Nonimmune Children Research Articles

Analysis of Contributing Factors to Stunting in Poso Regency: A Perspective from the Special Stunting Handling Index

Introduction: The prevalence of stunting in children in Indonesia, including Poso Regency, remains relatively high despite a decrease in recent years. This study aims to analyze factors associated with stunting in Poso Regency. Methods: This study employed a cross-sectional analytical method with a sample size of 250 mothers and their children under 2 years old, using structured questionnaires and direct measurements to collect data. Univariate analysis, chi-square tests and binary logistic regression were performed with a final report of adjusted odds ratios (AORs) and 95% confidence intervals (CI). All of the analyses used Stata version 15. Results: Results indicate a significant association between stunting and the child's gender, maternal education, immunization, and breastfeeding. Boys face a 2.3 times higher risk of stunting, while children of mothers with primary education have a 4.7 times higher risk compared to those with higher education. Non-immunized and non-breastfed children also exhibit significantly higher stunting risks. Conclusion: The study underscores the impact of factors such as the child's sex, maternal education, immunization, and breastfeeding on stunting in Poso Regency. The study emphasizes the need for targeted educational programs by healthcare professionals, policy-driven nutritional support initiatives, and community-based awareness campaigns to effectively address stunting in Poso Regency.

Cluster sampling methodology to evaluate immunization coverage.

Immunization is a key component of primary health care and an indisputable human right. Vaccines are critical to the prevention and control of infectious disease outbreaks. The coronavirus disease 2019 (COVID-19) pandemic and associated disruptions over the past two years have strained the health systems, with many children missing out on essential childhood vaccines. To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre (CHC) Dighal and to determine the factors influencing the existing immunization coverage. A coverage evaluation survey was conducted according to the 30-cluster sampling technique, which is the standard methodology for such surveys devised by World Health Organization. A total of 300 children aged 12-23 months were included, whose immunization details were noted from their immunization cards. Full immunization rate was noted in 86.7% of the children, with partial and non-immunized children accounting for 9% and 4.3% respectively. The full immunization dropout rate was 4.2%. The common reasons for partial or non-immunization were family problem including illness of mother, vaccine not being available and child being ill. Place of birth (P = 0.014) and availability of immunization card (P < 0.001) were significant predictors of the immunization status. Since the study was conducted in 2020/2021, health services were disrupted due to the COVID-19 lockdown. Due to the coverage being higher than the national average, it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.

Determination the Knowledge, Attitudes and Perceptions of Mothers (Caregiver) Towards Immunization of their Children in South Punjab Region of Pakistan

Aim: To assess the knowledge, attitudes and perceptions of mothers (caregiver) towards immunization of their children. Methodology: This community based cross-sectional KAP study was conducted in 15 UCs of south Punjab. Multistage random sampling technique, lottery method and bottleneck method was used to select the tehsils, UCs and households for the study. Households with children between eighteen to twenty-four months of age and Mothers/Caregivers with age between twenty to fifty years were included in the study. The semi-structured questionnaire was used to calculate the knowledge and attitude score of the study participants. Data were analyzed in SPSS version 25. Results: Parents/caregivers had good knowledge (50.80%), moderate knowledge (42.40%) and poor knowledge (6.80%)regarding routine immunization. Also, parents/caregivers had a positive attitude (86.40%), neutral attitude (8.70%) and negative attitude (4.90%).The majority of children (67.40%) were fully immunized followed by partially immunized children (25.80%) and non-immunized children (6.80%). Conclusion: The study concluded that parents were well aware regarding immunization and its health-related outcomes and showed positive attitude towards immunization. Majority of the children were completely immunized for all the childhood vaccine preventable diseases and the ratio of non-immunized children was very low as compared to completely and partially immunized population have awareness regarding immunization. Keywords: Knowledge, attitude, practice, Southern Punjab, Pakistan, Developing Country

Determinants of immunization status among 12-24 months old children in Ethiopia: Using 2019 Ethiopian mini demographic and health survey data.

Vaccination is a global success story, one of the most effective and successful health interventions for health and development, saving the lives of millions of children every year. In 2018, nearly 870,000 Ethiopian children did not receive the life-saving measles, diphtheria, and tetanus vaccines. This study aimed to determine what factors influence children's immunization status in Ethiopia. Immunization status was examined in a sample of 1843 children aged 12-24 months using data from the 2019 Ethiopian Mini Demographic and Health Survey 2019. The study used percentages to show the prevalence of immunization status among children. The marginal likelihood effect was used to determine the impact of each category of the explanatory variable on one response category of immunization status. Ordinal logistic regression models were constructed, and the best-fitting model was selected to identify significant immunization status variables. The immunization prevalence among children was 72.2% (34.2% fully immunized and 38.0% partially immunized), while about 27.8% of children were non-immunized. The fitted partial proportional odds model revealed that child immunization status was significantly associated with region afar (OR = 7.90; CI: 4.78-11.92), family planning use (OR = 0.69; CI: 0.54-0.88), residence (OR = 2.22;CI: 1.60-3.09), antenatal visit (OR = 0.73;CI: 0.53-0.99), and delivery place (OR = 0.65;CI: 0.50-0.84). Vaccinating children was a significant step forward in improving and protecting child health in Ethiopia, as the proportion of non-immunized children was about 27.8%. The study showed that the prevalence of non-immunization status among rural children was 33.6% and about 36.6% among children from non-educated mothers. As a result, it is agreeable that treatments are better to focus on targeting essential childhood vaccinations by promoting maternal education about family planning, antenatal visits, and maternal access to health care.

Чaстота носительства S. pneumoniae у организованных детей г. Ханты-Мансийска

Aim: to assess the landscape of pneumococcus serotypes among children organized in kindergarten groups in Khanty-Mansiysk city. Patients and Methods: the study included 510 children (2-6 years old) attending kindergartens in Khanty-Mansiysk city. The children were divided into 2 groups: vaccinated (n=50) and non-vaccinated against pneumococcal infection (n=460). The data on vaccination status were received from the prophylactic immunization records (Form 063/u) and child's medical records (Form 112/u). In addition, the following data were analysed: age, gender, gestation age at birth, attitudes of child's legal representatives towards vaccinations, and the presence of chronic health problems. Pneumococcal polysaccharide conjugate adsorbed 13-valent vaccine (PCV-13) was used for the prevention of pneumococcal disease. Nasopharyngeal swabs were collected from children as a source of biological material. The pneumococcus was detected using a culture-based method and PCR assay. Results: the average age of organized children examined in Khanty-Mansiysk for Streptococcus pneumoniae (S. pneumoniae, pneumococcus) was 54.31 [53.46–55.16] months. In 56% of the examined children, pneumococcal DNA was found in nasopharyngeal swabs by polymerase chain reaction assay. The identified serotypes in 71.1% of cases were the same as in the PCV13 vaccine formulation. The most common serotypes detected were 4 (27%), 19 F (13.3%), 23 F (3.6%) and serogroup 6 (11.6%). In children immunized against S. рneumoniae, the pneumococcal strain DNAs, same as the vaccine strain DNAs, were found in 53.7% of cases, while in non-immunized children — in 73% of cases (OR 0.54, 95% CI 0.29–0.97). Conclusion: the increasing prevalence of S. рneumoniae carriage in children as they get older and attend organized children's groups for a longer time, along with the predominance within the population of the same pneumococcus strains as those in the vaccine formulation, dictate the need for timely immunization against pneumococcal infection in compliance with the National Vaccination Schedule (vaccination at 2 and 4.5 months of age, revaccination at 15 months of age). KEYWORDS: children, pneumococcal infection, S. pneumoniae, vaccination, pneumococcal conjugate vaccine, children in organized groups, carriage. FOR CITATION: Girina A.A., Petrovsky F.I., Petrovskaya Yu.A., Zaplatnikov A.L. Prevalence of S. pneumoniae carriage among children organized in kindergarten groups in Khanty-Mansiysk city. Russian Journal of Woman and Child Health. 2023;6(2):164–168 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-164-168.

Determinants of Immunization Status Among 12-24 Months Old Children in Ethiopia: Using 2019 Ethiopian Mini Demographic and Health Survey Data

Background: Vaccination is a global success story, one of the most effective and successful health interventions for health and development, saving the lives of millions of children every year. In 2018, nearly 870,000 Ethiopian children did not receive the life-saving measles, diphtheria, and tetanus vaccines. This study aimed to determine what factors influence children's immunization status in Ethiopia. Methods: Immunization status was examined in a sample of 1843 children aged 12-24 months using data from the 2019 Ethiopian Mini Demographic and Health Survey 2019. Percentages were used to show the prevalence of immunization status among children. The marginal likelihood effect was used to determine the impact of each category of the explanatory variable on one response category of immunization status. Ordinal logistic regression models were constructed, and the best-fitting model was selected to identify significant immunization status variables. Results: The prevalence of immunization status among children was found to be 72.2% (34.2% fully immunized and 38.0% partially immunized), while about 27.8% of children were non-immunized. The fitted partial proportional odds model revealed that child immunization status was significantly associated with region afar (OR = 7.90; CI: 4.78-11.92), family planning use (OR = 0.69; CI: 0.54-0.88), residence (OR = 2.22;CI: 1.60-3.09), antenatal visit (OR = 0.73;CI: 0.53-0.99), and delivery place (OR = 0.65;CI: 0.50-0.84). Conclusions: Vaccinating children was a significant step forward in improving and protecting child health in Ethiopia. The study showed that the prevalence of non-immunized children varied between rural (33.6%) and uneducated mothers (36.6%). As a result, it is agreeable that treatments are better to focus on targeting essential childhood vaccinations by promoting maternal education, antenatal visits, and maternal access to health care.

Severe imported malaria involving hyperparasitemia (≥ 10%) in non-immune children: Assessment of French practices

BackgroundPlasmodium falciparum hyperparasitemia (over or equal to 10%), isolated or associated with other severity criteria, should be managed in a pediatric intensive care unit according to the French pediatric guidelines. The main objective of our study was to describe the management and course of these special cases. Population and methodsWe conducted a retrospective study in eight French hospital facilities from January 2007 to December 2014. We reviewed the management of non-immune children aged 0–15 years, assessing the following: clinical and paraclinical data, type of care unit, treatment initiated, initial and long-term course. Data were analyzed for the whole population and for two groups according to the place of first-line management: group A (in pediatric intensive care unit), and group B (other places). ResultsA total of 61 children were included, 14 (23%) of whom were initially admitted to the intensive care unit (group A), all with neurological or hemodynamic disorders. Only 23 children (38%) overall received intravenous antimalarial treatment and the other patients received exclusively oral treatment. No deaths were reported. Median parasitemia was comparable in the two groups. In group B (n = 47/61, 77%), isolated hyperparasitemia, jaundice, and renal failure were predominant. The children who underwent initial intravenous treatment (n = 5/47, 11%) all progressed favorably, as did 92% of the children who received oral treatment (n = 42/47, 89%). ConclusionA majority of children with Plasmodium falciparum hyperparasitemia were managed outside the pediatric intensive care unit via the oral route, against the French pediatric guidelines except when neurologic or hemodynamic disorders were present. Initial clinical evaluation and hospital supervision are essential for the best management of these patients.

BNT162b2 Vaccine-Associated Myo/Pericarditis in Adolescents: A Stratified Risk-Benefit Analysis.

BackgroundMale patients ages 12–17 years have an elevated risk of mRNA vaccination‐associated myo/pericarditis. A risk‐benefit analysis of first and second doses of mRNA vaccination in adolescent boys by health status and history of SARS‐CoV‐2 infection has not been performed.MethodsUsing the Vaccine Adverse Event Reporting System (VAERS), we identified BNT162b2 [Pfizer‐BioNTech] myo/pericarditis occurrence according to CDC criteria. Main outcomes were as follows: 1) post‐vaccination myo/pericarditis crude incidence in adolescents aged 12–15 and 16–17; and 2) two risk‐benefit analyses by age, sex, comorbidity, variant and history of infection.ResultsCases of myo/pericarditis (n = 253) included 129 after dose 1 and 124 after dose 2; 86.9% were hospitalized. Incidence per million after dose two in male patients aged 12–15 and 16–17 was 162.2 and 93.0, respectively. Weighing post‐vaccination myo/pericarditis against COVID‐19 hospitalization during delta, our risk‐benefit analysis suggests that among 12–17‐year‐olds, two‐dose vaccination was uniformly favourable only in nonimmune girls with a comorbidity. In boys with prior infection and no comorbidities, even one dose carried more risk than benefit according to international estimates. In the setting of omicron, one dose may be protective in nonimmune children, but dose two does not appear to confer additional benefit at a population level.ConclusionsOur findings strongly support individualized paediatric COVID‐19 vaccination strategies which weigh protection against severe disease vs. risks of vaccine‐associated myo/pericarditis. Research is needed into the nature and implications of this adverse effect as well as immunization strategies which reduce harms in this overall low‐risk cohort.

Diphtheria in Children- A Clinical Profile of Cases during an Outbreak in Kerala, India

Introduction: Diphtheria is an acute potentially fatal infectious disease caused by the toxigenic strains of Corynebacterium diphtheriae. Acute respiratory obstruction, toxic myocarditis and neurologic weakness are the most important complications of diphtheria. The clinical presentation and severity of diphtheria vary in immunized and non-immunized children. Early diagnosis and prompt treatment including administration of diphtheria antitoxin and antibiotics minimize mortality. Aim: To observe the changing trends in the clinical presentation of diphtheria during the 2016 outbreak and its association with immunization status and antitoxin administration. Materials and Methods: This Longitudinal prospective study conducted among children admitted to Government Medical College, Kozhikode, Kerala, a tertiary care centre with a diagnosis of diphtheria during January 2016 to December 2016. Details of socio-demographic data, clinical presentation, investigations, immunization status, treatment and complications were collected using a semi-structured performa. These children were managed by an interim guideline provided by the state authorities. They were followed-up for 3 months. The data was analyzed using Statistical Package for Social Sciences (SPSS), version 18.0. Results: Among 76 children, 62(82%) were from Malappuram and Kozhikode districts, which have relatively low immunization coverage. Most admissions were in July 2016. Majority (58, 76.3%) of children belonged to Muslim community. The mean age was 8.1 years with male to female ratio 1.53:1. Most of the children (47, 62%) were unimmunized or partially immunized. Cultures were positive for C. diphtheriae in 20 children. Complications were noted in 36 children, which included asymptomatic myocarditis in 31, symptomatic myocarditis in one, palatal palsy in nine, loss of accommodation in four and distal weakness in five. Only one child who received antitoxin within 72 hours of disease onset developed neurological complications. Complications were common in children who received less than minimum three doses of diphtheria vaccines compared to those who received three or more doses (54% vs. 44%). There was no mortality. Conclusion: There was an upward shift in age of affected children. Neurological complications were significantly less in those who received antitoxin within 72 hours of disease onset. Regular monitoring helped to detect asymptomatic myocarditis. The outbreak highlighted the need to improve awareness about diphtheria and better vaccination coverage, especially in older children.

Assessment of Factors Associated with Low Measles Vaccine Effectiveness in Honkolo-Wabe District, Ethiopia

Background:-Measles is an acute illness and the most contagious childhood diseases. Almost all non-immune children contract this respiratory disease if exposed to the virus. The disease characterized by prodarmal fever, conjunctivitis, coryza and presence of Koplik spots. Prior to the introduction of vaccination programs, measles affected almost every child in the world. The expected sero conversion was estimated to 80-85% when 0.5ml live attenuated measles vaccine correctly administered subcutaneously at 9 months and more than 95% after 12months. This study was aimed to describe vaccine effectiveness and assess factors contributing to low measles vaccine effectiveness in Honkolo-Wabe district, Ethiopia. Methods:-Community based unmatched case-control study, involving 51 children who had previous measles illness were randomly selected and 153 controls were selected from the community three for each case in July, 2014. Vaccination status and other risk factors for the study children were ascertained through by interviewing mothers /care giver and observing the cold chain management. Epi-info version 7 was used for data analysis. Results:-Measles vaccine effectiveness was estimated at 70.9% [95% CI=65-79%]. Age of measles vaccine given, poor health seeking behavior of the community, number of dose and inappropriate vaccine transportation from district health office to health post, administration of reconstituted vaccine after 6hrs by HEW were identified as the contributing factors for low measles vaccine effectiveness in Honkolo-Wabe district. Contacting with laboratory confirmed or epidemiological linked measles cases statically significant regard to measles [OR=23.77, 95% CI=9.17-64.25]. Of the study participants 19.6%, 44.6% and 3.9% were received one, two and three doses of measles vaccine respectively. About 3.9%, 45.1% and 12.3% of the participants were received first dose of measles vaccination before, at 9month and after nine month respectively. However 18.6% of the study participants were not received 2nd does. Only 35.3% of the participants were received their second doses after 12month their birth. Conclusions:-Measles vaccine effectiveness was low. Age of children, number of dose, inappropriate vaccine transportation and utilization of reconstituted vaccine after 6hrs were contributing factors for low measles vaccine effectiveness. Regular monitoring and ensure of all birth cohort have received at least 2 doses of measles vaccine at 9month of their birth and above. Improve cold chain management at health post and use reconstituted vaccine within 6 hours.

Trends in Urban Immunization Coverage in India: A Meta-Analysis and Meta-Regression.

ObjectivesTo assess the gaps and trends in child immunization coverage among urban and rural areas in India, and compare the success of immunisation program in each.MethodsPubMed, Scopus, and Crossref, and Google Scholar electronic databases were searched on October 9, 2019, and March 21, 2020, for studies that measured and reported immunization coverage indicators in India. Random-effects meta-analyses and meta-regressions were conducted.ResultsThe authors' search identified 545 studies, and 2 were obtained by expert suggestion. Among these 68 studies and 6 surveys were included. They found that full immunization coverage has grown yearly at 2.65% and 0.82% in rural and urban areas, respectively whereas partial immunization coverage declined by −2.44% and −0.69%, respectively. Percentage of nonimmunized children did not show a statistically significant trend in either.ConclusionWhile rural immunization coverage has seen a large increase over the past two decades, the progress in urban areas is weak and negligible. This was largely attributable to a focus on minimizing dropouts in rural areas. However, a lack of significant reduction in unimmunized children may indicate left-out children or pockets in both rural and urban areas. The poor performance of immunization programs in urban areas, coupled with a larger impact of COVID-19, warrants that India urgently adopts urban-sensitive and urban-focused policies and programs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12098-021-03843-0.

Plasmodium falciparum-specific B cell responses in malaria-susceptible children and malaria-immune adults

Abstract Malaria is a vector-borne disease caused by parasites of the Plasmodium genus that infect millions of people annually, with P. falciparum being the most common and deadliest species. Development of immunological protection against clinical malaria requires chronic or repetitive parasite exposure, is mediated by IgG, and is correlated with antibodies against proteins expressed by merozoites, the free form of the parasite that invades erythrocytes. The goal of our study was to better understand the development of this protective antibody response, using merozoite surface protein 1 (MSP1) as a model antigen. MSP1 is highly abundant on the merozoite surface, highly immunogenic, and highly variable between parasite strains. Using B cell tetramers, we isolated MSP1-specific IgM+ and IgG+ memory B cells (MBCs) from immune adults and non-immune children living in Tororo, Uganda, a region of high transmission. In children, MSP1-specific B cells were mainly unswitched (IgM+) classical MBCs (cMBCs; CD21+ CD27+), while adults showed enrichment for class-switched (IgG+) cMBCs. Sequence analysis of the heavy chain variable regions revealed that MSP1-specific MBCs from adults carried higher rates of somatic hypermutation and showed extensive clonal expansion compared to those from children. When expressed as IgG, antibodies from IgM+ MBCs showed low avidity to MSP1, while those from IgG+ MBCs displayed strong reactivity with recombinant MSP1 and whole merozoites and inhibited parasite growth. These results suggest that extensive evolution of B cell responses takes place as a result of life-long P. falciparum exposure, which may be essential for the development of protection against malaria.

“Stick without a Carrot”: An Anthropological Analysis of the Daily Press on Mandatory MMR Immunization in Serbia

The vaccine is considered in academic, foremost medical, but also in political and public discourse as one of the greatest human achievements. Immunization has saved and is saving millions of lives around the world. However, from a historical perspective, immunization was always followed by more or less public resistance due to its alleged negative side-effects, such as outbursts of severe illnesses. A mandatory childhood vaccine against measles, mumps, and rubella (MMR) is part of the current controversy over the harmfulness of vaccines in Serbia. In view of the fact that the media is an important source for transmitting health messages and understanding health issues, the subject of this paper is the media presentation of MMR immunization in Serbia. How was the state health care narrative on MMR immunization presented in the Serbian daily press during the last two measles outbreaks in 2014-2015 and 2017-2018? By using the theoretical “text-context-hypertext” approcah to media content by Ljiljana Gavrilović, Serbian broadsheets and daily papers, such as Blic, Kurir, Politika, Večernje Novosti, from the period 2014-2020, are analyzed. The preliminary results show that the news that concurs with the 2014-15 measles epidemic differs greatly from the news during the 2017-18 epidemic. During the first period, the papers carried medical experts’ advice on the benefits and importance of the MMR vaccine, criticizing (irrational and emotional) parents (mostly mothers) who do not vaccinate their children, in parallel with parental lay evidence on its harmfulness. From approximately 2017 anti-vaccination attitudes disappeared from the newspapers, even from the yellow press. This is concomitant with the new Law on the Protection of the Population against Communicable Diseases (2016), which penalizes anti-vaccination lobbying. In other words, instead of gaining public trust in the health sector and the state by presenting facts, offering dialogue with opponents and systematic education, the state leaders discredited and excluded opposing opinions as “uncivilized”, “irrational” and part of “anti-vaccination lobbying”. Studies explained that citizens of post-socialist countries trust more individuals (friends and family) and distrust the state authorities (as enemies). By introducing compulsory penalties for non-vaccination, the state only deepened this historical and cultural distrust between the state and its citizen. To conclude, insults to parents of non-immunized children, threats of penalties and actual penalties, and the exaggeration of the outcomes of the 2014-15 measles epidemic did not lead to mass immunization. On the contrary, all this acted only counterproductively, as the latest epidemic broke out precisely among non-vaccinated and semi-vaccinated populations. Therefore, it is suggested in the paper that this vaccine should be optional, parallel with the introduction of organized promotion of MMR vaccination, its benefits and side-effects, detailed information on vaccine content, greater freedom of media content on the MMR vaccine, and open public dialogue of parents with medical experts.

Impact of rotavirus vaccine on admissions due to acute gastroenteritis and rotavirus gastroenteritis in Israel

We examined the impact of insertion of the Rotavirus vaccine (RVV) into the Israeli National Immunisation Programme (NIP) on hospitalisations due to both acute gastroenteritis (AGE) and Rotavirus gastroenteritis (RVGE) in children. We retrospectively analysed the medical records of children aged <5years admitted with a diagnosis of AGE between 2008 and 2016 in two children's hospitals in central Israel. Clinical, laboratory, microbiological data and RV immunisation status were retrieved. Data were compared before and after the introduction of the RVV into the NIP. A total of 2042 children were admitted with AGE. Hospitalisations due to AGE and RVGE decreased from 3310 to 1950 and from 1027 to 585 per 100000 admissions, respectively, after the RVV (relative risk reduction (RRR) of 41% and 43%, respectively). RV remained the most common pathogen in both study periods. There was no significant difference in the clinical course between immunised and non-immunised children admitted with RVGE. The introduction of the RVV to the NIP significantly reduced the admissions due to both AGE and RVGE in children <5years. However, RV is still the most common agent for admissions due to AGE in this age group.

Can Complementary Prime-Boost Immunization Strategies Be an Alternative and Promising Vaccine Approach Against Dengue Virus?

Dengue is one of the most important diseases transmitted by mosquitoes. Dengvaxia®, a vaccine registered in several countries, cannot be administered to non-immune individuals and children younger than 9 years old, due to safety reasons. There are two vaccine candidates in phase 3 efficacy trials, but their registration date is completely unknown at this moment. So, the development of new vaccines or vaccine strategies continues to be a priority for the WHO. This work reviews some complementary prime-boost immunization studies against important human pathogens. Additionally, it reviews the results obtained using this regimen of immunization against dengue virus as a potential alternative approach for finding a safe and efficient vaccine. Finally, the main elements associated with this strategy are also discussed. The generation of new strategies of vaccination against dengue virus, must be directed to reduce the risk of increasing viral load through sub-neutralizing antibodies and it must be also directed to induce a polyfunctional T cell response. Complementary prime-boost immunization strategies could emerge as an interesting approach to induce solid immunity or at least to reduce viral load after natural infection, avoiding severe dengue. Subunit vaccine could be safe and attractive antigens for this strategy, especially proteins including B, and T-cells epitopes for inducing humoral and cellular immune responses, which can play an important role controlling the disease.

IMMUNOPROPHYLAXIS – PROBLEMS AND PRIORITIES IN NURSING

Introduction: Immunizations represent the most effective and most useful prophylactic activity to achieve individual and collective immunity against a particular infectious disease. Over the last decade the number of non-immunized children has increased in the country. This problem should become a priority for solving for every country according to the WHO. The implementation of obligatory planned immunizations and reimmunizations as well as targeted immunizations and recommended immunizations include the nurse as an active participant in the medical team that carries out them. The operation of the physician and the nurse are leading and very responsible.&#x0D; Objective: To outline the problems and priorities in the nursing activity related to immunoprevention in the conditions of primary care.&#x0D; Material and Methods: Study was conducted in the 2019. on the territory in Sofia, in, with 560 children up to 18 years subject to immunization. Documentary methods, lectures and statistical methods were used.&#x0D; Results and discussion: Immunization prophylaxis is precisely regulated and performed by medical teams in outpatient care. It has a number of specifics and requires knowledge, communication and technical skills from the nurse.&#x0D; Conclusions: The control of the implementation of the preventive measures is carried out correctly by the structures of the RHI and the doctor in the ambulatory. Nursing care related to immune prophylaxis requires the nurse to know and accurately complete and complete the documentation, plan, transport and store the vaccinations that are administered properly. To be able to motivate and explain to the parents the necessity of the immunizations and the reimmunizations as well as their behaviour in case of post-vaccination reactions. Increasing the health culture of parents regarding immune prophylaxis will lead to a decrease in non-immunized children due to refusal and will also improve and broaden the immune prophylaxis in the country.

Immunogenicity and safety of WHO-approved TRC-ID regimen with a chromatographically purified Vero cell rabies vaccine with or without rabies immunoglobulin in children

ABSTRACTIntroduction: Children are at risk of rabies exposure in many Asian countries. The safety and immunogenicity profile of the WHO-approved two-site intradermal Thai Red Cross regimen (modified TRC-ID regimen; 2–2-2–0-2) with a new chromatographically purified Vero-cell rabies vaccine (CPRV) is lacking.Area covered: We studied the safety and immunogenicity of the TRC-ID regimen with a new CPRV in non-immunized Thai children with possible or proven rabies exposure. Thirty-nine seronegative patients (age range 2–14 years) with rabies exposure (WHO categories II or III) received two 0.1-mL intradermal doses of CPRV at both deltoid regions on days 0, 3, 7, and 28. Twenty-five patients (64.1%) received rabies immunoglobulin due to having rabies exposure, according to WHO category III. All serum samples were tested for rabies neutralizing antibody (Nab) by the rapid fluorescent focus inhibition test (RFFIT) before vaccination, and on days 14 and 90 after vaccination. All patients had an adequate immune response (Nab titers ≥ 0.5 IU/mL) on days 14 and 90. No patients died of rabies infection. No serious adverse reactions were observed.Expert commentary: CPRV is economic, safe, and immunogenic if given as the modified TRC-ID regimen in children.

Imported malaria in northern Italy: epidemiology and clinical features observed over 18 years in the Teaching Hospital of Brescia.

Even though malaria incidence is decreasing worldwide, travel-related cases reported in Europe have remained stable in recent years. In Italy, incidence had increased in the 1990s, reaching a peak in 1999; a slow decline was then reported over the subsequent decade. To our knowledge, few published data are available on imported malaria in Italy since 2010. In this article we aimed to analyse trends in imported malaria in the teaching hospital of Brescia, northern Italy, over the last 18 years. All malaria cases diagnosed from 1999 to 2016 in Spedali Civili Hospital, Brescia, were retrospectively identified. Demographic, clinical and travel-related data were described. A total of 1200 cases of imported malaria were diagnosed in Brescia during the study period. Among them, 225 were children. A trend of increasing paediatric cases was identified over the study period, while cases in adults were stable. Most cases were diagnosed between August and October. Patients were most likely exposed in sub-Saharan Africa (87.2%). The main reported travel reason was travelling to visit friends and relatives (66.0%). A significantly higher risk of severe malaria was observed in non-immune patients and children visiting friend and relatives (P < 0.001 and P = 0.006, respectively). Our study reveals a relatively stable incidence in imported malaria cases with a peak during the summertime. A large and increasing paediatric burden of disease was identified. Imported malaria requires attention since in Italy a potential reappearance of autochthonous Plasmodium vivax malaria transmission cannot be excluded. Preventive action and physician awareness should be especially directed to children visiting friends and relatives in endemic countries and to non-immune patients since they both represent high-risk groups for severe malaria.

How to hold an ethical pox party

Pox parties are a controversial alternative to vaccination for diseases such as chickenpox. Such parties involve parents infecting non-immune children by exposing them to a contagious child. If successful, infection...

Assessment of the HBV vaccine response in a group of HIV-infected children in Morocco

BackgroundSince its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV vaccine was introduced in 1999, and since then all infants, including vertically HIV-infected infants, have been following the vaccination schedule, implemented by the Moroccan ministry of health. An assessment of the immunization of these children is important to optimize efforts aimed at tackling Hepatitis B coinfection, within the country.MethodsForty-nine HIV-infected children (HIV group) and 112 HIV uninfected children (control group) were enrolled in this study. Samples were tested by Elisa (Monolisa Anti-HBs, Biorad) to quantify the anti-HBs antibodies. The % of lymphocyte subsets i.e. CD4+ T cells, CD8+ T cells, B cells, and NK, was determined by flow cytometry, using CellQuest Pro software (Becton-Dickinson), and for HIV group, HIV viral load was measured by real time PCR assay (Abbott). All variables were statistically compared in the two groups.ResultsThe median age was 51 ± 35 months for the HIV group and 50 ± 36 months (p > 0.05) for the control group. Female represented 63% and 41% (p = 0.01), among the HIV group and the control group, respectively. Among HIV-infected children, 71.4% (35/49) were under HAART therapy at the enrollment in the study. Seroprotection titer i.e. anti-HBs ≥10mUI/ml among control group was 76% (85/112), and only 29% (14/49) among the perinatally HIV-infected children (p < 0.0001). Lower % of CD4 + T cells was observed in HIV-infected children with a poor anti-HBs response.ConclusionIn this studied group, we have shown that despite the vaccination of HIV-children with HBV vaccine, 71% did not show any seroprotective response. These findings support the need for monitoring HBV vaccine response among HIV-infected children in Morocco, in order to revaccinate non-immunized children.