Epidemiology of invasive pneumococcal disease in young Jamaican children [abstract]

OBJECTIVE: To describe the epidemiology of invasive pneumococcal disease in children less than five years of age admitted to the island's only children's hospital. METHODS: Medical and laboratory records were reviewed to identify all patients admitted to the Bustamante Hospital for Children during the period 1995-1999 who had pneumococcus isolated from any normally sterile body fluid. Patients who were five years of age or older were excluded. Information on age, gender, clinical spectrum, resistance pattern and outcome was obtained from medical records using pre-coded questionnaires. Poor outcome was defined as mortality or significant morbidity. RESULTS: We identified 98 cases of invasive pneumococcal disease, with an estimated incidence of 34.5 per 100,000 in children under 5 years of age. Eighty-eight percent of cases were less than 2 years of age. The main clinical diagnoses were pneumonia (70 percent), and meningitis (35 percent). Multiple foci were present in 17 percent of these patients. Ten percent of cases had underlying sickle cell disease and 9 percent were HIV ELISA positive. Poor outcome occurred in 21 percent of patients with meningitis. All deaths occurred in the infant group. CONCLUSIONS: Jamaica's intermediately high estimated incidence supports the need for further studies to assess the stereotypes causing pneumococcal disease in the Jamaican population, with a view to development of an appropriate vaccine suited to the Jamaican pattern of disease. (AU)

Hepatitis B carrier state in young Jamaican children [abstract]

OBJECTIVE: To determine the seroprevalence of the hepatitis B carrier state in Jamaican children. METHODS: Serum specimens from 525 randomly-selected students attending one of 6 basic/pre-schools in the Kingston and St.Andrew region were tested at the MIcrobiology Laboratory of the University Hospital of the West Indies for hepatitis B surface antigen and hepatitis B antibodies. A second specimen was sent from each patient to a private laboratory where the tests were repeated and cross-checked against the results obtained from the UHWI laboratory. Demographic data concerning patients age and sex, maternal age and socio-economic status obtained from a parent interview were recorded on a pre-coded questionnare. The age of the students ranged from 3 years to 6 years with a mean age of 4 years. The male to female ratio was 2:3. Eighty percent of the mothers were under thirty-five years of age. RESULTS: The carrier state was identified in 12 percent of students. Six percent of the study sample had a reactive test for antibodies to hepatitis B surface antigen. CONCLUSION: The high prevalence of hepatitis B carrier state in children under 6 years of age supports infection acquired perinatally from infected mothers. This seroprevalence rate would classify Jamaica as an area of high endemicity and further support the urgent need for a national hepatitis B screening. (AU)