Retinitis following varicella in a vaccinated child with acute lymphoblastic leukemia

Serious ocular disease following varicella (chickenpox) is rare in children. In addition, retinitis in children with hematologic malignancies may present a difficult diagnostic challenge because infectious retinitis may mimic leukemic involvement of the eye. We report a 7-year-old patient with T-cell acute lymphoblastic leukemia in remission who presented with visual complaints 2 weeks after developing chickenpox. Ophthalmologic evaluation revealed acute retinitis in the right eye. Prolonged therapy with acyclovir resulted in near complete recovery. Early diagnosis of VZV retinopathy and aggressive antiviral treatment is critical to prevent acute and long-term ocular sequelae.     

Parental attitudes to health of children in child-care centres and options when children are ill

OBJECTIVE: To determine parental attitudes regarding the health of children attending child-care centres, to explore concerns when children who normally attend child care are ill, and to investigate options in these circumstances. METHODOLOGY: Focus groups conducted with parents whose children attended child-care centres. Ten focus groups were conducted. RESULTS: Many parents encountered difficulty when children who normally attend child care were ill and there was a lack of options for care. Parents were concerned about the spread of infections among children but considered that there were also many health and other advantages for their children in attending child care. Child-care centres were perceived as providing a valuable support role for families. CONCLUSIONS: Many parents lack adequate options for care when their children are ill. Parents' concerns regarding health in child care are important in policy decisions regarding the health of children in child care, and the development of alternative care services for children.     

Determining the rate of varicella vaccine rash in children with moderate-severe eczema

OBJECTIVES: To determine the rate and severity of vesicular reactions following varicella vaccine in children with moderate-severe eczema. Secondary endpoints included the rates and severity of local reactions and eczema severity change within 42 days of vaccination. METHODS: Prospective open intervention pilot study of varicella vaccine in children aged 12 months to 13 years with moderate-severe eczema. Children were given varicella vaccine alone and followed for 42 days after vaccination. RESULTS: Fifty children, aged 12 months to 10.5 years were recruited, with complete follow-up for 48. A vesicular rash with a single lesion occurred in one child (2.1% (95% CI: 0, 11.1%)), 10 days following vaccination. Local reactions, including erythema, swelling and tenderness, were reported in eight children (16.7%). A flare-up of moderate-severe generalized eczema was reported in one child (2.1%) during the first week following varicella vaccine. CONCLUSIONS: Vesicular rash and local reactions following varicella vaccination were no more common or severe in children with moderate-severe eczema than that reported in the published literature in children without eczema. Eczema in the 42 days following vaccination did not appear to increase in severity.     

Congenital varicella syndrome in the absence of cutaneous lesions

A case of congenital varicella syndrome characterized by intrauterine growth retardation, ocular and neurologic abnormalities, but no cutaneous lesions is reported. This case highlights the risk of embryopathy from varicella infection during pregnancy in non-immune women.     

Staff immunisation: policy and practice in child care

Aim: The aims of this study were to determine the level of knowledge among child‐care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child‐care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. Methods: A cross‐sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child‐care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic‐regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. Results: Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child‐care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. Conclusions: The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment.     

Special needs of children with type 1 diabetes at primary school: perceptions from parents, children, and teachers

Objective:  To identify the special needs of children with type 1 diabetes at primary school taking into account the perceptions reported by parents, children, and teachers.
Methods:  This was a cross-sectional survey carried out at nine public hospitals with a cohort of 6- to 13-yr-old children. Parents were personally informed about the objectives of the survey and the necessity to involve their children and the teachers. The self-reporting questionnaire included demographic information as well as some questions that helped to evaluate the general situation of children with type 1 diabetes at primary school, main worries about the disease, and possible improvement measures.
Results:  A total of 430 questionnaires were completed and validated of which 39% were filled in by parents, 35% by children, and 26% by teachers. The majority of children were 10–13 yr old and came from public schools. At school, most children required glucose monitoring, but few of them (9–12%) needed insulin administration. Some parents (7%) experienced problems at their schools when they informed them about their children's disease, 2% were finally not accepted, and 1% were forced to change school. Major children's concerns included the ability to recognize hypoglycemia or to self-administer insulin. Parents, teachers, and children demanded better information at school about diabetes and about emergency management.
Conclusions:  The three population groups agreed about the necessity of having more available information on diabetes at schools. Although some discriminatory behavior was still occurring, it seemed it has been diminishing in recent years.     

Day care and asthma morbidity

An association between attendance at day care centres and lower respiratory symptoms among pre-school asthmatic children who were attending follow-up appointments at a specialist respiratory outpatient clinic was studied. Parents of 69 children completed a questionnaire. Because of the variation in the age distribution of the two groups, analysis was restricted to children aged 2-4 years old; results from 49 children were analysed. Cough, wheeze at night and wheeze on waking occurred significantly more frequently in the two weeks prior to clinic visits among asthmatics attending day care. Among asthmatic children requiring specialist outpatient follow up, those attending day care are more likely to be troubled by lower respiratory symptoms than those looked after at home.     

Observation as a therapeutic intervention for infants and young children in care

More than half of all children entering care in the UK are infants and children under five. The emotional and mental health needs of this population tend to be overlooked. Research described in this paper aimed to find out about the experience of an infant or young child in care and to inform training and support for health and social care professionals. The study found that therapeutic observation with a looked-after infant was feasible and provided an in-depth perspective on the experiences of the baby and his foster carers. The paper outlines the clinical context, defines therapeutic observation, describes stages in the first year of life of the observed infant and his transition to adoption, discusses functions of the therapeutic observer, describes applications of the research and makes suggestions for further research.     

The child group used as a reference system when analysing frequency of morbidity in day–care centres

Morbidity frequency was analysed among children attending six day–care centres in a suburb of Stockholm, Sweden. Absence due to illness was calculated annually for each child and correlated with each child's own group. Thus a child was classified as "often sick" or "mainly healthy" in relation to the other children in the child's own group, constituting a reference system. In almost every group a "sick third" was found, whose absence due to illness was twice that of the rest of the group. Children from families of lower social standing, those with a relatively large number of siblings and those living in poor social conditions were found to be among those most often reported as sick. In such families, smoking was more commonplace. These parents more often lived in a rented apartment than in a single detached owner house. Multiple linear regression analysis revealed that young mothers and children with several siblings had the strongest correlation with absence due to illness of the proband child. Increasing maternal age revealed improvement vis–a–vis all socioeconomic parameters investigated, reflecting an improvement in standing correlated to less sick children.     

Palliative care for disabled children and young people

Palliative care for disabled children and young people embraces holistic, high quality, evidence-based care, recognition and timely management of symptoms, recognition and discussion with the multidisciplinary team and with families about the possibility of dying and care and support through life, death and bereavement.Systems are being piloted across the UK to collect data about who and where children and young people with palliative care needs are and to ensure robust funding mechanisms are established for provision of care in an equitable way.Decision-making within a legal and ethical framework is paramount in this area of clinical practice, along with clinical networking within care pathways to ensure care delivered is of the highest standard.     

Evaluation of Live Attenuated Varicella Vaccine (Oka-RIT Strain) and Combined Varicella and MMR Vaccination in 13–17-Month-Old Children

ABSTRACT. The Oka-RIT strain of live attenuated varicella vaccine at dose levels 5300 PFU (high titre) and 2000 PFU (low titre) was tested in 13–17-month-old children; 50% of the children received the varicella vaccine alone, and the other 50 % received it together with a measles-mumps-rubella (MMR) vaccine. The high titre and low titre varicella vaccines induced 96% and 92% seroconversion rates, respectively. Following combined vaccination with MMR, the corresponding seroconversion rates for varicella were significantly lower at 85% and 72% respectively. Seroconversion rates to measles, mumps and rubella were not affected by the combination of varicella vaccine plus MMR vaccination. Single varicella vaccine at both titre levels was found safe, although 10% of the children had minor skin reactions, possibly attributable to the vaccine. Reactions typically associated with MMR vaccination did not significantly increase after the combined varicella plus MMR vaccination. This study confirmed that the Oka-RIT strain varicella vaccine is safe and immunogenic in healthy young children, but failed to find a totally satisfactory combination for a varicella-MMR vaccine.