House dust mite-specific immunotherapy alters the natural course of atopic march.

Allergen immunotherapy (AIT) is an effective treatment for patients with allergic diseases; it has been shown to modify the underlying cause of the disease. The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic-related diseases such as allergic rhinitis, asthma, and atopic dermatitis. HDM allergen is an important factor in the pathogenesis of allergic diseases. Sensitization to HDM allergen often occurs early in life and appears to play an important role in the progression from allergic rhinitis to asthma in children. The role of HDM AIT results in immunologic tolerance, provides an alternative option for treating HDM allergy through targeting the mechanisms of allergic reaction, and creates a long-term benefit. There are two forms of testing for aeroallergen, either detect by skin testing or by in vitro IgE assays. Both subcutaneous immunotherapy and sublingual immunotherapy are effective in the treatment of allergic diseases. In the future, new forms of allergen extracts can help improve safety and efficacy of AIT. Novel approaches to immunotherapy currently being explored include the use of adjuvants, allergen-derived peptides, modified recombinant allergen vaccines, and gene-specific immunotherapy.

Measles re-emerges and recommendation of vaccination.

Measles is a highly infectious viral illness and is one of the world's most contagious diseases that can affect all people if they have not been vaccinated or have not had it before. Before measles vaccine became available in 1963, major epidemic occurred approximately every 2 to 3 years and thus 99% of the people were thought to have been infected naturally with measles virus and got immune for life. In 2000, measles was declared eliminated from the United States, and yet 1215 cases have been reported from 30 states as of August 22, 2019. Currently, there are several large measles outbreaks universally, and some people who were not immune and they need to get their measles, mumps, rubella (MMR) vaccine to prevent measles outbreaks. As vaccination coverage increases, the average age of measles infection can change to adolescents and young adults. In addition, the protective antibodies derived from vaccination might decrease gradually, and the risk of measles infection in young adults is increasing regardless of international travelling.

Why Zika virus infection has become a public health concern?

Prior to 2015, Zika Virus (ZIKV) outbreaks had occurred in areas of Africa, Southeast Asia, and the Pacific Islands. Although a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, such a connection has not yet been scientifically proven. In May 2015, the outbreak of ZIKV infection in Brazil led to reports of syndrome and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes; the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed ZIKV infection in Brazil. Currently, ZIKV outbreaks are ongoing and it will be difficult to predict how the virus will spread over time. ZIKV is transmitted to humans primarily through the bite of infected mosquitos, Aedes aegypti and Aedes albopictus. These mosquitoes are the principle vectors of dengue, and ZIKV disease generally is reported to include symptoms associated with acute febrile illnesses that clinically resembles dengue fever. The laboratory diagnosis can be performed by using reverse-transcriptase polymerase chain reaction (RT-PCR) on serum, viral nucleic acid and virus-specific immunoglobulin M. There is currently no vaccine and antiviral treatment available for ZIKV infection, and the only way to prevent congenital ZIKV infection is to prevent maternal infection. In February 2016, the Taiwan Centers for Disease Control (Taiwan CDC) activated ZIKV as a Category V Notifiable Infectious Disease similar to Ebola virus disease and MERS.

Randomized Open Trial Comparing 2-Dose Regimens of the Human Papillomavirus 16/18 AS04-Adjuvanted Vaccine in Girls Aged 9-14 Years Versus a 3-Dose Regimen in Women Aged 15-25 Years.

BACKGROUND: This randomized, open trial compared regimens including 2 doses (2D) of human papillomavirus (HPV) 16/18 AS04-adjuvanted vaccine in girls aged 9-14 years with one including 3 doses (3D) in women aged 15-25 years. METHODS: Girls aged 9-14 years were randomized to receive 2D at months 0 and 6 (M0,6; (n = 550) or months 0 and 12 (M0,12; n = 415), and women aged 15-25 years received 3D at months 0, 1, and 6 (n = 482). End points included noninferiority of HPV-16/18 antibodies by enzyme-linked immunosorbent assay for 2D (M0,6) versus 3D (primary), 2D (M0,12) versus 3D, and 2D (M0,6) versus 2D (M0,12); neutralizing antibodies; cell-mediated immunity; reactogenicity; and safety. Limits of noninferiority were predefined as <5% difference in seroconversion rate and <2-fold difference in geometric mean antibody titer ratio. RESULTS: One month after the last dose, both 2D regimens in girls aged 9-14 years were noninferior to 3D in women aged 15-25 years and 2D (M0,12) was noninferior to 2D (M0,6). Geometric mean antibody titer ratios (3D/2D) for HPV-16 and HPV-18 were 1.09 (95% confidence interval, .97-1.22) and 0.85 (.76-.95) for 2D (M0,6) versus 3D and 0.89 (.79-1.01) and 0.75 (.67-.85) for 2D (M0,12) versus 3D. The safety profile was clinically acceptable in all groups. CONCLUSIONS: The 2D regimens for the HPV-16/18 AS04-adjuvanted vaccine in girls aged 9-14 years (M0,6 or M0,12) elicited HPV-16/18 immune responses that were noninferior to 3D in women aged 15-25 years. CLINICAL TRIALS REGISTRATION: NCT01381575.

Congenital Systemic Fungus Infection in Twin Prematurity-A Case Report and Literature Review.

Congenital candidemia sepsis is a serious condition especially for the prematurity. Early recognition is always not the scenario and this leads to high morbidity and mortality. Twin pregnancy complicates the problems further. This report presents a case of congenital candidiasis in a twin preterm and literatures review of five twin pairs with the same scenario. In conclusion, for twin prematurity, if one is suspected to have invasive candidiasis, both of them should receive a full course of antifungal therapy through the intravenous route.

Current recommendations for the Japanese encephalitis vaccine.

Japanese encephalitis (JE) is a mosquito-borne flavivirus infection and an important cause of encephalitis in most of Asia and parts of the western Pacific. Most people infected with the JE virus (JEV) are asymptomatic or seemingly suffer from a nonspecific, flu-like illness; in others, JE can cause illness ranging from fever and headache to severe encephalitis. Although it can cause significant morbidity and mortality, JE is a vaccine-preventable disease, and vaccination programs have proven most effective in preventing and diminishing the burden of disease. Such JE vaccines have been available for decades with four types of JE vaccines-live attenuated SA14-14-2 vaccine, inactivated mouse brain-derived vaccine (JE-MB), inactivated Vero cell culture vaccine (JE-VC), and live attenuated chimeric vaccine (IMOJEV)-and are currently used in most countries. In some Asian countries such as Japan, China, Taiwan, Korea, and Thailand, immunization programs have been conducted for children and so the ongoing incidence of JE has declined considerably in recent decades. Until quite recently, the primary JE vaccine in use internationally has been the JE-MB, which is now commonly replaced by cell culture-based vaccines.

Can probiotics be used to treat allergic diseases?

Probiotics are proprietary formulations of specific microorganisms and quantified populations of live bacteria that are intended to confer a health benefit on the host. These different strains and combinations of microorganisms have a wide and varying range of clinical and immunologic capacities that can modify intestinal microbial populations in ways that can benefit the host. The enhanced presence of probiotic bacteria in the intestinal microbiota has been found to correlate with protection against atopy. The prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has increased sharply over the past 2-3 decades in many countries, and allergies are now the most common chronic disease among children throughout the world. In the past few years, probiotics have been advocated for the management of allergic diseases in many parts of the world. So far, probiotics have shown more promise, albeit limited, in the primary prevention of allergic disease rather than in the treatment of established disease.

Iron deficiency anemia in predominantly breastfed young children.

BACKGROUND: Due to the increase of breastfeeding in infants, iron deficiency anemia (IDA) related to prolonged, predominant breastfeeding should be of concern. Mostly, the manifestation of IDA is indistinguishable and the enthusiastic advocacy of breastfeeding without concomitant education of complementary food may lead to ignorance of breast milk-related IDA, which may result in impaired psychomotor development of the baby. This retrospective study was conducted to re-emphasize this easily ignored but still prevalent illness. METHODS: This retrospective study involved 15 breastfeeding babies who were diagnosed with IDA between January 2007 and December 2010 at age 6-18 months. The clinical presentation, age at diagnosis, initial hemoglobin level and mean corpuscular volume, growth percentile, and duration of treatment were recorded and analyzed. RESULTS: None of the babies was suspected to have anemia by caregivers. Pallor was noticed by physicians in nine patients; one patient had seizure, one patient had pica, and, for the remaining four patients, IDA was diagnosed incidentally due to other medical events. Oral iron supplementation for an average of 3.6 months improved both hemoglobin level (from 8.0 g/dL to 11.5 g/dL) and mean corpuscular volume (from 57.5 fL to 73.9 fL). Most babies had appropriate growth and normal neurological development; two babies had both IDA and thalassemia. CONCLUSION: Although the association of IDA with prolonged, predominant breastfeeding is well known, its presentation is so subtle that its detection relies mainly on alert medical personnel.

Clinical analysis of Enterobacter bacteremia in pediatric patients: a 10-year study.

BACKGROUND: Enterobacter species has emerged as an important pathogen of nosocomial bacteremia. The purpose of this study is to review the clinical characteristics of bacteremia in pediatric patients. MATERIALS AND METHODS: We reviewed retrospectively the medical records of patients (under the age of 18 years) having Enterobacter bacteremia who were treated at Taipei the Veterans General Hospital from January 2001 to June 2011. RESULTS: In total, 853 positive blood cultures were obtained from 620 patients during the study period. Among them, 96 episodes of Enterobacter bacteremia were found in 83 patients, accounting for 11.3% of all bacteremia. Eighty-two cases (98.8%) were nosocomial infections. Most of the cases were neonates (62 cases, 74.7%) and premature infants (51 cases, 61.5%). The common sources of bacteremia were the respiratory tract (53.0%), followed by intravascular catheter (10.8%), multiple sources (10.8%), and the gastrointestinal tract (8.4%). The overall case fatality rate was 18.1%, with the highest rate being reported among premature infants. The factors responsible for the deaths were leukocytosis and a higher median number of underlying diseases. CONCLUSION: Based on the findings of the present study, it can be concluded that Enterobacter species are probably an important pathogen of nosocomial bacteremia in premature neonates. The number of underlying diseases should be considered a major factor influencing the prognosis.

Recommendations for rotavirus vaccine.

Rotavirus infection has been the leading cause of gastroenteritis among children in Taiwan. Studies have shown that 40% of hospitalization for acute gastroenteritis can be prevented through the use of vaccines, including a live, attenuated monovalent rotavirus vaccine and a pentavalent, human-bovine reassortant rotavirus vaccine. In 2009, the World Health Organization suggested that rotavirus vaccine should be included in all national immunization programs. This review summarizes issues and recommendations discussed during an expert meeting in Taiwan. The recommendations included: (1) rotavirus vaccine should be offered to all healthy infants (including those without contraindications, such as immunodeficiency) at an appropriate age; (2) either monovalent or pentavalent vaccine can be administered concurrently with routine injected vaccines; (3) the administration of rotavirus vaccine must be administered at least 2 weeks prior to oral polio vaccination; (4) the first vaccine dose for infants should be administered between age 6 weeks and age 14 weeks 6 days and the course should be completed by age 8 months 0 day; (5) pentavalent vaccines can be administered at 2 months, 4 months, and 6 months while monovalent vaccines can be taken at 2 months and 4 months; (6) a combined use of monovalent and pentavalent vaccine is justified only when the previous dose is unavailable or unknown; and (7) rotavirus vaccines may be given to premature infants, human immunodeficiency virus infected infants and infants who have received or are going to receive blood products.

An overview of the recent outbreaks of the avian-origin influenza A (H7N9) virus in the human.

Since the first human infection with influenza A (H7N9) viruses have been identified in Shanghai on March 31, 2013, the latest variant of the avian flu virus has spread across four Chinese provinces recently. Human infections with avian influenza are rare and this is the first time that human infection with a low pathogenic avian influenza A virus has been associated with fatal outcome. To date (May 5(th), 2013), China had reported 128 confirmed H7N9 infections in human, among 27 died. Most reported cases have severe respiratory illness resulting in severe pneumonia and in some cases have died. No evidence of sustained human-to -humans at this time, however, there is one family cluster with two confirmed cases for which human-to-human transmission cannot be ruled out. Recent evidence showed that the gene sequences of this novel H7N9 virus is primarily zoonotic and may be better adapted than other avian influenza viruses to infect human. Effective global infection control is urgently needed, and further surveillance and analyses should be undertaken to identify the source and mode of transmission of these viruses.

Otorrhea as a sign of medical treatment failure in acute otitis media: two cases with silent mastoiditis complicated with facial palsy.

We report two children with otitis media who developed facial palsy despite prompt antibiotic therapy. Brain images revealed silent mastoiditis. Persistent otorrhea may be a cautious sign of medical treatment failure or complication of acute otitis media, including mastoiditis or facial palsy. Delayed identification of coexisting mastoiditis or hesitation over surgical intervention may lead to treatment failure and complications. Adequate intravenous antibiotics and myringotomy provide reasonable and appropriate management to prevent permanent sequelae.

Etiology of empyema thoracis and parapneumonic pleural effusion in Taiwanese children and adolescents younger than 18 years of age.

We analyzed blood and pleural fluid samples from 89 Taiwanese children with empyema thoracis and parapneumonic pleural effusion. Streptococcus pneumoniae was the major pathogen, identified in 12 children by bacterial culture and 53 children by molecular techniques, and serotype 19A was the dominant serotype. Also noteworthy was the detection of pneumococcal serotype 1, Haemophilus influenzae and Mycoplasma pneumoniae in these children.

Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria.

Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non-FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (brief-symptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan's general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.

Cranial ultrasonographic findings in healthy full-term neonates: a retrospective review.

BACKGROUND: Ultrasonography is a non-invasive diagnostic technique, and it has been used to detect intracranial lesions in neonates for a long time. Correspondingly, screening tests using cranial ultrasonography have been applied for early detection of intracranial lesions in full-term neonates during the past decade. METHODS: We retrospectively reviewed the findings of cranial ultrasonographic screening tests in healthy full-term neonates between September 2004 and August 2009. The ultrasonographic findings were divided into the following categories: (a) nonsignificant (NS) group, including normal and normal variations, (b) minor anomaly group, including tiny cystic lesions, mild hemorrhage, or mild ventricular anomaly, and (c) major anomaly group, including significant anomaly of any intracranial pathology. The participants with major anomalies were further reviewed, and the following medical records of all enrolled patients were reviewed until they were 24 months of age. RESULTS: There were a total of 3186 neonates who received cranial ultrasonographic screening examination during the 5-year period, and most of them (2982 cases, 93.6%) were assigned to the NS group. The most common normal variation was the presence of cavum septum pellucidum (1979 cases, 62.1%). Minor anomalies were found in 202 (6.3%) neonates, including 119 (3.7%) neonates with tiny cysts, and 59 (1.9%) neonates with mild intraventricular hemorrhage. Major anomalies were found in two (0.06%) neonates, including obstructive hydrocephalus and agenesis of the corpus callosum. Two other infants (0.06%) initially presented with minor anomaly or normal variation, but they were diagnosed as Moyamoya disease and neonatal seizure some months later. CONCLUSION: The incidence of minor and major anomalies detected by cranial ultrasonographic screening examinations in healthy full-term neonates is 6.3% and 0.06%, respectively. Thus, cranial ultrasonographic screening testing may play a role in the early diagnosis of intracranial anomalies of otherwise healthy neonates. However, this examination cannot exclude or detect all cranial abnormalities, including many potential neurologic diseases of neonates, so continuing clinical diligence is still important for all infants.