RESEARCH:

1. Epidemiology and outcomes of bacterial meningitis in Mexican children: 1993-2003

A retrospective review of the hospital-based medical records of Mexican children aged 1 month to 18 years, diagnosed with acute bacterial meningitis (ABM) between 1993 to 2003 from a large inner city referral hospital in Mexico City, was used to characterize the epidemiology, clinical features, and outcomes of infection. Data suggested that introduction of the Hib vaccine in pediatric populations in Mexico resulted in a significant decline in Hib meningitis in the region, however, S. pneumoniae remains a persistent pathogen in this population. While the study was relatively small, it was based on records from a large inner city referral hospital in Mexico City, that treats patients from many regions of the country. The authors therefore propose that these findings may be viewed as a surrogate marker for what is occurring in the larger community, and highlight the need for the implementation or the broadening of coverage for already existing vaccination programs in children, against S. pneumoniae in order to prevent acute bacterial meningitis and to elicit indirect herd immunity for other age groups.

2. IPD in HIV seropositive Brazillian children and adolescents

The risk of developing pneumonia in HIV-infected individuals is 10 to 100 times greater than that of HIV-uninfected individuals. In Brazil, HIV infection is one of the primary risk factors for invasive pneumococcal disease (IPD), however, studies in HIV-infected patients remain scarce. Using data from the Instituto de Infectologia Emilio Ribas (IIER), a total of 19 cases of IPD were identified in HIV seropositive patients aged 1 month to 20 years and hospitalized between 1993 and 2000. Eighty four per cent of the HIV seropositive IPD patients had a clinical diagnosis of pneumonia, and 16% had meningitis; 68% were children less than 2 years of age and 84% were less than 5 years of age. The case fatality ratio was 10%. Fifty four per cent of the cases in children less than 2 years of age were caused by serotypes covered by PCV7. These findings underline the urgent need for pneumococcal vaccine to protect these high-risk children and increased understanding of the mechanisms underlying pneumonia infection in HIV-infected populations to achieve effective pneumonia control.

3. Pneumococcal pneumonia and potential prevention with vaccine formulations in Uruguayan children

S. pneumoniae is currently the leading bacterial cause of pneumonia in Uruguayan children.  A recent study of the burden of pneumococcal disease in the country helps to assess the potential health impact and efficacy following potential PCV introduction. A retrospective study conducted by the Ministry of Health, National Reference Children’s Hospital, and Medical School, Montevideo, Uruguay, analyzed 410 specimen samples from 2000 to 2004, from patients with pneumococcal pneumonia aged 0 to 14 years, to assess causes of pneumococcal disease and associated serotypes. Study findings revealed that the most frequent serotypes were 14, 1, 5, 3, 9V, 6B and 7F, in decreasing order, and 48% of invasive S. pneumoniae isolates were obtained from children younger than 24 months, the main target group for conjugate pneumococcal vaccines. For this group, PCV7 would cover 60%, and PCV10 would cover 83.8%. The results of this study provide local evidence to support the recent decision by the Uruguay Ministry of Health to introduce PCV into the Uruguayan national immunization program.

4. Risk factors for X-ray pneumonia in Chilean infants from socioeconomic disadvantaged populations

A birth cohort of 188 infants, born in low-income area of Santiago, Chile were followed longitudinally on a monthly basis to assess health outcomes in this population. In particular the author’s examined the relationship between breastfeeding or wheezing during the initial stages of life, and pneumonia outcomes during the first year of life. Study findings revealed that infants who had one or more wheezing episodes during the first 3 months of life had a 7-fold greater risk of developing pneumonia during the first year of life, particularly during the first six months. In contrast, exclusive breastfeeding during the first 4 months of life protected against pneumonia. These findings suggest that public health policies encouraging exclusive breastfeeding behavior and efficient management of wheezing will likely help to reduce the incidence of pneumonia in children.

5. Effects of season at birth on asthma and pneumonia in Brazilian children and adults

The effects of seasonal weather at the time of birth and ambient temperature during the first six months of life were assessed on hospitalizations due to asthma and pneumonia in preschool children, and on diagnosis of asthma in adulthood. The study was based on individuals from a 1982 birth cohort consisting of 5, 914 patients in Pelotas, Rio Grande do Sul, Brazil who were longitudinally followed until adulthood, defined as 23-24 years of age. The risk of hospitalization due to pneumonia and asthma was found to be significantly higher among children born from April to June (Fall) compared with those born from January to March (Summer). In addition, during the first six months of life, risk of hospitalization was higher for children born in the coldest part of the year. The effects of seasonality decreased with age, and the association with asthma in adulthood was weak. These data shed light on environmental determinants of pneumonia in Brazilian children, and factors that may contribute to improvements in both management and prevention strategies in this population.

6. Routine Surveillance of Bacterial Pneumonia and Meningitis in the Americas

The Pan American Health Organization (PAHO) has supported epidemiologic surveillance of bacterial pneumonia and meningitis in children >5 years old across Latin America and recently reported data from hospital sentinel surveillance for bacterial pneumonia in six countries in Latin America: Ecuador, El Salvador, Guatemala, Honduras, Panama, and Paraguay. A total of 49,143 hospitalizations in children aged <5 years were reported by sentinel hospitals, of which 15.6% (7,672) were suspected pneumonia cases. Of these, 54.3 % (4,165) were classified as probable bacterial pneumonias and the reported case fatality was 3.2% (Figure 1). Only 6.4% (267) of bacterial pneumonia infections were confirmed as such by isolation. Streptococcus pneumoniae accounted for 20.6% (55) of isolates.

IMMUNIZATION:

7. Latin American Vaccination Week ’08 Advances toward Record Goals

The 2008 Vaccination Week in the Americas (VWA) took place April 16-24th and set a goal of vaccinating 62 million people in 44 different countries against disease such as measles, rubella, polio, tetanus, diphtheria, yellow fever, rotavirus, hepatitis B, and whooping cough. Since its inception six years ago, VWA has been instrumental in immunizing more than 200 million children and adults while educating millions more on the importance of disease prevention.  These efforts have inspired European countries to hold their own European Immunization week and PAHO hopes to create a “World Vaccination Week.”

PROFILES:

8. Interview with Dr. Ciro de Quadros of The Sabin Vaccine Institute

Dr. Ciro de Quadros is the Executive Vice President of the Sabin Vaccine Institute and, before joining the organization in 2003, served as the Director of the Division of Vaccines and Immunization of the Pan American Health Organization. He has also worked for the World Health Organization as Chief Epidemiologist for the Smallpox Eradication Program in Ethiopia. He participated in the pioneering development of surveillance and containment strategies for smallpox eradication and directed successful polio and measles eradication efforts for the Western Hemisphere. Dr. de Quadros is an Associate Adjunct Professor at the Johns Hopkins School of Hygiene and Public Health and an Adjunct Professor in the Department of Tropical Medicine at The George Washington University School of Medicine and Health Sciences. He completed his medical and public health studies in Brazil.  Read more...

9.  Interview with Nurse Dochyta Falcon, Nueva Segovia, Nicaragua

Dochyta Falcon works as a nurse in the Dr. Alfonso Moncada Guillen Hospital in Ocotal, Nicaragua, a town high in the country’s northern mountains. In addition to her duties at the hospital, Dochyta organizes educational workshops on community health and prevention in rural communities across the country and personally visits dozens of families in her community every year. Dochyta is often the first to see children brought to the hospital suffering from pneumonia. Read more...

10. Baby Illyria, Mexico City, Mexico

Twin sisters, Illyria and Romina Velasco Carranza entered day-care together at age 9 ½ months.  They were each healthy, playful babies.  As is typical in day-care settings, a number of children were healthy carriers of the pneumococcal bacterium. Both Illyria and Romina became ill after only a short time in day-care.  Read more...

11. Juancito’s Story, Nueva Segovia, Nicaragua

Jose Ramon, Carmen Emilia and their children live on a patch of farmland in a tiny, remote northern village of Nicaragua. For more than two years, Juancito, one of their four children, suffered from recurring bouts of pneumonia. He was often running a fever, racked by coughing fits, and exhausted. With the closest health post 15 miles away down a dusty foot path and reachable for the family only on foot, Jose Ramon and Carmen Emilia often chose to treat Juancito with traditional medicines, giving him chamomile tea and rubbing his chest with oil to alleviate his symptoms.   Read more...

Upcoming Events:

The 48th Annual ICAAC/IDSA 46th Annual Meeting will take place in Washington, DC October 25-28th. The American Society for Microbiology presents the 48th annual Interscience Conference on Antimicrobial Agents and Chemotherapy in conjunction with the Infectious Disease Society of America’s 46th annual meeting. Registration is available online and on site. For more information, please visit: http://www.icaacidsa2008.org/

The American Public Health Association’s 136th Annual Meeting & Exposition will be held from October 25-29, in San Diego, California. Deadline for early and discounted registration is August 15. For more information, please visit: http://www.apha.org/meetings

The National Foundation for Infectious Diseases, Emory Department of Medicine – Division of Infectious Diseases and Emory Vaccine Center will sponsor a Clinical Vaccinology Course, from November 14-16, in Bethesda, MD. Early registration is available until October 8. For more information, please visit: http://www.nfid.org