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A Survey of Doctors' Awareness of Simultaneous Vaccination.

Hojun LEE ; Hyun Seok SEO ; Seok Won CHOI ; Ji Sung KIM ; Eun Eui KIM ; Cheol Am KIM ; Byeong Hee SON ; Kyun Woo LEE

Pediatric Infection & Vaccine.2015;22(2):69-74. doi:10.14776/piv.2015.22.2.69

PURPOSE: In this study, doctors were surveyed with a questionnaire to determine whether they performed simultaneous vaccination and whether there were any concerns about safety or anxiety. The purpose of this study was to determine any problems associated with doctors readily performing simultaneous vaccination. METHODS: A trained surveyor visited 241 doctors from every institution registered with the National Immunization Program (NIP) located within six districts (gu) in the City of Busan (Dongnae-gu, Geumjeong-gu, Yeonje-gu, Suyeong-gu, Busanjin-gu, Haeundae-gu); a total of 155 (64%) valid responses were obtained. RESULTS: Of the 155 respondents, 144 (93%) were already performing simultaneous immunizations and 141 (91%) had a positive view of the practice. However, among the 144 doctors performing simultaneous immunizations, 67 (47%) were not confident about its safety; side effects were seen after simultaneous immunization by 86 doctors, 35 (41%) of whom believed that the frequency or possibility of side effects in simultaneous immunizations was higher than that in sequential immunizations. CONCLUSIONS: The use of simultaneous immunization is expanding quickly. However, among the doctors performing simultaneous immunizations, a high percentage had concerns over its unproven safety and potential side effects, indicating the need for academic societies or government institutions to present evidence to address such concerns.
Anxiety ; Busan ; Surveys and Questionnaires ; Immunization ; Immunization Programs ; Vaccination*

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A Small Outbreak of Measles in 2013: In a Single Hospital in Northern Gyeonggi-do.

Min Jae KIM ; So Hyun KIM ; Sung Un KIM ; Mi Jin JANG ; Hyun Seung LEE ; Young Hoon KIM ; Ji Whan HAN ; Jin Tack KIM ; Pil Sang JANG

Pediatric Infection & Vaccine.2015;22(2):63-68. doi:10.14776/piv.2015.22.2.63

PURPOSE: This study analyzed a small outbreak of measles at a single hospital located in northern Gyeonggi-do in 2013. METHODS: We reviewed the medical records of measles patients at The Catholic University of Korea Uijeongbu St. Mary's Hospital from August to October, 2013. RESULTS: Fifteen children were confirmed to have measles by RT-PCR and serum IgM test; 1 neonate, 11 infants, and 3 toddlers. None of the patients had received Measles-Mumps-Rubella vaccination. All patients showed B3 type in viral genotyping. Nine children (60%) had been exposed to measles during treatment for other diseases in the pediatric ward. Incubation period was between 8 and 15 days. Fever started at a median 10 days after exposure and persisted for a median of 8 days. Rash showed at a median 13 days after exposure. Respiratory complications were observed in 40% of patients. Diarrhea developed in 53% of patients. CONCLUSION: Although measles has been well-controlled due to the high rate of vaccination coverage, it is possible to have an outbreak at any given time, especially in infants. We must learn from this outbreak, and remain fully aware of the possibility of reemergence and provide proper management, including vaccination or immune globulin administration, to infants exposed to measles. Reevaluation of serum IgG titer of neonates, infants, and pregnant women may be the first step to prevent further outbreaks.
Child ; Cross Infection ; Diarrhea ; Disease Outbreaks ; Exanthema ; Female ; Fever ; Gyeonggi-do* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Infant, Newborn ; Korea ; Measles* ; Medical Records ; Pregnant Women ; Vaccination

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Effectiveness of Varicella Zoster Immune Globulin Administration within 96 Hours versus more than 96 Hours after Exposure to the Varicella-Zoster Virus.

Sun Ja KIM ; Byung Kee LEE ; Yang Hyun KIM ; Soo Jin KIM ; Yae Jean KIM

Pediatric Infection & Vaccine.2015;22(2):55-62. doi:10.14776/piv.2015.22.2.55

PURPOSE: Varicella Zoster Immune Globulin (VZIG) is available in Korea for post-exposure prophylaxis of the Varicella-zoster virus (VZV) in high-risk patients. In July 2013, the United States Centers for Disease Control and Prevention (US CDC) recommended extending the time for administration of VariZIG(R) from within 96 hours up to 10 days after VZV exposure. This study was performed to analyze the effectiveness of VZIG prophylaxis between the two groups of patients who received VZIG within 96 hours and more than 96 hours of exposure to varicella. METHODS: A retrospective chart review was performed in pediatric patients who received VZIG at Samsung Medical Center, Seoul, Korea from January 2001 to December 2012. RESULTS: A total of 91 patients were identified. Fifty-seven patients were male (62.6%) and the median age was 5.91 years. Thirty-nine patients (42.9%) were exposed to VZV in the hospital. Underlying diseases were solid tumors (41.8%), hematologic malignancies (40.7%), and others (17.5%). Forty-five patients (49.5%) were hematopoietic cell transplant recipients. Seventy-four patients (81.3%) received VZIG within 96 hours after VZV exposure. There was no significant difference in the development of chickenpox between the two groups (2.7% vs. 5.9%, P=0.4664). In 22 seronegative patients, we also observed no significant difference between the groups in terms of the development of chickenpox (6.6% vs. 0%, P=0.667). CONCLUSIONS: This study showed that the effectiveness of VZIG for the prevention of chickenpox was comparable between patients who received VZIG within 96 hours and those who received VZIG more than 96 hours after exposure to VZV.
Centers for Disease Control and Prevention (U.S.) ; Chickenpox* ; Hematologic Neoplasms ; Herpes Zoster* ; Herpesvirus 3, Human* ; Humans ; Korea ; Male ; Post-Exposure Prophylaxis ; Retrospective Studies ; Seoul ; Transplants

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Clinical Features of Kawasaki Disease with Pyuria.

Hyo Jin KIM ; Joo Young LEE ; Ui Yoon CHOI ; Soo Young LEE

Pediatric Infection & Vaccine.2017;24(3):141-145. doi:10.14776/piv.2017.24.3.141

PURPOSE: Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. METHODS: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retrospectively analyzed. RESULTS: Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD. CONCLUSIONS: KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.
Anti-Bacterial Agents ; C-Reactive Protein ; Child ; Coronary Vessels ; Fever ; Humans ; Immunoglobulins ; Inflammation ; Inpatients ; Liver ; Male ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Pyuria* ; Retrospective Studies ; Urinary Tract Infections

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The First Newborn Screening Study of T-Cell Receptor Excision Circle and κ- Deleting Recombination Excision Circle for Severe Combined Immunodeficiency in Korea: A Pilot Study.

Sohee SON ; Ji Man KANG ; Jong Min KIM ; Sein SUNG ; Yi Seoul KIM ; Haejeong LEE ; BitA Reum KIM ; Yeon Kyoung LEE ; Sun Young KO ; Son Moon SHIN ; Yae Jean KIM

Pediatric Infection & Vaccine.2017;24(3):134-140. doi:10.14776/piv.2017.24.3.134

PURPOSE: Severe combined immunodeficiency (SCID) is the most serious form of primary immunodeficiency. Infants with SCID are susceptible to life-threatening infections. To establish newborn screening for SCID in Korea, we performed a screening test for T-cell receptor excision circle (TREC) and κ-deleting recombination excision circle (KREC) in neonates and investigated the awareness of SCID among their parents. METHODS: Collections of dried blood spots from neonates and parent surveys were performed at the Samsung Medical Center and Cheil General Hospital & Women's Healthcare Center in Korea. The amplification crossing point (Cp) value <37.0 was defined as TREC/KRECpositive based on cutoff values from measuring multiplex real-time polymerase chain reaction. A Cp value >39.0 was defined as negative. RESULTS: For TREC/KREC screening, 141 neonates were enrolled; 63 (44.7%) were male. One hundred forty neonates (99.3%) had positive TREC/KREC results at the time of the initial test; 82.3% and 75.9% were positive and 17.0% and 23.4% were weakly positive for TREC and KREC, respectively. In one neonate (0.7%), the initial TREC/KREC test result was negative. However, repeated tests obtained and confirmed a positive result. For an awareness survey, 168 parents were engaged. Only 2% of parents (3/168) knew that the newborn screening test for SCID had been introduced and performed in other countries. Eighty-four percent of parents (141/168) replied that nationwide newborn SCID screening should be performed in Korean newborns. CONCLUSIONS: In this study, newborn SCID screening was performed along with assessment of public awareness of the SCID test in Korea. The study results showed that newborn SCID screening can be readily applied for clinical use at a relatively low cost in Korea.
Delivery of Health Care ; Hospitals, General ; Humans ; Infant ; Infant, Newborn* ; Korea* ; Male ; Mass Screening* ; Neonatal Screening ; Parents ; Pilot Projects* ; Real-Time Polymerase Chain Reaction ; Receptors, Antigen, T-Cell* ; Recombination, Genetic* ; Severe Combined Immunodeficiency* ; Surveys and Questionnaires ; T-Lymphocytes*

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Evaluation of Antibodies Against Haemophilus influenzae Type b in Korean Adults.

Ji Hyen LEE ; Han Wool KIM ; Soyoung LEE ; Kyung Hyo KIM

Pediatric Infection & Vaccine.2017;24(3):125-133. doi:10.14776/piv.2017.24.3.125

PURPOSE: After the introduction of Haemophilus influenzae type b (Hib) vaccine in 1995 in Korea, it was included in the national immunization program in 2013. In the post-Hib vaccine era, some studies in other countries reported that invasive Hib disease affects adults, especially the elderly and immunocompromised persons, more often than it affects children. To evaluate disease susceptibility, quantitative and qualitative analysis of anti-polyribosylribitol phosphate (PRP) antibodies were carried out in Korean adults aged 20 to 85 years. METHODS: Sera were collected from 39 healthy adults (20 to 50 years of age) and from 30 elderly adults (75 to 85 years of age) who did not have immune-compromising conditions. The concentration of anti-PRP immunoglobulin G (IgG) and serum bactericidal indices (SBIs) were measured by enzyme-linked immunosorbent assay and serum bactericidal assay. RESULTS: Geometric mean concentrations of anti-PRP IgG and geometric mean SBIs were 0.88 µg/mL (95% confidence interval [CI], 0.17 to 3.85) and 354 (95% CI, 50 to 2,499) in young adults and 1.67 µg/mL (95% CI, 0.53 to 5.24) and 449 (95% CI, 146 to 1,376) in elderly adults, respectively. When the threshold of seropositivity for anti-PRP IgG was applied as 0.15 or 1.0 µg/mL, which is the protective antibody level in children, seropositive rates were 87.2% or 53.8% in young adults and 100% or 60% in elderly adults. The seropositivity rates of the SBI (SBI ≥4) were 82.1% and 100% in the groups, respectively. CONCLUSIONS: Most subjects in the adult and elderly adult groups display immunity to Hib based on quantitative and qualitative antibody levels, but not all. Because high immunization and low Hib circulation rates may reduce the natural Hib immunity in the population, monitoring Hib immunity as well as disease are needed continuously.
Adult* ; Aged ; Antibodies* ; Child ; Disease Susceptibility ; Enzyme-Linked Immunosorbent Assay ; Haemophilus influenzae type b* ; Haemophilus influenzae* ; Haemophilus* ; Humans ; Immunization ; Immunization Programs ; Immunoglobulin G ; Korea ; Young Adult

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Incomplete Kawasaki Disease in a 5-Month-Old Girl Associated with Cerebrospinal Fluid Pleocytosis and Epidural Fluid Collection.

Jung Ok KIM ; Hyeon Ju LEE ; Kyoung Hee HAN

Pediatric Infection & Vaccine.2015;22(1):40-44. doi:10.14776/piv.2015.22.1.40

Cases of incomplete Kawasaki disease (KD), wherein the patient does not fulfill the full diagnostic criteria for KD, are often detected in infants younger than 6 months of age. The clinical manifestations in infants with incomplete KD may resemble other infectious diseases, including meningitis. For this reason, clinicians may have difficulty differentiating incomplete KD from other infectious diseases in this population. Various neurological features are associated with KD, including aseptic meningitis, subdural effusion, facial nerve palsy, cerebral infarction, encephalopathy, and reversible corpus callosum splenial lesions on magnetic resonance imaging. We report a case of a 5-month-old girl with incomplete KD, associated with cerebrospinal fluid pleocytosis and an epidural fluid collection. Echocardiography indicated dilatation of the main coronary arteries. The girl made a complete recovery, with resolution of both the epidural fluid collection and coronary artery aneurysms. In this case, the child is well, and showed normal developmental milestones at the 7-month follow-up.
Aneurysm ; Cerebral Infarction ; Cerebrospinal Fluid* ; Child ; Communicable Diseases ; Coronary Vessels ; Corpus Callosum ; Dilatation ; Echocardiography ; Epidural Abscess ; Facial Nerve ; Female ; Follow-Up Studies ; Humans ; Infant* ; Leukocytosis* ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Paralysis ; Subdural Effusion

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A Case of Childhood Typhoid Fever Complicated with Acute Nephritis.

Eun Min OH ; Ji Hyun SIM ; Ji Hyen HWANG ; Hyung Eun YIM ; Yun Kyung KIM

Pediatric Infection & Vaccine.2015;22(1):36-39. doi:10.14776/piv.2015.22.1.36

Typhoid fever can cause serious complications, such as enterobrosia, meningitis, pneumonia, myocarditis, hepatitis, osteomyelitis, and disseminated intravascular coagulation in 10-15% of the patients. Kidney complications are very rare, and a few cases have been reported in children. We are reporting a case of childhood typhoid fever complicated with acute nephritis present with albuminuria, hypertension, and renal failure.
Albuminuria ; Child ; Disseminated Intravascular Coagulation ; Hepatitis ; Humans ; Hypertension ; Kidney ; Meningitis ; Myocarditis ; Nephritis* ; Osteomyelitis ; Pneumonia ; Renal Insufficiency ; Typhoid Fever*

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Febrile Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum beta-Lactamase-Producing and-Nonproducing Bacteria: A Comparative Study.

Do Hee AHN ; Kyu Won KIM ; Hye Kyung CHO ; Han TCHAH ; In Sang JEON ; Eell RYOO ; Yong Han SUN

Pediatric Infection & Vaccine.2015;22(1):29-35. doi:10.14776/piv.2015.22.1.29

PURPOSE: The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum beta-lactamase (CA-ESBL)-producing and -nonproducing bacteria. METHODS: We analyzed febrile UTIs in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records. RESULTS: Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL-producing Escherichia coli and Klebsiella spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever (4.2+/-2.7 vs.3.7+/-2.1 days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen. CONCLUSIONS: There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.
Anti-Bacterial Agents ; Bacteria* ; beta-Lactamases ; Child ; Data Collection ; Escherichia coli ; Fever ; Humans ; Klebsiella ; Medical Records ; Retrospective Studies ; Urinary Tract Infections* ; Vesico-Ureteral Reflux

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Clinical Manifestation of Eosinophilic Meningitis in Korean Children: A Single Institution's Experience.

Jung Hee BYUN ; Seong Yeol CHOI ; Dong Soo KIM ; Ki Hwan KIM

Pediatric Infection & Vaccine.2015;22(1):23-28. doi:10.14776/piv.2015.22.1.23

PURPOSE: The aim of this study was to investigate the clinical manifestations and laboratory characteristics of eosinophilic meningitis in Severance Children's Hospital. METHODS: We examined 6,335 children under the age of 18 years old who had visited the tertiary hospital in Seoul, Korea, and had received cerebrospinal study results between January 2007 and July 2012. The medical records of the patients identified as eosinophilic meningitis were retrospectively reviewed. RESULTS: Eosinophilic meningitis was diagnosed in 39 patients (0.6%). The mean age was 6 years (range 0-18 years) and the sex ratio was 1.3:1 (22 males and 17 females). The underlying diseases and past history were neurologic disease (n=36, 92%). Eosinophilic meningitis was diagnosed in thirty-five patients who had undergone postoperation neurosurgery (90%). The most common symptoms were fever (50%), headache (20%), vomiting (15%), seizure (10%), and dizziness (5%). The average duration for recovery was five days, and intravenous antibiotics or steroids were used. CONCLUSIONS: Manifestations of eosinophilic meningitis are similar to other types of meningitis. The most common cause of eosinophilic meningitis in children was neurosurgery. Eosinophilic meningitis should be considered for patients showing fever and headache after neurosurgery. Through careful investigation, use of improper antibiotics could be avoided.
Anti-Bacterial Agents ; Child* ; Dizziness ; Eosinophilia ; Eosinophils* ; Fever ; Headache ; Humans ; Korea ; Male ; Medical Records ; Meningitis* ; Neurosurgery ; Retrospective Studies ; Seizures ; Seoul ; Sex Ratio ; Spinal Puncture ; Steroids ; Tertiary Care Centers ; Vomiting

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