[Post-exposure prophylaxis against measles]. / Posteksponeringsprofylakse mod mæslinger.

This review article deals with the newest guidelines in post-exposure prophylaxis against measles and puts forward recommendations on how this prophylaxis should be handled with regards to children in all ages, both immunosuppressed and competent.

Influenza-associated illness is an important contributor to febrile convulsions in Danish children.

OBJECTIVE: To determine the burden of febrile convulsions attributed to influenza like illness in a western country during ten influenza seasons. METHODS: Based on national Danish registries, we explored the association between influenza like illness (ILI) activity and weekly number of hospital admittances for febrile convulsions in time-series analyses. We included data on 59,870 admissions for febrile convulsions in children between three months and five years of age in the period 1995-2005. RESULTS: There was a significant relation between ILI-activity and number of children admitted for febrile convulsions with a systematic increase in admissions to pediatric wards about one week before the national surveillance system detected the corresponding rise in ILI-activity. The yearly number of admissions attributable to ILI varied from 11 to 47% of admissions and was highest during influenza epidemics. This was in particular observed in seasons when a new strain of influenza A/H3N2 was circulating. During these epidemics, influenza contributed to 29-47% of admissions. CONCLUSIONS: Influenza like illness is associated with a considerable burden of febrile convulsions in children, most pronounced in years with epidemics. As febrile convulsions are just one of many complications contributing to the burden of influenza in children, this should be taken into consideration when planning a vaccination strategy for preventing influenza-related morbidity in younger children.

Universal screening for hepatitis B among pregnant women led to 96% vaccination coverage among newborns of HBsAg positive mothers in Denmark.

In Denmark selective screening programs of pregnant women for hepatitis B missed 30-50% of high-risk groups and in late 2005 a universal screening of pregnant women for HBsAg was implemented. During a 2-year period a prospective enhanced surveillance of the universal screening was performed to examine the effectiveness of universal HBV-screening of pregnant women and HBV-immunizations of their newborn, and to provide a prevalence-estimate for HBV in Denmark. On a opt out basis all women in Denmark attending antenatal care were tested for hepatitis B serology. Vaccination data of the newborns and households of HBsAg positive pregnant women were assembled. Among 140,376 HBsAg tests of pregnant women, 371 (0.26%) were positive. The prevalence among women of Danish origin was 0.012% and 2.74% among foreign born women, highest for women from Southeast Asia (14.5%). Genotype C was the most prevalent (37%) and 13% had a HBVDNA ≥10(8) IU/ml. The prevalence estimate of chronic hepatitis B in Denmark was 0.2-0.3% in the general population. Among children born within the project period, 96% received vaccination at birth compared to 50% of siblings born prior to universal screening. During 3 years of passive follow-up two transmissions (0.5%) have been notified. Among children born of the positive mothers prior to the trial-period 7.3% had been notified. Thus the prevalence of HBV positive mothers has more than doubled in Denmark over the last 40 years, but among women of Danish origin it has decreased 10-fold. By replacing selective screening with universal, identification of newborns in need of HBV-immunization was increased from 50% to almost complete coverage, and also identifies mothers with high viral load for evaluation of pre-term treatment to interrupt in utero transmission.

Burden of illness of the 2009 pandemic of influenza A (H1N1) in Denmark.

We analysed Danish surveillance data to estimate influenza-associated morbidity and mortality in 2009. To obtain population-based estimates of the clinical attack rate, we combined data from two different primary health care surveillance systems, national numbers of the proportion of positive influenza tests, and data from a web-based interview on health care seeking behaviour during the pandemic. From a national registry, we obtained data on hospital admissions (ICD-10 codes) for influenza related conditions. Admission to intensive care was monitored by a dedicated surveillance scheme. Mortality was estimated among laboratory confirmed cases but was also expressed as excess all-cause mortality attributed to influenza-like illness in a multivariable time series analysis. In total, we estimated that 274,000 individuals (5%) in Denmark experienced clinical illness. The highest attack rate was found in children 5-14 years (15%). Compared with the expected number of hospital admissions, there was an 80% increase in number of influenza related hospital admissions in this age group. The numbers of patients admitted to intensive care approached 5% of the national capacity. Estimates of the number of deaths ranged from 30 to 312 (0.5-5.7 per 100,000 population) depending on the methodology. In conclusion, the pandemic was characterised by high morbidity and unprecedented high rates of admissions to hospitals for a range of influenza-related conditions affecting mainly children. Nonetheless, the burden of illness was lower than assumed in planning scenarios, and the present pandemic compares favourable with the 20th century pandemics.