Rotavirus gastroenteritis in Norway: analysis of prospective surveillance and hospital registry data.

We aimed to evaluate rotavirus morbidity and describe rotavirus epidemiology in hospitalized children in Norway to provide information before the introduction of new rotavirus vaccines. We retrospectively reviewed 14,973 gastroenteritis hospitalizations in children aged <5 y for the period 1995 to 2004, and prospectively surveyed for rotavirus in 311 children aged <5 y admitted with diarrhoea to 3 hospitals in 2006-2008. The proportion of rotavirus among all gastroenteritis hospitalizations was estimated at 14.5% from the retrospective data and at 62.9% in the prospective data. The annual incidence of rotavirus hospitalizations is estimated to be 3 per 1000 children <5 y of age, corresponding to approximately 900 (range 735-1092) hospitalizations each year. Children aged 6-23 months accounted for 61% of all confirmed rotavirus cases, and average duration of hospital stay for rotavirus cases was 1.3 days. We observed a predominance of rotavirus infections from March through May, similar to the seasonality of diarrhoea-associated hospitalizations with viral and unspecified aetiology. No rotavirus-associated deaths were reported. It is estimated that two thirds of all gastroenteritis hospitalizations in children <5 y of age may be attributable to rotavirus in Norway. Continued surveillance and further studies are needed to assess the full burden of rotavirus disease and its economic impact in Norway.

Detection and characterization of group A rotaviruses in children hospitalized with acute gastroenteritis in Norway, 2006-2008.

To assess the genetic diversity of rotavirus strains in Norway, the distribution of rotavirus genotypes was studied in children admitted to hospital with acute gastroenteritis. The detection of rotavirus in stool samples was compared using an enzyme-linked immunosorbent assay (ELISA), an immunochromatographic test and RT-PCR. Children <5 years of age admitted to hospital with diarrhea in three large hospitals were enrolled prospectively from March 2006 to February 2008. Rotavirus was detected in 58% of the children by the immunochromatographic test, in 63% by ELISA and 72% by RT-PCR. A total of 219 (70%) rotavirus isolates were characterized in order to determine the genotype. The predominant G types included G1 (53%), G9 (16%), and G3 (13%), and the frequency of G3 varied more than G9 between seasons (8-20%). The P[8] genotype was identified in 188 (86%) of samples, and the globally common genotype combinations G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8] accounted together for >80% of infection. No unusual rotavirus strains were detected, and only four samples contained mixed infections. This study demonstrates that ELISA has similar specificity but lower sensitivity compared to RT-PCR. The immunochromatographic test had the lowest sensitivity and specificity compared to the other assays. Rotaviruses causing severe gastroenteritis leading to hospitalization of children <5 years of age in Norway include the common genotypes, however, a considerable geographical and seasonal variation was observed in the distribution of these genotypes. These data may be important for assessing the need for introducing rotavirus vaccines into immunization programs in Norway.

Community-acquired pneumonia (CAP) in children in Oslo, Norway.

AIM: To investigate the epidemiology and clinical characteristics of community acquired pneumonia (CAP) in children before the introduction of the 7-valent pneumococcal vaccine in the national vaccination programme. METHODS: For the period 21 May 2003 to 20 May 2005 hospitalization rates for pneumonia in children were obtained from retrospective studies of medical journals. Pneumonia was also studied prospectively in children less than sixteen years old referred to Ullevål University Hospital (Oslo) in the same time period. RESULTS: The overall observed hospitalization rate of pneumonia was 14.7/10 000 (95% CI: 12.2-17.1), for children under five it was 32.8/10 000 (95% CI: 26.8-38.8), and for children under two 42.1/10 000 (95% CI: 32.0-52.3). In the clinical study 123 children, of whom 59% (73) were boys, met the inclusion criteria and were enrolled. Only 2.4% (3) had pneumonia complicated with pleural effusion and in general few complications were observed. No patients required assisted ventilation, and none were transferred to the intensive care unit. Penicillin was effective as treatment for pneumonia. CONCLUSION: Pneumonia, seen in a paediatric department in Oslo, is a common but benign disease. Penicillin is effective as treatment for pneumonia in Norwegian children.

Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study.

BACKGROUND: Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute (< 14 days disease duration) and subacute osteomyelitis (> or = 14 days disease duration), and differentiate osteomyelitis patients from those with other acute onset musculoskeletal features. METHODS: In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. RESULTS: The total annual incidence rate of osteomyelitis was 13 per 100,000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100,000). The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3-3.7). The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002). Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3-14.7). ESR > or = 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43%) patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. CONCLUSION: The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.

[Invasive pneumoccal disease in children in Oslo 1998-2004]. / Invasiv pneumokokkinfeksjon hos barn i Oslo 1998-2004.

BACKGROUND: Invasive pneumococcal disease (IPD) is an important cause of morbidity and mortality in Norwegian children. MATERIAL AND METHODS: This retrospective study included all children (under 16 years) with isolates of Streptococcus pneumoniae from a normally sterile site admitted to the Department of Paediatrics at Ullevaal University Hospital in the period 1998 to 2004. We studied the epidemiology, predisposing factors, clinical picture, antimicrobial resistance, outcome of IPD and the theoretical coverage of the 7-valent conjugate pneumococcal vaccine (PCV7) in these children. The isolates were tested for antimicrobial susceptibility, serogrouped and serotyped. RESULTS: 68 children were identified; 31 of them had one or more predisposing factors. Six children died, all of them had a predisposing factor. Six of the seven children who survived with sequelae were previously healthy. 67 of 68 isolates were fully susceptible to benzyl penicillin and 13 isolates showed intermediate susceptibility or resistance to erythromycin. Serogroups or serotypes were obtained in 66 children. 24 (36.8%) children fulfilled the criteria for PCV7. 35 (51.1%) children had serotypes covered by the vaccine. Only 12 (17.6%) fulfilled the criteria for PCV7 and had serotypes covered by it. Four of the six children who died had serotypes covered by PCV7. INTERPRETATION: Invasive pneumococcal disease is a serious condition in children and vaccination can prevent disease in many children.

Incidence and characteristics of arthritis in Norwegian children: a population-based study.

OBJECTIVE: The purpose of this work was to assess the annual incidence of arthritis in children and describe early disease and patient characteristics, microbiologic features, and immunogenetic factors in children with different subgroups of childhood arthritis. PATIENTS AND METHODS: A population-based multicenter study was performed in southeastern Norway between June 1, 2004, and May 31, 2005. The total population of children under 16 years of age was 255,303. Physicians were asked to refer their patients with suspected arthritis to the local department of pediatrics or rheumatology. The children were assessed on the basis of clinical, radiologic, and laboratory examinations at inclusion and followed up at 6 weeks, 6 months, and thereafter as long as clinically indicated. A chart review was performed to identify patients with arthritis who had not been included prospectively. RESULTS: The total annual incidence of arthritis was 71 per 100,000 children. Transient arthritis, juvenile idiopathic arthritis, postinfectious arthritis, and infectious arthritis were found in 43, 14, 9, and 5 of 100,000 children, respectively. The incidence was higher in children under the age of 8 years than in older children (107 vs 34 per 100,000). Arthritis occurred more frequently in boys than in girls before the age of 8 years but not thereafter. The median age of onset was lower in children with infectious arthritis than in those with other types of arthritis. Monarthritis was less frequent in patients with juvenile idiopathic arthritis than in the other subgroups (64% vs 83%-100%). Ten percent of the patients had poststreptococcal reactive arthritis, and only 1 had enteropathic arthritis. Autoantibodies and the presence of HLA-B27 were associated with juvenile idiopathic arthritis. CONCLUSIONS: The annual incidence of childhood arthritis was 71 per 100,000 children. We found several factors that may help in differentiating between subgroups of arthritis.

Radiographic follow-up of community-acquired pneumonia in children.

AIM: To evaluate the value of radiographic follow-up of community-acquired pneumonia in children who are previously healthy. METHODS: Patient records for the years 2003 and 2004 at the Ullevål University Hospital in Oslo were reviewed, and a total of 245 children were selected for the study. Radiographs were evaluated by two paediatric radiologists independently. RESULTS: One hundred and thirty-three patients had control radiographs, of which 106 were normal and 27 were abnormal. Only three of 27 patients with abnormal findings had further clinical problems that could be related to the pneumonia. Two of 106 with normal findings had further clinical problems, despite the normal control radiograph. Of the 112 without radiographic follow-up, 10 had subsequent clinical problems, but most occurred within the first 4 weeks after discharge, before controls would have been scheduled. There were five patients who may have benefited from controls. One relapse could theoretically have been prevented. Four patients were cases for whom the pneumonias were the first manifestations of chronic lung disease. Such patients may have some benefit from control radiographs, but only in terms of detecting the chronic disease at an earlier stage, not in altering the clinical course. Such modest benefits must be weighed against the consequences of providing follow-up to a large number of healthy children, and making lots of abnormal findings with no clinical significance. CONCLUSION: Control radiographs are not very valuable in children who are otherwise healthy.

[Typhoid and paratyphoid fever in children]. / Tyfoid- og paratyfoidfeber hos barn.

BACKGROUND: Febrile illness without focal symptoms in a child who has visited tropical or sub-tropical areas is an increasing health problem in western countries. In the department of paediatrics at Ullevaal University Hospital, malaria, typhoid and paratyphoid fever are the most frequent infectious diseases acquired in tropical or sub-tropical areas. MATERIALS AND METHODS: We describe all 31 children under 16 admitted between 1998 and 2003 who had blood cultures positive for Salmonella typhi or Salmonella paratyphi A or B. RESULTS: Nearly all the children were second or third generation immigrants from the Indian subcontinent. Fever was the main symptom at onset. Out of 31 salmonella strains, 8 showed reduced sensitivity to quinolones, which are the drugs of choice. Clinical poor response to treatment is associated with reduced sensitivity to nalidixic acid in vitro. CONCLUSION: Blood cultures prior to administration of antibiotics are important in providing correct diagnosis and appropriate treatment. Before visiting endemic areas, groups at risk should be informed that there are vaccines available against typhoid fever.

[Infections in immunosuppressed children]. / Infeksjoner hos immunsupprimerte barn.

BACKGROUND: Children undergoing transplantation or treatment for cancer have periods with severe immunosuppression; hence they are very susceptible to infections. A bacterial infection can rapidly become life threatening, and it is crucial to promptly start antibiotic treatment. MATERIALS AND METHODS: The background for this article is a two-day discussion among Norwegian paediatricians about infections in immunosuppressed children. In addition we have reviewed the literature by searches in PubMed, reference books and international guidelines. RESULTS AND INTERPRETATION: When a neutropenic patient becomes febrile, one should quickly do a thorough clinical examination, secure relevant microbiological samples, and start treatment with broad-spectrum antibiotics. As standard treatment for Norwegian children we recommend a combination of intravenous ampicillin and gentamicin. Patients who have clinical signs of septic shock should be given cefotaxime and gentamicin. If they get worse or show no signs of recovery after 3 to 5 days, a change to monotherapy with cefotaxime is recommended. Patients already treated with cefotaxime should be switched to meropenem, possibly in combination with vancomycin. Antifungal and/or anti-anaerobic treatment should also be considered.

[Treatment of serious infectious diseases in children]. / Behandling av alvorlige infeksjonssykdommer hos barn.

BACKGROUND: Serious systemic infections represent a major challenge to all paediatric departments, hence the importance of having treatment guidelines available. MATERIALS AND METHODS: Based on a review of the literature and a meeting of Norwegian paediatricians with an interest in the field, guidelines for the treatment of serious infectious diseases are proposed. RESULTS: The two main new proposals include once daily dosage of aminoglycosides and increased dosage of aciclovir in the treatment of herpes simplex encephalitis. INTERPRETATION: The main objective of the meeting was to maintain a conservative and environmental-friendly antibiotics policy in order to contribute to the prevention of antibiotic resistance.

[Hepatitis C in children--diagnosis, follow-up and treatment]. / Hepatitt C hos barn--diagnostikk, oppfølging og behandling.

Hepatitis C-virus infection is relatively infrequent among children in the western world. Although most hepatitis C infections in children evolve to chronicity, liver damage is usually mild. In April 2001, a selected group of Norwegian paediatricians interested in infectious diseases convened to discuss the clinical management of hepatitis C in children. So far, no consensus reports concerning follow-up of hepatitis C infected mothers and their children or clinical management of chronic hepatitis C infection in childhood have been published. In view of the limited experience with hepatitis C among Norwegian children, strategies for the clinical management of hepatitis C infection are discussed based upon available literature and experience from England and Sweden. We present epidemiological data, the risk of vertical transmission and the clinical characteristics of hepatitis C in children. Procedures for follow-up of hepatitis C infected mothers and their children and guidelines for treatment of hepatitis C infected children are proposed. Long term follow-up to identify those who require treatment is important.

[Hepatitis B in children--diagnosis, follow-up and treatment]. / Hepatitt B hos barn--diagnostikk, oppfølging og behandling.

350 million people worldwide are chronic carriers of the hepatitis B virus. Mainly because of immigration, the number of children with chronic hepatitis B infection in Norway is also increasing, although the absolute number is still small. In April 2001, a group of Norwegian paediatricians interested in infectious diseases held a meeting to discuss the clinical management of chronic hepatitis B in children and develop recommendations. The recommendations are based on current European and American guidelines, experience from England and Sweden, and a review of the literature. International epidemiological data and data from Norway are briefly presented, followed by recommendations regarding diagnosis, follow-up and treatment of chronic hepatitis B infection in children. Children at risk of contracting hepatitis B from their mothers should be immunized shortly after birth. Paediatricians should follow up children with chronic hepatitis B infections in order to identify those who may be eligible for treatment.