A Case of Investigation and Diagnosis of Immune Thrombocytopenic Purpura After Vaccination of COVID-19 Inactivated Vaccine

Objective:Analyze the relationship between inoculating one case of the COVID-19 inactivated vaccine(Vero cell)and immune thrombocytopenic purpura to provide a reference for the standardized handling of adverse events following immunization.Methods:According to the"National Monitoring Program for Suspected Adverse Reactions to Vaccinations,"an on-site investigation,data collection and analysis,expert group diagnosis,and medical association assessment were conducted on a case of immune thrombocytopenic purpura in District A of Chongqing after vaccination with the inactivated COVID-19 vaccine.The assessment report was delivered to the three relevant parties,the case was reviewed,and the experience was summarized.Results:The investigation and diagnosis by the district-level vaccination abnormal reaction expert group concluded that the disease that occurred after vaccination with the COVID-19 inactivated vaccine was secondary immune thrombocytopenic purpura,an abnormal reaction to the vaccination.The medical damage was classified as Level II Grade B.The vaccine production enterprise raised objections to this conclusion.After re-assessment by the municipal-level medical association,the conclusion was consistent with that of the district-level medical association.The vaccine production enterprise did not raise any further objections.Conclusion:Through active collaboration among district and municipal-level medical associations,disease control institutions,and vaccination units,the recipients have been promptly and effectively treated,providing financial support for their subsequent treatment and safeguarding their rights.The investigation and disposal procedures for adverse events following immunization in Chongqing are clear,and the mechanism is sound.It is necessary to continue strengthening the monitoring of adverse events following immunization according to the existing plan and to ensure timely and standardized handling.Simultaneously,it is crucial to strengthen vaccine management and vaccination management.

Helicobacter pylori eradication in patients with chronic immune thrombocytopenic purpura

AIM: To assess the effect of Helicobacter pylori (H. pylori) eradication on platelet counts in patients with chronic immune thrombocytopenic purpura (cITP).

A murine model for human immune thrombocytopenic purpura and comparative analysis of multiple gene expression in bone marrow and spleen

Homeostasis of platelet number in human and other mammals is well maintained for prevention of minor bleeding and for other im- munological functions, but the exact molecular mechanism responsible for immune thrombocytopenic purpura （ITP） has not been fully understood. In an effort to identify genetic factors involved in initiation of platelet production in response to bleeding injury or platelet destruction, we have successfully generated an animal model of human ITP via intraperitoneal injection of anti-platelet antibody into the Balb/c mouse. Platelet counts were dropped dramatically in animals that received antibody injection within 4 h, maintained at the mini- mum level for a period of 44 h, started to rebound after 48 h, and reached to the maximum at 144 h （6 days）. Final homeostasis reached at approximately 408 h （17 days）, following a minor cycle of platelet number fluctuation. Using semi-quantitative RT-PCR, we assessed and compared mRNA level of CD41, c-myb, c-mpl, caspase-3, caspase-9, GATA-1, and Bcl-xl in bone marrow and spleen. Alteration of mRNA expression was correlated with the change of platelet level, and an inverse relationship was found for expression of the genes be- tween bone marrow and spleen. No transcription was detectable for any of the seven genes in bone marrow at the time when platelet number reached the maximum （144 h）. In contrast, mRNA transcripts of the seven genes were found to be at the highest level in spleen tissue. This is the first study of simultaneous detection of multiple platelet related genes in a highly reproducible ITP animal model. Our results provided the supportive evidence that expression of the above seven genes are more related to negative regulation of platelet number in spleen tissue, at least in the model animals.

Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient

A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura(ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack oftuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.

Study of establishing disease-syndrome combined with animal model for immune thrombocytopenic purpura without additional conditions

Objective:To explore the feasibility of establishing the disease-syndrome combined animal model for immune thrombocytopenic purpura(ITP)without additional conditions.Methods:Three batches of data related to the ITP model mice obtained by replication at different time were analyzed,and whether the APS-injected model mice replicated through the passive immune modeling method could simulate the pathogenesis and clinical characteristics of human ITP was evaluated according to the differentiation criteria for diseasesyndrome combined model.Results:The APS-injected replicated ITP model mice possessed the following traits:(1)Compared with the normal group,the platelet count was significantly decreased,and coagulation time was significantly increased in the model group(P<.01).(2)Compared with the normal group,the medullary thrombocytogenous megakaryocytes were significantly decreased(P<.05,.01,.001).(3)The APS-injected sites and other parts of the model mice had spontaneous hemorrhage.(4)Behavioral changing signs were observed 1 week after the modeling(i.e.low activity,delayed activity,poor appetite,skin petechia/hemorrhage and spontaneous hemorrhage at the injected sites or other parts),and were getting more and more severe.Conclusion:According to the syndrome differentiation criteria for disease-syndrome combined model of ITP,the APS-injected animal model of ITP replicated through the passive immune modeling method without additional conditions possesses the characteristics of disease-syndrome combined model.It provides an ideal tool for the development of traditional Chinese medicine pharmacology experiment.

Eltrombopag Managed Severe Immune Thrombocytopenic Purpura in Pregnancy: A Case Report, Latifa Hospital, DHA, Dubai, UAE

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder, defined by a platelet count of less than 100 × 109/L, secondary to impaired production and immune destruction of platelets. Bleeding tendency is the main presentation of this condition. Clinical symptoms and investigations will confirm the diagnosis. Steroid is the first line of treatment. Although Rituximab and Thrombopoietin receptor agonists are useful second line agents in non-pregnant adults, the data about their role in pregnancy are still limited. We present the case of a 30 year old primigravida, who was a known case of chronic ITP since childhood;the course of her disease was fluctuating, for which oral steroids were used accordingly. She presented with gum bleeding and petechial rash with very low platelets count. She was sponsored by the Patient Support Program and was given Eltrombopag during the third trimester. She responded well to Eltrombopag with no noticeable side effects, neither to the mother nor to the baby so far. Eltrombopag has been assigned Category C by the Federal Drugs Agency (FDA) nevertheless there are no well controlled data in the literature about its role in pregnancy.

Chronic Immune Thrombocytopenic Purpura in a Young Female with Rheumatoid Arthritis (Unusual Course)

We present a case of a 29-year-old female from Sudan, who was diagnosed with rheumatoid arthritis (RA) in 2005 and with immune thrombocytopenic purpura (ITP) in 2009. The ITP immediately followed using, for four weeks, a combination of medications that included rifampicin. The platelets count continued to be low thereafter. During the year following her diagnosis with ITP, she reported gradual improvement in her joints symptoms, which continued during her pregnancy in 2011. Following puerperium, her chronic ITP resolved completely;however, her joint disease flared up few months later. To our knowledge, there are no reported cases of chronic ITP, which were drug induced at first in a patient of RA except with gold therapy. Similarly, there are no reports on cases that recovered from chronic ITP after delivery. Finally, this case highlights the impact different coexisting autoimmune diseases may have on each other regarding course and prognosis.

Effect of lead exposure on the immune function of lymphocytes and erythrocytes in preschool children

Objective: To investigate the influence of lead exposure on the immune function of lymphocytes and erythrocytes in preschool children. Materials and methods: A group of 217 children three to six years of age from a rural area were given a thorough physical examination and the concentration of lead in blood samples taken from each subject was determined. The indices of lymphocyte immunity (CD^+3CD^+4, CD^+3CD^+8, CD^+4CD^+8, CDˉ3CD^+19) and erythrocyte immunity (RBC-C3b, RBC-IC, RFER, RFIR, CD35 and its average fluorescence intensity) of 40 children with blood lead levels above 0.483 μmol/L were measured and compared with a control group. Results: The blood lead levels of the 217 children ranged from 0.11 μmol/L to 2.11 μmol/L. The CD^+3CD^+4and CD^+4CD^+8 cells were lower (P＜0.01) and the CD^+3CD^+8 cells were higher in the lead-poisoned subjects than those in the control group (P＜0.05). CD^+3 and CDˉ3CD^+19 did not show significant differences. Although the RBC-C3b rosette forming rate was lower and the RBC-IC rosette forming rate was higher in the lead-poisoned group, this difference could not be shown to be statistically significant (P＞0.05). RFIR was found to be lower in the lead-poisoned group (P＜0.01). Compared with the control group, the positive rate of CD35 was not found to be significantly different in a group of 25 lead-poisoned children (P＞0.05), while the average fluorescence intensity was lower in the lead-poisoned group (P＜0.05). Conclusion: Lead exposure can result in impaired immune function oft lymphocytes and erythrocytes in preschool children.

Helicobacter pylori-associated immune thrombocytopenia:Clinical features and pathogenic mechanisms

Immune thrombocytopenia (ITP) is an autoimmune disease mediated by anti-platelet autoantibodies. There is growing evidence that the eradication of Helicobacter pylori (H. pylori) effectively increases platelet count in a considerable proportion of ITP patients infected with this bacterium. In the majority of ITP patients responding to H. pylori eradication therapy, the anti-platelet autoantibody response is completely resolved with no relapse for more than 7 years, indicating that the disease is cured. Therefore, adult patients with suspected ITP should be examined for H. pylori infection, and eradication therapy is recommended if the infection is present. Notably, however, the efficacy of H. pylori eradication therapy in ITP patients varies widely among countries, with a higher response rate in Japan compared with the United States and European countries other than Italy. The pathogenesis of H. pylori-associated ITP is still uncertain, although the mechanisms are known to involve multiple factors. H. pylori may modulate the Fc&#x003b3;-receptor balance of monocytes/macrophages in favor of activating Fc&#x003b3; receptors, and H. pylori components may mimic the molecular makeup of platelet antigens. Further studies of the pathogenic process of H. pylori-associated ITP may be useful for the development of new therapeutic strategies for ITP.

Eltrombopag-related renal vein thromboembolism in a patient with immune thrombocytopenia: A case report

BACKGROUND Eltrombopag is an orally administered thrombopoietin receptor agonist linked to a heightened risk of treatment-related thromboembolism.Both venous and arterial thromboses have been documented in the medical literature.CASE SUMMARY In the absence of nephropathy,a 48-year-old patient receiving eltrombopag for immune thrombocytopenia(ITP)developed renal vein thrombosis and pulmonary embolism.The renal vein thrombus spontaneously resolved during subsequent anticoagulant treatment,restoring venous circulation.CONCLUSION A rapid upsurge in platelets,rather than their absolute number,may trigger thrombotic events in this setting.For patients at high thrombotic risk,individualized eltrombopag dosing and vigilance in platelet monitoring are perhaps needed during treatment of ITP.

Serum Zinc Levels and Immune Status of Children with Persistent Diarrhea Following Oral Zinc Supplementation

Background: Persistent diarrhea (PD) is a common disease in childhood worldwide. Clinical studies suggested that zinc supplementation is useful in most PD children. However, the relationship between the zinc and immune status of the PD children has not been reported. Objective: To examine serum zinc levels and immune status in 6 to 24 months old children with PD before and after 120 days of oral zinc supplementation and to evaluate the effects of zinc supplementation on serum zinc levels and immune status in PD children. Methods: A case control study was carried. Fifty-eight children aged 6 to 24 months with PD were enrolled. 58 patients were divided into two groups, zinc group (28 cases) and control group (30 cases). Laboratory investigation of serum zinc levels, Lymphocyte subsets (CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio) and immunoglobulins (IgG, IgA and IgM) levels was carried out in all these patients once at enrollment and again after 120 days of treatment. Results: Before treatment, the serum zinc concentration was 4.37 ± 1.23 μmol/L in zinc group and 4.42 ± 1.45 μmol/L in control group (P > 0.05). However, after treatment, the serum zinc concentrations in the zinc group were significantly higher (8.81 ± 2.56 μmol/L), as compared to the control group (4.12 ± 1.02 μmol/L) (P < 0.05). Regarding immune status, Lymphocyte subsets CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio and IgG, IgA and IgM levels of all the children with PD were measured once at enrollment and again after 120 days of treatment. There were no significant differences between the zinc and the control groups in CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratios (P > 0.05) before giving treatment. However, after 120 days of treatment, in the zinc group there was a significant rise in CD4+% (53.60 ± 5.78). The CD4 was significantly higher in the zinc group as compared to the control group (44.73 ± 4.39) (P < 0.05). Besides CD4+%, the CD4+/CD8+ ratio was also found to be higher among zinc group (1.49 ± 0.29) as compared to the control group (1.26 ± 0.18) after treatment (P < 0.05). But there were no statistically significant differences in CD3+% and CD8+% between zinc and control group after treatment (P > 0.05). Regarding immunoglobulins, there were no significant differences between zinc and control group in IgG, IgA and IgM levels (P > 0.05) at the time of enrollment (before treatment). However, after treatment, the mean IgG levels in zinc group and control group were 6.36 ± 0.95 g/l and 5.67 ± 0.74 g/l, respectively, P < 0.05. Similarly, after treatment, IgM levels in the zinc group were found significantly higher (1.58 ± 0.13 g/l), as compared to the control group (1.43 ± 0.20 g/l) (P < 0.05) but no significant differences in IgA levels were evident between the two groups after treatment. Conclusion: Administration of oral zinc supplement improved both serum zinc levels and immune status in children with PD. Zinc supplementation should be administered as adjunctive therapy for PD children.

Mechanism study of the effect of Ningxue Shengban decoction on regulating the ratio of Treg/Th17 cells and downstream inflammatory factors in immune thrombocytopenia model mice

Background:To explore the role and mechanism of T cell imbalance in the process of immune thrombocytopenic purpura(ITP)and the efficacy of the Ningxue Shengban decoction in treating this disease.Methods:Passive immune ITP mouse model was established by injecting CD41 monoclonal antibody into BALB/c mice.The mice were divided into different groups for intervention and drug administration for 9 days.The therapeutic effects(blood cell count,bone marrow morphology)were observed.The changes in the number and proportion of regulatory T/Th17 cells in each group,as well as the expression of key transcription proteins and genes(Foxp3,RORγt)in mouse spleen,and the secretion of related inflammatory factors(interleukin-17,TGF-β,interleukin-21,interleukin-10)in serum were detected.Results:Ningxue Shengban decoction significantly increased the peripheral blood platelet count in ITP mice,improved bone marrow morphology,restored the imbalance of regulatory T/Th17 ratio,and exerted a positive regulatory effect on target proteins and downstream inflammatory factor secretion.Conclusion:Ningxue Shengban decoction may exert its therapeutic effect in treating ITP by regulating T cells and exerting immune regulatory function.

Effect of tanshinone on blood coagulation, inflammatory factors and immune function in children with allergic purpura

Objective:To investigate the effects of tanshinone treatment on coagulation function, inflammatory factors and immune function in children with allergic purpura, and to guide clinical medication.Methods:130 children with allergic purpura diagnosed in a certain hospital from November 2015 to June 1818 were selected. According to the random number table method, they were divided into control group and study group, 65 cases in each group. The control group was given conventional anti-allergic drugs, and the study group was treated with tanshinone on the basis of the control group. The changes of renal function, inflammatory factors, coagulation function and immune function were compared between the two groups before and after treatment.Result:There were no significant differences in renal function, inflammatory factors, coagulation function and immune function between the two groups (P>0.05). After treatment, the levels of renal function Scr, BUN and Cysc and were significantly decreased in the two groups, and the inflammatory factors PCT, CRP levels were significantly decreased in the two groups (P<0.05). The above indexes of the study group were significantly lower than the control group (P<0.05). After treatment, APTT and PT levels were significantly increased in both groups, and FIB and ESR levels were significantly lower (P<0.05). The levels of APTT and PT in the study group were significantly higher than those in the control group, and the FIB and ESR level was significantly lower than that in the control group (P<0.05). After treatment, the levels of IgG, C3 and C4 were significantly lower in the two groups (P<0.05). The levels of IgG, C3 and C4 in the study group were significantly lower than those in the control group (P<0.05).Conclusion: Tanshinone combined with anti-allergic drugs has significant curative effects on children with Henoch-Schonlein purpura. It can significantly reduce renal function damage, alleviate inflammation stress response, improve coagulation function and correct immune disorders. And it is worthy of clinical application.

New mechanisms of the TCM spleen-based treatment of immune thrombocytopenia purpura from the perspective of blood neurotransmitters

Objective:To explore new mechanisms of the traditional Chinese medicine (TCM)spleen-based treatment of immune thrombocytopenic purpura (ITP) from the perspective of blood neurotransmitters.Methods:In this randomized controlled multi-center clinical study,271 ITP patients who met the diagnostic criteria of 'syndrome of spleen failing to manage blood' were randomized into three groups:group A administered Jianpi Yiqi Shexue (JYS) granules,1 bag per treatment,bid;group C administered prednisone as a draught at an initial dose of 1.0-1.5 mg/kg/day at 8:00 AM;and group B administered a combination of the interventions in groups A and C.Each treatment cycle lasted 21 days.Results:After treatment,scores of platelet distribution width (PDW) were significantly decreased in groups B and C,and there were significant differences among the three groups (P =.0131).Pairwise comparisons showed that PDW was significantly different between group A and group B (P =.005) and between group A and group C (P =.041) but not between group B and group C.Hemorrhage grading scores were significantly different between day 1 and day 7 in group A and group B (P <.001) but not in group C.The hemorrhage grading scores on day 14 and day 21 were significantly different from that on day 1 in all three groups (P <.001).Serum 5-hydroxytryptaminelevels did not change significantly before and after treatment in the three groups (P >.05).Serum β-endorphin and vasoactive intestinal peptide levels were significantly different between group A and group B (both P <.001).Conclusions:The JYS prescription may regulate the expression levels of blood neurotransmitters via the brain-gut axis in patients with 'spleen deficiency' ITP and thus activate hemostatic mechanisms to promote hemostasis.β-EP and VIP are key neurotransmitters of the JYS-induced functional regulation.

Effect of Saccharomyces boulardii in combined with Ruianji oral liquid on the cellular immune function in children with rotavirus enteritis

Objective: To explore the effect of Saccharomyces boulardii (S. boulardii) in combined with Ruianji oral liquid on the cellular immune function in children with rotavirus enteritis (RVE). Methods: A total of 96 children with RVE who were admitted in our hospital from August, 2016 to July, 2017 were included in the study and randomized into the observation group and the control group with 48 cases in each group. The patients in the two groups were given water-electrolyte and acid-base balance maintaining, antivirus, and fluid infusion. The patients in the control group were given Ruianji oral liquid, 5 mL/time from 5 months to 12 months, 2 times/d;5 mL/time greater than 12 months, 3 times/d. On the above basis, the patients in the observation group were given S. boulardii, 0.125 g/time when less than 12 months, 1 time/d;0.25 g/time when greater than 12 months, 2 times/d, taking with warm water. After 1-week treatment, the efficacy was evaluate. The fasting peripheral venous blood before and after treatment in the two groups was collected. ELISA was used to detect the serum TNF-α, IL-6, and IL-8. FCM was used to detect CD3+, CD4+, and CD8+. CD4+/CD8+ was calculated. SRID was sued to detect IgA and IgG. Results: TNF-α, IL-6, and IL-8 after treatment in the observation group were significantly lower than those in the control group. CD3+, CD4+, and CD4+/CD8+after treatment in the observation group were significantly higher than those in the control group, while CD8+ was significantly lower than that in the control group. IgA and IgG after treatment in the observation group were significantly higher than those in the control group. Conclusions: S. boulardii in combined with Ruianji oral liquid can inhibit the expressions of inflammatory cytokines in children with RVE, strengthen the cellular immune function, and effectively improve the clinical symptoms.

Why are children and many adults not affected by COVID-19? Role of the host immune response

Children are less susceptible to COVID-19 than adults:they often have asymptomatic and very rarely severe forms.This protection is valid for all variants of the virus.The aim here is to compare the immune response of children with that of adults,asymptomatic adults or those with mild disease with those who develop severe Covid.Several protective factors for children have been mentioned but some of them do not seem to be involved.Indeed,there is no clear difference in the quantity of virus receptors(angiotensin-converting enzyme 2(ACE2),transmembrane serine protease 2(TMPRSS2))present according to age that could explain a lesser entry of the virus into the cells of the nose,oropharynx and lungs of children.In fact,children and adults generally have similar viral loads and respiratory tract excretions.Most adults,like children,have antibodies(and T cells)that cross-react with human coronavirus(HCoVs)and respiratory syndrome coronavirus 2(SARS-CoV-2),but this humoral reactivity does not correlate with disease severity in adults;the difference appears to be more qualitative(IgM and anti-S in children and IgG and IgA and anti-N in adults)than quantitative,and mildly affected adults have some of the characteristics of the cross-reactivities of children.At the cellular level,the difference between children and adults lies more in the naivety of the T cells involved.The amount of salivary and mucosal IgA is negatively correlated with age and positively correlated with the absence of Covid infection:these IgAs are different and more effective than serum IgA.Severe COVID-19 is characterized by hyperinflammation following invasion of the lower respiratory tract when the virus has not been cleared from the upper respiratory tract by innate immunity.Age is associated with an alteration of the immune system,often with a chronic hyperinflammatory state:deficient innate immunity combined with age-related dysregulation of adaptive immunity could cause severe COVID-19.The innate cellular response in the upper and lower airways is more effective in asymptomatic children and adults:the interferon response is earlier and involves immune rather than epithelial cells,the latter being associated with hyperinflammation.This early response is critical given the ability of SARS-CoV-2 to suppress interferon 1(IFN-1)responses.Regulatory Treg cells(which prevent the inflammatory response from spiraling out of control)are prevalent in the respiratory tissues of children.The response of myeloid cells(neutrophils and macrophages/monocytes),which are also responsible for hyperinflammation,is also qualitatively different in mildly affected children and adults compared to severe Covid:there is enrichment of classical monocytes and dysfunctional neutrophils in severe cases.It would be useful to explore why the response of children to SARS-CoV-2 is the opposite of that to influenza virus(which causes classical monocyte influx and overproduction of inflammatory cytokines).Oral dysbiosis is associated with severe COVID-19 and the diversity of the oropharyngeal microbiota is inversely correlated with age.Mycoplasma co-infections amplify viral replication and are associated with severe Covid;children may have more protective anti-mycoplasma IgG because they are more frequently exposed to community infections.The role of hyperinflammation in severe COVID-19 justifies the use of immunomodulatory drugs:hydroxychloroquine,ivermectin,anti-histamines,corticosteroids.Probiotics have been used to restore the gut microbiota that interacts with the lung microbiota.Reduction of the permeability of the intestinal barrier has been proposed.Treatment of immune aging with a prostaglandin inhibitor works well in aged mice by restoring dendritic cell migration.Stimulation of innate immunity by a pathogen recognition motif receptor agonist works in mice.

Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infections(VPIs)can effectively minimize this infection burden.However,data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.AIM To evaluate the immunization status,VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital(Bangkok,Thailand)were retrospectively reviewed.Immunization status was evaluated via their vaccination books.Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated,and divided into VPIs and non-VPIs.Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded.Severity of infection,length of hospital stay,ventilator support,intensive care unit requirement,and mortality were assessed.RESULTS Seventy-seven children with a mean age of 3.29±4.17 years were included in the study,of whom 41(53.2%)were female.The mean follow-up duration was 3.68±1.45 years.Fortyeight children(62.3%)had vaccination records.There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization(52.0%)and accelerated vaccine from Infectious Diseases Society of America(89.5%)(P<0.001).Post-liver transplant,47.9%of the children did not catch up with ageappropriate immunizations.There were 237 infections requiring hospitalization during the 5 years of follow-up.There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations.The risk of serious infection was high in the first year after receiving a liver transplant,and two children died.Respiratory and gastrointestinal systems were common sites of infection.The most common pathogens that caused VPIs were rotavirus,influenza virus,and varicella-zoster virus.CONCLUSION Incomplete immunization was common pre-and post-transplant,and nearly all children required hospitalization for non-VPIs or VPIs within 5 years posttransplant.Infection severity was high in the first year post-transplant.

How parents' education and working status affect the nutrition and immunization status of preschool children in India

Objective:The aim of the paper is to see how educational and working status of the parents affect the nutritional and immunization status of preschool children in India.Methods:We have used data of more than 24 000 preschool children spread over different states in India.The data were collected by National Family Health Survey(NFHS-2) in 1998-99.For assessing the nutritional status,only the Z-scores of weight-forheight (WHZ) have been computed and for immunization status,it has been seen whether BCG,DPT3,Polio3 and measles have been administered.Children who fall below -2SD(-3SD) from median are considered to be moderately(severely) malnourished.Results:According to the NFHS-2 data,70%of children are vaccinated by BCG,50%receive the full course of DPT,54%get all the three dozes of polio and only 42%are protected from measles by vaccination in India.The percentages of moderately and severely wasted children in India are 12.1 and 2.8,respectively.There is a marked regional variation of these percentages.Bivariate and multivariate analysis clearly points to the need of educational status of mothers rather than fathers for proper nutritional and immunization status of preschool children.Parents’occupation and working status also have some effect,but not so pronounced as parents’education.Conclusion:The Indian preschool children need particular attention for high risk of wasting and low immunization.The prevalence of malnutrition can be arrested more by improving the mother’s education level rather than their fathers and by raising the standard of living of their house-holds.

Evaluation of Comparative Management of Expanded Program Immunization for Children in Iran and in the World

Background: EPI is one of the most cost-effective public health interventions that have already been identified. Mass vaccination is one of the most effective public health strategies that lead to a dramatic reduction in the incidence of many infectious diseases. This is a descriptive study (eco-logical exploratory) where data about the status of routine immunization of children under 6 years in 6 selected countries in terms of the routine immunization programs in each country, the coverage and reported cases of vaccine-preventable diseases from 2006 to 2008 were collected assuming that each country is a representative of a Continent;data about the status of Iran were also collected and a comparative study was performed in the next step. It is worth mentioning that selecting these countries was according to health experts to consolidate the data. Collection tools are data of international (WHO and UNICEF) and national organizations of the above countries. In all countries surveyed, triple vaccine, vaccines of polio, hepatitis B, measles, rubella and mumps are part of the routine immunization program for children under the age of 6 years, with the explanation that in South Africa only measles vaccine is injected instead of measles, rubella and mumps vaccines. The coverage rate of the vaccine and other vaccines in Iran was the best compared to other countries. This represents the widespread activity of health care systems of the country in the field of vaccination and tireless efforts of healthcare workers and health centers.