Evaluation of Village-level Childhood Immunization Coverage in the Lao People’s Democratic Republic: Measles as indicator? / Lao Medical Journal

Background@#Outbreaks of vaccine preventable-disease control and elimination are impeded by impaired focal vaccination uptake. Therefore, we aimed at assessing vaccination uptake and comparing with passive surveillance (PS) report at village level.@*Methods@#A community-based cross-sectional survey was conducted in the villages covered by two health centers in Bolikhamxay province, including non-Hmong and Hmong ethnic groups. Data collection was conducted by interviewing mothers or caregivers of children aged 6 to 23 months. The vaccination status was identified by vaccination cards, and compared with PS report at village level, which was collected from health centers. The Pearson’s chi-square test was used to compare these proportions, and pairwise correlation was used for the correlation of observed vaccination coverage.@*Finding@#Sixteen villages were included, nine were from Luk52 health center area and 7 from Namkhou health center area. There was a significantly strong correlation for pentavalent pneumococcal conjugate vaccine, Japanese encephalitis, Measles and Rubella and full immunization coverage compared to others. This correlation was not observed in the non-Hmong population. Amongst non-Hmong, the recorded coverage was lower in PS than in the survey regardless of type of vaccine. In contrast, amongst Hmong most vaccines had higher recorded coverage in PS than in the survey except Bacillus Calmette–Guérin (BCG) and hepatitis B at birth dose. MR and JEV vaccine, commonly given at the same time, were the only one that did not have significantly different coverage between PS and the survey (p<0.334).@*Conclusion@#The mis-estimatation of immunization coverage from the PS reporting system highlights further research needed to determine a better indicator of village-level vaccination coverage, but measles could be an indicator of prioritizing the settings.

Serological Diagnosis for Infectious Diseases: Not As Easy as It Appears ! / Lao Medical Journal

Serological diagnoses for infectious diseases such as those based on disease¬specific IgM antibody detection often confuse clinicians and therefore make treatment decisions difficult. This is due to the relatively long persistence of IgM in the blood circulation following exposure to the organism or nonspecific polyclonal activation of memory cells. We report a Lao patient diagnosed as having scrub typhus on admission based on detection of IgM to Orientia tsutsugamushi and initially treated with Doxycycline. The patient became afebrile but had severe pulmonary involvement. The blood culture was subsequently positive for Leptospira spp. which is the cause of leptospirosis. The admission blood sample of the patient was negative for Orientia tsutsugamushi, Rickettsia typhi, and Rickettsia spp. DNA targets, by PCR, suggesting that the patient did not have scrub typhus, murine typhus or Spotted Fever. After one week of IV ceftriaxone treatment, the patient improved and was discharged well. The positive IgM to scrub typhus detected on admission was probably due to previous exposure to O. tsutusgamushi, and scrub typhus was not the cause of her presenting illness. Fortunately, Doxycycline, given to the patient for scrub typhus treatment, is also effective for leptospirosis preventing death. However, the patient required intravenous ceftriaxone (which would not have been effective for scrub typhus) when she developed severe disease. This patient’s illness is a reminder that clinicians should be cautious about serological diagnosis. At present, laboratory diagnosis of leptospirosis remains a big challenge for the clinicians because the existing gold standard test such as Microscopic Agglutination Test (MAT) and culture are labour intensive, expensive and seldom available. Until the development of the simple, rapid, and more reliable tests, the empirical treatment of patients with suspected leptospirosis with doxycycline, penicillins or ceftriaxone are strategies to reduce severe complications and death although it should be born in mind that penicillins and ceftriaxone will not be effective against rickettsial organisms.

A Study on the differences in Blood Pictures of Premature Babies and Term Babies

The author has studied on the differences in blood pictures, especially the differences of blood pictures in capillary blood and venous blood, in 25 premature babies and 50 term babies from birth to 7 days of age sequentially during the period of 6 monts from April 1980 to Sept. 1980. The results are summarized as follws; 1. As comparing blood pictures with term babies, premature babies showed somewhat lower values in erythrocyte, hemoglobin, hematocrit. MCV, MCH, leucocyte and platelet but somewhat higher values in reticulocyte and MCHC. 2. As comparing blood pictures with the venous blood, the capillary blood showed significantly higher values in erythrocyte, hemoglobin and hematocrit during the neonatal period in both premature babies and term babies, but showed somewhat lower values in MCV, MCH, MCHC, and platelet. 3. According to the time of clamping the umbilical cord after birth, there were significant differences of blood pictures between early and late clamping of the umbilical cord. 4. The highest mean erythrocyte counts in both term babies and premaature babies were 5,896,000/cub.mm and 5,542,000/cub.mm at 3-6 hours after birth. Those values were gradually decreased to 5,104,000/cub.mm and 4,753,000/cub.mm on the 6th-7the day of life. 5. The highest average hemoglobin levels in both term babies and premature babies were 21.1gm/dl and 19.5gm/dl at 3-6 hours after birth. Those values were gradually decreased to 18.1gm/dl and 17.1gm/dl on the 6th-7th day of life. 6. The mean values of hematocrit in both term babies and premature babies were higest, 64.5% and 59.9% at 3-6 hours after birth. Those values were gradually decreased to 54.8% and 50.2% on the 6th-7the of life. 7. The average total serum protein levels in both term babies and premature babies were 5.76gm/dl and 5.22gm/dl at birth. Those values were increased to 6.45gm/dl and 5.74gm/dl at 3- hours after birth. 8. The average MCV in both term babies and premature babies showed highest values, 114.2fl and 110.1fl at birth. Those values were gradually decreased to 107.0fl and 103.4fl on the 6th-7th day of life. 9. The average MCH in both term babies and premature babies showed highest values, 36.8pg and 35.3pg at birth. Those values were gradually decreased to 107.0fl and 103.4fl on the 6th-7th day of life. 10. The average MCHC in both term babies and premature babies showed constant levels, 31.3-32.0% and 32.2-33.1% from birth to 7the day of life. 11. The average platelet counts in both term babies and premature babies were 243,000/cub.mm and 229,000/cub.mm during the first 4 days of life. Those values were gradually increased to 283,000/cub.mm and 253,000/cub.mm on the 6th-7the day of life. 12. The highest reticulocyte counts in both term babies and premature babies were 3.1% and 3.6% at the age of 3-6 hours. Those values were rapidly dropped down from 4th day to 7th day of life, decreasing from 1.7% and 1.9% to 1.0% and 1.3%. 13. The highest llecucyte counts in both term babies and premature babies were 25,794/cub.mm and 23,363/cub.mm at the age of 3-6 hours. Both values were gradually decreased to 13,213/cub.mm and 11,870/cub.mm on the 6th-7th day of life.

A Case of Congenital Choledochal Cyst

We experienced a case of congenital choledochal cyst in a 6 months old korean female infant with complaints of abdominal distension, jaundice, loose stool and a large mass of the abdomenin the right upper quadrant since about 3 months prior to admission. The diagnosis was confirmed by clinical symptoms and signs, physical examination, radiological findings and surgical findings. She was operated with good result and discharged in well condition 28 days after. The review of the related literature was made briefly.

A Case of congenital Tuberculosis

We experienced a case of congenital tuberculosis in 17 days old female infant who had miliary tuberculosis. She was admitted at the gae fo 17 days with a history of high fever and irritavility for 2 days, when she seemed to be weak, underdeveloped and undernourished, and there were diminished aeration on the right lung fields, hpatosplenomegaly,and stat ionary weight She was lst child born of 30 year-old woman after a 6 year of infertility and was normally born at the 37 weeks?gestation period with 2,500 Gm. Weight. She began to cough at the age of 7 days. Her mother, aged 28, was diagnosed as having tuberculous pelvic peritonitis, when she was operated on the left salphingostomy. Infan's chest film showed miliary tubercuous pattern and gastric washing exam. For A.F.B was positive but tuberculin skin test was negative. Finding of endometrial biopsy of mother was consistent with tuberculous eddometritis Diagnosis was established by onset,chilical syndrom,gastric washing, chest film, family history and maternal endometrial biopsy. The reviw of the related literature was made briefly.

A Cases of Autoimmune Hemolytic Anemia

In the autoimmune hemolytic anemia abnormal antibodies directed against red cells are produced by the patient himself. The pathologic mechanism in which erythrocyte survival is decreased as a result of the deposition of specific antibody on the red cell surface is uncertain. The abnormal antibody is most freqeuntly of the lgG or IgM class and occasionally may be IgA. A case of autoimmune hemolytic anemia was confirmed by CBC and Coombs test in a 11years old boy. We are reporting the laboratory data and our experiences of the patient with the reviews of the literatures.

A Case of Disseminated Neuroblastoma

Neuroblastoma is one of the most common malignant tumor in infant and children, which arises from sympathetic nerveous system. this is almost always lethal in children when regional extension or dissemination exists at the time of diagnosis. An exception exists in a special pattern of metastasis to the liver, skin or bone mawow which has batter prognosis. We had experienced a case of generalized disseminated neuroblastoma in 7years and 6 month olds girl which was arised from posterior mediastinum. It was confirmed histologically and by a value of urine VMA. So, we had treated with anticancer drugs I.V. for 68 weeks but the patient expired on May, 1978. Pertinent literatures concerning neuroblastoma were also reviewed.