Case Fatality Rate In Children Research Articles

Epidemiology of pneumococcal meningitis hospitalizations in pediatric population in Spain (1998–2006)

The burden of hospital admissions for pneumococcal meningitis in pediatric population in Spain during a 9-year period was estimated. Data were obtained from the national information system (computerized hospital discharge data). There were 770 hospital admissions with an annual incidence of 1.44 cases per 100,000 population. Rate of death and case-fatality rate were 0.11 per 100,000 population and 7.92%, respectively. The higher incidence and rate of death was found in children up to 12 months of age and the higher case-fatality rate in children of 10–14 years of age. Further studies assessing the incidence of pneumococcal meningitis in post-vaccination period are needed.

Six year multicenter surveillance of invasive pneumococcal infections in children.

Monitor clinical and microbiologic features including antimicrobial susceptibility of invasive pneumococcal infections among children. A 6-year (September, 1993, through August, 1999) prospective surveillance study of all invasive pneumococcal infections in children. Infants and children cared for at eight children's hospitals in the United States with culture-proved invasive pneumococcal infection. During the 6-year period 2581 episodes of invasive pneumococcal infection occurred in 2498 children. Underlying conditions were present in 29% of the children. Of children without an underlying condition, 15% of the total infections occurred in those 25 to 60 months old. As the ages of the children advanced the proportion of cases classified as bacteremia declined, whereas the proportion classified as pneumonia increased. Also, as the ages of the children increased the proportion of isolates in serotypes/serogroups 1, 3 and 23 increased. whereas the proportion for serotype 14 diminished. During the 6 years of the study, there was a significant increase in the percentage of isolates intermediate or resistant to penicillin (P < 0.000001) or intermediate to ceftriaxone (P < 0.002). By the sixth year of the study, 37 and 11% of the isolates were nonsusceptible to penicillin or ceftriaxone, respectively. Antibiotic use in the 30 days before diagnosis of systemic pneumococcal infection occurred in 30 to 35% of the children for each of the 6 years. The overall case-fatality rate for children with systemic pneumococcal infection was 1.56%. Mortality was greatest in children >60 months old and in those with underlying conditions; mortality was not related to antibiotic susceptibility. The percentage of pneumococcal isolates recovered from children with systemic infection which were intermediate for penicillin or ceftriaxone or resistant to penicillin increased steadily during the 6-year period. There was also a trend toward increasing rates of resistance to ceftriaxone. The age and serogroup/serotype distributions of our patients support the recommendations to consider administration of the seven valent pneumococcal conjugate vaccine for all children 24 to 59 months old, with special consideration for selected groups.

The consequences of reducing transmission of Plasmodium falciparum in Africa

Malaria transmission intensity in Africa varies over several log orders, from less than one infected bite per year to more than one thousand. In this review we examine the consequences in terms of age pattern, clinical spectrum and overall burden of disease and discuss the possible implications for interventions that reduce exposure to infected bites. With very low transmission intensity, all age groups are susceptible to severe malaria. With increasing transmission intensities, older children and adults suffer less severe disease and with high transmission rates the majority of severe cases occur in infants under one year of age. This pattern reflects the increasingly rapid acquisition of immune responses that limit the life-threatening effects of malaria with increasing exposure to the parasite. The clinical spectrum of severe malaria varies with transmission: with high transmission, severe malarial anaemia dominates and cerebral malaria is rare. As one moves towards lower transmission rates, cerebral malaria accounts for an increasingly large proportion of cases. Although the population risk of severe disease falls with age, the risk of death at an individual level may rise with age after an initial fall from very high case fatality rates in children aged under 6 months. Of central interest to malaria control is how the overall amount of disease in childhood varies with transmission. Data from a number of sources suggest that, with low transmission, the amount of malarial disease rises with increasing exposure but that this saturates relatively early. A key issue is whether the same pattern obtains for deaths, both those directly due to malaria and those from all causes. The methodological limitations of ecological comparisons between different areas are discussed before presenting a review of attempts to use this approach in Africa. This suggests that children living in areas of low malarial endemicity have all-cause mortality rates about half of those of children living in areas of moderate to high transmission. Deaths in the first year of life rise linearly with increasing exposure to malaria over a wide range of transmission intensities; by contrast all-cause mortality in children aged 0-4 years appears to saturate at relatively low transmission intensities. These data suggest that interventions that reduce exposure to malaria parasites, such as insecticide-treated bed nets (ITNs), will have the greatest chance of a sustained effect when used in areas where disease burdens are high but the frequency of parasite exposure is low-to-moderate. In conditions of high transmission, initial reductions in mortality may prove difficult to sustain as the reduced level of transmission may still lie on the part of the curve where mortality has saturated. However, at all levels of transmission the overall balance of benefits, including reduced load on families and health services from non-life-threatening malaria, favours the widespread introduction of ITNs in endemic areas of Africa.

Sequelae after bacterial meningitis in childhood.

The neurological outcome of bacterial meningitis in children was evaluated retrospectively. Data were obtained from a large study on children aged between 1 month and 15 y who initially visited the emergency department of Sophia Children's Hospital, Rotterdam, The Netherlands with meningeal signs. This study presents data from 103 patients in whom bacterial meningitis was diagnosed. Neisseria meningitidis was the dominant pathogen of meningitis. We found a 2% case-fatality rate in children with bacterial meningitis and a 13% rate of sequelae among survivors: 7% hearing impairment and 7% neurological sequelae. Children with bacterial meningitis caused by Streptococcus pneumoniae and those with acute focal neurological symptoms tended to have the worst prognosis.

Pediatric burn injuries in Tehran, Iran

The objective of this study was to identify the epidemiologic features of pediatric burn injuries in western Tehran. Study subjects included all children up to the age of 15 years who were treated as inpatients at the Tohid Burn Center in Tehran between April 1995 and March 1998. Among the 3341 burns admitted to the Center over the 3-year study period, 1454 (43.5%) occurred in children less than 16 years of age. The overall case fatality rate for children was 16%, while the annual burn incidence rates ranged from 22.7 to 17.8 burns per 100 000 child-years. The overall gender ratio (boys/girls) was 2.6. Children less than 2 years of age had the highest burn incidence and burn mortality rates. These findings will be used as a basis for developing targeted preventive programs to protect Iranian children from burns.

Intensive nursing care of kwashiorkor in Malawi

The case fatality rate for children with kwashiorkor in central hospitals in Malawi was 30.5% (275/901) in 1995. The purpose of this study was to determine whether improved case management with intensive nursing care could lower this case fatality rate. A total of 75 children admitted with kwashiorkor in Blantyre, Malawi, received intensive nursing care. This included nursing in individual clean beds with blankets, a nurse:child ratio of 1:3, supervised feedings every 2 h, a paediatrician with expertise in treating kwashiorkor always available for consultation, laboratory evaluation for systemic infection and empiric use of ceftriaxone. Nineteen of these children died (25%). The causes of death were life threatening electrolyte abnormalities (hypokalaemia, hyponatraemia, hypophosphataemia) in nine cases, overwhelming infection in eight cases and congestive heart failure in two children. Children infected with the human immunodeficiency virus were more likely to die (9/20), as were children with life threatening electrolyte abnormalities (9/15) and children with more severe wasting. When compared with 225 children treated in the same year at the same institution, who were carefully matched for severity of kwashiorkor, intensive nursing did not improve overall survival.

Pneumococcal disease among children in a rural area of west Africa.

The pneumococcus is a frequent cause of pneumonia and other serious infections among young children in developing countries. Defining the pattern of pneumococcal infection in these countries is important so that, with the advent of pneumococcal conjugate vaccines, rational vaccination policies can be developed. Children younger than 5 years of age who attended clinics in a rural area of The Gambia, West Africa, were screened by assistants during a 2-year period. Children with predefined features suggestive of a diagnosis of pneumonia, meningitis or septicemia were referred to the Medical Research Council Field Station at Basse for investigation. Of 2898 children investigated 103 cases of invasive pneumococcal disease (70 definite and 33 probable) were identified, suggesting that the incidence of this infection in the study community is at least 554/100,000/year in children younger than 1 year of age and 240/100,000/year in those younger than 5 years, rates many times higher than those found in industrialized societies. The mean age of presentation was 15 months; more boys than girls were affected. Cases of pneumonia were encountered 8 times more frequently than those of meningitis. Antibiotic resistance was rarely found and cases of pneumonia, but not meningitis, responded well to treatment. Case-fatality rates in children with pneumonia and meningitis were 1 and 55%, respectively. The most prevalent pneumococcal serotypes were types 6, 14, 19, 1 and 5. About 60% of invasive pneumococcal infection in children in this community could potentially be prevented by a nine-valent pneumococcal conjugate vaccine (types 1, 4, 5, 6B, 9, 14, 18, 19F and 23) given at the ages of 2, 3 and 4 months.

Child Mortality Impact of a Measles Outbreak in a Partially Vaccinated Rural African Community

In spite of a measles vaccination coverage of 58%, 33% of 60 infant and child deaths were attributed to measles in a rural area of Kenya in 1988. Among 252 measles cases, there were 20 acute and 5 late deaths which may have been caused by the measles. Median age at infection was 44 months, with 16% of cases below 1 year of age. The highest age-specific attack rates (43% and 41%) were in unvaccinated children 6-11 months and 1-2-year-olds. The overall case fatality rate for children below 5 years was 12.6%, for unvaccinated children below 5, 16.2% and among children below 9 months, 24%. Children in homes with several cases had a higher case fatality ratio than had isolated cases, although not significantly so (RR 1.93, 95% CI 0.71-5.24). The median age of the children who died was 12 months. Overall vaccine efficacy was 62% for children 1-4 years. Our findings suggest that the measles vaccination coverage must be raised considerably in order to reduce mortality rates, and that alternative ways to project infants are needed.

Acute Lower Respiratory Tract Infections in Hospitalized Patients with Diarrhea in Dhaka, Bangladesh

This study focused on 401 children less than 5 years old who were hospitalized with acute lower respiratory tract infection (ALRI) and diarrhea in Dhaka, Bangladesh, and who were investigated for the presence of both bacterial and viral respiratory tract pathogens as well as for selected diarrheal pathogens. The most common manifestations of ALRI were pneumonia (374 cases), bronchiolitis (12 cases), and tracheobronchitis (11 cases). The majority (77%) of the illnesses were in children less than 2 years of age, and 88% of the children were malnourished. A respiratory tract pathogen was identified in 30% of the patients, and a diarrheal pathogen was identified in 34%. The overall case-fatality rate in children with ALRI and diarrhea was 8%. The case-fatality rate was 14% in children with bacterial pneumonia and diarrhea, 3% in those with viral pneumonia and diarrhea, and 14% in malnourished children with shigellosis and ALRI. The most common respiratory tract pathogens were respiratory syncytial virus, Streptococcus pneumoniae, influenza viruses, and Haemophilus influenzae type b.

Isoantibodies to inherited types of β-lipoproteins (Ag) and immunoglobulins (Gm and Inv): Serological and clinical aspects

Children transfused with whole blood or plasma can develop isoantibodies against immunoglobulin (Gm and Inv) and β-lipoprotein (Ag) genetic factors. Immunization against these factors is common in children with thalassemia, but is also observed in children with hemophilia. Transfusion of incompatible Gm plasma results in only mild reactions. More severe reactions are observed when incompatible Ag plasma is transfused. When the clinical manifestations of thalassemia are severe, anti-Gm and/or anti-Ag antibodies are found more frequently. More than 50 per cent of the children with these antibodies have been transfused within the first year of life. Splenectomy results in the lowering of the titer or the disappearance of anti-Gm or anti-Ag antibodies. The presence of anti-Ag isoprecipitins is associated with an increased case fatality rate in children with thalassemia.