Evaluation of Effectiveness and Safety of Influenza Vaccine in Children with Acute Lymphoblastic Leukemia: A Systematic Review / 中国药学杂志

OBJECTIVE: The effictiveness and safety of influenza vaccine for children with acute lymphoblastic leukemia (ALL) were reviewed by searching the published literature to explore the optimal vaccination strategy for clinical reference. METHODS: According to the principles of PICOS, the retrieval strategy of the research topic was developed, and the english literature databases such as PubMed and Embase were searched. RESULTS: A total of 186 literatures were retrieved, 29 of which were valid.Studies have shown that inactivated influenza vaccination in most children with ALL can produce a moderate intensity immune response, and the seroprotection rates of subtypes/lines can reach 33%-85% (A/HIN1), 38%-92% (A/H3N2), 14%-92%(B) and 37%-88% (pH1N1), respectively. Seroconversion rates were 0%-65% (A/HIN1), 20%-85% (A/H3N2), 0%-92%(B) and 11%-81% (pH1N1), respectively, which were lower than those of healthy children or children with solid tumors.Studies on the effectiveness of vaccines in preventing laboratory-confirmed influenza or influenza-like illness are limited and the RESULTS are conflicting. Higher baseline absolute lymphocyte counts, IgG levels at the time of vaccination, off or low-intensity stages of chemotherapy, older children, and booster doses may result in a stronger immune response.Live attenuated influenza vaccine, high-dose influenza vaccine and adjuvant influenza vaccine did not improve the immune response of children with ALL.The vaccine was well tolerated in all treatment stages with mild adverse reactions. CONCLUSION: Available data suggest that the standard dose of inactivated influenza vaccine should be administered at the maintenance chemotherapy stage.The vaccine's clinical effectiveness has yet to be verified in well-designed clinical trials.

A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children

PURPOSE: There are limited population-based data regarding herpes zoster in children. Thus we conducted a multi-institutional epidemiological analysis of herpes zoster in children and comparative analysis according to their immune status. MATERIALS AND METHODS: The study included 126 children under the age of 18 years who were hospitalized for herpes zoster at 8 hospitals in South Korea, between July 2009 and June 2015. The subjects were divided into 2 groups according to their immune status, and medical records were reviewed. RESULTS: There were 61 cases (48.4%) in the immunocompetent group and 65 cases (51.6%) in the immunocompromised group. Median age was older in immunocompromised group (11.4 vs. 8.6) (p<0.001). The mean duration of hospitalization was longer in immunocompromised group (11.0 vs. 6.6) (p<0.001). Patients were treated with oral or intravenous antiviral agents. A total of 12 in immunocompetent group were cured only by oral acyclovir. No treatment failure was found in both groups. Six immunocompromised patients had postherpetic neuralgia and 1 case was in immunocompetent group. In immunocompetent children, herpes zoster was likely caused by early varicella infection. There was no increase in progression of severity in both groups due to appropriate treatment. CONCLUSION: Early initiation of therapy is necessary for those in immunocompromised conditions. And inactivated herpes zoster vaccination may be considered in immunocompromised adolescents in the future.

Assessment of Serologic Immunity to Diphtheria-Tetanus-Pertussis After Treatment of Korean Pediatric Hematology and Oncology Patients

The aim of this study was to investigate the diphtheria-tetanus-pertussis antibody titers after antineoplastic treatment and to suggest an appropriate vaccination approach for pediatric hemato-oncologic patients. A total of 146 children with either malignancy in remission after cessation of therapy or bone marrow failure were recruited. All children had received routine immunization including diphtheria-tetanus-acellular pertussis vaccination before diagnosis of cancer. The serologic immunity to diphtheria, tetanus and pertussis was classified as: completely protective, partially protective, or non-protective. Non-protective serum antibody titer for diphtheria, tetanus and pertussis was detected in 6.2%, 11.6%, and 62.3% of patients, respectively, and partial protective serum antibody titer for diphtheria, tetanus and pertussis was seen in 37%, 28.1%, and 8.9% of patients. There was no significant correlation between the severity of immune defect and age, gender or underlying disease. Revaccination after antineoplastic therapy showed significantly higher levels of antibody for each vaccine antigen. Our data indicates that a large proportion of children lacked protective serum concentrations of antibodies against diphtheria, tetanus, and pertussis. This suggests that reimmunization of these patients is necessary after completion of antineoplastic treatment. Also, prospective studies should be undertaken with the aim of devising a common strategy of revaccination.

Esofagitis herpética en el niño inmunosuprimido

Introducción. La esofagitis por herpes es una enfermedad que se presenta principalmente en pacientes inmunosuprimidos; hasta 1985 la mayoría de los casos se diagnosticaban durante las autopsias, lo que ha cambiado con el advenimiento de la endoscopia. Material y métodos. Se revisaron los expedientes de pacientes inmunosuprimidos a los que se les hizo endoscopia y biopsias de enero de 1992 a junio de 2002, se analizó: edad, sexo, sintomatología, lesiones orales, hallazgos endoscópicos e histológicos y enfermedad de base. Resultados. Se analizaron 137 casos, de los cuales 12 tuvieron esofagitis por virus del grupo herpes, 6 correspondieron al sexo femenino y 6 al masculino; la edad varió de 14 meses a 15 años. Cinco pacientes tenían leucemia, 5 tenían algún tumor sólido, 1 enfermedad de Kawasaki y 1 trasplante renal. Los síntomas principales fueron: disfagia y sialorrea. Diez enfermos tenían lesiones en la mucosa oral y la endoscopia mostró úlceras y placas blanquecinas. El estudio histológico en estos casos mostró cambios característicos de infección por herpes virus. Conclusión. Doce pacientes inmunosuprimidos con sintomatología esofágica tuvieron esofagitis por herpes virus. Los síntomas más constantes fueron disfagia y sialorrea. La endoscopia permite localizar las lesiones y mediante la toma de biopsias llegar al diagnóstico etiológico e indicar el manejo a seguir.

Introduction. Herpetic esophagitis is mainly observed in immunocompromised patients; before 1985 most cases were diagnosed at autopsy but this has changed with the introduction of endoscopy. Material and methods. Clinical charts of immunocompromised patients (n =137) in which an endoscopic procedure was practiced, from January 1992 to June 2002 were reviewed period; age, gender, symptoms, oral lesions, main disease, endoscopic histopathological findings, were reviewed. Results. Herpetic esophagitis was found in 12 of 137 cases, 6 were females; age varied from 14 months to 15 years; main disease was leukemia in 5 cases, a solid tumor in 5, Kawasaki's disease in 1, and renal transplant in 1. Main symptoms observed were dysphagia and syalorrhea; in 10 cases oral lesions were present. Esophageal ulceration and white plaques were observed in the endoscopic study and the characteristic changes of Herpes virus infection were observed in the histopathological study. Conclusion. We present 12 cases of herpetic esophagitis in immunocompromised children in whom syalorrhea and dysphagia were the main symptoms.

Invasive Aspergillosis in Immunocompromised Children / 대한소아혈액종양학회지

PURPOSE: An increasing number of immunocompromised patients are contracting opportunistic infections caused by Aspergillus, resulting in a significant morbidity and mortality. We reviewed the clinical presentation, radiologic characteristics, histopathologic findings, treatment strategies, and outcome of invasive aspergillosis (IA) in immunocompromised children. METHODS: Thirteen children having IA were retrospectively analyzed. RESULTS: Acute myelogenous leukemia (n=9, 69.2%) was the most common underlying disease, followed by acute lymphocytic leukemia (n=2), Fanconi anemia (n=1), and chronic granulomatous disease (CGD, n=1). Pulmonary involvement was present in 12 patients (92.3%). The sinuses or nose were involved in 4 (30.8%). The patient with CGD had lung, soft tissue, and bone involvement. Central nervous system, gastrointestinal, heart involvement were not documented. Histology or culture proven IA were found in 6 patients (46.2%). In pulmonary IA, typical findings of thoracic computed tomography, such as halo sign or air-crescent sign, was observed in 6 patients. Amphotericin B was given to all patients along with itraconazole (69.2%), G- or GM-CSF (84.6%). AmBisome was subsequently substituted for Amphotericin in 4. One patient with pulmonary mycetoma underwent lobectomy. Seven patients (53.8%) were improved by antifungal measures, but no patients achieved a long term survival. IA was implicated as a cause of death in 7 (4 with massive pulmonary hemorrhage). Most of the rest succumbed to the relapse of underlying leukemia. CONCLUSION: IA remains a formidable infection in immunocompromised children despite current treatment. Lung was the most common site of infection and massive pulmonary hemorrhage might ensue. Early diagnosis and development of effective measures, including surgery, are warranted.

Three cases of listeria infection in the immunocompromised children

No abstract available.