Illness In Young Children Research Articles

Lactose avoidance for young children with acute diarrhoea.

Young children with acute diarrhoea, typically due to infectious gastroenteritis, may temporarily stop producing lactase, the intestinal enzyme that digests lactose. This means they may not digest lactose, the main sugar in milk, and this may worsen or prolong the diarrhoeal illness. However, there is uncertainty whether avoiding lactose-containing milk or milk products helps young children recover from acute diarrhoea more quickly. To assess if avoiding or reducing intake of lactose-containing milk or milk products shortens the duration and severity of illness in young children with acute diarrhoea. We also sought other indicators of morbidity and overall mortality. We searched the Cochrane Infectious Diseases Group Specialized Register (14 May 2013), Cochrane Central Register of Controlled Trials (CENTRAL) published in The Cochrane Library (Issue 4, 2013), MEDLINE (1996 to 14 May 2013), EMBASE (1974 to 14 May 2013), and LILACS (1982 to 14 May 2013), and the reference lists of potentially relevant trials, key conference proceedings, and wrote to individuals and organizations in the field. Randomized or quasi-randomized controlled trials that assessed the effects of avoiding or reducing exposure to lactose in young children under five years with acute diarrhoea. We extracted data using the standard methods of the Cochrane Infectious Diseases Group, and two review authors independently evaluated trial quality and data extraction. Continuous outcomes were compared using mean difference (MD), and dichotomous outcomes using the risk ratio (RR). We presented all results with 95% confidence intervals (CI) and assessed the quality of evidence using the GRADE approach. We included 33 trials enrolling 2973 children with acute diarrhoea. Twenty-nine trials were exclusively conducted on inpatients, all from high- or middle-income countries. Fifteen trials included children aged below 12 months, and 22 excluded children who were being breast-fed.Compared to lactose-containing milk, milk products, or foodstuffs, lactose-free products may reduce the duration of diarrhoea by an average of about 18 hours (MD -17.77, 95% CI -25.32 to -10.21, 16 trials, 1467 participants, low quality evidence). Lactose-free products probably also reduce treatment failure (defined variously as continued or worsening diarrhoea or vomiting, the need for additional rehydration therapy, or continuing weight loss) by around a half (RR 0.52, 95% CI 0.39 to 0.68, 18 trials, 1470 participants, moderate quality evidence).Diluted lactose-containing milk has not been shown to reduce the duration of diarrhoea compared to undiluted milk or milk products (five trials, 417 participants, low quality evidence), but may reduce the risk of treatment failure (RR 0.65, 95% CI 0.45 to 0.94, nine trials, 687 participants, low quality evidence). In young children with acute diarrhoea who are not predominantly breast-fed, change to a lactose-free diet may result in earlier resolution of acute diarrhoea and reduce treatment failure. Diluting lactose-containing formulas may also have some benefits but further trials are required to have confidence in this finding. There are no trials from low-income countries, where mortality for diarrhoea is high, and malnutrition is more common.

A replication-incompetent influenza virus bearing the HN glycoprotein of human parainfluenza virus as a bivalent vaccine

Influenza virus and human parainfluenza virus (HPIV) are major etiologic agents of acute respiratory illness in young children. Inactivated and live attenuated influenza vaccines are approved in several countries, yet no vaccine is licensed for HPIV. We previously showed that a replication-incompetent PB2-knockout (PB2-KO) virus that possesses a reporter gene in the coding region of the PB2 segment can serve as a platform for a bivalent vaccine. To develop a bivalent vaccine against influenza and parainfluenza virus, here, we generated a PB2-KO virus possessing the hemagglutinin-neuraminidase (HN) glycoprotein of HPIV type 3 (HPIV3), a major surface antigen of HPIV, in its PB2 segment. We confirmed that this virus replicated only in PB2-expressing cells and expressed HN. We then examined the efficacy of this virus as a bivalent vaccine in a hamster model. High levels of virus-specific IgG antibodies in sera and IgA, IgG, and IgM antibodies in bronchoalveolar lavage fluids against both influenza virus and HPIV3 were detected from hamsters immunized with this virus. The neutralizing capability of these serum antibodies was also confirmed. Moreover, the immunized hamsters were completely protected from virus challenge with influenza virus or HPIV3. These results indicate that PB2-KO virus expressing the HN of HPIV3 has the potential to be a novel bivalent vaccine against influenza and human parainfluenza viruses.

HMPV Lineage Nomenclature and Heparin Binding

Human metapneumovirus (hMPV), first described in 2001 [1], is responsible for causing serious respiratory illness in young children, the elderly and immunocompromised patients. Four distinct lineages of hMPV have been identified with the original nomenclature for these subgroups (A1, A2, B1 and B2), reported by van den Hoogen et al. [2], utilised by many. An alternate terminology (1A, 1B, 2A and 2B) was also published by Ishiguro et al. in 2004 [3] which has been adopted by others. However, this has caused some confusion in the interpretation of publication results as the terminology is similar yet describes different subtypes. As a result, a number of investigators have made a submission to the International Committee on Taxonomy of Viruses (ICTV, ICTV taxonomic proposal 2012.012V) for the official adoption of the original terminology as an approved nomenclature for hMPV [4]. We welcome this officially approved nomenclature which should provide clarification of these subtypes in future. Therefore to assist with the interpretation of our recently published research in the 2012 special issue of Viruses: Pneumoviruses and Metapneumoviruses entitled "Diversity in Glycosaminoglycan Binding Amongst hMPV G Protein Lineages" [5] we have updated the Figure 3 in this letter (see Figure 1), showing the proposed ICTV terminology compared to the Ishiguro classification (used in our publication). Note that in the original publication the alphanumeric order for the Ishiguro classification was transposed (e.g., 1A was referred to as A1).

Kawasaki Disease; A Review Article

Kawasaki disease is believed to be the commonest vasculitis of medium vessels in Asian children. However, the majority of children with Kawasaki disease continue to remain undiagnosed perhaps because of the lack of awareness amongst pediatricians. The clinical features of Kawasaki disease can be confused with other common conditions such as Scarlet fever, Stevens Johnson syndrome, Measles fever, systemic onset JIA, etc. Development of coronary artery abnormalities is the hallmark of Kawasaki disease and accounts for most morbidity and mortality associated with the disease. Quick recognition of the disease and early treatment with intravenous immunoglobulin results in a significant decrease in the occurrence of coronary artery abnormalities. This review emphasizes that Kawasaki disease should be considered in differential diagnosis of all febrile illnesses in young children.

Factors that may explain observed associations between trivalent influenza vaccination and gastrointestinal illness in young children

BackgroundPreviously published studies reported an increased risk of gastrointestinal illness in the 14 days following trivalent influenza vaccination (TIV) in young children. While gastrointestinal illness may be a true adverse effect of TIV, other factors may influence this observed association, such as seasonal illness patterns and children being exposed to gastrointestinal pathogens at medical visits. The objective of this study was to examine factors influencing the association between TIV and gastrointestinal illness. Specifically, using data from a previous influenza vaccine safety study, we examined the association between medical encounters without TIV and gastrointestinal illness. MethodsUsing electronic health record (EHR) data from 6 managed care organizations (MCOs), we identified medically attended gastrointestinal illness cases among children 24–59 months in the 2002–2006 influenza seasons. We matched each case to four controls on sex, birthdate (month/year), MCO, influenza season, and presence of a chronic condition. We then looked 1–14 days prior to the index date (gastrointestinal illness diagnosis date) to determine whether the child had a medical encounter. We excluded previous medical encounters with gastrointestinal-related diagnoses or TIV. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals. ResultsWe identified 2062 gastrointestinal illness cases and matched them to 8248 controls. We observed increased odds of gastrointestinal illness within 14 days after a medical encounter (odds ratio=1.9; 95% confidence interval [CI]: 1.7–2.2) among children without chronic conditions. Among children with chronic conditions, the odds ratio was 3.9 (95% CI: 2.5–6.2). ConclusionsWe demonstrated that another exposure related to vaccination, medical visits, is also associated with increased odds for gastrointestinal illness. This study highlights challenges of interpreting results from observational vaccine safety studies when there are co-occurring exposures, and the importance of investigating confounding in EHR data, which are an essential resource for vaccine safety research.

Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India

Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

It's Just a Virus! Viral Etiologies of Fever Without a Source

Colvin JM, Muenzer JT, Jaffe DM, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics. 2012; 130(6): e1455-e1462; doi: 10.1542/peds.2012-1391Investigators from Washington University, St. Louis and Biological Mimetics, Inc., Frederick, MD conducted a study to better understand the viral etiologies of fever without an apparent source (FWS) in young children. Children aged 2 to 36 months who presented to the emergency department (ED) at St. Louis Children’s Hospital with a temperature of ≥38°C without an apparent source and who had blood obtained for clinical management were enrolled. Children with symptoms suggestive of a viral respiratory infection or who had a positive rapid test for influenza were excluded. Two comparison groups of children were also enrolled: (1) children aged 2 to 36 months who presented to the ED with a temperature of ≥38°C but had a probable or definite bacterial infection, and (2) afebrile children aged 2 to 36 months who were having an ambulatory surgical procedure. Blood and/or nasopharyngeal (NP) specimens were collected from study children. Polymerase chain reaction (PCR) testing was used to identify viruses. The main outcome was the type and frequency of viruses detected in each study group. Secondary outcomes were antibiotic utilization among children with FWS and demographic and clinical variables associated with viral infection.A total of 206 children were enrolled: 75 with FWS, 15 with fever and a probable or definite bacterial infection, and 116 who were afebrile. All children with bacterial infection and 29% of children with FWS were hospitalized. Viruses were detected in 76% of children with FWS, 40% with bacterial infection, and 35% who were afebrile (P < .001). The viruses identified most frequently in children with FWS were adenovirus, human herpesvirus-6 (HHV-6), and enterovirus. Each was detected significantly more frequently in those with FWS (identified in 57%) than in those with bacterial infection (13%) or who were afebrile (7%). Epstein-Barr virus was the most commonly detected virus in children with bacterial infection (23%) and rhinovirus was the most commonly detected in afebrile subjects (16%). Children with FWS were significantly more likely to have >1 virus identified and to have a virus detected from their blood or NP specimen than children in the bacterial or control groups. Among children with FWS, 45% received antibiotics, including 91% of those who had adenovirus. The only significant demographic or clinical characteristic of children who had adenovirus, HHV-6, or enterovirus infection compared to children with no virus detected was that the white blood count was more likely to be >15,000 cells/mm3 in children who had adenovirus (P = .003).The authors conclude that viruses are frequently detected in children aged 2 to 36 months with FWS and that use of blood specimens for virus detection could increase virus identification and decrease empiric antibacterial treatment.This important study has several limitations. First, the investigators did not enroll all eligible children with FWS but only those who presented to the ED when study personnel were working. This introduces selection bias. Second, the inclusion criterion requiring that blood work be ordered by the treating provider as part of the clinical work-up introduces additional bias, as those with FWS for whom no blood work was ordered were excluded. Third, detection of a virus does not mean that the virus was responsible for the child’s fever, although the viruses most frequently identified in the febrile children are typically thought to be pathogenic (and many of those found in the afebrile cohort are thought to have low pathogenicity). Finally, virus detection was limited to blood and NP specimens in this study. Notably, stool specimens, which may increase virologic yield, were not included.The management of FWS has evolved along with the vaccination landscape: occult bacteremia has essentially disappeared in highly-vaccinated populations.1 Increasingly, febrile infants and young children with an unrevealing physical examination may have either a urinary tract infection2 or “a virus.” While worried parents may balk at the “it’s just a virus” diagnosis, this study gives it credence. Of note, the yield of virus-specific diagnoses increased from 49% with the use of PCR on NP specimens (which is the standard of care in most pediatric hospitals) to 76% when both NP and blood were assayed by PCR. These findings suggest, among other things, that the application of new technologies will improve our ability to render a specific diagnosis for febrile illnesses in young children. (See also AAP Grand Rounds, June 2012;27[6]:65.3)

Hsp90 Inhibitors Exhibit Resistance-Free Antiviral Activity against Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is a major cause of respiratory illness in young children, leading to significant morbidity and mortality worldwide. Despite its medical importance, no vaccine or effective therapeutic interventions are currently available. Therefore, there is a pressing need to identify novel antiviral drugs to combat RSV infections. Hsp90, a cellular protein-folding factor, has been shown to play an important role in the replication of numerous viruses. We here demonstrate that RSV requires Hsp90 for replication. Mechanistic studies reveal that inhibition of Hsp90 during RSV infection leads to the degradation of a viral protein similar in size to the RSV L protein, the viral RNA-dependent RNA polymerase, implicating it as an Hsp90 client protein. Accordingly, Hsp90 inhibitors exhibit antiviral activity against laboratory and clinical isolates of RSV in both immortalized as well as primary differentiated airway epithelial cells. Interestingly, we find a high barrier to the emergence of drug resistance to Hsp90 inhibitors, as extensive growth of RSV under conditions of Hsp90 inhibition did not yield mutants with reduced sensitivity to these drugs. Our results suggest that Hsp90 inhibitors may present attractive antiviral therapeutics for treatment of RSV infections and highlight the potential of chaperone inhibitors as antivirals exhibiting high barriers to development of drug resistance.

Excretion of enterovirus 71 in persons infected with hand, foot and mouth disease

BackgroundHand, foot and mouth disease (HFMD) is a common illness in young children. It also can be seen in adults occasionally. Enterovirus 71 (EV71), a pathogen that causes not only HFMD but also neurological complications and even death, has caused many HFMD outbreaks in China. However, till now the data about the duration of EV71 shedding is very limited.ResultsA total of 136 throat swabs and fecal samples were collected from 27 children and 3 adults, which includs 7 close contacts, 9 mild cases and 14 severe cases,. The participants were divided into three groups namely, severe case group, mild case group and close contact group. All the samples were assayed with real-time polymerase chain reaction (PCR). Kruskal-Wallis Test was employed to compare the difference in duration of viral RNA shedding among three groups. The results showed that significant difference in duration of EV71 shedding was found among three groups (P < 0.01). The longest duration of EV71 shedding in fecal samples is 54 days and 30 days in throat swabs.ConclusionsHFMD is characterized by extended excretion of EV71. Our results suggest that the duration of EV71 shedding is correlated with the severity of the disease. EV71 shedding through feces can persist more than 54 days. Prolonged virus shedding is a potential risk factor of proliferating HFMD epidemic.

Validity of information on atopic disease and other illness in young children reported by parents in a prospective birth cohort study

BackgroundThe longitudinal birth cohort study is the preferred design for studies of childhood health, particularly atopic disease. Still, prospective data collection depends on recollection of the medical history since the previous visit representing a potential recall-bias. We aimed to ascertain the quality of information on atopic disease and other health symptoms reported by parental interview in a closely monitored birth cohort study. Possible bias from symptom severity and socioeconomics were sought.MethodsCopenhagen study on Asthma in Childhood (COPSAC) is a clinical birth cohort study of 411 children born of asthmatic mothers from 1999 to 2001. Child health is monitored at six-monthly visits with particular emphasis on atopic symptoms and infections. Data from the first three study years on 260 children was compared with records from their family practitioner as an external reference.ResultsA total of 6134 medical events were reported at the COPSAC interviews. Additional 586 medical events were recorded by family practitioners but not reported at the interview. There were no missed events related to asthma, eczema or allergy. Respiratory, infectious and skin related symptoms showed completeness above 90%, other diseases showed lower completeness around 77%. There was no meaningful influence from concurrent asthma or socioeconomics.ConclusionsThe COPSAC study exhibited full sensitivity to the main study objectives, atopic disease, and high sensitivity to respiratory, infectious and skin related illness. Our findings support the validity of parental interviews in longitudinal cohort studies investigating atopic disease and illness in childhood.

265 Difference between Enterovirus and Human Parechovirus Infections in Young Children with Sepsis-Like Illness

IntroductionEnterovirus (EV) or Human Parechovirus (HPeV) infections are common causes of sepsis-like illness in young children. We investigated differences in incidence, clinical characteristics and management of EV and HPeV infections...

Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children

Hand-foot-and-mouth disease (HFMD) and herpangina are commonly prevalent illness in young children. They are similarly characterized by lesions on the skin and oral mucosa. Both diseases are associated with various enterovirus serotypes. In this study, enteroviruses from patients with these diseases in Korea in 2009 were isolated and analyzed. Demographic data for patients with HFMD and herpangina were compared and all enterovirus isolates were amplified in the VP1 region by reverse transcription-polymerase chain reaction and sequenced. Among the enterovirus isolates, prevalent agents were coxsackievirus A16 in HFMD and coxsackievirus A5 in herpangina. More prevalent months for HFMD were June (69.2%) and May (11.5%), and June (40.0%) and July (24.0%) for herpangina. Age prevalence of HFMD patients with enterovirus infection was 1 year (23.1%), 4 years (19.2%), and over 5 years (19.2%). However, the dominant age group of herpangina patients with enterovirus infection was 1 year (48.0%) followed by 2 years (28.0%). Comparison of pairwise VP1 nucleotide sequence alignment of all isolates within the same serotypes revealed high intra-type variation of CVA2 isolates (84.6–99.3% nucleotide identity). HFMD and herpangina showed differences in demographic data and serotypes of isolated enteroviruses, but there was no notable difference in amino acid sequences by clinical syndromes in multiple comparison of the partial VP1 gene sequence.

Hospitalization due to human parainfluenza virus-associated lower respiratory tract illness in rural Thailand

Background Human parainfluenza viruses (HPIVs) are an important cause of acute respiratory illness in young children but little is known about their epidemiology in the tropics. Methods From 2003–2007, we conducted surveillance for hospitalized respiratory illness in rural Thailand. We performed reverse‐transcriptase polymerase chain reaction on nasopharyngeal specimens and enzyme immunoassay on paired sera Results Of 10,097 patients enrolled, 573 (5%) of all ages and 370 (9%) of children <5 years of age had evidence of HPIV infection (HPIV1=189, HPIV2=54, HPIV3=305, untyped=27). Average adjusted annual incidence of HPIV‐associated hospitalized respiratory illness was greatest in children aged <1 year (485 per 100,000 person years). Conclusions In Thailand, HPIV caused substantial illnesses requiring hospitalization in young children.

Indirect, out-of-pocket and medical costs from influenza-related illness in young children

BackgroundStudies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. ObjectiveTo determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. MethodsUsing a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003–2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. ResultsData were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. ConclusionsOut-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination.

Expression and immunogenicity of novel subunit enterovirus 71 VP1 antigens

Hand, foot, and mouth disease (HFMD) is a common viral illness in young children. HFMD is caused by viruses belonging to the enterovirus genus of the picornavirus family. Recently, enterovirus 71 (EV71) has emerged as a virulent agent for HFMD with severe clinical outcomes. In the current report, we conducted a pilot antigen engineering study to optimize the expression and immunogenicity of subunit VP1 antigen for the design of EV71 vaccines. DNA immunization was adopted as a simple technical approach to test different designs of VP1 antigens without the need to express VP1 protein in vitro first. Our studies indicated that the expression and immunogenicity of VP1 protein can be improved with alternated VP1 antigen designs. Data presented in the current report revealed novel pathways to optimize the design of VP1 antigen-based EV71 vaccines.

Abstract 16850: The Impact of Coxsackievirus Infection on Cardiac Stem Cells and Postnatal Heart Development

Coxsackievirus B (CVB) is an enterovirus that most commonly causes a self-limited febrile illness in young children, but in severe cases it can progress to myocarditis or meningo-encephalitis. The long-term consequences of mild CVB infection are unknown, although CVB antibodies are encountered more frequently in patients with heart failure than in the general population, raising the possibility that this cardiotropic virus could have lasting sequelae even in subclinical infection. Previously we described a mouse model in which early postnatal exposure to doxorubicin depleted c-Kit+ cardiac stem cells (CSCs) and resulted in cardiac dysfunction in adult animals that could only be elicited by a prolonged exercise challenge or experimentally induced myocardial infarction. We and others have shown that CVB infects actively proliferating neural stem cells and induces cell death. In this study, we report that cultured CSCs isolated from neonatal mouse hearts were also susceptible to cytopathic CVB infection. To test the hypothesis that CVB infection might deplete the CSC population in the heart during self-limited infection, we inoculated neonatal BALB/c mice with recombinant CVB expressing eGFP and assessed the effects of viral infection on CSCs. We observed infected CSCs in cardiac tissue as well as a 50% reduction in the number of c-Kit+ cells in adult animals. Our observations indicate that CVB can target CSCs in the neonatal heart, infecting them and triggering their destruction. Similar to our findings in the doxorubicin late-onset heart failure model, we suggest that the loss of CSCs during subclinical CVB infection in early childhood may predispose to late-onset heart failure. Further work is needed to demonstrate the cardiovascular consequences of CSC infection and depletion after neonatal CVB infection.

Evidence of Homosubtypic but Not Heterosubtypic Immunity in Children after Wild-Type Influenza Illness

Background and aims: Cross-protection between different influenza A subtypes (heterosubtypic immunity) has been shown in animals after infection with wild-type influenza and administration of some types of influenza vaccines. However, data regarding protective heterosubtypic immunity in humans are limited. The aim of this analysis is to examine data from unvaccinated subjects followed in multiyear, culture-confirmed vaccine efficacy studies for evidence of heterosubtypic protection. Methods: Four 2-year studies of children aged 6-71 months were analyzed. Placebo recipients were separated into cohorts based on whether the subject experienced culture-confirmed influenza illness in year 1. The incidence of influenza illness by subtype per cohort was calculated for year 2. Subjects with confirmed illness in year 1 were compared with subjects with no evidence of any influenza illness in year 1. Results: Table Conclusions: In this analysis of the 2-year incidence of culture-confirmed influenza illness in young children, there was evidence of homosubtypic protection induced by wild-type influenza illness; however, there was no evidence of heterotypic or heterosubtypic protection. These results support previous observations that children may not develop lasting, clinically significant heterosubtypic protection after wild-type influenza infection. Sponsored by MedImmune, LLC.

Evidence of Homosubtypic But Not Heterosubtypic Immunity in Young Children Following Wild-type Influenza Illness

The effect of subtype-specific influenza illness in young children on the probability of influenza illness in the following year was analyzed for placebo recipients in four 2-year vaccine efficacy studies. There was evidence of homosubtypic protection but no evidence of heterosubtypic protection; however, a moderate-to-low level of heterosubtypic protection could not be ruled out. This analysis supports previous observations that children do not develop lasting, clinically significant heterosubtypic protection after influenza illness.

CONCENTRATION-RISK RELATIONSHIP FOR VOLATILE ORGANIC COMPOUNDS IN INDOOR AIR AND RESPIRATORY HEALTH OF CHILDREN IN LEIPZIG, GERMANY

Background and Aims: To assess the form of associations between respiratory illness in young children and domestic exposure to volatile organic compounds (VOC) and to apply a novel approach to redu...

Progress of vitamin D and bronchial asthma

As an immune regulator, vitamin D plays a role in asthma. In the fetus, vitamin D participates in immune system and lung development. It has been reported that vitamin D deficiency may explain a portion of the asthma epidemic. Beneficial associations have been reported between vitamin D and asthma severity in children. Epidemiologic studies have also suggested that higher prenatal vitamin D intakes have a protective role against wheezing illnesses in young children. In addition, vitamin D may play a therapeutic role in steroid resistant asthmatics and there is interest in using vitamin D therapeutic-ally to complement conventional asthma therapy, such as specific immunotherapy. Key words: Vitamin D; Vitamin D receptor; Bronchial asthma