ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A safe and effective influenza vaccine is needed to prevent serious influenza illness in infants younger than 6 months of age. The purpose of this study was to determine whether two doses of the cold-adapted (ca) influenza A reassortant vaccine would be safe and immunogenic in this age group. In the first part of this study, infants received two doses of 105or 10850% tissue culture-infectious dose (TCID50) of the ca influenza vaccine separately from routine immunizations. In the second part of this study two 106TCID50doses of the ca influenza vaccine were given with routine immunizations at 2 and 4 or 2 and 6 months of age. Thecainfluenza vaccine was well-tolerated by participants in both parts of this study. Two doses of thecainfluenza vaccine were immunogenic in infants who received them separately from routine immunizations; 83% of vaccinees developed protective titers of serum hemagglutination-inhibition (HAI) antibody. In contrast, when thecavaccine was administered with routine immunizations, protective HAI antibody titers were induced in only 20% of those immunized at 2 and 4 months of age and 50% of those immunized at 2 and 6 months of age. There were no statistically significant associations between HAI antibody response tocainfluenza vaccination and dose schedule, presence of passively acquired maternal HAI antibody, ethnic group or breast-feeding status. Young age at the time of first immunization, however, appeared to correlate with decreased response to the hemagglutinin antigen of the influenza A virus. Further studies are needed to determine whether a larger dose of vaccine (107TCID50) could be used safely to improve the serum antibody response to influenza in very young infants.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

During outbreaks of measles, measles vaccine is recommended for infants considered to be at risk who are 6 months of age and older. In a prospective trial the serologic response to early measles immunization has been evaluated in 125 infants given monovalent measles vaccine at 6 to 8.5 months of age and measles-mumps-rubella at 15 months. The response to vaccination was measured by plaque reduction neutralization (PRN) assay and enzyme immunoassay. Infants were grouped by the mother's immunization history: natural immunity (n= 60, Group 1); killed followed by live, further attenuated vaccine (n= 22, Group 2); and live, further attenuated vaccine only (n= 43, Group 3). The prevaccination geometric mean titer (GMT) by PRN for Group 1 (GMT = 69) was significantly higher than that of Group 2 (GMT = 18) or 3 (GMT = 13). Seroconversion (4-fold increase in PRN titer) rates after monovalent vaccine were 31,71 and 76% for Groups 1,2 and 3, respectively. Seroconversion percentages were higher when measured 6 to 8 weeks after vaccination compared with 4 to 5 weeks. After measles-mumps-rubella ≥97% of all infants had PRN titers >120 and were measles IgG-positive by enzyme immunoassay. These data show that as demographics shift to a well-vaccinated maternal population and susceptibility in younger infants, measles vaccination before the currently recommended age will be effective.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Until recently measles was a very severe illness of infancy and early childhood in Jordan. Incidence rates were estimated to be as high as 500 to 1000/100 000 and case fatality rates were as high as 10%. Since 1981 mandatory and routine vaccination was introduced by the Ministry of Health. Because infants accounted for the most severe cases and almost all mortality, measles vaccine was given at 9 months of age. No booster doses were recommended. Since 1981 there has been a steady shift in the age distribution of cases toward the older age group. In recent years children >5 years of age accounted for >60% of cases. Commensurate with that the mortality rate has decreased to almost nil in recent years. There is also evidence of a marked decrease of inpatient admission of measles cases to one of the largest hospitals, the Jordan University Hospital. Despite high immunization rates in excess of 88%, however, outbreaks of measles continue to occur. To evaluate the impact of measles vaccination on outbreaks, a study in one village in 1987 showed that there was almost no protective efficacy in children >5 years of age (relative risk 0.80 and confidence interval 0.06 to 0.67vs.relative risk 0.73 and confidence interval 0.54 to 1.15).Although the current measles immunization strategy has decreased the mortality and morbidity rates, we propose that the continuing occurrence of outbreaks necessitates the addition of a booster dose after 15 months of age. Because mumps and rubella continue to cause a problem in Jordan, a combined measles-mumps-rubella vaccine at the age of 18 months along with the diphtheria-tetanus toxoids-pertussis and oral poliovirus vaccine booster doses could be the best and most cost-effective strategy.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To characterize the epidemiology of Alaska Native children hospitalized for respiratory syncytial virus infections, we reviewed records of hospitalizations during the winter seasons of 1991 to 1992 and 1992 to 1993 at a hospital in Anchorage and a rural hospital in the Yukon Kuskokwim Delta (YKD) region of southwestern Alaska. The median age of hospitalization for respiratory syncytial virus infection was 2 months of age for YKD residents and 4.5 months for Anchorage residents. Sixteen percent of the hospitalized YKD children were less than 1 month of age, whereas the same was true for only 3% of the Anchorage children. Eight percent of the YKD patients required mechanical ventilation, whereas none of the Anchorage patients required ventilation. The median hospital stay was 4.8 days for YKD patients and 3.2 days for Anchorage patients. Hospitalization rates for infants less than 1 year of age were 33/1000 for Alaska Natives in Anchorage and 100/1000 for those in the YKD region. The extremely high hospitaliza

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Human parvovirus B19 has been associated with several diseases. Aplastic crisis in patients with chronic hemolytic anemia, erythema infec-tiosum, hydrops fetalis and arthritis are among the common diseases caused by this virus infection. In the period between July, 1991, and March, 1992,48 patients with aplastic crises were hospitalized at Saudi Aramco-Dhahran Health Center, Dhahran, Saudi Arabia. Forty-six patients had homozygous sickle cell disease, one had hemoglobin H disease and one had hereditary elliptocytosis. Evidence of recent human parvovirus infection was present in 91% of the cases. Leukopenia was present in 21%, neutropenia in 27% and thrombocytopenia in 42%. This differs from previous reports in which red blood cell aplasia causing anemia was the only hema-tologic finding reported in most patients. There were no cases of erythema infectiosum in either the patients or the community during the epidemic and the reason for this phenomenon is not obvious. The almost limited occurrence of aplastic crisis in patients with sickle cell disease in a population with a high incidence of other types of chronic hemolytic anemias is of interest.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We undertook a randomized, placebo-controlled, double blind trial of cytomegalovirus (CMV) immunoglobulin (CMVIG) for prevention of CMV-associated disease in 183 multiply transfused, premature neonates. CMVIG (150 mg/kg) or placebo was given within 24 hours of the first transfusion and at Day 10. If an intravenous catheter was still in place an additional dose was given between Days 20 and 30. The globulin and placebo groups were well-matched with respect to birth weight, gestational age, Apgar score, birth to a CMV-seropositive mother, requirement for assisted ventilation and exposure to CMV-positive, unscreened blood products. Among infants followed for more than 10 days, 18 (10.5%) developed CMV infection; 9 had symptomatic CMV disease (5 placebo; 4 CMVIG). Among infants born to a CMV-seropositive mother, CMVIG use was associated with a CMV syndrome rate of 3.2% (95% confidence interval, 0.2 to 18.5%) compared to 12.5% (95% confidence interval, 4.5 to 27.6%) among placebo recipients (P= 0.163). Among placebo recipients infants born to CMV-seropositive mothers were more likely to have a virologically confirmed CMV syndrome than those born to a CMV-seronegative mother, despite receipt of blood not screened for CMV antibody (P= 0.012). Multivariate analysis demonstrated that two factors were independently associated with CMV acquisition: the volume of CMV-seropositive blood products transfused (P= 0.005); and birth to a CMV-seropositive mother (P= 0.006). Infusions of CMVIG were well-tolerated. This study reaffirms that perinatally acquired CMV disease is more common among infants born to CMV-seropositive mothers than CMV-seronegative mothers, even without use of CMV-screened blood products.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Serial C-reactive protein (CRP) and erythrocyte sedimentation rate determinations were compared with clinical course and outcome at 1 to 2 months in 63 children with acute hematogenous osteomyelitis. High CRP values (163 \pm 108 mg/liter) on admission began to descend after the second day of treatment. From the fourth day on higher (P= 0.03 toP= 0.0001) CRP values distinguished a complicated from an uneventful course of acute hematogenous osteomyelitis and the patients symptomatic at follow-up (P= 0.003 toP= 0.0001) from asymptomatic ones. Children who developed extensive radiographic changes had elevated CRP values for a longer time (32 \pm 13 days) than children with typical changes (11 \pm 6 days,P= 0.0001). Erythrocyte sedimentation rates did not identify the type of clinical course but higher values on Days 4 to 7 distinguished children symptomatic at follow-up (P= 0.02) from asymptomatic ones. Monitoring serial CRP values can alert the physician to complications and predict outcome earlier than clinical signs or roentgenograms.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Analysis of restriction fragment length polymorphisms is a well-established method of “DNA fingerprinting” that has been used to trace the transmission of particular strains ofMycobacterium tuberculosisduring investigations of outbreaks. This report describe the use of restriction fragment length polymorphisms and arbitrarily primed polymerase chain reaction analysis to investigate two outbreaks of tuberculosis that affected six children who attended two pediatric wards in our hospital. In both outbreaks a history of household exposure to an adult withM. tuberculosiswas obtained and suspected tuberculous contacts were identified. We have demonstrated unequivocally the strain relationship among the isolates in all the cases by restriction fragment length polymorphisms and arbitrarily primed polymerase chain reaction analysis. These techniques are very useful for performing epidemiologic studies of tuberculosis in children where natural history of tuberculosis infection is different from that in adults in that it is almost always primary infection rather than reactivation.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A clinical study was conducted in three Chinese community hospitals to investigate the reliability of respiratory rate and various clinical signs in the diagnosis of pneumonia among 54 children less than 5 years of age. Anteroposterior chest film was used as the diagnostic standard. The cutoff criterion for rapid breathing was 50 breaths/minute for infants ages 2 to 11 months and 40/minute in children 1 to 5 years old. Rapid breathing was a better predictor of pneumonia than rales (positive predictive values of 74.5 and 66.9%). Nasal flaring, chest indrawing, stridor and cyanosis of the tongue had predictive values of >86%, but these clinical signs were observed in only a small proportion of patients. We recommend that village health workers use rapid breathing for diagnosis of pneumonia, rather than auscultation which is difficult and has proved unreliable. Sensitivity, specificity and positive and negative predictive values are presented for seven signs and symptoms of pneumonia.

ISSN:0891-3668    

出版商:OVID    

年代:1995

数据来源: OVID