ABSTRACT
Objective: In many countries, universities require students to either show a physician-certified proof of immunity or to get vaccinated against measles, mumps, rubella and varicella, prior to their registration in medical and paramedical majors. The objective of this study was to evaluate the need to implement this policy in Lebanon. DESIGN: A cross-sectional study was performed on students of the Lebanese University [LU], faculties of Medicine, Dentistry, Pharmacy and Public Health. Methods: The serological immunity status was assessed by determining specific antibody titer and the disease and vaccination history of 502 students was collected. Based on percentages of susceptibility, a cost-effectiveness analysis was performed to compare systematic vaccination without prior serological testing with selective vaccination of seronegative students. Results: Percentages of individuals with serologically confirmed immunity against varicella, measles, rubella and mumps were 93%, 86%, 88% and 75% respectively, and 42% of the students were susceptible to at least one of the pathogens covered by the MMR vaccine. Compilation of 186 vaccination records indicated that only 19 students [10%] had been adequately vaccinated. Moreover, among those, 7 students [37%] were still unprotected against at least one virus. Systematic vaccination against MMR was found to be 4-5 times less expensive than selective vaccination, while selective vaccination of seronegative individuals was more cost-efficient for varicella. Conclusion: since, in this population, very few individuals were able to present a proof of adequate vaccination, it is recommended to systematically vaccinate healthcare students in Lebanon against MMR. For varicella, selective vaccination after serological testing should be performed.
ABSTRACT
Diagnosis, initial workup and immediate prognosis in congenital or acquired heart diseases revealed by cardiogenic shock [CS] in a Lebanese paediatric multicentric study. During a six-year period [is. January 1999 to 31 December 2004], 56 paediatric patients aged between 0 and 7 years have been admitted to the emergency departments or neonatal and intensive care units in ten different Lebanese hospitals, for high degree of CS suspicion with underlying cardiac disease. All diagnoses were confirmed by echocardiography.All children were initially in a critical condition with signs of CS. Congenital heart diseases [CHD], specially left obstructive diseases [coarctation of the aorta, critical aortic stenosis, hypoplastic left heart syndrome] were the main etiologies found in newborns, followed by dilated cardiomyopathies in infants and children. Mortality was higher in the following two groups of patients : intubation, no diuresis after the first hour of admission despite therapeutic measures [prostaglandines in newborns, dopamine, dobutamine and furosemide]. Beside those pathologies necessitating specific treatment, all the CHD [excluding hypoplastic left heart syndrome, one case of critical aortic coarctation and one case of congenital mitral regurgitation] were transferred to the catheterization laboratory or to surgery in a good hemodynamic condition. CS remains a notable medical problem observed in the emergency and paediatric intensive care units in Lebanon. Immediate prognosis is related to : immediate recognition of the CS, nature of the car-diopathy and initial response to therapeutic procedures such as rapid improvement of respiratory status and rapid diuresis. Echocardiography is a reliable, quick and non-invasive procedure for initial diagnosis