Immunogenicity and safety of a DTaP-IPV//PRP-T vaccine (Pentaxim) booster during the second year of life in Thai children primed with an acellular pertussis combined vaccine.

This study assessed the booster immune response to a pentavalent combination vaccine containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and conjugated-Hib polysaccharide antigens, (DTaP-IPV//PRP-T, Pentaxim, an AcXim family vaccine) at 18-24 months of age. Study subjects received a three-dose primary vaccination at 2, 4 and 6 months with a hexavalent vaccine containing the same antigens plus recombinant hepatitis B surface antigen. Antibody concentrations were measured immediately before and one month after vaccination. Reactogenicity and safety were evaluated from parent reports. Before the booster dose, 92.9% of the 156 children included in this study still had anti-PRP antibody titers > or = 0.15 microg/ml. Seroprotective concentrations of anti-diphtheria, tetanus and poliovirus antibodies were maintained in 97 to 100% of subjects in the interval between primary and booster vaccination. One month after the booster dose, all subjects had seroprotective anti-PRP (> or = 1 microg/ml), diphtheria and tetanus (> or = 0.1 IU/ml) and poliovirus types 1, 2, 3 (> or = 8 1/dil) antibody levels. At least 92.3% of subjects had 4-fold increases in concentrations of anti-pertussis antigens from pre- to post-booster dose. Geometric mean titers (GMTs) increased from 3.8 to 181.2 EU/ml and from 18.0 to 289.7 EU/ml for anti-PT and anti-FHA, respectively. The anti-PRP GMT increased from 1.6 to 58.0 microg/ml. The pentavalent DTaP-IPV//PRP-T vaccine booster was well tolerated and highly immunogenic, following primary vaccination with a hexavalent vaccine.

Incidence and risk factors for non-nucleoside reverse transcriptase inhibitors (NNRTI)-related rash in Thai children with HIV infection.

The present study evaluated the incidence and risk factors that correlated with the development of non-nucleoside reverse transcriptase inhibitor (NNRTI) related rash in 69 Thai children followed prospectively. The overall incidence of NNRTI-related rash was 16% (22% for NVP and 4% for EFV rash). The only significant predictive factor that correlated with the development of NNRTI-related rash in a multivariate logistic regression model was a CD4% decrease at week 12.

Regression of a cervical spinal mass following highly active antiretroviral therapy (HAART) in child with advanced human immunodeficiency virus (HIV) disease.

This report documents a case of infiltrating cervical spinal mass, most likely a spinal tumor, in a girl with HIV infection that regressed following HAART and without treatment of the tumor or any anti-infectives.

D-dimer as an indicator of dengue severity.

Background: Dengue infection is a problem of global concern. The clinical spectrum of the disease varies from an acute febrile course accompanied by mild hemorrhagic manifestations with uneventful recovery to refractory shock and massive bleeding with high mortality. Several mechanisms may be involved in the pathogenesis of bleeding, namely: vasculopathy, thrombocytopenia, coagulopathy and dissiminated intravascular coagulopathy (DIC). Objective: To determine the relationship between D-dimer (DD) levels and clinical outcome in dengue patients. Method: Children with suspected dengue infection admitted to King Chulalongkorn Memorial Hospital were enrolled. D-dimer (DD) was sequentially measured during the course of illness using whole blood and a rapid semiquantitative system (SimpliRed). Diagnosis of dengue infection was confirmed by serology and WHO criteria were used for classifying dengue severity. Results: 41 dengue patients, 22 girls and 19 boys were recruited in the study. The mean age was 9.68 years. There were 12 (29.3 %) cases of dengue fever (DF) and 29 (70.7 %) cases of dengue hemorrhagic fever (DHF). DD was more significantly present in the DHF group (87 %) than in the DF group (13%) (P<0.03). The sensitivity and specificity of DD in predicting severe dengue infection (DHF) were 90% and 67 %, respectively. Sequential analysis of DD showed higher levels at all stages of dengue infection. It correlated with the disease severity. Conclusion: Semiquantitative DD assay measurements in children suffering from dengue infection significantly correlated with dengue severity.

The prevalence of varicella-zoster virus infection in normal healthy individuals aged above 6 months.

The prevalence of varicella-zoster virus (VZV) infection was studied by determining the presence of IgG antibody to VZV (anti-VZV IgG) using ELISA method. Three hundred and fifty sera collected from Thai healthy individuals aged above 6 months (mean age +/- standard deviation = 14.9 +/- 11.4) were tested, the prevalence of VZV infection was 64.6% (225/350). All samples were randomly sampling from healthy children and blood donors who visited the hospital and clssified into 7 groups, 50 samples each, according to their age, i.e., group 1; 6 months-3 years, group 2; 4-6 years, group 3; 7-9 years, group 4; 10-14 years, group 5; 15-19 years, group 6; 20-24 years and group 7; above 25 years. The prevalence of VZV infection were 12%, 42%, 64%, 70%, 78%, 84% and 100% respectively. The mean amount of anti-VZV IgG among groups of positive VZV infection (225 samples) was 86.8 +/- 29.7 unit/ml. The mean amount of anti-VZV IgG was highest in 6 months-3 years age group (113.6 +/- 39.2 unit/ml). Significant difference of the mean amount of anti- VZV IgG was found between group 1, 3, 6 and other groups (p-value < 0.05). There was a correlation between history of varicella and the presence of anti-VZV IgG in the serum. 95.3% of individuals with positive history has already had the antibody. The important associated factors that might involve VZV infection were age, number of members in family and place of exposure to VZV infection. Other factors, such as sex and income did not show any association to VZV infection.

Childhood shigellosis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand: a 5-year review (1996-2000).

The objective of this study was to evaluate the demographic data and clinical presentation of childhood shigellosis, and to study the microbiological data and antimicrobial susceptibilities of Shigella spp. Nine thousand nine hundred fourteen stool culture specimens from children aged 0-15 years who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2000 were retrospectively reviewed. Data were collected from microbiological records and medical charts of childhood shigellosis in terms of demographic data, symptoms, signs, and complications of the patients, and the species and antimicrobial susceptibilities of the organisms. The data were analyzed in terms of means, ranges, and percentages. Of 1,523 children whose stool cultures were positive for pathogenic bacteria, 80 (5.3%) were infected with Shigella spp; 34 females and 46 males. The age distribution ranged from 1 day to 13 years with a mean age of 3.6 years. Common clinical presentations included diarrhea (96.6%), fever (77.6%) and vomiting (44.8%); seizures were the most common complication found (27.6%). Watery and mucous were the most common characteristics of stools. The major Shigella spp found was S. sonnei (62.8%), which was susceptible to co-trimoxazole, ampicillin, cefazolin and ciprofloxacin in 2.3, 84.1, 100 and 100%, respectively. A short course of quinolones or oral cephalosporins should be recommended for the treatment of childhood shigellosis in areas with low susceptibility rates to co-trimoxazole and ampicillin.

Concomitant dengue infection and Kawasaki disease in an infant: a case report and literature review.

A previously healthy 11-month-old girl presented with fever and rash for 6 days. Physical examination revealed an irritable infant with a high fever, injected conjunctivae, red cracked lips, posterior auricular lymphadenopathy, hepatomegaly, generalized erythematous maculopapular rash and petechial hemorrhage on trunk, face and extremities. Complete blood count showed atypical lymphocytosis and thrombocytopenia. Dengue infection was initially diagnosed. The persistent fever and clinical manifestations of Kawasaki disease (KD) were observed on day 8 with high erythrocyte sedimentation rate (56 mm/hr). Treatment of KD included intravenous immunoglobulin on day 9 of the illness. Desquamation of the fingers was found on day 15 of the illness. Ectasia of left coronary artery with small aneurysmal dilatation was detected by echocardiography on day 15 of the illness. Hemagglutination-inhibition test and enzyme-linked immunosorbent assay for dengue virus eventually showed a four-fold rising. According to the literature review, this is the second reported case of dengue infection concomitant with KD. The natural course of each disease may be modified and causes some difficulties in diagnosis and management.

Serum and urine sodium levels in dengue patients.

We evaluated serum and urine sodium levels in children with dengue infections. Children with acute febrile illness admitted to Bhumibol Adulyadej Hospital in Bangkok from January 1999 to January 2000 were enrolled. Serum and urine sodium levels were measured before initiating intravenous fluid therapy. Two milliliters of blood were obtained on admission and before discharge to test for anti-dengue virus antibody using the enzyme-linked immunosorbent assay technique. Hyponatremia was defined as a serum sodium level <130 mEq/l and depletion of circulatory volume was defined as a urine sodium level < 20 mEq/l. Out of 93 enrolled patients, 49 were categorized as dengue patients and 44 were as non-dengue patients. Six dengue patients developed shock whereas 43 patients did not. The mean serum sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). Hyponatremia was 9.7 times more common in dengue patients. Among dengue patients, the mean serum sodium level was significantly lower in shock patients compared to non-shock patients (p-value = 0.003). However, the prevalence of hyponatremia was not different between the two groups. The mean urine sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). A urine sodium level < or = 20 mEq/l was 8.1 times more common in dengue patients. Among dengue patients, the mean urine sodium level was not significantly different between shock and non-shock patients. In shock patients, a urine sodium level < or = 20 mEq/l was 7.6 times more common.

Prevención de la transmisión vertical del HIV / Prevention of vertical transmission HIV

There are 40 million people in the world living with HIV/AIDS, two-thirds in Africa and one-fifth in Asia. In the developing world, the number of women with HIV infection is surpassing men. Each year, two million HIV-infected women give birth and 630 000 infants contract HIV. Important procedures to prevent perinatal HIV-1 transmission include counseling, HIV testing, family planning, obstetric care, antiretroviral agents, and avoidance of breastfeeding. In Thailand, the Ministry of Public Health recommends zidovudine plus single dose of nevirapine while the Thai Red Cross recommends highly active antiretroviral therapy. Thailand is moving towards the implementation of a nationwide MTCT plus program to provide long-term comprehensive care for the whole family. Drug resistance especially to single dose nevirapine may limit its future use in exposed women. Choosing the best strategy is an evolving process that must be tailored to each setting's infrastructure and resources.

Hay 40 millones de personas en el mundo con HIV/sida, de los cuales dos tercios viven en Africa y un quinto en Asia. En los países en vías de desarrollo el número de mujeres con infección por HIV sobrepasa a los hombres. Cada año, dos millones de mujeres infectadas por HIV dan a luz y 630 000 lactantes contraen la infección. Los procedimientos más importantes para evitar la transmisión vertical del HIV-1 comprenden: el asesoramiento, la realización de pruebas para la detección del HIV, la planificación familiar, la atención obstétrica, el uso de agentes antirretrovirales y evitar el amamantamiento. En Tailandia, el ministerio de Salud Pública recomienda la administración de zidovudina más una única dosis de nevirapina, mientras que la Cruz Roja tailandesa sugiere la implementación de terapia antirretroviral de gran actividad. Tailandia se dirige hacia la instrumentación de un programa nacional sobre transmisión vertical del HIV para brindar atención integral a largo plazo para toda la familia. La resistencia a las drogas, especialmente a dosis únicas de nevirapina puede limitar su uso futuro en mujeres expuestas. La elección de la mejor estrategia constituye un proceso evolutivo que debe seguirse de cerca de acuerdo con la infraestructura y los recursos de cada región.

A phase IV open label study to assess the safety, tolerability and immunogenicity of a Haemophilus influenzae type B (Hib) CRM197 conjugated vaccine administered to healthy infants at 2, 4, and 6 months of age.

The objective of this prospective clinical study was to evaluate the safety, tolerability and immunogenicity of Chiron Hib vaccine (Vaxem Hib) in Thai infants. This trial was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand from June to November 1999. Three intramuscular injections of the vaccine were given to 119 infants at 2, 4 and 6 months of age. Reactions and adverse events after the vaccination were recorded. Blood samples for anti-PRP antibody were collected before the first immunization, and after the second and third immunizations. After the second dose, 91% and 58% of the subjects had anti-PRP antibody titers of > or =0.15 microg/ml and > or =1.0 microg/ml, respectively. After the third dose, 99% and 90% of the subjects had anti-PRP antibody titer > or =0.15 mcirog/ ml and > or =1.0 microg/ml, respectively. Local and systemic reactions were mild and transient. The study indicates that Vaxem Hib vaccine is safe and well tolerated. Three doses of the vaccine are necessary to achieve adequate protection in infants.

Undetectable plasma HIV-1 RNA with strong gag-pol specific interferon-gamma ELISPOT response in an HIV-1 clade A/E-infected child untreated with antiretroviral therapy.

We report a 7-year HIV-1 clade A/E-infected child untreated with antiretroviral therapy who had positive HIV antibody testing but undetectable plasma HIV-1 RNA by Roche Amplicor version 1.5 and bDNA version 3.0. DNA PCR was positive by methods using gag/pol primers but not env/pol primers. The patient had strong HIV-1-specific cytotoxic T lymphocyte responses, which likely contributed to her low viral burden and undetectable plasma HIV-1 RNA.

Hospital-based epidemiology of childhood cholera: a 6-year review in a university hospital in Bangkok, Thailand.

BACKGROUND: Cholera is the cause of severe acute watery diarrhea. Without proper fluid therapy, severe cholera kills half of the affected patients. In terms of epidemiology and surveillance, up-to-date information of this disease in each country is essential. OBJECTIVES: To evaluate 1) prevalence, serogroups, serotypes and antimicrobial susceptibility pattern of V cholerae, and 2) demographic data and clinical manifestation of pediatric patients with cholera. MATERIAL AND METHOD: Microbiogical records of children aged 0-15 years with cholera, who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 1995 and December 2000 were retrospectively reviewed Serogroups, serotypes, and antimicrobial susceptibility of V. cholerae were studied Medical records of children with positive stool cultures for V. cholerae were reviewed in terms of demographic data, clinical manifestation of the patients. RESULTS: Of 11,709 stool culture specimens, pathogenic bacteria were found in 1,745 specimens and 95 specimens (5.4%) were positive for V. cholerae. V. cholerae O1 and non-O1/non-O139 were found in 52.6% and 47.4%, respectively. Common serotypes of V. cholorae O1 were Ogawa. Antimicrobial susceptibility of the pathogens to co-trimoxazole, ampicillin, ceftriaxone, ciprofloxacin and gentamicin were 55.0%, 56.4%, 91.4%, 92.5% and 94.9%, respectively. Age distribution of the patients ranged from 2 months to 15 years with an average age of 2.92 years. Clinical manifestations included acute watery diarrhea (92.8%), vomiting (56.4%), fever (37.5%), hypotension (19.6%) and abdominal pain (3.8%). Stool leukocytes were microscopically detected in 20% of the patients. No patients died in the present study. CONCLUSION: Childhood cholera in Thailand still exists. Most patients presented with acute watery diarrhea. Regarding antimicrobial susceptibility pattern, ceftriaxone and quinolones are appropriate drugs of choice.

Seroprevalence of anti-RSV IgG in Thai children aged 6 months to 5 years.

Respiratory syncytial virus (RSV) is the single most important cause of lower respiratory tract infection during infancy and early childhood worldwide including Thailand. The magnitude as well as the intensity of both infection and host response to the RSV infection determine the severity of disease. To determine the presence of anti-RSV IgG in children of different age groups, 124 serum samples were randomly collected from healthy children aged 6 months to 5 years. All of them were assayed for anti-RSV IgG using a commercial ELISA kit. The mean prevalence rate was found to be 68.91%. The prevalence increased with age: from 6 to 11 months, 11.76%; from 12 to 17 months, 41.67%; from 18 to 23 months, 60.87%; from 24 to 29 months, 88.24%; from 30 to 35 months, 78.57%; from 36 to 41 months, 94.44% and from 42 to 60 months, 100%. The amount of anti-RSV IgG among the groups was significantly different (p = 0.006). No sexual preponderance was found. RSV infection commonly occurred in children aged 12 to 29 months. All children older than 5 years had experienced a RSV infection.

Prevalence of parvovirus B19 infection in Thai young adults.

The prevalence of antibody to human parvovirus B19 in 128 Thai healthy young adults was measured. Antibodies of the immunoglobulin G (IgG) class were investigated in serum samples of 51 males and 77 females aged 18-24 years (mean 19.83; SD 1.07) by a commercial enzyme-linked immunosorbent assay (ELISA) using high specific recombinant parvovirus B 19 antigen. Only 14 out of 128 (10.94%) sera were found positive, including 6 males and 8 females. No sex preponderance was observed. The amount of antibody calculated as antibody index was not statistically significant difference between genders.

Rectal prolapse associated with cytomegalovirus pseudomembranous colitis in a child infected by human immunodeficiency virus.

We report a newly recognized presentation of cytomegalovirus (CMV) enterocolitis in a 4-year-old girl with newly diagnosed HIV disease who presented with rectal prolapse. Gross findings showed multiple whitish punctate lesions. An endoscopic examination revealed multiple shallow ulcers and pseudomembranes along the colon. A biopsy from colonic tissues demonstrated CMV-like inclusion bodies. A direct immunofluorescence assay using specific CMV monoclonal antibody was positive for CMV-infected cells in specimens from the rectal smear.

Efficacy and safety of meropenem as an empirical treatment for febrile neutropenia in children with cancer.

Meropenem is a promising carbapenem antibiotic as an empirical monotherapy in patients with febrile neutropenia (FN). With the limited data of the therapy in pediatric patients, the authors conducted this study to evaluate the efficacy and safety of meropenem as empirical antibiotic therapy in 30 pediatric cancer patients with FN (mean age = 7.5 years), who were admitted to King Chulalongkorn Memorial Hospital from May 2000 to December 2001. Meropenem 60 mg/kg/day was given intravenously every 8 hours. The efficacy of meropenem was assessed as successful, inconclusive and failure on days 3 and 5 of the therapy and compared to that of other empirical antibiotics used from January 1997 to April 2000. The study showed that six blood culture specimens (20%) grew organisms, half of which were considered to be contaminants, and six urine culture specimens (20%) grew gram negative rod bacteria. On day 3 and 5 of the therapy, the success rate of meropenem was higher than that of comparatives (30.0% vs 17.6% on day 3, 50.0% vs 39.3% on day 5). The use of meropenem appeared safe, with minimal side effects. In conclusion, the present study showed that meropenem was safe and tolerable in children. The efficacy as an empirical monotherapy in pediatric cancer patients with FN was satisfactory, with a failure rate of 23.3 per cent on day 5 of treatment.

Acceptability of oral typhoid vaccine in Thai children.

To determine the acceptability of oral typhoid vaccine to Thai children, 434 volunteers, aged 4-15 years (average age = 8.2 years), were assigned to take three capsules of oral typhoid vaccine (one capsule every other day). Success was defined as the subjects' being able to swallow all three capsules. Information concerning the subjects' level of education, eating habits, and ability to take medicines in a variety of preparations (syrups, tablets and capsules) was obtained. The overall success rate was 94.2%; the rates were 84.4%, 94.9%, and 100% in the age groups 4-6 years, 7-9 years, and 10-12 years respectively. The rates were 82%, 85.7%, 93.3%, 96.4%, 98.8%, 100% and 100% in the students of kindergarten 1, kindergarten 2, elementary grade 1, grade 2, grade 3, grade 4, and grade 5 respectively. There was a correlation between a child's prior ability to take tablets/capsules and his success in swallowing the oral typhoid vaccine.

Risk factors for Epstein-Barr virus infection in Thai infants.

To identify the risk factors for Epstein-Barr virus (EBV) infection among infants in Bangkok, Thailand, a case-control study was conducted during 1997-1999. Blood samples were collected from 257 Thai infants aged 6 months to 2 years. Serum samples were assayed for specific EBV IgG antibodies based on a commercial enzyme-linked immunosorbent assay kit. The subjects' parents were interviewed with structured questionnaires to collect details about their infants' age, sex, socioeconomic background, and place of child rearing. The infants were classified into two groups: positive and negative EBV IgG; factors related to the risks of infection were also determined. The overall seropositivity rate of the study infants was 36.2%. Infants aged 1-2 years had a 3.64 times higher risk than those aged 6 months -1 year (p < 0.0001). Infants living in families with an income of < or = 10,000 baht/month (1 US dollar = 42 baht) had a 1.33 times higher risk than those with a family income of >10,000 baht/month (p = 0.03). Infants who were reared at home had a 2.92 times higher risk than those reared outside the home (p = 0.05). By logistic regression analysis, age (> 1 years) and family income (< or = 10,000 baht/month) were the two risk factors associated with EBV infection.

Typhoid fever in children: experience in King Chulalongkorn Memorial Hospital.

Blood cultures of children treated at King Chulalongkorn Memorial Hospital from 1986 to 2000 were retrospectively reviewed and 19 specimens were positive for Salmonella typhi. Of 14 patients whose medical records were available, the age range was between 2 years and 15 years with a male to female ratio of 1.8:1. Major presentations were prolonged fever with a mean duration of 7 days and gastrointestinal manifestations including abdominal pain (71%), hepatomegaly (64%), anorexia (57%), vomiting (57%), and diarrhea (50%). Most cases had normal hematocrit values with white blood cell counts of 5,000-9,000 cells/mm3 and the percentage of neutrophils was 60-89. Complications were abnormal urine sediments (3) including a case of typhoid nephritis, severe enteritis (2) and acute hemolysis (1). Most isolates were susceptible to cotrimoxazole, ampicillin and ceftriaxone by the disk diffusion susceptibility test. Defervescence was seen within 3-14 days after antibiotic therapy. There was no mortality.

Clinical features of diphtheria in thai children: a historic perspective.

To study the clinical and laboratory features of childhood diphtheria, the cases of 381 children with clinical and bacteriological diagnoses of diphtheria who were treated at the Children's Hospital between 1976 and 1985 were reviewed. Of these, 191 were males and 190 were females. The mean age was 4.6 years. Approximately 75% of the patients had no history of immunization. Common manifestations of diphtheria included patch (100%), fever (92.4%), upper respiratory tract infection (91.6%), upper airway obstruction (42.3%), hoarseness (36.7%), and bull neck (11.3%). The mean duration of fever prior to admission was 3.3 days with a range of 0-11 days. Patch sites included the tonsils (91.9%), the pharynx (55.9%), the larynx (27.8%) and others (24.4%). Complications included upper airway obstruction (42.3%), cardiac complications (10.0%) and neurological complications (4.7%). The mortality rate was 5.8%. There were significant associations between death and the presence of bull neck, laryngeal patch, airway obstruction and cardiac complications. Early recognition and prompt treatment will decrease complications and mortality in this group of patients.