Changing patterns of hepatitis A and E sero-prevalences in children after the 1999 earthquakes in Duzce, Turkey

Aim:   Hepatitis A and E are enteric viral diseases that are characteristically found in developing countries. Sero-epidemiological data about both infections showed higher prevalence rates soon after the 1999 earthquakes in Duzce, Turkey. The aim of the present study was to evaluate the data 4 years after the earthquakes.
Methods:   The study group included 589 children (72.3% boys) who were between the ages of 6 months and 17 years (mean age 11.5 years). The children were separated into three groups: Group 1 (ages 6 months to 5.9 years), Group 2 (ages 6.0–12.9 years) and Group 3 (ages 13.0–17.0 years). Serum anti-hepatitis A virus IgG and anti-hepatitis E virus IgG were determined using commercial enzyme-linked immunosorbent assay kits. The data were tested for statistical significance with the χ²-test.
Results:   The sero-prevalence rates of hepatitis A and E were 63.8% and 0.3%, respectively. The sero-prevalence rates of both hepatitis A and E increased with age, and there was no significant difference between the genders. Hepatitis A infection was associated with socio-economic condition, crowded living environment, and education level of the family ( P  < 0.01).
Conclusions:   Hepatitis A infection is still common, whereas hepatitis E infection appears to be relatively rare in paediatric age groups in Duzce, Turkey.     

Hepatitis A,B and C seroprevalence in Pakistan

A cross sectional study was conducted to determine the seroprevalence of Hepatitis A, B, and C virus in healthy Pakistani children. HAV IgG antibody was assayed in 258 subjects and it was found that 94% children by 5 years of age had HAV IgG-antibody. The overall seroprevalence of HAV IgG antibody was 55.8% and IgM 5.3%. HBVsAb levels assayed in 236 healthy children showed a seroprevalence of 2.97%. Similarly, HCV antibody seroprevalence was found to be a low 0.44% in healthy children. HAV is a major cause of Hepatitis, as compared to HBV and HCV which are of low endemicity.     

Birthweight, breast-feeding, parental weight and prevalence of obesity in schoolchildren aged 10–12 years, in Greece; the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study

Background: The purpose of the present study was to determine the prevalence of overweight and obesity in a sample of Greek children aged 10–12 years, and to evaluate these rates in relation to parental weight and birthweight.
Methods: During the 2005–2006 school period, 700 schoolchildren (323 boys, 377 girls) were randomly recruited from 18 schools, in Athens. Height and weight were measured and body mass index (BMI) was calculated. Cut-off points for BMI defining obesity and overweight for gender and age were calculated in accordance with international standards.
Results: Overall, 8.6% of boys and 9.0% of girls were obese, and 33.9% of boys and 22.1% of girls were overweight. Having an obese parent increased the odds of having an overweight or obese child (P < 0.01). Compared to non-breast-fed, boys who were breast-fed for >3 months had 70% lower likelihood of being overweight or obese (P < 0.01) and breast-fed girls had 80% lower odds (P < 0.01). Excessive birthweight (>3500 g) increased by 2.5-fold the likelihood of being overweight or obese only in girls (P < 0.05).
Conclusions: Parental weight, lack of breast-feeding and excess birthweight (in girls) were significant predictors of overweight or obesity in Greek children aged 10–12 years.     

The epidemiology of health conditions of newly arrived refugee children: A review of patients attending a specialist health clinic in Sydney

Aim:   To determine the prevalence of common diseases in newly arrived refugee children, resettled in Sydney, by region of birth. To identify health needs of refugee children in Australia.
Methods:   We prospectively screened for common diseases in refugee children attending a specialist paediatric refugee clinic, the Children's Hospital, Westmead, between May 2005 and December 2006. Screening tests included full blood count, Mantoux, vitamin D level, hepatitis B serology, syphilis serology, Schistosomiasis serology and malarial antigens.
Results:   There were 239 patients, the majority (75%) from Africa, with 127 girls and 112 boys. Thirty-six percent were 0–7 years old, 45% were 8–12 years old and 19% were 13–17 years old. Of those tested, 16% had Schistosomiasis, 5% had malaria and 4% were hepatitis B carriers. Of 216 children who had Mantoux tests, 33% were ≥10 mm and 24% were ≥15 mm, including four children with active disease (2 lymphadenitis, 1 pulmonary and 1 gastric). Vitamin D deficiency was the most common diagnosis: 61% had serum 25(OH)D3 <50 nmol/L. Anaemia was present in 15%. Disease prevalence was higher in children from Africa than Asia or the Middle East, and most of the children were asymptomatic. Given that we have only seen about 10% of the refugee children resettled in New South Wales, our results may not be generalisable to all refugees.
Conclusion:   Our findings suggest that screening refugee children for common treatable conditions, even if they are asymptomatic, is paramount. In addition to infectious diseases screening, nutritional deficiencies should routinely be screened for.     

Urinary uric acid : creatinine ratios in healthy Turkish children

Background:  Determining uric acid : creatinine ratios in random urine samples may be useful to assess the excretion of uric acid in children. Because it was shown that urinary uric acid excretion varies with age and geographic area, it is important to have accurate reference values of uric acid excretion. The aim of the present study was therefore to obtain regional reference values for urinary uric acid : creatinine ratios in healthy Turkish children.
Methods:  A total of 1306 children aged 1 month–15 years were analyzed for uric acid and creatinine, and urinary uric acid : creatinine ratios were determined from each sample. The second non-fasting morning urine samples were taken from all the children. Urine samples were analyzed for uric acid using the uricase method, and for creatinine with the Jaffe reaction.
Results:  The mean ± SD and 5th–95th percentiles of urinary uric acid : creatinine ratios (mg/mg) were 1.09 ± 0.48 and 0.27–1.87 at 1–6 months, 0.86 ± 0.41 and 0.19–1.64 at 7–12 months, 0.76 ± 0.32 and 0.32–1.43 at 1–3 years, 0.63 ± 0.29 and 0.20–1.23 at 4–6 years, 0.44 ± 0.24 and 0.14–0.93 at 7–11 years, and 0.30 ± 0.14 and 0.12–0.62 at 12–15 years. Uric acid : creatinine ratios were not significantly different between boys and the girls except at 12–15 years. Girls aged 12–15 years had higher urinary uric acid : creatinine ratio when compared with boys ( P  < 0.05). There was no correlation between urinary uric acid : creatinine ratio and protein intake.
Conclusions:  Urinary uric acid : creatinine ratio changes with age. When assessing urinary uric acid : creatinine ratio, the clinician should consider the age of the child.     

Hepatitis A seroprevalence among infants aged 12 months in Ankara

Seroprevalence studies in various age groups contribute to a better understanding of hepatitis A infection and response to hepatitis A immunization. Hepatitis A seroprevalence in 12-month-old infants from Ankara was studied. Among 601 healthy infants, overall hepatitis A seropositivity was found to be 23.5%. There were no gender differences in seropositivity (22.6% for male and 24.5% for female infants). Although vaccination of infants would be an ideal prevention strategy, presence of maternal anti-hepatitis A virus (HAV) antibody interferes with the immune response to hepatitis A vaccine in infants and young children. Therefore, further knowledge about decay of maternal antibody in infants is important in determining the optimal age for vaccination against hepatitis A. There is no recommendation for routine hepatitis A vaccination in Turkey. However, we need more seroprevalence studies in different age groups to decide the appropriate timing/age of vaccination.     

Nationwide canadian study of hepatitis a antibody prevalence among children eight to thirteen years old

BACKGROUND: Hepatitis A vaccines provide consistent, long-lasting protection and have been available for almost 10 years in Canada, but their use remains limited. It is difficult to assess their optimal utilization given that our knowledge of hepatitis A epidemiology in Canada is fragmentary. Unlike the United States, no nationwide study of hepatitis A prevalence has ever been done in Canada. Consequently we do not know the incidence of infection in children and what would be the most appropriate age for hepatitis A vaccination. OBJECTIVE: To estimate the proportion of 8- to 13-year-old children who have been infected with hepatitis A virus (HAV) and the risk factors for this infection on a nationwide scale. METHODS: Children were sampled in 10 Canadian provinces, comprising 5 regions, using random digit dialing methodology with regional stratification. Demographic data and information about risk factors for hepatitis A were collected by the telephone interviewers. Oral fluid samples were self-collected and mailed to the laboratory, where they were tested for anti-HAV IgG. RESULTS: Of 6740 contacted families with a child of required age, 1688 (25%) agreed to participate and answered the questionnaire. From these, 1074 oral fluid samples were received, and 1057 could be analyzed. Anti-HAV IgG was detected in 2.7% of subjects, with variation by region from 0.8 to 3.4%. The parents of 54 subjects (5.1%) reported that their child had previously been vaccinated against HAV. Anti-HAV IgG was present in 2.0% of unvaccinated subjects, among whom antibody prevalence was 19.4% in children born in HAV-endemic countries, 6.1% in Native children and 4.2% in travelers to endemic countries. In multivariate analysis of all subjects, the presence of anti-HAV IgG was significantly associated with birth in an endemic country, travel to an endemic country, Native status (American Indian and Inuit population), female gender and vaccination against HAV. In nonvaccinated, non-Native children born in Canada who did not travel to endemic countries, anti-HAV prevalence was 1.1%. CONCLUSIONS: The risk for hepatitis A during childhood is low in Canada. Almost all teenagers (>97%) would be at risk for infection in case of contact with HAV. Changes in immunization policy against hepatitis A should be considered.     

Are C‐reactive protein and homocysteine cardiovascular risk factors in obese children and adolescents?

Background: Several prospective epidemiological studies have demonstrated that high-sensitivity C-reactive protein (hsCRP) and plasma homocysteine (hcy) are predictors of future coronary events among healthy men and women. The aim of the present study was therefore to investigate a possible relationship between hsCRP, hcy levels and body mass index (BMI), relative weight (RW), serum leptin levels, and cardiovascular risk factors in obese children and adolescents.
Methods: The study involved 28 obese children and adolescents (13 girls, 15 boys; BMI>95‰ for age and sex), 4.5–15 years of age (mean 10.7 ± 0.6 years), who attended hospital for a basic obesity check-up. The association between hsCRP, hcy levels and BMI, RW, serum leptin levels, and cardiovascular risk factors such as blood pressure (BP), lipid profile, serum fasting insulin levels, and insulin resistance indexes, was investigated.
Results: Serum hsCRP level was positively correlated with BMI ( r = 0.512, P  < 0.01), RW ( r = 0.438, P  < 0.05), systolic and diastolic BP ( r = 0.498, P  < 0.01), serum leptin levels ( r = 0.457, P  < 0.05), but not with serum lipid, glucose, fasting insulin, plasma hcy levels or insulin resistance indexes. For hcy level, in contrast, no correlation was found with BMI, RW, systolic and diastolic BP, serum lipid levels, leptin, hsCRP, glucose, fasting insulin levels, or insulin resistance indexes.
Conclusions: hsCRP is correlated with BMI, RW, BP and leptin, which are risk factors for coronary heart disease, which supports the relationship between obesity, inflammation and atherosclerosis. hsCRP in childhood obesity might be a useful index to predict possible atherosclerotic events.     

Prevalence of Mycoplasma IgM in children with lower respiratory tract illness

Background:  Few data are available for the recent occurrence of Mycoplasma infections in children in Japan. The purpose of the present study was therefore to identify the prevalence of Mycoplasma infections in children in Japan.
Methods:  IgM antibodies to M. pneumoniae were prospectively determined using the Meridian ImmunoCard Mycoplasma test in hospitalized patients with lower respiratory tract infections between January 2004 and June 2007. A total of 858 hospitalized patients aged 0–15 years (445 male, 413 female), diagnosed as having acute pneumonia or bronchitis, were enrolled. The number of patients with pneumonia or bronchitis was 331 (male/female, 167/164) and 527 (male/female/ 278/249), respectively. Two hundred and five of the 858 patients (23.9%) were ImmunoCard positive. Of the 205 patients, 121 children and 84 children were diagnosed as having pneumonia and bronchitis, respectively. One hundred and forty-three of the 727 patients (19.7%) <5 years of age were ImmunoCard test positive.
Conclusions:  M. pneumoniae infection is not rare in children aged <5 years in Japan.     

Prevalence and determinants of cytomegalovirus infection in pre-school children

Aim:   The aim of this study is to measure the seroprevalence of cytomegalovirus (CMV) infection in 3.5-year-old children, and identify the determinants of seropositivity.
Methods:   A total of 1714 children were enrolled at birth. Approximately half were small for gestational age and half were appropriate for gestational age. Information on the children was collected at birth, 1 year and 3.5 years. At 3.5 years blood was collected and tested for CMV-specific immunoglobulin by an enzyme-linked immunosorbent assay in 530 children.
Results:   The weighted seroprevalence of CMV was 32.8% (95% confidence interval (CI) 27.4–38.1%). The seroprevalence of CMV varied markedly by ethnicity (European: 26.5% (95% CI 20.9–32.2%); Maori: 68.0% (44.0–92.0%); Pacific: 74.5% (56.3–92.6%); Indian: 50.0% (20.2–79.8%); Chinese: 47.2% (10.8–83.5%); Other: 21.9% (0.0–52.7%); P < 0.001). Socio-economic factors, number of siblings, day care centres attendance, maternal smoking, breastfeeding and other factors examined were not related to CMV seropositivity.
Conclusions:   The seroprevalence of CMV in New Zealand pre-school children is similar to that reported from other developed countries. The finding of marked ethnic differences is unexplained by socio-economic factors, or other factors that were examined.     

Head circumference and development in young children after renal transplantation

Background:  Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation.
Method:  Standard deviation scores (SDS) of height and HC and developmental quotient (DQ) after successful renal transplantation were evaluated in 12 recipients under 5 years of age. At the time of transplantation their mean age was 2.5 years and mean bodyweight was 9.0 kg.
Results:  Mean height SDS was −3.0 at transplantation and increased to −2.3 at 1 year after transplant (P = 0.002). Mean HC-SDS increased from −1.4 to −0.9 at 1 year after transplant (P = 0.02). As for each category of DQ examined 1 year after transplant, mean scores of gross motor function, basic practice, personal relations, speech and recognition increased from 69 to 90 (P = 0.007), from 77 to 102 (P = 0.02), from 87 to 103 (P = 0.04), from 71 to 90 (P = 0.0006), and from 88 to 101 (P = 0.03), respectively.
Conclusion:  In young children, physical growth, HC growth and DQ scores increased 1 year after transplantation. Dialysis and transplantation program should be planned in young children with end-stage renal failure in anticipation of growth and development of each patient.     

Clinical impact of altered immunoglobulin levels in Henoch–Schönlein purpura

Background:  The aim of the present study was the identification of immunological features, present at the time of diagnosis, that would predict the severity of Henoch–Schönlein purpura and its outcome.
Methods:  A cohort study was carried out in a tertiary pediatric hospital of 69 children with Henoch–Schönlein purpura, in whom serum complement components C3, C4 and IgA, IgM, IgG were repeatedly determined.
Results:  During the acute phase of the disease in 54/69 patients (78.3%) immunological imbalances were observed. In 24/54 cases (44.4%) certain complications involving the kidneys and the gastrointestinal tract were noted as opposed to in 3/15 children (20%) without immunologic abnormalities. In 50/69 children (72.5%), elevated serum IgA was detected and 16 of them (32%) developed renal involvement while only 1/19 children (5.3%) with normal IgA concentration had renal involvement. Considering separately the group of 9/69 children (13%) with increased IgM and those with normal IgM levels (53/69; 76.8%), irrespective of IgA and IgG concentration, we found a comparable percentage of children who had both renal and intestinal involvement without, however, developing severe complications, which were exclusively seen in patients with increased IgA (5/7 children) and reduced IgM levels. Serum C3 fraction was elevated in 26 children (37.7%) and in 73% of cases it was associated with increased serum IgA values.
Conclusion:  Renal involvement was seen in 32% of children with increased IgA values. Most importantly, elevated IgA concentration along with reduced IgM levels was associated with higher prevalence of severe complications.     

High perinatal seroprevalence of cytomegalovirus in northern Taiwan

Aim:   The living style, health-care system and socio-economic environments have changed substantially in Taiwan over past 20 years. This study was aimed to estimate the current perinatal cytomegalovirus (CMV) seroprevalence in northern Taiwan.
Methods:   In a Taiwan Birth Panel Study, 483 pairs of mothers and neonates were prospectively recruited from one tertiary medical center, one local hospital, and two obstetric clinics located in northern Taiwan from April 2004 through January 2005. Sera of their paired maternal and cord blood were tested by an enzyme-linked immunosorbent assay method for CMV IgG and IgM antibodies. Additional data were collected for health measures and epidemiological characteristics through trained interviewers utilising structured questionnaires.
Results:   Among 483 mothers studied, 93% were Taiwanese, 6.4% were immigrants from the south-eastern Asia and Mainland China, and 0.6% was aborigines. The seropositive rate of CMV IgG and IgM among the mothers was 91.1% and 3.5%, respectively. The immigrant mothers and the mothers younger than 20 years of age had a higher IgM seroprevalence ( P  < 0.05). Furthermore, 90.8% of the offspring had CMV IgG seropositivity and yet none of the neonates were CMV IgM positive.
Conclusion:   The seroprevalence of CMV among childbearing women is high in northern Taiwan. The immigrant mothers and the teenage mothers appear to have higher seropositivity of CMV IgM.     

Haemophilus influenzae type b antibodies in vaccinated and non-vaccinated children

Background: Invasive Haemophilus influenzae type b (Hib) infection has a high morbidity among young children, but the burden of disease and rate of Hib are different in different regions. The aim of the present study was to investigate the levels of Hib antibodies and the oropharyngeal Hib prevalence in young children.
Methods: One hundred-fifty nine healthy children aged 19–36 months of age were included in this cross-sectional study. Anti-polyribosylribitol phosphate (anti-PRP) antibody concentrations were measured using commercially available enzyme-linked immunosorbent assay (ELISA), and serotyping of isolated Hib strains was conducted by slide agglutination with specific antisera.
Results: Of the study participants, 57 (35.8%) were fully vaccinated (group 1A); 17 (10.7%) were incompletely vaccinated (group 1B), and 85 (53.5%) were non-vaccinated (group 2). Geometric mean titer (GMT) of anti-PRP antibody was 3.8 μg/mL, 2.2 μg/mL and 0.49 μg/mL in group 1A, group 1B and group 2, respectively. While all children in group 1 ( n  = 74) had seroprotective antibody concentrations (≥0.15 μg /mL), of the children in group 2 ( n  = 85) 31.8% did not have seroprotective anti-PRP levels ( P  < 0.0001). A total of 68.2% in group 2 had natural immunity. Nineteen children (33.3%) in group 1, and 46 (54.1%) in group 2 had oropharyngeal Hib colonization ( P  = 0.0004).
Conclusions: Hib conjugate vaccine is immunogenic and reduces Hib colonization. Each country should investigate the burden of Hib disease and the natural immunity in young children, and should determine antigenic dose, number of doses administered and dose intervals before deciding whether to introduce Hib conjugate vaccine in routine immunization programs.     

Continuity of behavioral and emotional problems from pre-school years to pre-adolescence in a developing country

Background:  All previous longitudinal community studies assessing the continuity of child behavioral/emotional problems were conducted in developed countries.
Method:  Six hundred and one children randomly selected from a Brazilian birth cohort were evaluated for behavioral/emotional problems through mother interview at 4 and 12 years with the same standard procedure – Child Behavior Checklist (CBCL).
Results:  CBCL Total Problem score presented a medium stability ( r  = .42) with externalizing problems showing higher stability and more homotypic continuity than internalizing problems. Of the children presenting deviant scores at the age of 4, only 31% remained deviant at the age of 12 ( p  < .001). A deviant CBCL Total Problem score at 12 years old was predicted by Rule-Breaking Behavior [OR = 7.46, 95% CI 2.76–20.19] and Social Problems [OR = 3.56, 95% CI 1.36–9.30] scores at 4 years of age. Either Rule-Breaking or Aggressive Behavior – externalizing syndromes – were part of the predictors for the three broad-band CBCL scores and six out of the eight CBCL syndromes.
Conclusions:  Behavioral/emotional problems in preschool children persist moderately up to pre-adolescence in a community sample. Externalizing problems at the age of 4 comprise the developmental history of most behavioral/emotional problems at pre-adolescence. Our findings concur with findings from developed countries and are quite similar for continuity, stability and predictability.     

Risk factors for urinary tract infection in children: A population-based study of 2856 children

Aim:   To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies.
Method:   A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional sample of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases.
Results:   Parents of 2856 children (mean age 7.3 years, range 4.8–12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1–30.4), daytime incontinence (OR 2.6, 1.6–4.5), female gender (OR 2.4, 1.5–3.8), and encopresis (OR 1.9, 1.1–3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in ≥8 year olds, 0% vs. 4% in 4–6 year olds).
Conclusions:   Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys.     

Hepatitis A as an etiologic agent of acute liver failure in Latin America

BACKGROUND: This prospective, multicenter study examined the importance of hepatitis viruses as etiological agents of acute liver failure (ALF) and the outcome of ALF cases in Latin American children and adolescents. METHODS: The study was conducted for minimum 12 months in 9 centers in Argentina, Brazil, Chile, Colombia, Costa Rica, and Mexico during 2001-2002. Hospitalized patients aged 1-20 years with a suspected diagnosis of ALF were included in the study and tested for serologic markers for hepatitis A, B, and C viruses. RESULTS: Of the 106 patients enrolled, 88 were included in the analysis. Median age was 5 years, and 55% with ALF were aged 1-5 years. A total of 37 individuals (43%) tested positive for anti-hepatitis A virus (HAV) immunoglobulin M (IgM) as marker of acute HAV infection; one was positive for anti-hepatitis B core antigen IgM and negative for hepatitis B surface antigen. None had markers of hepatitis C virus infection. Mortality rates in the overall study cohort (45%) and for those who tested anti-HAV IgM positive (41%) were similar. Forty-one percent of all patients and 46% of those positive for anti-HAV IgM underwent transplantation. The mortality rate in those with liver transplantation was half of that in patients who were not transplanted (28% versus 57%). CONCLUSIONS: HAV was the main etiologic agent of ALF in the population studied.