Virological and serological studies on poliomyelitis in Karachi,Pakistan. I. Outbreaks in 1990-91

Between October 1989 and September 1991, 124 cases of poliomyelitis visited the Department of Paediatrics, Civil Hospital Karachi, Pakistan. The majority of them were between 6 months and 2 years of age and the epidemics occurred during the hot seasons. The dominant serotype was poliovirus type 1 during the epidemic season in 1990 and type 2 in 1991. All the polioviruses isolated from the patients were wild-type. Virological studies also disclosed that enteroviruses other than polioviruses were prevalent among healthy children as well as among diarrheal and polio patients. A serological survey to elucidate the serological efficacy of oral polio vaccine (OPV) showed that: (i) in 112 unimmunized children, after disappearance of transplacental maternal antibody during early infancy, antibody prevalence increased gradually and > 80% of the children were seropositive against all three types of polioviruses at 5 years of age; (ii) in 201 children immunized with full doses of OPV in their infancy, the decrease in antibody titer during infancy was less and seroprevalence rose sharply afterwards: at 2 years of age, > 80% of them were seropositive against all three types of the virus. The rapid increase of seroprevalence might be the effect of OPV administration. However, the prevalence was lower than that in developed countries.     

Role of provocation poliomyelitis in vaccine-associated poliomyelitis

The impact of different vaccine administrations in the Federal Republic of Germany, in relation to vaccine-associated paralytic poliomyelitis (VAPP) was studied. (This only means that on the basis of the temporal relation of vaccination and onset, the vaccine cannot be ruled out as possible cause.) Oral polio vaccine (OPV) was given between 1963 and 1977 only and recommended simultaneously with inactivated vaccines (DT/DPT) between 1980 and 1985. In the first period 10 VAPP cases occurred among 9.96 million estimated vaccinees aged under 2 years. In the second period 6 cases of provocation poliomyelitis (PRP) were found among 2.9 million estimated OPV/DT/DPT vaccinees of the same age group. Statistically the VAPP/PRP frequencies in the two periods studied did not achieve significance.     

Endemic measles in Karachi, Pakistan and validation of IMCI criteria for measles

Aim: To estimate the incidence of measles in Karachi, Pakistan and to determine the proportion of children with measles based on the WHO integrated management of childhood illness (IMCI) criteria with a positive IgM for measles or dengue.
Methods: Patients up to 14 years old were screened for febrile rash illnesses at five Karachi hospitals. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.
Results: Screening 1 219 061 patients over a 39-month period identified 3503 qualified children. Most (76.8%) measles cases occurred in children under five years of age. The average annual incidence rate was 0.68 per 1000 in year 1; 0.19 in year 2 and 0.08 in year 3 of surveillance. Pneumonia and diarrhoea were the most common complications. Of 18.1% hospitalized, 1.6% died. Of 2286 children tested, 1599 (69.9%) were measles IgM positive. Of 542 measles IgM negative children, 66 (12%) were dengue IgM positive. The predictive positive value for the IMCI case definition was 75%.
Conclusion: The IMCI case definitions for measles is reasonable but may overestimate measles incidence. Measles continues to be a public health problem in Pakistan; increased efforts to control measles are urgently needed.     

Breastfeeding in England: time trends 2005–2006 to 2012–2013 and inequalities by area profile

Breastfeeding rates in England have risen steadily since the 1970s, but rates remain low and little is known about area‐based trends. We report an ecological analysis of time trends in area breastfeeding rates in England using annual data on breastfeeding initiation (2005–2006 to 2012–2013) and any breastfeeding at 6–8 weeks (2008–2009 to 2012–2013) for 151 primary care trusts (PCTs). Overall, breastfeeding initiation rose from 65.5% in 2005–2006 to 72.4% in 2012–2013 (average annual absolute increase 0.9%). There was a statistically significantly higher (interaction P < 0.001) annual increase in initiation in PCTs in the most deprived (1.2%) compared with the least deprived tertile (0.7%), and in PCTs with low baseline breastfeeding initiation (2005–2006; 1.4%) compared with high baseline initiation (0.6%). Similar trends were observed when PCTs were stratified by the proportion of teenage mothers and maternal smoking, but not when stratified by ethnicity. Although breastfeeding prevalence at 6–8 weeks also increased significantly over the observed time period (41.2% in 2008–2009, 43.7% in 2012–2013; annual increase 0.7%), there was no difference in the average increase by deprivation profile, ethnicity, teenage mothers and maternal smoking. However, PCTs with low baseline prevalence in 2008–2009 saw a significantly larger annual increase (0.8%) compared with PCTs with high baseline prevalence (0.07%). In conclusion, breastfeeding initiation and prevalence have seen higher increases in areas with low initial breastfeeding, and for initiation, more disadvantaged areas. Although these results suggest that inequalities in breastfeeding have narrowed, rates have plateaued since 2010–2011. Sustained efforts are needed to address breastfeeding inequalities.     

Epidemiology of childhood type I diabetes in Crete, 1990-2001

AIM: To study the epidemiological patterns of childhood-onset type I diabetes in Crete, Greece. METHODS: The incidence (new cases per 100,000 per year) from 1990 to 2001 was determined in the population of Crete < or = 14 y of age. RESULTS: A total of 89 cases was ascertained. The standardized annual incidence rate was 6.1 per 100,000 population [95% confidence interval (95% CI) 4.9-7.5]. Incidence rates were higher in children 10-14 y of age, boys and residents of urban areas (6.8, 6.7 and 6.6 per 100,000, respectively). Incidence rates were higher [relative risk (RR) 1.46, 95% CI 0.956-2.24] during the 6 y period 1996-2001 (7.2, 95% CI 5.4-9.4) than during the 6 y period 1990-1995 (4.9, 95% CI 3.4-6.9). This increase was more prominent in residents of urban areas and 10-14-y-old children. CONCLUSIONS: Although an increase was noted during the period 1990-2001, the childhood type I diabetes incidence rates in Crete remain among the lowest both in Europe and in the Mediterranean islands.     

Incidence of insulin dependent diabetes mellitus in Karachi, Pakistan

Accepted 16 September 1996
OBJECTIVES—To determine the incidence of insulin dependent diabetes mellitus (IDDM) among children aged up to 16 years residing in the city of Karachi, Pakistan, during the five years from 1989 to 1993.
DESIGN—Retrospective study of incidence using hospital and clinic records.
SETTING—The city of Karachi, Pakistan.
SUBJECTS—Children satisfying standard criteria for the diagnosis of IDDM, attending treatment facilities for the first time during the study period.
MAIN OUTCOME MEASURES—The incidence of IDDM in this population and its variation by age and sex.
RESULTS—The incidence of IDDM in this population is 1.02/100 000 per year, which is one of the lowest incidence rates yet reported.
CONCLUSIONS—The very low incidence of IDDM, contrasted with the substantially higher incidence among migrants, supports the view that environmental factors are the major determinants of variations in the incidence of this condition between populations.

     

Nationwide study of injury‐related deaths among children aged 1–4 years in China, 2000–2008

Aims: The aims of this study are to investigate injury mortality in children aged 1–4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. Methods: The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1–4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. Results: During the 9‐year study period, the injury mortality rates for children aged 1–4 years declined significantly by an average of 5.4% each year (P < 0.001; 95% confidence interval (CI): 3.6–7.0%) overall in China, with a decrease of 4.8% (P < 0.001; 95% CI: 2.5–7.1%) and 9.9% (P < 0.001; 95% CI: 4.9–14.7%) in rural and urban areas, respectively. The proportion of injury‐related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year (P < 0.001; 95% CI: 2.6–8.0%) and 6.1% (P < 0.001; 95% CI: 2.7–9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury‐related deaths in children aged 1–4 years. Conclusion: Childhood injury is still the leading cause of death in children aged 1–4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury.     

Epidemiological features of Kawasaki disease in Korea, 2006–2008

Background: The aim of this study was to estimate the incidence and describe the epidemiological characteristics of Kawasaki disease among children in Korea. Methods: Questionnaires for surveying the epidemiology of Kawasaki disease were distributed to a total of 101 hospitals that conduct pediatric residency programs. Then, we retrospectively obtained the data, which covered a three‐year period (2006–2008) and analyzed them. Results: During the three‐year study period, a total of 9039 cases of Kawasaki disease were reported from 84 hospitals (response rate, 83.2%), comprising 5375 boys and 3664 girls (male : female ratio, 1.47:1). The outbreak rate per 100 000 children <5 years old was 108.7 in 2006, 118.3 in 2007 and 112.5 in 2008 (average rate, 113.1). The seasonal distribution showed a slightly higher incidence rate in winter and summer. The patients’ mean age of onset was 32.6 months, while the proportions of sibling cases and recurrent cases were 0.17% and 2.2%, respectively. Coronary arterial abnormalities were detected during follow up by echocardiogram in 17.5% of all cases including dilatations (16.4%) and aneurysms (2.1%). Conclusions: The average annual incidence rate of Kawasaki disease in Korea has been continuously increasing, and reached 113.1/100 000 children <5 years old, which is the second highest rate in the world.     

U.S. childhood cancer survival, 1973–1987

The surveillance, epidemiology, and end-results (SEER) data on 5-year relative survival rates (1973-1987) for the most common pediatric tumors (ages 0–14) were analyzed. The SEER data are population based, so the observed progress in survival from childhood cancer represents the real impact that development in cancer treatment had on the population followed by the registry. The greatest increase in survival rate from 1973 until 1987 has been achieved in hematopoietic tumors such as acute lymphocytic leukemia (ALL), in which survival increased from 47.6% (1973–1977) to 60.8% (1983–1987), and Burkitt's lymphoma in which survival increased from 27.6% (1973–1977) to 68.7% (1983–1987). Solid tumors showed a less steep, but steady increase in survival rates. Flattening in the survival rates since 1978–1982 has been observed for acute leukemia, astrocytoma, medulloblastoma, and osteosarcoma. Females have better survival rates for most pediatric tumors, except Hodgkin's disease. Analysis of race of childhood leukemia confirmed that black children have worse survival than white. When solid tumors were analyzed by stage at presentation, there was no indication that diagnosis in earlier stages of disease accounted for the improved survival. Observed flattening in the survival rates since 1978–1982 of leukemia and some solid tumors warrants further follow-up. © 1994 Wiley-Liss, Inc.     

Management of inguinal hernia of childhood as practiced in Karachi,Pakistan

Inguinal hernia in children is a common condition worldwide. Despite improvements in surgical care, it still carries a certain mortality and morbidity. The age group most susceptible to complications is under 2 years of age. There is still delay between diagnosis and surgical intervention. There is no strong evidence at present to recommend simultaneous contralateral exploration in unilateral inguinal hernia.