Lead exposure and iron deficiency among Jammu and New Delhi children

In order to examine the prevalence of lead exposure and iron deficiency in Jammu, blood lead (B-Pb) and erythrocyte protoporphyrin (EP-ZnPP) levels were measured in a group of 125 children and compared with B-Pb and EP levels of 46 New Delhi children. The mean B-Pb level of Jammu children was 15 μg/dl and ZnPP level 46 μg/dl. The frequency distribution of B-Pb in Jammu children according to the 1997 CDC stratification showed that only 33% were below the 10 μg/dl “normal” threshold levels and 50.5% were between 10–19 μg/dl, an increasing level of concern. The remaining 16.5% were in the medical intervention lead poisoned level between 20–87 μg/dl with corresponding EP levels between 29–160 μg/dl. The mean B-Pb and ZnPP levels for New Delhi children were 14 μg/dl and 55 μg/dl respectively. This study on Jammu children shows a modest increase in mean B-Pb and EP levels from those in 1985; the percentage of children with higher levels of B-Pb>10 μg/dl have significantly increased. Moreover, the continued underlying high prevalence of iron deficiency among these children predisposes them to increased lead absorption from various sources thus aggravating further, the detrimental effects of lead. Therefore, a more extensive screening of all children below 10 years of age and an ongoing B-Pb and EP monitoring and iron supplementation programme for Jammu and New Delhi is essential. An environmental assessment of the sources leading to serious lead intoxication problem in Jammu, a rapidly growing and overpopulated city of the state of Jammu and Kashmir is strongly recommended.     

Erythrocyte protoporphyrin and blood lead levels of children from Jammu and Srinagar and papier mache trainees

In order to examine the prevalence of iron deficiency and environmental lead absorption in children, erythrocyte protoporphyrin (EP) and blood lead (B-Pb) levels were measured in a group of 112 children from Jammu and Srinagar. The mean EP levels were 50 and 59 μg/dl and mean B-Pb were 15 and 8 μg/dl respectively. Similarly, the mean B-Pb and EP levels of papier mache trainees/workers were 23/25 and 96/98 μg/dl respectively. These results suggest higher incidence of iron deficiency in Srinagar children compared with those in Jammu. However, the mean B-Pb level of Jammu children was twice those in Srinagar. While this follow-up study on papier mache trainees/workers shows significant improvement in B-Pb since 1981, these levels are close to the currently recognized cut-off levels for children. Moreover, the continued underlying iron deficiency predisposes these young female trainees/workers to enhanced lead absorption, thus regular monitoring of both EP and B-Pb is recommended.     

The prevalence and etiology of anemia among HIV-infected children in India

In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2–12 years were prospectively enrolled in 2007–2008. Measured parameters included serum ferritin, vitamin B₁₂, red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B₁₂ deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18–26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score −2.5 vs. -1.9), stunted (height Z-score −2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p < 0.01), and higher log viral load (11.1 vs. 7.1, p < 0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p = 0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p < 0.01). Conclusion Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.     

Supplemental food may not prevent iron-deficiency anemia in infants

Objective  The present study evaluates the role of supplementary food and medicinal iron intake in preventing irondeficiency anemia in children aged between 4 to 6 months. Methods  During a case-control study in “Tabriz Children Hospital”, nutritional and medicinal-iron intake of 60 consecutivelyselected patients with iron-deficiency anemia were compared with 60 non-anemic children of similar age and sex distributions. Results  The mean hemoglobin concentration, corpuscular volume and serum iron were 9.11 g/dl, 65.41 fL and 19.33 μg/dl, in case group; and 12.6 g/dl, 75.18 fL and 78.28 μg/dl, in control group, respectively. There was no statistically significant difference between age of case and control groups when complementary-semisolid foods were started (P=0.058), but the mean of received medicinal iron in case group was significantly lower than control group (P<0.001). Conclusion  Supplementary food intake alone is not efficient to prevent iron deficiency anemia since the age of 4–6 months. So, regular administration of medicinal iron is crucial to prevent iron-deficiency anemia in children aged 4–6 months.     

Iron food supplement

Objective : To develop an iron rich supplement with locally available foods and to test its feasibility in school going children (7–9 Years) belonging to low income families.Methods : From the upper primary school in Rajendranagar 7–9 year-old children were screened for hemoglobin (Hb) levels and 36 children having Hb levels below 11 g/dl were selected. Based on their Hb levels, age, and gender, 24 children were grouped as experimental and the rest as control. A supplement food (laddoo) was developed using locally available foods like jaggery, processed rice flakes, graden cress seeds and amaranth seeds (45:40:10.5). In the experimental group, children were given oneladdoo per day for a period of 60 days. Effect of supplement on Hb levels, height and weight was assessed.Result : Anthropometric parameters showed that 97% of these children were undernourished, majority (50%) were in grade II malnutrition followed by grade (25%) and grade II (22%). A significant increase in Hb levels was observed in both the boys and girls after 30 days of supplementation only. The increase was comparatively more in the first 30 days than the second 30 days. The overall increase in Hb levels was more in 7–8 years than the 8–9 years age group. In majority of the subjects progression from one Hb level to the next higher level was observed. There was no significant improvement in their height and weight.Conclusion : The product developed contributed around 39-mg% iron. Thus its efficacy as an iron rich supplement in combating iron deficiency anemia is reflected in the results obtained.     

Vitamin A status of socio-economically backward children

A comprehensive survey was carried out to asses the Vitamin A status of pre-school (0–6 yrs.) and school age (6–12 yrs.) children of socio-economically backward families from slums of Bombay and its suburbs. The Vitamin A, protein, calories and iron from the rice and dal based diet was found to be below recommended dietary allowances (RDA). Among the 1956 children surveyed 20% of the children showed low (<20 μg/dl) serum vitamin A levels. 4.8% of the children were suffering from one or the other signs of Vitamin A deficiency. Rose Bengal stain test (RBST) and conjuctival impression cytology (CIC) indicted the signs of mild conjuctival xerosis and of early epithelial changes which were correlated with serum vitamin A levels. Serum iron, PCV, Hb and RBC levels were below normal. The anthropometric measurements of these children were below 50th percentile of Indian Council of Medical Research (ICMR) standards. Due to lack of proper nutrition, the overall growth of children is either retarded or not upto the standard levels as was noted in majority of the children.     

Blood lead levels of children with pica and surma use

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 μg/dl (±SD 6.8: median 10 μg); only 6 had high levels between 30–33 μg/dl. In 88 children with pica, the mean blood lead level was 23.0 μg/dl (±SD 13.82; median 17 μg) which was significantly higher than the control; 26 had high levels between 30–92 μg/dl. Sixteen children with pica and surma- use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.     

Iron status in presumably healthy children 10 months, 2 years and 4 years of age

Iron status was assessed using a combination of several biochemical indicators (serum ferritin, erythrocyte protoporphyrin, serum iron, MCV, hemoglobin) in 3,676 apparently healthy children. Children who were 10 months, 2 years and 4 years of age were selected from the population undergoing a free medical check up in a Paris Child Health Center. The prevalence of iron deficiency in children of parents from continental France was 29% in the 10 month olds, 13% in the 2 year olds and 7% in those who were 4 years of age. Corresponding figures in children born of immigrant parents were 50%, 44% and 15% respectively. Iron deficiency anemia was found in 8% of 10 month olds from continental France versus 23% in the other group. Children born of parents from the South Sahara were found to be at high risk for iron deficiency.     

Iron nutritional status of preschool children

Low hemoglobin and low MCHC levels were indicative of high incidence of iron deficiency in preschool children. The extent of iron deficiency as assessed by serum ferritin and free erythrocyte protoporphyrin showed a different trend. While FEP levels were highly suggestive of extensive iron deficiency (in 40–45% of children below the age of 5 years), low serum ferritin was seen in only 16–20% of children. The discrepant finding of high serum ferritin, and high erythrocyte protoporphyrin despite low MCHC in the present study, possibly reflects iron deficiency status along with chronic infection resulting in hyperferritinemia and hyperprotoporphyrinemia. It may be also due to associated folate deficiency resulting in non utilization of iron leading to the elevated levels of protoporphyrin.     

Lipid and lipoprotein profiles in children with familial hypercholesterolaemia: effects of therapy

In 71 children with familial hypercholesterolaemia the effect of dietary and/or medical treatment was evaluated. Initial total cholesterol and low density lipoprotein (LDL)-cholesterol levels were significantly lower in children who were consecutively treated by diet (Step-One-Diet) than in those who received additional medication. By dietary treatment, the median total cholesterol level (236.5 mg/dl; range 210–510 mg/dl) was reduced by 7.4% and the median LDL-cholesterol level (162 mg/dl; range 126–423 mg/dl) by 9.9%. By dietary and medical therapy, the median total cholesterol level (330 mg/dl; range 270–424 mg/dl) was reduced by 29.7% and the median LDL-cholesterol level (263 mg/dl; 192–333 mg/dl) by 25.9%. High density lipoprotein (HDL)-cholesterol and HDL 3 remained unchanged. HDL 2 showed a significant decrease of 15.6% up to 27 mg/dl (13–42 mg/dl) on medical treatment. Apolipoprotein A I levels did not change during therapy. Initial apolipoprotein B levels were significantly higher in children who were treated by diet and medication and were reduced by 28.9% by combined therapy. In 28 patients (39.4%) an excess of lipoprotein (a) was detected. Regarding the apolipoprotein E phenotype, 32.2% of the patients carried the risk gene ɛ4 in a hetero- or homozygous form. Conclusion Early dietary and/or medical treatment in hypercholesterolaemic children significantly ameliorates the lipoprotein status. The pretherapy lipoprotein status seems to prognosticate the effectiveness of therapy. Received: 16 April 1997 / Accepted in revised form: 27 May 1998     

Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia

The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7–18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1–3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7–68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. Conclusion: The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children’s population.     

Iodine nutritional status of children in North East India

Objective To assess the iodine nutritional status of school children in selected areas of Imphal West District of Manipur where endemic goitre and associated iodine deficiency disorders (IDD) are prevalent in the post-salt iodization period. Methods A total of 961 school children in the age group 6–12 yrs of both sexes were clinically examined for goiter from three study areas-one from rural block and two from urban areas. One hundred twenty urine samples were, analysed for iodine and thiocyanate respectively. One hundred and five edible salt samples were also collected from the households to evaluate the iodine content. Drinking water samples from different sources were collected and iodine level was analysed to study the bioavailability of iodine in the region. Results The total goiter rate was 34.96% (Grade 1–32.15%; Grade 2–2.81%) showing that IDD is a severe public health problem. The median urinary iodine levels in the studied areas were in the ranges from 12.5–17.5 μg/dl indicating no biochemical iodine deficiency in the region. Mean urinary thiocyanate level was 0.839±0.33 mg/dl showing that the people consume sufficient foods containing thiocyanate precursors. About 82% salt samples had iodine level more than 30 ppm and the iodine content in salt samples less than 15 ppm was only about 3% indicating the salt samples at house hold contain adequate iodine. Conclusion Iodine content in drinking water samples ranged from 1.8–2.6 μg/l showing that the studied region is environmentally iodine deficient. Inspite of the consumption of adequate iodine, the existing goiter prevalence among school children during post salt iodization phase ensures that environmental factors other than iodine deficiency may have the possible role in the persistence of endemic goiter in the population. The role of thiocyanate in this regard may not be ruled out.     

Serum transferrin receptor in children and adolescents with inflammatory bowel disease

Iron studies are difficult to interpret in patients with chronic inflammatory states such as inflammatory bowel disease (IBD). Serum transferrin receptor (TfR) has been reported to be a reliable tool for the diagnosis of iron deficiency in adults. Our aim was to evaluate the role of serum TfR in diagnosing iron deficiency in children and adolescents with IBD. A total of 63 consecutive patients with IBD, aged 9 to 22 years (median 15 years), were tested for serum haemoglobin level, mean corpuscular volume (MCV), and serum iron, transferrin, ferritin and serum TfR levels. Those found to be anaemic were compared with seven age-matched subjects with iron deficiency anaemia (IDA) and 24 age-matched children without signs of anaemia or inflammation. Of the 63 patients with IBD, 26 had anaemia. Based on ferritin levels and MCV indices, anaemia was classified as IDA in 11 patients and as anaemia of chronic disease (ACD) in 15 patients. Mean serum TfR level in normal controls was 3.5 mg/l (range 1.2–8.2 mg/l). Mean (±SD) serum TfR levels were significantly lower in the IBD patients with ACD (5.3 ± 2.3 mg/l) than in the IBD patients with IDA (8.2 ± 3.1 mg/l) (P < 0.05). Serum TfR levels above 5 mg/l identified 10/11 IBD patients with IDA. The calculated TfR/ferritin ratio was 84 (range 17–367) for controls and 133 (range 6.4–1840) for IBD patients. A cut-off level of 350 (91% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value) was established for the diagnosis of IDA in IBD. Conclusion The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level ≥350. Received: 1 June 1999 / Accepted: 16 February 2000     

Iodine deficiency in district Kinnaur, Himachal Pradesh

The state of Himachal Pradesh is a known iodine deficiency endemic region since the last 40 years. The state government is supplying iodised salt to the district since 1970 No recent survey has been conducted on the prevalence of iodine deficiency from the district Kinnaur which is located at an average altitude of 10,000 feet above sea level. A total of 1094 children in the age group of 6–10 years were included in the study and clinically examined. The total goitre prevalence of 6.1% was found in the subjects studied. Urine samples were collected from 226 children and were analysed using standard laboratory procedures. It was found that the percentage of children with <2 mcg/dl, 2–4.9 mcg/dl, 5–9.9 mcg/dl and 10 and above mcg/dl of urinary iodine excretion (UIE) level was 1.3, 5.8, 10.6 and 82.3 respectively. A total of 242 salt samples were collected and analysed using the standard iodometric titration method. Results showed that almost 90% of the families were consuming salt with an iodine content of 15 ppm and more which is the stipulated level of iodisation of salt. The findings of the study indicate that iodine nutrition is in the transition phase from iodine deficient to iodine sufficient. Findings revealed a need for further strengthening the monitoring of the quality of salt being distributed in Kinnaur to achieve elimination of iodine deficiency.     

Ocular health of rural children with special reference to vitamin ‘A’ deficiency

Primary school children of a rural area numbering 400 were screened to assess their ocular health particularly for presence of vitamin ‘A’ deficiency disease. A major proportion of children (33.0%) suffered from trachoma followed by vitamin ‘A’deficiency diseases of eye (20.25%). Most of the children with deficiency disease consumed less than 1400 calories daily in their diet. Serum vitamin ‘A’ levels estimated in limited cases revealed that all children with deficiency diseases had lower values than normal, even those with no manifestations (control) were near the vicinity of lower margin of normal range (10ug/100 ml). Application of primary levels of prevention will help in preventing the common ocular conditions in rural areas.     

Lipoprotein(a) and cardiovascular risk factors in a cohort of 6-year-old children. The Rivas-Vaciamadrid Study

We have studied the distribution of lipoprotein(a) (Lp(a)) and its relation to lipid profiles and a family history of cardiovascular disease in grandparents in a cohort of 673 6-year-old Spanish children. Lp(a) levels were highly skewed, showed no differences between sexes and had no relevant relations with anthropometric variables. When compared with children without a family history of stroke, children with a family history of this disorder showed significantly higher levels of Lp(a) (median 13 mg/dl, range 2–110 mg/dl versus 9 mg/dl, range 2–120 mg/dl, P =0.02). Also the percentage of children with a family history of stroke was higher in the group of children with Lp(a) levels above 30 mg/dl than in the group who exhibited lower levels (20.9% versus 10.4%, P =0.002). Children with a family history of coronary heart disease had higher levels of Lp(a) than children without such history (median 14 mg/dl, range 2–120 mg/dl versus 8 mg/dl, range 2–62 mg/dl, P =0.03). Finally, when compared with children with Lp(a) levels <30 mg/dl, those with Lp(a) levels above 30 mg/dl showed significantly higher mean levels of total cholesterol (174.9 versus 169.4 mg/dl, P <0.05), low-density lipoprotein-cholesterol (109.1 versus 102.4 mg/dl, P <0.05), and apolipoprotein B (81.9 versus 74.6 mg/dl, P <0.05). Conclusion: our study shows the existence of an association between high levels of lipoprotein (a) in 6 year-old children and a family history of both cerebrovascular and coronary disease in grandparents. High levels of lipoprotein (a) were also associated with high levels of low-density lipoprotein-cholesterol and apolipoprotein B.Abbreviations Apo apolipoprotein - LDL low-density lipoprotein - Lp(a) lipoprotein(a)     

SEVERE IRON DEFICIENCY ANEMIA IN 42 PEDIATRIC PATIENTS

The objective of this study was to determine the clinical and laboratory features of children with severe iron deficiency anemia. The authors retrospectively reviewed the charts of 198 children with iron deficiency anemia to ascertain cases of severe iron deficiency anemia. Forty-two children with severe iron deficiency anemia were evaluated. The median age was 21 months (range, 7-240 months) at diagnosis and 27 children were 13-24 months of age. For 35 children the major source of calories was derived from cow's milk. The median hemoglobin was 4.6 g/dL (range, 2.1-6 g/dL) and the median serum ferritin was 5 &#119 g/L (range, 1-11 &#119 g/L). Twenty-nine received oral iron and 13 required packed red blood cell transfusions because of co-morbid cardiorespiratory distress. Severe iron deficiency anemia mostly affects children during their second year of life. Oral iron therapy is sufficient for most children, but packed red blood cell transfusions may be needed.     

Iron supplementation in children with Celiac Disease

Objective : To evaluate the effect of iron supplementation, in addition to gluten free diet (GFD), on hematological profile of children with Celiac Disease (CD).Methods : Children diagnosed as CD as per modified ESPGAN criteria were prospectively evaluated for their hematological profile at the time of their enrolment and after consuming GFD for at least one year. The results were compared with age and sex matched controls. Evaluation of hematological profile included hemoglobin estimation, complete blood counts, peripheral blood smear examination, serum iron, total iron binding capacity (TIBC), and serum ferritin estimation. All the enrolled cases were given iron supplementation in addition to exclusion of gluten from their diet. Repeat intestinal biopsy was performed in all the cases after completing 1 year on GFD.Results : Twenty one children (mean age 6.67 years, range 4 2–11 years) diagnosed as CD who completed at least one year of regular follow up on GFD (mean 1.5 years, range 1 2–2 years) were analysed for their hematological profile at the time of enrolment and after consuming GFD and iron supplementation. At the time of enrolment all the children had hemoglobin level <11 gm%, 78% had microcytic hypochromic anemia and 22% had dimorphic anemia, with lower mean MCV, MCH and serum ferritin levels, and a significantly higher mean TIBC as compared to controls (p <0.001). In the follow up evaluation of these cases on GFD, mean hemoglobin levels were comparable with controls but the cases continued to have lower mean MCV, MCH serum ferritin levels (p <0.05) and higher mean TIBC (p <0.05). Seven children had mild anemia. Serum ferritin levels showed a negative correlation with the grade of villous atrophy and lamina propria infiltrate.Conclusion : Our results suggest that iron deficiency anemia (IDA) is commonly associated with CD and iron deficiency state continues for a longer time even after excluding gluten from the diet and iron supplementation. Apart from offering them GFD rich in iron, early detection and treatment of IDA and prophylactic iron folic acid supplementation will go a long way to optimize their mental and psychomotor functions.     

中国7个月～7岁儿童铁缺乏症流行病学的调查研究

目的　调查我国儿童铁减少 (ID)、缺铁性贫血 (IDA)及铁缺乏症患病率。方法　采用分层抽样的方法 ,以全国 15个省 ,2 6个市县为调查点 ,随机抽取 9118名 7个月～ 7岁儿童为调查对象 ,检测末梢血血红蛋白 (Hb)、锌原卟啉 (ZPP)、血清铁蛋白 (SF)等指标。结果　 7个月～ 7岁儿童ID32 5 %、IDA 7 8% ;7～ 12个月ID 4 4 7%、IDA 2 0 8% ;13～ 36个月ID 35 9%、IDA 7 8% ;37个月～ 7岁ID 2 6 5 %、IDA 3 5 %。不同年龄组儿童ID、IDA、铁缺乏症患病率由高到低依次为 7～ 12个月 (婴儿组 ) ,13～ 36个月 (幼儿组 ) ,37个月～ 7岁 (学前组 ) ,各年龄组差异有显著意义 (P <0 0 1)。农村婴儿组ID 35 8%、IDA 30 1%、Hb ( 98 8± 9 1)g/L ;城市婴儿组ID 4 8 1%、IDA 16 8%、Hb ( 10 1 0± 6 8)g/L。农村幼儿组ID 31 0 %、IDA 15 5 %、Hb ( 98 2± 10 5 )g/L ;城市幼儿组ID 38 0 %、IDA 4 4 %、Hb( 10 2 8± 6 9)g/L。农村学前儿童组ID 2 7 6 %、IDA 6 3%、Hb( 10 1 2± 8 6 )g/L ;城市学前儿童组ID2 6 0 %、IDA 1 9%、Hb( 10 4 2± 4 4 )g/L。农村 7个月～ 7岁儿童铁缺乏症患病率 4 2 0 % ,城市 7个月～ 7岁儿童铁缺乏症患病率 39 5 % (P <0 0 1)。城市婴儿和幼儿ID患病率显著高于农村 (P <0     

Epidemiological characteristics of pertussis in Estonia,Lithuania, Romania,the Czech Republic,Poland and Turkey—1945 to 2005

Pertussis epidemiology was examined in selected Central and Eastern European countries andTurkey (CEEs) from 1945 to 2005. Epidemiology and immunisation coverage data were collected fromNational Health Departments and Epidemiology Institutes. Pertussis diagnosis was made by the World Health Organization (WHO) clinical criteria, laboratory confirmation and/or epidemiological link, except for Romania (WHO clinical case definition used). In the pre-vaccine era, pertussis incidence (except Turkey) exceeded 200/100,000 (range180–651/100,000), with 60-70% of cases occurring in pre-school children. Until 2007, a second-year booster was givenin Estonia, Lithuania and Turkey, and an additional pre-school booster elsewhere. During 1995–2005, immunisation coverage by the age of 2 years exceeded 80% (range 80–98%) and, excluding Estonia, pertussis incidence was <3/100,000. Age-specific incidence rates rose in 5–14 year olds in Poland, Estonia and the Czech Republic. Incidence rates in children <1 year of age remained unchanged. There were two age distribution patterns. In the Czech Republic and Estonia, 16% of cases occurred in pre-school children and 17% and 22% in children >15 years of age, respectively; in Romania, Turkey and Lithuania, 51%, 71% and 73%, respectively, occurred in pre-school children and <7% in children aged >15 years.Pertussis infection persists, despite high immunisation coverage. Compared with the pre-vaccine era, the age distribution changed differentially in CEEs, with an apparent shift towards older children. Sources of support  This review of data was produced with the financial support of GlaxoSmithKline Biologicals.