Identification of the child with influenza A (H1N1): Clinical criteria versus the rapid influenza A-B test

Introduction: During the influenza A (H1N1) pandemic infection, the Ministry of Health in Mexico recommended that it be considered as a suggestive clinical picture in patients with fever, cough and headache. In some places where the resource was available, the rapid seasonal influenza (A-B) test was used as an alternative identification strategy. Methods: From April 2009 to May 2010, patients under 18 years of age with acute respiratory tract symptoms were included in a retrospective study. They underwent the following procedures: 1) application of the clinical criteria recommended by the federal Ministry of Health during the A (H1N1) pandemic;2) rapid test for seasonal influenza (A-B), and 3) search for the influenza A (H1N1) virus by means of the real time polymerase chain reaction (RT-PCR). The study was approved by the research and ethics committee at the Central South Hospital of the government-owned Mexican Petroleum Company (PEMEX). Results: One hundred and thirty pediatric patients with a median age of eight years and a range between one and 17 years were included. Taking into account the Ministry of Health’s criteria, we found the following: 50% sensitivity, 69% specificity, 80% positive predictive value and 27% negative predictive value versus the rapid test that displayed 82% sensitivity, 70% specificity, 80% positive predictive value and 27% negative predictive value. Conclusions: Clinical criteria display low sensitivity in the infected children studied, whereas the rapid influenza A-B test constitutes a better option to identify these patients.

Evaluation of Adverse Events Following Immunization against Rotavirus Regardless of Recommended Age Restriction

Introduction: Mild and moderate Adverse Events Following Immunization (AEFI) against Rotavirus has not received much attention when the vaccine is administered regardless of recommended age restriction. Objectives: To describe the behavior of mild and moderate AEFI in immunized subjects against Rotavirus, in who age restriction period had not been considered. Methods: A case-control study in which we included immunized patients with monovalent oral vaccine against rotavirus and divided them into two groups: 1) Infants who received RV1 vaccine without considering the recommended period, and 2) Infants who were vaccinated with the recommended schedule. Results: From the total doses, 143/1894 (7.5%) were administered outside the restriction period. The most frequent AEFIs with the first dose were purpura, polypnea, and rhinorrhea;For the second dose: purpura, bloody stools, irritability and rhinorrhea. Conclusions: This study shows the benefits from vaccination regardless of age restriction are more beneficial compared to the possible risks of AEFI.

Association between an Incomplete Vaccination Schedule and Nosocomial Sepsis among Children with Cancer

Background: Patients with cancer constitute a special group where immunization programs are often interrupted to begin treatment with chemotherapy. Sepsis is one of the main complications in this group. Methods: A hospital-based case-control study matched by age was carried out among subjects ≤ 9 years of age with cancer diagnosis. Children with cancer without sepsis and children with surgical pathology were included as controls;children with sepsis were included as cases. A bivariate logistic regression was used to determine the factors associated to nosocomial sepsis, and odds ratios were calculated with 95% confidence intervals. The percentage of attributable risk was calculated for the variables included in the final model. Results: Nineteen children with cancer and sepsis and 83 controls were included. Twelve (44%) caseshad an incomplete vaccination schedule according to their age. The association force between incomplete schedule and sepsis was 10.1 (95% CI, 3 - 36;p < 0.05). Conclusions: Approximately, 20% to 65% of the cases of serious nosocomial infection can be associated to an incomplete vaccination schedule. Strategies should be implemented to improve the general pediatric population’s vaccination status before a serious disease, such as cancer or another chronic condition preventing the application of vaccines, develops.