The Safety and Immunogenicity of a Trivalent, Live, Attenuated MMR Vaccine, Priorix (TM) / 소아과

PURPOSE: This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella (MMR) vaccine, Priorix (TM) in Korean children. METHODS: From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received Priorix (TM) at four centers: Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. RESULTS: Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days post- vaccination, were: For measles, in the age group 12-15 months, 3, 838.6 mIU/mL [3, 304.47, 4, 458.91]; in the age group 4-6 years, 1, 886.2 mIU/mL [825.83, 4, 308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1, 112.71]; in the age group 4-6 years, 2, 473.8 U/mL [1, 518.94, 4, 028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. CONCLUSION: When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine (Priorix (TM) ), adverse events were limited to those generally expected with any live vaccine. Priorix (TM) demonstrated excellent immunogenicity in this population.

An Outbreak of Acute Gastroenteritis Presenting with Metabolic Acidosis in Many Nurseries in Gyeonggi Province, Korea

PURPOSE: The hospital-acquired outbreak of acute gastroenteritis caused by a virus is currently one of major health problems among newbron nurseries in Korea. We report an outbreak of acute gastroenteritis with metabolic acidosis over a eight-month period in many nurseries in Gyeonggi-do, Korea. METHODS: We retrospectively evaluated 73 neonates who were admitted in Ansan Hospital, Korea University Medical Center, presenting with symptoms of acute viral gastroenteritis from March, 2001 to September, 2003. Epidemiologic, clinical and laboratory data for these neonates were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus and enzyme immunoassay (EIA) for astrovirus, norwalk virus and enteric adenovirus were performed in 54 and 16 neonates, respectively. RESULTS: The mean age at admission was 9.5 +/- 3.9 days. The mean body weight was significantly decreased, compared with mean birth weight. The numbers of severe dehydration were 37 (50.7%) and severe metabolic acidosis (pH < 7.2) were 40 (54.8%). Although the symptoms and laboratory findings were all compatible with acute gastroenteritis caused by a virus, the positive results for ELISA for rotavirus and EIA for astrovirus, norwalk virus and enteric adenovirus were 8 (14.8%) for 54 neonates and none for 16 neonates, respectively. CONCLUSION: Recognizing an outbreak of viral gastroenteritis necessitates notification of local health officials, collection of appropriate specimen for diagnosis and prompt institution of infection control measures.

A Case of Nonspecific Interstitial Pneumonia in a Child

Interstitial pneumonia is a heterogenous group of inflammatory and fibrosing lesions that manifest themselves as infiltrative lung disease. Of these, nonspecific interstitial pneumonia is characterized as a variable degree of interstitial inflammation with or without fibrosis and is distinguished from usual interstitial pneumonia and desquamative interstitial pneumonia, histologically. The influx of inflammatory cells and the responses of immune effector cells injury to the alveolar wall and these initial injuries results in alveolitis and fibrosis. Consequently, the gas exchange throughout the alveolar wall is impaired and the patients suffer from lung diseases of a restrictive pattern. The chief complaints represented are dyspnea and dry cough. We experienced a case of nonspecific interstitial pneumonia in a 10-year old girl. The patient had been healthy and had not been exposed to organic dusts or other toxic materials. The pathology of lung biopsy tissue showed that the alveoli were thickened by a mixture of chronic inflammatory cells and collagen type fibrosis. High resolution computed tomography(HRCT) found the patchy areas of ground-glass opacity with patchy consolidation and irregular reticular opacity, and diffuse distribution without zonal predominance. The forced vital capicity(FVC) was 31%, forced expiratory volume in one second (FEV1) 29% and FEV1/FVC 90%, so a restrictive pulmonary insufficiency was found.

The Influences of Obesity on Bone Mineral Density in Children / 대한소아내분비학회지

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.

Adolescent Depression in a Provincial City

PURPOSE: Most studies of depression in adolescents, have been conducted in western countries. Accordingly, we took a survey in the city of Ansan to discover the actual state of depression in adolescents and found a solution. METHODS: Twelve questions of modified diagnostic criteria for DSM-IV(Diagonstic and Statistical Mannual of Mental Disorders, 4th ed.) major depressive disorder were filled out by 1,158 middle and high school students in Asan. The diagnosis of depression was made when more than six of 12 items were positive and the diagnosis of depressed mood, irritable mood, or loss of interest or pleasure was made when at least one of them was positive. RESULTS: There were 71 students(6.2%) who had major depression. Depressed mood was highly prevalent among Ansan teenagers(12.3%). Girls showed(20.8%) more symptoms than boys(16.7%). One hundred-five students(9.1%) thought seriously about attempting suicide. CONCLUSION: Depression and depressed moods are more highly prevalent among Ansan adolescents than American adolescents. So we point to the importance of broad screening of depression in this vulnerable population.

A Survey on the Adolescent Health Care in Pediatric Practice

PURPOSE: This study was designed to establish standard guidelines to meet the growing health care needs of adolescents by direct assessment of pediatricians' current practices, attitude and obstacles to the primary care of adolescents. MEHTODS: A questionnaire consisting of 9 questions, including personal characteristics of respondents, current health care practice of adolescents, attitude, obstacles to providing adolescent care, interest in further training, roles of Korean Pediatric Society for adolescent medicine, etc., was completed by 214 pediatricians. RESULTS: Among the respondents, 87.4% were in the 4th or 5th decade of age, and 88.8% of respondents were working for private clicins. More than 60% of respondents were managing patients without age limits. Most of the respondents were interested in adolescent medicine. However, approximately one half of all respondents answered that they could not currently provide satisfactory care to their adolescent patients. Obstacles to providing adolescent care include : their image as "baby doctors", lack of knowledge and skills in adolescent medicine, lack of separate hours for adolescents and concern that parents would object to certain types of care. Among respondents who wanted to further training, many were interested in Continuing Medical Education(CME) course, lecture series, introducing reading lists and publishing textbooks, while others expressed their interest in a newsletter and mini-fellowship. Respondents expected the Korean Pediatric Society to play a role in activating the adolescent medicine as a field for pediatric practice through educating adolescents, pediatricians and advertising via mass media. CONCLUSION: Future policy decisions and medical education must respond to these realities in pediatric practice.

A Study on Menarchel Age and Monthly Incidence of School Girls in Ansan

PURPOSE: Menarche is an important life event, making the transition from childhood to early womanhood. It is a significant physical and physiological event that adolescent girls feel sexual identity and it affects on psychological development. The onset of menstruation is considered a practical indication of sexual maturity in girls. On a population level, mean menarcheal age is considered to be primarily an indicator of living conditions and health. The purpose of this study is to determine menarcheal age in Ansan, Korea in present time and confirm and analize the seasonal variation in menarche in Ansan, Korea. METHODS: The cross-sectional study was done on menarche in 4,786 junior high and high school girl students (11-20years old) of Ansan city. RESULTS: 1) The mean menarcheal age was 12.4+/-1.1 years. 2) The menarcheal ages of 12-year-old, 16-year-old, and 20-year-old girls were 11.4+/-0.7, 12.3+/-0.9, 13.2+/-1.1 respectively. These data show earlier onset of menarche at the younger age groups with statistical significance at p<0.01. 3) The menarche occurred most frequently on August (14.9%), followed by July (12.1%), January (10.2%), December (9.7%). CONCLUSIONS: The mean menarcheal age of the subjects was 12.4+/-1.1 years and it was not different from the mean age of menarche in Europe and United States. These data showed that there was a seasonal variation in the onset of menarche, peak in the summer and winter and it seems to be affected complicatedly by many factors such as seasonal factor, phylogenetic factor ontogenetic factor, environmental factor, psychologic status, nutritional status etc.