Factors associated with missed and delayed DTP3 vaccination in children aged 12 - 59 months in two communities in South Africa, 2012 - 2013

Background. Although immunisation services are available to all children in South Africa (SA), many children miss or have delays in receiving vaccines. There are limited data on factors associated with missed or delayed vaccination in children in this setting. Objectives. To assess vaccination coverage and factors associated with missed and delayed diphtheria-tetanus-pertussis vaccine third dose (DTP3) vaccination in children aged 12 - 59 months in two SA communities. Methods. We used data from household-level healthcare utilisation surveys conducted in Soweto in 2012 and in Pietermaritzburg in 2013. Information on vaccination status was recorded from the Road to Health cards or vaccination history from clinics for children aged <5 years. Factors associated with missed or delayed DTP3 vaccination were assessed using unconditional logistic regression. Results. Of a total of 847 eligible children aged 12 - 59 months, 716 had available vaccination information. Overall DTP3 vaccination coverage was high for both sites: 90.6% in Pietermaritzburg and 93.9% in Soweto. However, 32.6% and 25.2% of DTP3 vaccinations were delayed (received after 18 weeks of age) in Pietermaritzburg and Soweto, respectively. The median delay for DTP3 vaccinations was 4.7 weeks (interquartile range 1.7 - 23.0). Factors associated with delayed DTP3 vaccination included being born in 2010 (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 1.4 - 6.3) or 2011 (aOR 2.7, 95% CI 1.3 - 5.7) compared with being born in 2008, probably due to vaccine shortages; a low level of education of the primary caregiver, with children whose caregivers had completed secondary education having lower odds of delayed vaccination (aOR 0.5, 95% CI 0.3 - 0.9) than children whose caregivers only had primary education; and maternal HIV status, with unknown status (aOR 3.5, 95% CI 1.6 - 7.6) associated with higher odds of delay than positive status. Factors associated with missed DTP3 vaccination (not vaccinated by 12 months of age) included two or more children aged <5 years in a household (aOR 2.4, 95% CI 1.2 - 4.9) compared with one child, and household monthly income <ZAR500 (aOR 3.4, 95% CI 1.1 - 11.4) compared with ≥ZAR2 000.Conclusions. Despite high overall DTP3 coverage observed in two communities, many vaccinations were delayed. Vulnerable groups identified in this study should be targeted with improved vaccination services to enhance uptake and timeliness of vaccination

Evaluación de pruebas alternativas al hemocultivo en el diagnóstico de la sepsis neonatal precoz / Evaluation of alternative hemoculture tests for the diagnosis of early neonatal tests

Se realizó un estudio prospectivo en 90 neonatos provenientes de madres con rotura prematura de membrana (RPM) mayor de 24h, con el objeto de establecer la incidencia de sepsis neonatal precoz (SNP), determinar su etiología y evaluar la capacidad diagnóstica de pruebas alternativas al hemocultivo; cultivo de hisopado de conducto auditivo externo, de aspirado nasofarígeo y de aspirado gástrico. En los neonatos nacidos vivos, se rigistró una incidencia del 4 por ciento (n=90) de RPM mayor de 24 h, y 6,9//(16/2293 recién nacidos vivos) padecieron SNP. La incidencia de SNP en neonatos de madres con RPM mayor de 24 h fue del 17,8 por ciento (16/90) y se distribuyó de la siguiente forma: 3,3 por ciento (3/90) asociado exclusivamente a RPM sin otro factor agravante, 5,6 por ciento (5/90) cuando se asoció la RPM a corioamnionitis y 8,9 por ciento (8/90) con prematurez. Con respecto a los agentes etiológicos de SNP, predominaron los Gram positivos y, dentro de ellos, Staphylococcus aureus. Ninguna de las pruebas evaluadas alcanzó la seguridad diagnóstica (sensibilidad más especificidad) necesaria para ser utilizada como pruebas alternativas al hemocultivo para diagnóstico de SNP por RPM mayor de 24 h. No obstante, ellas pueden ser empleadas como pruebas complementarias para contribuir a la identificación de recién nacidos de alto riesgo que hayan estado expuestos a infección del líquido amniótico o corioamnionitis

Virus sincicial respiratorio en menores de 5 años hospitalizados con infección respiratoria aguda baja / Respiratory syncitial virus in children under 5 years of age with acute lower respiratory infections

Entre julio 1988 y septiembre 1989, durante el período invernal, se investigó la presencia de Virus Sincicial Respiratorio (VSR) en 150niños menores de 5 años con infección respiratoria aguda (IRA) del tracto inferior (bronquiolitis: 56 por ciento; neumonías: 23 por ciento; bronquitis: 21 por ciento) por medio de un método rápido (inmunofluorescencia indirecta) sobre células del aspirado nasofaríngeo obtenido por succión con bomba de vacío. Se detectó antígeno de VSR en el 21,33 por ciento de los casos estudiados. El 25 por ciento de las bronquiolitis, el 17,6 por ciento de las neumonías y el 15,6 por ciento de las bronquitis resultaron positivas para VSR. La mayor frecuencia de positividad en bronquiolitis fue estadísticamente significativa (p<0,01). En neumonías se observó una disminución de la positividad a medida que aumentaba la edad. La distribución por grupo etáreo de los resultados positivos, independientemente del cuadro clínico, mostró una mayor frecuencia de VSR en menores de 23 meses. No se detectó diferencia significativa con respecto al sexo, estado nutricional y vacunación en pacientes con o sin VSR. En el grupo de 0-5 meses, el 42 por ciento de los casos positivos correspondió a menores de 30 días de vida. En 4/5 neonatos con VSR y en 3/12 menores de 12 meses con VSR se detectó la adquisición intrafamiliar de esta infección ya que se registró internación previa de hermanos con VSR en nuestro servicio. Se sugiere la necesidad de contar con métodos rápidos de estudio de la etiología viral en las IRAs a nivel hospitalario, lo que permitirá implementar estrategias más sólidas de control y tratamiento

Benign recurrent intrahepatic cholestasis (Summerskill and Walshe syndrome). Case report and revision of bibliography

We describe the case of a 58-year old woman who had four episodes of choluric jaundice and severe pruritus, starting at age 48. Each episode lasted about four months and had a spontaneous remission. During icteric episodes, conjugated bilirubinemia, alkaline phosphatase, and to a lower degree transaminases, were increased; white cell count was higher and there was a marked rise in sedimentation rate. Between such episodes there was a complete clinical remission, and laboratory alterations returned to normal, although sometimes a high alkaline phosphatase persisted. There was no history of previous drug intake known to produce these disorders. During the last icteric episode, an exploratory laparatomy, with roentgenographic study was done, which demonstrated that the extrahepatic biliary tract was intact. Histology revealed that the liver showed a preserved, regular architecture, of which the salient feature was intrahepatic cholestasis. Corticoids and cholestyramine were of little benefit for pruritus.