Human metapneumovirus infection in the paediatric population

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Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia

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Age-Matched comparison of children hospitalized for 2009 pandemic H1N1 influenza with those hospitalized for seasonal H1N1 and H3N2

Background: A wide spectrum of clinical manifestation ranging from deaths to a mild course of disease has been reported in children infected with the 2009 pandemic H1N1 (pH1N1) influenza. Methodology/Major Findings: We conducted an age-matched control study comparing children hospitalized for pH1N1 with historic controls infected with seasonal H1N1 and H3N2 influenza to correct for the effect of age on disease susceptibility and clinical manifestations. We also compared children with pH1N1 to children concurrently admitted for seasonal influenza during the pandemic period to adjust for differences in health-seeking behavior during the pandemic or other potential bias associated with historic controls. There was no death or intensive care admission. Children with pH1N1 were more likely to have at least one risk condition for influenza, an underlying chronic pulmonary condition, more likely to have asthma exacerbation and to be treated with oseltamivir. There was no difference in other aspects of the clinical course or outcome. Conclusion: Disease manifestation of children hospitalized for pH1N1 infection was mild in our patient population. © 2011 Chiu et al.published_or_final_versio

Emergence of NDM-1-producing Enterobacteriaceae in China

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Early diagnosis of primary human herpesvirus 6 infection in childhood: Serology, polymerase chain reaction, and virus load

Qualitative and quantitative polymerase chain reaction (PCR) for human herpesvirus 6 (HHV-6) DNA in whole blood and plasma was correlated with serology and clinical assessment in 143 children hospitalized for undifferentiated febrile illness to evaluate options for diagnosis of primary HHV-6 infection on the acute blood specimen. PCR and serology for HHV-7 were done in parallel to define serologic cross-reactions. Using HHV-6 seroconversion as the reference standard, detection of HHV-6 DNA in whole blood in the absence of antibody in the plasma was the most reliable evidence of primary HHV-6 infection. Detection of HHV-6 DNA in plasma and a high virus load in whole blood (>3.3 log 10 copies/5 μL) had a sensitivity of 90% and 100%, respectively, in diagnosing primary HHV-6 infection. However, both were occasionally found in patients with other infections, possibly associated with HHV-6 reactivation. Maternal antibody may confound interpretation of serology in patients under 3 months of age.published_or_final_versio

Human coronavirus NL63 infection and other coronavirus infections in children hospitalized with acute respiratory disease in Hong Kong, China

Background. Human coronavirus NL63 (HCoV-NL63) is a recently discovered human coronavirus found to cause respiratory illness in children and adults that is distinct from the severe acute respiratory syndrome (SARS) coronavirus and human coronaviruses 229E (HCoV-229E) and OC43 (HCoV-OC43). Methods. We investigated the role that HCoV-NL63, HCoV-OC43, and HCoV-229E played in children hospitalized with fever and acute respiratory symptoms in Hong Kong during the period from August 2001 through August 2002. Results. Coronavirus infections were detected in 26 (4.4%) of 587 children studied; 15 (2.6%) were positive for HCoV-NL63, 9 (1.5%) were positive for HCoV-OC43, and 2 (0.3%) were positive for HCoV-229E. In addition to causing upper respiratory disease, we found that HCoV-NL63 can present as croup, asthma exacerbation, febrile seizures, and high fever. The mean age (± standard deviation [SD]) of the infected children was 30.7 ± 19.8 months (range, 6-57 months). The mean maximum temperature (± SD) for the 12 children who were febrile was 39.3°C ± 0.9°C, and the mean total duration of fever (± SD) for all children was 2.6 ± 1.2 days (range, 1-5 days). HCoV-NL63 infections were noted in the spring and summer months of 2002, whereas HCoV-OC43 infection mainly occurred in the fall and winter months of 2001. HCoV-NL63 viruses appeared to cluster into 2 evolutionary lineages, and viruses from both lineages cocirculated in the same season. Conclusions. HCoV-NL63 is a significant pathogen that contributes to the hospitalization of children, and it was estimated to have caused 224 hospital admissions per 100,000 population aged 6 years each year in Hong Kong. © 2005 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

Influenza-related hospitalizations among children in Hong Kong

Background: It has been difficult to define the burden of influenza in children because of confounding by the cocirculation of respiratory syncytial virus (RSV). In Hong Kong, China, the influenza and RSV infection seasons sometimes do not overlap, thus providing an opportunity to estimate the rate of influenza-related hospitalization in a defined population, free from the effects of RSV. Methods: In a retrospective, population-based study, we estimated the influenza-associated excess rate of hospitalization among children 15 years old or younger in the Hong Kong Special Administrative Region from 1997 to 1999. Data from a single hospital with intensive use of virologic analyses for diagnosis were obtained to define and adjust for underestimation of the model. Results: Peaks of influenza and RSV infection activity were well separated in 1998 and 1999 but overlapped in 1997. The adjusted rates of excess hospitalization for acute respiratory disease that were attributable to influenza were 278.5 and 288.2 per 10,000 children less than 1 year of age in 1998 and 1999, respectively; 218.4 and 209.3 per 10,000 children 1 to less than 2 years of age; 125.6 and 77.3 per 10,000 children 2 to less than 5 years of age; 57.3 and 20.9 per 10,000 children 5 to less than 10 years of age; and 16.4 and 8.1 per 10,000 children 10 to 15 years of age. Conclusions: In the subtropics, influenza is an important cause of hospitalization among children, with rates exceeding those reported for temperate regions. Copyright © 2002 Massachusetts Medical Society.published_or_final_versio

Changes in nasopharyngeal carriage and serotype distribution of antibiotic-resistant Streptococcus pneumoniae before and after the introduction of 7-valent pneumococcal conjugate vaccine in Hong Kong

This study assessed the changes in serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates in children before and after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Hong Kong. Nasopharyngeal specimens were collected from 1978 and 2211 children (ages, 2 to 6 years) attending day care centers or kindergartens in period 1 (1999-2000) and period 2 (2009-2010), respectively. Carriage of PCV7 serotypes decreased from 12.8% to 8.6% (P < 0.01). The relative contribution of PCV7 serotypes 14 and 18C had decreased, whereas that for non-PCV7 serotypes 19A, 6A, 6C, 23A, and 15B had increased. In period 2, PCV7 penetration rate (at least 1 dose) for children aged 2, 3, 4, and 5 years was 43%, 35.7%, 26.7%, and 20.4%, respectively. In multivariate analysis, PCV7 use was the only independent variable associated with fewer PCV7 serotype carriages (odds ratio 0.5; P = 0.001). In period 2, high rates of dual penicillin/erythromycin nonsusceptibility were found in serotypes 6B (77.3%), 14 (100%), 19F (100%), 23F (78%), 19A (75%), 6A (87.8%), 6C (59.3%), and 23A (78.9%).postprin

Risk-stratified seroprevalence of SARS coronavirus in children residing in a district with point-source outbreak compared to a low-risk area.

1. SARS coronavirus has low transmissibility at the community level. 2. Subclinical SARS coronavirus infection is rare in children.published_or_final_versio

Virologically confirmed population-based burden of hospitalization caused by influenza a and b among children in Hong Kong

Background. We sought to determine the virologically confirmed hospitalization rates associated with influenza virus infection among Hong Kong children. Methods. Patients <18 years of age who lived on Hong Kong Island (a separate island within Hong Kong) and were admitted to either of the only 2 public hospitals on the island for a febrile acute respiratory infection on 1 fixed day of the week in each hospital from October 2003 through September 2006 were prospectively recruited. These 2 hospitals together accounted for 72.5% of all general pediatric admissions in Hong Kong Island with a known population denominator. Nasopharyngeal aspirates were obtained from all recruited patients and were tested for influenza A and influenza B viruses by direct antigen detection and culture. Results. All cases of influenza A during 2003-2004 were caused by H3N2 virus, whereas 85.7% of cases during 2004-2005 were due to H3N2 virus, and 93.5% during 2005-2006 were due to H1N1 virus. During 2004-2005, infants <1 year of age had the highest rate of hospitalization for influenza A (103.8 cases per 10,000 population), whereas children 1 year of age had the highest rate of hospitalization during the other 2 seasons (95.5 and 54.6 cases per 10,000 population during 2003-2004 and 2005-2006, respectively). A protection rate of 25%, presumably attributable to maternal antibodies, was seen in infants <1 year of age who were hospitalized during 2003-2004 with infection due to an H3N2 virus that had been in circulation. The hospitalization rates for influenza B were highest among children 2-4 years of age. Conclusions. This population-based study of hospitalizations due to virologically confirmed influenza demonstrated a very high burden of disease among young children in Hong Kong. The morbidity varied with virus type, subtype, and antigenic variants. © 2009 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio