Malignant Disease in Children whose Mothers had Chickenpox,Mumps, or Rubella in Pregnancy

To test the hypothesis that leukaemia may follow virus infection in pregnancy an analysis was made of deaths which occurred in a cohort of children born in 1951 and 1952 after pregnancies in which the mothers suffered virus infections—chickenpox or mumps at any stage of gestation or rubella in the first 18 weeks. All deaths which occurred between the children''s second birthday and the end of 1971 were studied.Two deaths from leukaemia occurred among the children whose mothers suffered from chickenpox, a significant excess. There were no deaths from leukaemia among the other children, but the causes of the two deaths after maternal mumps—Ewing''s tumour and Still''s disease—are noted because of their rarity.     

Epidemiology of chickenpox in England and Wales, 1967-85

Routine sources of data on chickenpox morbidity and mortality in England and Wales were reviewed for 1967-85. Only two epidemics occurred, one in 1967 and one in 1980, both of which were immediately followed by two to three years of low incidence. The age distribution of the disease appears to be changing, with more cases now being reported in children aged 0-4 years. The number of deaths in adults have, however, increased, particularly those deaths that are associated with pneumonia and immunosuppression. At present in England and Wales more deaths are attributed to chickenpox than to whooping cough and mumps.Widespread use of selective immunisation against chickenpox might be justified in England and Wales, but before routine immunisation of the child population can be considered special surveys to determine the incidence and severity of chickenpox and the effect of the vaccine on the subsequent development of herpes zoster are needed as well as cost-benefit studies of immunisation.     

Childhood leukaemia in the West Berkshire and Basingstoke and North Hampshire District Health Authorities in relation to nuclear establishments in the vicinity.

During the years 1972-85, 89 children aged 0-14 were registered with leukaemia in the West Berkshire and Basingstoke and North Hampshire District Health Authorities. Two nuclear establishments are located within the health authorities, and a third is situated nearby. Fifty of the 143 electoral wards in the two district health authorities lie wholly within, or have at least half their area lying within, a circle of radius 10 km around the establishments. In those 50 electoral wards 41 children aged 0-14 were registered with leukaemia, 28.6 registrations being expected on the basis of leukaemia registration rates in England and Wales (incidence ratio = 1.4, p less than 0.05). This excess was confined to children aged 0-4, among whom there were 29 registrations of leukaemia, 14.4 being expected (incidence ratio = 2.0, p less than 0.001). In the remaining 93 electoral wards there was a small and non-significant increase in the number of registrations of leukaemia at age 0-14 (48 observed, 40.8 expected; incidence ratio = 1.2). There was no obvious trend in the incidence of childhood leukaemia over the 14 years and the overall occurrence of the malignancy in the 143 electoral wards was consistent with a random distribution. In the surrounding Oxford and Wessex Regional Health Authorities the number of registrations of leukaemia at age 0-14 was virtually identical with that expected on the basis of registration rates in England and Wales (362 observed, 372.5 expected; incidence ratio = 1.0). These data indicate that in the two district health authorities studied there was an excess incidence of childhood leukaemia during 1972-85 in the vicinity of the nuclear establishments. In the West Berkshire and Basingstoke and North Hampshire District Health Authorities an average of 60,000 children aged 0-14 lived within a 10 km radius of a nuclear establishment each year. The normal expectation of leukaemia in these children was two cases a year, whereas the recorded incidence was three cases per year, representing one extra case of leukaemia each year among these 60,000 children.     

Influence of maternal insulin-dependent diabetes mellitus on neonatal morbidity.

OBJECTIVE: To compare the neonatal morbidity rates (corrected for gestational age at delivery and method of delivery) among infants of women with insulin-dependent diabetes mellitus and those of women without diabetes. DESIGN: Historical cohort analysis. SETTING: Tertiary care centre. PATIENTS: All liveborn infants of women with insulin-dependent diabetes mellitus (IDM group) born between Jan. 1, 1980, and Dec. 31, 1989, each matched for gestational age at delivery, method of delivery and year of birth with two newborns of women without diabetes (control group). MAIN OUTCOME MEASURES: Neonatal respiratory distress, jaundice, hypoglycemia, polycythemia, hypocalcemia, intraventricular hemorrhage, seizure and macrosomia. RESULTS: There were 230 infants in the IDM group and 460 in the control group. Compared with the control group the IDM group had significantly higher incidence rates of glucose infusion (odds ratio [OR] 5.38), birth weight above the 90th percentile (OR 4.15) and neonatal jaundice (OR 1.94). No significant difference was found in the incidence rate of respiratory distress, polycythemia or hypocalcemia. The maternal serum hemoglobin A (HbA) level was not significantly related to birth weight, and neither the serum HbA level nor the presence of macrosomia was predictive of neonatal morbidity. Nearly 25% of the infants in the IDM group were born before 37 weeks'' gestation; 48.2% of these were delivered early because of maternal hypertension. CONCLUSIONS: Neonatal morbidity in infants of women with diabetes is determined more by gestational age at delivery than by the maternal diabetes. Within the limits obtained in this study the degree of control of the diabetes does not seem to affect neonatal morbidity.     

Illness in the family

OBJECTIVE: To update reports of increases in the rates of admission to hospital and death from asthma among children and young adults in Canada during the 1970s by examining data for the 1980s. DESIGN: Age-standardized rates were calculated from data for people less than 35 years of age at the time of death from asthma, bronchitis or other respiratory conditions (from 1980 through 1989) and at the time of admission to hospital for treatment of these diseases (from 1980 through 1988). Standardized mortality ratios were calculated with the death rate for Canada as the expected rate. SETTING: Data for all of Canada were examined by sex, age group and province. RESULTS: In contrast to sharp increases in the rate of death from asthma observed from 1970 through the early 1980s among Canadians less than 35 years of age, the rate showed no net change between 1980 and 1989; on average, there were 58 deaths in this age group annually. During the decade, the rates of death from asthma were three times higher in Saskatchewan and Alberta than in Newfoundland. The national rate of hospital admission/separation for asthma, however, increased greatly, though changes in the rate varied by province. Increases of over 90% were observed in Prince Edward Island and New Brunswick, whereas little overall change occurred in Newfoundland, Manitoba and Saskatchewan. The rate of hospital admission/separation for asthma was highest in Prince Edward Island and lowest in Manitoba and British Columbia. Although the rates of hospital admission/separation for asthma among boys aged less than 15 years of age were consistently 50% higher than those among girls of that age, the rate among people aged 15 through 34 years was twice as high among females as males. A slight decrease in the rates of death from respiratory conditions other than asthma was observed, together with a steady, fairly substantial decline in the rates of hospital admission/separation for these conditions. CONCLUSIONS: Whether there is any relation between increases in rates of admission to hospital for asthma and trends in the rates of death from asthma during the decade will require further study.     

Epidemiology of Plasmodium malariae infection in Gambela, Ethiopia

Malaria incidence and prevalence surveys were performed from December, 1967 to February, 1969 among the indigenous Nilotic inhabitants of Gambela, a small administrative centre in the western lowlands of Ethiopia. Entomological data suggested that malaria transmission was seasonal and this was consistent with monthly P. falciparum parasite rates. Monthly P. malariae parasite rates, however, were consistent with an hypothesis of homogeneity. The age-specific incidence of quartan malaria among 26 children zero to 11 years old at the start of study was examined at 28 day intervals over a 15-month period. The resulting data suggested that parasite acquisition was a slow process and an annual P. malariae incidence of 0.17 was derived. This statistic was supported by studies performed five years later: The incidence of P. malariae among 102 infants followed from birth up to 48 months of age was 0.16-0.20. An attempt was then made to account for the prevalence of P. malariae in terms of the entomological conditions observed in Gambela. Macdonald's formula for the sporozoite rate was used to derive hypothetical relative proportions of P. falciparum and P. malariae among the observed sporozoite-positive mosquito populations. About 4% of the sporozoite challenges were estimated to be of P. malariae. An hypothetical annual entomological P. malariae inoculation rate was then made by multiplying the number of observed sporozoite inoculations per person (approximately 10/year) by the proportion of them estimated to be of P. malariae. The annual P. malariae sporozoite challenge was thus estimated at 0.4 per person, in good agreement with the annual incidence estimates from parasite rates in children.     

Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis

Background

In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. We evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators.

Methods and Findings

National data were analyzed with an interrupted time-series analysis that used diarrhea-related mortality or hospitalization rates as the main outcomes. Monthly mortality and admission rates estimated for the years after rotavirus vaccination (2007–2009) were compared with expected rates calculated from pre-vaccine years (2002–2005), adjusting for secular and seasonal trends. During the three years following rotavirus vaccination in Brazil, rates for diarrhea-related mortality and admissions among children <5 y of age were 22% (95% confidence interval 6%–44%) and 17% (95% confidence interval 5%–27%) lower than expected, respectively. A cumulative total of ∼1,500 fewer diarrhea deaths and 130,000 fewer admissions were observed among children <5 y during the three years after rotavirus vaccination. The largest reductions in deaths (22%–28%) and admissions (21%–25%) were among children younger than 2 y, who had the highest rates of vaccination. In contrast, lower reductions in deaths (4%) and admissions (7%) were noted among children two years of age and older, who were not age-eligible for vaccination during the study period.

Conclusions

After the introduction of rotavirus vaccination for infants, significant declines for three full years were observed in under-5-y diarrhea-related mortality and hospital admissions for diarrhea in Brazil. The largest reductions in diarrhea-related mortality and hospital admissions for diarrhea were among children younger than 2 y, who were eligible for vaccination as infants, which suggests that the reduced diarrhea burden in this age group was associated with introduction of the rotavirus vaccine. These real-world data are consistent with evidence obtained from clinical trials and strengthen the evidence base for the introduction of rotavirus vaccination as an effective measure for controlling severe and fatal childhood diarrhea. Please see later in the article for the Editors'' Summary     

口服咪达唑仑对儿童术前分离焦虑的效果分析

目的:明确与父母分离焦虑在不同年龄段小儿的发生率,并探讨术前口服咪达唑仑对减轻患儿术前焦虑的效果。方法:募集442例年龄12岁的非心脏手术患儿,分为咪达唑仑组和对照组,每组再按照年龄分为五个年龄段。咪达唑仑组患儿术前30分钟给予0.5 mg/kg咪达唑仑口服;对照组则未予任何制剂。观察并比较不同年龄段患儿入手术室与家长分离时的情况。结果:药物组分离焦虑发生率显著低于对照组。在各年龄组中,8个月到3岁的婴幼儿是发生分离焦虑比例最高的年龄段。对照组分离焦虑的发生率为16.94%,研究组为8%,较对照组有显著下降(P0.05)。此外,研究组小于8个月和3-5岁组患儿发生分离焦虑的比例也均较未用药组有显著下降(P0.05)。结论:分离焦虑与患儿年龄相关,低龄患儿在手术前有明显的分离焦虑,术前30分钟口服咪达唑仑0.5 mg/kg能显著改善分离时的焦虑,但不能完全消除。     

不同时间段睡眠剥夺配合改良式水合氯醛保留灌肠法在婴幼儿肺功能检查中的效果分析

摘要 目的：探讨不同时间段睡眠剥夺配合改良式水合氯醛保留灌肠法在婴幼儿肺功能检查中的镇静效果。方法：前瞻性选取2018年2月~2020年8月本院收治并需行肺功能检查的婴幼儿临床资料,纳入194例婴幼儿作为研究对象,根据随机数字表法简单随机分为四组。对照组（n=48）不进行睡眠剥夺,短时段组（n=48）行短时段睡眠剥夺,中时段组（n=49）行中时段睡眠剥夺,长时段组（n=49）行长时段睡眠剥夺。对比四组婴幼儿的入睡时间、镇静效果及不良反应。结果：四组婴幼儿入睡时间的组间差异具有统计学意义（P＜0.05）。与对照组相比,联合睡眠剥夺干预的三组婴幼儿在10 min内进入睡眠的例数明显增多;随着睡眠剥夺时间增加,睡眠剥夺的三组婴幼儿超过30 min才进入睡眠的例数明显少于对照组。四组婴幼儿镇静效果的组间比较差异具有统计学意义（P＜0.05）;与对照组相比,联合睡眠剥夺干预的三组婴幼儿镇静效果明显升高,镇静总有效率均高于对照组（P＜0.05）。在实验期间,四组婴幼儿均出现不同类型的不良反应,各类型不良反应发生率及总发生率的组间比较,差异均无统计学意义（P>0.05）,但长时段组出现情绪烦躁的比例略高。结论：睡眠剥夺配合改良式水合氯醛灌肠法对婴幼儿具有良好的镇静效果,但长时段睡眠剥夺可能会使其情绪烦躁,需在检查完成后悉心安抚婴幼儿情绪。     

A General HIV Incidence Inference Scheme Based on Likelihood of Individual Level Data and a Population Renewal Equation

We derive a new method to estimate the age specific incidence of an infection with a differential mortality, using individual level infection status data from successive surveys. The method consists of a) an SI-type model to express the incidence rate in terms of the prevalence and its derivatives as well as the difference in mortality rate, and b) a maximum likelihood approach to estimate the prevalence and its derivatives. Estimates can in principle be obtained for any chosen age and time, and no particular assumptions are made about the epidemiological or demographic context. This is in contrast with earlier methods for estimating incidence from prevalence data, which work with aggregated data, and the aggregated effect of demographic and epidemiological rates over the time interval between prevalence surveys. Numerical simulation of HIV epidemics, under the presumption of known excess mortality due to infection, shows improved control of bias and variance, compared to previous methods. Our analysis motivates for a) effort to be applied to obtain accurate estimates of excess mortality rates as a function of age and time among HIV infected individuals and b) use of individual level rather than aggregated data in order to estimate HIV incidence rates at times between two prevalence surveys.     

Assessing Children's Exposures and Risks to Drinking Water Contaminants: A Manganese Case Study

Background: Compared to adults, children maybe more highly exposed to toxic substances in drinking water because they consume more water per unit of body weight. The U.S. Environmental Protection Agency (USEPA) has developed new guidance for selecting age groups and age-specific exposure factors for assessing children's exposures and risks to environmental contaminants. Research Aim: To demonstrate the application and importance of applying age-specific drinking water intake rates, health reference values, and exposure scenarios when assessing drinking water exposures because these approaches illustrate the potential for greater potential for adverse health effects among children. Methods: manganese, an essential nutrient and neurotoxicant, was selected as a case study and chemical of potential concern for children's health. A screening-level risk assessment was performed using age-specific drinking water intake rates and manganese concentrations from U.S. public drinking water systems. Results: When age-specific drinking water intake rates are used to calculate dose, formula-fed infants receive the highest dose of manganese from drinking water compared to all other age groups. Estimated hazard quotients suggest adverse health effects are possible. Use of USEPA's standardized childhood age groups and childhood exposure factors significantly improves the understanding of childhood exposure and risks.     

The risk of leukaemia in young children from exposure to tritium and carbon-14 in the discharges of German nuclear power stations and in the fallout from atmospheric nuclear weapons testing

Towards the end of 2007, the results were published from a case–control study (the “KiKK Study”) of cancer in young children, diagnosed <5 years of age during 1980–2003 while resident near nuclear power stations in western Germany. The study found a tendency for cases of leukaemia to live closer to the nearest nuclear power station than their matched controls, producing an odds ratio that was raised to a statistically significant extent for residence within 5 km of a nuclear power station. The findings of the study received much publicity, but a detailed radiological risk assessment demonstrated that the radiation doses received by young children from discharges of radioactive material from the nuclear reactors were much lower than those received from natural background radiation and far too small to be responsible for the statistical association reported in the KiKK Study. This has led to speculation that conventional radiological risk assessments have grossly underestimated the risk of leukaemia in young children posed by exposure to man-made radionuclides, and particular attention has been drawn to the possible role of tritium and carbon-14 discharges in this supposedly severe underestimation of risk. Both ³H and ¹⁴C are generated naturally in the upper atmosphere, and substantial increases in these radionuclides in the environment occurred as a result of their production by atmospheric testing of nuclear weapons during the late 1950s and early 1960s. If the leukaemogenic effect of these radionuclides has been seriously underestimated to the degree necessary to explain the KiKK Study findings, then a pronounced increase in the worldwide incidence of leukaemia among young children should have followed the notably elevated exposure to ³H and ¹⁴C from nuclear weapons testing fallout. To investigate this hypothesis, the time series of incidence rates of leukaemia among young children <5 years of age at diagnosis has been examined from ten cancer registries from three continents and both hemispheres, which include registration data from the early 1960s or before. No evidence of a markedly increased risk of leukaemia in young children following the peak of above-ground nuclear weapons testing, or that incidence rates are related to level of exposure to fallout, is apparent from these registration rates, providing strong grounds for discounting the idea that the risk of leukaemia in young children from ³H or ¹⁴C (or any other radionuclide present in both nuclear weapons testing fallout and discharges from nuclear installations) has been grossly underestimated and that such exposure can account for the findings of the KiKK Study.     

Acquired immunity and postnatal clinical protection in childhood cerebral malaria

By analysing data on the age distribution of cerebral malaria among sites of different transmission intensities, we conclude that the most plausible explanation for the epidemiological patterns seen is that (i) cerebral malaria is caused by a distinct set of Plasmodium falciparum antigenic types; (ii) these antigenic types or 'CM strains' are very common and induce strong strain-specific immunity; and (iii) the postnatal period of protection against cerebral malaria is much longer than the period of protection against other forms of severe disease. The alternative hypothesis that cerebral malaria may be caused by any 'strain' of P. falciparum is compatible with the data only if a single exposure is sufficient to protect against further episodes. This is not consistent with observations on the history of exposure of patients with cerebral malaria. Finally, it is clear that although the delayed peak in incidence of cerebral malaria (with age) can be generated by assuming that subsequent exposures carry a higher risk of disease, such an explanation is not compatible with the observation that severe disease rates are low among infants and young children in areas of high transmissibility.     

Modeling the effects of varicella vaccination programs on the incidence of chickenpox and shingles

Two possible dangers of an extensive varicella vaccination program are more varicella (chickenpox) cases in adults, when the complication rates are higher, and an increase in cases of zoster (shingles). Here an age-structured epidemiologic—demographic model with vaccination is developed for varicella and zoster. Parameters are estimated from epidemiological data. This mathematical and computer simulation model is used to evaluate the effects of varicella vaccination programs. Although the age distribution of varicella cases does shift in the simulations, this does not seem to be a danger because many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the simulations, zoster incidence increases in the first three decades after initiation of a vaccination program, because people who had varicella in childhood age without boosting, but then it decreases. Thus the simulations validate the second danger of more zoster cases.     

Mass-specific metabolic rate and sperm competition determine sperm size in marsupial mammals

Two complementary hypotheses have been proposed to explain variation in sperm size. The first proposes that post-copulatory sexual selection favors an increase in sperm size because it enhances sperm swimming speed, which is an important determinant of fertilization success in competitive contexts. The second hypothesis proposes that mass-specific metabolic rate acts as a constraint, because large animals with low mass-specific metabolic rates will not be able to process resources at the rates needed to produce large sperm. This constraint is expected to be particularly pronounced among mammals, given that this group contains some of the largest species on Earth. We tested these hypotheses among marsupials, a group in which mass-specific metabolic rates are roughly 30% lower than those of eutherian mammals of similar size, leading to the expectation that metabolic rate should be a major constraint. Our findings support both hypotheses because levels of sperm competition are associated with increases in sperm size, but low mass-specific metabolic rate constrains sperm size among large species. We also found that the relationship between sperm size and mass-specific metabolic rate is steeper among marsupials and shallower among eutherian mammals. This finding has two implications: marsupials respond to changes in mass-specific metabolic rate by modifying sperm length to a greater extent, suggesting that they are more constrained by metabolic rate. In addition, for any given mass-specific metabolic rate, marsupials produce longer sperm. We suggest that this is the consequence of marsupials diverting resources away from sperm numbers and into sperm size, due to their efficient sperm transport along the female tract and the existence of mechanisms to protect sperm.     

Epidemiological patterns of tuberculosis in Croatia in the period 1996-2005

The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, besides the yearly routine reports, was done in 1996 in Croatian. We were, therefore, interested to explore incidence trends and to highlight the early post-war tuberculosis epidemiological patterns in the next ten years period (1996-2005). A retrospective analysis of epidemiological data on all registered tuberculosis cases in Croatia searching the databases of 21 Croatian Public Health Institutes and the National Tuberculosis Registry was made. During the study period, the total tuberculosis incidence rates in Croatia dropped from 45 to 25.8/100 000 inhabitants. The average highest age-specific rates were recorded in the age group > or = 65 years being in decrease in all age groups. Paediatric cases (0-14 years) represented 4.5% of all cases. Tuberculosis cases among males were recorded in 64% cases, and 83.6% were indigenous population. Tuberculosis was bacteriologically confirmed in 67.7% cases. A low proportion of drug resistance (3.3%) was recorded. During 1985-2005, 56 tuberculosis cases among 242 AIDS cases were reported. Tuberculosis mortality showed a decreasing trend (p < 0.001). However, tuberculosis has still had the highest mortality rates among infectious diseases in Croatia. Despite the War chain of events and tuberculosis programmatic changes, tuberculosis incidence rates in Croatia have been decreasing but they are still far away from national target, incidence rate of 10/100 000 declared in 1998 and much higher than in European Union and Western Europe. Tuberculosis among children, resistance to tuberculosis drugs and HIV prevalence, significant problems in many European countries, have not caused problems in tuberculosis control in Croatia. This favourable epidemiological situation must be kept and improved through strengthened tuberculosis control measures.     

义乌地区儿童过敏性结膜炎过敏原分析

目的了解过敏性结膜炎患儿常见过敏原及其分布特征,为预防和脱敏治疗提供依据。方法采用免疫印迹法对363例过敏性结膜炎患儿进行血清过敏原检测,并对结果进行分组比较。结果患儿中检出率居前3位的吸入性过敏原分别为尘螨(50.41%)、猫毛(3.03%)和霉菌(2.48%);检出率居前3位的食物性过敏原分别为淡水鱼(10.74%)、海鱼(7.44%)和鸡蛋白(6.34%)。吸入性过敏原(62.26%)和食物性过敏原(41.60%)总检出率比较差异有统计学意义(P0.05)。婴幼儿组、学龄前组和学龄组患儿均以尘螨为常见过敏原,其检出率分别为33.33%、52.76%和52.00%。不同年龄患儿牛奶过敏检出率比较差异有统计学意义(P0.05),婴幼儿组牛奶过敏检出率最高,为12.82%。男、女患儿过敏原阳性率比较差异无统计学意义(P0.05)。不同年龄患儿过敏原阳性率比较差异无统计学意义(P0.05)。婴幼儿组、学龄前组和学龄组患儿均以单纯吸入性过敏原和单一过敏原为常见。1月-3月为儿童过敏性结膜炎的低发季节。结论通过血清过敏原检测可明确过敏性结膜炎的过敏原。尘螨是本地区儿童过敏性结膜炎常见过敏原。     

The shapin of psychiatry by science and humanism. II. An emerging synthesis of science and humanism.

Serological surveys of rubella antibody were carried out using the hemagglutination-inhibition test, with a view to studying the distribution of seroimmune individuals according to age and intermingling with other populations. Specimens were collected from different age groups including infants, children and adults, among the inhabitants of Montreal from 1963 to 1968. From the results obtained it was possible to establish the pattern of rubella antibody development in this urban community. Surveys were also conducted among the inhabitants of Les Iles de la Madeleine, a Canadian island in the Gulf of St. Lawrence, and among the population of Easter Island, an isolated island in the South Pacific remote from any large land mass.It was seen that, among the inhabitants of Montreal, presumably maternally acquired rubella antibody was present in 95% or more of the infants, the same percentage of seroimmune individuals as was found among the adult women 25 to 30 years of age. Passively acquired rubella antibodies decreased rapidly, attaining their lowest levels among children 1 to 2 years old. Rubella infection occurred in young children and its incidence rose steeply from school age to adolescence, leaving 7 to 9% of the adults without antibody. The highest geometric mean antibody titres were found among children 4 to 10 years of age.The same pattern of rubella antibody development was found among the population of Les Iles de la Madeleine, except that in adults the percentages of seropositives reached practically 100%. Antibody titres decreased with advancing age and became lower than those found among children.Detection of rubella antibody in serum samples derived from the inhabitants of Easter Island indicated that this population had experienced rubella infection not long before the Canadian Medical Expedition of 1964-1965. This status is determined from the high proportion of seroimmune individuals in each age group and the uniformly high antibody titre.Island populations appear to represent the ideal subjects for estimating the duration of the immunity conferred by any attenuated rubella vaccine that will eventually be licensed.     

Respiratory distress syndrome in infants of Cardiff residents during 1965-75.

The incidence of respiratory distress syndrome (RDS) among singleton infants of Cardiff residents was greater during 1970-4 than in the preceding five years. This was consistent with changes in the distribution of gestational age and birth weight. Case fatality rates among infants with RDS fell only slightly during the period examined. Detailed examination of secular trends during 1965-75 suggested (a) that increased use of elective delivery without assessment of pulmonary maturity increases the risk of RDS, and (b) that innovations in the management of RDS during the early 1970s cannot be assumed to have had widespread impact on case fatality rates.     

Prolonged Seasonality of Respiratory Syncytial Virus Infection among Preterm Infants in a Subtropical Climate

Objective

There is limited epidemiological data on the seasonality of respiratory syncytial virus (RSV) infection in subtropical climates, such as in Taiwan. This study aimed to assess RSV seasonality among children ≤24 months of age in Taiwan. We also assessed factors (gestational age [GA], chronologic age [CA], and bronchopulmonary dysplasia [BPD]) associated with RSV-associated hospitalization in preterm infants to confirm the appropriateness of the novel Taiwanese RSV prophylactic policy.

Study Design

From January 2000 to August 2010, 3572 children aged ≤24-months were admitted to Taipei Mackay Memorial Hospital due to RSV infection. The monthly RSV-associated hospitalization rate among children aged ≤24 months was retrospectively reviewed. Among these children, 378 were born preterm. The associations between GA, CA, and BPD and the incidence of RSV-associated hospitalization in the preterm infants were assessed.

Results

In children aged ≤24 months, the monthly distribution of RSV-associated hospitalization rates revealed a prolonged RSV season with a duration of 10 months. Infants with GAs ≤32 weeks and those who had BPD had the highest rates of RSV hospitalization (P<0.001). Preterm infants were most vulnerable to RSV infection within CA 9 months.

Conclusions

Given that Taiwan has a prolonged (10-month) RSV season, the American Academy of Pediatrics'' recommendations for RSV prophylaxis are not directly applicable. The current Taiwanese guidelines for RSV prophylaxis, which specify palivizumab injection (a total six doses until CA 8–9 months) for preterm infants (those born before 28^6/7 weeks GA or before 35^6/7 weeks GA with BPD), are appropriate. This prophylaxis strategy may be applicable to other countries/regions with subtropical climates.