[Pediatrics. Using the McIsaac score for the indication of rapid diagnostic testing in children with streptococcal pharyngitis]. / Pédiatrie. 3. Le score de McIsaac: une aide à l'indication des tests de diagnostic rapide dans tes angines à streptocoques A.

The McIsaac scoring system is a tool designed to predict the probability of streptococcal pharyngitis in children aged 3 to 17 years with a sore throat. Although it does not allow the physician to make the diagnosis of streptococcal pharyngitis, it enables to identify those children with a sore throat in whom rapid antigen detection tests have a good predictive value.

[Hepatitis B immunization in the neonate and the immunocompromised: time to resort to dedicated teams?]. / Vaccination de l'immunocompromi et du nouveau-né contre l'hepatite B: faut-il recourir à des équipes dédiées?

The hepatitis B virus is likely to induce a severe disease when the infection occurs in vulnerable individuals. For that reason, clear recommendations are issued that vaccine prevention be offered to the immunocompromised and to the infant newly born to a chronically infected mother. However, the vaccine coverage is definitely suboptimal among these patients and a fair proportion of them are only partially vaccinated. An increase in vaccine coverage is demonstrated in several studies involving dedicated nursing or medical teams. The prevention of hepatitis B infection in vulnerable patients requires a systemic and punctilious approach to such a point that one should consider letting the management of these preventive measures to dedicated nursing or medical teams.

Molecular epidemiology of the nasal colonization by methicillin-susceptible Staphylococcus aureus in Swiss children.

Nasal carriage of Staphylococcus aureus contributes to an increased risk of developing an infection with the same bacterial strain. Genetic regulatory elements and toxin-expressing genes are virulence factors associated with the pathogenic potential of S. aureus. We undertook an extensive molecular characterization of methicillin-susceptible S. aureus (MSSA) carried by children. MSSA were recovered from the nostrils of children. The presence of Panton-Valentine leukocidin (PVL), exfoliatins A and B (exfoA and exfoB), and the toxic-shock staphylococcal toxin (TSST-1) and agr group typing were determined by quantitative PCR. A multiple-locus variable-number of tandem repeat analysis (MLVA) assay was also performed for genotyping. Five hundred and seventy-two strains of MSSA were analysed. Overall, 30% were positive for toxin-expressing genes: 29% contained one toxin and 1.6% two toxins. The most commonly detected toxin gene was tst, which was present in 145 (25%) strains. The TSST-1 gene was significantly associated with the agr group 3 (OR 56.8, 95% CI 32.0-100.8). MLVA analysis revealed a large diversity of genetic content and no clonal relationship was demonstrated among the analysed MSSA strains. Multilocus sequence typing confirmed this observation of diversity and identified ST45 as a frequent colonizer. This broad diversity in MSSA carriage strains suggests a limited selection pressure in our geographical area.

Severe postnatally acquired cytomegalovirus infection presenting with colitis, pneumonitis and sepsis-like syndrome in an extremely low birthweight infant.

Few cases of severe postnatally acquired cytomegalovirus (CMV) infection are reported in premature infants. We report on an extremely low birthweight (ELBW) preterm infant who presented with a sepsis-like syndrome and multiple organ involvement, notably pneumonitis and colitis. The course of infection was assessed by repeated analysis of urine, tracheal aspirates and blood. The patient was given intravenous ganciclovir. The clinical course was rapidly favorable. Development of neutropenia led to the discontinuation of the antiviral treatment after 28 days. Follow-up showed moderate white matter anomalies on cerebral MRI, a transient hypoacusis and a mild developmental delay at 18 months of corrected age. To the best of our knowledge, this is the first description of a severe combination of pneumonitis and colitis in postnatal CMV infection. Many issues remain controversial and are discussed. We propose that antiviral treatment should be considered in severe postnatal CMV infection in ELBW patients.

[Pediatrics]. / Pédiatrie.

This article summarizes the medical progress achieved in 2 frequent and 2 rare pathologies: 1. Cryptorchidism should be operated around 12 months of age and hormonal treatment abandoned in order to maintain fertility and avoid development of testicular tumors. 2. For the treatment of streptococcal pharyngitis oral cephalosporins for 4 to 5 days are equivalent to a Penicillin treatment of 10 days. 3. Thanks to carvedilol (a beta-blocker agent), levosimendan (a calcium sensibiliser) and nesiritide (an analog to the natriuretic peptide) a new hormonal approach to cardiac failure is possible. 4. Corticosteroids allow to improve quality of live and life expectancy in Duchenne muscular dystrophy, provided treatment starts early and a multidisciplinary approach is assured.

[Evidence of new foci of tick-borne encephalitis in the French speaking part of Switzerland]. / Evidence de nouveaux foyers d'endémie de méningo-encéphalite verno-estivale en Suisse romande.

The incidence of tick-borne encephalitis (TBE) has more than doubled in Switzerland in recent years. In the French part of Switzerland several patients seem to have acquired the infection outside of known endemic foci. Thirty patients with TBE living or having acquired the infection in the French speaking part of Switzerland between 2000 and 2005 were identified. For one patient it wasn't possible to obtain precise information about the place of acquisition of the infection and 16 patients were infected in known endemic foci. Among the 13 remaining patients, 6 were infected on the southern shores of the lake of Neuchâtel and 7 in the plaine of Orbe. We conclude that there are new foci of TBE in the northern regions of the canton of Vaud. Vaccination should be proposed to the population at risk of these regions. In addition it is important that persons with outdoor activities in this regions respect the preventive

[Vaccinations during adolescence: the role of physicians and school health services]. / La vaccination a l'adolescence: rôle des praticiens et des services de santé scolaire.

As the rate of doctor-patient encounter is low during adolescence, it is justified to administer vaccines within the school health system. indeed, the first results of the HBV vaccination are extremely encouraging. In Switzerland, it is recommended to immunize adolescents 11 to 15 against diphtheria, tetanus, HBV and meningococcus C. Vaccination against varicella is recommended for those who display no history of varicella. This vaccine, along with adjustment immunizations should be done by primary care physicians. All pediatricians, general practitioners and gynecologists should take every opportunity to check adolescents' vaccination status and immunize them according to what they found.

How to improve communication on vaccine issues at the national level? INFOVAC-PED: an example from Switzerland.

For physicians in private practice, rapid access to relevant and up-to-date objective information is required to better meet their clients' concerns on vaccine-related issues. To meet this need, INFOVAC-PED, an academic network of on call pediatric infectious diseases experts who can be reached free of charge at a central e-mail address, now answers Swiss physicians' questions within 24-48h. INFOVAC-PED also distributes monthly bulletins including news from the Federal Office of Public Health, vaccine producers, literature survey, and answers to most frequently asked questions. The rapid success of this novel initiative underlines the need to better support front line physicians.

Value of the comparative enzyme-linked immunofiltration assay for early neonatal diagnosis of congenital Toxoplasma infection.

BACKGROUND: The transplacental transfer of specific maternal IgG antibodies makes the diagnosis of congenital Toxoplasma infection quite difficult in the neonate. The enzyme-linked immunofiltration assay (ELIFA), comparing at delivery the immunologic profile of the mother's antibody response and that of her child, allows discrimination between IgG antibodies of maternal origin and IgGs synthesized by the fetus. OBJECTIVE: To evaluate the diagnostic reliability of the comparative ELIFA for diagnosing congenital Toxoplasma infection as well as the reliability of testing for IgM- and IgA-specific antibodies in cord blood. METHODS: From November, 1991, to December, 1995, an ELIFA was prospectively performed at delivery on blood samples obtained from 227 women with primary Toxoplasma infection during pregnancy and from their infants. For each child the ELIFA result was evaluated in relation to the serologic follow-up: disappearance of specific anti-Toxoplasma gondii IgG antibodies in the absence of treatment before 12 months of age indicating an uninfected child, as opposed to persistence beyond 12 months of age indicative of a congenital infection. RESULTS: Of 227 children 139 were lost to follow-up. Among the 88 children available for follow up, the ELIFA was negative in 70 infants, 69 of whom were confirmed to be uninfected. Thirteen of these 69 cord blood ELIFA-negative samples were positive for anti-T. gondii IgM and/or IgA detected by means of a conventional immunosorbent agglutination assay. Of the remaining 18 children (representing 75% of all new cases of congenital toxoplasmosis diagnosed during the study period at our institution), the ELIFA was positive in 16, negative in 1 and inconclusive in 1. CONCLUSIONS: The ELIFA test is a valuable tool for diagnosing congenital T. gondii infection and in differentiating between true neonatal infection and cord blood contamination. In our experience the diagnostic sensitivity of the ELIFA test was 94.1% and the specificity was 98.6%. The cord blood was contaminated by specific maternal anti-T. gondii IgA and/or IgM in as many as 20% of the cases.

[Hepatitis B vaccination strategies]. / Hepatitis-B-Impfstrategien.

With the introduction of a vaccine against hepatitis B in the early 1980s, a vaccination strategy targeted at high risk groups was implemented in most developed countries. Although such a strategy is efficient on an individual basis, it has been shown that it only has a limited impact on the overall rate of infections in the population. Public health authorities were therefore prompted to additionally recommend a universal vaccination strategy to reduce and ultimately eliminate hepatitis B infections. The option to primarily vaccinate infants, adolescents or both age groups depends on the epidemiological situation of a country, the availability of organisational facilities, financial resources and acceptability. Combining a targeted and a universal vaccination strategy provides the optimal protection against hepatitis B, both at an individual and population level.

[General hepatitis B vaccination in Switzerland: what is the attitude of vaccinating physicians?]. / Generelle Hepatitis-B-Impfung in der Schweiz: Was halten die impfenden Arzte davon?

The purpose of this study is to assess Swiss physicians' knowledge on hepatitis B, their perception of parental information concerning this infection, their attitude towards planned universal vaccination, and their agreement with different universal immunisation scenarios. Vaccination scenarios were assessed in the following groups: infants, children at school entry, children aged 11 to 13, and children aged 14 to 16. Furthermore, scenarios involving the immunisation of school-aged children included the administration of the vaccine doses by the child's private physician or by the school health officer. Questionnaires were mailed to members of the Swiss Society of Pediatrics (n = 994), to a random sample of family physicians (n = 1000), to internists practicing general medicine (n = 500), and to chief medical officers of school health services in nine major Swiss cities. Physicians reported that they were sufficiently well informed on the serious potential sequelae of hepatitis B and the efficacy of vaccine prevention, but insufficiently informed on its epidemiology. They do not fundamentally disagree with the introduction of universal immunisation and think that parents are not aware of the potential long term dangers associated with this infection. Pediatricians and general practitioners believe that vaccinating infants at the cost of three extra injections would not be accepted by their peers and parents, and that immunising older children in their office would be feasible though difficult. School health officers believe that the immunisation of children aged 14 to 16 within the school health setting would be feasible. Universal vaccination of older children and adolescents is the scenario that best fits Switzerland's needs, perceptions and present circumstances.

[Introduction of general hepatitis B vaccination in Switzerland]. / Einführung der generellen Hepatitis-B-Impfung in der Schweiz.

The Swiss Federal Office of Public Health and the Advisory Board on Immunisation recommended that all adolescents aged 11 to 15 should be vaccinated against hepatitis B in December 1997. The introduction of universal immunisation is justified for epidemiological and economical reasons. Universal immunisation in no way excludes the immunisation of all persons exposed to a specific risk and the prenatal screening and immunisation of exposed newborns. Hepatitis B vaccines are safe and highly effective. The main reasons for this recommendation are summarised in the article.

[Practical recommendations for general introduction of hepatitis B vaccination]. / Praktische Ratschläge zur generellen Einführung der Hepatitis-B-Impfung.

The Swiss Federal Office of Public Health and the Swiss Advisory Board on Immunisation recommended that universal vaccination against hepatitis B be introduced in January 1998. The target population for immunisation are youngsters between 11 and 15 years of age. This recommendation does not preclude ongoing selective vaccination of individuals in high risk groups, nor the routine immunisation of individuals younger or older than the target age (if needed). Injections should be given in the deltoïd area and needle length is critical to ensure proper resorption of the antigen and adequate immune response. Three doses are recommended at times 0, 1 month and 6 months with no booster dose. The time interval between the second and third dose should not be shorter than 2 months but can be longer than 5 months. Vaccination initiated with one commercial brand can be completed with a different brand. The simultaneous administration of immune globulin with the initiation of vaccination and the measurement of serum antibodies after completion of vaccination are unnecessary.