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??At present??the world has entered the strategic stage of eradicating wild and vaccine derivative poliovirus before 2018. China has successfully eradicated wild poliovirus and the vaccination policy needs to be changed immediately. Inactive poliovirus vaccine??IPV?? should be introduced into Chinese routine immune program gradually.     

Avidity and titers of the antibody response to two inactivated poliovirus vaccines with different antigen content

The inactivated poliovirus vaccine is heat stabile, gives high serum IgG concentrations but less pronounced mucosal immunity and must be given as repeated injections. A new enhanced-potency Dutch inactivated vaccine could circumvent these difficulties. We compared antibody concentrations measured as neutralization or ELISA titers, and avidity of serum and salivary antibodies in children vaccinated with three doses of the earlier Swedish vaccine given over nine months or the new antigen-rich vaccine. After three doses, but not after two, serum neutralization titers for type 1 and type 3 poliovirus were higher using the new vaccine but secretory IgA levels in saliva were similar. The avidity of the serum IgC antibodies was significantly higher after two doses of the new vaccine than after three doses of the old. Thus the new vaccine gives excellent antibody responses of high titers and avidities, but should preferably be given in three doses.     

Growth of infants with IgE-mediated cow''s milk allergy fed different formulas in the complementary feeding period

Observational studies have shown that allergic infants, irrespective of the type of diet, show various degrees of growth depression in the first year of life. We investigated whether the type of milk in the complementary feeding period (6-12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age, WA; length-for-age, LA; and weight-for-length, WL, z-scores) in infants with cow's milk allergy (CMA). Infants with immunoglobulin E-mediated CMA breastfed at least 4 months and progressively weaned in the 5- to 6-month period were randomly assigned to three special formulas, a soy formula (n = 32), a casein hydrolysate (n = 31), and a rice hydrolysate (n = 30). A fourth, non-randomized group was made up by allergic infants still breastfed up to 12 months (n = 32). Groups were compared for WA, LA, and WL z-scores at 6, 9 and 12 months of age. All groups showed low WA and LA z-scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA.     

Antibody response to poliovirus immunization in childhood leukemia

Polio antibody titers were determined in 29 children with ALL in various clinical stages, including a group of five patients in continuous remission for over five years and who, at the time of study, were off all therapy for at least six months. Regardless of the stage of disease, no detectable YM response was elicited. The five children described above displayed the same depressed response as did the other children with ALL. This strongly suggests an inherent defect in the immune system of these children with ALL unrelated to therapy.     

Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life

Background: Recently, rice-based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. Aim: To evaluate the growth of infants fed with a rice-based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. Methods: A total of 88 infants were enrolled between March 2002 and March 2004. Fifty-eight infants with atopic dermatitis (AD) and cow's milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice-based hydrolysate formula (RHF), 17 with a soy-based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cow's milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3-monthly intervals in the first year of life, and at 6-monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z-scores of weight for age were calculated. Statistics: One-way analysis of variance and Student's t -test were used for statistical comparison. Significance was set at p <0.05. Results: No significant differences between the RHF, SF and eHCF groups were observed for the z-score of weight for age during the first 2 y of life, but a significantly lower difference was seen in the RHF group compared to the control group in the intervals 9 mo–1 y ( p =0.025) and 1–1.5 y ( p =0.020) of age. In contrast, the SF and eHCF groups were comparable to the control group, but the eHCF group was significantly lower ( p =0) in the first trimester of life.
Conclusion: Even if our findings show no significant difference between RHF and control, low weight observed in infants fed with RHF raises doubts about the nutritional adequacy of rice-hydrolysate formulas.     

Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.     

Clinical correlates of response to pneumococcal immunization

OBJECTIVE: The inability to form antibodies to polysaccharide antigens may occur as a part of a more significant immunodeficiency or as an isolated defect. The latter has been reported in some children with recurrent upper and lower respiratory tract infections and evaluation of the responsiveness of such patients to polysaccharide antigens is indicated as part of their assessment. The present study evaluated the pattern of antibody responses of patients immunized with pneumococcal vaccine as part of the investigation of recurrent upper and lower respiratory tract infections to determine if any correlation exists between these responses and clinical presentation. METHODOLOGY: An analysis was performed of antibody responses to pneumococcal serotypes 3, 4 and 6 following immunization with a 23-valent vaccine in 42 children with normal IgG levels who were evaluated for recurrent infections. Antibody responses were assessed in relation to clinical features and the results of other immunological investigations. RESULTS: Of the 42 patients evaluated, 25 (59%) were responders to all serotypes tested. Failure to respond to serotype 3 alone was the least common pattern of non-response. Recurrent pneumonia, but not otitis media with discharge or chronic productive cough, was significantly associated with a lack of response to two or three serotypes. Failure to respond to serotype 3 alone or in combination with other serotypes was associated with more significant immune abnormalities. CONCLUSION: In a selected population of children with recurrent bacterial infections, pneumococcal serotype 3 is a strong immunogen. In this clinical group recurrent pneumonia is associated with a defect in response to multiple pneumococcal serotypes.     

The incidence and type of reactions to plain and adsorbed DTP vaccines

Abstract The incidence and type of reactions after administration of plain and adsorbed diphtheria-tetanus-pertussis vaccine were recorded in a blind controlled prospective study of 2041 vaccinations in 1075 infants receiving routine childhood immunization. There was no significant difference in the total incidence or type of general reactions after plain and adsorbed vaccine, but local reactions were significantly less frequent after plain vaccine. General reactions were recorded after 41.5% of vaccinations with plain vaccine and after 40.8% of vaccinations with adsorbed vaccine. Local reactions were reported in 66.7% and 76.5% of recipients respectively. The most commonly reported systemic reactions were irritability and fever. Three recipients of plain vaccine and one of adsorbed vaccine suffered hyporesponsiveness or collapse. One recipient of each vaccine suffered a convulsion. No persisting sequelae were recorded.     

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??Pneumonia is still the leading cause of death in children younger than 5 years old worldwide. The infection caused by the virus and / or bacteria which cause pneumonia frequently can be prevented by vaccine immunization. Such pathogens include influenza virus, measles virus, Bordetella pertussis, Haemophilus influenza and Streptococcus pneumoniae. It has been well demonstrated that immunizing children with these vaccines can prevent pneumonia and decrease the following death.     

Outbreak of pertussis in highly immunized adolescents and its secondary spread to their families

An outbreak of pertussis was recognized in a highly immunized sixth-grade class of schoolchildren. Among 43 children aged 11–12 years in the class, 38 had been immunized with three doses or more of DTP containing whole-cell pertussis vaccine, two with two doses of DTP and three children were unimmunized. The last DTP vaccines had been given 6–10 years before the outbreak. A total of eight children with pertussis suffering paroxysmal coughing attacks for 3 weeks or more were identified, seven being fully immunized and one unimmunized. Among the eight cases, two were confirmed by both culture and serology and one by serology alone. The attack rate in fully immunized children was 18.4% (7/38). Secondary spread of pertussis was identified in five of the households from which the eight patients originated. A total of six cases of pertussis from these five households were identified, and two of these were culture-confirmed. These observations suggest that vaccine-induced immunity weakens considerably 6–10 years after vaccination, and that booster immunization with DTP instead of DT is therefore recommended for the control of pertussis.     

Diphtheria immunization rates and the effect of several sociodemographic factors on immunization of children in eastern Turkey

BACKGROUND: One of the aims of the World Health Organization is to eliminate diphtheria in all countries. Thus, it is important to achieve a high level of childhood immunization. The present study was performed to determine the level of child immunization against diphtheria and the effect of several sociodemographic factors on immunization of children aged 0-6 years. METHODS: Using the cluster-sampling method, 767 healthy children were selected at random from three provinces in eastern Turkey. Children were categorized as completely vaccinated, incompletely vaccinated, unvaccinated or vaccination status unknown. If the child had no immunization card, he/she was categorized as vaccination status unknown. RESULTS: Of the 767 children, 72.3% were completely vaccinated, 18.3% were incompletely vaccinated and 5.7% were not vaccinated. Vaccination status was unknown for 3.7% of children. As the age of the children increased, the proportion of completely vaccinated children increased and the proportion of non-vaccinated and incompletely vaccinated children decreased. The vaccination rates increased in parallel with the education level of the parents. While the vaccination rate was significantly correlated with the socioeconomic level of the families, it was inversely correlated with sibling number. CONCLUSIONS: The results of the present study show that the immunization status necessary for the elimination of diphtheria has not yet been reached in eastern Turkey. In immunization programs for children in eastern Turkey, priority should be given to increasing primary immunization levels to 90-95% with three or more doses of diphtheria toxoid.     

Immunization myths and realities: responding to arguments against immunization

As vaccination programs continue to successfully control more and more infectious diseases, and the effects of these diseases become less visible, there has been increased focus on adverse events following immunization. Vaccines have been falsely implicated in the causation of a range of conditions, especially those which affect infants and young children, and whose aetiology is unknown, poorly understood or multifactorial. This paper explores some of the common immunization myths that clinicians may face. It is essential that health professionals have access to accurate information and are able to respond appropriately to parental concerns. This involves good communication; listening, empathy and tailoring advice to the specific concerns of the parent. Finally, health professionals need to provide consistent messages based on solid research evidence.     

Altered T lymphocyte phenotype at birth in babies born to atopic parents

Flow cytometry was used to analyse the cord blood T cells of 33 babies at high risk 'HR' for developing allergy (born to at least one atopic, asthmatic parent), and 10 low risk 'LR' babies (born to non-atopic parents), following normal term deliveries. Significantly lower numbers of CD25⁺, (activated) T cells (p<0.005) were seen in the cord blood of the HR babies who had developed both allergic symptoms and positive skin prick tests by one year of age when compared with the LR group. CD45RO⁺ (memory) T cells were detected in both HR and LR babies with a trend for lower numbers of memory cells to be detected in HR infants who later developed allergic symptoms and/or positive skin prick tests. Significantly lower numbers of CD4⁺/CD45RO⁺ were seen in the cord blood of HR babies who developed allergic symptoms compared to HR babies who showed no sign of allergy by one year and to the LR babies (p<0.05 and p<0.005). The presence of activated and memory T cells at birth implies intra-uterine priming. The significantly lower numbers of memory T cells in the HR babies suggests a suppression of T cell activation or lack of antigenic priming in this group. This prenatal influence on babies born to atopic parents may have important implications with regard to the mechanisms underlying atopic sensitisation.     

Current issues in evaluating the efficacy of oral poliovirus vaccine and inactivated poliovirus vaccine immunization.

Although epidemic poliomyelitis in the United States has been eliminated, there are a number of current issues that concern the use of oral attenuated poliovirus vaccine in comparison with the new enhanced-potency inactivated vaccine. Although wild-type poliovirus is almost eradicated in developed nations, vaccine-induced polio exists, at a low but persistent rate. This article reviews the current issues and suggests a return to the Institute of Medicine's 1988 recommendations concerning combined immunization with inactivated poliovirus vaccine and oral poliovirus vaccine.     

Adverse reactions to immunization with newer vaccines in the very preterm infant

OBJECTIVE: To study the frequency and types of adverse reactions to currently available vaccines in very preterm infants. METHODS: Case notes were obtained for very preterm infants < or =30 weeks' gestational age who received their first immunization at the Royal Women's Hospital, Melbourne, during 1999-2003. Data were extracted for the time periods 48 h before and 48 h after immunizations, with the data extraction blinded as to whether the period being evaluated was pre- or post-immunization. Data collected focused on the frequency and severity of apnoea, respiratory support, fever and clinical consequences of adverse reactions. RESULTS: A total of 48 very preterm infants were immunized during the period; 37 infants had Comvax (Haemophilus influenzae type B and hepatitis B vaccine), Infanrix (diphtheria, tetanus and acellular pertussis vaccine) and inactivated poliomyelitis vaccine, and 11 infants had Comvax and Infanrix only. Their mean (SD) gestational age at birth was 26.4 (1.7) weeks with mean birthweight of 872 (235) g. The mean postnatal age at immunization was 76 (20) days. Low-grade fever (>37.5 degrees C per axilla) occurred in 16 (33%) infants after immunization, but none before immunization (P < 0.001). There was no substantial change in recorded apnoea. No serious adverse events were noted. Four (8%) infants underwent a septic work up post-immunization. The C-reactive protein was increased in all four infants, but other tests for sepsis were negative. CONCLUSION: Fever remains a common adverse event following immunization of the preterm infant in spite of the development of a new generation of vaccines.     

中国儿童免疫规划疫苗接种程序和相关问题

<正>根据《疫苗流通和预防接种管理条例》,疫苗分为第一类疫苗和第二类疫苗。第一类疫苗,是指政府免费向公民提供,公民应当依照政府规定受种的疫苗,包括国家免疫     

Lack of plasma leptin response to feeding in newborn infants

Objective:   Previous reports of the postprandial regulation of leptin are controversial, and there have been few studies on the effects of breast-feeding on postprandial regulation in newborn infants. We examined the response of plasma leptin to breast- and formula-feeding in newborn infants.
Methods:   We measured the plasma leptin levels using an enzyme-linked immunosorbent assay kit before and after feeding in 12 breast-fed and 11 formula-fed mature infants.
Results:   There was no significant difference in plasma leptin levels in breast-fed infants before and after feeding or in artificially fed infants before and after feeding.
Conclusion:   Our results suggest that feeding does not play a role in the acute response of circulating leptin levels in either breast- or formula-fed infants.     

Incidence of apnoea and bradycardia in preterm infants following triple antigen immunization

Ninety-seven preterm infants were immunized with diphtheria-tetanus-pertussis (DTP) prior to discharge from hospital. The mean gestational age at birth was 28.1 weeks (range 24-34) and the mean age at immunization was 80.6 days (range 44–257). Nineteen (20%) infants developed apnoea or bradycardia within 24 h of immunization. The infants who developed apnoea and/or bradycardia had a younger gestational age at birth than those who did not (P= 0.03), were artificially ventilated for longer (P= 0.01) and were more likely to have a diagnosis of chronic lung disease (P= 0.006). In the majority of infants these events were not clinically significant. Two infants who developed concurrent upper respiratory tract infections required additional oxygen and one of them was treated with oral theophylline. In general, it is safe practice to immunize preterm infants with DTP unless otherwise contraindicated. However, it is recommended that cardiorespiratory function is monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.     

儿科临床常用药物与预防接种的关系

<正>随着计划免疫(EPI)工作的进展,儿童所能接种的疫苗种类越来越多,但疫苗对机体而言毕竟是一种异体蛋白,势必会引发少部分人产生预防接种反应或疑似预防接种反