Anti-HBs Titers Following Pentavalent Immunization (DTwP- HBV-Hib) in Term Normal Weight vs Low Birthweight Infants

Objective: To compare anti-HBs titers between term low birthweight (1800-2499 g) infants and normal birthweight infants, 6weeks after last dose of primary immunization with pentavalentvaccine, and to study adverse events following immunization(AEFI) with pentavalent vaccine.Design: Cohort study.Setting: Tertiary-care hospital predominantly catering to urbanpoor population of East Delhi.Participants: 265 low birthweight (1800-2499 g) and 265 normalbirthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccinewas administered within 24 hours of birth followed by three primarydoses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBstiters were estimated after 6 weeks of third dose of pentavalentvaccine. Adverse events following immunization (AEFI) monthwere observed for a month after each dose of pentavalent vaccine.Main outcome measures: Anti HBs antibody titers after 6 weeksof primary immunization, and AEFI.Result: 443 (83.5%) infants (225 low birthweight and 218 normalbirthweight infants) completed the follow-up. Seroprotectionagainst hepatitis B virus was achieved in both groups afterpentavalent vaccine administration. Anti HBs GMTs in lowbirthweight infants (194.8 mIU/mL) and normal birthweight infants(204.2 mIU/mL) were comparable (P = 0.17). No serious adverseevents were observed in either group.Conclusion: Three primary doses of pentavalent vaccineadministered along with zero dose of Hepatitis B vaccine at birthprovide good seroprotection. The vaccine appears to be safe inboth low birth weight and normal birthweight infants born at term.

Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.

Objective: To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Tertiary-care hospital. Participants: 324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL). Intervention: 100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment. Outcome variables: Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Results: Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention. Conclusion: There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

Pattern of Candida isolates in hospitalized children.

Nosocomial candidemia is the 4(th) most common pathogen in blood stream infection. Emergence of non-albicans Candida species with often intrinsically resistance fluconazole pattern may lead to difficulty in management of septicemia. Although the present study isolated 80% of non albicans candida species with C.tropicalis as the most common (35%) species, 96% of our Candida species isolated were sensitive to fluconazole. The probable causes of low resistance pattern to fluconazole in our institute are discussed. It is however necessary to identify the complete clinical response to the given treatment. Therefore, appropriate identification of species with susceptibility testing would be advisable before start of anti-fungals. This would prevent emergence of fluconazole resistance.

Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi.

BACKGROUND & OBJECTIVE: Epidemics of cholera caused by toxigenic Vibrio cholerae O1 and O139 (Bengal strain) represent a major public health problem in most developing countries. In view of the reported shift in epidemiology and pattern of antibiotic resistance in this was study carried out to assess the development of resistance to essential drugs like fluoroquinolones during treatment of cholera and cholera like cases in Delhi. METHODS: Faecal specimens collected from 1184 patients with cholera and cholera like illness between 2001-2006 admitted to Guru Teg Bahadur hospital, East Delhi were subjected to culture isolation. Antimicrobial susceptibility testing of V. cholerae isolates was done by disc diffusion method. RESULTS: Of the 1184 faecal samples examined, 670 (56.6%) were positive for V. cholera from 2001- 2006. V. cholerae El Tor Ogawa (54.6%) was more common than serotype Inaba (32.5%). During 2004-2006 V. cholerae Inaba emerged as the predominant serotype. Resistance to nalidixic acid, furazolidone and co-trimoxazole was constantly high (100%). Multiple antibiotic resistance (MAR) V. cholerae O1 Inaba isolates exhibited increased resistance to ciprofloxacin with MIC >4 microg/ml, but largely all remained susceptible to other antibiotics like, gentamicin, tetracycline and chloramphenicol. INTERPRETATION & CONCLUSION: V. cholerae have a permanent existence in the environment and during the quiescent period, their survival in water bodies allows dissipation of resistance patterns to different serotypes or strains of V. cholerae O1 and therefore there is need for constant observation.