Controversial and unsolved problems in the prevention of infectious hepatitis]

Data are presented indicating that 1 ml of 10% and 1% immunoglobulin possessed similar epidemiological activity in the prophylaxis of infectious hepatitis. It was shown that redical action of infectious hepatitis on the epidemic process was possible only in case of embracement by immunoglobulin vaccination of not less than 80% of children aged from 1 to 11 years. The economic effect of the introduction of 1% immunoglobulin constituted about 40 000 roubles per 100 000 persons vaccinated. Besides, a possibility of side-effects were nilin case of placental immunoglobulin since in the 1% preparation nonspecific biologically active substances could penetrate in much lesser amounts.     

Various epidemiological principles of the spread of viral hepatitis in the Astrakhan district]

Analysis of many-year changes in the vitral hepatitis incidence in the Astrakhan region showed a significant cyclicity of the epidemic process: its incidence rose 4 times during the period of from 1957 to 1976; four of these elevations were comparatively high (in 1960, 1964, and 1974). Lately the group of children aged from 3 to 7 years has been of the greatest epidemiological significance, but at present greatest incidence of the disease fell on the group of persons aged from 8 to 14 years. This can be connected with gamma-globulin vaccinations given to children aged under 10 years. Seasonal distribution of morbidity in different are groups was about the same and reflected the general automn-winter seasonal prevalence.     

Certain data concerning the analysis of the foci of infectious hepatitis in cases of subsequent occurrence of the disease in families

Materials of epidemiological analysis of familial infectious hepatitis nidality in 104 families are presented. The data obtained pointed to the preponderant affection of children constituting 97.1% of primary and 87.7% of subsequent cases in familial foci. Infection was brought to the families by schoolchildren in 57.7% of the cases, and by organized preschoolchildren--in 31.7% of the cases. The greatest affection of schoolchildren aged from 7 to 14 years in the foci with subsequent occurrence of the disease (77.7%) was explained by their marked age activity. This led to the conclusion that mass prophylaxis with alpha-globulin of these particular groups of children was of primary importance. The differences of the specific ratio of adults who contracted the disease in familial foci and in the region as a whole pointed to the possibility of infection of adults outside the family and on the prevalence in them of serum hepatitis.     

Prevention of infections hepatitis by gamma globulin

Infectious hepatitis, a viral disease, has become increasingly more important in recent years. It is believed that the great increase in reported cases is not due entirely to better reporting, but that there has been an actual increase in the incidence of this disease. The comparatively long incubation period in infectious hepatitis, the high incidence in persons in close contact with patients who have the disease, and the fact that in most instances contact between persons is the mode of spread, makes this disease particularly suitable for the use of an immunizing agent which would be administered after exposure. From the studies reviewed it is apparent that gamma globulin is of value in preventing hepatitis both when administered as mass prophylaxis in an epidemic, and when given to persons in close contact with a person who has the disease. Widespread use of gamma globulin prophylactically among persons who have been in close contact with the occasional patients with infectious hepatitis seen by practicing physicians might often obviate the need for mass immunization. It should be stated that there is little evidence for the effectiveness of gamma globulin in the therapy of infectious hepatitis. In a study in which very large amounts (average dose 45 cc.) of gamma globulin were given very early in the disease, no significant difference was observed between those injected and a control group.     

PREVENTION OF INFECTIOUS HEPATITIS BY GAMMA GLOBULIN

Infectious hepatitis, a viral disease, has become increasingly more important in recent years. It is believed that the great increase in reported cases is not due entirely to better reporting, but that there has been an actual increase in the incidence of this disease. The comparatively long incubation period in infectious hepatitis, the high incidence in persons in close contact with patients who have the disease, and the fact that in most instances contact between persons is the mode of spread, makes this disease particularly suitable for the use of an immunizing agent which would be administered after exposure.From the studies reviewed it is apparent that gamma globulin is of value in preventing hepatitis both when administered as mass prophylaxis in an epidemic, and when given to persons in close contact with a person who has the disease. Widespread use of gamma globulin prophylactically among persons who have been in close contact with the occasional patients with infectious hepatitis seen by practicing physicians might often obviate the need for mass immunization. It should be stated that there is little evidence for the effectiveness of gamma globulin in the therapy of infectious hepatitis. In a study in which very large amounts (average dose 45 cc.) of gamma globulin were given very early in the disease, no significant difference was observed between those injected and a control group.     

Improvement in the tactics of systematic gamma globulin prevention of viral hepatitis taking the morbidity prognosis into account]

On the example of 4 cites of the RSFSR under conditions of expected epidemic threat a possibility was shown of directed influence on the viral hepatitis A epidemic process of preseasonal gamma-globulin prophylaxis conducted in 90% of "organized" children, aged from 1 to 12 years. The dose used was 0.75 ml of a 10% preparation. The method of Gorky Institute of Epidemiology and Microbiology was used to prognosticate the morbidity. It is recommended to improve the tactics of preseasonal gamma-globulin prophylaxis with consideration to the data of the viral hepatitis prognosis.     

西安市2010-2015年0-5岁儿童HBV感染状况的流行病学研究

摘要 目的：总结西安市2010-2015年 0-5岁儿童乙肝病毒感染的发病趋势和流行病学特征,寻找高危人群。通过随访研究获取HBV感染儿童疾病转归及乙肝监测系统存在的问题,为乙肝监测系统完善及制定防治策略提供科学依据。方法：采用描述性流行病学方法对西安市2010-2015年的0-5岁儿童乙肝患者进行三间分布描述分析;采用前瞻性队列研究方法,检测母亲及儿童的外周血HBV病毒学情况,获得母亲感染状况和患儿转归。结果：6年间,西安市0-5岁儿童共上报乙肝病例175例,年均HBV感染率为6.05/10万,2013年最高,为9.73/10万,以散发为主;0-1岁为高发年龄段,男童发病多于女童;未央区、雁塔区为高发地区。截止2016年8月,随访HBV感染学龄前儿童139例,仅17例完成流行病学调查和体检检测,失访率高达87.7%,17例HBV感染儿童中HBsAg慢性化高达88.2%,其中14例(82.3%)母亲为HBsAg阳性者。结论：西安市0-5岁儿童HBV感染的高危人群为HBsAg阳性母亲的儿童,与宫内感染/母婴传播有关。0-5岁HBV感染儿童转归结局不良,建议加强HBV宫内阻断,并对高危新生儿进行乙肝抗体监测。     

Spread of viral hepatitis in organized children's collectives and the methods for its early diagnosis]

The authors present the results of observations over 407 children aged from 2 months to 16 years from the foci of viral hepatitis in children's collective bodies. During the quarantine a determination was made in children of the glutamic-pyroracemic, glutamic-oxalic transaminases (GPT and GOT, respectively) and of the hepatitis B antigen (HBAg). A necessity of using the enzymatic tests for the purpose of early diagnosis of viral hepatitis was shown, since 84% of the cases developing in the next focus coursed as an unicteric form without any markked clinical signs; HBAg was revealed in 6.1% of the children examined. A complex examination of the personnel and of the persons who came in contact with the patients with viral hepatitis showed the ways of spread of hepatitis B in a collective body; it was found that the viral hepatitis B infection took place both by parenteral and enteral routes. The expediency of active observation over the children, recipients of blood and plasma, with determination in them of the activity of the enzymes and HBAg for early diagnosis of parenteral infection was substantiated. It was also shown that the incidence of the unicteric forms of viral hepatitis in a focus of infection depended not on the periods of gamma-globulin administration but on the age of children who contracted the infection. Thus, the prevalence of the unicteric forms of the disease over the icteric ones in children under 3 years of age was more pronounced than in older children.     

Infectious hepatitis; report of an outbreak of 24 cases

In an epidemic of 24 cases of infectious hepatitis in a small lumbering community, the majority of cases occurred in children. Sixteen of them were pupils in one school. The school apparently was the focus for the spread of infection, which is thought to have been through contact between persons. Five multiple case households with eight secondary cases were observed. With one exception, gamma globulin was not used for the prophylaxis of infectious hepatitis in families in which one member had the disease.     

Haemoglobin variants and Plasmodium falciparum malaria in children under five years of age living in a high and seasonal malaria transmission area of Burkina Faso

ABSTRACT: BACKGROUND: Genetic factors play a key role in determining resistance/susceptibility to infectious disease. Susceptibility of the human host to malaria infection has been reported to be influenced by genetic factors, which could be confounders if not taken into account in the assessment of the efficacy of interventions against malaria. This study aimed to assess the relationship between haemoglobin genotypes and malaria in children under five years in a site being characterized for future malaria vaccine trials. METHODS: The study population consisted of 452 children living in four rural villages. Hb genotype was determined at enrolment. Clinical malaria incidence was evaluated over a one-year period using combined active and passive surveillance. Prevalence of infection was evaluated via bi-annual cross-sectional surveys. At each follow-up visit, children received a brief clinical examination and thick and thin blood films were prepared for malaria diagnosis. A clinical malaria was defined as Plasmodium falciparum parasitaemia >2,500 parasites/ul and axillary temperature [greater than or equal to]37.5degreesC or reported fever over the previous 24 hours. RESULTS: Frequencies of Hb genotypes were 73.2% AA; 15.0% AC; 8.2% AS; 2.2% CC; 1.1% CS and 0.2% SS. Prevalence of infection at enrolment ranged from 61.9%-54.1% among AA, AC and AS children. After one year follow-up, clinical malaria incidence (95% CI) (episodes per person-year) was 1.9 (1.7-2.0) in AA, 1.6 (1.4-2.1) in AC, and 1.7 (1.4-2.0) in AS children. AC genotype was associated with lower incidence of clinical malaria relative to AA genotype among children aged 1-2 years [rate ratio (95% CI) 0.66 (0.42-1.05)] and 2-3 years [rate ratio (95% CI) 0.37 (0.18-0.75)]; an association of opposite direction was however apparent among children aged 3-4 years. AS genotype was associated with lower incidence of clinical malaria relative to AA genotype among children aged 2-3 years [rate ratio (95% CI) 0.63 (0.40-1.01)]. CONCLUSIONS: In this cohort of children, AC or AS genotype was associated with lower risk of clinical malaria relative to AA genotype only among children aged one to three years. It would be advisable for clinical studies of malaria in endemic regions to consider haemoglobin gene differences as a potentially important confounder, particularly among younger children.     

INFECTIOUS HEPATITIS—Report of an Outbreak of 24 Cases

In an epidemic of 24 cases of infectious hepatitis in a small lumbering community, the majority of cases occurred in children. Sixteen of them were pupils in one school. The school apparently was the focus for the spread of infection, which is thought to have been through contact between persons. Five multiple case households with eight secondary cases were observed. With one exception, gamma globulin was not used for the prophylaxis of infectious hepatitis in families in which one member had the disease.     

剑阁县2001-2010年法定传染病流行特征及防治对策分析

目的：通过分析10年法定传染病疫情的流行趋势和三间分布特征,为制定传染病预防控制策略和措施提供依据。方法：采用描述性流行病学方法分析疫情趋势和三间分布情况,数据资料用SPSS10．0和Excel2003进行统计分析。结果：2001～2010年共报告乙、丙类传染病25种26129例,年均发病率386．89／10万,年均死亡率0．15／10万,10年间报告法定传染病以血源及性传播传染病和呼吸道传染病为主,居第1位的是血源及性传播传染病,共报告5种12453例,占53．03％;其次是呼吸道传染病,共报告5种9828例,占41．85％,近3年发病居于各类传染病首位;第三位的是肠道传染病,共报5种1149例,占4．89％。发病居前5位的传染为乙肝、肺结核、流行性腮腺炎、痢疾、麻疹,主要传染病以乙肝、肺结核为主,近年性传播疾病呈快速增长趋势。结论：血源及性传播传染病和呼吸道传染病是今后重点防控传染病。     

剑阁县2001～2010 年法定传染病流行特征及防治对策分析

目的:通过分析10年法定传染病疲情的流行趋势和三间分布特征,为制定传染病预防控制策略和措施提供依据.方法:采用描述性流行病学方法分析疫情趋势和三间分布情况,数据资料用SPSS10.0和Excel 2003进行统计分析.结果:2001～2010年共报告乙、丙类传染病25种26 129例,年均发病率386.89/10万,年均死亡率0.15/10万,10年间报告法定传染病以血源及性传播传染病和呼吸道传染病为主,居第1位的是血源及性传播传染病,共报告5种12 453例,占53.03％;其次是呼吸道传染病,共报告5种9828例,占41.85％,近3年发病居于各类传染病首位;第三位的是肠道传染病,共报5种1149例,占4.89％.发病居前5位的传染为乙肝、肺结核、流行性腮腺炎、痢疾、麻疹,主要传染病以乙肝、肺结核为主,近年性传播疾病呈快速增长趋势.结论:血源及性传播传染病和呼吸道传染病是今后重点防控传染病.     

Epidemiology of viral hepatitis in the Estonian SSR

The epidemiological peculiarities of viral hepatitis in the Estonial SSR as a whole, as well as in Tallinn and in the surrounding Harju region were studied. The study revealed that during the last 10 years the total decrease of morbidity in viral hepatitis was observed due to a decrease in infectious hepatitis, pronounced periodic and seasonal morbidity fluctuations being absent. A sharp decrease in infectious hepatitis morbidity had been achieved by carrying out planned gamma globulin prophylaxis among children. Viral hepatitis morbidity in the republic was determined by the adult population and manifested as sporadic cases of infectious and serum hepatitis. Infectious hepatitis was transmitted mainly through every day contacts, while the leading factor in the transmission of serum hepatitis consisted in various injections. The relatively high morbidity level of serum hepatitis was mainly determined by morbidity in large cities.     

Advisability of carrying out mass prevention of infectious hepatitis with gamma globulin

In Vilnius 15,183 pupils in 20 schools were observed for two years; in October, 1966, gamma globulin prophylaxis of infectious hepatitis was carried out among all the pupils of these schools. 17.062 pupils in 27 schools, who received no gamma globulin, were used for control. At the end of the first year of observation morbidity rate among the immunized children was found to be considerably lower than among the school children of the control group. During the second year of observation morbidity rate among the children of the "old" immunized group increased 3.5-fold and did not significantly differ from morbidity rate among the children of the control group. The latter increased 1.8-fold. The authors have come to the conclusion that the effect of gamma globulin prophylaxis on the epidemic process depends on the method of such prophylaxis. The method of prophylaxis by introducing gamma globulin immunization with universal coverage, as the use of the former method is not followed by an increase in total morbidity (i.e. among both immunized and nonimmunized children) during the second year after immunization, which is observed after prophylaxis by universal immunization.     

Epidemiological aspects of cytomegalovirus infection in babies aged under one

Sreening data obtained on babies aged under one and selected by random (1,910 children) or target (2,658 children) choice for cytomegalovirus (CMV) infection during the period of 10 years (1992-2001) were compared with mortality rate. The methods used were enzyme immunoassay, immunofluorescence and polymerase chain reaction. The babies were divided as follows: newborn infants (group I), babies aged 1-3 months (group II), 4-6 months (group III) and 7-12 months (group IV). Specific clinical features of CMV infection in newborn infants were studied on 69 cases (37--with CMV monoinfection and 32--with mixed infection). The serological screening revealed a 2.1-fold growth of the infection rate among randomly selected newborn infants during the 10 year period. Positive correlation between the infection rate among children of this age group and the neonatal mortality rate was established. High risk factors of CMV infection were revealed as well as increased infection rate and frequency of clinical cases with the prevailing neurological pathology in group III. Early diagnosis, the exclusion of mixed infections and early adequate therapy were shown to play a decisive role in the outcome of the disease. The algorithm of epidemiological surveillance and the regional program of prophylaxis were worked out.     

英国等地不明原因儿童肝炎的暴发情况及病因

2022年3月31日,苏格兰首先报告了5例患有不明原因重症肝炎的儿童。世界卫生组织（World Health Organization,WHO）于4月15日就不明原因儿童肝炎发布指导性意见,对确诊病例、可疑病例和流行病学相关病例进行了定义。截至4月21日,已有12个国家报告169例确诊病例,从1月龄至16岁不等。临床表现为急性肝炎,谷草转氨酶（aspartate aminotransferase,AST）或谷丙转氨酶（alanine aminotransferase,ALT）>500IU/L,多数患儿有黄疸、恶心、腹痛、乏力、嗜睡和胃肠道症状,包括腹泻和呕吐,大多数患儿无发热。17例接受了肝移植,至少报告1例死亡。考虑到流行病学特点和患儿的临床特征,感染性因素导致该疾病的可能性更大。病例的实验室检查结果均排除了甲、乙、丙、丁和戊型肝炎,并提示腺病毒可能与不明原因儿童肝炎有关,但其他感染性因素或环境因素仍不能完全排除。本文对此次不明原因儿童肝炎的发展情况及其可能病因进行了介绍。该疾病存在输入性风险,我国应对此早做准备。     

Prophylactic efficacy of reaferon in viral hepatitis A and acute respiratory infections in children

Reaferon, the analog of human alpha 2-interferon obtained by gene engineering techniques, was studied with a view to its use for the prevention of hepatitis A. The study involved children of preschool age in Tashkent. In a strictly controlled trial children aged 2-6 years received the preparation orally in a dose of 1 X 10(6) I. U. or the diluent alone used as placebo. The preparation was administered to 1,100 children and the placebo to 1,078 children. The preparation and placebo were administered twice a week for two months. On the whole, during that period hepatitis A morbidity in both test and control groups of children was the same (5.1% and 4.9% respectively), but among children of nursery age receiving Reaferon the incidence of hepatitis A and acute respiratory viral infections was lower than among those receiving the placebo, though this difference was statistically significant only for cases of acute respiratory infections.     

Thyroid disease and other maternal factors in mongolism

One hundred women, who at the age of 35 years or more had had a child with mongolism, were investigated to discover any relation between thyroid disease and autoimmunity and mongolism and to search for other possible etiological factors. They were compared with 100 matched controls. The mothers of mongoloid children had a higher incidence of thyroid disease, either hypo- or hyperactivity (11 compared with three in the control group). The proportion with thyroglobulin antibodies was the same (18.8%) in both groups and mean serum protein-bound iodine levels were similar. There was no difference in reproductive history, diseases other than of the thyroid, frequency of previous pelvic and abdominal x-rays or incidence of infectious hepatitis during the year prior to conception.     

Primary and Secondary Antifungal Prophylaxis in the Immunocompromised Child: Where do we Stand?

Invasive opportunistic fungal infections are important causes of morbidity and mortality in immunocompromised children undergoing chemotherapy or haematopoietic stem cell transplantation (HSCT). Primary and secondary chemoprophylaxis of invasive fungal infections targets high risk disease-related patients with acute myeloid leukaemia, high risk acute lymphoblastic leukaemias, recurrent leukaemias and those following allogeneic HSCT. The rationale for antifungal prophylaxis in high risk patients comes from two different aspects. On the one hand, is the difficulty of instant diagnosis and, on the other hand, the consequences of morbidity and mortality by invasive infectious diseases. Although we have limited pediatric data concerning antifungal prophylaxis, it has become part of infectious disease supportive care schemes in most of paediatric leukaemia and HSCT centres. This review has insights on the evidence concerning primary and secondary antifungal prophylaxis in immunocompromised children. Although our knowledge comes from large adult studies concerning antifungal agents, there is a great need for evidence of primary or secondary antifungal prophylaxis in large pediatric clinical trials in order to have a consensus in primary and secondary antifungal prophylaxis in immunocompromised children.