A Fatal Case of Disseminated Tuberculosis Coincident with Measles-Rubella Vaccination / 한국역학회지

The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.

Thimerosal in Vaccine and Risk Communication

No abstract available.

A Case of Congenital Anomaly of the Pancreatic Duct Discovered in a Child with Recurrent Acute Pancreatitis / 대한소화기내시경학회지

Congenital pancreatic duct anomalies result from an error in the complex developmental process. Congenital pancreatic duct anomalies may be categorized by their mechanisms into migration anomaly, fusion anomaly, and duplication anomaly. These ductal abnormalities have been implicated to be potential causes for both acute and chronic pancreatitis. We have recently observed a congenital anomaly of the pancreatic ducts in which bifurcated main pancreatic ducts drain through the major papilla in a 10 year-old boy presenting with recurrent acute pancreatitis. Although its causal relationship with acute pancreatitis is unclear, this kind of pancreatic ductal anomaly has not been found in the literature.

Primary Humoral Immune Responses to Formalin Inactivated Hemorrhagic Fever with Renal Syndrome Vaccine (Hantavax(R)): Consideration of Active Immunization in South Korea

The efficacy of a formalin-inactivated hemorrhagic fever with renal syndrome (HFRS) vaccine and the effectiveness of a related vaccination program have not been previously evaluated. We measured the primary immune responses to Hantavax by plaque reduction neutralizing antibody test (PRNT), hemagglutination inhibition test (HAI), ELISA and high density particle agglutination test (HDPA) in order to confirm a possible biological efficacy through independent substantiation of experimental results and to compare the results with previous studies. Following two doses of primary vaccination, the seroconversion rate of PRNT and HAI antibody was 33.3% (10/30)[95% C.I. 17.3-52.5%] and 26.7% (8/30) [95% C.I. 12.3-45.9%], respectively. The correlation between PRNT and HAI antibody showed a statistical significance (r=0.58, p 0.01). The seroconversion rate of HDPA and ELISA were both 76.7% (23/30) [95% C.I. 57.7-90.1%], which correlated well with each other(r=0.58, p 0.01). In our study, Hantavax elicited low neutralizing antibody responses, at least in the volunteers samples that we tested. The vaccination program, including the vaccine itself, that has been adopted by the national immunization program to protect against HFRS in Korea should be re-evaluated and re-formulated to produce a higher protective immune response rate.

Distribution of Anti-Mumps IgM Antibody in Children Presumptively Diagnosed of Mumps

PURPOSE: Outbreaks of mumps continue to occur, even though the number of patients diagnosed of mumps has decreased considerably with the widespread use of vaccine. The accurate diagnosis of mumps is needed to understand the epidemiology of mumps and analyse the safety and effectiveness of vaccine. Therefore, we attempted to appraise the accuracy of provisional diagnosis of mumps in clinical practice by measuring mumps specific antibody. METHODS: Thirty-six patients with presumptive diagnosis of mumps were enrolled from four university hospitals. Medical history including MMR vaccination was obtained, and anti-mumps IgM antibody test(ELISA. Denka Seiken Co., Ltd., Tokyo, Japan), complete blood counts and amylase were measured. RESULTS: Among 36 patients presumptively diagnosed of mumps, anti-mumps IgM antibody was positive in 14 patients(38.8%), negative in 20(55.5%) and equivocal in 2(5.5%). In two patients who were not vaccinated against mumps, one had anti-mumps IgM antibody and the other did not. All four patients, vaccinated with MMR twice after their first birthday did not have anti-mumps IgM antibody. The sites of involved glands and the associated localized as well as systemic symptomatologies were not different between patients with anti-mumps antibody and those without. The proportion and degree of increment of serum amylase level were not different between the two groups. CONCLUSION: A significant number of patients with provisional diagnosis of mumps appear to be due to other causes. Amylase, commonly used in clinical practice, does not differentiate mumps from other illnesses involving the parotid glands. Mumps can be accurately diagnosed only by laboratory tests including anti-mumps antibody. The two-dose MMR vaccination program needs to be reinforced.

Antibody Response and Adverse Reaction Following Immunization with MMR Vaccine Produced on Human Diploid Cells in Korean Children

No abstract available.

Immune Response to SA14-14-2 Live Attenuated Japanese Encephalitis Vaccine

PURPOSE: SA14-14-2 live attenuated Japanese encephalitis (JE) vaccine has been administered safely and effectively to more than 100 million children in China since 1988, and recently licensure of the vaccine in Korea has been sought. Immune response to the vaccine was investigated. MEHTODS: In the first clinical evaluation of the vaccine outside of China, we monitored side effects in 93 children and evaluated plaque reduction neutralizing test (PRNT) antibody and IgM antibody responses to a single dose given as primary JE vaccination in 74 children, 1-3 years old (mean age 27 months). RESULTS: No significant adverse events were noted. PRNT antibodies (geometric mean titer [GMT] of 183) were produced in 96% of the 74 subjects. In 10 other children who previously had been immunized with two or three doses of inactivated JE vaccine, the booster administration of SA14-14-2 vaccine produced an anamnestic response in all, with a GMT of 3378. In a comparison group of 25 children previously immunized with two doses of inactivated vaccine, neutralizing antibody titers were detected in 16 (64%). Viral specific IgM was detected in nine primary vaccinees (13%) but in others, IgM may have declined to undetectable levels in the four week postimmunization sample. CONCLUSION: Live attenuated SA14-14-2 JE vaccine is a promising alternative to the only commercially available live attenuated JE vaccine for national childhood immunization programs in Asia.

The changing epidemiology of hepatitis A in children and the consideration of active immunization in Korea

Currently, Korea is a low endemicity country for HAV, especially in children. However, recent reports of hepatitis A outbreaks show that there has been a shift of disease incidence to adolescents and young adults, with 2 cases of acute liver failure in one reported outbreak. We need to study the immune status for HAV in order to provide information for the establishment of preventive measures and possible consequences of HAV in Korea. A total of 334 infants, children and adolescents less than 20 years of age living in rural areas of Kyonggi Province, Korea were evaluated for anti-HAV immune status in 1996. Five hundred and eighty-four primary school children living in the same area were separately evaluated for the natural seroconversion rate between 1993 and follow-up samples taken in 1996. Anti-HAV IgG antibody was measured by enzyme immunoassay (HAVAB EIA kit, Abbott Laboratories, Chicago, Illinois, USA). In comparison with previous reports of seroprevalence rates, our data confirmed a dramatic drop in seroprevalence rates among children and adolescents under 20 years of age living in rural areas, from over 63.8% two decades ago to 4.6% in 1996. Natural acquisition of HAV antibody in primary school children rarely occurs, registering only 0.5% during three years. Several outbreaks in young adults during 1996-1998 suggested that immunity against HAV in this population is so low that massive outbreaks are unavoidable. Teenagers and young adults, especially soldiers, who are likely to be exposed to contaminated food or water, would also have a greater risk of hepatitis A. Immunizing children with HAV vaccine as a routine schedule should also be considered in Korea in the future, particularly if the disease burden could be estimated and the cost-effectiveness of the vaccine could be proved.

National Surveillance in Influenza Outbreak during Winter of 1997 and 1998 in Korea / 감염

BACKGROUND: Influenza is a pandemic disease because of the frequent antigenic variation. There is an international influenza network by WHO, but no national surveillance system has been established in Korea. The purpose of this study was to understand the influenza epidemiology by examining the incidence of influenza-like illness (ILI) and the subtype of isolated viruses in Korea during the winter of 1997 and 1998. METHODS: The consultation rates and clinical features of ILI were based on the weekly reports by 71 sentinel physicians (SP) from October 1997 to March 1998. Throat swabs from patients with ILI were collected and inoculated to Madin-Darby Canine Kidney (MDCK) cells. Isolates were identified by hemagglutination (HA), indirect immunofluorescence assay (IFA) and confirmed by hemagglutination inhibition (HI), and restriction fragment length polymorphism (RFLP). RESULTS: The incidence of ILI and virus isolation peaked in December 1997 and decreased to the baseline in February 1998. Influenza occurred mostly in 1- to 5-years old children and systemic symptoms were the main clinical features. One-hundred and thirty two influenza viruses among 2,071 specimens were isolated. The major subtype of isolates was A/H3N2 (A/Sydney/05/97). A/H1N1 subtype was isolated at low levels (4 strains), whereas B and A/ H5N1 were not. RFLP for M gene was compatible with those bands of A/H3N2 and A/H1N1. CONCLUSION: Influenza epidemiology was studied on the basis of a nationwide surveillance system during 1997 and 1998. The incidence of ILI and virus isolation peaked in December 1997 and predominant strains of isolates were closely related to A/H3N2. To establish a more effective system, it is necessary to increase the number of participating SP and laboratories.

Serological Immunity to Diphtheria among Korean Population / 감염

BACKGROUND: Diphtheria epidemics in Russia have spread to all the other independent states of the former Soviet Union and East European countries around 1990s. One of the most important measures in preventing diphtheria is to maintain high levels of immunity in the population. We studied the diphtheria antibody levels of 1,086 participants to investigate herd immunity in Korea. METHODS: The tested 1,086 serum specimens were collected from healthy individuals from September 1995 to March 1996. Diphtheria antitoxin titers were measured by a micro cell culture method using Vero cells. Antibody titer of 0.01 IU/ml to neutralize diphtheria toxin is an internationally accepted protective level. RESULTS: We studied the diphtheria antitoxin titer levels of 1,086 cases consisting of 579 males and 507 females. The proportion of protective antitoxin level to diphtheria is 69.2%. Diphtheria antitoxin levels showed no significant difference between males and females. The highest seropositive rate was observed in the 5 to 9-year old age group(95.8%). The seropositivity rate declined with age. The lowest seropositive rate was observed in the 20~39 years of age, maximally 43.4 %. Over 40 years of age, the seropositive rates increased again. CONCLUSION: The antibody titers in the Korean population declined from 95.8% to below 50% with age in the 1~39 year-old age group. To maintain the rate of population with protective antibodies to diphtheria, we recommend Td booster immunization to adults with low antitoxin titers and continuous survey for antitoxin titers.

Use of vaccine in the era of antimicrobial resistance: need of effective pneumococcal vaccines

Streptococcus pneumoniae is an important pathogen causing invasive infections particularly in children. Penicillin-nonsusceptible pneumococci are very prevalent in Korea and a difficult problem in antimicrobial treatment. Immunization with effective vaccines including viral and bacterial vaccines has proven to be the most effective and reliable method to prevent the target disease. Universal immunization to infants with Haemophilus influenzae type b conjugate vaccine has dramatically proven to be very effective in reducing invasive Hib diseases and also the carriage rate. The 23-valent pneumococcal polysaccharide vaccine is effective in preventing invasive diseases in young adults and covers most of the penicillin-nonsusceptible types. It has not proven very effective in the prevention of otitis media, and is unable to elicit adequate antibody response in children younger than 2 years of age. Recently a new polysaccharide-protein conjugate vaccine was developed which can elicit antibody response in children younger than 2 years of age. However, the vaccine is only 8-valent at the moment. Studies are required to determine the possible idiotypic modulation and nonproductive immune response when polysaccharide vaccine is administered to infants. Part of the problem of antimicrobial-resistant pneumococcal infection may be solved in the future with the use of improved vaccine. Preventing pneumococcal infections with safe and effective vaccines will not only reduce the development of antibiotic resistance, but could also be the most cost-effective method to control pneumococcal disease.

A Case of Congenital Tuberculosis

Perinatal tuberculosis can be divided into congenital tuberculosis due to intrauterine infection and neonatal tuberculosis due to infection irnmediately following birth. It is a rare disease entity with only 300 cases reported worldwide. In Korea, only a few cases have been reported and only 1 case has been confirmed by autopsy at neonatal period. Although the majority of the mothers are found to have advanced tuberculosis and the children themselves are usually of premature birth, early diagnosis is difficult and despite antituberculous medication, the mortality rate is high. We report a premature baby with respiratory difficulty admitted to our hospital, whose mother was found to have miliary tuberculosis during the course of management. The baby died and autopsy was performed to confirm congenital tuberculosis.

The Effect of Measles Vaccination Before Turning 1 Year-old on the Measles Antibody Response to Immunization with MMR

PURPOSE: With the implementation of measles vaccination programs, the number of patients with measles has decreased. However, epidemics still occur with high morbidity in infants less than 1 year of age. This fact calls for the establishment of optimal preventive measures against measles. The study was carried out to determine the effect of measles vaccination on an infant immunized before one year of age, any the measles immunity conferred by MMR. METHODS: Seventy-seven healthy infants (13.7 +/- 1.8 months) were immunized with the MMR vaccine (Triviraten Berna : Edmonston-Zagreb strain, Rubini strain, Wistar RA 27/3 strain), 50 of the infants have received measles vaccine before turning one-year old. The antibody titers of measles-specific IgG were measured by enzyme immunoassay. RESULTS: The antibody titers before and after MMR vaccination were significantly higher in infants previously immunized with measles vaccine compared to those not immunized. However, the greater number of infants not previously immunized with measles vaccine showed significant increase of measles antibody titers after MMR vaccination compared to those previously immunized with measles vaccine. Measles vaccine failure occurred in 6 infants (12.0%), all of whom acquired measles immunity following MMR vaccination. Measles immunogenicity to MMR did not differ with respect to the age of previous measles vaccination. CONCLUSION: The results indicate that measles vaccination in infants less than 1 year of age will not decrease the measles immunity following MMR vaccination, and it is suitable to vaccinate against measles in infants between 6-12 months of age, if needed.

The Effect of Measles Vaccination Before Turning 1 Year-old on the Measles Antibody Response to Immunization with MMR

PURPOSE: With the implementation of measles vaccination programs, the number of patients with measles has decreased. However, epidemics still occur with high morbidity in infants less than 1 year of age. This fact calls for the establishment of optimal preventive measures against measles. The study was carried out to determine the effect of measles vaccination on an infant immunized before one year of age, any the measles immunity conferred by MMR. METHODS: Seventy-seven healthy infants (13.7 +/- 1.8 months) were immunized with the MMR vaccine (Triviraten Berna : Edmonston-Zagreb strain, Rubini strain, Wistar RA 27/3 strain), 50 of the infants have received measles vaccine before turning one-year old. The antibody titers of measles-specific IgG were measured by enzyme immunoassay. RESULTS: The antibody titers before and after MMR vaccination were significantly higher in infants previously immunized with measles vaccine compared to those not immunized. However, the greater number of infants not previously immunized with measles vaccine showed significant increase of measles antibody titers after MMR vaccination compared to those previously immunized with measles vaccine. Measles vaccine failure occurred in 6 infants (12.0%), all of whom acquired measles immunity following MMR vaccination. Measles immunogenicity to MMR did not differ with respect to the age of previous measles vaccination. CONCLUSION: The results indicate that measles vaccination in infants less than 1 year of age will not decrease the measles immunity following MMR vaccination, and it is suitable to vaccinate against measles in infants between 6-12 months of age, if needed.

Influenze Virus

No abstract available.

Neutralizing Antibody Response To Two Doses Of Formalin Inactivated Mouse Brain-Derived Hantaan Virus Vaccine(HantavaxR) In Healthy Adults / 감염

BACKGROUND: Hemorrhagic fever with renal syndrome is a serious health problem in Korea. Formalin inactivated mouse brain-derived Hantaan virus vaccine (HantavaxR) has been available since 1990 and recom-mended in national immunization programs for children and adults by the health authority. However, Hantavax has not been evaluated for efficacy in a randomized, placebo-controlled clinical trial and data on neutralizing antibody responses in human trials are limited. To investigate humoral immune responses to Hantavax, we studied volunteers immunized according to the recom-mended two dose schedule. METHODS: With informed consent, 30 healthy adults were immunized with two doses of Hantavax (Lot No. 6001, 2360002) 0.5ml given intramuscularly on deltoid muscle 4 weeks apart. The monovalent vaccine, pro-duced from the ROK 84-105 strain, is inactivated with 0.05% formalin and has an ELISA antigen titer of 4096. Sera were collected before vaccination and 4 weeks after each dose for a total of 90 serum samples from 30 vaccinees. Neutralizing antibodies were measured at Unit-ed States Army Medical Research Institute of Infectious Disease (Ft. Detrick, MD) in plaque reduction neutrali-zation tests. Antibody titers were expressed as the highest serum dilution that reduced the standard viral dose (45 ~ 58 plaque forming units of Hantaan virus strain 76-118 by 50 percent. Serum binding antibodies also were mea-sured in a high density particle agglutination test (Hanta-dia R) at Yonsei University. RESULTS: Neutralizing antibodies were detected in only 5 of 30 vaccinees given two doses of Hantavax, yielding seroconversion rate of 16.7%. The endpoint titers of reactive sera were 1:320, 1:10, 1:10, 1:10, and 1:40 respectively. The seroconversion rate measured by high density particle agglutination test was 80.0% (24/30). CONCLUSION: These results indicated that the poor neutralizing antibody response observed in this study suggests that further evaluations of the protective effi-cacy of inactivated mouse brain-derived Hantaan virus vaccine against HFRS.

A Case of Kasabach-Merritt Syndrome with Involvement of Airway Obstruction Treated with Interferon Alfa-2a / 대한소아혈액종양학회지

We have recently encounted a case of Kasabach-Merritt syndrome which were characterized by hemangioma, thrombocytopenia, and disseminated intravascular coagulation. The skin of anterior neck and tongue was involved by large mass of hemangioma. Patient was taken ventilator care from upper airway obstruction of hemangioma. He was placed on combined therapy with steroid and interferon alfa-2a for 13weeks. Blood platelet count increased to acceptable range(>20000/mm3) after 10weeks of interferon alfa-2a treatment and the hemangioma decreased in size. But, he expired from failure of airway maintenance, uncontrollable bleeding and septic shock on hospital day 93. A brief review of the literature ensues with the case report.

Humoral and Cell Mediated Immune Response After Immunization with Varicella Vaccine (Oka/LG)

PURPOSE: We evaluated the humoral and cellular immune response to varicella-zoster virus after vaccination with varicella vaccine (Oka/LG strain). METHODS: The seroprevalence rate of fluorescent antibody to membrane antigen (FAMA) was evaluated among 178 children and 15 adults. After vaccination, seroconversion rate of FAMA, varicella-zoster virus (VZV) specific IgG and cell mediated immune response to glycoprotein I was performed. RESULTS: The seropositive rate of FAMA against VZV in healthy children ages 3 to 6 was 43.1%. A past history of chickenpox illness was confirmed in 15.2% of children who had positive response in FAMA assay in 90.9%. 34.5% of those without a past history of chickenpox had antibodis. The seropositive rate in children vaccinated with varicella vaccine in the past was found to be 46.3% in questionnaire and 44.4% in immunization schedule, lower than that of other studies (greater than 90%). The seroconversion rates in children vaccinated with the Oka/LG were 97.1% with 2,500pfu and 100.0% with 5,000pfu. Antibodies appearing after the Oka/LG vaccination were found to have glycoprotein I zone confirmed by western blotting. The rate of cell mediated immune response was 88.2% in children and 100.0% in adults. CONCLUSION: Further investigation about the effect of the various varicella vaccines used in Korea and about the cause of their immunzation failure after vaccination is needed.

Vaccine Adverse Reaction and National Vaccine Injury Compensation

No abstract available.