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.

Infantile wheezing and bronchodilator treatment.

Wheezing is a symptom, not a diagnosis. Wheezing disorders are not equal to childhood asthma. Wheezing in the youngest children is often episodic, associated with upper respiratory infection. Early wheezing disorders, particularly in the first 2-3 years of life, should be considered as largely independent of later childhood asthma. It is difficult to distinguish an initial episode of asthma triggered by a viral respiratory infection from acute viral bronchiolitis. Most of the infants with wheezing have transient conditions associated with diminished airway function at birth and do not have increased risks of asthma or allergies later in life. There is no evidence for an overall beneficial clinical effect of nebulized a2-agonists in acute severe wheezing episodes or acute bronchiolitis in infants, although some may seem to respond.

Hereditary angioedema: a family study.

Hereditary angioedema (HAE) is a rare, life-threatening, autosomal dominant disease characterized by recurrent episodes of angioedema, and caused by a deficiency of the plasma protein C1-esterase inhibitor (C1-INH). Clinical manifestation of HAE may first develop during childhood but typically presents around puberty with nonpruritic and non-pitting edema of the subcutaneous and mucosal tissues. Up to now, there has been no published report of HAE case in Taiwan. We reported a 33 year-old female patient who had recurrent painful swelling of face and hands since 27 years of age. She first suffered from sudden onset of painful swelling of the eyelids and lips in August 1998 when she was pregnant for the first time. Subsequently, similar episodes recurred for a few times. Her blood test disclosed that her C3 and C4 were 125 mg/dl and 6 mg/dl, respectively. Her uncle died of laryngeal edema at the age of 30 years. Her father and elder brother also had the similar history of recurrent facial and hand swelling. The C4 levels of her elder brother were 6 mg/dl and 13.3 mg/dl on two separate occasions. The C1-INH antigen serum level and functional assay of the index patient and ten other family members were studied. A total of seven members of the family were confirmed to have type 1 HAE as evidenced by the low C4 and low C1-INH antigenic level and functional activity. Two of the seven cases were asymptomatic up to the date of our report.

Comparison of breath-actuated and conventional constant-flow jet nebulizers in treating acute asthmatic children.

To compare the therapeutic effects of two small-volume jet nebulization devices, a breath-actuated nebulizer (BAN) and a constant-flow nebulizer (CFN), this study was conducted. Seventy-two asthmatic patients, aged 5 to 15, were randomly enrolled into this study (39 to the CFN group, 33 to the BAN group). Nebulization treatment with terbutaline solution (5.0 mg /2 ml) diluted with 2 ml isotonic saline for 10 minutes was performed after measurements of baseline spirometry, SaO2, and pulse rate. Measurements of spirometry, SaO2 and pulse rate were repeated at 0, 5, 15 and 30 minutes after the end of the nebulization treatment. After treatment, for within-group comparison, all the spirometric parameters (including FEV1, PEF and FEF25-75%) and SaO2 at various time points of both groups significantly improved. The pulse rate also significantly increased (only at 15 and 30 min for the CFN group). For between-group comparison, the BAN group had greater improvement in all the data of spirometric parameters and SaO2 at various time points, but only reached statistical significance at some time points in PEF, FEF25-75% and SaO2. The pulse rate of the BAN group was significantly higher than that of the CFN group beginning 5 minutes after treatment. In conclusion, the BAN device is better than the CFN device in improving the spirometric parameters and oxygen saturation of asthmatic children during an equal 10-minute nebulization therapy. These results, associated with the higher pulse rate evoked in the BAN group, suggest a higher lung deposition ratio in the BAN device.

Efficacy of nebulized budesonide in hospitalized infants and children younger than 24 months with bronchiolitis.

To evaluate the effect of nebulized budesonide on acute, young, wheezing patients, a total of 73 patients, aged below 24 months, who were hospitalized due to bronchiolitis were randomly enrolled into this study according to age. They were divided into four groups and treated with four kinds of nebulized solutions. Group I consisted of 18 patients under 12 months old who were treated with budesonide (1 mg/2 ml) diluted with 2 ml isotonic sodium chloride. Group II consisted of 18 patients under 12 months old who were treated with 4 ml isotonic sodium chloride. Group III included 16 patients between 12 and 24 months old who were treated with terbutaline (5 mg/2 ml) diluted with 2 ml isotonic sodium chloride. Group IV included 21 patients between 12 and 24 months old who were treated with budesonide (1 mg/2 ml) and terbutaline (5 mg/2 ml). Clinical data on respiratory rate, wheezing score, cyanosis score and accessory respiratory muscle utilization score were recorded in all patients before and after treatment throughout the entire hospitalization. The results of this study showed no benefits from nebulized budesonide in infants with bronchiolitis either younger than 12 months old or between 12 and 24 months of age. The duration of admission also showed no significant differences among the groups.

The function profile of compressed-air and ultrasonic nebulizers.

In order to study the detailed function of two kinds of nebulizers commonly used in clinical asthma treatment, compressed-air and ultrasonic, this study was conducted. At the beginning, various flow rates were adjusted, paired with different volumes of solutions in the container. The changes of temperature, pH, and osmolality during the course of nebulization were examined. Normal saline, terbutaline, and fenoterol solutions were used as the nebulized solutions. The study was performed in an environment in ambient temperature around 20 degrees C and relative humidity around 70%. The results showed a minimal 6 L/min flow rate was required to nebulize the solution when using the compressed-air nebulizer. The dead volume was about 0.8 ml for compressed-air and 8.5 ml for the ultrasonic nebulizer. When using the compressed-air nebulizer, the temperature, both in the solution and at the mouthpiece site, dropped gradually. On the contrary, the temperatures at both sites increased a little bit when using the ultrasonic nebulizer. The pH values of pure terbutaline and fenoterol nebulized solutions were acidic (3.58 and 3.00 respectively). The osmolality of terbutaline and fenoterol nebulized solutions were isotonic. The osmolality increased gradually during the course of nebulization, to a greater extent in the compressed-air nebulizer. In conclusion, both types of nebulizers have their special features. The ultrasonic nebulizer displays less extent in change of temperature and osmolality during nebulization and is expected to be a better device in treating asthmatic patients in terms of lesser effect on cooling and changing the osmolality of airway mucosa.

A comparison of terbutaline and fenoterol unit dose vials in treating children with acute asthmatic attacks.

To compare the bronchodilation and adverse effects of two commercially marketed short-acting beta2-adrenergic agonists, terbutaline (Bricanyl, 5.0 mg/2ml) and fenoterol (Berotec,1.25 mg/2ml) unit dose vials (UDV), 108 acute asthmatic children, aged 5 to 14, were randomly enrolled into this study. Nebulization treatment for 10 minutes using an air compressor nebulizer was performed after measurements of baseline spirometry, SaO2, blood pressure and pulse rate. Same measurements were repeated at 0, 5, 15 and 30 minutes after the end of the nebulization treatment. The blood pressure was also monitored immediately and 30 minutes after treatment. Almost all the spirometric parameters of both treatments at various time points significantly improved. The pulse rate significantly increased at 15 and 30 min. The SaO2 significantly increased at 30 min. The systolic blood pressure significantly decreased immediately (terbutaline only) and at 30 min (fenoterol only). No significant change was found in diastolic blood pressure. When the laboratory parameters at the same time points were compared. Significant better results for fenoterol treatment were found in FEV, at 30 min (p = 0.048), PEF at 15 and 30 min (p = 0.049 and p = 0.027, respectively), FEF25-75% at 30 min (p = 0.033), mean absolute increase of PEF at 15 min (p = 0.034) and 30 min (p = 0.021), FEF25-75% at 30 min (p = 0.046), and in mean percent increase of FEF25-75% at 30 min (p = 0.047). The adverse effects for both groups were almost equal and around 21%. In conclusion, both terbutaline and fenoterol UDV nebulization treatments are effective in treating acute asthmatic children. The adverse effects are nearly equal. The fenoterol UDV nebulization treatment shows a little better result in improving pulmonary function than does terbutaline.