Epidemiologic study of Kawasaki disease in Korea, 1997-1999: comparison with previous studies during 1991-1996

We performed a retrospective epidemiologic survey on Kawasaki disease (KD) from 1997 to 1999 in Korea. We sent a questionnaire to 111 training hospitals, and summarized the data from 50 hospitals that responded. Data from a total of 3,862 cases were collected, which showed no difference in annual incidence and a seasonal predilection for summer. The male-to-female ratio was 1.51:1, and the mean age was 29.7 months. The prevalence of sibling cases was 0.26%, and the rate of recurrent cases was 2.3%. The proportion of patients with KD among total hospitalized pediatric patients was 1.19% in average, showing a significant difference according to the regions. Coronary arterial (CA) abnormalities were detected by echocardiography in 19.8% of cases (737/3,723) including dilatations in 601 cases (16.1%) and aneurysms in 191 cases (5.1%). Data from total 8,251 cases in the 1990s including the cases in the present study, in Korea showed a mean age of patients 28.9 months, male-to-female ratio 1.6:1, seasonal predilection for summer, prevalence of sibling cases 0.24%, rate of recurrent cases 2.3%, incidence of CA abnormalities 21.0%, and incidence of CA aneurysms 5.2%, with statistically significant decreasing trends in the male-to-female ratio and the rate of CA abnormalities.     

Virus evolution during a severe dengue epidemic in Cuba, 1997

Full-length genomic sequences from six DENV-2 isolates sampled at different times during a dengue outbreak that occurred in Cuba in 1997 were determined. Phylogenetic analysis indicated that these isolates fall into the "American/Asian" genotype. Genome analysis revealed strong conservation of the structural proteins and the non-coding regions (5' NCR and 3' NCR). Nucleotide substitutions were observed in non-structural genes and most notably in the NS5 gene. There was a clear pattern of virus evolution during the epidemic; the earliest isolates sampled differed from those sampled later by amino acid replacements in the NS1 and NS5 proteins, although there was no evidence that these represented escape mutants. Further studies are therefore required to define the functional role of amino acid replacements observed and their possible relation to disease severity.     

Pediatric imported malaria. Experience of the hospital center of Versailles (1997-2001)

Few data are available about pediatric imported malaria, whereas the number of cases seems in constant increase. Patients and methods: all pediatric malaria cases diagnosed by a positive thin or thick blood film at the Versailles Hospital, from January 1997 to December 2001, were studied retrospectively. Results: sixty cases of pediatric imported malaria were studied. They were 58 cases of uncomplicated malaria and 2 cases of severe malaria; 85% of the children had travelled to sub-Saharan Africa and 15% to Oceania; 90% of the children were of African origin. Plasmodium falciparum was found alone in 84% of the cases. The anti-malarial chemoprophylaxis was inappropriate in 92% of the cases. No child had profited from preventive measures against mosquitos. Fever > 37,5 degrees C was observed in 100% of the cases. The other clinical signs were present in less than 50% of the cases. The median of haemoglobin and platelet was 10.5 g/dL and 141,000/mm(3), respectively. After treatment, the evolution was good in all the cases, without relapse or any consequences. Discussion/conclusion: our study, in agreement with the national data, confirms the increase in the number of case of pediatric imported malaria, and underlines the mediocrity of the prevention, in particular in term of anti-malarial chemo-prophylaxis. These data, in a context of regular increase of international travels to endemic areas, suggest the necessity to improve the information of the general public, and the urgency of a better staff training of health care workers concerning malaria, in order to improve the prevention and the treatment of this potentially fatal disease.     

Clinical experience of 17 cases of imported malaria at a Taiwan university hospital, 1999-2005.

BACKGROUND AND PURPOSE: Malaria had been eradicated in Taiwan since 1965, but there are currently 30 to 50 imported cases annually. The management of imported malaria continues to be challenging due to evolving drug resistance of Plasmodium parasites. METHODS: We retrospectively analyzed the clinical presentations, treatment, and outcomes of all 16 adult patients (17 episodes) with imported malaria diagnosed during 1999-2005. The clinical and laboratory features were obtained from the medical records. RESULTS: Malaria was acquired in sub-Saharan Africa in 6 cases and Southeast Asia in 11 cases. The initial presentations were nonspecific, including fever (17/17 cases), headache (11/17), nausea, vomiting or diarrhea (10/17), cough (3/17), thrombocytopenia (15/17), mild hyperbilirubinemia (13/17), leukopenia (6/17) and anemia (4/17). Careful travel history led to the correct diagnosis in 16 of 17 cases. All 17 cases survived without any recrudescence. Four cases presented with hyperparasitaemia (>5%). Two patients were admitted to an intensive care unit for complicated malaria, and both were cured by artesunate plus mefloquine. Some suboptimal practices, such as non-standard therapeutic regimen and lack of daily parasitemia counting were noted. CONCLUSIONS: A differential diagnosis of malaria should be made in all patients who have fever after travel to any endemic area. To further improve the management of imported malaria, timely consultation of an experienced infectious disease specialist is necessary.     

Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group]

Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.     

A study of enterovirus isolations in Glasgow from 1977 to 1997.

The number and range of enteroviruses isolated in the Regional Virus Laboratory, Glasgow during 1977-1997 was determined. Over this period, 3,039 enterovirus isolations were reported. The echoviruses represented 67% of isolations with echovirus 4 (due to an outbreak in 1990), echovirus 30 and echovirus 11 being the most frequently isolated types. The pattern of prevalence of non-polio enteroviruses had changed from the previous 20-year period with echovirus types isolated more often (77% vs. 55.4%) and coxsackieviruses isolated less often (23% vs. 44.6%). The polymerase chain reaction (PCR) introduced into the routine diagnostic service in 1996 increased the detection of enteroviruses from cerebrospinal fluid samples compared with traditional cell culture methods. Finally, the 5' nontranslated region (NTR, bases 63-475) and the VP4/VP2 region (bases 581-1199) of selected echovirus 30 and coxsackie B3 isolates were sequenced. These represented endemic and epidemic types respectively and were shown to be closely related within their type, but different from the published sequences. The current echovirus 30 strains differed from 1966 isolates by 16-20% in both the 5' NTR and VP4/VP2 regions. The coxsackie B3 isolates, predominant in 1997 after 5 years of absence, were also dissimilar from previously isolated strains, causing a small outbreak.     

2006-2010年广州市输入性登革热监测分析及防控策略探讨

目的分析2006-2010年广州市输入性登革热病例的流行病学特征,探讨防控策略和措施。方法从国家《疾病监测信息报告管理系统》、登革热个案调查表和调查报告中收集病例资料,设计并建立输入性登革热病例数据库,采用描述流行病学方法分析其流行病学特征。结果 2006-2010年广州市共报告输入性登革热病例66例（7.21%）,2006年（1.29%,10/775）占全年报告病例总数的构成比较低,2007年（44.44%,16/36）、2008年（50.00%,3/6）、2009年（83.33%,15/18）、2010年（27.16%,22/81）构成比均较高。66例中男49例（74.24%）,女17例（25.76%）;职业以商业服务者（39.40%,26/66）、干部职员（13.64%,9/66）、家务及待业者（10.61%,7/66）为主;年龄集中在20～50岁（83.33%,55/66）;发病高峰为8～11月份（69.70%,46/66）;输入来源洲依次为亚洲（89.39%,59/66）、非洲（6.06%,4/66）、拉丁美洲（3.03%,2/66）和大洋洲（1.52%,1/66）,最大输入来源地为东南亚国家（74.24%,49/66）。入境前发病病例（69.70%,46/66）多于入境后发病病例（30.30%,20/66）。结论广州市输入性登革热病例数占报告病例总数的构成比较大,防控重点在于输入性病例的发现和报告能力,需提高出入境口岸检疫能力和医疗机构的及时诊断和报告能力。     

Mortality among drug addicts in Bologna - A cohort study (1977-1997)

Our study concerns the life status at the 31st december1997 of 1214 DA (drug addicts, mostly heroin addicted), enrolled by a SerT (Servizio per Tossicodipendenti, DA Healthcare Unit) in Bologna over the 1977-1996 period. All subjects were categorised by their HIV status (positive, negative or unknown), life status (alive or dead) and cause of death. Data were analysed with the Chi-square test and the test of difference between two proportions. We calculated the standard mortality ratio (SMR), the mortality rates per 100 person-years (P-Y), and the death probability according to Grevile's formula, both in the population of Bologna and in our DA population. We observed 182 deaths (14.99%) among the 1214 monitored over a 8012 person-year period. From 1984 to 1997 the mortality rate in the DA population was 2.27 per 100 P-Y. In the 1986-1996 period the death probability among DA was 4-to 5-fold higher than in the general population for the same age groups. From 1977 to 1983 no disease was recorded among the first 200 enrolled subjects. From 1984 to 1977 mortality was 28.1% among the 426 HIV-positive DA, 0.46% among the 433 HIV-negative DA, and 17.1% among the 355 DA with unknown HIV status. AIDS caused 106 deaths (58%), overdoses 40 (22%), car accident 15 (8%), hepatic cirrhosis 9 (5%), and other causes (miscellany) 11 (6%). In 1 (0.5%) case the cause of death was unknown. The mortality rate (MR) for AIDS was 12.8% for females, 7.4% for males (p<0.05); the MR for overdose was 3.8% for males, 0% for females; the MR for car accident was 1.2% for males, 1.3% for females; the MR for the miscellany of other causes was 1.3% for males and 0% for females. The SMR in the 20-49 age group in the 1984-1990 period was 34.7, while in the 1991-1996 period it was 143.4.     

Epidemiological evaluation of Serratia marcescens isolates in one Japanese hospital during the two years from April 1997 to March 1999

One hundred fourteen isolates of Serratia marcescens from different patients in Showa University Fujigaoka Hospital during the 2 years from April 1997 to March 1999 were investigated in this study. The isolation frequency(37%, 43 of the isolates) of O-serotype 14(O14) was highest among the 16 different serotypes, and that(24%, 27 of the isolates) of O2 was secondarily highest, while these types were frequently isolated from patients in the surgical ward. O14 with major bacteriocin types 4 and 9(B4 and B9, respectively) showed resistance to piperacillin, the third and fourth generation cephems, new quinolones and aminoglycosides except gentamicin tested. However, O2 with major B1 and B5 showed much greater sensitivity to the antimicrobial agents tested than O14. Furthermore, O2 and O14 were frequently isolated from patients' sputa(41%, 11 of the 27 isolates) and urine(72%, 31 of the 43 isolates), respectively. These findings suggested that S. marcescens O14 with B4 and B9, more resistant to various agents, and O2 with B1 and B5, more sensitive to various agents, show a tendency to inhabit the urinary and respiratory tracts in the hospital patient's body, respectively, having a high risk of hospital infection.     

Hypersensitivity to the imported fire ant. A report of 49 cases.

Two South American species of the fire ant group, Solenopsis richteri and Solenopsis invicta, now occupy more than 150 million acres in 13 southern states and cause systemic allergic reactions to their stings. We report 49 cases of such reactions with case reports and documentation. Specificity of the sting was documented by either typical pustule formation or positive skin tests. Of 37 patients treated with hyposensitizing injections, 10 have subsequently been restung. Only one suffered a systemic reaction. Problems of cross-reactivity with other insects are discussed and the literature is reviewed. Hypersensitivity to the imported fire ant continues to be a serious problem in the southern United States and appears to be amenable to properly instituted hyposensitization therapy.     

Respiratory viral infections among pediatric inpatients and outpatients in Taiwan from 1997 to 1999

The present study examined the association of specific virus infections with acute respiratory tract conditions among hospitalized and outpatient children in a subtropical country. A total of 2,295 virus infections were detected in 6,986 patients between 1997 and 1999, including infections caused by respiratory syncytial virus (RSV) (1.7%), parainfluenza virus (2.0%), influenza B virus (2.6%), adenovirus (4.0%), herpes simplex virus type 1 (4. 4%), influenza A virus (5.5%), and enterovirus (12.7%). There were 61 mixed infections, and no consistent seasonal variation was found. One or more viruses were detected among 24.8% of hospitalized patients and 35.0% of outpatients. The frequencies and profiles of detection of various viruses among in- and outpatients were different. The occurrence of enterovirus infections exceeded that of other viral infections detected in 1998 and 1999 due to outbreaks of enterovirus 71 and coxsackievirus A10. RSV was the most prevalent virus detected among hospitalized children, whereas influenza virus was the most frequently isolated virus in the outpatient group. Most respiratory viral infections (39.3%) occurred in children between 1 and 3 years old. RSV (P < 0.025) and influenza A virus (P < 0.05) infections were dominant in the male inpatient group. In addition, most pneumonia and bronchiolitis (48.4%) was caused by RSV among hospitalized children less than 6 months old. Adenovirus was the most common agent associated with pharyngitis and tonsilitis (45.5%). These data expand our understanding of the etiology of acute respiratory tract viral infections among in- and outpatients in a subtropical country and may contribute to the prevention and control of viral respiratory tract infections.     

Characteristics of epidemiological strains of influenza A virus (H3N2) isolate in 1997-1999. Virus A/Moscow/10/99--a candidate to become the vaccine strain

Antigenic properties of influenza A(H3N2) viruses isolated during two epidemic seasons 1997-98 and 1998-99 in Russia are analyzed. All strains are antigenic variants of the reference strain A/Sydney/5/97. Characteristics of epidemic strain A/Moscow/10/99, proposed by WHO expert committee as vaccine strain for 1999-2000 have been studied. This strain, isolated on chick embryos, is characterized by high reproductive activity in chicken embryos with an infectious titer of 10(6) EID50/0.2 ml, easily adapts to MDCK culture, and has a thermostable hemagglutinin.