Immunization History Research Articles

Clinical Characteristics and Etiological Spectrum of Pancytopenia in Pediatric Age Group: A Cross-Sectional Outlook From a Developing Country.

BackgroundThe etiologies of pancytopenia in the pediatric age group remain exceedingly ubiquitous and warrant extensive hematological and interventional investigations like bone marrow biopsy. It varies widely from benign nutritional disorders to fatal malignancies. The present study aims to delineate the prevalence of various causes of pancytopenia in the pediatric population.MethodsThe present cross-sectional study included 96 patients between the age of one month till 15 years with pancytopenia. Study participants were evaluated for various parameters including their demographical details, clinical features, immunization history, and nature of the disorder. The prevalence of various etiologies (nutritional, neoplastic, infectious, autoimmune, and others) of pancytopenia was ascertained.ResultsOf the 96 patients, 42 (43.75%) were males with a mean age of 69.47 ± 7.12 months. Fever was present in 71.87%, arthralgias in 56.25%, weight loss in 35.41%, and failure to thrive in 18.75% of patients. The bone marrow examination revealed aplastic changes in 36 (37.50%), hyperplastic changes in 21 (21.87%), and normal cellularity in 40.62% of patients. Megaloblastic anemia was the most common nutritional cause of pancytopenia present in 21.85% of cases. Acute lymphoblastic leukemia (ALL) was the most prevalent neoplastic etiology present in 19.79% of patients. Aplastic anemia, miliary tuberculosis, parvovirus B19, and hemolytic anemia were other notable etiologies.ConclusionMegaloblastic anemia and infections like tuberculosis were common treatable etiologies of pancytopenia among the pediatric age group. ALL was the most common neoplastic etiology. Bone marrow biopsy remains crucial in elucidating the various neoplastic and nutritional etiologies of pancytopenia in children.

Analysis on the epidemic characteristics and genetic characteristics of varicella in Beijing from 2019 to 2021

The reported incidence of varicella in Beijing from 2019 to 2021 were 63.8/100 000, 32.2/100 000 and 38.6/100 000, respectively. There were two VZV epidemics in Beijing each year, one peaked in May and the other in November. However, the first VZV epidemic almost disappeared in 2020. Among the cases involved in the varicella outbreaks in school, the proportion of the students with no history of vaccine immunization, 1 dose of immunization and 2 doses of immunization were 33.12%, 44.79% and 22.08%, respectively. The major body of VZV breakthrough cases was children aged 6-14 years (523/755, 69.27%). The proportion of moderate- or severe-rash were 55.32%, 39.06%, 29.96% in the three groups of cases with no immunization history, 1 dose of immunization and 2 doses of immunization, respectively (P<0.001). A total of 1 089 varicella samples were collected, and 837 (76.86%) were confirmed to be PCR-positive for VZV and were identified as VZV wild strains. 311 VZV strains were sequenced successfully, and 307 strains were clade 2 (98.72%), 1 clade 3 (0.32%) and 3 Clade 5 (0.96%). Compared with the representative strains, the nucleotide similarities of ORF22 fragments were between 99.4% and 100%, and amino acid similarities were between 99.4% and 100%.

Antibody levels of measles, rubella and mumps viruses in healthy population in Shanghai from 2010 to 2020

Objective: To determine IgG antibody levels of measles, rubella, mumps in healthy population in Shanghai from 2010 to 2020 and analyze the trend of antibody changes in different age groups. Methods: 10 828 healthy people without measles, rubella and mumps in Shanghai were included in the study from 2010 to 2020. Serum samples were collected from 12 age groups, and the serum IgG antibody of measles, rubella and mumps were detected by ELISA. The difference of antibody positive rates and antibody levels were analyzed. Results: The median age M (Q1, Q3) of 10 828 objects were 8 years old (9 months old, 20 years old). Males accounted for 48.34% (5 234/10 828) and females accounted for 50.92% (5 514/10 828). Unknown gender information accounted for 0.74% (80/10 828), and 27.03% (2 927/10 828) of participants had unknown MMR immunization history. The total positive rates of measles, rubella and mumps IgG antibody were 76.78%, 64.46% and 64.29% and their GMCs were 541.45 mIU/ml, 31.76 IU/ml and 133.73 U/ml respectively. There were significant differences in serum IgG antibody GMC of measles, rubella and mumps in each year (Fmeasles=180.74, P<0.001; Frubella=189.95, P<0.001; Fmumps=122.40, P<0.001). The positive rate of measles antibody was higher than that of rubella and mumps, and the difference was statistically significant (χ²=518.09, P<0.001). Conclusion: The level of measles IgG antibody in healthy people in Shanghai is higher, while the level of rubella and mumps IgG antibody is slightly lower.

Problems with catch-up HPV vaccination after resumption of proactive recommendations.

We previously reported that the suspension of the proactive recommendation for human papillomavirus (HPV) vaccination in Japan led to an increase in infection rates and incidence of cytological abnormalities, 1 Sekine M Yamaguchi M Kudo R et al. Suspension of proactive recommendations for HPV vaccination has led to a significant increase in HPV infection rates in young Japanese women: real-world data. Lancet Reg Health West Pac. 2021; 16100300 PubMed Google Scholar , 2 Yagi A Ueda Y Ikeda S et al. The looming health hazard: a wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine. Lancet Reg Health West Pac. 2022; 18100327 PubMed Google Scholar and appealed for proactive recommendations to be reinstated. 3 Ueda Y Yagi A Ikeda S Enomoto T Kimura T Beyond resumption of the Japanese government's recommendation of the HPV vaccine. Lancet Oncol. 2018; 19: 1563-1564 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar In response to our findings, the Japanese Ministry of Health, Labour, and Welfare resumed proactive recommendations for the HPV vaccine in April, 2022, and initiated catch-up vaccinations for women who might have missed the opportunity to receive the vaccine during the period when proactive recommendations were suspended. 4 Haruyama R Obara H Fujita N Japan resumes active recommendations of HPV vaccine after 8·5 years of suspension. Lancet Oncol. 2022; 23: 197-198 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar A large proportion of women in the target age group (17–25 years) in Japan's fiscal year 2022 will be eligible for the recommended catch-up vaccination (figure). 5 Nakagawa S Ueda Y Yagi A Ikeda S Hiramatsu K Kimura T Corrected human papillomavirus vaccination rates for each birth fiscal year in Japan. Cancer Sci. 2020; 111: 2156-2162 Crossref PubMed Scopus (24) Google Scholar To reduce the incidence of invasive cervical cancer in Japan, a catch-up vaccination programme with at least 50% coverage will be required. 6 Simms KT Hanley SJB Smith MA Keane A Canfell K Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health. 2020; 5: e223-e234 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar To date, England, Sweden, Denmark, and the USA have successfully implemented national catch-up HPV vaccination programmes. In these countries, catch-up vaccination has been reported to have substantially reduced the incidence of cervical precancer and invasive cancer. However, in England, low vaccination coverage among the catch-up generation has been reported. Coverage of three doses of the HPV vaccine was high for women who received the routine vaccination at age 12–13 years (80·9–88·0%), but lower for the catch-up cohorts (70·8–75·7% for age 14–16 years, and 38·9–48·1% for age 16–18 years). 7 Falcaro M Castañon A Ndlela B et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398: 2084-2092 Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar Catch-up vaccination is challenging in Japan because no national HPV vaccine register exists, and immunisation histories are maintained individually by each municipality (approximately 1700) that has provided routine vaccinations. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar For example, if a woman who received the HPV vaccination at age 12–16 years in one municipality moves to a residential address in another municipality, it would not be possible to ascertain her vaccination history from the previous municipality. Thus, a woman who has received three doses of the HPV vaccine in one municipality would be advised to receive three more doses of the HPV vaccine if she moved to another municipality. Thus, the vaccination programme will rely on patient recall regarding personal vaccination history. In our previous study, 1230 women aged 20–22 years between fiscal year 2014 and fiscal year 2017 were asked in a questionnaire whether they had been vaccinated in the past. 140/308 (45·5%) of those who responded that they had not been vaccinated had received 1–3 doses of the vaccine. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar In our current analysis of 1778 women aged 20–26 years in fiscal year 2020 (appendix), 199/879 (22·6%) of those vaccinated reported that they had never been vaccinated. Recall of women who visited clinics with their parents at age 12–16 years and received the HPV vaccine was poor.

Determinants of Stunting in Pre-School-Aged Children in Ujung Bulu Subdistrict

Stunting is one of the main nutritional problems in children in Indonesia. Stunting becomes a serious problem because it is associated with the quality of human resources in the future. Stunted toddlers will experience a level of intelligence that is not optimal, making children more susceptible to disease and in the future will be at risk of decreasing productivity levels. The purpose of this study was to determine the factors related to the incidence of stunting in pre-school age children. This type of research is observational analytics with a case-control design. The subjects of the study studied were toddlers who experienced and did not experience stunting. The sample of this study was children in PAUD schools and kindergartens in Ujung Bulu District, a total of 43 people consisting of 23 stunted children as cases and 20 children who were not stunted as controls. The results showed that the results of the statistical factor test of ANC services (p = 0.001), breastfeeding (p = 0.000) and consumption of Fe tablets (p = 0.012) were related to stunting events. Meanwhile, the factor of the child's immunization history (p = 0.091) is not related to the incidence of stunting. It is recommended to pregnant women to pay more attention to ANC visiting services, breastfeeding and child immunization because it plays a very important role in stunting events.

The role of exclusive breastfeeding on sIgA and lactoferrin levels in toddlers suffering from Acute Respiratory Infection: A cross-sectional study

Secretion of Immunoglobulin A (sIgA) and lactoferrin is a nutrient content in breast milk that can increase immunity in preventing infectious diseases such as Acute Respiratory Infection (ARI). This research aims to determine the role of exclusive breastfeeding (EBF) on sIgA and Lactoferrin levels in toddlers suffering from ARI. A cross-sectional study was conducted on 124 toddlers under five from January–July 2021. Toddlers were selected using a purposive technique sampling from three Community Health Centers in Central Jakarta. Data were analyzed using t-test and ANOVA. The history of immunization, EBF, and frequency of ARI was significantly associated with levels of sIgA and lactoferrin. Parity only correlated with sIgA but not with lactoferrin levels. Maternal and toddlers' age, gender, and nutritional status were not significantly related to sIgA and lactoferrin levels. There is a significant (p-value <0.001) difference in the mean protein sIgA and lactoferrin levels in toddlers who were given EBF with ARI frequency <2 times and toddlers who were given EBF with ARI frequency ≥2 times. Toddlers who were exclusively breastfed with ARI frequency <2 times had higher levels of sIgA and lactoferrin (188901.77 pg/ml and 262.32 ng/ml, respectively) compared to infants given EBF with ARI frequency ≥2 times (136683.47 pg/ml and 181.49 ng/ml, respectively). History of immunization was also significantly (p-value <0.05) associated with levels of sIgA and lactoferrin in infants with ARI. The content of sIgA and lactoferrin in breast milk and immunization can increase the body's immune system in toddlers suffering from ARI.

Pharmacists' Seasonal Influenza Vaccine Recommendations.

Seasonal influenza vaccination rates among European countries remain low despite the World Health Organization’s recommendations to vaccinate high-risk groups. Healthcare worker recommendations are strong predictors of increased vaccination uptake in the population. Therefore, this study aimed to analyze seasonal influenza vaccination recommendation behavior among pharmacists towards high-risk groups including patients, coworkers, and pharmacists’ family members during the COVID-19 pandemic. This cross-sectional, questionnaire-based research was conducted in Switzerland during the flu season and sent to all members of the Swiss Pharmacist Association. In December 2020, 569 community pharmacists completed the online survey. The influenza vaccination recommendation rates for high-risk patients were 93.6% for the elderly, 70.7% for pregnant women, 65.2% for immunocompromised people, and 60.3% for patients with chronic diseases. Pharmacists tend to recommend influenza immunization to patients more than to family members and colleagues. Holding a certification to administer immunization and personal influenza vaccine history were the main predictors for recommending influenza vaccination to patients, family members, and colleagues. Our results indicated that influenza vaccination recommendation rates in our whole sample of pharmacists, were higher for vaccinated and immunizing pharmacists. Ensuring high vaccinations rates and high ratio of immunizing pharmacists may be important in promoting seasonal influenza vaccination in the general population.

Immunisation rates and predictors of undervaccination in infants with CHD.

Vaccination coverage for infants with CHD is unknown, yet these patients are at high risk for morbidity and mortality associated with vaccine-preventable illnesses. We determined vaccination rates for this population and identified predictors of undervaccination. We prospectively enrolled infants with CHD born between 1 January, 2012 and 31 December, 2015, seen in a single-centre cardiology clinic between 15 February, 2016 and 28 February, 2017. We assessed vaccination during the first year of life. Subjects who by age 1 year received all routine immunisations recommended during the first 6 months of life were considered fully vaccinated. We also evaluated influenza vaccination during subjects' first eligible influenza season. We obtained immunisation histories from primary care providers and collected demographic and clinical data via a parent survey and chart review. We used multivariable logistic regression to identify predictors of undervaccination. Among 260 subjects, only 60% were fully vaccinated. Vaccination rates were lowest for influenza (64.6%), rotavirus (71.1%), and Haemophilus influenzae type b (79.3%). Cardiac surgery with cardiopulmonary bypass during the first year of life was associated with undervaccination (51.5% versus 76.4% fully vaccinated, adjusted odds ratio 2.1 [95% confidence interval 1.1-3.9]). Other predictors of undervaccination were out-of-state primary care (adjusted odds ratio 2.7 [1.5-4.9]), multiple comorbidities (≥2 versus 0-1, adjusted odds ratio 2.0 [1.1-3.6]), and hospitalisation for >25% of the first year of life (>25% versus ≤25%, adjusted odds ratio 2.1 [1.1-3.9]). Targeted quality improvement initiatives focused on improving vaccination coverage for these infants, especially surrounding cardiac surgery, are needed.

Epidemiological characteristic of rubella by age group during 12 years after the national introduction of rubella vaccine in Hangzhou, China

ABSTRACT This study aimed to evaluate the implementation and impact of rubella-containing vaccine (RCV) by describing the rubella epidemiology and seroepidemiology in Hangzhou. We collected rubella cases of Hangzhou in the Information System for Disease Control and Prevention in China between 2009 and 2020, and performed a descriptive analysis. We applied a multi-stage stratified random sampling method to recruit participants for serological tests of rubella. Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Immunoglobulin G (IgG) antibodies against rubella in serum samples. Univariate and multivariate analyses are used to detect the association between the level of rubella IgG and related factors. The incidence of rubella cases per million population decreased from 15.8 in 2009 to .1 in 2020. The proportion of rubella cases in women of childbearing age was higher than in men. A total of 4,362 subjects were tested serologically for rubella. The percentage of people whose rubella IgG antibody titers were above the minimum protective level (20 IU/ml) was 80.60% (95% CI: 79.4%–81.8%) and the geometric mean concentration (GMC) for rubella IgG was 58.34 IU/ml. The data indicated that Hangzhou had made good progress toward the elimination of rubella, whereas women of childbearing age still had a higher proportion of rubella cases, which might lead to increased risk of subsequent CRS. The positive rate and GMC of rubella IgG were significantly influenced by age and immunization history of RCV. Therefore, we should stress the importance of pushing forward the campaign for supplementary vaccination of rubella in adults.

Incidence of Influenza Virus Infection among Wroclaw's Healthcare Workers in Pre-COVID-19 2019-2020 Influenza Season Using Novel Flu SensDx Device.

Background: Healthcare workers (HCWs) are more exposed to influenza infection, and the influenza vaccination is recommended each year, to reduce the risk of influenza infection and prevent influenza transmission. This study is a cross-sectional study and the objectives were to determine the rate of influenza virus infection among HCWs in the 2019–2020 influenza season. Methods: Between January and March 2020, a survey was carried out in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). The novel point-of-care testing Flu SensDx device was used, which detects the M1 protein of the influenza virus using electrochemical impedance spectroscopy from biological material (throat/nasal swabs). Results: A total of 150 samples were collected. The majority of participating HCWs by profession were 83 physicians (55.3%) and half (51.3%) of the participating HCWs worked in PHCS. Influenza vaccination coverage was 61.3% in 2019–2020 and 46.0% in the 2018–2019 season for all participants. Of the participating HCWs, 44.0% were positive tested by the Flu SensDx device. There were no statistically significant differences among the positive tested HCWs, their influenza immunization history, and the presence of symptoms of influenza-like illness (p > 0.05). Conclusion: Although the results of the present study suggest that influenza vaccination does not reduce the frequency of influenza virus detection by Flu SensDx testing in the HCWs participants, larger studies are needed to estimate the incidence of influenza virus infection among HCWs to understand the underlying mechanism and fine-tune policies aimed at reducing nosocomial infections.

Assessment of Clinical Effectiveness of BNT162b2 COVID-19 Vaccine in US Adolescents

The emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2 has led to increases in both infections and hospitalizations among adolescents. Little is known about the effectiveness of the BNT162b2 vaccine in adolescents in the general population, as opposed to a clinical trial population. To estimate the effectiveness of the BNT162b2 vaccine in adolescents aged 12 to 18 years. This was a matched case-control study among adolescents (aged 12-18 years) who had results from a SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test. Immunization histories, relevant clinical data, and RT-PCR test results were obtained from the Yale New Haven Health System's medical records between June 1, 2021, and August 15, 2021, when the Delta variant caused 92% of infections in Connecticut. Case participants were defined as adolescents who had a positive test result and an associated medical encounter. Control participants were defined as those who had a negative test result and were matched to a case participant by age, county of residence, and date of testing. Adolescents were defined as fully immunized if they had received 2 doses of vaccine at least 14 days before focal time. The primary outcome measured was SARS-CoV-2 infection confirmed by RT-PCR. The vaccine's effectiveness (VE) was estimated using matched odds ratios from conditional logistic regression models. Secondary measures included estimated VE by clinical symptoms, number of vaccine doses received, and elapsed time from immunization. A total of 6901 adolescents were tested for SARS-CoV-2. The final sample comprised 186 case participants and 356 matched control participants. The median age was 14 (IQR, 13-16) years, 262 (48%) identified as female, 81 (15%) as Black, 82 (15%) as Hispanic, and 297 (55%) as White. Overall, 134 (25%) were fully immunized (case participants, 10 [5%]; control participants, 124 [35%]). The median time between immunization and the SARS-CoV-2 test was 62 days (range, 17-129 days). Within 4 months of receiving 2 doses, VE against any infection was estimated to be 91% (95% CI, 80%-96%); against asymptomatic infection, 85% (95% CI, 57%-95%). Effectiveness after a single dose was estimated to be 74% (95% CI, 18%-92%). In this retrospective case-control study of US adolescents, 2 doses of BNT162b2 vaccine appeared to provide excellent protection for at least 4 months after immunization against both symptomatic and asymptomatic SARS-CoV-2 infections.

122 Tetanus Prophylaxis for Injuries Referred to a Plastic Surgery Service

Abstract Aim To ascertain whether there is appropriate documentation of tetanus immunisation status. To determine whether appropriate tetanus prophylaxis is offered to those with an incomplete or unknown immunisation history for tetanus prone and high-risk tetanus prone wounds. To improve adherence to the green book of immunisation tetanus guidance. Method We performed an audit of wounds referred to plastic surgery in a 3-week period to ascertain whether the green book guidance was satisfied. A poster intervention for junior colleagues that illustrated the guidance was implemented. Re-audit was performed. Results Tetanus immunisation status was documented in 17 (34%) patients. Of 22 with tetanus prone wounds, 11 (50%) had an incomplete tetanus immunisation, but only 3 (27%) received a booster vaccine. Of the 11 high risk tetanus prone wounds, 10 (91%) had an incomplete tetanus immunisation status, but only 5 (50%) received a booster vaccine and none were offered tetanus immunoglobulins. Following intervention, tetanus immunisation status was documented in 23 (46%) patients. In the re-audit, 12 (24%) sustained a tetanus prone injury and 4 (33%) of these had complete immunisation. Of the remaining 8, 7 (88%) received a booster vaccine and 1 patient refused. Of the 4 high risk tetanus prone wounds, 3 (75%) had an incomplete tetanus immunisation status, all of whom received a booster vaccine and 1 (25%) was offered tetanus immunoglobulins. Conclusions We observed greater engagement with the tetanus immunisation guidance and improvement in the assessment and management of tetanus prone injuries.

Immunization coverage of children aged 24-35 months in the Islamic Republic of Iran: a national cluster coverage survey.

Although vaccination coverage against a disease is not exactly the same as community immunity against that disease, it is undoubtedly directly related to it and provides an estimate of the coherence and efficacy of community health infrastructure. To evaluate the vaccination coverage of children throughout the Islamic Republic of Iran in 2019. This was a cross-sectional study. A probability proportional to size cluster sampling method was used and the vaccination data of 8682 children aged 24-35 months were collected in the form of 1447 clusters, each comprising six participants. Only valid data, including vaccination card or electronic health files, were used. The results were reported in the form of descriptive tables. Overall, 97.82% of Iranian participants (8068 of 8248) and 90.32% of non-Iranian participants (392 of 434) had received all essential childhood vaccination by the time of interview. In total, 93.02% of all participants had presentable vaccination cards, and the immunization history of 535 (6.16%) children was retrieved using their electronic health files. The dropout rate between receiving pentavalent vaccine 1 and pentavalent vaccine 3 was 0.01%. In 29 provinces, vaccination coverage was ≥ 95%. In the other two provinces, the figure was 93.30%. Immunization coverage of children aged 24-35 months fully complied with eradication/elimination goals of vaccine-preventable diseases. In 2019, measles and rubella elimination was certified in the Islamic Republic of Iran. However, non-Iranian residents with immunization coverage < 95% constitute a high-risk group for possible outbreaks.

Infectious complications and optimising infection prevention for children with cochlear implants

To describe the clinical epidemiology of children receiving cochlear implants, as well as the management and outcomes of cochlear implant infections and adherence to infection prevention measures. A retrospective observational study was conducted in children ≤18 years who received cochlear implants in Western Australia's tertiary paediatric hospital. Information was obtained from medical and laboratory records regarding demographics, indication for implant, implant infection and preoperative Staphylococcus aureus screening/decolonisation. Immunisation history was examined using the Australian Immunisation Register. Overall, 118 children received cochlear implants, with 158 devices inserted (599 cochlear implant insertion-years). An implant infection rate of 3.8% (6/158) was identified during the study period (four pneumococcal and two community-acquired methicillin resistant S. aureus infections). All required surgical management, with an overall median duration of antibiotic therapy of 37 days (interquartile range (IQR) 29-48) and median length of stay of 8 days (IQR 8-9.5). All devices were retained and there were no relapses or deaths. Half of the children who developed cochlear implant infections (50%, 3/6) were up-to-date with additional pneumococcal vaccinations and no children (0%, 0/118) received S. aureus screening/decolonisation before implant insertion. Favourable outcomes were achieved with cochlear implant retention; however, the treatment was burdensome for families. We demonstrate significant scope to improve adherence to existing infection prevention strategies and provide direction for optimising preventative measures in the future. These include ensuring parental education, additional pneumococcal vaccinations and S. aureus decolonisation which are delivered as an infection prevention bundle to the growing population of infants receiving cochlear implants.

Medical factors associated with caregiver intention to vaccinate their children against COVID-19

ObjectiveTo describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. MethodsWe conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child’s EHR. Results513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0–21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7–5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020–2021 season compared to those who did, 95% CI 2.0–5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. ConclusionsThis study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.

Health behaviour practices and expectations for a local cancer survivorship programme: a cross-sectional study of survivors of childhood cancer in Hong Kong.

Lifestyle choices may influence health outcomes in cancer survivors. This study of childhood cancer survivors in Hong Kong investigated factors associated with health-protective and health-damaging behaviours; it also examined expectations of a survivorship programme. This cross-sectional study recruited survivors of childhood cancer ≥2 years after treatment. Survivors completed a structured questionnaire to report their health practices and the perceived values of survivorship programme components. Multivariable logistic regression analysis was conducted to identify factors associated with health behaviours. Two hundred survivors were recruited (mean age=23.4 ± 8.8 years; mean duration since treatment, 13.4 ± 7.6 years). Comparatively few survivors exercised ≥4 days/week (16.0%), used sun protection (18.0%), and had a balanced diet (38.5%). Furthermore, comparatively few survivors reported that they had not undergone any immunisation (24.5%) or were unsure (18.5%) about their immunisation history. Most adult survivors were never-drinkers (71.0%) and never-smokers (93.0%). Brain tumour survivors were more likely to have unhealthy eating habits, compared with haematological malignancy survivors (odds ratio [OR]=2.45; 95% confidence interval [CI]=1.29-4.68). Lower socioeconomic status was associated with inadequate sun protection (OR=0.20; 95% CI=0.05-0.83), smoking (OR=5.13; 95% CI=1.48-17.75), and exposure to second-hand smoke (OR=3.52; 95% CI=1.42-8.69). Late-effects screening (78.5%) and psychosocial services to address psychological distress (77%) were considered essential components of a survivorship programme. Despite the low prevalences of health-damaging behaviours, local survivors of childhood cancer are not engaging in health-protective behaviours. A multidisciplinary programme addressing late effects and psychosocial aspects may address the multifaceted needs of this special population.

Correlation between Catch-up Growth in Early Childhood with Cognitive Ability among School-Aged Children (10–12 Years): A Longitudinal Study

BACKGROUND: Children’s cognitive abilities are influenced by the nutritional condition of children in early childhood. Catch-up growth in early childhood affects cognitive abilities at school age. AIM: This study aims to analyze the effect of catch-up growth in early childhood on the cognitive abilities of school-aged children in Indonesia. METHODS: This study was a cohort study incorporating 10 years of follow-up using three waves of secondary data (1997, 2000, and 2007) from the Indonesia Family Life Survey. Research studies and data analysis were carried out from April to September 2021. The initial data collection of the study was conducted in 1997 when the children were 0–23 months old, then followed in 2000 (age 3–5 years) and 2007 (age 10–12 years). The study subjects were 537 children aged 0–23 months in 1997. Cognitive ability was measured using the Raven Progressive Matrices method. Statistical analysis for cognitive ability scores with catch-up growth was carried out using one-way analysis of variance and multivariate analysis using the generalized linear model. RESULTS: Significant differences were observed in the cognitive ability scores of normal children and stunted children who did not experience catch-up growth (p&lt;0.001), but the cognitive scores of normal children are not significantly different from the stunting catch-up growth group. Other factors that affect the cognitive ability score were as follows: (1) Child factors consist of child stunting status, head circumference, hemoglobin levels, duration of breastfeeding, and complete basic immunization history; (2) parental factors such as father’s occupation, parental education, and number of parity; (3) household socioeconomic factors (household income and wealth index); and (4) environmental factors (housing area, father’s smoking habit, defecation facilities, and household drinking water sources). CONCLUSION: Cognitive abilities of school-age children were most influenced by catch-up growth, stunting status, duration of breastfeeding, number of parity, father’s education, father’s occupation, and father’s smoking habit. Children who experience catch-up growth have better cognitive abilities than stunted non-catch-up group or who experience stunting during early life.

Characteristics of End-Stage Kidney Disease in a Cohort of Indigenous and Non-Indigenous Adults in Northwestern Ontario, Canada

Background: In Canada, the prevalence of chronic kidney disease is two-fold higher among Indigenous than non-Indigenous people. Direct comparisons of clinical characteristics between Indigenous and nonIndigenous end-stage kidney disease (ESKD) patients have not been previously conducted. We compared demographic and clinical characteristics of Indigenous and non-Indigenous adults with ESKD receiving dialysis at the primary hospital serving a region with 20% Indigenous population. Methods: During 4 years, 186 adults with ESKD were recruited for a clinical trial to analyze the response to pneumococcal immunization. Demographic and clinical data, including age, sex, residency, dialysis characteristics, etiology for chronic kidney disease, comorbidities, history of infections and prior pneumococcal immunization were compared between 91 Indigenous and 94 non-Indigenous individuals.

Effect of breastfeeding on children's health and its relationship to NRAMP1 expression: A cross-sectional study

Toddlers with exclusive breastfeeding can increase immunity in preventing infectious diseases such as Upper Respiratory Tract Infections (ARI). The body's resistance to disease is controlled by Natural Resistance-Associated Macrophage Protein 1 (NRAMP1). NRAMP1 contributes to the pathophysiology of several intercellular infections, including ARI. The purpose of this study was to determine the effect of breastfeeding on children's health and its relationship to NRAMP1 expression. A cross-sectional study was conducted on 124 toddlers in October 2020–June 2021. Toddlers were selected purposively from three Community Health Centers in Central Jakarta. The first group (n = 62) was exclusive breastfeeding and the second group (n = 62) was not exclusive breastfeeding. The characteristics of mothers and toddlers were collected using a structured questionnaire supported by medical record data. Meanwhile, NRAMP1 expression and NRAMP1 protein levels were obtained from the examination of blood samples. Examination of NRAMP1 gene mRNA expression by real-time PCR method and serum NRAMP1 protein levels by ELISA method. Data were analyzed using t-test, ANOVA, and multiple linear regression. The results obtained that the average mRNA expression of NRAMP1 gene and protein levels of NRAMP1 in infants who were not exclusive breastfeeding were 6.88 fold change (FC) and 315.02 pg/ml compared to those who received exclusive breastfeeding of 11.36 FC and 1087.74 pg./ml. Parity, immunization history, exclusive breastfeeding, and frequency of ARI were significantly associated with NRAMP1 gene mRNA expression and NRAMP1 protein levels (P < 0.05). Maternal and under-five age, gender, and nutritional status were not significantly related (P > 0.05). Exclusive breastfeeding was the dominant factor influencing NRAMP1 gene mRNA expression (OR: 4268) and NRAMP1 protein content (OR: 737,362). Antibodies obtained from exclusive breastfeeding in synergy with the NRAMP1 gene form the body's immunity in infants suffering from ARI.

Profile of Diphtheria Cases Hospitalized at Tertiary Referral Hospital in Indonesia: 10 Years' Experience.

This is a report about children diphtheria cases' profile in Cipto Mangunkusumo Hospital, Jakarta from 2006 to 2017. Occurrence was the highest in ≥5-years-old age group (67.7%) with male predominance (58.8%). Thirty five point three percent cases had no immunization history and 38.2% cases had incomplete booster history. Pseudomembrane occurred in all cases, mostly found in pharynx (67.6%) and tonsil (61.8%).