Immunogenicity of recombinant hepatitis B vaccine: comparison of two different vaccination schedules.

BACKGROUND: Neonatal immunization with hepatitis B (HB) vaccine induces protective levels of antibody (anti-HBs > or =10 IU/L) in a majority of vaccines. However, the duration of protection after HB vaccination in infants is unknown. A smaller proportion of children vaccinated beginning at birth with three doses of HB vaccine were found to have protective titers 5-10 years after initial vaccination. Long-term efficacy of HB vaccine depends mainly on peak antibody levels after vaccination, and subjects were observed to have lower levels of antibodies if they received the first dose of vaccine immediately after birth. The aim of our study was to compare the immunogenicity of two different HB vaccine schedules in infants born to HB surface antigen-negative mothers. METHODS: Anti-HBs titers in infants vaccinated with two different schedules were compared. Infants were vaccinated at 0, 2, and 9 months (group 1) or at 2, 4, and 9 months (group 2). In total, 267 blood samples were analyzed at a mean of 14.20 +/- 2.39 months after the third vaccine dose. Sera were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) using commercial enzyme immunoassay kits. RESULTS: The geometric mean titers for anti-HBs were 95.00 and 379.51 IU/L and the rates of anti-HBs more than > or =100 IU/L were 57.7 and 94.9% in group 1 and 2 infants, respectively. CONCLUSION: Delaying the first dose of the HB vaccine until 2 months after birth produces a higher immune response and can provide longer term protection.

Seroprevalence of IgG antibodies against Bordetella pertussis in healthy individuals aged 4-24 years in Turkey.

The distribution of IgG antibodies to Bordetella pertussis was investigated in serum samples from 550 subjects, aged 4-24 years, to determine the optimal age for booster immunisation. Levels of antibody to B. pertussis antigens were determined using an ELISA that measures a mixture of pertussis toxin, filamentous haemagglutinin and lipopolysaccharide. Geometric mean titres of anti-pertussis antibodies in subjects aged 4-6 years were significantly lower than those in other age groups, which reflects waning immunity following vaccination. High positive titres in older children and adolescents suggested acquired B. pertussis infection, and booster doses at the ages of 7 and 15 years are therefore suggested.

Toilet training in Turkey: the factors that affect timing and duration in different sociocultural groups.

BACKGROUND: The aim of the present study was to determine the patterns of toilet training and the factors that may be related to its timing and duration and the approaches of different sociocultural groups within a developing country. METHODS: This cross-sectional survey was performed on 745 children who live in three different sociocultural settlements. The factors that might have affected initiation and completion age and duration of toilet training were assessed with t-test, ANOVA and logistic regression analysis. RESULTS: Mean initiation and completion ages were 22.05 +/- 6.73, 28.05 +/- 8.40 months respectively. The families living in rural and semi-urban settlements, mothers educated for less than 5 years, unoccupied mothers, children living in houses which do not have a toilet inside, families who use washable diapers, who use Turkish style toilets and who use punishment methods started training earlier. In the infants whose mothers had an education over 12 years, completion age was later than others and the earliest completion age was seen in families who used punishment method. Mean duration needed to complete toilet training was 6.84 +/- 7.16 months. The duration of training was longer in families living in rural and semi-urban settlements, mothers educated for less than 5 years, unoccupied mothers, children living in houses which do not have a toilet inside, families who use washable diapers and when the initiation was before the child was 18 months old. CONCLUSION: Toilet training shows differences among cultures. The age of initiation may be increased as the parents are educated better and a child-orientated approach becomes more popular than the parent-orientated approach.

Diffuse arterial aneurysms in a case of Ehlers-Danlos syndrome--a case report.

A three-year-old boy with the diagnosis of Ehlers-Danlos syndrome (EDS) with persistent ductus arteriosus and multiple diffuse arterial aneurysms is presented. The case is classified as "EDS type unknown" because the clinical features and the inheritance pattern differ from the types described previously. It is stressed that the diagnosis of the disease is important for genetic counseling and surgical intervention.

Comparison of the reactogenicity of three different immunization schedules including diphtheria, tetanus, pertussis, Haemophilus influenza b and polio vaccine in Turkey.

BACKGROUND: In Turkey, several changes have been made in the vaccination schedule. Vaccines against diphtheria, tetanus, pertussis and poliomyelitis were applied as DTwP and OPV until the end of 2006. Hib vaccine was added to the schedule and was administered as a separate injection in 2007 as DPT + OPV + Hib. DTaP-IPV/Hib combined vaccine replaced them in 2008. The aim of this study was to evaluate the alterations in the frequency of adverse reactions of these different schedules in the consecutive three years. METHODS: A total of 2401 infants who were vaccinated in Gazi University Well Child Clinics during the first 3 months of each schedule were enrolled in the study. Local and systemic adverse events were recorded in diaries by the parents for the next three days. RESULTS: No significant differences existed between infants vaccinated with DPT + OPV and DPT + OPV + Hib regarding all adverse events detected. Frequency of local and systemic reactions were lower in infants vaccinated with DTaP-IPV/Hib combined vaccine (p < 0.001). Frequency of adverse events in infants vaccinated with DPT + OPV or DPT+ OPV + Hib were highest at booster doses. CONCLUSIONS: The original experience of the study is the demonstration of the adverse event profile for three different schedules which allowed us to draw the profile of the adverse events in a country with changing national schedules. Implementation of Schedule 3 reduced the adverse events of vaccination. Thus reduction in the number of injections and reactogenicity of pertussis vaccine contributed to an increase in the compliance to the vaccination program.

Evaluation of perinatal and intrafamilial hepatitis B prevention programmes in a well child clinic: 9-year follow-up study in Turkey.

Evaluating the performance of well child clinics on adherence to recommended perinatal hepatitis B prevention programmes as well as assessing the outcome of infants living with hepatitis B surface antigen (HBsAg)-positive parents is important. A retrospective study was performed of 336 babies who had at least one HBsAg-positive parent and were followed-up in the well child clinic of Gazi University Hospital (Ankara, Turkey) between 2001 and 2009. Rates of passive immunisation in 109 babies with HBsAg-positive mothers and initiation of hepatitis B vaccination of all 336 babies with HBsAg-positive parents were 98.8% and 100% respectively. Ninety-two babies (27.4%) were lost to follow-up before completing primary immunisation. The recommended perinatal hepatitis B prevention programme was performed successfully in 194 of the 306 infants who were old enough for post-vaccination serotesting (63.4%). One baby became HBsAg-positive, and 88.1% of babies were seroprotected. Hepatitis B surface antibody (anti-HBs) levels were found to be increased if the HBsAg-positive parent was the father. There was a negative correlation between serotesting time and anti-HBs titres. The study infants had a total of 187 siblings and 123 (65.8%) were serotested after completing primary immunisation with 108 found to be seropositive. Although the vaccination rate in the perinatal hepatitis B prevention programme is satisfactory, post-vaccination serotesting and evaluation of infants and their siblings are still deficient.

The effect of the baby-friendly hospital initiative on long-term breast feeding.

The aim of this study was to evaluate the effects of 'baby-friendly hospital initiative' (BFHI) on breast feeding. In the four consecutive months after BFHI in Gazi University Hospital (November 2002-February 2003), breast feeding status until the second year of life in 297 babies, born in the same hospital was compared with the values of 258 babies born before BFHI (November 2001-February 2002). The exclusive breast feeding rate in the first 6 months was higher in the babies born after BFHI. Cox regression analysis revealed that BFHI increases the duration of breast feeding 1.5 times. At the end of the second year, cumulative rate of breast feeding was higher in the group after-BFHI (p=0.0036). The rate of breast feeding was increased by BFHI implementation.

Attitudes and practices regarding circumcision in Turkey.

BACKGROUND: In Turkey, circumcision is a necessity for boys to gain a masculine identity. In contrast to Western societies, where circumcision is performed in the neonatal period, it is performed at older ages in our population, and the timing may affect the psychosocial well-being of males. The person who performs the operation, a physician or a traditional circumciser, may affect their health as well. OBJECTIVE: To provide some information about the practice of circumcision in Turkey, such as timing, by whom and why it is performed in our country, and relation of their fathers' past emotions about their own circumcision to this current practice. METHODS: Questionnaires were filled out in face-to-face interviews with parents of 1235 male children under 16 years of age who attended well-child clinics of Gazi University Hospital and 10 different primary health care centres throughout Ankara, Turkey. RESULTS: Median age of circumcision was found to be 6 years. Only 14.8% of children were circumcised before 1 year of age. The main reasons for circumcision were religious and traditional. The medical benefits of the procedure outweighed the traditional reasons for only 15.2% of the families. The operation was carried out by a traditional circumciser in 13.3% of the children. Most of the fathers who could remember their own emotions about circumcision confessed that they had been frightened. They remembered the procedure as painful. Indeed, the mean age of their sons' circumcision was close to their own circumcision age. CONCLUSIONS: Traditions still play an important role in the timing of circumcision and by whom and why it is performed in Turkey. Changing times and educational levels do not seem to affect the traditional approach to circumcision.

Humoral immune response against antigen 60 in BCG-vaccinated infants.

An ELISA assay based on the A-60 antigen complex from Mycobacterium bovis BCG cytoplasm was used to detect anti-mycobacterial antibodies of different classes in the sera of 63 BCG-vaccinated infants during the 6-month post-vaccination period. The mean IgM and IgA levels increased, whereas the mean IgG level decreased after BCG vaccination. However, in a minority of cases only Ig levels were above the cut-off line: this was true for IgM in 11/63 (17%) cases and for IgA in 14/63 (22%) of cases but none of the tested infants was anti-A60 IgG ELISA positive. Fifty-two infants (83%) were tuberculin-positive eight weeks after vaccination, and no significant difference in mean antibody levels of tuberculin-positive and negative cases was observed, except for IgG (p < 0.05).

Humoral immune response in infants after BCG vaccination.

SETTING: Child welfare division of a university-based department of pediatrics in Turkey. OBJECTIVE: To determine specific IgM and IgG response after BCG vaccination. DESIGN: Prospective, randomized trial. METHODS: Serum samples of 66 infants were taken before and at 2, 4, 6 and 15 months after vaccination. 35 infants were vaccinated at the first month and 31 at the second month after delivery. An ELISA assay was performed using PPD antigen. RESULTS: IgM antibodies increased significantly (P < 0.05) during the post-vaccination period. On the other hand IgG antibodies decreased in the second month after vaccination. At the fourth month the IgG level began to rise continuously (P < 0.01). The infants who were vaccinated at the second month showed a higher IgM response at the second and fourth month than those vaccinated in the first month (P < 0.05), but the difference was not visible thereafter (P > 0.05). 52 infants (78%) were tuberculin positive 8 weeks after vaccination. CONCLUSION: Anti-PPD IgM and IgG levels rise progressively in BCG-vaccinated infants.

Tuberculoma in the suprasellar cistern: possible CT--misinterpretation as aneurysm.

A patient with multiple intracranial tuberculomas mimicking aneurysms is reported. The diagnosis was established by CT during the treatment of tuberculous meningitis. Anti-tuberculous therapy was continued until the radiological resolution of the lesions. A discussion of previous reports on the non-operative treatment of intracranial tuberculomas is included.

Experience of Turkish parents about their infants' teething.

AIM: To evaluate Turkish parents' experience about their infants' teething; which symptoms they have seen and attributed to teething and how they have acted to manage these symptoms. METHODS: A questionnaire form was applied by face-to-face interview to 335 families who have children less than 18 months of age and have at least one tooth. They were asked questions to clarify the eruption time and sequence of primary teeth of their infants and whether their infants had some symptoms they attributed to teething. RESULTS: The mean eruption time of the primary teeth was 7.4 +/- 2.0 months, with a range of 3-17 months. Teeth eruption time was found similar in both genders. Teeth eruption time of the term and preterm infants was similar. (P > 0.05). The first tooth erupted was the lower central incisor in the 288 infants (86.0%) and upper central incisor in 44 infants (13.1%). Most of the families (98.8%) reported that their children had suffered from at least one of the symptoms that were mentioned in the questionnaire. The most commonly reported symptom was increase in biting, followed by irritability and fever. Of the children who were taken to a health care centre, in 78.8% the symptoms were attributed to teething and in 7.1% a bacterial infection was found and antibiotics were prescribed. CONCLUSION: When an infant at teething age has some symptoms, they may be attributed to teething but other possible causes must be ruled out first.