Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant.

OBJECTIVE: . To describe a case of vaccine associated paralytic poliomyelitis (VAPP) and relate this to current UK immunization policy. METHOD: A case report in which the clinical course and factors leading to the diagnosis are described and then related to reports of paralytic poliomyelitis in the literature. RESULTS: The child in this case was left severely disabled by paralytic poliomyelitis. The pathological process was related to a pararectal abscess needing urgent drainage shortly after immunisation. CONCLUSION: The skeletal muscle damage due to the presence of the pararectal abscess may have acted as the 'provocation' in the development of poliomyelitis. Adoption of a policy of initial vaccination by the parenteral route as in the USA and European countries has been shown to greatly reduce this risk. The UK could adopt this policy which would minimise the risk of VAPP, as all recorded paralytic poliomyelitis in the UK in the last decade has been vaccine related.

The safety and immunogenicity of a recombinant hepatitis B vaccine in neonates.

A study to evaluate the safety and immunogenicity of a yeast derived recombinant DNA hepatitis B vaccine (Engerix-B) was conducted in healthy newborn infants born to low risk European mothers negative for hepatitis B surface antigen (HBsAg). The vaccination schedule using 20 micrograms doses was administered intramuscularly at 0, 1 and 6 months. The seroconversion rate was 99% (90 of 91 infants). The geometric mean titer of antibody to hepatitis B was 1259 mIU/mL one month after the third dose of vaccine. Possible side effects reported by the mothers were minor and uncommon. This vaccine is highly immunogenic and safe for use in infants.

Outbreak of pulmonary tuberculosis in children.

A case of miliary tuberculosis in a 4-year-old child led to contact tracing, revealing 32 children with evidence of tuberculous infection. 3 adult cases were also identified. The source case was a mother who passed on the infection at two Christmas parties. Limited exposure to the organism caused infection, suggesting a virulent strain and a susceptible subgroup. A range of complications of primary tuberculosis in children was seen. Minor side-effects of the chemotherapeutic agents occurred in most children but only 3 suffered substantial toxic effects. The limited range of agents marketed in a presentation suitable for young children was a serious difficulty.

Rubella encephalopathy.

Rubella is a rare cause of acute neurological symptoms with only a few reported cases. We describe a case which was diagnostically confusing initially because results of examination of blood and cerebrospinal fluid suggested bacterial meningitis.

Effects of maternal smoking on fetal growth and nutrition.

Standard anthropometric measurements were made on 320 term neonates to investigate the influence of smoking on fetal growth and nutrition. Maternal height and triceps skinfold thickness were also measured. Of 320 infants, 126 (39%) were born to mothers who smoked. Maternal triceps skinfold thickness was significantly smaller in smoking mothers. A correlation existed between maternal and infant triceps skinfold thickness. Measurements of infant growth, birthweight, occipito-frontal circumference, and crown-to-heel length were significantly smaller in infants of smoking mothers and remained significantly smaller when corrections were made for maternal triceps skinfold thickness, height, and social class. While these data do not exclude a nutritional mechanism for the effect of maternal smoking on the fetus, the major growth-retarding effects remain after corrections for this. This reduction in occipito-frontal circumference in infants of smoking mothers, and the possible significance of this is stressed.

Aetiological factors in rickets of prematurity.

Six very preterm (< 32 weeks' gestation) infants who developed late-onset respiratory distress were each matched for sex and gestation with 2 control preterm infants. Radiologically and biochemically the diagnosis of rickets and rachitic respiratory distress seemed clear and the pattern conformed with other reports of the syndrome. The control infants were of similar gastational ages but there was a significantly higher incidence of pre-eclampsia in the pregnancies of index cases. Also significant was a prolonged illness of several weeks' duration in the index cases; this illness was either heart failure due to patent ductus arteriosus or prolonged ventilation in the early weeks of life for apnoeic attacks. Awareness of these 2 aetiological factors shows the necessity of monitoring such infants for evidence of rickets. The use of water-soluble antirachitic prophylaxis such as 1 alpha-hydroxy-vitamin D or 1,25-dihydroxy-vitamin D is sometimes indicated.

Laryngeal oedema due to hereditary angioedema.

A case is reported in which a young man suffering from hereditary angioedema was admitted with severe airway obstruction due to groww pharyngeal and laryngeal oedema. Tracheostomy was necessary. The rationale of treatment with epsilon aminocaproic acid, tranexamic acid and fresh frozen plasma is discussed. The patient subsequently underwent dental extractions under general anaesthesia with tracheal intubation without complications.

Familial anglo-oedema--a particularly severe form.

A case of hereditary angio-oedema is described together with the family history and manifestations in the father of the patient. The problems encountered in his management are discussed, including tracheostomy and genetic counselling.