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A number of newly-developed vaccines are available nowadays, whilst others, which are well-established, have been improved. The collection of epidemiological data, however, is equally important in assessing and providing insight into prophylactic measures. The beneficial effects and risks of vaccination may be calculated by special formulae. Changes in the effect of vaccines can be detected by constant reevaluation of the epidemiological situation by means of these formulae. Another possibility lies in the calculation of the borderline number of complications of a certain disease when the risks of the sequelae of the disease or of the vaccination are about equal. Examples of valuable and recommendable vaccinations are vaccination against measles, poliomyelitis, tetanus and tick-borne encephalitis. A follow-up of the case mortality of whooping-cough in Austria over the past 15 years and a consideration of the fatal complications of vacinnation, as quoted by Ehrengut, reveals that the risks of the disease balanced the risks of vaccination with usual vaccines, already in 1971 (1976 with WHO data). A beneficial effect of BCG vaccination is still present, but the influence on mortality figures is very slight only. However, the benefit of BCG may lie in the prevention of deaths from leukaemia observed by some authors. Paraspecific effects of some vaccinations are mentioned. Finally, cost-benefit calculations for Austria are presented in the case of vaccination against measles and mumps, which appear to be highly recommendable, not only from the medical, but also the economic point of view.
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PMID:[Modern trends in vaccination policy: evaluation of benefits, risks and cost (author's transl)]. 10 58

This paper is a description of a vaccination programme against the most frequent communicable diseases among children: measles, tuberculosis, diphtheria, tetanus, whooping-cough and poliomyelitis. The programme is to be carried out in three different climate zones (town, forest and savanna) and over a period of six years. The project is supported by US-AID and UNICEF.
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PMID:[A broad program of vaccination in the Ivory Coast]. 22 14

Seven patients, aged 12 to 19 years, had atypical measles. Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain. The characteristic rash was erythematous, maculopapular, and progressed frequently to vesicular, petechial, or purpuric lesions. It initially involved palms and soles with subsequent spread to proximal extremities and the trunk, sparing the face. Six of six chest roentgenograms showed infiltrates. Findings not previously described in atypical measles included liver enzyme elevations, thrombocytopenia, disseminated intravascular coagulation, possible transmission among three siblings, and suspected cardiac involvement. Measles complement fixation titers compatible with recent infection were seen in all patients. All patients had previously received killed measles vaccine. A substantial number of persons who are older adolescents or young adults may be at risk of developing atypical measles.
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PMID:Atypical measles in adolescents and young adults. 44 83

The vaccination status was investigated in 1482 patients between the ages of 1 and 14 years admitted to hospital with scarlet fever. Most of the patients were vaccinated against tuberculosis (97.7%), diphtheria, tetanus and whooping-cough (95.3%) and poliomyelitis (94.1%), relatively few against measles (21.1%) and very few indeed against mumps (0.7%) and tick-borne encephalitis (1.9%). The booster vaccination against tetanus and diphtheria had been omitted in more than 40%. Although the beneficial results of vaccination against tuberculosis, diphtheria-pertussis-tetanus and poliomyelitis remained more or less the same, the tendency towards vaccination did not spread as might have been anticipated. On the contrary, the extent of vaccination decreased, especially during the past years. In the same way the tendency towards vaccination against measles showed a sudden slowing down after a period of rapid increase. This implies that vaccination of children does not tend towards perfection. The vaccination rates differ widely between foreign children living in Vienna and natives. Although the foreigners show a similar vaccination distribution pattern as the natives, the numbers of unvaccinated children are much higher.
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PMID:[Vaccination status of children in the Vienna area (author's transl)]. 74 51

This report reviews the manifestations in fifteen children of proved adenoviral pneumonia. Patients' ages ranged from 43 days to 4 years and 1 month. Twelve cases were younger than 2 years old. Adenoviral infections were proved by positive viral cultures or a four-fold increase of the complement fixation titer. Prolonged fever and cough were found in all cases. In 13 patients, respiratory distress occurred; 5 needed mechanical ventilation. Injected throats, conjunctivae and ear drums were common. Other clinical pictures included abdominal discomfort, hepatomegaly, skin rash, convulsion and bleeding tendency. Abnormal laboratory findings were mild anemia, leukopenia, thrombocytopenia, elevated erythrocyte sedimentation rate and C-reactive protein, impaired liver function test, and prolonged prothrombin time and partial thromboplastin time. Anemia (11 cases), leukopenia (7 cases) and elevated transaminases levels (7 cases) were more common than previously reported. All patients had para-hilar peribronchial infiltrates in chest roentgenography. Segmental atelectasis and compensated hyper-expansion were found frequently. Pleural effusion were noted in six of our cases. Air leak syndrome occurred in three patients who had received mechanical ventilation. Three of the 15 patients expired: one had a preceding measles infection, all had disseminated intravascular coagulopathy. For patients with antibiotic-resistant pneumonia, adenoviral studies should be done. Extrapulmonary manifestations, and some abnormal laboratory findings, i.e., mild anemia, leukopenia, impaired liver function are clues to adenoviral infections, while bleeding tendency can be regarded as a poor prognostic sign for children with adenoviral pneumonia.
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PMID:Adenoviral pneumonia in children. 132 94

In immunocompetent patients, infection by the measles (rubeola) paramyxovirus produces fever, cough, coryza, Koplik's spots, and, on the skin, a macular erythema that can become confluent. The erythema has a striking cephalocaudal spread and clearing. The diagnosis of measles on a skin biopsy and the distinction from an erythema multiforme type of drug eruption can be difficult. We studied a skin biopsy from a patient with the acquired immunodeficiency syndrome (AIDS) who presented with measles. In contrast to erythema multiforme, the measles biopsy has necrosis of clusters of keratinocytes in the high spinous layer and granular layer of the epidermis, whereas erythema multiforme has necrosis of basal keratinocytes. Multinucleated keratinocytes may or may not be prominent in the measles biopsy. Cytoplasmic swelling of the keratinocytes in the granular layer may be present even when multinucleated cells are sparse. Immunoperoxidase reactivity for measles virus protein is present in intranuclear inclusions and in the cytoplasm of infected upper spinous keratinocytes. There were more cells with positive staining in the biopsy from the AIDS patient than in another biopsy from an immunocompetent patient with measles. The AIDS patient was seronegative for measles throughout the course of the illness. The examination of the skin biopsy can be very important in the diagnosis of measles in AIDS patients or immunocompromised patients who may not develop the usual diagnostic serology.
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PMID:Cutaneous manifestations of measles in AIDS. 143 Apr 71

The clinical features, microbiology, treatment, and outcome in 24 children diagnosed with lung abscess at Harare Central Hospital during 1979-88 were reviewed retrospectively. This condition is rare in children, and the present study is the first to address lung abscess in Zimbabweans. 17 (71%) of the 24 patients were male and their mean age was 4.9 years. The most common presenting symptoms were fever, cough, and breathlessness. Abnormal chest signs (e.g., localized dull percussion note, with amphoric or bronchial breathing) were detected in 18 cases. Foremost among the predisposing factors were measles (25%), empyema thoraxis (17%), and unconsciousness (13%). Bacteria were isolated from 18 children, with Staphylococcus aureus (8 cases), group A beta hemolytic streptococci (4 cases), and Pseudomonas aeruginosa (3 cases) the most common. Treatment consisted of bronchoscopy to aspirate pus from the bronchus and exclude foreign bodies as well as antibiotic administration. There were 6 deaths (25% case fatality rate). The prevention or prompt treatment of measles is urged to reduce further the incidence of this rare health condition. However, the spread of human immunodeficiency virus infection among children in sub-Saharan Africa is likely to be accompanied by pediatric lung abscess cases secondary to pneumonia.
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PMID:Lung abscess in children in Harare, Zimbabwe. 147 6

Physicians analyzed December 1982-November 1989 data on 48 2-60 month old children with empyema thoracis at the University of Calabar Teaching Hospital in southeastern Nigeria to determine the incidence and etiology of empyema thoracis in this region. The incidence rate stood at 2/1000 pediatric admissions. 3 children died (6.3%), all of heart failure. 47 children suffered from fever, cough, and breathlessness, the symptoms for pneumonia. Even though bronchopneumonia is a common complication of measles which occurs frequently in Calabar, only 3 children (6.25%) also had measles. The most frequent complication of this accumulation of pus in the thoracic cavity was congestive heart failure (16 cases). 47 patients suffered from anemia (hemoglobin levels 11 gm/dl). Hemoglobin levels of 54% of all patients decreased over time to 8 gm/dl. In fact, 2 children had hemoglobin levels of 4.4 gm/dl and they experienced cardiac failure. Laboratory personnel were only able to examine pleural aspirates from 37 patients. They did not detect any organisms in 27% of these aspirates. This may have been due to parent's widespread practice of giving medication to all the children before coming to the hospital. 45.9% of the aspirates only grew Staphylococcus aureus while another 8.1% grew it and other pathogens. About 90% of the pathogens were resistant to ampicillin and penicillin and almost 90% were sensitive to cloxacillin, gentamicin, and erythromycin. Cloxacillin was very expensive and parenteral erythromycin was unavailable. Nevertheless the pediatricians used parenteral gentamicin and cloxacillin. The parents were responsible for buying the antibiotics which tended to be costly. All the patients required emergency closed tube thoracostomy drainage within 24 hours of admission. 83.3% remained in the hospital for 2 weeks and 33.3% for 1 month. Despite the rarity of empyema, long hospitalization and expensive drugs make it an important disease in Calabar.
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PMID:Clinical and bacteriological study on childhood empyema in south eastern Nigeria. 150 92

Rhinoviruses (HRVs) were isolated from 307 children (7.1%) in the virological surveillance of 4334 children with acute respiratory tract illnesses in Morioka, Japan (September 1973-December 1983). Although HRVs were isolated throughout the year, frequency of HRV infection was significantly higher (p less than 0.001) during the April-November (233/2853; 8.2%) than during the December-March (47/1481; 5.0%). There were two peaks of incidence in May (9.5%) and September (9.1%). During the May-September, the rate of HRV infection was higher in patients under the age of 11 months than the next higher group of 1-2 years old (p less than 0.001). The incidence decreased with increasing age. The illnesses of HRV infection were analysed in 294 patients, except one patient who had symptoms of measles, from whom HRV was isolated singly. Although HRV-associated illnesses were generally mild (57.5%). Upper respiratory tract illnesses (URTIs) with fever were found in 22.1% and lower respiratory tract illnesses (LRTIs) in 20.4% of these. The rate of LRTI was higher during the epidemic period (April-September) than other periods (p less than 0.02). Major symptoms of HRV-associated illnesses observed were sore throat (87.4%), cough (84.0%), and nasal obstruction and/or discharge (72.8%). Wheezing was observed in 21.8% of these. From 19 (21.8%) of 47 patients clinically diagnosed as asthmatic bronchitis in this survey, viruses were isolated. HRV was detected most frequently in 12.8% of these patients, followed by respiratory syncytial virus (RSV, 6.4%) and adenovirus (2.1%). HRV- and RSV-associated asthmatic bronchitis were observed during April-September and November-February, respectively. Viral dual infections were detected in total 20 cases included 12 HRV-associated cases. In no case was the illness of greater severity than might have been caused by either agent acting singly.
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PMID:[Virological surveillance of acute respiratory tract illnesses of children in Morioka, Japan. II. Rhinovirus infection]. 166 66

Clinical and chest radiographic findings were recorded prospectively in 185 children with cough who attended an outpatient clinic in Papua New Guinea. Children were studied if they were between 8 weeks and 6 years of age; patients with wheeze, stridor, measles, or pertussis were excluded. 56 children (30%) had radiological evidence of pneumonia. The presence of either a respiratory rate greater than or equal to 50/min or chest indrawing, or of both signs, was a good indication of pneumonia, with a predictive power of 46% for a positive test and 83% for a negative test. A more complex definition of tachypnoea, as a respiratory rate greater than or equal to 40/min in children over 12 months old and greater than or equal to 50/min in infants, showed little additional diagnostic benefit.
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PMID:Clinical signs of pneumonia in children. 168 34


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