Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran

The seroprevalence of hepatitis E virus infection [HEV] in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals [2.3%]. Seroprevalence increased significantly with age from 3/255 [1.2%] in children < 10 years to 8/110 [7.3%] in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas

Combination therapy with interferon and ribavirin for chronic hepatitis C infection in beta-thalassaemia major

Treatment of chronic hepatitis C virus [HCV] infection in transfusion-dependent betathalassaemia major patients is complicated by existing hepatic siderosis and the fear of ribavirinassociated haemolysis. We evaluated the efficacy and side-effects of combination interferon-alpha [INF] and ribavirin therapy for HCV-infected thalassaemia patients. A total of 17 patients were enrolled [10 nonresponders to INF monotherapy, 7 naive to treatment, mean age 23.1 years] and they received 12 months of combination therapy. The sustained virological response rate 6 months after treatment was 58.8%. Blood transfusion requirements during treatment temporarily increased by 36.6%. Combination therapy was tolerated by, and may be useful for, HCV-infected thalassaemia major patients

Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002-2003

To determine the frequency and pattern of antibiotic susceptibility of uropathogens in urinary tract infection [UTI] from 3 university hospitals we carried out a retrospective review of urine culture and antibiotic sensitivity testing from symptomatic outpatients and inpatients during 2002-2003. Of 5600 samples, 703 [12.6%] were culture positive, 38.7% of which were from hospitalized patients. Escherichia coli was the leading cause of UTI in both groups of patients. The rates and roles of other pathogens, including Pseudomonas spp. [5.3%-10.4%], Enterobacter spp. [0%-5.7%], Staphylococcus spp.] 5.4%-26.4%], differed in each hospital. Differences in antibacterial susceptibility patterns were observed. Ampicillin [82%-100%] and co-trimoxazole [50%-90%] resistance were the most frequent. Methicillin resistance in Staphylococcus spp. ranged from 17% to 60%

Measles seroepidemiology among adolescents and young adults: response to revaccination

We evaluated the seroprevalence of measles antibody and response to measles re-immunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti- measles IgM and IgG titres were assessed again 2- 4 weeks after revaccination in 144 [105 seronegative, 39 seropositive] individuals: 75 seronegative participants responded to revaccination anamnestically [P < 0.001] and developed immunity 11 also showed IgM response [probably primary vaccine failure immunity]; 38 seropositive participants, remained seroprotected without significant increase in antibody titre [P = 0.577]. Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected

Measles seroepidemiology among adolescents and young adults: Response to revaccination [SARI; 2003]

Despite a high coverage with measles vaccine, outbreaks of measles occur with an increasing proportion in older children and adults who have been vaccinated. The aim of this study was to determine the anti- measles seroepidemiology in adolescents and young adults, and the responses of subjects to revaccination. Five hundred and ninty adolescents and young adults 15 to 25 years old previously received one or two doses of measles vaccine [15-19 years old subjects; 2 doses at 9 and 15 months of age and 20-25 years old subjects; one dose after 12 months of age] with no history of physician diagnosed measles were redcruited to determine the seroprevalence of IgG measles antibody. Two to six weeks after revaccination, anti measles IgM and IgG antibodies titers were assessed by ELISA methods, to differentiate between the primary and secondary vaccine failure. The results were compared and analyzed. From 590 subjects, 263 were serologically negative or susceptible. Of 105 susceptible revaccinated subjects 75 showed anamnestic IgG and 11 of them also showed IgM responses [probably primary vaccine failure]. No significant responses were observed in 39 seroprotected subjects to revaccination except one subject. The results showed that 44.6% of vaccinated adolescents and young adults were serologically susceptible to measles. The rates of primary and secondary vaccine failure, herd immunity with 95% coverage were 4.7%, 27.1% and 83%, respectively. The study showed that vaccination- induced anti-measles antibody decline overtime especially in the absence of natural boosting. Catch-up vaccination or third dose of measles vaccination is recommended

[Response to extra dose of hepatitis B vaccine in non-seroprotected children 10 years after primary immunization]

The aim of the present study was to identify the true extent of non-responsiveness in children vaccinated against Hepatitis B virus [HBV] ten years ago at birth whom were serologically susceptible to HBV,and had poor antibody response to booster HBV vaccine. Twenty low-and non-responding 11.5 years old children recuited in by another study received three additional doeses of HB vaccine 4-6 weeks apart. Anti-HbS antibody titers were assessed before and 4-6 weeks after each dose of vaccine by using ELISA method. All children showed anamnestic antibody responses after receiving the first additional dose of vaccine. There was no significant differences between the mean concentration of antibody after the first, second and third doses of vaccine. Study results showed that those children who did not respond to booster does of the HB vaccine may not be real non-responder.HB vaccine at infancy induces long-time immunologic memory which provides seroprotection by exposure to HBs-Ag

[Tuberculous meningitis in a 3 month old infant, a case report]

Tuberculosis especially tuberculous meningitis rarely accurs before 3 months of age. Though treatable, it may be fatal despite modern treatment. The diagnosis of congenital TB/TB meningitis should be considered in any neonate/infant with pneumonia _meningitis who fails to respond to conventional treatment, particularly in a child from ethnic or socioeconomic environment where tuberculosis is prevalent

[Resistant Kawasaki disease, case report and literatures review]

A child with aggressive and resistant Kawasaki disease with coronary aneurysm is described. Despite two doses of immune globulin and high dose of aspirin the patient was treated with the third dose of immune globulin. The patient apparently responded to normalization of symptoms and signs, with no more progression of coronary artery abnormalities

Kawasaki disease in East Mazandaran, Islamic Republic of Iran, 1997-2002

We conducted a retrospective review of all cases of Kawasaki disease admitted to the major referral centres in Sari, East Maz and aran from 1 November 1997 to 30 October 2002. Of 29 probable cases, 25 were confirmed, giving an average annual incidence rate of 7.3 per 100 000 in children 0-5 years. The mean age of all cases was 38 months [range: 3.5-80 months]. There was a male predominance. The mean time between the onset of illness and diagnosis was 8.2 +/- 3.1 days. Five of the 25 patients had cardiovascular abnormalities before treatment. All patients were treated with intravenous immunoglobulin and 22 [88%] responded to a single dose of treatment and high doses of acetylsalicylic acid; 2 patients needed a second dose of IVIG, and 1 patient required a third. Complete recovery was noted in all patients except for 1, who is under follow-up and treatment

Rapid reinfection by Giardia lamblia after treatment in a hyperendemic area: the case against treatment

We selected 405 children aged 1-10 years with Giardia lamblia infection but without abdominal or gastrointestinal complaints for the previous month. For 5 days, 204 received metronidazole 15 mg/kg/day and 201 received B-complex syrup. Stool samples were examined 2-3 weeks and 3 months after treatment and results were tested with chi-squared. Weight and height 6 months after treatment were compared with primary weight and height by Z-score and Student t-test. Metronidazole efficacy at 2-3 weeks was 85.3%. Three months after treatment, 60 were reinfected [34.5%] and 71 had spontaneously cleared [35.3%]. Because of high reinfection, spontaneous clearing and treatment failure rates, and the lack of effect on nutritional status or growth, we do not recommend treatment for children with asymptomatic giardia infection

Long-term antibody response and immunologic memory in children immunized with hepatitis B vaccine at birth

To evaluate the long-term immunity and immunologic memory provided by universal hepatitis B vaccination program at birth, and to evaluate the booster effects of different dosages of hepatitis B vaccine on children, who lost protective antibody titers to hepatitis B surface antigen [HBs -Ag], this study was conducted. Community-based sero-epidemiologic study was done on 453 healthy 10.5 years old Iranian children, one decade after implementation of a mass hepatitis B vaccination program. A booster vaccination with different dosages was given for children who did not have protective level of anti-hepatitis B surface antigen antibody [anti-HBs]. Quantitative serologic responses to different dosages of vaccine were compared using X[2] statistical test. A total of 42% children [191 of 453] children had low concentration [<10IU/L] of anti HBs antibody, 18.5% [84 of 453] were susceptible [antibody titer <2IU/L]. 87.2% of 165 nonprotected-boostered vaccines showed immunologic memory to different doses of booster, and developed protective antibody titer two weeks later. The differences between pre- [3.48 +/- 3.39; mean +/- SD] and post- [153 +/- 163.84] vaccination antibody titers were significant [p=0.000]. Antibody titers achieved by different doses of vaccine had significant proportion to vaccine doses. No hepatitis B infection markers were detected in those children who were not sero-protected and did not respond to booster dose of vaccination. According to these findings, universal hepatitis B vaccination program at birth provides adequate protection against hepatitis B virus infection at least for 10 years. It might suggest that booster vaccination is not recommended, but further follow-up studies at adulthood age group are recommended