Quantitative real-time polymerase chain reaction for enteropathogenic Escherichia coli: a tool for investigation of asymptomatic versus symptomatic infections.

BACKGROUND: Enteropathogenic Escherichia coli (EPEC) strains are pediatric pathogens commonly isolated from both healthy and sick children with diarrhea in areas of endemicity. The aim of this study was to compare the bacterial load of EPEC isolated from stool samples from children with and without diarrhea to determine whether bacterial load might be a useful tool for further study of this phenomenon. METHODS: EPEC was detected by polymerase chain reaction (PCR) of colonies isolated on MacConkey plates from 53 diarrheal and 90 healthy children aged <2 years. DNA was isolated from stool samples by cetyltrimethylammonium bromide extraction. To standardize quantification by quantitative real-time PCR (qRT-PCR), the correlation between fluorescence threshold cycle and copy number of the intimin gene of EPEC E2348/69 was determined. RESULTS: The detection limit of qRT-PCR was 5 bacteria/mg stool. The geometric mean load in diarrhea was 299 bacteria/mg (95% confidence interval [CI], 77-1164 bacteria/mg), compared with 29 bacteria/mg (95% CI, 10-87 bacteria/mg) in control subjects (P = .016). Bacterial load was significantly higher in children with diarrhea than in control subjects among children <12 months of age (178 vs 5 bacteria/mg; P = .006) and among children with EPEC as the sole pathogen (463 vs 24 bacteria/mg; P = .006). CONCLUSIONS: EPEC load measured by qRT-PCR is higher in diarrheal than in healthy children. qRT-PCR may be useful to study the relationship between disease and colonization in settings of endemicity.

Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban areas in Lima, Peru.

BACKGROUND: Diarrheagenic Escherichia coli strains are being recognized as important pediatric enteropathogens worldwide. However, it is unclear whether there are differences in age-related susceptibility to specific strains, especially among infants. METHODS: We conducted a passive surveillance cohort study of diarrhea that involved 1034 children aged 2-12 months in Lima, Peru. Control stool samples were collected from randomly selected children without diarrhea. All samples were analyzed for common enteric pathogens and for diarrheagenic E. coli with use of multiplex real-time polymerase chain reaction. RESULTS: The most frequently isolated pathogens in 1065 diarrheal episodes were diarrheagenic E. coli strains (31%), including enteroaggregative (15.1%) and enteropathogenic E. coli (7.6%). Diarrheagenic E. coli, Campylobacter species, and rotavirus were more frequently isolated from infants aged >or=6 months. Among older infants, diffusely adherent E. coli and enterotoxigenic E. coli were more frequently isolated from diarrheal samples than from control samples (P <.05). Children aged >or=6 months who were infected with enterotoxigenic E. coli had a 4.56-fold increased risk of diarrhea (95% confidence interval, 1.20-17.28), compared with younger children. Persistent diarrhea was more common in infants aged <6 months (13.5% vs 3.6%; P <.001). Among children with diarrheagenic E. coli-positive samples, coinfections with other pathogens were more common in children with diarrhea than in control children (40.1% vs 15.6%; P <.001). CONCLUSIONS: Diarrheagenic E. coli strains were more frequently isolated in samples from older infants. In this setting with high frequency of pathogen exposure and high frequency of breastfeeding, we hypothesize that the major age-related differences result from decreased exposure to milk-related protective factors and from increased exposure to contaminated food and water.

Intention to change nutrition-related behaviors in adult participants of a Supplemental Nutrition Assistance Program-Education.

OBJECTIVE: To determine whether participation in selected Supplemental Nutrition Assistance Program-Education (SNAP-Ed) lessons had an impact on the intent to improve nutrition-related behaviors of participants. METHODS: A quantitative study using a retrospective post-then-pre design to measure SNAP-Ed outcomes of 203 adult participants after selected nutrition lessons in 14 counties across the state of Utah. After the intervention participants completed a retrospective post-then-pre survey evaluating intent to improve nutrition behaviors related to the SNAP-Ed lessons. Wilcoxon signed rank test with Bonferroni correction and paired t test were used. RESULTS: Participants reported sometimes engaging in nutrition related behaviors before attending SNAP-Ed lessons and intent to usually engage in these behaviors after attending SNAP-Ed lessons. CONCLUSION AND IMPLICATIONS: This study demonstrated that participation in selected SNAP-Ed lessons was positively related to the intent of participants to improve nutrition-related behaviors.

[Determining factors of overweight and obesity in children at school age in Peru]. / Determinantes del sobrepeso y la obesidad en niños en edad escolar en Perú

Obesity in children at school age is an increasing problem in Peru. It concentrates in urban areas, mainly in Lima where one out of three children is overweight. An initial study in 80 schools in Lima showed that the lack of physical activity would have a greater impact on overweight and obesity in school children than the amount of food intake. More detailed studies are required. In spite of the limited information available regarding its determining factors, it is necessary to implement culturally-sensitive measures to fight this problem as part of the current nutritional policies, and prevent the problem from spreading, making sure the sustainability of the health system is not affected.

Safety and immunogenicity of an investigational fully liquid hexavalent DTaP-IPV-Hep B-PRP-T vaccine at two, four and six months of age compared with licensed vaccines in Latin America.

OBJECTIVE: This trial assessed the safety of a fully liquid investigational hexavalent DTaP-IPV-Hep B-PRP-T vaccine containing 10 µg Hansenula polymorpha-derived recombinant hepatitis B (hep B) antigen for primary vaccination of infants at 2, 4 and 6 months of age compared with licensed comparators. METHODS: Participants received the DTaP-IPV-Hep B-PRP-T vaccine (group 1, N = 1422) or licensed DTwP-Hep B//Hib (Tritanrix-Hep B/Hib) and oral poliovirus vaccines (group 2, N = 711). The incidence of severe fever (≥ 39.6°C rectal equivalent) in the 2 groups was compared statistically; reactogenicity was evaluated from parental reports. Anti-Hep B antibody titers were measured in a subset of participants (no hepatitis B vaccination at birth) 1 month after dose 3. RESULTS: The investigational vaccine was well tolerated. After any dose, fever (rectal equivalent temperature ≥ 38°C) was observed in 74.8% and 92.7% of participants in groups 1 and 2; severe fever was observed in 4.0% and 5.5% of participants. Solicited injection site and systemic reactions were numerically less frequent in group 1 than group 2, although this difference was not assessed statistically. In both groups, all participants included in the immunogenicity analysis achieved anti-Hep B ≥ 10 mIU/mL and ≥ 96.2% of participants achieved anti-Hep B ≥ 100 mIU/mL, although geometric mean titer was approximately 3-fold lower for the investigational vaccine. CONCLUSION: This new, fully liquid acellular pertussis hexavalent vaccine demonstrated less reactogenicity than the licensed comparator whole cell pertussis vaccine and was highly immunogenic for the new Hep B valence.

Determinantes del sobrepeso y la obesidad en niños en edad escolar en Perú / Determining factors of overweight and obesity in children at school age in Peru

La obesidad en escolares es un problema que se encuentra en incremento en el Perú. Está concentrado en las zonas urbanas, principalmente en Lima donde uno de cada tres niños tiene exceso de peso. Un estudio inicial en 80 colegios de Lima mostró que más importante sería la falta de actividad física que el volumen de la ingesta para explicar el sobrepeso y la obesidad en escolares. Se requieren estudios más detallados al respecto. A pesar de la limitada información disponible de sus determinantes, es necesario implementar medidas culturalmente apropiadas para combatirla como parte de las políticas nutricionales actuales, y así prevenir que el problema continúe incrementándose y que la sostenibilidad del sistema de salud no se vea afectada.

Obesity in children at school age is an increasing problem in Peru. It concentrates in urban areas, mainly in Lima where one out of three children is overweight. An initial study in 80 schools in Lima showed that the lack of physical activity would have a greater impact on overweight and obesity in school children than the amount of food intake. More detailed studies are required. In spite of the limited information available regarding its determining factors, it is necessary to implement culturally-sensitive measures to fight this problem as part of the current nutritional policies, and prevent the problem from spreading, making sure the sustainability of the health system is not affected.