百日咳疫苗接种对婴幼儿百日咳临床表现的影响

目的 探讨百日咳疫苗接种对婴幼儿百日咳临床表现的影响.方法 回顾性分析不同百日咳疫苗接种状态的百日咳婴幼儿临床表现及外周血细胞水平的差异.结果 共入组1083例<3岁百日咳患儿,其中未接种组551例,接种组532例;发病年龄<3月龄392例,含未接种372例,接种20例;≥3月龄691例,含未接种179例,接种512例...     

Immune response after influenza vaccination in children with cancer

PURPOSE: To assess the immune response to inactivated trivalent split influenza vaccine in children with cancer. PROCEDURES: Forty-four children with various types of malignancies received two doses of influenza vaccine 2-4 weeks apart. Hemagglutinin-inhibition (HI) antibody titers were determined in paired sera obtained just before the first vaccination and 4 weeks after the second vaccination. RESULTS: Influenza vaccine was administered to all children without any serious adverse effects. Protective titer rates (proportion of patients achieving antibody titers > or =40 among those with pre-vaccination titers <40) and response rates (proportion of patients with fourfold or more antibody rise) were 72% and 65% for H1N1, 60% and 40% for H3N2, and 38% and 46% for influenza B, respectively. However, patients on chemotherapy showed a significantly lower immune response to influenza A than those having completed chemotherapy; protection titer rates were 42% versus 90% for H1N1 (P = 0.006) and 25% versus 83% for H3N2 (P = 0.019). For influenza B, patients with low IgG showed a lower response rate than those with high IgG (29% vs. 61%, P = 0.040). Multivariate analysis revealed that factors significantly associated with a lower immune response were low IgG (P < 0.001) and administration of chemotherapy (P = 0.003) for H1N1, administration of chemotherapy (P = 0.008) for H3N2, and low white blood cell (WBC) count (P = 0.030) and low IgG (P = 0.030) for influenza B. CONCLUSIONS: Influenza vaccination given to children with cancer was safe and induced immune reaction comparable to healthy children, although patients on chemotherapy and/or with chemotherapy-related conditions had a limited ability to produce a sufficient immune response.     

Fever and neutropenia in children with cancer: diagnostic parameters at presentation

We evaluated 91 episodes of fever in 46 profoundly neutropenic children with cancer, in a search for any symptom, sign or laboratory test that would serve to identify patients with septicemia and differentiate them from those in no immediate need of prompt antimicrobial therapy. Seventeen episodes (19%) were bacteremias, 59 (64%) were suspected septic infections, 9 (10%) were focal bacterial infections and 6 (7%) proved not to be bacterial infections. We were unable to detect any parameter, either on admission or after two days of antimicrobial therapy (except for blood culture findings), that would be helpful in differentiating bacteremia from an episode not of bacterial origin. We focused on serum levels of C reactive protein and found them unreliable on an individual level. Prompt institution of antimicrobial therapy at the occurrence of fever results in low mortality, but does not allow assignment of cases to different categories.     

Australian guidelines for the management of children with achondroplasia

Achondroplasia is the most common form of skeletal dysplasia. In addition to altered growth, children and young people with achondroplasia may experience medical complications, develop and function differently to others and require psychosocial support. International, European and American consensus guidelines have been developed for the management of achondroplasia. The Australian focused guidelines presented here are designed to complement those existing guidelines. They aim to provide core care recommendations for families and clinicians, consolidate key resources for the management of children with achondroplasia, facilitate communication between specialist, local teams and families and support delivery of high-quality care regardless of setting and geographical location. The guidelines include a series of consensus statements, developed using a modified Delphi process. These statements are supported by the best available evidence assessed using the National Health and Medicine Research Council's criteria for Level of Evidence and their Grading of Recommendations Assessment, Development and Evaluation (GRADE). Additionally, age specific guides are presented that focus on the key domains of growth, medical, development, psychosocial and community. The guidelines are intended for use by health professionals and children and young people with achondroplasia and their families living in Australia.     

Acceptance and timeliness of standard vaccination in children with chronic neurological deficits in north-western Switzerland

There are no special recommendations for basic vaccinations in patients with chronic neurological deficits distinct from the nationwide advocated schedule in Switzerland. Reports describing adverse neurological events possibly related to vaccinations have attracted public attention. It is unclear if patients with chronic neurological deficits are more reluctantly vaccinated compared to healthy children. We therefore investigated the acceptance of vaccinations in such patients and healthy controls in a retrospective case-control study. At the University Childrens Hospital, Basel, Switzerland we investigated 100 patients with chronic neurological deficits and 200 age-matched healthy controls regarding the issue of vaccination rates and ages. The total number of administered vaccinations against diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib), mumps, measles, rubella and hepatitis B were significantly lower in patients compared to healthy controls ( P <0.01 for each of the respective vaccines). Patients had an increased risk to receive the third pertussis, diphtheria, and tetanus vaccinations (relative risks (RR) for late vaccination 1.53, 1.53, and 1.54 respectively, P <0.01 for all comparisons), the second (RR=1.60, P <0.05) and third Hib vaccinations (RR=1.52, P <0.05), and the third polio vaccination (RR=1.43, P <0.05) later than controls. Conclusion:Children with chronic neurological deficits received fewer vaccinations than healthy controls. In addition, patients received vaccinations later than healthy children. Hence, it may be assumed that children with chronic neurological deficits are at an increased risk to acquire preventable infections. Therefore, vaccination should be promoted as part of the consultation during a routine appointment with the specialist.     

Coverage of recommended vaccines in children at 7–8 years of age in Flanders, Belgium

Aim:  Evaluation of the coverage of primary diphtheria-tetanus-pertussis (DTP), poliomyelitis, hepatitis B (HBV) and measles-mumps-rubella (MMR) vaccine doses recommended before the age of 18 months in 7-year-old school children in Flanders, Belgium. Meningococcal serogroup C and DT-polio vaccines offered respectively as catch-up and booster vaccinations were also evaluated.
Methods:  Parents of 792 children born in Flanders in 1997 and selected by cluster sampling were interviewed at home in 2005. Vaccination data since infancy were collected retrospectively from vaccination documents and school health records.
Results:  Coverage rates were 88.0% for the first dose of MMR, and 72.0%, 84.2% and 91.4% for the recommended HBV, DTP and poliomyelitis primary vaccine doses, respectively. These rates included catch-up of missed infant MMR (4.9%) and HBV (6.4%) vaccinations. In addition, 88.3% of the target group received the DT-polio booster dose recommended at 6 years of age and 83.1% a meningococcal C vaccine dose. Preventive public health services as well as private physicians were involved to a varying extent. A lower socioeconomic status of the family was associated with a higher risk of nonvaccination.
Conclusion:  Vaccinators in Flanders reach children relatively well during infancy and at school age, but catch-up of missed infant vaccine doses, especially MMR, should be optimized.     

人类免疫缺陷病毒感染儿童疫苗接种情况调查

目的 了解人类免疫缺陷病毒（HIV）感染患儿这一特殊群体疫苗接种情况。方法 对截至2016年12月31日,在国家艾滋病综合防治信息系统中,现住址为湖南省、确诊HIV感染时年龄在15岁以下、可随访到的HIV感染患儿148例进行问卷调查,了解其疫苗接种、HIV感染诊断及相关疾病诊断治疗情况。结果 148例HIV感染患儿中,男70例（47.3%）,女78例（52.7%）;140例（8例拒答）知晓确诊感染HIV时的年龄为3.8（0.2~14.8）岁;感染来源为母婴传播133例（91.7%）,血液传播1例（0.7%）,不详14例（9.5%）;129例（87.2%）接受抗病毒治疗,未治疗19例（12.8%）。乙肝疫苗、卡介苗、脊灰减毒活疫苗、百白破三联疫苗接种率相对较高（70.9%~77.7%）,但远低于全国水平（≥ 97%）,后续疫苗的接种率随患儿年龄增长逐步降低。患儿接种疫苗后无严重不良反应。结论 国内儿童HIV感染途径主要是母婴传播,HIV感染儿童诊断延迟明显,疫苗接种率低,需要加强HIV感染患儿的早诊断、早治疗及疫苗接种,提高患儿生存质量。     

Paediatricians' attitudes and practices towards HPV vaccination

Aim: In June 2006, the human papillomavirus (HPV) vaccine, Gardasil, was licensed for use in the United States. We examined whether paediatricians would recommend the vaccine, obstacles they encountered and characteristics associated with not recommending the HPV vaccine to all eligible patients. Methods: Four hundred fifty general paediatricians, 200 members of the section of infectious diseases and 200 members of the section of adolescent medicine of the American Academy of Pediatrics web‐based directory were surveyed. Results: Of 752 eligible paediatricians, 373 (50%) responded. Eighty‐eight percent (292 of 332) of respondents stated that they would give the vaccine to all, 36 (11%) would give it to some and 4 (1%) would give it to none of their eligible patients. The main obstacles were cost and safety; a minority expressed concern about the vaccine's potential impact on adolescent sexual activity. Physicians who would not recommend HPV vaccination to all eligible patients were more likely to be generalists, have higher intrinsic religiosity, self‐describe as conservative, report later adoption of new drugs/vaccines, and would not encourage vaccinating their own daughter or the daughter of a close friend. Conclusion: Although paediatricians are highly supportive of the HPV vaccine, certain characteristics may predict reluctance to immunize.     

Nutritional support for children with cancer

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enterai nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enterai nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enterai nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.     

Influenza vaccination among household contacts of children with cystic fibrosis and healthy children

BACKGROUND:

It is recommended that household contacts of children with cystic fibrosis and household contacts of children <2 years of age receive annual influenza vaccinations. There is little information documenting whether this recommendation is being followed.

METHODS:

A 20-question survey was distributed to caregivers of children with cystic fibrosis and to caregivers of healthy children <17 years of age seen in a Saskatoon (Saskatchewan) tertiary care centre. Survey questions addressed the influenza vaccination status of the child and household contacts. Respondents were also asked to rate the influence of various factors on the decision to vaccinate, using a 5-point Likert scale.

RESULTS:

Reported vaccination rates were 21%, 25% and 7% among household contacts of children with cystic fibrosis, children <2 years of age and children ≥2 years of age, respectively. Advice from their physician, belief that they were too healthy, and inconvenient times and locations of vaccination centres were significant influences when compared among the three groups. Other main deterrents to vaccination were belief that the vaccine does not prevent influenza and belief that its side effects are greater than its benefits.

CONCLUSION:

By understanding motivators and barriers to vaccination among household contacts of children with cystic fibrosis, effective strategies may be implemented to improve vaccination coverage against influenza. Strong recommendations by clinicians and improved access to vaccination centres are essential components in improving influenza vaccination coverage.     

Hepatitis B vaccination and immune response in children with malignant diseases

Fifty children with malignant diseases were vaccinated against hepatitis B. Twenty-nine children suffered from leukaemia or non-Hodgkin's lymphoma; 14 of these were on intensive chemotherapy (group I) and 15 were without intensive therapy (group II). The other 21 children had various forms of solid tumours, 14 of them were on intensive therapy (group III) and 7 were without intensive therapy (group IV). To evaluate the immune response, we determined antibody titres over a period of more than 14 weeks after the first vaccination. As 22 out of 50 patients had received passive immunisation together with either the first or the first and second vaccination, antibody titres at the 14th and 18th week (i.e. more than 10 weeks after passive immunisation) were used to evaluate the vaccination results. An antibody titre of 10 mIU/ml was considered to be a positive response. All patients of group IV, but only 4 out of 14 in group III, 4 out of 15 in group II, and 0 out of 14 in group I produced antibody titres higher than 50 mIU/ml. In contrast to the full response in group IV, two-thirds of all other patients had no immune response (<10 mIU/ml). Based on our experience we recommend vaccinating patients suffering from solid tumours and receiving no intensive therapy (group IV) against hepatitis B and protecting all the other children with malignant diseases by passive immunisation, if necessary.Abbreviations ALL acute lymphatic leukaemia - AML acute myelocytic leukaemia - CML chronic myelocytic leukaemia - NHL non-Hodgkin's lymphoma - RMS rhabdomyosarcoma - HBV hepatitis B virus - HBsAg hepatitis B surface antigen - HBeAg hepatitis B e antigen - anti-HBs antibody against HBsAg - RIA radioimmunoassay - BFM 81 protocol ALL therapy protocol 1981 (Berlin-Frankfurt-Münster)     

Low-dose warfarin for the prevention of central line-associated thromboses in children with malignancies--a randomized, controlled study

Background: Central venous lines (CVLs) are essential in the care of children with malignancies, but are associated with venous thromboembolism (VTE) and infections. Effective and safe prophylactic approaches are deficient. Aim: To perform a study of adjusted low-dose warfarin for the prevention of CVL-related VTE in children with malignancies. Methods: Children with newly diagnosed cancer, a CVL in a jugular vein and an expected treatment period of over 6 mo were eligible for the study. Participants were randomized to low-dose warfarin, with intended international normalized ratio (INR) 1.3-1.9, or to a control group. Primary outcome was VTE in a jugular vein diagnosed by ultrasonography at 1, 3 and 6 mo after inclusion. Secondary outcome was CVL-related infections, mainly measured as days on antibiotics or positive blood cultures. Results: The study enrolled 73 children, and 62 completed it fully. Asymptomatic CVL-related VTE was frequent (42%), but often transient. Regardless of severity, timing and duration, CVL-related VTE was equally frequent among children on warfarin as compared to controls (p=0.44). Low-dose warfarin (p=0.59) or jugular CVL-related VTE (p=0.91) did not have any impact on days on antibiotics, but we observed a tendency towards an association between CVL-related VTE and positive blood cultures (p=0.15).

Conclusion: Our randomized study of low-dose oral anticoagulation for the prevention of CVL-related asymptomatic VTE in children with cancer did not show any benefit of warfarin adjusted to maintain INR between 1.3 and 1.9.     

Psychosocial problems in families of children with cancer

Objective The aim of this study is to assess the effect of diagnosis of cancer on the parents, to study the coping response adopted by the child and the family and to evolve counseling strategies. Methods Prospective questionnaire based. Thirty four parents of children suffering from cancer were included, of which 15 belonged to joint families and 19 to nuclear families. Results The family support played an important role in giving emotional sustenance, besides shared care of the child, the sibling and the household. Emotional and psychological impact was maximum on the mothers. Siblings of the cancer child were also affected both by way of behaviour problems and school performance. Behaviour problems in the cancer child included temper tantrums, as also verbal and physical abuse of mothers. Group therapy was useful for sharing emotional trauma and exchanging day to day problems of childcare. Positive outlook helped in better care of the cancer child. Conclusion The family structure was the foundation for emotional and psychological security. Psychological support by professional tumour support group would enhance this.     

Japanese clinical guidelines for chronic pain in children and adolescents

Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese ‘clinical guidelines for chronic pain in children and adolescents’ in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents.     

Survey of Japanese pediatricians on vaccination of children with neurological disorders

Background: Primary care physicians in Japan are often unwilling to vaccinate children with neurological disorders. The aim of the present study was to determine the state of vaccination in children who are severely handicapped and/or have convulsive disorders, in order to increase the vaccination rate in this patient population. Methods: Six hundred and eighty pediatricians belonging to Osaka Shonika Ikai were asked to answer a questionnaire, and 359 doctors responded. Results: Two hundred and thirty‐four doctors consulted for febrile seizures (Fs), 190 for epilepsy and 145 for conditions affecting severely handicapped children, responded that they refused to vaccinate. The reasons for reluctance to vaccinate these children were short interval since the last seizure, including febrile (226 doctors) and epileptic (121 doctors) seizures. It was especially likely that a child with a past history of status epilepticus would be refused vaccination. Primary care doctors are very cautious about the indications for vaccination, especially the inoculation of live vaccines, because they often induce post‐vaccination fever‐associated convulsions. Intractable daily epileptic seizures was the most common reason for refusal to vaccinate severely handicapped children. Examples of inadequate decision‐making as regards the indications for vaccination were: “need more than 6 months observation since last seizure whether Fs or epileptic”, “need EEG examination for Fs”, “contraindication because of low bodyweight and/or chronic wheezing in severely handicapped children”. Conclusions: There is a need to provide correct information about the adverse effects of vaccination and for greater cooperation between primary care doctors and pediatric neurologists.     

Immunisation in children with cancer

Immunosuppression of varying degree is present in children with cancer. This can range from mild to severe. Cancer itself, particularly leukaemia and lymphoma, can cause suppression of cellular and humoral immune function. However, cytotoxic antineoplastic therapy is the main contributor. Immune alteration is reflected by decreases in neutrophils, lymphocytes, immunoglobulin levels, and specific antibodies against previous vaccinations and infections. Immune recovery post-treatment occurs in a differential manner, with innate immune function recovering before adaptive immune function, and with B-cell function recovering faster than T-cell function. As a result of these changes children with cancer, and particularly those who are also haematopoietic stem cell transplant (HSCT) recipients, have an acquired immune deficiency, and are at increased risk of significant morbidity and mortality from infections. It is therefore important to ensure that such children are maximally protected against vaccine-preventable diseases. This can be achieved by optimising the vaccination strategy in children during immunosuppressive cancer treatment and after completion of treatment. Vaccination should be routine practice for all children treated for cancer. The vaccination strategy should not only include the patient, but also the household members and healthcare contacts of the patient.     

Japanese guidelines for the management of intussusception in children, 2011

Background: The Japanese Society of Emergency Pediatrics has formulated evidence‐based guidelines for the management of intussusception in children in order to diagnose intussusceptions promptly, to initiate appropriate treatment as early as possible, and to protect intussuscepted children from death. Methods: Literature was collected systematically via the Internet using the key words “intussusception” and “children.” The evidence level of each paper was rated in accordance with the levels of evidence of the Oxford Center for Evidence‐based Medicine. The guidelines consisted of 50 clinical questions and the answers. Grades of recommendation were added to the procedures recommended on the basis of the strength of evidence levels. Results: Three criteria of “diagnostic criteria,”“severity assessment criteria,” and “criteria for patient transfer” were proposed aiming at an early diagnosis, selection of appropriate treatment, and patient transfer for referral to a tertiary hospital in severe cases. Barium is no longer recommended for enema reduction (recommendation D) because the patient becomes severely ill once perforation occurs. Use of other contrast media, such as water‐soluble iodinated contrast, normal saline, or air, is recommended under either fluoroscopic or sonographic guidance. Delayed repeat enema improves reduction success rate, and is recommended if the initial enema partially reduced the intussusception and if the patient condition is stable. Conclusions: The guidelines offer standards of management, but it is not necessarily the purpose of the guidelines to regulate clinical practices. One should judge each individual clinical situation in accordance with experiences, available devices, and the patient's condition.