Towards global poliomyelitis eradication: the successes and challenges for a developed country

Abstract:    The Sabin oral polio vaccine (OPV) has been remarkably successful, with three major regions of the world declared polio free. Mutations of the live attenuated poliovirus during genomic replication have resulted in polioviruses with increased neurovirulence. Recently, mutated vaccine-derived polioviruses have circulated in countries with low OPV vaccination coverage causing outbreaks of poliomyelitis in the islands of Haiti, the Dominican Republic, the Philippines and Madagascar. Ultimately the total eradication of poliomyelitis requires the cessation of OPV use. The current questions of how best to continue polio immunisation and when OPV should be withdrawn are addressed. Prolonged excretion of poliovirus in stools following cessation of vaccination has the potential to infect unimmunized susceptible children. In Australia the change to the use of inactivated polio vaccine (IPV), while more costly, will avoid the very low risk of vaccine associated paralytic poliomyelitis (one case per 2.5 million doses) and maintain immunity against polio. In the future, new vaccines may provide the solution to the problem of OPV cessation.     

Surveillance of cold chain system during Intensified Pulse Polio programme-2006 in Chandigarh

Objective To evaluate the maintenance of cold chain system in the Intensive Pulse Polio Immunization (IPPI) campaign in the Union Territory, Chandigarh. Methods A cross sectional study was conducted in 18 designated vaccine sub-depots, where OPV vials were stored prior to IPPI and 25 IPPI booths out of the designated 406 IPPI booths in U.T, Chandigarh. The booths were selected by stratified random sampling technique. 25 Vaccine vials, one from each booth were selected and sent for potency testing at Central Research Institute (CRI)-Kasauli. Results All the randomly selected vaccine samples were reported portent, as per the reports provided by CRI — Kasauli. Cold chain maintenance and temperature charting was found satisfactory. Conclusion There are some avoidable errors which leaves room for improvement, which can be in the form of provision of adequate number of exhaust fan, voltage stabilizers, etc. Uninterrupted power supply should be ensured. Lastly, more emphasis is to be given on maintenance of cold chain system in reorientation training program of all health functionaries.     

Role of provocation poliomyelitis in vaccine-associated poliomyelitis

The impact of different vaccine administrations in the Federal Republic of Germany, in relation to vaccine-associated paralytic poliomyelitis (VAPP) was studied. (This only means that on the basis of the temporal relation of vaccination and onset, the vaccine cannot be ruled out as possible cause.) Oral polio vaccine (OPV) was given between 1963 and 1977 only and recommended simultaneously with inactivated vaccines (DT/DPT) between 1980 and 1985. In the first period 10 VAPP cases occurred among 9.96 million estimated vaccinees aged under 2 years. In the second period 6 cases of provocation poliomyelitis (PRP) were found among 2.9 million estimated OPV/DT/DPT vaccinees of the same age group. Statistically the VAPP/PRP frequencies in the two periods studied did not achieve significance.     

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1–11 years agegroup. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/ 1000 children born in 1974–76, 7.7/1000 children born in 1977–1980 and 2.3/1000 children born in 1981–1984 (expected to increase to 3.1/1000 when all children born in 1981–84 cross 5th year of life). Immmunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974–80 when immunisation was a clinic based activity. Coverages increased from 50 to 80% during 1981–85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.     

Surveillance of acute flaccid paralysis in Australia, 1995-97. Australian Paediatric Surveillance Unit

OBJECTIVE: Acute flaccid paralysis (AFP) surveillance in Australia as part of the World Health Organization (WHO) certification process for polio eradication in the Western Pacific region. METHODS: Active monthly AFP surveillance through the Australian Paediatric Surveillance Unit, from March 1995 to December 1997. RESULTS: Based on 80 cases, the reported overall rate of AFP was 0.73 per 10(5) children < 15 years (below the expected 1 per 10(5)). The major causes of AFP were Guillain-Barré syndrome (51%) and transverse myelitis (19%). According to the WHO virological classification, there was no case of poliomyelitis, 37.5% were 'non-polio' and 62.5% cases were 'polio compatible' due to inadequate stool testing and follow-up. However, case review by an expert panel enabled 95% to be classified as 'non-polio'. CONCLUSION: Australia must improve AFP surveillance to confirm absence of wild poliovirus. Paediatricians can help Australia meet its certification requirements and contribute to the global eradication effort by reporting and investigating all cases of AFP.     

Limitations of child injury data from the CPSC's National Electronic Injury Surveillance System: the case of baby walker related data.

OBJECTIVES: The US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) is a primary source for children's consumer product injury surveillance data in the US. Differing interpretations of the emergency department based NEISS baby walker data by various parties prompted this detailed examination, reclassification, and analysis of the NEISS data to explain these discrepancies. METHODS: Case selection was performed by searching the NEISS 1982-91 database for the baby walker product code and various text strings for children less than 24 months old. False negative and false positive cases were identified and reclassified. Adjusted population rates were computed and the types and locations of hospitals contributing to the sample were examined. RESULTS: One per cent false positive and 4% false negative misclassification rates were observed. In 1991, two children's hospitals reported 14% of the baby walker related injuries, though these hospitals made up just 2% of the sample frame. Through random allocation, one state currently contains four acute care hospitals and the only two children's hospitals reporting to the NEISS system. These six hospitals contributed 18% of the walker cases whereas the state represents only 3% of the US infant population. CONCLUSIONS: Misclassification in NEISS baby walker reports is minimal, with false negatives outweighing false positives. For trend analysis of product related injuries at the frequency of occurrence observed for baby walkers, NEISS suffers from low sensitivity due to sampling error. For children's injuries, NEISS' estimates have been affected by children's hospitals coming in and out of the sample and currently reflects a random geographic imbalance because one state contributes both of the reporting children's hospitals. To overcome these problems improved multiple product coding, a unique baby walker code, and stratification of children's hospitals in an enlarged NEISS sample is recommended.     

Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy

Objectives

The vaccine schedule was changed in 2013 in France, which resulted in fewer vaccinations. However, to maintain disease protection, both vaccine timeliness and high coverage should be respected. In the context of growing vaccine hesitancy, we aimed to describe compliance with the immunization program according to the age recommended for each dose for non-preterm children less than 2 years old.

河南省2010~2011年疑似预防接种异常反应监测分析

目的：分析河南省疑似预防接种异常反应（AEFI）的发生特征,评价河南省目前使用疫苗的安全性。方法：通过中国免疫规划监测信息管理系统收集河南省2010年1月1日至2011年12月31日报告的AEFI个案数据,采用描述性方法对相关指标进行流行病学分析。结果：河南省2010~2011年共报告AEFI个案2415例,主要集中在郑州市、洛阳市和焦作市（1238例,51.26%）。男女比为1.32∶1,报告AEFI病例年龄以小于1岁为主（799例,33.08％）。发生AEFI的疫苗主要是麻疹疫苗和百白破疫苗,共占61.24%,发生率分别为30.3/10万和5.0/10万,接种剂次以第1剂次为主（1528例,63.27%）。发生AEFI最多的前5种疫苗临床损害以炎症反应和过敏性症状为主,不同疫苗引起的AEFI临床表现不同（χ2=304.5,P<0.001）。2415例AEFI个案中一般反应1946例（80.58%）,异常反应348例（14.41%）,偶合症98例（4.06%）,心因性反应13例（0.51%）,不明原因反应10例（0.41%）。AEFI预后良好,治愈率为90.64%。结论：小年龄儿童和首剂接种应得到预防接种服务人员和儿童家长的密切关注。     

北京上海广州深圳4家儿童医院肺炎住院患儿肺炎链球菌分离株的血清型分布

目的了解目前从中国住院治疗肺炎患儿分离到的肺炎链球菌的血清型分布，及几种蛋白多糖结合疫苗的覆盖率，评估应用蛋白多糖结合疫苗预防肺炎链球菌感染的价值。方法选择2006年2月16日至2007年2月16日在首都医科大学附属北京儿童医院、复旦大学附属儿科医院、广州市儿童医院和深圳市儿童医院呼吸科住院治疗的肺炎患儿为研究对象，采用一次性吸痰管收集全部病例的呼吸道分泌物标本分离肺炎链球菌，部分患儿进行脑脊液、血液和胸腔积液中肺炎链球菌的分离。采用荚膜肿胀实验进行血清型分析。对4家儿童医院肺炎链球菌分离率和血清型进行分析，率的比较采用χ2检验或Fisher精确概率法。结果 研究期间共纳入2 865例肺炎患儿，2 865例呼吸道吸取物标本中分离到肺炎链球菌279株，其中有2株不同血清型菌株分离自同一病例，分离阳性率为9.7％（278/2 865）。3/8例胸腔积液中分离到肺炎链球菌，其中2例同时从呼吸道分泌物分离到肺炎链球菌，取其一进行血清分型，另1株从胸腔积液中分离的肺炎链球菌复苏失败，未进行血清分型。脑脊液和血液标本中未分离到肺炎链球菌。共有279株肺炎链球菌进行了血清型分析，以19F型最常见（60.6％，169/279），其次为19A（9.7％，27/279）、23F（9.3％，26/279）和6B（5.4％，15/279），上述4种血清型占全部菌株的84.9％（237/279）。肺炎链球菌7价结合疫苗（PCV7）覆盖率为81.0％，但在北京仅为46.0％，明显低于上海（80.0%）、广州(98.4%)和深圳（94.4%）。9价、10价和11价疫苗的覆盖率与PCV7相比并没有明显增加。13价疫苗的覆盖率（92.8％）较PCV7明显升高。结论4家儿童医院肺炎住院患儿分离的肺炎链球菌以19F、19A、23F和6B型常见。PCV7覆盖率为87％     

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??At present??the world has entered the strategic stage of eradicating wild and vaccine derivative poliovirus before 2018. China has successfully eradicated wild poliovirus and the vaccination policy needs to be changed immediately. Inactive poliovirus vaccine??IPV?? should be introduced into Chinese routine immune program gradually.     

Nonbacterial osteitis in children: data of a German Incidence Surveillance Study

Aim:  To analyse the incidence, clinical presentation, laboratory and radiological findings, as well as diagnostic approaches and therapeutic procedures in paediatric patients suffering from nonbacterial osteitis. Methods:  A nationwide incidence survey was conducted from 2006 to 2008 through monthly contacts with all German paediatric and paediatric–orthopaedic hospitals. Children with osteomyelitic bone lesions newly diagnosed as suffering from nonbacterial osteitis were identified. Cases were assessed using a questionnaire to be filled in by the treating physician containing information on time since first symptoms, associated diseases, diagnostic procedures, localization of lesions, complications, laboratory and histological results, and treatment. Results:  Nonbacterial osteitis was newly reported in 148 children. The annual incidence was estimated at 0.4 per 100 000 children. Mean manifestation age was 11.4 years (SD 3.2); 99 children (67%) were girls. Palmoplantar pustulosis was observed in 8 (6%). Unifocal manifestations were seen in 50 (34%) patients. Of all patients with vertebral involvement (15%), 9% suffered from vertebral fractures. Bone biopsies were taken in 79 (53%) patients. Conclusions:  Nonbacterial osteitis is an auto‐inflammatory disorder resulting in at least 60 new paediatric cases/year in Germany. Spinal lesions and complications are frequently observed, even at first diagnosis.     

Use of growth charts in Canada: A National Canadian Paediatric Surveillance Program survey

BACKGROUND:In 2010, the WHO Growth Charts for Canada were recommended for use in Canada, while the US Centers for Disease Control and Prevention (Georgia, USA) charts remained in active use.OBJECTIVE:To assess the availability, utilization of and satisfaction with growth charts in clinical practice in Canada.METHODS:In October 2012, a one-time survey was sent through the Canadian Paediatric Surveillance Program (CPSP) to 2544 paediatricians and 280 family physicians with a stated interest in paediatrics.RESULTS:The response rate was 24% (63% general paediatricians, 36% subspecialists, 1% family physicians). Of these respondents, 68% preferred the WHO charts for infants and 49% for children and youth. Regarding the WHO charts, 49.7% of respondents reported concerns with their inability to assess weight for children >10 years of age, and many believed that there were too few percentile lines between the third and 97th percentiles for infant (24%) and for child and youth measures (19%). The addition of extreme percentiles (0.1 and 99.9), shading on charts and lack of availability with electronic medical record providers were other concerns mentioned by 10% to 13% of respondents.CONCLUSION:There is support for the use of the WHO data for monitoring the growth of Canadian children. Concerns regarding the design of the charts were raised. These survey results lend support to the redesign of the WHO Growth Charts for Canada, as was recently completed in 2014.     

National Project on the Prevention of Mother-to-Infant Infection by Hepatitis B Virus in Japan

In Japan, a nationwide prevention program against mother-to-infant infection by hepatitis B virus (HBV) started in 1985. This program consists of double screenings of pregnant women and prophylactic treatment to the infants born to both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mothers. These infants are treated with two injections of hepatitis B immune globulin (HBIG) and at least three injections of plasma derived hepatitis B vaccine. We sent questionnaires about the numbers of each procedure or examination during nine months of investigation period to each local government in 1986 and 1987. 93.4% pregnant women had the chance to be examined for HBsAg, and the positive rate was 1.4 to 1.5%. The HBeAg positive rate in HBsAg positive was 23 to 26%. The HBsAg positive rate in neonates and in infants before two months were 3% and 2% respectively. Some problems may arise, because 27 to 30% of infants need the fourth vaccination in some restricted areas.     

Acquired immunodeficiency syndrome in children: report of the Centers for Disease Control National Surveillance, 1982 to 1985

Since national surveillance for acquired immunodeficiency syndrome (AIDS) began in 1981, the Centers for Disease Control (CDC) has received reports of more than 20,000 cases of AIDS in the United States. As of December 31, 1985, 307 of these cases had been diagnosed in children younger than 13 years of age. The number of cases is increasing rapidly. The number of cases reported in 1985 more than doubled those reported in 1984. The major risk factors in children for acquiring infection with the causative agent, human immunodeficiency virus (HIV), were having a mother known to be infected and/or at increased risk for infection and receiving a transfusion of blood or blood products. Of the 307 children with AIDS, 73% were reported from one of four states: New York, New Jersey, Florida, and California. Most AIDS cases in children occur in black or Hispanic infants and toddlers. The estimated incubation period for AIDS in children has increased each surveillance year, with the longest incubation exceeding 7 years. The prognosis for children with AIDS is poor and infants less than 1 year of age have the shortest survival time following diagnosis. Continued national surveillance for AIDS is mandatory for establishing effective prevention programs to control the spread of the disease. The CDC encourages all health care personnel to report cases of AIDS to their public health departments.     

Renal failure in Wilms' tumor patients: A report from the National Wilms' Tumor Study Group

This report defines the incidence and determines the etiology of renal failure (RF) in patients undergoing treatment for Wilms' tumor (WT). The database of the National Wilms' Tumor Study (NWTS) was searched to identify all children reported to have developed chronic renal failure. There were 55 patients found to have RF. Of these, 39 patients had bilateral tumors, 15 with unilateral disease and one with a WT in a solitary kidney. The median interval from diagnosis to the onset of renal failure was 21 months. The incidence of RF in bilateral WT was 16.4% for NWTS-1 & -2, 9.9% for NWTS-3, and 3.8% for NWTS-4. The incidence of RF in unilateral WT remained stable. The most common etiologies of RF were: bilateral nephrectomy for persistent or recurrent tumor (24 pts), Drash syndrome (12 pts), progressive tumor in the remaining kidney (5 pts), radiation nephritis (6 pts), and other causes (5 pts). The etiology of renal failure was not reported in three children. Children with unilateral WT and a normal contralateral kidney have a very low incidence of RF, and this review does not support a recommendation for parenchymal sparing procedures in these patients. Children with bilateral WT are at risk for the development of RF, and parenchymal sparing procedures are warranted. © 1996 Wiley-Liss, Inc.     

Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants

ObjectiveTo analyze the implementation of a protocol proposed by the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária – ANVISA) to improve sepsis diagnosis in very low birth weight newborns.MethodsThis was a prospective study that evaluated the implementation of a protocol involving clinical and laboratory criteria (hematologic scoring system of Rodwell and C-reactive protein serial measurements), recommended by ANVISA, to improve the diagnosis of neonatal sepsis in very low birth weight newborns. The study included all patients who were born and remained in the neonatal intensive care unit until discharge or death, and excluded those with congenital diseases. The main outcomes measured in newborns before (2006-2007) and after implementation of the protocol (2008) were the rates of early and late-onset sepsis, use of antibiotics, and mortality. Means were compared by Student's t-test and categorical variables were compared by the chi-squared test; the significance level for all tests was set at 95%.ResultsThe study included 136 newborns with very low birth weight. There was no difference between groups regarding general clinical characteristics in the studied periods. There was, however, a decrease in the number of diagnoses of probable early-onset sepsis (p < 0.001), use of antimicrobial regimens (p < 0.001), and overall mortality and infection-related mortality (p = 0.009 and p = 0.049, respectively).ConclusionThe implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population.