Pneumoparotid: a rare cause of parotid swelling in a 7-year-old child.

PROBLEMS/OBJECTIVES: Pneumoparotid is a rare condition in which air is insufflated through Stensen's duct into the parotid gland. This causes mostly painless swelling in the parotid region. CASE REPORT: We report on a 7-year old girl presenting with painless unilateral swelling of the left parotid region, present for one month. Computer tomography showed the presence of air in the left parotid gland and in both the left and right Stensen's duct. A thorough history revealed the girl was insufflating the parotid glands intentionally as a response to stress. The patient was comforted and instructed to avoid insufflation manoeuvres, which resulted in complete resolution. CONCLUSION: Pneumoparotid should be considered part of a differential diagnosis in children and adolescents presenting with painless uni- or bilateral swelling of the parotid gland. Supportive and conservative treatment is advocated.

Compliance and immunogenicity of two hepatitis B vaccination schedules in sex workers in Belgium.

OBJECTIVES: To compare the coverage for the third dose and the compliance to two hepatitis B vaccination schedules: 0,1,4 versus 0,1,6 months, in commercial sex workers (CSW) in Belgium; to compare the immunogenicity of the actually administered schedules. METHODS: In seven health centres in Belgium, hepatitis B vaccination was offered free of charge to CSW. In a randomised, prospective study a commercialised hepatitis B vaccine (Engerix-B 20mcgr) was offered according to one of both schedules. After complete vaccination, bleeding was performed to assess immunogenicity. RESULTS: Between June 2003 and September 2004, 615 non-immune CSW were enrolled, of whom 52% in the 0,1,4 month schedule (n=322). Coverage of the third dose was 57% overall, 59% (0,1,4) and 54% (0,1,6), respectively. Age, the health centre and drug use significantly influenced the compliance and the coverage of dose 3, whereas the planned vaccination did not. When comparing the immunogenicity results as a function of the actually administered vaccination schedule, immune responses did not significantly differ between CSW receiving the third dose 4-6 months and those receiving it at least 6 months after the first dose. In total, 19 persons (8%) were not protected after a full vaccination course (anti-HBs <10IU/L). Two health centres measured markedly lower anti-HBs levels. CONCLUSIONS: In this highly mobile at-risk population, a 0,1,4 month schedule is more easy to offer and confers equal protection within a shorter period of time. We therefore propose this 0,1,4 month schedule to vaccinate CSW in the future.