Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran.

The seroprevalence of hepatitis E virus infection (HEV) in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals (2.3%). Seroprevalence increased significantly with age from 3/255 (1.2%) in children < 10 years to 8/110 (7.3%) in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas.

The impact of maternal measles-rubella immunization on the 12-month-old infant's immune response to measles-mumps-rubella vaccine immunogenicity.

This study was conducted to assess the roles of maternal measles-rubella (MR) vaccination before pregnancy on the persistence of passive immunity against MR in their infant before measles-mumps-rubella (MMR) immunization and the effects on the immunogenicity of MMR vaccine. Before and 4-8 weeks after MMR immunization of all healthy 12-month-old infants, sera samples were prepared. According to their mother's history of MR vaccination, infants were divided into two groups. Anti-MR antibodies were measured by the quantitative enzyme-linked immunosorbent assay (ELISA) method. The difference in seroconversion rates and the mean concentration of antibodies (MCA) between the two groups of infants were analyzed by descriptive statistical methods. In total, 7 and 12 sera, all from infants born from MR-vaccinated mothers, were positive against measles and rubella, respectively. The seroconversion rates were 90.5 and 53% in seronegative infants against measles and rubella, respectively, without statistically significant differences between the two groups of infants. However, the MCA differences were significant; measles P = 0.000, rubella P = 0.019. The MR vaccination of mothers may cause the prolongation of passive immunity in their infants, and may influence the immunogenicity of MMR vaccination. This finding should be considered for the optimal scheduling of the first dose of MMR vaccine. Also, the results showed that the immunogenicity of the rubella component of the MMR vaccine was lower than that reported.

Combination therapy with interferon and ribavirin for chronic hepatitis C infection in beta-thalassaemia major.

Treatment of chronic hepatitis C virus (HCV) infection in transfusion-dependent beta-thalassaemia major patients is complicated by existing hepatic siderosis and the fear of ribavirin-associated haemolysis. We evaluated the efficacy and side-effects of combination interferon-alpha (INF) and ribavirin therapy for HCV-infected thalassaemia patients. A total of 17 patients were enrolled (10 nonresponders to INF monotherapy, 7 naive to treatment, mean age 23.1 years) and they received 12 months of combination therapy. The sustained virological response rate 6 months after treatment was 58.8%. Blood transfusion requirements during treatment temporarily increased by 36.6%. Combination therapy was tolerated by, and may be useful for, HCV-infected thalassaemia major patients.

Combination therapy with interferon and ribavirin for chronic hepatitis C infection in beta-thalassaemia major

Treatment of chronic hepatitis C virus [HCV] infection in transfusion-dependent betathalassaemia major patients is complicated by existing hepatic siderosis and the fear of ribavirinassociated haemolysis. We evaluated the efficacy and side-effects of combination interferon-alpha [INF] and ribavirin therapy for HCV-infected thalassaemia patients. A total of 17 patients were enrolled [10 nonresponders to INF monotherapy, 7 naive to treatment, mean age 23.1 years] and they received 12 months of combination therapy. The sustained virological response rate 6 months after treatment was 58.8%. Blood transfusion requirements during treatment temporarily increased by 36.6%. Combination therapy was tolerated by, and may be useful for, HCV-infected thalassaemia major patients

Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran

The seroprevalence of hepatitis E virus infection [HEV] in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals [2.3%]. Seroprevalence increased significantly with age from 3/255 [1.2%] in children < 10 years to 8/110 [7.3%] in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas

Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002-2003.

To determine the frequency and pattern of antibiotic susceptibility of uropathogens in urinary tract infection (UTI) from 3 university hospitals we carried out a retrospective review of urine culture and antibiotic sensitivity testing from symptomatic outpatients and inpatients during 2002-2003. Of 5600 samples, 703 (12.6%) were culture positive, 38.7% of which were from hospitalized patients. Escherichia coli was the leading cause of UTI in both groups of patients. The rates and roles of other pathogens, including Pseudomonas spp. (5.3%-10.4%), Enterobacter spp. (0%-5.7%), Staphylococcus spp.) 5.4%-26.4%), differed in each hospital. Differences in antibacterial susceptibility patterns were observed. Ampicillin (82%-100%) and co-trimoxazole (50%-90%) resistance were the most frequent. Methicillin resistance in Staphylococcus spp. ranged from 17% to 60%.

Respiratory viruses in hospitalized children with acute lower respiratory tract infections, Mazandaran Province, Iran.

We conducted this study to determine the contribution of respiratory viruses in 202 hospitalized children (1 mo-5 yr) with clinical evidence of acute lower respiratory tract illness (ALRI). Nasopharyngeal specimens were assayed for viruses detection by indirect immunoflourescent method. Viral agents were identified from 109 (54%) cases (9 cases had dual infection). The most commonly detected virus was parainfluenza virus 3 in 32 (15.8%) cases followed by respiratory syncytial virus 26 (12.9%) parainfluenza 1 and parainfluenza 2 each 13 (6.4%) influenza A 16 (7.4%), influenza B; 7(3.5%), and adenovirus 12 (5.9%). There were no demographic, clinical, radiologic or laboratory parameters except for recurrent wheeze (OR: 4.47; (95% CI: 1.98-10.73) and fever (OR: 3.27; (95% CI: 1.73-6.20), which could differentiate between patients with or without viral etiology.

Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002-2003

To determine the frequency and pattern of antibiotic susceptibility of uropathogens in urinary tract infection [UTI] from 3 university hospitals we carried out a retrospective review of urine culture and antibiotic sensitivity testing from symptomatic outpatients and inpatients during 2002-2003. Of 5600 samples, 703 [12.6%] were culture positive, 38.7% of which were from hospitalized patients. Escherichia coli was the leading cause of UTI in both groups of patients. The rates and roles of other pathogens, including Pseudomonas spp. [5.3%-10.4%], Enterobacter spp. [0%-5.7%], Staphylococcus spp.] 5.4%-26.4%], differed in each hospital. Differences in antibacterial susceptibility patterns were observed. Ampicillin [82%-100%] and co-trimoxazole [50%-90%] resistance were the most frequent. Methicillin resistance in Staphylococcus spp. ranged from 17% to 60%

Measles epidemiology in Mazandaran province, Iran, 2000-2002.

To determine the incidence and characteristics of measles, cases reported to the Health Center for Diseases Control 2000-2002 were reviewed. Demographics data, vaccination status and its relation to occurrence the disease were analysed. A total of 729 cases (270 women,162, 269, 298, over the 3 years) were reported. The annual incidence rates over the 3 years were 7.1, 11.9 and 12.7 for each 10(5) population. In full vaccinated subjects, 46.5% of the cases occurred and 39.9% of the cases had not been vaccinated. Because of the high incidence rate of measles both in vaccinated and unvaccinated individuals, paying more attention to proper shipping and storing of vaccine, and even catch-up immunization for increasing herd immunity are recommended.

Pertussis seroimmunity among mother-infant pairs and infant immune response to pertussis vaccination.

This study was designed to evaluate seroprevalence rates of antibodies to pertussis in mothers and their infants, and the immunogenicity of pertussis vaccine in the presence or absence of pertussis antibodies in infants. Blood samples were collected from 110 mother-infants pairs before the first dose of pertussis vaccination and from 69 infants 4-8 weeks after administration of the third dose of DTwP vaccine. Pertussis antibodies were >25 U/mL in 88(78.9%) mothers and 50(45.3%) infants with a mean titer of 67(SD 48.1) and 33.5 (34.7) U/mL, respectively. After administration of three doses of DTwP vaccine, 53(76.8%) infants were seroconverted (MCA titer 87.4 (51.3)U/mL. Immunologic response to vaccination was similar between the two groups of infants; 30/37 (81.1%) of seronegative infants and 23/32 (71.9%) of seropositive infants at pre-vaccination, showed seroconversion after the vaccination (P = 0.36). The results of this study demonstrated that most of the studied mothers were serologically immune to pertussis, and this immunity was transferred to their infants. Pre-vaccination antibody did not affect infants immune response to vaccination.

Measles seroepidemiology among adolescents and young adults: response to revaccination.

We evaluated the seroprevalence of measles antibody and response to measles reimmunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti-measles IgM and IgG titres were assessed again 2-4 weeks after revaccination in 144 (105 seronegative, 39 seropositive) individuals: 75 seronegative participants responded to revaccination anamnestically (P < 0.001) and developed immunity, 11 also showed IgM response (probably primary vaccine failure); 38 seropositive participants remained seroprotected without significant increase in antibody titre (P = 0.577). Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected.

Measles seroepidemiology among adolescents and young adults: response to revaccination

We evaluated the seroprevalence of measles antibody and response to measles re-immunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti- measles IgM and IgG titres were assessed again 2- 4 weeks after revaccination in 144 [105 seronegative, 39 seropositive] individuals: 75 seronegative participants responded to revaccination anamnestically [P < 0.001] and developed immunity 11 also showed IgM response [probably primary vaccine failure immunity]; 38 seropositive participants, remained seroprotected without significant increase in antibody titre [P = 0.577]. Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected

Kawasaki disease in East Mazandaran, Islamic Republic of Iran, 1997-2002.

We conducted a retrospective review of all cases of Kawasaki disease admitted to the major referral centres in Sari, East Mazandaran from 1 November 1997 to 30 October 2002. Of 29 probable cases, 25 were confirmed, giving an average annual incidence rate of 7.3 per 100 000 in children 0-5 years. The mean age of all cases was 38 months (range: 3.5-80 months). There was a male predominance. The mean time between the onset of illness and diagnosis was 8.2 +/- 3.1 days. Five of the 25 patients had cardiovascular abnormalities before treatment. All patients were treated with intravenous immunoglobulin and 22 (88%) responded to a single dose of treatment and high doses of acetylsalicylic acid; 2 patients needed a second dose of IVIG, and 1 patient required a third. Complete recovery was noted in all patients except for 1, who is under follow-up and treatment.

Rapid reinfection by Giardia lamblia after treatment in a hyperendemic area: the case against treatment.

We selected 40S children aged 1-10 years with Giardia lamblia infection but without abdominal orgastrointestinal complaints for the previous month. For 5 days, 204 received metronidazole 15 mg/kg/day and 201 received B-complex syrup. Stool samples were examined 2-3 weeks and 3 months after treatment and results were tested with chi-squared. Weight and height 6 months after treatment were compared with primary weight and height by Z-score and Student t-test. Metronidazole efficacy at 2-3 weeks was 85.3%. Three months after treatment, 60 were reinfected (34.5%) and 71 had spontaneously cleared (35.3%). Because of high reinfection, spontaneous clearing and treatment failure rates, and the lack of effect on nutritional status or growth, we do not recommend treatment for children with asymptomatic giardia infection.

Rapid reinfection by Giardia lamblia after treatment in a hyperendemic area: the case against treatment

We selected 405 children aged 1-10 years with Giardia lamblia infection but without abdominal or gastrointestinal complaints for the previous month. For 5 days, 204 received metronidazole 15 mg/kg/day and 201 received B-complex syrup. Stool samples were examined 2-3 weeks and 3 months after treatment and results were tested with chi-squared. Weight and height 6 months after treatment were compared with primary weight and height by Z-score and Student t-test. Metronidazole efficacy at 2-3 weeks was 85.3%. Three months after treatment, 60 were reinfected [34.5%] and 71 had spontaneously cleared [35.3%]. Because of high reinfection, spontaneous clearing and treatment failure rates, and the lack of effect on nutritional status or growth, we do not recommend treatment for children with asymptomatic giardia infection

Kawasaki disease in East Mazandaran, Islamic Republic of Iran, 1997-2002

We conducted a retrospective review of all cases of Kawasaki disease admitted to the major referral centres in Sari, East Maz and aran from 1 November 1997 to 30 October 2002. Of 29 probable cases, 25 were confirmed, giving an average annual incidence rate of 7.3 per 100 000 in children 0-5 years. The mean age of all cases was 38 months [range: 3.5-80 months]. There was a male predominance. The mean time between the onset of illness and diagnosis was 8.2 +/- 3.1 days. Five of the 25 patients had cardiovascular abnormalities before treatment. All patients were treated with intravenous immunoglobulin and 22 [88%] responded to a single dose of treatment and high doses of acetylsalicylic acid; 2 patients needed a second dose of IVIG, and 1 patient required a third. Complete recovery was noted in all patients except for 1, who is under follow-up and treatment

Long-term antibody response and immunologic memory in children immunized with hepatitis B vaccine at birth.

Four hundred and fifty three healthy children immunized with a course of hepatitis B vaccine beginning at birth were tested at 10-11 years of age for persistence of anti-hepatitis B-S antigen antibody (anti-HBs); and responses of children without protective antibody to different doses of hepatitis B vaccine booster were evaluated. Although nearly 42% of them were not seroprotected, but most of boosted subjects (87.3%) retained robust immunologic memory and rapidly retained a protective anti-HBs antibody titer of at least 10 IU/L after booster vaccination.