A community-based cross-sectional immunisation survey in parents of primary school students.

Immunisation is a very important aspect of child health. Invasive pneumococcal and influenza diseases have been major vaccine-available communicable diseases. We surveyed demographics and attitudes of parents of primary school students who received pneumococcal conjugate vaccination (PCV) and compared them with those who did not receive pneumococcal vaccination. The survey was carried out in randomly selected primary schools in Hong Kong. Questionnaires were sent to nine primary schools between June and September 2014. Parents of 3,485 children were surveyed, and 3,479 (1,452 PCV immunised, 2,027 un-immunised) valid questionnaires were obtained. Demographic data were generally different between the two groups. PCV-immunised children were more likely to be female (57.0 vs. 52.2%, P=0.005), born in Hong Kong (94.2 vs. 92.3%, P=0.031), have a parent with tertiary education (49.2 vs. 31.8, P<0.0005), from the higher-income group (P=0.005), have suffered upper respiratory infections, pneumonia, otitis media or sinusitis (P=0.019), and have doctor visits in preceding 12 months (P=0.009). They were more likely to have received additional immunisations outside the Hong Kong Childhood Immunization Programme (64.0 vs. 30.6%, P<0.0005) at private practitioner clinics (91.1 vs. 83.5%, P<0.0005). Un-immunised children were more likely to live with senior relatives who had not received PCV. Their parents were less likely to be aware of public education programme on PCV and influenza immunisation, and children were less likely to have received influenza vaccination. The major reasons for PCV immunisations were parent awareness that pneumococcal disease could be severe and vaccines were efficacious in prevention. The major reasons for children not being immunised with PCV were concerns about vaccine side effects, cost, vaccine not efficacious or no recommendation by family doctor or government. In conclusion, PCV unimmunized children were prevalent during the study period. Reportedly, they were generally less likely to have received influenza and other childhood vaccines, and more likely to live with senior relatives who had not received PCV and influenza. These observations provide important demographic data for public health policy in childhood immunisation programme.

Validation of Pediatric Index of Mortality 2 in three pediatric intensive care units in Hong Kong.

OBJECTIVE: To compare the probabilities of death predicted by Pediatric Index of Mortality 2 (PIM2) and Pediatric Index of Mortality 1 (PIM1) models against actual mortalities in 3 pediatric intensive care units in Hong Kong. METHODS: All consecutive patients admitted to pediatric intensive care units in 3 regional non-teaching hospitals between Jan 2006 and December 2006 were included. The data required for PIM1 and PIM2 were collected. The probabilities of death predicted by PIM1 and PIM2 were validated against the actual probability of mortality. RESULTS: Of the 540 patients were included in this study, only seven deaths were observed (1.3%). PIM 1 and PIM 2 overestimated the mortality rate by giving a greater mortality rate. (PIM1: 13.4, Standardized mortality ratio = 0.52, 95% CI = 0.14 to 0.91; PIM2: 14.2, Standardized mortality ratio =0.49, 95% CI = 0.13 to 0.86) The discrimination of PIM1 and PIM2 were satisfactory as reflected by area under receiver-operator characteristic curve of 0.889 (95% CI: 0.703 to 1.000) and 0.904 (95% CI: 0.738 to 1.000) respectively. Calibration was not possible due to insufficient death cases. CONCLUSIONS: The current study showed that PIM2 and PIM1 had similar accuracy in mortality prediction in Hong Kong. The current study also demonstrated the difficulty to calibrate the mortality model when actual mortality rate is low.

Percutaneous relief of tension pneumomediastinum in a child.

The purpose of this article was to describe the experience of relieving tension pneumomediastinum by a fluoroscopic-guided percutaneous method. We inserted a percutaneous drainage catheter with a Heimlich valve under fluoroscopic guidance to relieve the tension pneumomediastinum in a 2-year-old girl who suffered from dermatomyositis with lung involvement. This allowed immediate relief without the need for surgery. The procedure was repeated for relapsed tension pneumomediastinum. Good immediate results were achieved in each attempt. We conclude that percutaneous relief of pneumomediastinum under fluoroscopic guidance can be performed safely and rapidly in patients not fit for surgery.