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1.
Objective
To determine current use of vitamin K (VK) prophylaxis in newborns and review the efficacy and effectiveness of regimens used.Design
Efficacy and effectiveness calculated using current practice details, data from Southern Ireland and two previous surveys, together with contemporaneous studies of vitamin K deficiency bleeding (VKDB).Setting
Current survey: United Kingdom (Great Britain and Northern Ireland). Efficacy and effectiveness tables: United Kingdom and Southern Ireland.Main outcome measures
Current VK prophylaxis following uncomplicated term deliveries. Relative risk of VKDB calculated for the VK actually received and for “intention to treat”.Results
Questionnaire response rate 95% (n = 243), all recommending VK prophylaxis. No association between unit size and route of administration. For uncomplicated term deliveries, 60% recommended intramuscular (IM) prophylaxis, 24% oral and 16% offered both routes without bias. All units offering IM gave a single dose, mostly 1 mg Konakion Neonatal. Oral regimens showed more variation: two thirds gave 2 mg (range 0.5–2 mg), the number of doses ranged from 1 to 11 and many used preparations off‐licence or the unlicensed Orakay. IM prophylaxis, if given, provided the best protection (most efficacious) against VKDB. However, on an intention‐to‐treat basis (effectiveness), there is no statistically significant difference between the risks of VKDB after intended IM VK and after oral prophylaxis intended to continue beyond a week.Conclusions
Although the principles of VK prophylaxis is now accepted by all, there is no uniformity in practice. Omission of prophylaxis appears to be a greater problem for IM than for multi‐dose oral prophylaxis, affecting overall effectiveness. 相似文献2.
Blair PS Platt MW Smith IJ Fleming PJ;CESDI SUDI Research Group 《Archives of disease in childhood》2006,91(2):101-106
Aims
To determine the combined effects of sudden infant death syndrome (SIDS) risk factors in the sleeping environment for infants who were “small at birth” (pre‐term (<37 weeks), low birth weight (<2500 g), or both).Methods
A three year population based, case‐control study in five former health regions in England (population 17.7 million) with 325 cases and 1300 controls. Parental interviews were carried out after each death and reference sleep of age matched controls.Results
Of the SIDS infants, 26% were “small at birth” compared to 8% of the controls. The most common sleeping position was supine, for both controls (69%) and those SIDS infants (48%) born at term or ⩾2500 g, but for “small at birth” SIDS infants the commonest sleeping position was side (48%). The combined effect of the risk associated with being “small at birth” and factors in the infant sleeping environment remained multiplicative despite controlling for possible confounding in the multivariate model. This effect was more than multiplicative for those infants placed to sleep on their side or who shared the bed with parents who habitually smoked, while for those “small at birth” SIDS who slept in a room separate from the parents, the large combined effect showed evidence of a significant interaction. No excess risk was identified from bed sharing with non‐smoking parents for infants born at term or birth weight ⩾2500 g.Conclusion
The combined effects of SIDS risk factors in the sleeping environment and being pre‐term or low birth weight generate high risks for these infants. Their longer postnatal stay allows an opportunity to target parents and staff with risk reduction messages. 相似文献3.
Aim
To quantitatively examine the influence of study methodology and population characteristics on prevalence estimates of autism spectrum disorders.Methods
Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. Two groups of studies estimated the prevalence of typical autism and all autism spectrum disorders (ASD). The extent of variation among studies and overall prevalence were estimated using meta‐analysis. The influence of methodological factors and population characteristics on estimated prevalence was investigated using meta‐regression and summarised as odds ratios (OR).Results
Forty studies met inclusion criteria, of which 37 estimated the prevalence of typical autism, and 23 the prevalence of all ASD. A high degree of heterogeneity among studies was observed. The overall random effects estimate of prevalence across studies of typical autism was 7.1 per 10 000 (95% CI 1.6 to 30.6) and of all ASD was 20.0 per 10 000 (95% CI 4.9 to 82.1). Diagnostic criteria used (ICD‐10 or DSM‐IV versus other; OR = 3.36, 95% CI 2.07 to 5.46), age of the children screened (OR = 0.91 per year, 95% CI 0.83 to 0.99), and study location (e.g. Japan versus North America; OR = 3.60, 95% CI 1.73 to 7.46) were all significantly associated with prevalence of typical autism. Diagnostic criteria, age of the sample, and urban or rural location were associated with estimated prevalence of all ASD.Conclusions
Sixty one per cent of the variation in prevalence estimates of typical autism was explained by these models. Diagnostic criteria used, age of children screened, and study location may be acting as proxies for other study characteristics and require further investigation. 相似文献4.
McGarvey C McDonnell M Hamilton K O'Regan M Matthews T 《Archives of disease in childhood》2006,91(4):318-323
Background
It is unclear if it is safe for babies to bed share with adults. In Ireland 49% of sudden infant death syndrome (SIDS) cases occur when the infant is bed‐sharing with an adult.Objective
To evaluate the effect of bed‐sharing during the last sleep period on risk factors for SIDS in Irish infants.Design
An 8 year (1994–2001) population based case control study of 287 SIDS cases and 831 controls matched for date, place of birth, and sleep period. Odds ratios and 95% confidence intervals were calculated by conditional logistic regression.Results
The risk associated with bed‐sharing was three times greater for infants with low birth weight for gestation (UOR 16.28 v 4.90) and increased fourfold if the combined tog value of clothing and bedding was ⩾10 (UOR 9.68 v 2.34). The unadjusted odds ratio for bed‐sharing was 13.87 (95% CI 9.58 to 20.09) for infants whose mothers smoked and 2.09 (95% CI 0.98 to 4.39) for non‐smokers. Age of death for bed‐sharing and sofa‐sharing infants (12.8 and 8.3 weeks, respectively) was less than for infants not sharing a sleep surface (21.0 weeks, p<0.001) and fewer bed‐sharing cases were found prone (5% v 32%; p = 0.001).Conclusion
Risk factors for SIDS vary according to the infant''s sleeping environment. The increased risk associated with maternal smoking, high tog value of clothing and bedding, and low z scores of weight for gestation at birth is augmented further by bed‐sharing. These factors should be taken into account when considering sleeping arrangements for young infants. 相似文献5.
Background
Coeliac disease (CD) is a disorder that may depend on genetic, immunological, and environmental factors. Recent observational studies suggest that breast feeding may prevent the development of CD.Aim
To evaluate articles that compared effects of breast feeding on risk of CD.Methods
Systematic review and meta‐analysis of observational studies published between 1966 and June 2004 that examined the association between breast feeding and the development of CD.Results
Six case‐control studies met the inclusion criteria. With the exception of one small study, all the included studies found an association between increasing duration of breast feeding and decreased risk of developing CD. Meta‐analysis showed that the risk of CD was significantly reduced in infants who were breast feeding at the time of gluten introduction (pooled odds ratio 0.48, 95% CI 0.40 to 0.59) compared with infants who were not breast feeding during this period.Conclusions
Breast feeding may offer protection against the development of CD. Breast feeding during the introduction of dietary gluten, and increasing duration of breast feeding were associated with reduced risk of developing CD. It is, however, not clear from the primary studies whether breast feeding delays the onset of symptoms or provides a permanent protection against the disease. Long term prospective cohort studies are required to investigate further the relation between breast feeding and CD. 相似文献6.
Aims
To investigate the diagnoses made for children referred to a “fits, faints, and funny turns” clinic.Methods
Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period.Results
Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non‐epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment.Conclusions
In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non‐epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non‐epileptic cause are common and can be safely managed expectantly. 相似文献7.
Taylor B Andrews N Stowe J Hamidi-Manesh L Miller E 《Archives of disease in childhood》2007,92(10):887-889
Objectives
To investigate whether meningococcal C conjugate vaccine (MCCV) caused relapse in children with steroid‐responsive nephrotic syndrome.Design
A population‐based study was conducted using an active surveillance system, developed to assess adverse events following vaccination, which linked hospital record information on relapses of nephrotic syndrome to community child health population MCCV data. An ecological study looking at hospital admissions for nephrotic syndrome in different age cohorts of children before and after the MCCV introductory campaign was also carried out.Settings
South East England, and England and Wales.Patients
52 children having 162 relapses of nephrotic syndrome. Also, all hospital admissions of children aged 2–18 years with steroid‐responsive nephrotic syndrome in England and Wales between 1995 and 2003, relating admissions to when MCCV was introduced in specific age cohorts.Main outcome measures and analysis method
Self‐controlled case series analysis looking for increased risk of relapse following MCCV and changes in admission rates for nephrotic syndrome (incidence ratio) following the introduction of MCCV to different age cohorts of children.Results
There was no increased risk of relapse following MCCV in the self‐control case series, where a relative incidence of 0.95 (95% confidence interval (CI) 0.61–1.47) was found in the 6‐month post‐vaccination period, or in the ecological study, which gave an incidence rate ratio of 1.05 (95% CI 0.95 to 1.15) for the quarter when MCCV was introduced and the following two quarters.Conclusions
We found no association between MCCV and nephrotic syndrome, which is therefore not a contraindication to meningococcal vaccination. 相似文献8.
Vázquez-Nava F Quezada-Castillo JA Oviedo-Treviño S Saldivar-González AH Sánchez-Nuncio HR Beltrán-Guzmán FJ Vázquez-Rodríguez EM Vázquez Rodríguez CF 《Archives of disease in childhood》2006,91(10):836-840
Aim
To determine the association between allergic rhinitis, bottle feeding, non‐nutritive sucking habits, and malocclusion in the primary dentition.Methods
Data were collected on 1160 children aged 4–5 years, who had been longitudinally followed since the age of 4 months, when they were admitted to nurseries in a suburban area of Tampico–Madero, Mexico. Periodically, physical examinations were conducted and a questionnaire was given to their parents or tutors.Results
Malocclusion was detected in 640 of the children (51.03% had anterior open bite and 7.5% had posterior cross‐bite). Allergic rhinitis alone (adjusted odds ratio = 2.87; 95% CI 1.57 to 5.25) or together with non‐nutritive sucking habits (adjusted odds ratio = 3.31; 95% CI 1.55 to 7.09) had an effect on anterior open bite. Bottle feeding alone (adjusted odds ratio = 1.95; 95% CI 1.07 to 3.54) or together with allergic rhinitis (adjusted odds ratio = 3.96; 95% CI 1.80 to 8.74) had an effect on posterior cross‐bite. Posterior cross‐bite was more frequent in children with allergic rhinitis and non‐nutritive sucking habits (10.4%).Conclusions
Allergic rhinitis alone or together with non‐nutritive sucking habits is related to anterior open bite. Non‐nutritive sucking habits together with allergic rhinitis seem to be the most important factor for development of posterior open bite in children under the age of 5 years. 相似文献9.
Objective
To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point‐of‐care HIV test (RPOCT) among pregnant women and their midwives.Design
A retrospective review of 717 notes to determine current HIV screening practices and a cross‐sectional survey using a self‐completed questionnaire for pregnant women and midwives.Setting
The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands.Participants
486 women attending the ANC or admitted to the PNW during a fortnight in May–June 2006. 72 midwives on the delivery ward completed a second questionnaire.Results
The questionnaire showed that 90.4% of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6% of the decliners. 92.8% of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2% would be happy to offer the test with appropriate training and guidance.Conclusions
Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is also acceptable to a clinically significant proportion of those who decline the standard test (21 of 59) and therefore has the potential to increase screening and detection rates. Hence, by allowing early diagnosis and the initiation of antenatal interventions, it could reduce the rate of mother‐to‐child transmission (MTCT) in the UK. 相似文献10.
Harrison MJ O'Hare AE Campbell H Adamson A McNeillage J 《Archives of disease in childhood》2006,91(1):16-19
Aims
To determine the prevalence of autistic spectrum disorder in a geographically defined population for children receiving services and compare this to the estimated prevalence based on a two source “capture–recapture” technique previously employed in biological populations to give a “true” prevalence with full ascertainment.Methods
Information on gender, age, and postcode sector was determined from nine different datasets maintained for children with autistic spectrum disorder and point prevalence was calculated. Data from the diagnostic services and the Special Needs System were entered into the two source “capture–recapture” calculation.Results
Of a total population of 134 661 under 15 year olds resident in Lothian in southeast Scotland, 443 were known to autism services, with a point prevalence of 32.9 per 10 000 (95% CI 29.8 to 36.0). The estimated prevalence using a capture–recapture method was 44.2 (95% CI 39.5 to 48.9), which suggests that 74% of affected children were registered with services in some way. The age distribution was similar to that of the background population under the age of 12 years and there was no indication of a rising prevalence. The ratio of boys to girls was 7:1.Conclusions
The prevalence of autistic spectrum disorder in a geographically based population employing two source capture–recapture analysis is comparable to that quoted for the best active ascertainment studies. This technique offers a tool for establishing the prevalence of this condition in health service populations to assist in planning clinical services. 相似文献11.
Objectives
To determine whether having had meningitis in infancy adversely affects academic achievement at age 16.Methods
A case–control study in England and Wales of 461 teenagers who had bacterial meningitis in infancy and 289 GP matched controls recruited when the index cases were aged 5. Outcome measures: Comparison between index cases and controls of the type of school attended; the number of GCSE examinations attempted; the number of examinations passed (grades A*–C) and achievement in five key subjects. Assessment of examination results according to the age at which meningitis occurred. The effect of meningitis‐associated disability on GCSE results.Results
36/461 (7.8%) index cases compared with none of the controls were in special schools. Significantly more index cases (117/461 (25.4%)) than controls (19/289 (6.6%)) did not pass any GCSE examinations. Significantly more index cases (184/385 (47.8%)) than controls (59/232 (25.4%)) attending comprehensive schools failed to achieve the national educational standard of five passes at grade C. Pupils attending comprehensive schools who did not have meningitis‐associated disability also passed significantly fewer GCSE examinations than the controls. The age at which meningitis had occurred was not associated with subsequent academic achievement.Conclusions
After meningitis in infancy a quarter of survivors failed to pass any GCSE examinations; nearly half of those attending state schools did not attain the national educational standard. “Healthy” survivors of bacterial meningitis in infancy pass significantly fewer GCSE examinations than the controls. All cases of bacterial meningitis in infancy should have a full postinfection assessment and continuing supervision. 相似文献12.
Aims
To assess co‐morbidity and risk factors for otitis media, tonsillopharyngitis, and lower respiratory infections in school children.Methods
Logistic regression analysis of co‐morbidity and risk factors for airway infections in a population based sample of 10 year old children living in Oslo, Norway. Main outcome measures: otitis media, tonsillopharyngitis, and lower respiratory infections in past 12 months.Results
Airway infections in 10 year old children were common, and significant co‐morbidity was found between the various airway infections. Home dampness was a risk factor for all infections, adjusted odds ratios ranging from 1.2 (95% CI 1.0 to 1.5) to 1.4 (95% CI 1.1 to 1.6) for otitis media and tonsillopharyngitis respectively. Atopic disease was a constitutional risk factor, particularly strong for lower airway infections (adjusted odds ratio 2.4, 95% CI 1.8 to 3.1). African or Asian ethnicities were associated with the airway infections, adjusted odds ratios ranging from 1.2 (95% CI 0.9 to 1.7) to 1.7 (95% CI 1.2 to 2.3).Conclusions
Respiratory tract infections were common in 10 year old children. There was substantial co‐morbidity between upper and lower airway infections. Environmental and constitutional factors were identified and positively associated with the infections. Results support the hypothesis of 1957 that the whole respiratory tract is one unit. 相似文献13.
Uldall P Alving J Hansen LK Kibaek M Buchholt J 《Archives of disease in childhood》2006,91(3):219-221
Aims
To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy.Methods
In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring.Results
In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non‐epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non‐epileptic paroxysmal event. Psychogenic non‐epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission.Conclusion
The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re‐evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child''s lifestyle. 相似文献14.
van den Hurk K van Dommelen P van Buuren S Verkerk PH Hirasing RA 《Archives of disease in childhood》2007,92(11):992-995
Objective
To assess the prevalence of overweight and obesity in children living in the Netherlands and compare the findings with the Third and Fourth National Growth Studies carried out in 1980 and 1997, respectively.Design and methods
Data were obtained from the child health care system. International cut‐off points for body mass index (BMI) were used to determine overweight and obesity. Cases were weighted for ethnicity and municipality size in such a way that the sample matched the distribution in the general population. The LMS method was used to calculate the age‐related distribution of BMI, and the prevalence was calculated from the fitted distribution.Patients
Data on 90 071 children aged 4–16 years were routinely collected by 11 community health services during 2002–2004.Results
On average, 14.5% of the boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9%, girls 6.9%) and 1997 (boys 9.7%, girls 13.0%). Similarly, 2.6% of the boys and 3.3% of the girls aged 4–16 years were obese, which is much higher than in 1980 (boys 0.2%, girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). At the age of 4, 12.3% of the boys and 16.2% of the girls were already overweight.Conclusions
The prevalence of overweight and obesity in the Netherlands is still rising, and at an even faster rate than before. Evidence‐based interventions are needed to counter the obesity epidemic, and there is an urgent need for pre‐school intervention programmes. 相似文献15.
Hopkins D Emmett P Steer C Rogers I Noble S Emond A 《Archives of disease in childhood》2007,92(10):850-854
Objective
To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed.Design
An observational cohort study.Setting
928 term infants from the Avon Longitudinal Study of Parents and Children in 1993–94.Methods
Haemoglobin and ferritin concentrations at 8 and 12 months were assessed in relation to type and quantity of milk intake at 8 months.Results
By WHO criteria, 22.7% of the infants were anaemic at 8 months and 18.1% at 12 months. More breast‐ than formula‐fed infants were anaemic at 8 and 12 months. Cows'' milk as the main drink was associated with increased anaemia at 12 months and low ferritin at 8 and 12 months. No association was found between any nutrients and haemoglobin concentrations. Protein and non‐haem iron intakes were positively associated with ferritin concentrations and calcium intake negatively. This effect was more marked in infants being fed cows'' milk. More than 25% of infants in the breast milk and cows'' milk groups and 41% of infants having >6 breast feeds per day had iron intakes below the lower reference nutrient intake. Feeding cows'' milk or formula above 600 ml or >6 breast feeds per day was associated with lower intakes of solids.Conclusions
Both breast and cows'' milk feeding were associated with higher levels of anaemia. Satisfactory iron intake from solids in later infancy is more likely if formula intake is <600 ml per day and breast feeds are limited to <6 feeds per day. Cows'' milk should be strongly discouraged as a main drink before 12 months. 相似文献16.
Objectives
Hypospadias, a common birth defect, has shown widespread variation in reported rates and temporal trends across countries over the last 30 years. The aim of this study was to determine the prevalence and trends of hypospadias in an Australian population.Design
Population‐based study of all male infants born in Western Australia (WA) between 1980 and 2000 diagnosed with hypospadias and notified to the WA Birth Defects Registry.Main outcome measures
Prevalence of hypospadias, birth outcome and association with other congenital anomalies, stratified by degree‐of‐severity.Results
1788 cases of hypospadias were registered in WA in 1980–2000 with an overall prevalence of 34.8 (95% confidence interval (CI): 33.2 to 36.4) cases per 10 000 births. The prevalence increased by 2.0% per annum (95% CI: 1.2% to 2.8%) from 27.9 in 1980 to 43.2 per 10 000 births in 2000 (p<0.001). Hypospadias was mild in 84% of cases, moderate‐severe in 11% and unspecified in 5%, with the number of moderate‐severe hypospadias almost doubling over time (p<0.01). There were 1465 (82%) cases of isolated hypospadias and 323 (18%) had co‐existing anomalies. Infants with co‐existing genital (relative risk (RR) 4.5; 95% CI: 3.3 to 6.1) or non‐genital (RR 1.5; 95% CI: 1.0 to 2.2) anomalies were more likely to have moderate‐severe hypospadias compared with isolated cases.Conclusion
Hypospadias affects one in 231 births and has been reported to have increased significantly over the last 20 years. Future investigation of the aetiology of hypospadias is important to identify potentially modifiable risk factors and ensure optimal male reproductive health in the future. 相似文献17.
Background
Inequalities in vaccine uptake exist. Studies suggest paediatric inpatients have lower rates of immunisation uptake than the general population. Various UK policies advocate opportunistic immunisation.Aim
To evaluate practice within a paediatric tertiary hospital in identifying and facilitating vaccination of inpatients who were not fully immunised.Methods
Case notes for 225 inpatients were examined. Thirty staff of various professions and grades were interviewed. Policies, forms and documents used in the hospital were reviewed.Results
Immunisation status was recorded for 71% of children admitted, but for 69% of these immunisations were documented as “up‐to‐date” without any further information recorded. At least 20% of inpatients were incompletely immunised, but very little was done to facilitate vaccination. There was no training for staff either in giving advice or in administering vaccines and staff views differed regarding the hospital''s role in immunisations. While there were guidelines for specific groups of patients, there were no general immunisation policies. Incorrect and out‐of‐date immunisation schedules were found on documents.Conclusions
Opportunities to immunise children continue to be missed by all levels of health care service provision. Tertiary centres have a role to play in supporting primary care services to ensure that these vulnerable children are appropriately immunised. Measures are being taken to address the problems identified in this study and we strongly suspect that other hospitals in the UK ought to be confronting these issues as well. 相似文献18.
Objective
To obtain information on the use of single antigen measles, mumps and rubella vaccines to improve estimates of population immunity and help predict outbreaks.Design
We requested information from providers of single antigen vaccines and from the Medicine and Healthcare products Regulatory Agency on requests for importation of single antigen measles and mumps vaccines.Setting
England and Wales.Main outcome measures
Number of doses of single measles, mumps and rubella vaccine, by age of child (in months), year given and area of residence, and number of children who have received all three single vaccinations.Results
Of 27 providers identified, 13 held single site clinics: nine were individual general practitioners and five held clinics at multiple sites. Data were received from 9/27 (33%) providers operating 40/74 (54%) clinic sites. We received information on 60 768 vaccinations administered by single vaccine providers and 269 917 doses requested for importation. For children born in 2001/2002, the minimum estimates for the proportion who received single measles vaccine are 1.7% in 2001 and 2.1% in 2002, with a reasonable maximum estimate of 5.6% over the 2 years. For single mumps vaccine, the minimum estimates are 0.3% in 2001 and 0.02% in 2002, with a maximum estimate of 4.0%.Conclusion
The contribution of single vaccines to immunity is small in comparison to that of the combined measles, mumps and rubella vaccine (MMR). For recent birth cohorts this contribution could increase routine coverage for measles‐containing vaccines by around 2%, still below the level of immunity required to sustain elimination. 相似文献19.
Dubos F Marechal I Husson MO Courouble C Aurel M Martinot A;Hospital Network for Evaluating the Management of Common Childhood Diseases 《Archives of disease in childhood》2007,92(11):1009-1012
Background
The impact of the heptavalent‐pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis in Europe has not yet been assessed.Objective
To determine whether heptavalent‐pneumococcal conjugate vaccine implementation in northern France has resulted in a decrease in the incidence of pneumococcal meningitis in children.Design
Multicentre retrospective cohort study from 2000 through 2005.Settings
All paediatric departments of the 18 hospitals in northern France.Patients
Patients <18 years of age, admitted for laboratory‐confirmed pneumococcal meningitis during the study period, were included.Interventions
Data were collected from medical files and the microbiological laboratories of each hospital and compared with the regional hospital discharge codes, using a capture–recapture method.Main outcome measures
The study assessed and compared global and age‐related incidence rates of pneumococcal meningitis in 2001 (pre‐vaccine era) and 2005.Results
77 cases were found through the capture–recapture method. The incidence rate of pneumococcal meningitis varied from 1.65/100 000 children <18 years in 2001 to 0.80/100 000 children in 2005 (53% reduction, 95% CI 31 to 74; p = 0.08). This has so far been significant only for children <2 years of age (8.9/100 000 in 2001 to 1.8/100 000 in 2005; 82% reduction, 95% CI 52 to 95; p = 0.03).Conclusion
A decline in pneumococcal meningitis has been observed in infants since heptavalent‐pneumococcal conjugate vaccination began in our area.In the United States, Streptococcus pneumoniae has been considered to be the principal pathogen for bacterial meningitis (47%) since Haemophilus influenzae type b vaccination became widespread during the 1990s and before the implementation of vaccination with the heptavalent‐pneumococcal conjugate vaccine (PCV7, Prevenar).1 In Western Europe, the mean incidence rate of pneumococcal meningitis has averaged 8.7 cases/100 000 in children <2 years old with incidence rates varying from 3.8 to 14.6/100 000 between countries.2 Between 2001 and 2004, the French Bacterial Meningitis Surveillance Network reported that S pneumoniae caused 42% of all cases of bacterial meningitis in children, 70% of these occurring in children <2 years old.3 The case‐fatality rate for this disease is estimated at 8–12% in children and has not dramatically changed for 20 years despite progress in diagnosis and treatment.1,4 Sequelae occur in 20–35% of cases and include deafness, motor deficits, learning disorders linked with concentration disorders, and memory problems.5,6PCV7, first approved in the US in 1999, targets the seven serotypes involved most frequently in the invasive pneumococcal diseases of young children.7,8 Serotypes 6B, 9V, 14, 18C and 23F, all present in this vaccine, account for most cases of pneumococcal meningitis today.9 PCV7 received marketing authorisation in Europe in February 2001, was available in France in April 2001 and was recommended in March 2002 for children with a disease at high risk of invasive pneumococcal infections (immunosuppression, sickle cell disease, etc),10 and children aged 2–24 months with risk factors for pneumococcal infection (ie, children cared for more than 4 h/week with more than two other children, children with breast‐feeding duration <2 months, children with at least two siblings), criteria which covered between 79 and 89% of children <2 years of age.11 The vaccination schedule uses a four‐dose regimen, at 2, 3 and 4 months of age and a booster dose during the second year of life. The impact of the PCV7 on the incidence of meningitis and other invasive pneumococcal diseases has been clearly demonstrated in North America and Australia,12,13,14,15,16 whose vaccination schedules are different from those in France.The aim of this study was to determine whether PCV7 implementation in a large area of northern France affected the incidence of pneumococcal meningitis in children. 相似文献20.
Owens S Abdel-Rahman IE Balyejusa S Musoke P Cooke RP Parry CM Coulter JB 《Archives of disease in childhood》2007,92(8):693-696