In vivo T-cell depletion using alemtuzumab in family and unrelated donor transplantation for pediatric non-malignant disease achieves engraftment with low incidence of graft vs. host disease.

In vivo T-cell depletion, using alemtuzumab therapy prior to SCT, can reduce the incidence of GVHD. This treatment has a potential to delay immune reconstitution resulting in increased morbidity due to viral illnesses. We retrospectively analyzed data on all pediatric patients with non-malignant disorders who received alemtuzumab-based conditioning regimens in our center over the last 10 yr (n = 91). Our data show an OS of 91.2%. The incidence of acute (grade 2-4) GVHD was 18.7% and that of chronic GVHD 5.5%. Viremia due to adenovirus, EBV and CMV was seen in 19.8%, 64.8% and 39.6% patients, respectively, with only two deaths attributed to viral infection (adenovirus). Chimerism level at three month was predictive of graft outcome. Nine patients, who had graft failure after first SCT, were salvaged with a second SCT using RIC and same donor (if available). Based on these results, we conclude that the use of in vivo T-cell depletion is safe, achieves good chimerism and does not lead to increased morbidity and mortality due to viral infections. It is associated with a reduced incidence of chronic GVHD.

Chronic norovirus infection in pediatric hematopoietic stem cell transplant recipients: a cause of prolonged intestinal failure requiring intensive nutritional support.

Norovirus infection is a major cause of nonbacterial gastroenteritis. In immunocompetent individuals the illness caused by norovirus is mostly self limiting. Excretion of norovirus has been reported to be prolonged in the immunocompromised including adult HSCT recipients. We report a case series of 13 children who received HSCT and required prolonged parenteral and enteral nutrition due to severe gut dysfunction accompanying protracted norovirus excretion that was monitored by RT-PCR. The median duration of viral excretion was 150 days (range 60-380) and the eventual clearance of norovirus from feces was closely associated with donor T cell recovery in the peripheral blood. There was no disease manifestation beyond the gut but the severity and length of norovirus associated illness suggests that HSCT should be delayed where possible in patients excreting the virus prior to conditioning therapy.

Prevalence, incidence, and epidemiological features of poliomyelitis in the Yemen Arab Republic.

There is a lack of reliable information on the extent of the poliomyelitis problem in developing countries, although the disease is thought to be more of a threat in urban than in rural areas. The Expanded Programme on Immunization (EPI) began operations in Yemen in 1977, and it was considered appropriate to try to establish the prevalence of residual paralysis due to poliomyelitis in children aged 5-13 years, in order to estimate the annual incidence of clinical cases of the disease, and to determine the epidemiological features of poliomyelitis in the country. The data thus obtained would provide a basis for assessing the impact of the immunization programme on the incidence of poliomyelitis.The results of the survey showed a prevalence of lameness due to poliomyelitis of 4.0 per 1000 children. The estimated annual incidence of the disease is thus 18.6 per 100 000 of the general population, or approximately 1088 cases each year, with an estimated 163 deaths. An estimated 5000 children aged 5-13 years are lame as a result of poliomyelitis. There was no significant difference in the incidence of the disease in rural and urban areas. The median age of onset was 1.92 years in the urban setting and 1.29 years in the rural setting, with more than half of all cases occurring before the age of 2 years. Immunization efforts should therefore be directed towards infants aged under 2 years. Although a national disease notification system was established in 1976, 95% of the clinical cases discovered during the survey had not been reported. This underlines the importance of special surveys in gathering the data necessary to evaluate the effectiveness of the immunization programme.