Hepatitis A virus vaccination strategy and pre-immunization screening of Bangladeshi children.

Background: HAV infection is endemic in many developing countries like India, Pakistan, Nepal etc. Several seroprevalence studies show high rates of sero-positivity among children by sub-clinical infection. Therefore mass vaccination against HAV has not been recommended in endemic countries. Objective: To determine whether routine hepatitis A vaccination is indicated for all Bangladeshi children & also to know whether pre-vaccination screening is necessary. Materials & Methods: Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the children of Bangladesh. Results: Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Age-specific sero-prevalence was 13 (23.2%) of 56 in 1-3 year,64 (55.2%) of 116 in 3-5 year, 39 (70.9%) of 55 in 5-10 year & 25 (92.6%) of 27 in 10-15 year age group. Cost benefit analysis showed that the total cost of screening followed by vaccination was almost 1.8 times less than the total cost of vaccination of all children without screening. Conclusions: Majority of the children were found sero-positive against HAV around 15 year of age. Therefore mass vaccination against HAV may not be required for Bangladeshi children.

Cholestatic jaundice during infancy: experience at a tertiary-care center in Bangladesh.

BACKGROUND AND OBJECTIVE: Cholestatic jaundice in early infancy is a difficult diagnostic problem. Early diagnosis is important for proper management. This retrospective study was conducted to find out the etiology and clinical profile of neonatal cholestatic disorders in Bangladesh. SETTING: Tertiary-care hospital in a developing country. METHODS: Clinical profile and cause of cholestatic illness were studied in 62 infants with cholestatic jaundice developing before three months of age and persisting for more than two weeks. RESULTS: Neonatal hepatitis (22; 35.5%--17 with TORCH, 5 with urinary infection), followed by biliary atresia (16; 25.8%) and idiopathic neonatal hepatitis (15; 24.2%), were the commonest causes of cholestasis. Mean age at presentation was 3.5 months. Ten (62.5%) of 16 biliary atresia cases were male and jaundice appeared before 14 days in 14 (87.5%) cases. CONCLUSIONS: Neonatal hepatitis, biliary atresia and idiopathic neonatal hepatitis were the common causes of neonatal cholestasis in infancy. Though cholestatic jaundice developed early, most of the cases presented late.

Drug induced hepatic focal nodular hyperplasia.

Focal nodular hyperplasia, an uncommon benign hepatic tumor, has been reported following ingestion of various drugs and chemical agents. The authors report a case of a young girl who developed such lesion following ingestion of anti-tuberculosis drugs for the treatment of her abdominal tuberculosis.

Safety of blind liver biopsy.

OBJECTIVE: The aim of the study was to observe the safety of blind liver biopsy in children. METHODS: One hundred fifteen consecutive liver biopsies in hospitalized children were evaluated retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostal space blind liver biopsies were performed by TruCut biopsy needle. RESULTS: The first biopsy sample was considered macroscopically adequate in 94.8% of cases. A definitive histological diagnosis was possible in 99.1% of cases. Sixty nine children were more than 5 years of age and of these 8 (11.6%) complained of pain at the biopsy site. External hemorrhage from the biopsy site was seen in 1 (0.9%) case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure. CONCLUSION: Blind liver biopsy in the studied hospitalized children was found to be a safe procedure.

Caroli's disease.

Carolis disease is a rare communicating segmental or diffuse dilatation of the intrahepatic biliary tree. Cholangitis, liver cirrhosis and cholangiocarcinoma are its potential complications. A case of Carolis disease in a boy of 6 years with bilobal involvement presenting with intermittent abdominal pain, fever and hepatomegaly is reported here.

Risk factors of persistent diarrhea in children below five years of age.

BACKGROUND/OBJECTIVE: Persistent diarrhea is a known cause of childhood mortality, morbidity and malnutrition in developing countries. This study was conducted to find out the host and environmental risk factors associated with persistent diarrhea in Bangladeshi children below 5 years of age. DESIGN: Prospective analytic case-control study. SETTING: Tertiary hospital in Dhaka, Bangladesh. METHODS: Fifty children with persistent diarrhea and 50 controls with acute diarrhea (matched for age and sex) comprised the study subjects. RESULTS: Most of the children (82%) were aged below 2 years. Among the risk factors, Grade III malnutrition (p<0.008), irrational antibiotic use during acute diarrheal episode (p<0.0000005), use of unsafe drinking water (p<0.004) and lack of exclusive breast-feeding up to the first four months of life (p<0.004) were significantly associated with persistent diarrhea. Logistic analysis showed irrational antibiotic use (p<0.0001) during an episode of acute diarrhea and lack of exclusive breast-feeding (p<0.05) during the first four months of life as independent risk factors associated with persistent diarrhea. CONCLUSION: Improvement of nutritional status, encouraging exclusive breast-feeding during the first four months of life, discouraging the irrational use of antibiotic for the treatment of acute diarrhea, and provision of safe drinking water may be important for the prevention of persistent diarrhea as these have been identified as risk factors in Bangladeshi children below five years of age.