART respectively. However Fisher’s Exact test did not show statistically significant difference between them (‘p’ value = 0.2).

Hyperpigmentation was found in 12.5% of the study subjects with ART. The other common oral conditions were Lichen Planus, Herpes Simplex and Bald tongue. Geographic Tongue was seen among 11.1% of the study subjects without ART.

Conclusions:

The study concludes that the subjects with and without ART did not show any difference in the prevalence of dental caries or periodontal status. Hyperpigmentation was the common condition found among subjects with ART and Geographic tongue among those without ART. However, further follow up studies are required to gain insight to the long term use of ART on oral tissues.

INTRODUCTION:

HIV a disease of Immunosuppression has affected millions. India has the largest number of people living with HIV outside of South Africa (Sontakke et al, 2011). There is adequate research regarding the frequency of oral manifestations among them, but are controversial. This may be due to differences in prescribed medications, stages of disease and way of transmission, inadequate diet due to presence of oral lesions (Aleixo et al, 2010; Davoodi et al, 2010). Awareness regarding the severity of oral lesions might help in improving their quality of life. Hence an attempt is made here to assess the dental caries experience and oral mucosal lesions among patients with and without ART

METHODOLOGY:

A Cross Sectional study was conducted for a period of three months among 130 people having HIV/AIDS at a rehabilitative centre, an organization run by a Non Governmental Organization, Mangalore. Before commencement of the study ethical clearance was obtained from Institutional Ethical Committee of A.J. Institute of Dental Sciences, Mangalore, India. Permission was obtained from the administrators of the organization. Subjects above the age group of 15 years, who gave informed consent, were included in the study, based on Convenience sampling.

A benchmark (“Gold Standard”) examiner trained and calibrated the trainee examiner. The Study Proforma included information on Gender, ART Therapy, and Literacy level. Dental caries was assessed using DMFT index, periodontal status was assessed using CPITN index and oral mucosal lesions were assessed according to criteria proposed by the EC-Clearinghouse. Oral Examination was done by a single calibrated examiner and the reliability was found to be 0.86.

Data on ART Therapy was obtained from the administrator of the organization from the medical records and the entire questionnaire was coded in order to maintain confidentiality.

The data was analyzed using SPSS version 16. Dental caries experience among people with and without ART was analyzed using Mann-Whitney U Test. Periodontal status and Oral Mucosal lesions among people with and without ART was analyzed using Fisher’s Exact Test. Level of significance was set at 0.05.

RESULTS:

Table 1 shows that among the 130 subjects who were enrolled in the study 15.4% were males, 84.6% were females and the mean age was 34.22 years. Among the subjects 86.2% were on Anti Retro Viral Therapy. Secondary school education was completed by 23.1% of them, while 13.8% of them were illiterate.

The study shows no significant difference in the dental caries experience of the study subjects with and without Antiretroviral Therapy (‘p’ value =0.946) as shown in Table-2.

Healthy periodontal status was seen in 3.6% of the study subjects with ART and 11.1% of the study subjects without ART. Calculus was seen in 42.9% of the subjects with ART and 55.6% of the subjects without ART. Shallow and deep pockets were observed in 32.1% and 14.3% of the subjects with ART as seen in Table-3.The study reveals no statistical significant difference among the study subjects with and without ART(‘p’ value =0.2).

Figure-1 shows that 44.6% of the study subjects needed Oral prophylaxis and 29.2% needed Oral Prophylaxis and Root Planning.

Table 4 shows the distribution of Oral mucosal conditions among study subjects with and without ART. It was seen that Hyperpigmentation was seen in 12.5% of the study subjects with ART. Lichen Planus, Herpes Simplex, Bald Tongue, Lichen Planus with Hyperpigmentation was seen in 3.6% of the study subjects respectively .The common condition among the subjects without ART was Geographic Tongue. However no statistical significant difference was seen between them (‘p’ = 0.256).

DISCUSSION:

HIV/AIDS is a global health problem affecting the immune system. Recognition of some oral manifestations of HIV disease, predicts the severity of immune suppression and disease progression. Majority of the study subjects were females compared to males and the mean age was 34.22 years. However studies conducted in South India have shown a higher number of male subjects when compared to females (Patil et al, 2011).

The median of dental caries among subjects with and without ART was 3.This is similar to study conducted on subjects without HIV /AIDS. This shows that dental caries affects all populations irrespective of their immune status. However Dental caries did not show statistical significant difference among subjects with and without ART. This is in disagreement to a study conducted by Phelan et al., who observed a high prevalence of dental caries among HIV infected women compared to HIV uninfected women (Phelan et al, 2004). In a study conducted among HIV patients in Brazil, it was reported that the DMFT index of the participants was 16.9 (Aleixo et al, 2010). Kasiraj, G.V., reported that a negative correlation existed between CD4 count and DMFT index (Kasiraj, 2012).

No statistical significant difference was registered between the periodontal status of the study subjects with and without ART (p>0.05).This finding is similar to a study conducted by Silvinha S.S Lemos and Choromanska M. But Ranganathan et al., revealed a greater severity and breakdown of periodontal tissues among HIV infected. Kiran K reported a severe periodontal breakdown with 9% of the subjects showing linear gingival erythema and 3.5% of them with necrotizing ulcerative gingivitis. The differences could be due to different indices used to record periodontal status or it shows that immunodeficiency alone does not predispose to periodontal problems (Lemos et al, 2010).

Hyperpigmentation was the most common finding among subjects on ART. According to a study done by Patil, B.A. et al 8.2% of the study subjects had hyperpigmentation and a prevalence of 38% was reported by Bravo, I.M. et al among Venezuelan population (Bravo et al, 2006; Patil et al, 2011). Davoodi, P. et al reported that 42% of the study subjects of Iran had Hyperpigmentation (Davoodi et al, 2010). This could be due to adrenocortical involvement by parasites giving rise to adrenal insufficiency and drugs like Azidothymidine used in ART, which leads to pigmentation (Sontakke et al, 2011). Disregulation of cytokines in HIV infected persons promote an increased release of alpha melanocyte stimulating hormone which may lead to mucosal hyperpigmentation (Masiiwa and Naidoo, 2011). However the presence of Lichen Planus, Herpes Simplex, Candidiasis was relatively low which is in disagreement to other studies (Howell et al, 1996; Sontakke et al, 2011).

These marked differences in the prevalence of HIV related oral lesions could be due to differences in the prescribed medications, the stage of the disease or the way of transmission (Davoodi et al, 2010). Other factors may be the examiner variability and different diagnostic criteria used (Patil et al, 2011).

Although HIV is a disease causing Immunosuppression, the study results do not show profound difference in dental caries experience, periodontal status and oral mucosal conditions among subjects with and without ART. Hyperpigmentation was the common condition seen among subjects with ART, which could be attributed to medications. There are some limitations in this study as this was conducted among institutionalized subjects representing a small sample where in-house medical and dental care is provided. A control group was not taken as it asks for HIV tests. Study subjects should have been compared according to their CD4 counts instead of those with and without ART.

CONCLUSION:

The study concluded that individuals on ART had a higher prevalence of oral mucosal lesions, and periodontal diseases but it was not statistically significant. There was no statistically significant difference in the dental caries experience among individuals with and without ART. However, further follow up studies with control group is required to gain insight in to oral and perioral manifestations among HIV infected.

ACKNOWLEDGMENTS:

The authors are grateful to the participants and the members of Snehasadana and its members for their support and cooperation in conducting the research.

Table 1:

Sociodemographic details of study subjects

Total Number of study subjects	130
	Males	20 (15.4%)
Females	110 (84.6%)
Mean age of the study subjects	34.22 years
Study subjects undergoing Antiretroviral therapy
	Yes	112 (86.2%)
No	18 (13.8%)
Educational Level of the study subjects
	Illiterate	13.8%
Less than Primary school	9.2%
Primary school	18.4%
Middle school	27.7%
Secondary school	26.2%
Intermediate	3.1%
Graduate	1.5%

Table 2:

Distribution of Dental Caries Experience among study subjects with and without ART

	ART	Median	Inter Quartile Range	Mean Rank	Mann-Whitney U	Z	Level of significance
Decayed	yes	2	6	65.27	982	-0.179	0.858
no	2	6.5	66.94
Missing due to caries	yes	0	1	65.09	962	-0.394	0.694
no	0	1.25	68.06
Filled	yes	0	0	66.3	918	-1.313	0.189
no	0	0	60.5
Filled with Decay	yes	0	0	64.5	896	-3.541	<0.001
no	0	0	71.72
DMFT	yes	3	6.75	65.59	998	-0.068	0.946
no	3	7.5	64.94

Table 3:

Distribution of Periodontal status among study subjects with and without ART

Periodontal Status (CPITN)	ART	Chi-Square Test
Yes	No	Fisher’s Exact Test value	Level of significance
Healthy	4(3.6%)	2(11.1%)	6.522	0.2
Bleeding	6(5.4%)	2(11.1%)
Calculus	48(42.9%)	10(55.6%)
Pocket 4-5mm	36(32.1%)	2(11.1%)
Pocket 6mm or more	16(14.3%)	2(11.1%)
Excluded	2(1.8%)	0(0%)
Total	112(100%)	18(100%)

Table 4:

Distribution of Oral mucosal conditions among study subjects with and without ART

ORAL MUCOSAL CONDITIONS	ART	Chi-Square Test
Yes	No	Fisher’s Exact Test value	Level of significance
No Abnormal Condition	70 (62.5%)	16(88.9%)	12.590	0.256
Leukoplakia	2(1.8%)	0(0%)
Lichen Planus	4(3.6%)	0(0%)
Candidiasis	2(1.8%)	0(0%)
Hyperpigmentation	14(12.5%)	0(0%)
Herpes Simplex	4(3.6%)	0(0%)
Bald Tongue	4(3.6%)	0(0%)
Geographic Tongue	0(0%)	2(11.1%)
Leukoplakia and Hyperpigmentation	2(1.8%)	0(0%)
Lichen Planus and Hyperpigmentation	4(3.6%)	0(0%)
Lichen Planus and Bald Tongue	2(1.8%)	0(0%)
OSMF and Bald Tongue	2(1.8%)	0(0%)
Bald Tongue, Candidiasis and OSMF	2(1.8%)	0(0%)
Total	112 (100%)	18(100%)

Figure 1:

Distribution of study subjects based on Treatment Needs