Incidence Rate In Children Research Articles

Clinical importance of neuroimaging in epilepsy

Epilepsy is a chronic condition throughout the world, characterized by recurrent seizures with no acute warning. Epilepsy is one of the most frequently seen neurological diseases, with an incidence of between 5 and 8 per 1000 in the general population. In children below the age of 16 years, epilepsy is seen at a rate of 0.5-1%, with the highest incidence rate in children below the age of 1 year.[1,2] For a patient who presents with a history of seizures, after physical and neurological evaluations, electroencephalography, biochemical and metabolic evaluations, computerized brain tomography (CT) and magnetic resonance imaging (MRI) should be planned according to the clinical priority of the patient. The basic role of radiological imaging in epilepsy is to define any structural anomalies or pathologies and to aid in the patient treatment protocol. In the majority of studies in industrialized countries, a specific etiology has been defined in 60-70% of cases. However, despite there being greater risk factors in developed countries, rates of specific etiology have been reported of 40% and lower. The etiological differentiation in these studies has generally been dependent on the clinical data, but if techniques are used, which are provided by advanced technology, an increase in the rates of specific etiology can be expected.[3,4] Depending on the level of development of the country, etiological differences, central nervous system infections and cerebrovascular events are seen.[1,5] The most common etiologies in those aged under 15 years have been found to be congenital structural defects, trauma, and hypoxic ischemic encephalopathy.[2] Within the last 10-15 years, significant advances have been made in imaging techniques. Intracranial anatomical structures clearly began to image. Some functional areas in the brain can be detected via imaging. The basic radiological modalities in cases with epilepsy are CT and MRI methods; partially ultrasonography (US) and digital subtraction angiography (DSA). In the preoperative evaluation of patients with resistant epilepsy who are candidates for surgery, single photon emission computerized tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopy (MRS), functional magnetic resonance (fMR), and magneto-encephalography (MEG) are other imaging methods which are used. US is widely used as it is easily applied to newborns, is repeatable, and does not contain ionizing radiation. In premature babies, it is useful in the determination of pathologies such as intracranial bleeding, hydrocephaly, and congenital anomalies.[6,7] The advantages of CT are that it is cheap, easily accessible, easy to apply, and the duration of taking the images is short. However, with the advent of MRI, the importance of CT has reduced, although it is still an imaging method which can be used in the first evaluation of seizures related to trauma, emergency situations, fever, or focal neurological changes. CT may be useful in pathologies including hemorrhage, infarct, Galen vein malformation, ventricular dilation, and calcification. It should be selected for hemorrhage, hydrocephaly, and major structural pathologies in both children and adults. CT can show approximately 50% of lesions such as vascular malformation and tumors causing epilepsy. In cases with characteristic CT findings such as tuberosclerosis and Sturge-Weber syndrome, noncalcified lesions (e.g., tubers) can be determined by MRI. The presence of bone artifacts in the temporal fossa, particularly when combined with the low-tissue contrast property of CT, makes it impossible to determine mesial temporal sclerosis (MTS). In conclusion, it can be said that CT should be preferred in conditions which cannot be performed or found by MRI. In an epileptic case which is normal on CT, it is necessary to perform MRI. With new developments in MRI technology, some previously undefined structural anomalies can now be easily determined. When MRI is compared with CT, high sensitivity, excellent soft-tissue contrast, the possibility of multiplanar imaging and the fact that it does not contain ionizing radiation have made MRI the leading method to be used in the evaluation of epileptic patients.[8,9] MRI plays an important role in epilepsy surgery in the definition of structural anomalies and pathologies and at the same time in the evaluation of the relationships between lesions and functional areas such as motor, speech, and memory areas. As the pathology defined by MRI conforms to clinical and electrophysiological data, it is important in terms of preventing false-positive results. The conformity of MRI findings with noninvasive electrophysiological data removes the necessity to apply invasive electroencephalographic imaging.[10] Postoperative follow-up MRIs can define residue or recurrent lesions and evaluate the adequacy of the surgical treatment. Being able to make an accurate postoperative evaluation of epileptogenic foci facilitates the follow-up of seizure prognosis.[11] In conclusion, the development of new imaging techniques every year gives us the opportunity to obtain additional radio-anatomic or physiopathological information. Therefore, it is thought that some of the above-written information of epilepsy patients will be revised in the near future.

Impfstatus bei Schülern in den 6.–10. Klassen 2011 – ein Ländervergleich. Handlungsbedarf für eine zielgerichtete nationale Impfstrategie

In Germany, surveillance of the population's immunisation is only mandatory for school beginners, not for adolescents. Therefore, no current data are available from the public health service related to the immunisation of adolescents. Also lacking are nationwide monitoring data regarding HPV vaccination among girls aged 12-18 years and the meningococcal C vaccination, both recently introduced by the German Standing Committee on Vaccination (STIKO) in 2009 and 2006, respectively. The present research and analysis therefore aims to determine which German states perform a monitoring of the vaccination status of adolescents, how immunisation rates differ across German states and what need for action, in terms of a nationwide immunisation strategy, can be derived. A systematic survey of vaccination coverage among students in grades 6-10 (age group 12-16 years) for the school year 2010/11 was undertaken. The defined documentation standard is based on the standard vaccinations for children and adolescents according to STIKO, requiring complete primary immunization (PI) and the number of booster vaccinations. In the analysis, 8 of 16 states were included, due to lack of data for the remaining states. In total, the public health service -examined 157,599 school children in 8 German states and checked 103,250 vaccination certificates (on average 68.1%, range 54.9-85.2%). The implementation of the booster vaccination among students in grades 6-10 proved to be insufficient. The 2-dose measles vaccination, required by the WHO for 95% of the population, was only nearly achieved by 2 of 8 German states -(Saxony-Anhalt, Brandenburg). The effects of insufficient immunisation coverage are shown by, for example, a higher measles incidence rate in children under 15 years and a persisting peak of pertussis incidence in 10- to 15-year-olds. The meningococcal C vaccination, introduced in 2006, was insufficiently taken up by students and very differently implemented among the 8 -German states (Saxony 73.9% vs. Bavaria 29.1%). HPV vaccination in girls has not yet been established (Brandenburg maximum 39.8%). Findings of this study show that the primary health care system is insufficient in reaching adolescents. Systematic checks of vaccination certificates in schools need to be extended, in cooperation with the public health service in order to identify gaps in vaccination. Through counselling and referrals to general practitioners or paediatricians there is the chance to catch up on missing vaccinations. It is necessary to promote catch-up programmes for newly indroduced vaccinations as well as for missed and booster vaccinations and to implement them in the health care system.

Time Trends and Gender Differences in Incidence and Prevalence of Type 1 Diabetes in Sweden

There are different opinions on a possible sex bias in diabetes. In Sweden we have access to data since the 1930s, making it an ideal model. We aimed to study gender differences and time trends in the incidence and prevalence of type 1 diabetes in Sweden. We found 31 articles on incidence and 8 on prevalence (6 overlapping). Times series on incidence were found regarding children 0-15 years of age (with the Swedish Childhood Diabetes Registry, SCDR, since 1977), with up to 14,721 children with diabetes and with a high degree of ascertainment. Incidence time series were also found for subjects aged 15-34 (Diabetes Incidence Study in Sweden, DISS, since 1983), with up to 7,369 subjects and with a lower degree of ascertainment compared to SCDR. Regarding age from 40 years and above fewer studies were found, and with a much lower number of subjects with type 1 diabetes. Diabetes incidence in children has had a relative increase of approximately 2% per year since 1938. Incidence rates in children 0-14 years of age show no gender differences, but in subjects aged 15-39 years a male preponderance up to twofold is found. Figures for subjects 40 years or older are more uncertain, but show a fairly equal incidence among men and women. The male preponderance in type 1 diabetes from age 15 up to 40-50 could be due to hormonal influence, with higher peripheral insulin resistance among men in young adults and younger middle age.

INCIDENCE AS THE MOST IMPORTANT INDICATOR OF HEALTH

Incidence should be considered as one of the most important indicators of health of the population. Since the 90’s of the last century, there is a number of negative trends in the health of children and teenagers such as the the steady increase in incidence rates of children in the Russian Federation, the increase in the number of chronic diseases and combined forms, increasing the number of children with disabilities. Growth of incidence is noted practically on all classes of diseases. The number of absolutely healthy children doesn’t exceed now 2–4%. In article the analysis of incidence of the children’s population according to negotiability to out-patient and polyclinic establishments of St. Petersburg is carried out.

Insecticide-Treated Plastic Sheeting for Emergency Malaria Prevention and Shelter among Displaced Populations: An Observational Cohort Study in a Refugee Setting in Sierra Leone

A double-blind phase III malaria prevention trial was conducted in two refugee camps using pre-manufactured insecticide-treated plastic sheeting (ITPS) or untreated polyethylene sheeting (UPS) randomly deployed to defined sectors of each camp. In Largo camp the ITPS or UPS was attached to inner walls and ceilings of shelters, whereas in Tobanda the ITPS or UPS was used to line only the ceiling and roof. In Largo the Plasmodium falciparum incidence rate in children up to 3 years of age who were cleared of parasites and monitored for 8 months was 163/100 person-years under UPS and 63 under ITPS (adjusted odds ratio [AOR] = 0.40, 95% confidence interval [CI] = 0.33–0.47). In Tobanda incidence was 157/100 person-years under UPS and 134 under ITPS (AOR = 0.85, 95% CI = 0.75–0.95). Protective efficacy was 61% under fully lined ITPS and 15% under roof lined ITPS. Anemia rates improved under ITPS in both camps. This novel tool proved to be a convenient, safe, and long-lasting method of malaria control when used as a full shelter lining in an emergency setting.

The association between Acute Lymphoblastic Leukemia in children and Helicobacter pylori as the marker for sanitation

BackgroundGreaves “delayed infection” hypothesis suggested that Acute Lymphoblastic Leukemia (ALL) in children is caused by a lack of exposure to infection in infancy, which may be due higher standards of sanitation. We have conducted an ecologic analysis of the relationship between sanitation, using Helicobacter pylori (H. pylori) as the marker, and the incidence of childhood ALL in 127 cancer registries from 28 countries.ResultsThere were inverse associations between H. pylori prevalence and ALL incidence rates in children. These associations were minor and only significant for ALL incidence rates for all cancer registries. They became non-significant and smaller in magnitude when the population source and/or the GNP per capita were added to the relationship. Furthermore, these results were unchanged when the associations were examined using the Generalized Estimating Equations.ConclusionsAlthough the findings showed lower prevalence of H. pylori and improved sanitation is associated with increased incidence of childhood ALL, they do not conclusively support Greaves “delayed infection” hypothesis.

Lymphoma subtype incidence rates in children and adolescents: First report from Brazil

BackgroundLymphoma is the third most common pediatric malignancy. The purpose of this study was to analyze the incidence rates of lymphoma in children and adolescents in Brazil. MethodsAll cases of Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and Burkitt lymphoma (BL) were extracted from 14 population-based cancer registries (PBCRs) from 2000 to 2005, and included children and adolescents 0–19 years old. Analyses included age-adjusted incidence rates (AAIRs) and age-specific incidence rates (ASIRs) by each PBCR. A social exclusion index (SEI) was built and used as proxy for socioeconomic status (SES) levels. Correlations between SES and incidence rates were investigated using Spearman's test. ResultsThe median incidence of lymphoma was 22.7/million. AAIRs of lymphomas varied from 12.9 (Salvador) to 34.5 per million (São Paulo). Median AAIR was 8.8/million, 9.8/million, and 2.9/million for NHL, HL, and BL, respectively. In all PBCRs except that of Recife, AAIR was slightly higher in males than females. The median ASIR was highest for HL (18.5/million) at 15–19 years for both genders. For NHL there were two peaks for ASIR: 11.1/million (1–4 years of age) and 13.2/million (15–19 years of age). The median ASIR for BL was highest among children aged 1–4 years (4.7/million) and in males. Higher SEI correlated with higher incidence of HL (P=0.06), whereas rates of NHL and BL did not correlate with SEI. Borderline different incidence rates were observed in HL correlated with cities with higher SEIs. ConclusionIncidence rates of lymphomas in Brazil do not differ compared to rates reported worldwide, although SES differences deserve further investigation.

Incidence of acute rheumatic fever in New Zealand children and youth

To estimate acute rheumatic fever (ARF) incidence rates for New Zealand children and youth by ethnicity, socioeconomic deprivation and region. National hospital admissions with a principal diagnosis of ARF (ICD9_AM 390-392; ICD10-AM I00-I02) were obtained from routine statistics and stratified by age, ethnicity, socioeconomic deprivation index (NZDep2006) and District Health Board (DHB). The mean incidence rate for ARF in 2000-2009 peaked at 9 to 12 years of age. Incidence rates for children 5 to 14 years of age for Māori were 40.2 (95% confidence interval 36.8, 43.8), Pacific 81.2 (73.4, 89.6), non-Māori/Pacific 2.1 (1.6, 2.6) and all children 17.2 (16.1, 18.3) per 100 000. Māori and Pacific incidence rates increased by 79% and 73% in 1993-2009, while non-Māori/Pacific rates declined by 71%. Overall rates increased by 59%. In 2000-2009, Māori and Pacific children comprised 30% of children 5-14 years of age but accounted for 95% of new cases. Almost 90% of index cases of ARF were in the highest five deciles of socioeconomic deprivation and 70% were in the most deprived quintile. A child living in the most deprived decile has about one in 150 risk of being admitted to the hospital for ARF by 15 years of age. Ten DHBs containing 76% of the population 5 to 14 years of age accounted for 94% of index cases of ARF. ARF with its attendant rheumatic heart disease is an increasing public health issue for disadvantaged North Island communities with high concentrations of Māori and/or Pacific families.

The Genetics of Osteosarcoma

Osteosarcoma is a primary bone malignancy with a particularly high incidence rate in children and adolescents relative to other age groups. The etiology of this often aggressive cancer is currently unknown, because complicated structural and numeric genomic rearrangements in cancer cells preclude understanding of tumour development. In addition, few consistent genetic changes that may indicate effective molecular therapeutic targets have been reported. However, high-resolution techniques continue to improve knowledge of distinct areas of the genome that are more commonly associated with osteosarcomas. Copy number gains at chromosomes 1p, 1q, 6p, 8q, and 17p as well as copy number losses at chromosomes 3q, 6q, 9, 10, 13, 17p, and 18q have been detected by numerous groups, but definitive oncogenes or tumour suppressor genes remain elusive with respect to many loci. In this paper, we examine studies of the genetics of osteosarcoma to comprehensively describe the heterogeneity and complexity of this cancer.

Clinical epidemiological characteristics of unintentional injuries among children

Objective To analyze the epidemiological characteristics of unintentional injuries among children patients at age of ≤ 14 years so as to provide scientific basis for prevention of the children injury. Methods ICD-10 coding was used to retrospectively analyze the epidemiological characteristics of the children patients with unintentional injuries at age of ≤ 14 years admitted from January to December 2009 and the factors affecting the prognosis were discussed. Results There were 3011 patients, with 1991 males (66.12%) and 1 020 females (33.88%). The patients at ages of < 1, 1-4, 5-9 and 10-14 years accounted for 8.24%, 53.30%, 27.90% and 10.56% respectively. The patients from the rural and urban areas accounted for 56.16% and 43.84% respectively. Trauma was the leading sort of injuries in four age groups, accounting for 70.56%, 62.68%, 89.64% and 87.74% respectively. Fall from height was the first cause of unintentional injuries in four age groups, with proportion for 47.58%,36.39%, 51.90% and 56.29% respectively. Muhinomial logistic regression analysis revealed that hospital stay, therapeutic mode ( operation/non-operation), inhabitancy ( urban/rural), causes of injuries and injury severity on admission were the risk factors affecting the prognosis (P < 0.05 ). The rural areas caused higher risk of disability than the urban areas ( OR = 2. 170 ,P < 0.01 ) and non-operation produced higher risk of death than operation (OR = 6.352,P < 0. 01 ). Conclusions The male patients with unintentional injury are more than the female ones, with the highest incidence rate in children at age of 1-4years. Trauma is the main kind of unintentional injury and the fall from height the leading cause of injury.The difference of the rural and urban areas indicates that correct choice of the preventive measures based oh the condition of the local area can attain effective prevention and control of the unintentional injuries. Key words: Child; Epidemiology; Unintentional injuries

Assessing the impact of malaria interventions on morbidity through a community-based surveillance system

The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment in rural Tanzania with a set of integrated interventions targeting both users and providers. The aim of this article is to evaluate the programme's impact on the community and health facility burden of malaria and to investigate the value of community-based reporting for routine malaria control programme monitoring. This work was implemented within the Ifakara Demographic Surveillance System (DSS) between 2004 and 2008. At community level the DSS staff routinely collected data on reported history of fever and severe malaria (convulsions) based on a 2-week recall. In parallel, we collected in-patient and out-patient fever and malaria diagnoses data from the 15 health facilities in the area. Treatment-seeking surveys conducted in the study area and nationally representative data were used to validate our measure of community fever. Between 2005 and 2008, community-reported fever incidence rates in children under the age of 5 years declined by 34%, from 4.9 to 3.2 average cases per child per year, whereas convulsions, a marker of severe malaria morbidity in children, decreased by 46%, from 4263 to 2320 cases for every 100,000 children per year. The decrease in the community rates was paralleled by a decrease in the health facility fever rates, although the number of fever cases seen in health facilities did not change because of population growth. Our data showed very good internal and external consistency with independent local and national surveys. There is an evidence of a substantial decline in the community burden of malaria morbidity between 2005 and 2008 in the Kilombero and Ulanga DSS areas in Tanzania, most likely as a result of malaria control efforts. The good internal and external consistency of the data shows that history of fever in the previous 2 weeks in children under the age of 5 years can be used as a morbidity monitoring tool.

Abstract 913: 5,10-Methylenetetrahydrofolate reductase C677T allele frequency and childhood leukemia incidence in predominantly European ancestry countries

Abstract 5,10-Methylentetrahydrofolate reductase (MTHFR) single nucleotide polymorphisms (SNPs) have been intensely studied as cancer susceptibility alleles. For childhood leukemia, data have indicated that the most commonly studied MTHFR SNP, C677T, is associated with a slightly reduced risk of acute lymphoblastic leukemia (ALL). Both childhood leukemia incidence and MTHFR allele frequencies show variation worldwide. Our objective was to conduct an ecologic study to determine whether the MTHFR C677T allele frequency and childhood leukemia incidence are associated. We used cancer incidence data collected by the International Agency for Cancer Research from 22 registries that captured 19,025 leukemia cases diagnosed between the ages of 0 and 14 years from the United States, Canada, Australia, and 18 European countries; data were restricted to registries with majority European ancestry populations in order to minimize confounding by ancestry. MTHFR allele frequencies were gathered from the literature to match as closely as possible the registry populations. We modeled the association between childhood leukemia incidence and MTHFR C677T allele frequency using Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Estimates of the minor C677T allele frequency ranged from 24% in Finland to 44% in Italy. There was a weak inverse correlation between leukemia incidence and MTHFR C677T allele frequency (r=0.19), that was stronger for ALL (r=0.30). Acute nonlymphoblastic leukemia (ANLL) incidence was positively correlated with MTHFR C677T allele frequency (r=0.36). Poisson regression results from linear models showed that the incidence of childhood leukemia decreased by 5% (95% CI 3%-6%) for every 5% increase in the C677T allele frequency. A similar pattern was observed for ALL with a RR of 0.93 (95% CI=0.92-0.95) but not acute non-lymphoblastic leukemia (ANLL) (RR=1.04, 95% CI=1.00-1.07). The significant inverse associations between the C677T allele frequency and leukemia and ALL incidence were specific to incidence rates for children diagnosed &amp;lt;10 years. These results are consistent with the results of case-control studies of the association between childhood leukemia and MTHFR allele frequency suggesting a modest risk reduction in association with the C677T allele. The strengths and limitations of ecological vs. case control study designs will be discussed in the context of these results to provide insight into the causal relationship between the MTHFR minor allele frequency and childhood leukemia risk. This research was supported by NIH grant T32 CA099936. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 913.

Mycobacterium avium avium and Mycobacterium avium hominissuis give different cytokine responses after in vitro stimulation of human blood mononuclear cells

Mycobacterium avium belongs to a group of over 130 species of non-tuberculous mycobacteria (NTM) or environmental mycobacteria. The subspecies Mycobacterium avium avium was originally described as the causative agent of bird tuberculosis, but was later found to cause disease also in humans. Small children display a special form of infection that is seldom detected in other age groups. It manifests as a chronic lymphadenitis usually in the head and neck region. The incidence rate is approximately 1-5/100,000 children/year. However, exposure to this bacterium is high as judged by sensitin skin test studies. Even if a lot of persons are infected with M. avium, a majority of them do not develop disease and the bacterium is therefore considered to be of low virulence, causing disease mainly in immunocompromised persons. Children with M. avium lymphadenitis, however, usually do not have any known deficiencies in the immune system. This thesis elucidates why small children are prone to develop disease by M. avium. Investigation of a possible zoonotic spread of this bacterium to children involved analysis and comparison of different strains isolated from birds and other animals and from children, using the restriction fragment length polymorphism (RFLP) method on insertion sequence IS1245, resulting in the finding that the children were infected exclusively with the new proposed subspecies M. avium hominissuis. Animals in general and birds in particular were infected with the subspecies M. avium avium (using the more narrow definition). Moreover, when investigating the immunological response of human peripheral blood mononuclear cells (PBMCs) to stimulation with M. avium hominissuis and M. avium avium, respectively, it was found that the former subspecies induced lower IFN-γ and IL-17 than the latter, but higher levels of Il-10, which might contribute to explain the higher pathogenicity of M. avium hominissuis in humans. Through studies of the geographical distribution of cases of M. avium infection in children in Sweden and the seasonal variation of the disease, a fluctuation of the incidence over the year was detected, with higher numbers of cases in the autumn months and lower numbers in the late spring. There was a higher incidence rate in children living close to water than in those living in the inland or in the urban areas. Therefore, outdoor natural water is the most probable source of infection in children with M. avium lymphadenitis. Through a descriptive clinical retrospective study, complete surgical removal of the affected lymph node was found to lead to better results than treatment by incision and drainage of abscess or expectation only. Finally there might be several explanations as to why an individual develops disease after infection with M. avium, such as, exposure, bacterial virulence factors or possible specific deficiencies of the immune system of the host or a combination of these factors. Which are the more important factors regarding children with M. avium lymphadenitis is still an open question.

Caregivers' Perspectives on Barriers to Transcranial Doppler Screening in Children with Sickle Cell Disease.

Abstract 2473Poster Board II-450 Introduction:Children with HbSS or HbSβothalassemia have an 11% risk of stroke before the age of 20 without intervention. Transcranial Doppler ultrasonography (TCD) has been instrumental in detecting children with sickle cell disease (SCD) at high risk of stroke. Yearly TCD screenings are recommended for children with HbSS or HbSβothalassemia between the ages of 2 and 16 years. However, annual TCD compliance rates are very low. Our objective was to complete a qualitative, descriptive analysis of caregiver understanding, opinions, and barriers to their child's annual TCD screenings. Methods:The study consisted of interviewing 28 caregivers of children diagnosed with HbSS or HbSβothalassemia. The interviews were structured around a Health Belief Model (HBM) framework. The HBM describes the interaction of perceived susceptibility, perceived severity, perceived barriers, perceived benefits, cues to action, self-efficacy, demographic factors, and psychosocial factors which together produce the likelihood that an individual will take a recommended health action. The interviews consisted of both open response questions and Likert scale type questions where the caregiver agreed (“5”) or disagreed (“1”) with a statement. Topics covered during the interview included caregiver knowledge of TCD, adherence to screening guidelines, perceived susceptibility of their child to stroke, barriers that may prevent annual TCD screenings, perceived benefits to screening, and self-efficacy. The interviews were audio recorded and were later transcribed and coded. Common themes were extracted from the transcriptions. Results:61% of the interviewed caregivers reported that their child underwent a TCD in the past year. Many caregivers perceived their child as being at high risk for stroke, as over 60% thought that stroke occurred either “sometimes” or “frequently” in children with SCD. All of the interviewed caregivers saw benefits to TCD screening. We identified seven categories of barriers expressed by caregivers: lack of knowledge, lack of self-efficacy, fear, financial barriers, transportation barriers, missed appointments, and hours of radiology clinic. Three of the most frequently mentioned barriers included lack of knowledge, lack of self-efficacy, and fear of chronic transfusions. Lack of knowledge was reported to be a barrier by 32% of caregivers who reported having very limited knowledge about TCD testing or that they had forgotten the information previously provided to them. 46% of caregivers did not know that TCD screening was an annual test, and only one of the 28 caregivers knew that chronic transfusions would result if the TCD was consistently abnormal. Additionally, only one caregiver knew the age recommendations for screening. Caregivers also seemed to lack self-efficacy, as 18% of caregivers believed they had no role in stroke prevention and 50% did not realize that they could request that their doctor order an annual TCD test. Many caregivers (29%) believed that chronic transfusions could cause their child a lot of problems. Less frequently cited barriers included financial barriers, transportation barriers, missed appointments, and daytime/weekday hours of radiology clinic. Conclusions:The most commonly encountered barrier to TCD screening described by caregivers was the lack of knowledge of the purpose and recommendations for TCD screenings. We propose that health care providers provide ongoing education at each visit to caregivers regarding stroke risk, TCD screening, and the current recommendations for children with SCD. Some of the barriers identified in this study can easily be addressed to increase TCD compliance rates and decrease stroke incidence rates in children with SCD; for example, offering night and weekend radiology hours or identifying transportation issues prior to a TCD appointment and providing transportation when needed. Educating caregivers on the risks and benefits of chronic transfusions in stroke prevention could also prove beneficial in reducing caregiver fear of chronic transfusions. Strengthening the therapeutic alliance between the caregiver, child, and health care team is essential in order to increase caregiver compliance and self-efficacy with TCD screenings and decrease stroke incidence in children with SCD. Disclosures:No relevant conflicts of interest to declare.

Epidemiological characteristics of pertussis in Estonia, Lithuania, Romania, the Czech Republic, Poland and Turkey-1945 to 2005.

Pertussis epidemiology was examined in selected Central and Eastern European countries andTurkey (CEEs) from 1945 to 2005. Epidemiology and immunisation coverage data were collected fromNational Health Departments and Epidemiology Institutes. Pertussis diagnosis was made by the World Health Organization (WHO) clinical criteria, laboratory confirmation and/or epidemiological link, except for Romania (WHO clinical case definition used). In the pre-vaccine era, pertussis incidence (except Turkey) exceeded 200/100,000 (range180-651/100,000), with 60-70% of cases occurring in pre-school children. Until 2007, a second-year booster was givenin Estonia, Lithuania and Turkey, and an additional pre-school booster elsewhere. During 1995-2005, immunisation coverage by the age of 2 years exceeded 80% (range 80-98%) and, excluding Estonia, pertussis incidence was <3/100,000. Age-specific incidence rates rose in 5-14 year olds in Poland, Estonia and the Czech Republic. Incidence rates in children <1 year of age remained unchanged. There were two age distribution patterns. In the Czech Republic and Estonia, 16% of cases occurred in pre-school children and 17% and 22% in children >15 years of age, respectively; in Romania, Turkey and Lithuania, 51%, 71% and 73%, respectively, occurred in pre-school children and <7% in children aged >15 years.Pertussis infection persists, despite high immunisation coverage. Compared with the pre-vaccine era, the age distribution changed differentially in CEEs, with an apparent shift towards older children.

S17. Cancer prevention by vaccination against hepatitis B

Chronic inflammation caused by persistent infection is closely related to a number of cancers; these include hepatitis B (HBV) or C and hepatoma, human papilloma virus and cervical cancer, and Helicobacter pylori and gastric cancer. The first evidence of cancer prevention by vaccination in humans was provided by HBV vaccination in infants. Chronic HBV is related to approximately 60%–90% of hepatocellular carcinomas (HCC) in adults and nearly 100% of childhood HCC in areas endemic for HBV infection. The first universal HBV vaccination program was launched in Taiwan and has continued for more than 20 years. Three or four doses of HBV vaccine were given to all infants starting from the first week of life. In addition, infants of high-risk mothers (with positive hepatitis B e antigen or high HBsAg titers) were given hepatitis B immunoglobulin within 24 h after birth. At 20 years after the launch of the HBV vaccination program in Taiwan, chronic HBV infection (HBsAg seropositive) rates in the general population below 20 years of age have revealed a remarkable reduction from 10%–17% before the vaccination program to 0.7%–1.7% after the program. HCC incidence rate in children 6–14 years old also fell from 0.52–0.54 to 0.13–0.20 per 100,000 (R.R.=0.25–0.36). HCC prevention failure is mainly related to vaccine failure to prevent chronic HBV infection. The causes of vaccine failure have included intrauterine infection, vaccine escape mutants, genetic hyporesponsive-ness, and poor compliance. Future efforts to reduce vaccine failure will improve the efficacy of liver cancer prevention by HBV vaccination. The experience of HCC prevention by HBV immunization may be applied to the prevention of other infection-related cancers.

Malaria incidence and efficacy of intermittent preventive treatment in infants (IPTi)

BackgroundIntermittent preventive antimalarial treatment in infants (IPTi) is currently evaluated as a malaria control strategy. Among the factors influencing the extent of protection that is provided by IPTi are the transmission intensity, seasonality, drug resistance patterns, and the schedule of IPTi administrations. The aim of this study was to determine how far the protective efficacy of IPTi depends on spatio-temporal variations of the prevailing incidence of malaria.MethodsOne thousand seventy infants were enrolled in a registered controlled trial on the efficacy of IPTi with sulphadoxine-pyrimethamine (SP) in the Ashanti Region, Ghana, West Africa (ClinicalTrial.gov: NCT00206739). Stratification for the village of residence and the month of birth of study participants demonstrated that the malaria incidence was dependent on spatial (range of incidence rates in different villages 0.6–2.0 episodes/year) and temporal (range of incidence rates in children of different birth months 0.8–1.2 episodes/year) factors. The range of spatio-temporal variation allowed ecological analyses of the correlation between malaria incidence rates, anti-Plasmodium falciparum lysate IgG antibody levels and protective efficacies provided by IPTi.ResultsProtective efficacy of the first SP administration was positively correlated with malaria incidences in children living in a distinct village or born in a distinct month (R2 0.48, p < 0.04 and R2 0.63, p < 0.003, respectively). Corresponding trends were seen after the second and third study drug administration. Accordingly, IgG levels against parasite lysate increased with malaria incidence. This correlation was stronger in children who received IPTi, indicating an effect modification of the intervention.ConclusionThe spatial and temporal variations of malaria incidences in a geographically and meteorologically homogeneous study area exemplify the need for close monitoring of local incidence rates in all types of intervention studies. The increase of the protective efficacy of IPTi with malaria incidences may be relevant for IPTi implementation strategies and, possibly, for other malaria control measures.

Medical Presentation of Constipation From Childhood to Early Adulthood: A Population-Based Cohort Study

Constipation is a common disorder in children and adults, but the role of gender and early life risk factors remains undefined. The aims of the study were as follows: (1) to estimate the incidence of medical presentation for constipation in a population-based birth cohort, and (2) to examine factors associated with constipation presentation from childhood to adulthood. A birth cohort of all children born between 1976 and 1982 to mothers who were residents of Rochester, Minnesota, and who remained in the community until age 5 was used for this study. Medical visits for constipation were identified by diagnoses codes and chart review. Subjects were followed up based on their diagnoses accumulated while younger than 21 years old, and 80% of subjects remained in the area until 18 years of age. Of 5299 birth cohort members without constipation presentation before age 5, the overall age- and sex-adjusted incidence was 3.9 per 1000 person-years. A higher incidence for constipation in females occurred beginning at 13 years to early adulthood (rate ratio, 2.6 for 13-16 y and 4.2 for 17 to <21 y). Children with a diagnosis for constipation at younger than 5 years of age had a significantly higher incidence for subsequent medical visits for constipation through adolescence and early adulthood compared with the incidence rate of children without an early medical presentation (rate ratio, 4.5 for 5-8 y, 2.5 for 9-12 y, and 3.9 for 17-20 y). Early medical presentation and female sex influence incident and repeat medical visits for constipation from childhood to early adulthood.

EFFECTIVENESS OF PNEUMOCOCCAL CONJUGATE VACCINE IN GREATER VANCOUVER, CANADA: 2004–2005

Active, population-based surveillance for invasive pneumococcal infections in Greater Vancouver (population 473,000 children) demonstrated a rapid, substantial decrease in incidence rates for children 6-23 months old with routine infant vaccination. In the subpopulation with best case ascertainment disease rates for 6-23 month olds decreased 84.6% (92.5% for vaccine serotypes).

Steep increase of incidence of childhood diabetes since 1999 in Austria. Time trend analysis 1979–2005. A nationwide study

In a prospective population-based incidence study all newly diagnosed type 1 diabetic patients 0-<15 years of age were registered by the Austrian Diabetes Incidence Study Group. The nationwide incidence of type 1 diabetes between 2000-2005 was compared with the previously published incidence rates. Long-term trends as well as seasonal trends were estimated by Poisson regression models. A total of 3,599 incident cases (1,908 boys; 1,691 girls) were identified. Case ascertainment was >92%. The overall incidence rate doubled from 7.3 (95% CI; 6.8-7.9)/100,000 in the period 1979-84 to 14.6 (95% CI, 13.7-15.4)/100,000 in the time period 2000-2005. A significant increase during the observation period of 26 years could be demonstrated in all age groups and both sexes (p<0.01), with the steepest increment during the last 5 years. Until 1994 the incidence rate in children 0-<5 years was rather stable, but afterwards increased dramatically with 9.2% (95% CI, 5.2-13.4) annually. Despite this steep increase in time trend, we did not observe a seasonal variation in this age group (0-<5) in contrast to significant seasonal variations in the groups 5-<10 and 10-<15 years of age. Over the past 26 years incidence of type 1 diabetes in childhood increased clearly in Austria. The steepest rise was observed in the last 5 years and in the younger age groups.