ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Context.The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for infants to protect against invasive disease, but its impact on otitis might also have public health importance.Objective.To examine the impact of PCV on the incidence of otitis media, frequent otitis media and tympanostomy tube procedures and to assess whether the effectiveness of the vaccine wanes after age 24 months and varies by race, sex or season.Design, setting and patients..From 1995 to 1998, 37 868 children at Kaiser Permanente in Northern California were randomized to receive PCV or a control vaccine in a double blind trial and were followed through April 1999.Interventions.Children received a primary series at 2, 4 and 6 months of age and a booster at 12 to 15 months.Main outcome measures.Visits for otitis, frequent visits for otitis and tympanostomy tube procedures. Otitis was ascertained from diagnosis checklists routinely marked by physicians.Results.Control children averaged 1.8 otitis visits per year. Children given PCV had fewer otitis visits than control children in every age group, sex, race and season examined. Intention-to-treat analysis permitted rejection of the null hypothesis that PCV is ineffective against otitis media (P< 0.0001). In children who completed the primary series per protocol, PCV reduced otitis visits by 7.8% [95% confidence interval (CI), 5.4 to 10.2%] and antibiotic prescriptions by 5.7% (CI 4.2 to 7.2%). Frequent otitis was reduced by amounts that increased with otitis frequency, from a 10% reduction in the risk of 3 visits to a 26% reduction in the risk of 10 visits within a 6-month period. Tube placements were reduced by 24% (CI 12 to 35%).Conclusion.In children followed up to 3.5 years, PCV provided a moderate amount of protection against ear infections while reducing frequent otitis media and tube procedures by greater amounts.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Persistent bacteremia despite antibiotic therapy has been correlated with adverse outcomes, including focal suppurative complications and death. Coagulase-negative staphylococci (CONS) are the most common cause of nosocomial infection in infants requiring neonatal intensive care and might yield more substantial pathology if infection were persistent.Methods.To compare the severity and features of persistent infection by CONS with those of other bacteria, we reviewed infants admitted to our neonatal intensive care unit from 1990 through 2001 who developed bacteremia at >5 days of age with recovery of the same bacterial species from blood for >24 h after initiation of antibiotic therapy to which the organism was susceptible. Cases were excluded if a focal complication was already present with the initial positive culture or if the medical record was unavailable. Outcomes of interest included focal suppurative complications, death attributable to infection and duration of hospitalization among survivors.Results.We identified 62 infants with sustained infection, caused by CONS in 30 and by other organisms in 32 [10 Gram-negative, 22 Gram-positive (16Staphylococcus aureus)]. Infants with persistent CONS had significantly lower birth weight and gestational age, but no difference was found for multiple other clinical and demographic risk factors. Indwelling vascular catheters were present at diagnosis in 85% of the infants (CONS 26 of 30, non-CONS 27 of 32). Responses of bacteremia to catheter removalvs.in situtreatment did not differ between the groups. No differences were observed for death from all causes (27vs.34%), death attributable to infection (6vs.12%) or duration of hospitalization among survivors [median (interquartile range): 102 (73 to 167)vs.107.5 (89 to 130) days]. Focal suppurative complications were significantly more frequent in infants persistently infected with non-CONS (28vs.3%;P= 0.01). Duration of persistence correlated with focal complication in non-CONS infants (r= 0.988;P< 0.001).Conclusions.Although persistent infection with CONS occurs in significantly smaller and less mature infants than with non-CONS, death is no more frequent and focal complications are significantly less frequent. Infants with persistent infection should undergo aggressive evaluation for focal complications, with the yield expected to be higher in those with non-CONS.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Beginning in 1990 Canada experienced a resurgence of pertussis. Changes in incidence and hospitalization according to age in the province of Quebec between 1983 and 1998 were examined to assess the presence of a cohort effect resulting from a poorly protective vaccine.Methods.The source of data on incident cases was pertussis notifications to the Quebec Ministry of Health and Social Services. Hospitalization data were extracted from the administrative database that collects information on each hospitalization.Results.The mean annual incidence before 1990 was 3.8 cases per 100 000 population which increased to 37.2 thereafter. Infants had the smallest increase (2.7-fold) when compared with children between 1 and 19 years who experienced a 9- to 15-fold increase and with adults (22.5-fold). The mean annual hospitalization rates increased from 2.7 per 100 000 before 1990 to 5.2 afterward. Ninety percent of hospitalizations occurred in children <5 years of age. The proportion of cases in 0- to 4-year-old children decreased, whereas it increased steadily in all other age groups during the entire study period. Between 1990 and 1998 the median age of cases shifted from 4.4 to 7.8 years. Pertussis affected predominantly children who were immunized with a vaccine introduced in the mid-1980s. The evolution of the age distribution of cases paralleled the aging of this cohort with a slow but steady drift of disease from early childhood to adolescence.Conclusion.The sudden increase in pertussis incidence in Canada can be largely attributed to a cohort effect resulting from a poorly protective pertussis vaccine used between 1985 and 1998.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.The cold-adapted, trivalent influenza vaccine (CAIV-T) may become an option for annual vaccination. However, there is little information regarding the immune response to repeated immunization with CAIV-T.Objective.To determine the antibody response to repeated immunization with CAIV-T and to compare this with the response after the first CAIV-T immunization.Design and methods.Healthy children were offered CAIV-T immunization for 4 consecutive years, and blood samples were taken from a subset in Years 1, 2 and 4. In Year 4, 156 similarly aged children who had not received influenza vaccine previously were immunized with the same CAIV-T.Results.The H3N2 and B components of the CAIV-T induced high antibody titers in Year 1 that were maintained during 4 years. The H1N1 titers were lower than the H3N2 or B titers. Comparison of the group immunized for 4 consecutive years with the group immunized for the first time revealed the following: (1) before immunization yearly immunized subjects were more likely to be seropositive to each of the three vaccine strains than those immunized for the first time (P< 0.05 for each); (2) after immunization the percentage of seropositive subjects to each of the strains was similar; (3) after immunization titers were higher in the subjects immunized for the first time than those immunized yearly (P< 0.05 for H3N2 and B).Conclusion.Yearly vaccination with CAIV-T induced high antibody titers, especially to the H3N2 and B strains in the vaccines. The titers in those immunized with CAIV-T for the first time were higher than in those immunized for 4 consecutive years.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Previous studies in patients with a history of Kawasaki disease have focused on vascular endothelial function in coronary arteries, and the endothelial function of systemic arteries is not fully understood. Furthermore the effect of vitamin C on systemic endothelial function after Kawasaki disease has not been elucidated.Objectives.We attempted to analyze endothelium-dependent vasodilatation in the brachial artery after Kawasaki disease by using high resolution ultrasonography and to investigate whether the acute administration of vitamin C could restore such systemic endothelial dysfunction.Methods.We compared 39 patients (7.1 ± 2.7 years) 1.0 to 9.6 years after acute Kawasaki disease with 17 matched healthy subjects (7.0 ± 3.1 years) as controls. Using high resolution vascular ultrasound, we measured brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilatation) and sublingual nitroglycerin (causing endothelium-independent dilatation).Results.The percent change in diameter of the brachial artery induced by reactive hyperemia in the patients with a history of Kawasaki disease (6.2 ± 3.9%) was significantly lower than that in the control group (14.1 ± 6.8%;P< 0.0001). No significant difference could be found in percent change in diameter induced by sublingual administration of nitroglycerin between the control (33.2 ± 13.7%) and the patients with a history of Kawasaki disease (30.6 ± 9.2%;P= 0.49). There was no significant difference in percent change in diameter of the brachial artery induced by reactive hyperemia between the patients who received gamma-globulin (6.0 ± 4.0%) and those who did not receive gamma-globulin (7.9 ± 3.3%;P= 0.33). Intravenous infusion of vitamin C significantly increased the percent change in diameter of brachial artery induced by reactive hyperemia in 19 patients with history of Kawasaki disease (6.6 ± 3.5 to 13.0 ± 5.5%;P< 0.0001), whereas no significant increase was seen in the percent change in diameter of brachial artery induced by reactive hyperemia in 20 patients with history of Kawasaki disease after placebo administration (6.5 ± 4.5 to 7.3 ± 4.9%;P= 0.20).Conclusions.Our study showed decreased percent change in diameter of the brachial artery induced by reactive hyperemia in patients with history of Kawasaki disease compared with the healthy children, indicating that systemic endothelial dysfunction exits after Kawasaki disease. Although such systemic endothelial dysfunction after Kawasaki disease is not influenced by early treatment with high dose gamma-globulin in the acute stage of Kawasaki disease, it can be restored by the acute intravenous administration of vitamin C.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Diagnostic problems in identifying congenital infection cases in infancy have thus far impaired the assessment of the role of congenital cytomegalovirus (CMV) infection in the etiology of sensorineural hearing loss (SNHL).Objective.To estimate the impact of congenital infection in children with SNHL by detection of CMV DNA in stored samples of neonatal dried blood (dried blood spots test).Methods.The Guthrie cards of 130 children with hearing loss >40 dB hearing loss were retrieved from the regional screening center. CMV DNA was extracted by thermal shock and amplified by PCR.Results.The percentage of SNHL cases attributable to congenital CMV infection was 10% (9 of 87) in infants whose SNHL had been diagnosed in their first 2 months of life and 34.2% (13 of 38) in children with deafness of unidentified cause that was diagnosed in early childhood. In the latter group 42.7% (12 of 28) of the children with a hearing loss of >70 dB were CMV-positive.Conclusions.The results suggest that congenital CMV infection has a more relevant role in the etiology of SNHL than previously reported. The data obtained in both groups suggest that 20 to 30% of all deafness cases are caused by CMV. The percent of congenital CMV cases alone appears to account for all the cases previously attributed to all congenital infections. More than 40% of deafness cases with an unknown cause, needing rehabilitation, are caused by congenital CMV.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID