Journal of Pediatric Infectious Diseases - Volume 7, issue 2

Authors: Rashid, Harunor | Khandaker, Gulam | Muhit, Mohammad A. | Booy, Robert

Article Type: Research Article

Abstract: Despite the fact that developing countries carry more than 90 global disease burden, only a small fraction of global medical research addresses their problems. It is interesting to note that even in the field of acute respiratory tract infections, a leading cause of mortality in poor settings, there has been disproportionately little research performed in developing countries. Using Bangladesh as an example, we discuss how clinical trials to address the most important health problems of the …developing world (that are also of relevance to the developed world) have been and can continue to be conducted in resource poor countries. To start with, we propose to conduct, in partnership with colleagues from resource rich countries, an influenza vaccine trial in Bangladesh to assess the efficacy of trivalent influenza vaccine, with and without the addition of supplementary measures like the promotion of hand hygiene in reducing pneumonia mortality among children under 5 years of age. Such research may produce a win-win situation for both developed and developing countries. Show more

Keywords: 10/90 gap, clinical trial, developing country, influenza, pneumonia

DOI: 10.3233/JPI-120350

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 49-53, 2012

Authors: Francis, Joshua R. | Blyth, Christopher C.

Article Type: Research Article

Abstract: The global burden of influenza virus infection is considerable, especially in young children, the elderly and those with underlying medical conditions. Young children are at greatest risk of requiring hospital admission with influenza virus infection. Effective antiviral treatment and prophylaxis strategies are available. Adamantanes, neuraminidase inhibitors and ribavirin all have antiviral activity. The neuraminidase inhibitors oseltamivir and zanamivir are most frequently prescribed. Neuraminidase inhibitors reduce length of illness and severity and are generally well …tolerated. Antiviral resistance is increasing globally. Antiviral resistance can occur de novo or following antiviral exposure. The incidence varies significantly between different drug classes and influenza strains. Despite increasing concern, most circulating influenza viruses remain sensitive to neuraminidase inhibitors. Show more

Keywords: Influenza, children, antivirals, neuraminidase inhibitors

DOI: 10.3233/JPI-120345

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 55-60, 2012

Authors: Khandaker, Golam M. | Dibben, Claire R.M. | Jones, Peter B.

Article Type: Research Article

Abstract: Accumulating evidence suggests that chronic diseases, physical as well as neuropsychiatric, may have their origins in early life. Alterations in fetal development have been reported to be associated with an increased risk of subsequent cardiovascular and metabolic disorders. This has been formulated as the fetal or developmental programming hypothesis. Schizophrenia is a severe and chronic neuropsychiatric illness of teenage and adult life. Birth cohort studies have reported low birth weight, delays in attaining motor milestones, …and deficits in premorbid cognitive and social functioning as factors associated with, and possible risk factors for future schizophrenia. These provide empirical support for the currently widely accepted neurodevelopmental hypothesis of schizophrenia, where abnormalities in early brain development contribute to the evolution of the disorder. Interference with brain development from infections in early life is in line with a neurodevelopmental view of schizophrenia. Prenatal maternal infections such as influenza have been linked with increased risk of both childhood sub-clinical psychotic symptoms and adult schizophrenia. Prenatal maternal infections can increase fetal exposure to excessive maternal glucocorticoids. This can reprogram the hypothalamic-pituitary-adrenal axis leading to increased risk of several chronic diseases including schizophrenia. In this review we focus on epidemiological and preclinical studies concerning prenatal maternal influenza and risk of both childhood psychotic symptoms and later development of schizophrenia in the offspring. We discuss these findings in light of the fetal programming hypothesis, which points towards common links, in early life, between chronic diseases, physical (such as hypertension and type-two diabetes) and neuropsychiatric (such as schizophrenia). Show more

Keywords: Schizophrenia, influenza, pregnancy, prenatal, infection, fetal programming, chronic disease, childhood development

DOI: 10.3233/JPI-120346

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 61-68, 2012

Authors: Yin, Jiehui Kevin | Salkeld, Glenn | Heron, Leon | Booy, Robert

Article Type: Research Article

Abstract: The disease burden of seasonal influenza in young children is substantial. And yet only the USA, Canada, Finland and one state in Australia currently have a routine influenza vaccine policy in place for young children. Few countries seem keen to follow their lead. This paper reviews the evidence required to inform a policy of universal paediatric vaccination; key features include protective effect, economic impacts and the safety of influenza vaccination in this age group. …We found that i. there is insufficient data on the protective effect of vaccinating infants aged 6–23 months, ii. there are very few economic evaluations and most of the current published economic evaluations involve modelling and were performed using data from a variety of sources which are not setting specific, and iii. safety data have not been specifically addressed by an in-depth separate systematic review. To better inform relevant policy making, we suggest that interdisciplinary research, (combining epidemiology and health economics at least), is required to fully examine the protective effect, economic impacts and safety of influenza vaccination in children aged 6–59 months. We also suggest that the safety data on influenza vaccination in this age group should be assessed specifically by an in-depth separate systematic review, using published and grey literature. Show more

Keywords: Policy-making, influenza vaccine, children, vaccination program, economic analysis, vaccine safety

DOI: 10.3233/JPI-120348

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 69-73, 2012

Authors: Khandaker, Gulam | Booy, Robert

Article Type: Research Article

Abstract: The WHO declared the first pandemic of the 21st century in June 2009 [influenza A(H1N1)pdm09]. The exact burden of the pandemic is still unknown and data continues to emerge on the direct and indirect costs associated with this pandemic. In this review we explore why the 2009 pandemic was so mild, what we might have done better to control and manage it then suggest some lessons for the future. Compared to previous influenza pandemics, the 2009 pandemic would …be considered mild. It raises questions as to whether the pandemic virus was less virulent compared with previous pandemics and/or whether advances in modern medicine helped to keep the mortality low. This is the first pandemic that has been tackled with the combination of antivirals, antibiotics, vaccines for both the virus and bacterial super-infections as well as advanced intensive-care management. The pandemic influenza virus showed some remarkable antigenic and genetic similarities with the 1918 pandemic H1N1 virus. Related to this, it spared the elderly who are usually at much higher risk of influenza morbidity and mortality during seasonal epidemics and pandemics. Show more

Keywords: Influenza, pandemic, mild

DOI: 10.3233/JPI-120347

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 75-81, 2012

Authors: Kendall, Mark

Article Type: Research Article

Abstract: Young children are of the highest hospital admission rate of all influenza cases. A broad and effective rollout of influenza vaccines for children is hindered by the current most common method of administration: the needle and syringe. Limitations include: reduced compliance due to needle-phobia; increased costs due to maintaining refrigeration due to transportation and storage (the "cold chain"); the need for qualified medical/nursing practitioners – to help reduce risk of unsafe injections …and needle-stick injuries; and potentially impeded immunity – by delivery to muscle and not accessing the abundant antigen presenting cell populations resident in skin and mucosal surfaces. This paper explores needle-free routes to improved childhood influenza vaccines rollout, by being a practical device for self-administration that has also generated significantly-improved immunogenicity and also the removal of the cold chain (through dry-formulation). Marketed devices targeting the mucosa through intranasal delivery (of liquid vaccine) are analysed, together with skin-targeting approaches currently in development – offering both improved immunogenicity and cold-chain removal by formulating the vaccine in a solid form. Show more

Keywords: Vaccinating against influenza, children

DOI: 10.3233/JPI-120349

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 83-88, 2012

Authors: Chow, Maria Yui Kwan | King, Catherine | flyon504+yayaBooy and, | Julie Leask,

Article Type: Research Article

Abstract: The annual incidence of laboratory-confirmed influenza is usually between 2 to vaccinate their children. The aim of our study was to determine parental intentions and behavior regarding influenza vaccination for their children and to explore explanatory variables. We conducted a cross-sectional survey in 16 child-care centers in Sydney, Australia, between November and December 2009, just after the first wave of the 2009 influenza pandemic. Survey packets were distributed at the child-care centers and e-mails were sent …to parents of children aged 6 months to 5 years, asking them to complete the questionnaire either on paper or over the web. The questions addressed knowledge, behavior, intentions and beliefs regarding seasonal influenza and vaccination. We analyzed the data by descriptive statistics as well as using both univariate and multivariate tests with logistic regression. We received 431 completed questionnaires (response rate: 44%). Vaccination was chosen by 59% of respondents as a method for preventing influenza. 21% of parents were extremely or very concerned about the likelihood of their child contracting influenza. During 2009, 12% of children were offered seasonal influenza vaccine by a health-care professional, but only 8% received it. For the coming 2010 season, 22% of parents were planning to have their child vaccinated while 52% were unsure about vaccinating. Nearly half (45%) were "unsure" whether influenza vaccine is more of a risk for children than actually having influenza. About 60% were unsure whether or not the vaccine should be recommended for chronically ill children. The two strongest discouragers to vaccination were a parental perception that the vaccine was new and the requirement for annual vaccination. The strongest behavioral predictors for vaccination in 2009 were the offer of vaccination by a health-care professional (OR: 35.7, 95% CI: 13.2–90.9) and the perception that the vaccine is safe for children aged 1–5 years (OR: 27.8, 95% CI: 3.6–200.0). Australian parents had limited knowledge about seasonal influenza vaccine, with almost half unsure about its safety for children. Health-care professionals are pivotal to promoting vaccination uptake, as parents considered them the most reliable source of information. Health-care professionals should be educated to provide up-to-date, accurate information to parents. Show more

Keywords: Influenza, vaccination, behavior, parents, children

DOI: 10.3233/JPI-120344

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 2, pp. 89-96, 2012