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Investigation on the Frequency and Severity of Common Adverse Reactions of Japanese Encephalitis Vaccines.

Boo Young KIM ; Dong Hyun KIM ; Hun Jae LEE ; Soo Kyung JUNG ; Xiao Shan LI ; Un Yeong GO ; Sook Kyung PARK ; Young Jin HONG

Korean Journal of Pediatric Infectious Diseases.2009;16(2):183-190.

PURPOSE: To evaluate the number and severity of adverse reactions after Japanese Encephalitis (JE) vaccination in children using different vaccines (inactivated vaccine or live attenuated vaccine) and to determine the ability and safety of the vaccines to provide effective immunization for JE. METHODS: From August 2006 to February 2007, we conducted a prospective cohort study of the adverse reactions associated with JE immunization in Korea. We investigated common adverse reactions during the 4 days following immunization using telephone collaborations with four public health centers and nine pediatric clinics. RESULTS: The mean age of children receiving the inactivated vaccines and live attenuated vaccines, respectively, were 1.4 y (range: 1 to 8.5) and 1.7 y (range: 1 to 8.3). The number of children that received the inactivated vaccines was 425 (64.6%). A total of 233 (35.4%) received the live attenuated vaccines. Fourteen children (3.3%) had more than one localized adverse event with the inactivated vaccine, and six (2.6%) had more than one event with the live attenuated vaccine (P=0.607). Systemic adverse reactions occurred in 5.2% vs. 8.2%, respectively, of these groups (P=0.131). Fever was more common in the live attenuated vaccine group than in the inactivated vaccine group on the day of vaccination (P=0.026). CONCLUSIONS: The rate of adverse events in our study was even lower than that previously reported. No significant difference in outcomes between inactivated vaccine and live attenuated vaccine was found in JE-immunized children. Fever was more common in the live attenuated vaccine group than in the inactivated vaccine group on the day of vaccination.
Asian Continental Ancestry Group ; Child ; Cohort Studies ; Cooperative Behavior ; Encephalitis, Japanese ; Fever ; Humans ; Immunization ; Japanese Encephalitis Vaccines ; Korea ; Prospective Studies ; Public Health ; Telephone ; Vaccination ; Vaccines ; Vaccines, Attenuated ; Vaccines, Inactivated

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Prevalence and Clinical Characteristics of Pertussis in Children, Cheonan, Korea.

Kun Song LEE ; Jae Sung SON ; Eun Hee CHUNG ; Hong Ki BAE ; Mee Jeong LEE ; Jeesuk YU ; Young Pyo CHANG ; Woo Sung PARK ; Jae Kyoung KIM ; Insoo RHEEM ; Eui Jung ROH

Korean Journal of Pediatric Infectious Diseases.2009;16(2):175-182.

PURPOSE: A number of countries have experienced an increase in pertussis during the past decade. In particular, there has been an increase in the incidence rate among adolescents and adults. To learn more about the current epidemiology of pertussis, we studied the prevalence and clinical characteristics of pertussis in children in Cheonan, South Korea. METHODS: We collected nasopharyngeal aspirates of 118 patients who were treated for respiratory symptoms at Dankook Univeristy Hospital between March 2008 and September 2009. We performed multiplex PCR for detection of Bordetella pertussis in those aspirates. RESULTS: Of the 118 patients, 10 (8%) were positive by PCR for B. pertussis. Six episodes occurred during the period July to September 2009. Nine of the 10 patients were less than 3 months old. Seven of them had not received DTaP vaccine. The mean duration of coughing before diagnosis was 10.9+/-5.2 days. Ten patients (100%) had paroxysmal cough and 8 (80%) had post-tussive vomiting. Only one patient had fever. One who had complications that include pneumonia, atelectasis and pneumomediastinum developed an absolute increase in leukocyte count (84,400/mm3). There was a statistically significant relation between vaccine being received and development of complications (P=0.033). CONCLUSION: We suspect that there was an epidemic of pertussis between July and September 2009. Further investigation by a pediatric or nationwide surveillance system is needed to monitor the changing epidemiology for pertussis.
Adolescent ; Adult ; Bordetella pertussis ; Child ; Cough ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Fever ; Humans ; Incidence ; Korea ; Leukocyte Count ; Mediastinal Emphysema ; Multiplex Polymerase Chain Reaction ; Organothiophosphorus Compounds ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Pulmonary Atelectasis ; Republic of Korea ; Vomiting ; Whooping Cough

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The Clinical Features of Pertussis in Infancy.

Soon Ju KIM ; Sang Eun KIM ; Jong Hyun KIM ; Jung Hyun LEE ; Jin Hee OH ; Dae Kyun KOH ; Hwa Young SUNG ; Jae Yon YU

Korean Journal of Pediatric Infectious Diseases.2009;16(2):167-174.

PURPOSE: Pertussis was very common in the past, but reported cases have dramatically decreased. The improvement of vaccination programs and unreadiness of laboratory confirmation seems to have developed this situation. This study investigated the frequency of pertussis among infants with a paroxysmal cough and compared the clinical characteristics between infants with and without pertussis. METHODS: Between June and November 2006, 27 infants admitted to the hospital that were 15-90 days old with a history of a cough for more than seven days were enrolled. The cough was described as: paroxysmal, whooping, and post-tussive vomiting. PCR and cultures for Bordetella pertussis with nasopharyngeal aspirates were obtained. The patients were divided into two groups: (1) the pertussis group that had positive results by PCR or culture; (2) the control group that had negative results by PCR and culture. Clinical and laboratory characteristics were compared between the two groups. RESULTS: Among the 27 cases, five (18.5%) were finally diagnosed with pertussis. Only one out of the five pertussis cases was initially diagnosed with a pertussis-like syndrome on admission. Compared to the group without pertussis, the pertussis group had a significantly higher frequency of: no fever (P=0.043), a paroxysmal cough (P=0.040), cyanosis (P=0.001), non-immunized status for DTaP (P=0.047), normal auscultation (P=0.028), normal chest X-ray findings (P=0.027), high absolute lymphocyte count (P=0.039), and low CRP (P=0.046). The patients with the diagnosis of pertussis had a significantly longer duration of coughing (27.2+/-10.6 vs. 12.6+/-5.6 days, P=0.039). CONCLUSION: Pertussis should be suspected in any infant with typical symptoms of pertussis in addition to: a persistent cough without fever, accompanied by paroxysms or cyanosis prior to the age of DTaP immunization. Active laboratory confirmation should be carried out to confirm more cases with pertussis.
Auscultation ; Bordetella pertussis ; Cough ; Cyanosis ; Fever ; Humans ; Immunization ; Infant ; Lymphocyte Count ; Polymerase Chain Reaction ; Thorax ; Vaccination ; Vomiting ; Whooping Cough

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Comparison of Urinary Tract Infections Caused by Escherichia coli and Non-E. coli in Infants.

Jin Kyo JOUNG ; Cheol Soon CHOI ; Seong Joon KIM ; So Hyun PARK ; Jong Hyun KIM ; Dae Kyun KOH

Korean Journal of Pediatric Infectious Diseases.2009;16(2):162-166.

PURPOSE: Urinary tract infection (UTI) is one of the most common bacterial infectious disease in childhood. Renal scarring is an important complication of UTIs. Known risk factors for renal scarring are younger age, anatomic defects, delayed treatment, and causative pathogens other than Escherichia coli. The aim of this study was to compare the characteristics of clinical and laboratory features of UTI with E. coli to those with non-E. coli in infants. METHODS: We reviewed the medical records of 1,120 infants under 12 months of age who had been admitted for UTIs between January 1998 and December 2007. All patients who were diagnosed with UTIs were divided into two groups (E. coli and non-E. coli UTIs). RESULTS: Three hundred twenty-four of 1,120 cases met the inclusion criteria. The number of E. coli and non-E. coli UTIs was 273 (84.3%) and 51 (15.7%), respectively. As compared to the non-E. coli UTI group, the E. coli UTI group was younger (3.59 vs. 4.47 months, P=0.008), a longer duration of pyuria (3.96 vs. 3.06 days, P=0.01), higher peripheral white blood cell counts (13.89 vs. 12.13x10(3)/mm3, P=0.043), and lower rates of high degree (III-V) vesico-ureteral reflux (P=0.005). CONCLUSION: UTIs with E. coli might have more severe clinical features and a lower prevalence of high grade vesico- ureteral reflux than UTIs with non-E. coli. However, no difference was noted in the clinical response to antibiotic therapy between the two groups.
Cicatrix ; Communicable Diseases ; Escherichia ; Escherichia coli ; Humans ; Infant ; Leukocyte Count ; Medical Records ; Prevalence ; Pyuria ; Risk Factors ; Ureter ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

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A Review of Staphylococcus aureus Infections in Children with an Emphasis on Community-associated Methicillin-resistant S. aureus Infections.

Young June CHOE ; So Yeon LEE ; Ji Yeon SUNG ; Mi Ae YANG ; Joon Ho LEE ; Chi Eun OH ; Jina LEE ; Eun Hwa CHOI ; Hoan Jong LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(2):150-161.

PURPOSE: Staphylococcus aureus causes a variety of infections, ranging from benign skin infections to fatal invasive infections. Recently, methicillin-resistant S. aureus (MRSA) infections have emerged in patients who do not have established risk factors. This study was conducted to characterize S. aureus infections in children with an emphasis on community- associated MRSA infections at a tertiary care pediatric facility during a 3-year period. METHODS: Four hundred twenty-nine cases of S. aureus infections diagnosed at the Seoul National University Children's Hospital between January 2004 and December 2006 were retrospectively reviewed. The cases were classified as hospital- onset (HO) or community-onset (CO), healthcare-associated (HA), or community-associated (CA) infections. RESULTS: Among the 206 cases <1 year of age, 72%, 7%, and 21% were HO-HA, CO-HA, and CA infections, respectively, as compared to 48%, 28%, and 24% among the 223 cases >1 year of age. The proportion of CO-HA infections among HA infections (8.6% vs. 37.1%, P<0.001) and the proportion of HA infections among the CO infections (24.5% vs. 54.3%, P<0.001) were greater in older children than in infants. Overall, 57% of the isolates were methicillin-resistant. Twenty-nine (30%) of 96 CA strains were MRSA, and the most common site of CA-MRSA infection was the skin and soft tissues (26 cases). CONCLUSION: The methicillin resistance rate of S. aureus from CA infections was high and CA-MRSA was most often associated with skin and soft tissue infections.
Child ; Humans ; Infant ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Risk Factors ; Skin ; Soft Tissue Infections ; Staphylococcus ; Staphylococcus aureus ; Tertiary Healthcare

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Diagnostic Value of Serum Procalcitonin in Febrile Infants Under 6 Months of Age for the Detection of Bacterial Infections.

Nam Hyo KIM ; Ji Hee KIM ; Taek Jin LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(2):142-149.

PURPOSE: The aim of this study was to determine the diagnostic value of serum procalcitonin (PCT) compared with that of C-reactive protein (CRP) and the total white blood cell count (WBC) in predicting bacterial infections in febrile infants <6 months of age. METHODS: A prospective study was performed with infants <6 months of age who were admitted to the Department of Pediatrics with a fever of uncertain source between July and September 2008. Spinal taps were performed according to clinical symptoms and physical examination. Serum PCT levels were measured using an enzyme-linked fluorescent assay. RESULTS: Seventy-one infants (mean age, 2.62 months) were studied. Twenty-six infants (36.6%) had urinary tract infections (UTIs), and 22 infants (31.0%) had viral meningitis. The remaining infants had acute pharyngitis (n=1), herpangina (n=1), upper respiratory tract infections (n=7), acute bronchiolitis (n=8), acute gastroenteritis (n=4), and bacteremia (n=2). The median WBC and CRP levels were significantly higher in infants with UTIs than in infants with viral meningitis. However, there were no differences in the median PCT levels between the groups (0.14 ng/mL vs. 0.11 ng/mL, P=0.419). The area under the receiver operating characteristic curve was 0.792 (95% CI, 0.65-0.896) for WBC, 0.77 (95% CI, 0.626-0.879) for CRP, and 0.568 (95% CI, 0.417-0.710) for PCT. An elevated WBC count (>11,920/microliter) and an increased CRP level (>1.06 mg/dL) were significant predictors of UTIs based on multiple logistic regression analysis. CONCLUSION: Serum PCT concentrations should be interpreted with caution in infants <6 months of age with a fever of uncertain source.
Bacteremia ; Bacterial Infections ; Bronchiolitis ; C-Reactive Protein ; Calcitonin ; Fever ; Gastroenteritis ; Herpangina ; Humans ; Infant ; Leukocyte Count ; Logistic Models ; Meningitis, Viral ; Oligopeptides ; Pediatrics ; Pharyngitis ; Physical Examination ; Prospective Studies ; Protein Precursors ; Respiratory Tract Infections ; ROC Curve ; Spinal Puncture ; Urinary Tract Infections

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Characteristics of Methicillin-resistant Staphylococcus aureus Nasal Colonization Among Neonatal Unit Staffs and Infection Control Measures.

Dong Hwan KIM ; Sun Mi KIM ; Ji Young PARK ; Eun Young CHO ; Chang Hee CHOI

Korean Journal of Pediatric Infectious Diseases.2009;16(2):131-141.

PURPOSE: In February 2007, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections occurred in two newborns in the neonatal unit of Sahmyook Seoul Hospital. We performed this study to investigate the characteristics of MRSA nasal carriage among neonatal unit staffs and the effective infection control measures. METHODS: Nasal swab specimens were obtained from the neonatal unit staff for the presence of MRSA. MRSA-colonized staffs were offered decolonization therapy with oral trimethoprim-sulfamethoxazole or 2% mupirocin ointment. Every 2-4 months after decolonizaton, repeat nasal swab specimens were obtained. Also, samples from the neonatal unit environment and room air were collected. RESULTS: Successful decolonization was achieved in 92% of the cases in 2 weeks after decolonization therapy, but most of the staffs were recolonized after several months. The nature of antibiotic susceptibility was changed from multi-drug- susceptible to multi-drug-resistant. The most frequently contaminated objects were dressing carts, computer keyboards, bassinets and washbowls. In environmental cultures using the settle microbe count method, the colony counts were decreased significantly at the last study period compared with the first study period in the neonatal room, breastfeeding room, service room, and dressing room (P<0.05). CONCLUSION: Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment, and monitoring of colonized and/or infected staffs. However, nasal decolonization therapy may induce multi-drug- resistant MRSA infection and had no effect on decreasing the MRSA nasal carriage rate in our study. Other factors might be more important, such as improving staff education, increasing hand hygiene practices, and environmental sterilization for controlling MRSA infections.
Bandages ; Breast Feeding ; Colon ; Hand Hygiene ; Humans ; Infant, Newborn ; Infection Control ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Skin ; Soft Tissue Infections ; Staphylococcus aureus ; Sterilization ; Trimethoprim, Sulfamethoxazole Drug Combination

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Clinico-epidemiologic Study of Nosocomial Rotaviral Gastroenteritis, 2001-2005.

Young Ah YOUN ; Seung Woo LEE ; Kyung Yil LEE ; You Sook YOON ; Ja Young HWANG ; Jung Woo RHIM ; Jin Han KANG ; Joon Sung LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(2):123-130.

PURPOSE: This study was performed to determine the clinical and epidemiologic characteristics of nosocomial rotavirus gastroenteritis. METHODS: We retrospectively analyzed 628 medical records of patients with rotavirus gastroenteritis between 2001 and 2005. The patients were divided into two groups (the community-acquired group [528 cases] and the nosocomial group [100 cases]. The epidemiologic and clinical indices between the groups were analysed. For clinical comparison, 100 age- matched cases were selected from the community-acquired group. RESULTS: The male-to-female ratio was similar (1.4:1 vs. 1.5:1), but the mean age was lower in the nosocomial group compared to the community-acquired group (21.9+/-15.5 months vs. 16.6+/-10.3 months, P<0.001). The patterns of age distribution, annual frequency, and seasonal distribution were similar in both groups. The proportions of nosocomial cases in each year ranged from 9.8% to 22.4% of annual rotaviral infections, and these were not proportional to annual cases. The duration of fever appeared more prominent in the nosocomial group, and the severity of diarrhea was not different between the groups. The cases with a BUN >20 mg/dL were more in the community-acquired group (16% vs. 4%, P=0.01). CONCLUSION: The clinical and epidemiologic charateristics of nosocomial rotavirus gastroenteritis were similar and correlated to those of the community-acquired gastroenteritis.
Age Distribution ; Cross Infection ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Medical Records ; Retrospective Studies ; Rotavirus ; Seasons

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Vaccines for Diarrheal Diseases.

Su Eun PARK

Korean Journal of Pediatric Infectious Diseases.2009;16(2):115-122.

Diarrhea is one of the most common causes of morbidity and mortality in children worldwide. Rotavirus is the most common cause of infectious diarrhea both in developed and developing countries. However, bacterial causes such as Salmonella typhi and Vibrio cholerae still play an important role in developing countries. Newly developed vaccines for rotavirus, S. typhi, and V. choleae are highly immunogenic and safe in children.
Child ; Developing Countries ; Diarrhea ; Humans ; Rotavirus ; Salmonella typhi ; Typhoid-Paratyphoid Vaccines ; Vaccines ; Vibrio cholerae

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Update on Tuberculosis in Children and Adolescents.

Jong Hyun KIM

Korean Journal of Pediatric Infectious Diseases.2009;16(2):107-114.

Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite significant improvements in diagnostic methods, scientific researches and clinical trials for new regimens of treatment or prevention in adult tuberculosis, childhood tuberculosis has been relatively neglected. Children are at high risk of severe disease, and reactivation of latent infection in adulthood perpetuates the epidemic. Therefore, a policy of tuberculosis control in childhood should be emphasized to improve control in the total population. To understand the new view of childhood tuberculosis, this article describes changes in the disease's national epidemiology, new diagnostic tools and treatment strategies, and multi-drug resistance.
Adolescent ; Adult ; Child ; Drug Resistance, Multiple ; Humans ; Tuberculosis

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