The Association between Influenza Treatment and Hospitalization-Associated Outcomes among Korean Children with Laboratory-Confirmed Influenza

There are limited data evaluating the relationship between influenza treatment and hospitalization duration. Our purpose assessed the association between different treatments and hospital stay among Korean pediatric influenza patients. Total 770 children < or = 15 yr-of-age hospitalized with community-acquired laboratory-confirmed influenza at three large urban tertiary care hospitals were identified through a retrospective medical chart review. Demographic, clinical, and cost data were extracted and a multivariable linear regression model was used to assess the associations between influenza treatment types and hospital stay. Overall, there were 81% of the patients hospitalized with laboratory-confirmed influenza who received antibiotic monotherapy whereas only 4% of the patients received oseltamivir monotherapy. The mean treatment-related charges for hospitalizations treated with antibiotics, alone or with oseltamivir, were significantly higher than those treated with oseltamivir-only (P < 0.001). Influenza patients treated with antibiotics-only and antibiotics/oseltamivir combination therapy showed 44.9% and 28.2%, respectively, longer duration of hospitalization compared to those treated with oseltamivir-only. Patients treated with antibiotics, alone or combined with oseltamivir, were associated with longer hospitalization and significantly higher medical charges, compared to patients treated with oseltamivir alone. In Korea, there is a need for more judicious use of antibiotics, appropriate use of influenza rapid testing.

Transient Acquired Hemophilia Associated with Mycoplasma Pneumoniae Pneumonia

Acquired hemophilia is a rare disorder caused by autoantibodies to factor VIII (FVIII) (also referred to as factor VIII inhibitors or anti-FVIII) and may be associated with pregnancy, underlying malignancy, or autoimmune disorders. A 33-month-old girl who presented with hematochezia and ecchymotic skin lesions was diagnosed with Mycoplasma pneumoniae pneumonia by serology and polymerase chain reaction. Hematologic studies showed a prolonged activated partial thromboplastin time (aPTT), partially corrected mixing test for aPTT, reduced levels of FVIII, and the presence of antibodies against FVIII. She was treated conservatively with prednisone and intravenous immunoglobulin (IVIG) without FVIII transfusion and recovered without sequelae. This report provides the first description of acquired hemophilia due to anti-FVIII in association with M. pneumoniae in Korea. We discuss this case in the context of the current literature on acquired hemophilia in children.

G and P Genotyping of Human Rotavirus Isolated in a University Hospital in Korea: Implications for Nosocomial Infections

To characterize rotavirus G and P genotypes circulating among infants and young children hospitalized with severe diarrhea in a university hospital in Gyeonggi province, Korea, and to examine any association of the genotypes and nosocomial infections, we genotyped 103 isolates of rotavirus by multiplex RT-PCR. In July 2001-June 2002, we found that globally common strains constituted 64.2% (G2P[4] 28.3%, G3P[8] 28.3%, G4P[8] 5.7%, and G1P[8] 1.9%), and the uncommon strain, G4P[6], constituted 26.4%. During July 2002-June 2003, the percentage of common strains decreased to 44.0% (G3P[8] 18.0%, G2P[4] 16.8%, and G1P[8] 10.0%), but G4P[6] increased to 36.0%. G9P[8] was identified in 10.0% of cases, and thus can be considered an emerging strain in Korea. Eight-eight percent of G4P[6] was isolated from newborn babies. Among the 103 patients, there was an evidence of nosocomial rotavirus infection in 23 children (22.3%). Of these, 19 (82.6%) were newborns infected with G4P[6] strains of rotavirus. Most of the children who acquired rotavirus infection nosocomially showed symptoms of diarrhea, vomiting, fever, poor sucking, or dehydration, regardless of the genotype. This study revealed that G4P[6] has been the major genotype causing nosocomial rotavirus infection in our hospital.

G and P Genotyping of Human Rotavirus Isolated in a University Hospital in Korea: Implications for Nosocomial Infections

To characterize rotavirus G and P genotypes circulating among infants and young children hospitalized with severe diarrhea in a university hospital in Gyeonggi province, Korea, and to examine any association of the genotypes and nosocomial infections, we genotyped 103 isolates of rotavirus by multiplex RT-PCR. In July 2001-June 2002, we found that globally common strains constituted 64.2% (G2P[4] 28.3%, G3P[8] 28.3%, G4P[8] 5.7%, and G1P[8] 1.9%), and the uncommon strain, G4P[6], constituted 26.4%. During July 2002-June 2003, the percentage of common strains decreased to 44.0% (G3P[8] 18.0%, G2P[4] 16.8%, and G1P[8] 10.0%), but G4P[6] increased to 36.0%. G9P[8] was identified in 10.0% of cases, and thus can be considered an emerging strain in Korea. Eight-eight percent of G4P[6] was isolated from newborn babies. Among the 103 patients, there was an evidence of nosocomial rotavirus infection in 23 children (22.3%). Of these, 19 (82.6%) were newborns infected with G4P[6] strains of rotavirus. Most of the children who acquired rotavirus infection nosocomially showed symptoms of diarrhea, vomiting, fever, poor sucking, or dehydration, regardless of the genotype. This study revealed that G4P[6] has been the major genotype causing nosocomial rotavirus infection in our hospital.

Epidemiological study on rotavirus-borne diarrhea in infants and children in different areas / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze and compare the epidemiological features of rotavirus diarrhea among infants in the different areas so as to provide data for rotavirus vaccine research.</p><p><b>METHODS</b>From Sep. 2001 through Sep. 2003, sentinel sites were set up in Suzhou Children's Hospital and Maanshan Hospital. Fecal samples from children (< 5 years) with acute diarrheal were collected and enzyme linked immunosorbent assay was used to detect rotavirus antigen. Reverse transcription-polymerase chain reaction was used to determine the G serotypes and P genotypes of rotavirus strains. The features of strains in the two places and other areas of China were analyzed and compared.</p><p><b>RESULTS</b>(1) Rotavirus infection appeared in autumn and winter, but the peaks varied. In Suzhou the peaks were from December to next February in 2001, and November to next January in 2002. But in Maanshan, it was November to next January for both two years. (2) Rate of rotavirus infection in Suzhou was much higher than that in Maanshan, infective rates of Inpatient Department and Outpatient Department are 47.28%, 28.39% and 30.38%, 14.77% respectively in the two hospitals. (3) Rates of infection in two hospitals showed age difference but the highest group was in 6 - 35 month-olds. No gender difference was found. (4) Secular distribution of G-typing and P-typing of rotavirus strain was different in Suzhou and Maanshan. G3 was mainly found in Suzhou and G1 in Maanshan. From 2002-2003 on, G3 became dominant in Maanshan.</p><p><b>CONCLUSION</b>Rotavirus caused diarrhea among infant and children were different in terms of areas, period and types, suggesting that the introduction of rotavirus vaccine should be adjusted according to different strains with specific types and optimal timeline.</p>

Epidemiologic Trends of Rotavirus Infection in the Republic of Korea, July 1999 through June 2002 / 대한진단검사의학회지

BACKGROUND: Rotavirus is the most common cause of childhood diarrhea worldwide. Although rotavirus is also the leading cause of infant and childhood diarrhea in Korea, much remains unknown about the trends of rotavirus infection by month and geographic region in Korea. To monitor epidemiologic trends of rotavirus infection, a laboratory-based rotavirus surveillance network was established in 2002. This is the first nationwide, multicenter evaluation of rotavirus epidemiology in Korea. METHODS: The rotavirus test results were collected retrospectively from eight network laboratories, from July 1999 to June 2002. Four laboratories used latex agglutination, three used immunochromatography, and one used enzyme-linked fluorescent assay for the detection of rotavirus antigen. RESULTS: Of 10, 441 stool specimens, 2, 496 (23.9%) were positive for rotavirus. During the 3-year period, the rotavirus season began in December-January, and ended in April-May. The rotaviruspositive percentage of summer, autumn, winter, and spring was 11.5%, 10.0%, 32.8%, and 30.0%, respectively. A few hospitals revealed summer epidemics. The rotavirus positive rate in each hospital varied from 15.3% to 44.2%. A common feature of the three hospitals showing the lowest rotavirus-positive percentage (i.e. 800 beds). The secondary care hospitals showed a higher positive proportion (27.5%) compared with tertiary care hospitals (21.1%). CONCLUSIONS: Overall, the rotavirus-positive percentage among all diarrheal specimens was similar to that of other developed countries. The results of this study showed that the autumn epidemic of the rotavirus has declined or disappeared and the peak season for rotavirus has shifted to late winter/early spring in Korea.