Immunogenicity and safety of a varicella vaccine, Okavax, and a trivalent measles, mumps and rubella vaccine, MMR-II, administered concomitantly in healthy Filipino children aged 12-24 months.

This trial was conducted to assess the immunogenicity and safety of the varicella vaccine, Okavax, when administered concomitantly with the measles, mumps and rubella vaccine, MMR-II, to children aged 12-24 months. A total of 299 children were randomized into three groups, those receiving Okavax only, MMR-II only, or both vaccines concomitantly. Antibody titers were determined by ELISA in blood samples taken immediately before, and 6 weeks after, vaccination. Parents recorded local and systemic reactions. Okavax elicited similar varicella seroconversion rates (> or = 93.9%) and high GMTs when given alone or with MMR-II (99.6 and 95.7 mIU/ml, respectively). The seroconversion rates (measles and rubella 100%, mumps > or = 75.0%) and high GMTs elicited by MMR-II were not affected by concomitant administration of Okavax. The incidence of adverse events was similar whether MMR-II and Okavax were administered concomitantly or separately, and the majority of local reactions were mild and transient, with fever the most frequent systemic event in all groups. In conclusion, these results show that the immune response and the reactogenicity profile of Okavax and MMR-II were similar when given together or alone. Concomitant administration of these vaccines can therefore be recommended for children in their second year of life.

Diagnosis and outcome of acute bacterial meningitis in early childhood.

OBJECTIVE: To estimate frequency of acute bacterial meningitis (ABM) in early childhood in hospital admissions, to describe clinical and diagnostic features, and to analyze mortality, complications and long term sequelae. DESIGN: Prospective study. SETTING: Pediatric wards and Rehabilitation Center of KEM Hospital, Pune. METHOD: Study subjects between the ages of 1 months to 5 years with ABM were recruited. Clinical details were recorded. CSF was analysed by routine biochemical methods, antigen detection tests (Latex agglutination LAT) and microbiological studies on special media. Management was as per standard protocols. Survivors were followed up long term with neurodevelopmental studies and rehabilitation programmes. RESULTS: In a study period of 2 years, 54 children (1.5% of all admissions) satisfied the criteria of ABM in early childhood; 78% were below one year and 52% were under the age of six months. Chief presentation was high fever, refusal of feeds, altered sensorium and seizures. Meningeal signs were present in only 26%. CSF C-reactive protein was positive in 41%, gram stain was positive in 67% LAT in 78% and cultures grew causative organisms in 50% of the cases. The final etiological diagnosis (as per LAT and/or cultures) were Streptococcus pneumoniae 39% Hemophilus influenzae type b 26% and others in 35% The others included one case of Neisseria meningitidis and 10 who were LAT negative and culture sterile. 39% patients developed acute neurological complications during the hospital course. 31% children with ABM died in hospital or at home soon after discharge. Six were lost to follow up. Of the 31 children, available for long term follow up (1-3 years), 14 (45%) had no sequelae. The remaining had significant neurodevelopmental handicaps ranging from isolated hearing loss to severe mental retardation with multiple disabilities. CONCLUSION: ABM in early childhood has a considerable mortality, morbidity and serious long term sequelae. Neurodevelopmental follow up and therapy should begin early. Etiological diagnosis can be enhanced by LAT and good culture media. H. influenzae b and S. pneumoniae account for more than 60% of ABM in early childhood.

Determination and analysis of multi- bacteria coinfection of acute pneumonia / 实用儿科临床杂志

Objective To investigate the proportion of streptococus pneumonia(SP), haemophilus influenzae (Hi),branhamella catarrhalis (BC), chlamydia pneumonia (CP) and mycoplasma pneumonia (MP) in children with acute pneumonia.Methods Fifty-three hospital-treated children with acute pneumofmonia were included in a prospective study. The enzyme immunoassay was used to detect antibodies in paired sera against non-capsulated Hi, Hi type-B capsular polysaccharide and whole cell, antibodies against pneumococcal pneumolysin, C-polysaccharide and pneumococcal pneumolysin, C-polysaccharide, surface protein A in circulating immune complexes and antibodies against BC and MP. Antibodies against CP by immunofluorescence in paired sera as well as blood cultures were detected in these cases.Results The evidence of bacteria infection was demonstrated in 32 cases (60.4 %) among children with acute pneumonia, of which 11 cases had 2 or 3 organisms coinfection. In these causative agents,SP and CP were the most common organisms (11/53 cases respectively,20.8 %), followed by MP (7/42,16.7 %),Hi(7/53,13.2 %).Conclusion SP,Hi,CP and MP are common causative agents of children with acute pneumonia and multi-agents coinfection isn′t ingnored in our empiric antibiotic therapy for the disease.