Rodolfo E. Begue

A case-control study to determine risk factors for hospitalization for rotavirus gastroenteritis in U.S. children.

Objective: The objective of this case-control study nested within a surveillance study conducted at 3 hospitals (Cincinnati Childrens Hospital Medical Center, Cincinnati, OH; Childrens Hospital of New Orleans, New Orleans, LA; and Hasbro Childrens Hospital, Providence, RI) was to identify risk factors for rotavirus gastroenteritis requiring hospitalization. Patients: Cases were children ≤59 months of age who were admitted with acute gastroenteritis (AGE) and found to have rotavirus infection. Controls were selected from a birth certificate registry (Cincinnati and Providence) or a registry of patients from a large practice consortium in 11 locations (New Orleans). Results: Three hundred forty-nine rotavirus-infected cases and 1242 control subjects were enrolled. Breast feeding was protective against hospitalization for rotavirus AGE for infants <6 months of age. (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–13.2). Low-birth-weight (<2500 g) infants had increased risk for hospitalization even beyond the first few months of life (OR, 2.8; 95% CI, 1.6–5.0). Children in child care were more likely to be hospitalized for rotavirus AGE than those cared for at home, particularly those ≥24 months of age (OR, 3.0; 95% CI, 1.8–5.3). Other characteristics associated with rotavirus AGE hospitalization were children <24 months of age covered by Medicaid or without insurance (OR, 2.1; 95% CI, 1.4–3.2) and having another child in the house <24 months of age (OR, 1.6; 95% CI, 1.1–2.3). The data suggest that maternal age <25 years (OR, 1.4; 95% CI, 1.0–2.0) and a mother with less than a high school education (OR, 1.5; 95% CI, 1.0–2.3) may also increase risk of rotavirus hospitalization. Conclusion: There are socioeconomic and environmental factors and aspects of the childs medical and dietary history that identify children at risk for hospitalization with rotavirus AGE.

Compliance issues related to the selection of antibiotic suspensions for children.

Objective. To evaluate the palatability, cost and other compliance issues as variables in the selection of antibiotic suspensions for children. Methods. Eighty-six physicians and health care personnel randomly sampled amoxicillin (used as a standard for comparison) and 11 other antibiotics, evaluating them in categories of appearance, smell, texture, taste and aftertaste. Overall scoring was then adjusted for cost, duration of therapy and dosing intervals. Results. Overall taste (palatability) ranking of antibiotics, highest to lowest, was as follows: loracarbef, cefdinir, cefixime, azithromycin, ciprofloxacin, trimethoprim-sulfamethoxazole, clarithromycin, trimethoprim, amoxicillin/clavulanate, cefpodoxime and cefuroxime. Overall rating of antibiotics was greatly influenced by other compliance variables, in order of their impact: cost; duration of therapy (5 vs. 10 days); and dosing intervals. Cost was not judged to be a major factor by most participants unless antibiotic expense was >

A Double-Blind Taste Comparison of Pediatric Antibiotic Suspensions

50.00 for treatment of otitis media in our hypothetical 2-year-old, 13-kg child. Taking all variables into consideration, final ranking from highest to lowest was azithromycin, cefdinir, loracarbef, cefixime, amoxicillin, trimethoprim-sulfamethoxazole, cefpodoxime, trimethoprim, clarithromycin, ciprofloxacin, cefuroxime and amoxicillin/clavulanate. Conclusions. Variables related to compliance for families filling antibiotic prescriptions and children taking these products are important in the selection of antimicrobial therapy. Because final assessment is likely to vary considerably among health care personnel, decisions must be made on an individual basis.

Treatment of cutaneous sporotrichosis with one daily dose of potassium iodide

This study examined the palatability of 22 antimicrobial suspensions by using five independent categories for scoring: appearance, smell, texture, taste, and aftertaste. The likely overall influence on patient compliance was also evaluated. Drugs were compared within their respective classes. The only antibiotics judged to be so unpalatable as to potentiallyjeopardize compliance were dicloxacillin, oxacillin, erythromycin/sulfisoxazole, and cefpodoxime. Among the penicillins, amoxicillin and ampicillin were preferred. Azithromycin was slightly superior to erythromycin and clarithromycin within the macrolide class. Many cephalosporins were ranked quite high, the best being loracarbef, cefadroxyl, cefprozil, and cefixime.

A prospective study of Shiga-like toxin-associated diarrhea in a pediatric population.

BACKGROUND Recommended treatment for cutaneous sporotrichosis consists of a saturated solution of potassium iodide (SSKI) administered in three daily doses (tid). Because compliance with this regimen has been a problem in our previous experience, we evaluated the use of one daily (qd) full dose of SSKI. METHODS Patients with culture-confirmed cutaneous sporotrichosis were entered in a randomized, nonblinded study to compare the safety and efficacy of qd vs. tid dosage of SSKI. RESULTS Fifty-seven patients were enrolled to receive either qd (29) or tid (28) SSKI. Three (1 in the qd and 2 in the tid group) were not compliant with the assigned regimen. Side effects were common but mild in both treatment groups (61% in the qd and 42% in the tid group, P = 0.17); treatment had to be discontinued because of side effects in 3 cases (2 in the qd and 1 in the tid group). Overall 26 (89.6%) and 25 (89.2%) of the individuals initially assigned to the qd and tid dosing schedule, respectively, were cured by the treatment. No relapse was detected after 45 days of follow-up. CONCLUSION These findings suggest that a single daily full dose of SSKI appears to be appropriate therapy for cutaneous sporotrichosis; further studies with larger numbers of patients are required.

Rhesus rotavirus vaccine effectiveness and factors associated with receipt of vaccine.

Although population-based studies have shown that children have the highest age-specific incidence of infection with the Shiga-like toxin-producing E. coli (SLTEC), these sporadic case series were not focused specifically on the pediatric age group. We undertook a prospective study to determine the frequency of detection of SLT in an exclusively pediatric population. The study design minimized ascertainment and referral bias by systematically defining the population by the presence of diarrheal symptoms rather than by specific diagnosis, previous submission of stool for culture, or referral to a diarrhea study. All children < 10 years of age hospitalized at a tertiary care pediatric hospital, irrespective of admission diagnosis, were surveyed prospectively at admission and for 2 days thereafter for the presence of defined diarrheal symptoms. From May 1, 1991, to April 30, 1992, 227 patients and 92 age- and season-matched controls were enrolled. Fecal SLT was detected in six (2.6%) patients, three of whom had E. coli 0157:H7 organisms were isolated; SLT was not found in any of the controls. SLT was more commonly detected in children 2–10 years of age and in bloody stools. Salmonella was isolated in six (2.6%) cases, Shigella in five (2.2%), and Yersinia in three (1.3%); rotavirus was detected in 46 (20.3%). Two patients with SLT-associated diarrhea had hemolytic uremic syndrome (HUS), and four had hemorrhagic colitis. SLT-associated diarrhea occurred in the summer and fall months in contradistinction to that with rotavirus, which occurred in the winter and spring. Because enteric infection with SLTEC may have serious sequelae, such as HUS, and because it occurs with a frequency comparable to that of other bacterial entero-pathogens, the evaluation of diarrhea in pediatric patients should include a search for SLTEC, particularly E. coli 0157:H7.

Epidemiology of sharp object injuries in a children's hospital

Background: The rhesus rotavirus tetravalent vaccine (RotaShield) had an efficacy of 75%–100% in preventing severe rotavirus disease in prelicensure clinical trials. Before RotaShields withdrawal because of reports of intussusception, there was an opportunity to evaluate the postlicensure effectiveness of the vaccine. The objective of this study was to determine the effectiveness of the RotaShield vaccine against rotavirus gastroenteritis requiring hospitalization and to evaluate factors associated with vaccine receipt. Methods: Rotavirus cases were identified through active hospital-based rotavirus surveillance at 3 childrens hospitals in Cincinnati, New Orleans and Providence. Cases were selected if they had been eligible for vaccine during the 10-month period when vaccine was available. Controls were matched to cases by date and county or state of birth. Immunization records were obtained from cases and controls to document receipt of RotaShield. Vaccine effectiveness (VE) was calculated for 1, 2, and 3 doses of vaccine with 95% confidence intervals (CI). Results: For the 10-month period, 136 cases and 440 controls were enrolled. For 3 versus 0 doses of RotaShield, the VE was 100% (CI: 75%, 100%); for 2 versus 0 doses, the VE was 100% (CI: 62%, 100%), and for 1 versus 0 doses the VE was 89% (CI: 49%, 97%). RotaShield receipt was associated with white race, having more than 1 adult in the household, having insurance and having an older, more educated mother. Conclusions: This postlicensure study of RotaShield effectiveness found the vaccine to be highly effective in preventing rotavirus disease requiring hospitalization.

Development and evaluation of a DNA vaccine based on Helicobacter pylori urease B: failure to prevent experimental infection in the mouse model.

BACKGROUND Limited data exist on the frequency, circumstances and management of sharp object injuries (SOIs) in pediatric facilities. METHOD SOIs reported at a large childrens hospital during a 2-year period were reviewed. RESULTS One hundred thirteen SOIs were reported for an average of 6 injuries per 100 employees per year. The greatest number of injuries occurred among nurses (46%) and physicians (23%), but phlebotomists experienced the highest rate (25.5 injuries per 100 full time equivalent employees per year). Most common locations were the patient room (27%), operating room (25%) and intensive care units (17%). Needles accounted for 71% of injuries and procedural devices accounted for 22%. Forty-eight percent of injuries occurred during use of the item, 42% after use or during disposal and 7% after disposal. Twenty percent were associated with loose sharps and 15% with inadvertent patient movement. Only 2 injuries were associated with recapping. Eighty-eight percent of the objects were contaminated with blood or body fluid. Of 88 known source patients 1 tested positive for hepatitis B surface antigen, 2 for hepatitis C virus and none for HIV. One hundred four employees sought treatment: 36 received tetanus vaccine; 14 received hepatitis B vaccine; 9 received hepatitis B immunoglobulin; and 12 received zidovudine. No employee subsequently tested positive for HIV, hepatitis B virus, or hepatitis C virus. CONCLUSIONS SOIs represent a frequent occurrence among pediatric health care workers. Minimizing the use of sharps, appropriately restraining patients during procedures and promptly disposing of sharp items after use might decrease the frequency of SOIs.

Immunogenicity of Helicobacter pylori urease b protein and DNA vaccines in a mouse model

Background:  The development of a vaccine against Helicobacter pylori has become a priority to prevent major morbidity and mortality associated with this infection. Our goal was to prepare and evaluate a DNA vaccine based on the urease B gene (ureB).

Experience with pandemic 2009 H1N1 influenza in a large pediatric hospital.

A vaccine could alleviate major morbidity and mortality associated with Helicobacter pylori infection. We immunized BALB/c mice with 3 doses of a protein or DNA vaccine based on H pylori urease B. Protein alone was immunogenic even after the first dose, whereas DNA did not elicit antibodies after 3 doses. DNA preceding protein (D-P-P) appeared to blunt the response to protein, whereas DNA following protein (P-D-D) shifted from a predominantly T helper 2 (Th2) profile to a balanced Th1:Th2 profile. These preliminary findings may have important implications for the development of an H pylori vaccine.