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Daily Bulletin - Hilbert School District

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Table of Contents
Welcome Address
Congress Organizing Committee
Program at a Glance
Venue Floor Plan
Congress Award
Social Program
Tour Program
General Information
Program
Detailed Scientific Program
Detailed Poster Program
Abstract
Special Session
Keynote & Plenary Lectures
Simultaneous Symposia
Free Paper Oral Presentations
Poster Presentations
Index of Authors
Taiwan Attraction
Sponsor Acknowledgement
1
2
4
6
8
12
13
14
16
20
20
35
45
45
48
53
91
113
176
183
185
Welcome Address
Dear Colleagues,
After two years from the event of the 4th Asian Congress of Pediatric Infectious
Disease (ACPID) which was held at Surabaya, Indonesia 2008, we meet again here in
the fifth ACPID. I am delighted to welcome you to the 5th ACPID in Taipei, Taiwan on
23-26 September 2010. This congress will be in conjunction with the 6th Annual
Meeting of Global Chinese Association of Clinical Microbiology and Infectious Diseases.
As we all know, infectious diseases endemic in Asian region are not yet eradicated.
There are still a number of important problems and unresolved issues affecting the
health and well being of children in Asian member countries. Despite the declining
incidence of some infectious diseases, there is a resurgence of the dormant group and
emergence of new ones. In this meeting, individual experiences can be shared and
suggestions can be given to reach an agreement on the best options regarding diagnosis,
diagnostics and management of these diseases to improve the welfare of our children.
I would like to extend my sincere appreciation to the speakers who have agreed to
share their knowledge and expertise on relevant issues, to all participants as well as to
our dear sponsors.
Finally, I would like to thank Prof. Chin-Yun Lee, Chairman of Organizing Committee
and his team for the dedication and hard work in preparation of this congress.
Best wishes and welcome
Sri Rezeki HADINEGORO
President
Asian Society for Pediatric Diseases
2
Welcome Address
Dear Colleagues,
On behalf of the Taiwan Pediatric Association and the Infectious Diseases Society of
Taiwan, I would like to welcome all of you to the 5th Asian Congress of Pediatric
Infectious Diseases (ACPID). Today, we are pleased to welcome over 2,000
outstanding experts and colleagues from 34 countries, 800 from Taiwan and 1200 from
abroad. In the next four days, we all will be gathered to discuss issues of common
concern during this congress on pediatric infectious diseases. We have prepared 4
plenary sessions, 19 symposium sessions, 4 free paper sessions, and also 7 luncheon
symposia and 3 satellite symposia for you to discuss important issues occurring around
the world, especially in four catergories of subjects: traditional pediatric infectious
diseases and pathogens, vaccine preventable diseases and vaccine development,
emerging pathogens and new issues, for example, genetic susceptibility to infectious
diseases and probiotics for infectious diseases.
This year, we received 237 abstracts submitted to the 5th ACPID. Ten abstracts were
selected for Travel Award, 3 Young Researcher Award, and 3 Outstanding Research
Award. I am confident that, in this meeting, individual experiences can be shared and
suggestions can be given to reach an agreement on the best options regarding diagnosis,
diagnostics and management of these diseases to improve the welfare of human beings.
In the next four days, we hope that we can come up with concrete resolutions and
recommendations for action in regard to infectious disease. I would like to take this
opportunity to thank all the experts here to share your experience and knowledge with
us.
Finally, I wish all the distinguished guests a fruitful stay in Taiwan. Thank you.
Sincerely yours,
Chin-Yun LEE
Chair
The 5th Asian Congress of Pediatric Infectious Diseases
3
Congress Organizing Committee
Organizing Committee
Chair
Co-Chair
Vice Chair
Vice Chair
Secretary General
Deputy Secretary General
Deputy Secretary General
Deputy Secretary General
Treasurer
Chin-Yun LEE, Taiwan
Tzou-Yien LIN, Taiwan
Ping-Ing LEE, Taiwan
Li-Ming HUANG, Taiwan
Ping-Ing LEE, Taiwan
Cheng-Hsun CHIU, Taiwan
Chun-Yi LU, Taiwan
Chih-Jung CHEN, Taiwan
Nan-Chang CHIU, Taiwan
Local Advisory Committee
Chairperson
Members
Fu-Yuan HUANG, Taiwan
Chih-Chien WANG, Taiwan
Ken-Gong WU, Taiwan
Luan-Yin CHANG, Taiwan
Jong-Min CHEN, Taiwan
Tou-Hwei CHEN, Taiwan
Ren –Bin TANG, Taiwan
Yung-Feng HUANG, Taiwan
Kao-Pin HWANG, Taiwan
Cheng-Yi LIU, Taiwan
Yung-Ching LIU, Taiwan
Ching-Chuan LIU, Taiwan
Scientific Committee
Chairperson
Members
Yhu-Chering HUANG, Taiwan
Luan-Yin CHANG, Taiwan
Chien-Chang CHEN, Taiwan
Po-Yen CHEN, Taiwan
Cheng-Hsun CHIU, Taiwan
Nan-Chang CHIU, Taiwan
Li-Min HUANG, Taiwan
Po-Ren HSUEH, Taiwan
Kao-Pin HWANG, Taiwan
Ping-Ing LEE, Taiwan
Ching-Chuan LIU, Taiwan
Chun-Yi LU, Taiwan
Chih-Chien WANG, Taiwan
Social Committee
Chairperson
Members
Po-Yen CHEN, Taiwan
Frank Leigh LU, Taiwan
Sui-Ling LIAO, Taiwan
Jeng-Shien KUO, Taiwan
4
Chia-Yunn CHUANG,Taiwan
Yung-Sen CHANG, Taiwan
International Advisory Committee
Chairperson
Members
Po-Ren HSUEH, Taiwan
Sri Rezeki HADENIGORO, Indonesia
Usa THISYAKORN, Thailand
Pornthep CHANTAVANICH, Thailand
Lulu C. BRAVO, Philippines
Yonghong YANG, China
Yu Lung LAU, Hong Kong
Rajeshwar DAYAL, India
Hindra Irawan SATARI, Indonesia
Nobuhiko OKABE, Japan
Jin Han KANG, Korea
5
Somthana DOUANGMALA, Malaysia
Keng-Ee CHOO, Malaysia
May B. MONTELLANO, Philippine
M. Ashraf SULTAN, Pakistan
Seng Hock QUAK, Singapore
H.T. WIKRAMASINGHE, SriВ Lanka
Tawee CHOTPITAYASUNONDH, Thailand
Somsak LOLEKHA, Thailand
Suchitra NIMMANNITYA, Thailand
Rosalinda B. SORIANO, Philippine
Program at a Glance
Date
Meeting
Room
Sep. 22 (Wednesday)
Sep. 23 (Thursday)
South
201A
201B
Lounge, 101
201
Sep. 24 (Friday)
Banquet VIP,
202
Hall, 3F
3F
4F
1F
102
103
07:45-08:30
08:30-10:00
10:30-11:00
11:00-12:00
GCACMID
Council
Meeting
12:00-13:30
Infectious Diseases in
(14:40-18:00)
Taiwan and Japan
Exhibition
16:00-17:30
SsS2 of 6th
GCACMID
(15:00-17:00)
SsS1 of 6th
GCACMID
(15:00-17:00)
15:30-16:00
Special Session: Important
13:30-15:30
DEF
ME1
ME2
AOM
EV71
PL1
PL2
Lounge,В 3FВ В В SS1
SS2
ASAP
Fungus
LS1
GSK
SS5
Dengue
SS3
Streptococcus
FP1
Viral RTI
В LS2
Dainippon
В Sumitomo
SS6
FP2
Vaccine
Viral
Safety
Non-RTI
Break
SaS1
SS9
Novartis
GI
SS7
Pneumococcus
SS8
Acute
Throat
ASPIDВ GeneralВ Assembly
В Opening
Ceremony &
KL
18:00-19:00
ABC
SouthВ 202
(10:00-10:30)
Infection
17:30-18:00
201
Break
Exhibition & Poster Session I
The 6th Annual Meeting of GCACMID (9:00-17:00)
10:00-10:30
201
Faculty Dinner (invitation required)
Welcome
19:00-21:30
Reception
KL = Keynote Lecture
FP = Free Paper Oral Presentation
PL = Plenary Lecture
LS = Luncheon Symposium
ME = Meet the Expert
SaS = Satellite Symposium
SS = Simultaneous Symposium
6
Sep. 25 (Saturday)
1F
102
201
201
ABC
DEF
ME3
ME4
Antimicrob.
Dengue
Resistance
Fever
SS12
SS10
Tuberculosis
SS11
Infectious
ESGARS
Diseases in
Sep. 26 (Sunday)
202
101
102
LS3
MSD
Pfizer
SS13
NB
Infection
SS19
EV71
PL3-1
(10:30-12:30)
LS4
Sanofi
Pasteur
SS15
Flu/H1N1
Probiotics
DEF
ME5
ME6
Pneumonia
TB
PL3-2
PL4
Meeting Room
07:45-08:30
08:30-10:00
10:00-10:30
(10:00-10:30)
SS4
SS14
ABC
Break
Exhibition
Exhibition / Poster Session II
LS5
201
Pathogens
MRSA
Paper Review
201
FP3
Bacterial
Asia
Break (10:30-11:00)
Date
FP4
SS18
SaS3
Lab Diagnosis
Want Pu
LS6
LS7
Pfizer
GSK
10:30-11:00
11:00-12:00
12:00-13:30
Closing
Miscella-
Ceremony
neous
(13:30-14:00)
Break
13:30-15:30
15:30-16:00
Local Session
SaS2
SS16
Roche
SS17
Pediatric AIDS Adolescent
(14:00-17:30)
Vaccines
16:00-17:30
17:30-18:00
18:00-19:00
Farewell Dinner (ticket required)
19:00-21:30
7
Venue Floor Plan
1st Floor
8
Exhibition Area, 1st Floor
9
2nd Floor
10
3rd Floor
11
Congress Award
Scientific Committee of the 5th ACPID Congress is pleased to announce the awardees
for the Outstanding Researcher Award, Young Researcher Award, and Travel Grant
Award.
Outstanding Researcher Award
Category
Epidemiology
Other Viral Infection
Other Viral Infection
Awardee
Chih-Jung CHEN
Jia-Feng WU
Akihiko SAITOH
Country
Taiwan
Taiwan
Japan
Young Researchers Award
Category
Respiratory Tract Infection
Pneumococcal Diseases
Influenza
Awardee
Ting-fan LEUNG
Yu-Chia HSIEH
Chun-Yi LU
Country
Hong Kong
Taiwan
Taiwan
Travel Grant Award
Category
Tuberculosis, Leprosy
Tuberculosis, Leprosy
HIV
Epidemiology
Dengue
Dengue
Pathogenesis, Mechanism
Enteric Infection
Antimicrobial Resistance and New Antibiotic
Laboratory Diagnosis
Awardee
Alireza FAHIMZAD
Adnan BAJRAKTAREVIC
Mohd Zaini Abd HAMID
Yun-Kyung KIM
Prayong VACHVANICHSANONG
Kamolwish LAOPRASOPWATTANA
Manel AMRI
Hui YU
Wenen LIU
Afreenish HASSAN
Country
Iran
Bosnia and Herzegovina
Malaysia
Korea
Thailand
Thailand
Algeria
China
China
Pakistan
The Awardees are restricted to the following terms and conditions.
z
Awardees must register and attend the Congress.
z
Awardees must claim his/her grant during September 24 to September 26, 2010 at the
Congress Secretariat (Room 105).
z
Awardees should present the passport and provide a photocopy of passport bio-page when
claiming grants.
z
The Congress Secretariat will not issue checks or pay the grant by bank transfer. All grants
will be in NT$.
z
No grant could be claimed by people other than the awardees.
z
No grant could be claimed after September 26, 2010.
12
Social Program
Welcome Reception (open to all delegates)
Date
Thursday, September 23
Time
19:00-21:30
Location
Dress Code
3rd Floor, Congress Venue
Smart Casual
Faculty Dinner (invitation required)
Date
Friday, September 24
Time
18:00-21:30
Location
Dress Code
Note
Diamond Tony’s PANORAMA Fusion Cuisine Dining Pub,
85th Floor, Taipei 101 Building
Smart Casual
17:40 gathering at the Lobby of Congress Venue
Farewell Dinner (ticket required)
Date
Time
Location
Dress Code
Note
Saturday, September 25
18:30-22:00
3rd Floor, Silks Palace at the National Palace Museum
Smart Casual
17:40 gathering at the Lobby of Congress Venue
13
Tour Program
The Organizing Committee offers 2 complimentary tours during September 25 to
September 26 to visit one of the following hospitals. The seats are reserved on the basis
of first come first served. Please sign up at the information counter from September 23
to the noon of September 24.
Tour A—National Taiwan University Children’s Hospital
z
Options
Option 1: 14:00-15:00, Saturday, September 25
Gathering at 13:30, the lobby of Congress Venue
Option 2: 15:00-16:00, Saturday, September 25
Gathering at 14:30, the lobby of Congress Venue
Option 3: 10:00-11:00, Sunday, September 26
Gathering at 9:30, the lobby of Congress Venue
Option 4: 11:00-12:00, Sunday, September 26
Gathering at 10:30, the lobby of Congress Venue
z
z
Minimum participants for each option: 15 people
Maximum participants for each option: 40 people
(on the first come, first served basis)
Deadline for signing up: noon of September 24
Established in 2008, National Taiwan University Children’s Hospital provides comprehensive
care for all newborns, infants, children, and adolescents. Major functions featured by NTUCH
include outpatient clinics, inpatient wards, intensive care units, operation rooms, teaching and
research facilities. The total number of inpatient is over 450 beds. The faculty includes a full
range of pediatric sub-specialists. They also cooperate with many other specialists in pediatric
surgery, pediatric anesthesiology, pediatric radiology, pediatric psychiatry, pediatric dentistry,
pediatric ENT and pediatric urology for caring those children in need. Integrated teamwork
has been established for children health care, especially focus on children with severe and
complex illnesses. In this new setting, a continuum medical care from motherhood, gene, fetus,
birth, newborn, infant, and all the way throughout childhood and young adults are provided.
Children are the main focus of NTUCH; therefore, the hospital building was designed to
provide a friendly environment. Its liveliness and brightness is created through employing vivid
colors and interesting figures. At the same time, we added professionally recruited and
designed areas for public artworks, playrooms, clinic waiting areas, and the family resources
center in the NTUCH building. These arrangements effectively bring artistic atmosphere,
exploration and inspiration into the service space of NTUCH, which enable each and every
child and their family in the hospital to somewhat release the stress and tension when bearing
their own illness, and replace them with delightful surprises and joyful events.
14
Tour B—Chang Gung Children’s Hospital
z
Options
Option 1: 14:00-15:00, Saturday, September 25
Gathering at 13:10, the lobby of Congress Venue
Option 2: 10:00-11:00, Sunday, September 26
Gathering at 9:10, the lobby of Congress Venue
z
z
Minimum participants for each option: 15 people
Maximum participants for each option: 80 people
(on the first come, first served basis)
Deadline for signing up: noon of September 24
Chang Gung Children's Hospital, the nation's first pediatric hospital founded by Chairman
Wang in 1993, dedicated exclusively to provide overall medical coverage to children and
secure a healthy future for families. The commitment to improving the health of all children is
as strong as it was over 10 years ago by management of Dr. Tzou-Yien Lin who is visioning
Chang Gung Children's Hospital as a recognized leader in combining patient care, research,
education and community service, recruited medical and nursing staff specialized in pediatric
medicine to provide comprehensive medical care to the children.
Chang Gung Children's Hospital strives to be the nation finest in the advancement of
healthcare for children by integrating excellent patient care, innovative research and quality
professional education into all of its programs. The Hospital has constructed healthcare
network with other institutions to provide comprehensive patient care, like NICU and PICU
transportation, and improve the quality of pediatric medical care. Furthermore, Chang Gung
Children's Hospital forges relationships with other hospitals for medical alliance and training
new generations of pediatric healthcare providers to share its accessible, fiscally responsible,
comprehensive, and innovative, high-quality medical and surgical care to children.
15
General Information
Language
English will be the official language of the Congress.
Opening Hours for Function Rooms
Registration
September 23
13:00-18:00
September 24-September 26
7:30-17:30
Exhibition, Internet Area
September 23
13:00-17:30
September 24-September 26
7:30-17:30
Secretariat, Speakers Ready Room
September 23
September 24-September 26
13:00-18:00
7:30-17:30
Lost and Found
Inquiries regarding lost or found items should be directed to Information Counter,
located in the lobby on the first floor, during scientific program hours.
Badges
All registered participants are required to wear the badges to enter the meeting rooms,
exhibition area, social programs and other related events.
Type of Badge:
Delegate
Exhibitor
Accompanying
Person
Staff
Electronic Congress Proceedings
Updated Congress proceedings will be downloadable from the official website of the
5th ACPID (http://www.2010acpid.org).
16
Internet Area/ Wireless Access
For your convenience, the wireless access is available throughout the congress venue.
You could also use the public computers in the internet area, sponsored by PFIZER Ltd.
The numbers of public computers are limited; therefore, please limit your time of usage
to 10 minutes each time.
Complimentary Breakfast
Simple breakfast will be served for Meet the Expert participants at the corridor of
Room 201, Congress Venue, during 7:30-8:00, September 24 to September 26.
Duplication/ Recording
Unauthorized photography, audio taping, video recording, digital taping or any other
forms of duplication are prohibited through every congress session.
Luncheon Symposium
All luncheon symposia are free of charge and open to full-registered participants. Light
lunch boxes will be provided before the sessions on the basis of first come, first served.
Mobile Phones
As a courtesy to all participants, please turn off your mobile phone or switch to silent
mode during all meeting sessions.
Useful Telephone Numbers
Emergencies/ Fire Department: 119
Police: 110
English-speaking Police: +886-2-2556-6007
English-Speaking Directory Assistance: 106
International Operator Assistance: 100
International Dial Codes: 002, 005, 006, 007, 009
Tourist Information Hotline: +886-2-2717-3737
Business Hours
Banks: 9:00-15:30, Monday to Friday
Offices: 9:00-18:00, Monday to Friday
Government Offices: 8:30-noon, 13:30-17:30, Monday to Friday
Department Stores: 11:00-21:30 daily
Shops & Retail Shops: 10:00-22:00 daily
(*Some shops open earlier and are closed on Sundays. There are many convenience
stores opening 24hrs.)
17
Transportation & Map
Map—Hotels and the Congress Venue
(Taipei International Convention Center)
18
Taxi
Charges are NT$70 (approx. US$2.5) for the first 1.25 kilometers, and NT$5 for each
additional 250 meters. NT$20 surcharge is added to fare between 11 p.m. and 6 a.m,
and additional NT$4 is charged for every 100 seconds of waiting. No tip is required.
Bus
Buses are the most important means of mass transportation in Taipei, with almost 200
routes throughout the city. It serves every 5-10 minutes and operates on an express
lane grid system. The ticket price of an adult is NT$15. Please prepare enough coins in
advance; no change will be given on buses.
MRT
The Mass Rapid Transit (MRT) system provides the most convenient commuting
service. The MRT currently has five lines in operation: the Brown Line (Wenshan-Neihu
Line), the Red Line (Tamshui
Line), the Orange Line
(Zhonghe Line), the Green
Line (Xindian Line), and the
Blue Line (Nangang-Yongning
Line). Single-journey ticket
prices
range
from
NT$20~NT$65 depending on
the distance you travel. A
NT$200 “ONE-DAY PASS”
purchased
from
service
booths will allow unlimited
travel along all MRT lines
within one day. Smoking,
drinking and gum chewing are
strictly prohibited. Detailed
MRT maps are available in
each MRT station.
19
Detailed Scientific Program
Day 1
Wednesday, September 22
Detailed Scientific Program—Sep. 22-23
15:00-17:00
Round Table Forum of The 6th GCACMID
Day 2
201A/201B, 2F
Thursday, September 23
09:00-17:00
13:30-18:00
The 6th Annual Meeting of GCACMID
Registration of Delegates
14:40-18:00
Special Session: Important Infectious Diseases in Taiwan and Japan
VIP Room, 4F
Lobby, 1F
202, 2F
Moderator: Tzou-Yen LIN (Taiwan)
S-01 2009 Novel H1N1 Influenza in Japan
Nobuhiko OKABE (Japan)
S-02 2009 Novel H1N1 Influenza in Taiwan
Luan-Yin CHANG (Taiwan)
Moderator: Fu-Yuan HUANG (Taiwan)
S-03 Current Immunization Issues in Japan
Hajime KAMIYA (Japan)
S-04 Dengue Fever in Taiwan
Ching-Chuan LIU (Taiwan)
Moderator: Li-Min HUANG (Taiwan)
S-05 Infections after Liver Transplantation
Akihiko SAITO (Japan)
S-06 Current Status of Community-associated Methicillin-resistant
Staphylococcus aureus in Taiwan, 2000s
Yhu-Chering HUANG (Taiwan)
18:00-19:00
KL
19:00-21:30
Opening Ceremony & Keynote Lecture
Moderator: Sri Rezeki S. HADINEGORO (Indonesia)
Hepatitis B Virus Infection - Host and Virus Interaction
201, 2F
Mei-Hwei CHANG (Taiwan)
Welcome Reception
Banquet Hall, 3F
20
Day 3
Friday, September 24
Lobby, 1F
201ABC, 2F
Cheng-Hsun CHIU (Taiwan), David GREENBERG (Israel)
07:45-08:30
Meet the Expert 2
ME2 Management of Enterovirus 71 Infection in Children
201DEF, 2F
Luan-Yin CHANG (Taiwan), Shao-Hsuan SHIA (Taiwan)
08:30-17:00
08:30-10:00
Poster Session 1
South Foyer, 101, 1F
Plenary Lecture 1
201ABC, 2F
Moderator: Sri Rezeki S. HADINEGORO (Indonesia)
PL1-01 Childhood Tuberculosis --- Old Wisdom and New Challenges
Ben J. MARAIS (South Africa)
PL1-02 HIV Vaccine:The Spring after a Long Winter?
Robert CHEN (USA)
08:30-10:00
Plenary Lecture 2
Moderator: Chin-Yun LEE (Taiwan), Usa THISYAKORN (Thailand)
PL2-01 The Threat of Influenza:The Past and the Future
201DEF, 2F
Ping-Ing LEE (Taiwan)
PL2-02 Invasive Pneumococcal Disease in Asia
Tzou-Yien LIN (Taiwan)
10:00-10:30
10:30-12:00
Coffee Break
Simultaneous Symposium 1
ASAP
Moderator: Daniel GOH (Singapore), Zulkifli ISMAIL (Malaysia)
SS1-01 Overview of Pneumococcal Disease in the Asia Pacific
101, 1F
102, 1F
Lulu BRAVO (Philipines)
SS1-02 Pneumococcal Disease and Flu Pandemics
Ping-Ing LEE (Taiwan)
SS1-03 Treatment and Antibiotic-Resistance Patterns of Pneumococcal Disease
Somsak LOLEKHA (Thailand)
10:30-12:00
Simultaneous Symposium 2
201ABC, 2F
Fungus
Moderator: Hoan-Jong LEE (Korea),Yhu-Chering HUANG (Taiwan)
SS2-01 An Update on Prophylaxis of Invasive Fungal Infection in Pediatric
Patients
Hoan-Jong LEE (Korea)
SS2-02 Advance of Diagnosis and Treatments of Invasive Fungal Disease in
Pediatric Hematology Malignancy
21
Detailed Scientific Program—Sep. 24
07:30-17:30
Registration of Delegates
07:45-08:30
Meet the Expert 1
ME1 Update of Management on Acute Otitis Media
Day 3
Friday, September 24
Detailed Scientific Program—Sep. 24
Theoklis ZAOUTIS (USA)
SS2-03 Diagnosis and Treatment Strategies of IA in Pediatric Patients
William J. STEINBACH (USA)
10:30-12:00
Simultaneous Symposium 3
201DEF, 2F
Streptococcus
Moderator: H.T. WIKRAMASINGHE (Sri Lanka), Po-Ren HSUEH (Taiwan)
SS3-01 Pathogenesis of Group A Streptococcal Infection in Taiwan
Jiunn-Jong WU (Taiwan)
SS3-02 Infection with Streptococcus dysgalactiae subsp equisimilis:
Children and Asia-relevant Issues
Takashi TAKAHASHI (Japan)
SS3-03 Streptococcus pyogenes Infection in Children of Mainland China: Changes of
Clone, Susceptibility and Macrolide Resistance Mechanisms over a 16-year
Period
Xuzhuang SHEN (China)
10:30-12:00
Free Paper 1
202, 2F
Viral Respiratory Tract Infection
Moderator: Keng Ee CHOO (Malaysia), Li-Min HUANG (Taiwan)
FP1-01 Clinical Course and Cost of Seasonal and Pandemic Influenza in Healthy
Children in an Outpatient Setting
Pukpen SIRIKUT, Piyarat SUNTARATTIWONG, Supichaya NETSAWANG,Tawee CHOTPITAYASUNONDH
(Thailand)
FP1-02 Pandemic (H1N1) 2009 Vaccination and School Closure Following
Outbreaks in Taipei City,Taiwan
Wen-Chan HUANG, Ping-Ing LEE, Po-Ren HSUEH, Muh-Yong YEN, Chun-Yi LU, Jong-Min CHEN, Luan-Yin
CHANG, Li-Min HUANG, Chin-Yun LEE (Taiwan)
FP1-03 Clinical Analysis of 304 Hospitalized Pediatric Patients with Influenza A
(H1N1) 2009 Virus Infection Confirmed by PCR
Yumi MIZUNO, Hiroe YOSHIDA, Jun ABE,Takashi MORITA,Tomonobu AOKI (Japan)
FP1-04 Seroepidemiologic Study on 2009 Pandemic Influenza A (H1N1) Infections
among Health Care Personnel
Ting-Yu YEN, Luan-Yin CHANG, Li Min HUANG, Chun-Yi LU (Taiwan)
FP1-05 Monovalent Vaccine for the Pandemic Influenza A (2009 H1N1) in Children
with Cancer Receiving Chemotherapy
Ting-Yu YEN, Shiann-Tarng JOU,Yung-Li YANG, Hsiu-Hao CHANG,Meng-Yao LU, Dong-Tsamn LIN, Kai-Hsin LIN,
Li Min HUANG,Luan-Yin CHANG (Taiwan)
FP1-06 Clinical Spectrum of Human Rhinovirus Infections in Hong Kong Children
TF LEUNG, LY TSE, GWK WONG, PKS CHAN (Hong Kong)
FP1-07 Seasonality and Risk Factor Analysis of Respiratory Syncytial Virus
22
Day 3
Friday, September 24
Chun-Fu TAI, Ping-Ing LEE, Ching-Chuan LIU, Chun-Yi LU, Jong-Min CHEN, Luan-Yin CHANG, Li-Min HUANG,
Chin-Yun LEE (Taiwan)
FP1-08 Epidemiology and Clinical Manifestations of Adenoviral Infection in
Hospitalized Children
Hyo Jin KWON,Yun-Kyung KIM (Korea)
12:00-13:30
Luncheon Symposium 1
201ABC, 2F
Sponsored by GlaxoSmithKline Far East B.V.
Moderator: Mei-Hwei CHANG(Taiwan), Lulu BRAVO (Philippines)
LS1-01 Respiratory Infections: A Look at Severity and Frequency in Asian Children
Lulu BRAVO (Philippines)
LS1-02 Dynamics of Pathogens in Bacterial Respiratory Diseases
David GREENBERG (Israel)
LS1-03 PHiD-CV: Innovation in Vaccine Design
Li-Min HUANG (Taiwan)
12:00-13:30
Luncheon Symposium 2
201DEF, 2F
Sponsored by Dainippon Sumitomo Pharma Co., Ltd.
Moderator: Tzou-Yien LIN (Taiwan), Hiroshige MIKAMO (Japan)
LS2-01 Impact on Antibiotic Resistance on Appropriate Antimicrobia Therapy
Po-Ren HSUEH (Taiwan)
LS2-02 Factors Influencing Pharmacoeconomic Positioning of Antimicrobial
Agents
Ping-Ing LEE (Taiwan)
LS2-03 Clinical & Economic Implications of Resistance and the Need to Consider
Opportunities for Improved Outcomes
David P. NICOLA (USA)
13:30-15:30
Simultaneous Symposium 5
201ABC, 2F
Dengue
Moderator: Ching-Chun LIU (Taiwan), Tawee CHOTPITAYASUNONDH (Thailand)
SS5-01 Molecular Epidemiology of Dengue Virus in Asia
Pei-Yun SHU (Taiwan)
SS5-02 Immunopathogenesis in Dengue Disease
Huan-Yao LEI (Taiwan)
SS5-03 Fluid Management in Dengue
Thanh Hung NGUYEN (Vietnam)
SS5-04 Dengue: From Disease to Vaccination
RГ©my TEYSSOU (France)
13:30-15:30
Simultaneous Symposium 6
Vaccine Safety
201DEF, 2F
23
Detailed Scientific Program—Sep. 24
Infection in Taiwan
Day 3
Friday, September 24
Detailed Scientific Program—Sep. 24
Moderator: Nan-Chang CHIU (Taiwan), Robert CHEN (USA)
SS6-01 Global Trends and Challenges in Vaccine Safety
Robert CHEN (USA)
SS6-02 Safety Issue in Rotavirus Vaccine (from Intussusceptions to PCV)
Anuj WALIA (India)
SS6-03 Monitoring the Safety of Influenza A (H1N1) 2009 Monovalent Vaccines,
United States, October 2009 through June 2010
Claudia VELLOZZI (USA)
SS6-04 Surveillance of 2009 Pandemic Influenza A (H1N1) Vaccine Safety in
Taiwan
Wan-Ting HUANG (Taiwan)
13:30-15:30
Free Paper 2
Viral Non-respiratory Tract Infection
Moderator: Jong-Min CHEN (Taiwan), M. Ashraf SULTAN (Pakistan)
FP2-01 Kidney Involvement in Dengue Patients: Is It Significant?
202, 2F
Prayong VACHVANICHSANONG, Usa THISYAKORN, Chule THISYAKORN (Thailand)
FP2-02 C-type Lectin Receptors Associated with Dengue Hemorrhagic Fever
Correlated to Viral Replication and Immune Augmentation
Kuender D.YANG, Lin WANG, Rong-Fu CHEN, Chiu-Ping LEE,Ya-Ting LO,Yu-Ni SU, Ho-Chang KUO, Ing-Kit LEE,
and Jien-Wei LIU (Taiwan)
FP2-03 Diagnosing Chikungunya in Children on the Basis of Fever and Arthralgia
Can Lead to a Misdiagnosis of Dengue Viral Infection or Other Febrile
Illness
Kamolwish LAOPRASOPWATTANA, Lamy KEAWJUNGWAD, Roongrueng JARUMANOKUL, Alan GEATER
(Thailand)
FP2-04 Multiple Dengue Serotypes and High Frequency of Dengue Hemorrhagic
Fever during 2008, Dengue Virus Outbreak in Punjab, Pakistan
Malik Asif HUMAYUN,Tariq WASEEM, Javed AKRAM (Pakistan)
FP2-05 Unusual Hepatic Manifestations of Pediatrics Dengue Infection and
Significant Potential Risk Factors in Thailand
W. CHOKEJINDACHAI, P. SUPRADISH, JI. BUENSUCESO, P. CHANTHAVANICH, J. KAEWKUNGWAL, S.
KALAYANAROOJ (Thailand)
FP2-06 Analysis of Immune Function in Patients with Hand, Foot and Mouth
Disease in Shanghai in 2009
Hu YUi, Xiu-feng YAN,Yi YANG (China)
FP2-07 Incidence Rates of Enterovirus 71 Infections in Young Children in Taiwan,
2008-09
Min-Shi LEE, Pai-Shan CHIANG, Shu-Ting LUO, Mei-Liang HUANG, Guan-Yuan LIOU, Kuo-Chien TSAO,Tzou-Yien
LIN (Taiwan)
24
Day 3
Friday, September 24
Chia-Yunn CHUANG, Ping-Ing LEE, Chun-Yi LU, , Jong-Min CHEN, Luan-Yin CHANG, Li-Ming HUANG, Chin-Yun
LEE (Taiwan)
FP2-09 Predictive Effect of Serial Serum Alanine Aminotransferase Levels on
Spontaneous Hepatitis B Virus e Antigen Seroconversion
Jia-Feng WU, Huey-Ling CHEN,Yen-Hsuan NI, Hong-Yuan HSU, Mei-Hwei CHANG (Taiwan)
FP2-10 Clinical Outcome and Risk Factors in Hepatitis B Virus Related Hepatitis
in Infancy after Universal Hepatitis B Vaccination
Yu-Ru TSENG, Huey-Ling CHEN, Fu-Chang HU, Jia-Feng WU,Yen-Hsuan NI,Man-Shan KONG,Yao-Jong YANG,
Hung-Chang LEE, Fu-Chen HUANG,
I-Fei HUANG,Wan-Hsin WEN, Hong-Yuan HSU. Mei-Hwei CHANG (Taiwan)
FP2-11 Preemptive Therapy for Cytomegalovirus Infections in Children after Live
Donor Liver Transplantation
Akihiko SAITOH, Seisuke SAKAMOTO, Shinya KAMIYAMA, Akinari FUKUDA,Takanobu SHIGETA,Tomohiro
KATSUTA, Kensuke SHOJI, Chikara OGIMI, Mureo KASAHARA (Japan)
15:30-16:00
Coffee Break
Sponsored by Adimmune Corporation
16:00-17:30 Simultaneous Symposium 7
Pneumococcus
Moderator: Cheng-Hsun CHIU (Taiwan), Lulu C. BRAVO (Philippines)
SS7-01 Why the Pneumococcus Remains a Problem
101, 1F
201ABC, 2F
Jeffrey N.WEISER (USA)
SS7-02 Risk Factors and Histopathologic Features of Pneumococcal Pneumonia
Complicated by Bronchopleural Fistula in Children
Yu-Chia HSIEH (Taiwan)
SS7-03 Relations between Antibiotic Use in the Community and S. Pneumoniae
Resistance
David GREENBERG (Israel)
16:00-18:00
Simultaneous Symposium 8
201DEF, 2F
Acute Throat
Moderator: Nan-Chang CHIU (Taiwan), Cornaglia GIUSEPPE (Italy)
SS8-01 The Throat Microbiota and the Resistance Patterns of Bacterial Pathogens
Pentti HUOVINEN (Finland)
SS8-02 Etiology, Clinical Features and Prognostic Factors of Acute Sore Throat
Susanna ESPOSITO (Italy)
SS8-03 Diagnostic Tools and Clinical Scores/Decision Rules:The Use of Rapid
Streptococcal Antigen Tests
Paul LITTLE (UK)
SS8-04 Treatment of Acute Sore Throat in Primary Care
25
Detailed Scientific Program—Sep. 24
FP2-08 Risk Factors Analyses of Enterovirus Infection
Day 3
Friday, September 24
Theo J. M.VERHEIJ (The Netherlands)
16:00-18:00
Detailed Scientific Program—Sep. 24
Simultaneous Symposium 9
GI Infection
Moderator: Seng Hock QUAK (Singapore), Po-Yen CHEN (Taiwan)
SS9-01 Epidemiology of Rotavirus and Norovirus Infection in Asia
103, 1F
Fang-Tzy WU (Taiwan)
SS9-02 Bacterial Enterocolitis in Asian Children
Naveen THACKER (India)
SS9-03 Host-Salmonella Interaction: Control of Inflammatory Response and Host
Cell Death by Salmonella Pathogenicity Island 1
Tomoko YAMAMOTO (Japan)
SS9-04 Post Marketing Surveillance Data after RGE Vaccines
Keith S. REISINGER (USA)
16:00-17:30
Satellite Symposium 1
Invasive Meningococcal Disease Prevention
Sponsored by Novartis Asia Pacific Pharmaceuticals Pte Ltd
Moderator: Wolfgang BENDER (Germany)
SaS1-01 Current Trends in Epidemiology of Meningococcal Disease in Asia
102, 1F
Li Min HUANG (Taiwan)
SaS1-02 Novel Conjugated Vaccines:The Potential for Broader Protection
Heinz Josef SCHMITT (Germany)
16:00-17:30 ASPID General Assembly
South Lounge, 3F
26
Day 4
Saturday, September 25
David P. NICOLAU (USA), Po-Ren HSUEH (Taiwan)
07:45-08:30 Meet the Expert 4
201DEF, 2F
ME4 Management of Dengue Hemorrhagic Fever/Dengue Shock Syndrome in
Children
Thanh Hung NGUYEN (Vietnam), Ching-Chuan LIU (Taiwan)
08:30-17:30
08:30-10:30
Poster Session II
Simultaneous Symposium 10
Tuberculosis
Moderator: Ren-Bing TONG (Taiwan)
SS10-01 Diagnosis of Tuberculosis in Children
South Foyer, 101, 1F
102, 1F
R. DAYAL (India)
SS10-02 Evidence Based Latent TB Infection Diagnosis in Children Contact
Toru MORI (Japan)
SS10-03 Contact Investigation and Latent TB Infection Treatment at National
Level: Taiwan and other Countries
Anita P.C. CHAN (Taiwan)
SS10-04 New Treatment and Prevention Options for Childhood TB
Ben J. MARAIS (South Africa)
08:30-10:30
Simultaneous Symposium 11
ESGARS
Moderator: Po-Ren HSUEH (Taiwan), Cornaglia GIUSEPPE (Italy)
SS11-01 The Evolving Epidemiology of MRSA
201ABC, 2F
Giuseppe CORNAGLIA (Italy)
SS11-02 Multidrug-resistance in Gram-negative Pathogens
Gian Maria ROSSOLINi (Italy)
SS11-03 Multidrug Resistant and Extensively Drug Resistant Tuberculosis: Current
Status and Future Prospects
Emmanuelle CAMBAU (France)
SS11-04 Susceptibility Testing and Epidemiology of Resistance in Europe Vincent JARLIER
(France)
27
Detailed Scientific Program—Sep. 25
07:30-17:30 Registration of Delegates
Lobby, 1F
07:45-08:30 Meet the Expert 3
201ABC, 2F
ME3 Continuous Challenge of Antimicrobial Resistance in Gram-negatives
(NDM-1)
Day 4
Saturday, September 25
08:30-10:30
Detailed Scientific Program—Sep. 25
Simultaneous Symposium 12
Current Status of Important Infectious Diseases in Asia
Moderator: Manzoor HUSSAIN (Bangladesh), Chin-Yun LEE (Taiwan)
SS12-01 Review of Global Measles Situation and Way forward
201DEF, 2F
M. Ashraf SULTAN (Pakistan)
SS12-02 Ongoing Challenges with Polio and the Use of Vaccines to Address Them
Nitin SHAH (India)
SS12-03 New Opportunities for the Control of Japanese Encephalitis by Vaccination
Alain BOUCKENOOGHE (Singapore)
SS12-04 Control of Malaria in Asia
Baldev S. PRAJAPATI (India)
08:30-10:00
Free Paper 3
202, 2F
Important Community Bacterial Pathogens
Moderator: Chih-Chien WANG (Taiwan), Yong Hong YANG (China)
FP3-01 A Phage Gene PHLB Contributing to Virulence in a Successful, Endemic
Clone Causing Pneumonia among Children
Yu-Chia HSIEH, Tzu-Long LIN, Cheng-Hsun CHIU, Yhu-Chering HUANG, Jin-Town WANG (Taiwan)
FP3-02 Invasive Pneumococcal Disease in Children Caused by Non7-Valent
Pneumococcal Vaccine (PCV7) Coverage Serotype
Ching-Fen SHEN, Kuan-Hsien LEE, Tzong-Shiann HO, Shih-Min WANG, and Ching-Chuan LIU (Taiwan)
FP3-03 Changes in the Nasal Colonization with Staphylococcus aureus in Children:
2004-2009
Wen-Tsung LO, Ching-Feng HUANG, Shyi-Jou CHEN, Chih-Chien WANG (Taiwan)
FP3-04 Factors Associated with Nasal Colonization of Methicillin-Resistant
Staphylococcus aureus among Healthy Children in Taiwan
Chih-Jung CHEN, Kuang-Hung HSU, Tzou-Yien LIN, Kao-Pin HWANG, Po-Yen CHEN, Yhu-Chering HUANG
(Taiwan)
FP3-05 Antimicrobial Susceptibility and Molecular Characterization of
Streptococcus pyogenes from Children in Southern Taiwan: Trend of
Erythromycin-resistance
Kuan-Hsien LEE, Tzong-Shiann HO, Ching-Fen SHEN, Shih-Min WANG, and Ching-Chuan LIU (Taiwan)
FP3-06 Excess Morbidity of Pertussis among Japanese Infants: Analysis Using An
Administrative Database
Masato TAKEUCHI, Hideo YASUNAGA, Hiromasa HORIGUCHI, Shinya MATSUDA (Japan)
FP3-07 Treatment of Children with Typhoid Fever: A Comparative Trial of
Cotrimoxazole and Ampicillin
Dilini Vasana KIRIDANA, Jeysuda devi SUDHARMAN, Nusra Mam BEGUM (Sri Lanka)
28
Day 4
Saturday, September 25
LM huang, G Ruiz-Palacios, TY Lin, L Hernandez, ML Guerrero, A Lavalle-Villalobos, M Moreira, V Bianco, D
Borys, M van der Wielen, J Miller
10:00-12:00
Simultaneous Symposium 4
202, 2F
MRSA
Moderator: Ian M GOULD (UK), Yhu-Chering HUANG (Taiwan)
SS4-01 MRSA in Asian Countries: Current Epidemiology and Treatment Issues
Doo-Ryeon CHUNG (Korea)
SS4-02 Community Associated MRSA - Epidemiology and Consequence for
Containment of MRSA
Robert SKOV (Denmark)
SS4-03 Panton-Valentine Leukocidin and other Staphylococcal Toxins
Graeme R NIMMO (Australia)
SS4-04 New Antibiotics for Methicillin-resistant Staphylococcus aaureus (MRSA)
Infections
Ian M. GOULD (UK)
10:30-11:00
11:00-12:00
Coffee Break
Sponsored by Pfizer Ltd.
Plenary Lecture 3-1
Moderator: Yuichiro YAMASHIRO (Japan)
101, 1F
201DEF, 2F
PL3-1-01 The Role of Probiotics in Infectious Diseases
Gregor REID (Canada)
11:00-12:00
Paper Review
201ABC, 2F
Ping-Ing LEE (Taiwan), Yu-Chering HUANG (Taiwan)
12:00-13:30
Luncheon Symposium 3
Sponsored by PFIZER Limited
Moderator: Cheng-Hsun CHIU (Taiwan), Yu-Chering HUANG (Taiwan)
201ABC, 2F
LS3-01 The emerging threat of MRSA for pediatric patients
Sheldon L. KAPLAN (USA)
LS3-02 Treatment options for MRSA infections
Chun-Yi LU (Taiwan)
12:00-13:30
Luncheon Symposium 4
Sponsored by Sanofi Pasteur
Moderator: Fu-Yuan HUANG (Taiwan), Victor CAREY (Australia)
LS4-01 The Value of IPV in the Polio Pre- and Post-Eradication Eras
Nitin SHAH (India)
29
201DEF, 2F
Detailed Scientific Program—Sep. 25
FP3-08 Immunogenicity and Safety of a PHID-CV Booster Dose Co-Administered
with a Candidate Meningococcal Tetanus Toxoid Conjugate Vaccine
(MENACWY-TT) in Children Previously Primed with PHID-CV
Day 4
Saturday, September 25
Detailed Scientific Program—Sep. 25
LS4-02 Hepatitis B Vaccination: Successes and Challenges
Mei-Hwei CHANG (Taiwan)
LS4-03 ImojevTM: A New Single-dose Vaccine against Japanese Encephalitis
Alain BOUCKENOOGHE (Singapore)
12:00-13:30
Luncheon Symposium 5
Sponsored by MSD Taiwan
Moderator: Ping-Ing LEE (Taiwan)
LS5-01 Burden of Preventable Disease with New Vaccines in Asia
102, 2F
Dang Duc ANH (Vietnam)
LS5-02 Rotavirus surveillance in the early RotaTeqera
Keith S. REISINGER (USA)
LS5-03 HPV Disease beyond Cervical Cancer: A Gender Neutral Vaccination
Approach
David KAPLAN (USA)
13:30-15:30
Simultaneous Symposium 13
NB Infection
Moderator: Nan-Chang CHIU (Taiwan), Rajeshwar DAYAL (India)
SS13-01 Prevention of Nosocomial Infection of the Neonate
102, 2F
Hiroyuki KITAJIMA (Japan)
SS13-02 New Treatment Strategies in the NICU: Targeting the Right Patients with
Early Antifungal Therapy
Theoklis ZAOUTIS (USA)
SS13-03 The Prevention of RSV Infection in High Risk Neonates and Children
Jaime E. FERGIE (USA)
SS13-04 New CDC Guideline for Group B Streptococcus
Yun F. WANG (USA)
13:30-15:30
Simultaneous Symposium 14
Flu/H1N1
Moderator: Patrick WOO (HK), Shan-Chwen CHANG (Taiwan)
SS14-01 Pandemic Influenza A, 2009: Why H1N1 but not H5N1?
201ABC, 2F
Albert D.M.E. OSTERHAUS (The Netherlands)
SS14-02 Influenza, Inflammation and Immunomodulation: from H5N1 to H1N1
Patrick WOO (Hong Kong)
SS14-03 Clinical Perspective of Novel Influenza (H1N1) in Children
Bin CAO (China)
SS14-04 Seroepidemiologic Studies on H1N1-2009 Infections in Singapore: Lessons
Learned and Clinical Implications
Vincent T.K. CHOW (Singapore)
30
Day 4
Saturday, September 25
Simultaneous Symposium 15
201DEF, 2F
Probiotics
Moderator: Chien-Chang CHEN (Taiwan), Yuichiro YAMASHIRO (Japan)
SS15-01 Manipulation of the Microbiota – a Critical New Era of Managing Pediatric
Infectious Diseases
Gregor REID (Canada)
SS15-02 Prevention and/or Alleviation of Infection in Preterm Babies and Oncology
Patients
Yuichiro YAMASHIRO (Japan)
SS15-03 Effect of Probiotics on Gastrointestinal Infection
Chien-Chang CHEN (Taiwan)
13:30-15:30
Free Paper 4
202, 2F
Miscellaneous
Moderator: Yung-Feng HUANG (Taiwan)
FP4-01 Disseminated Bacillus Calmette–Guerin Infection, Description and Report
of Sixteen Cases
Anahita Sanaei DASHTI, Abdollah KARIMI (Iran)
FP4-02 Medicinal Plants in Treating Multi-drug Resistant Tuberculosis: An
Ethnographic Case Study from Kishoreganj District in Bangladesh
Md. Ariful Haque MOLLIK (Bangladesh)
FP4-03 Two Independent Cases of Interferon-Оі Receptor 1 Deficiency with Multiple
Osteomyelitis
Obinata KAORU, Kamata AYAKO , Lee TSUBASA , Niizuma TAKAHIRO,Kinoshita KEIJI, Mihara YUKA (Japan)
FP4-04 Body Mass Index as a Significant Predictor for Survival of Children on
Antiretroviral Treatment: A Five-Year Follow-Up Study in Malawi
Solomon Chih-Cheng CHEN, Joseph Kwong-Leung YU, Jung-Der WANG (Taiwan)
FP4-05 The Pharmacokinetics of Lopinavir/Ritonavir Twice Versus Once Daily in
Treatment-Experienced HIV-Infected Children
Kulkanya CHOKEPHAIBULKIT, Maneeratn NUNTARUKCHAIKUL, Tim R. CRESSEY, Wanatpreeya
PHONGSAMART, Orasri WITTAWATMONGKOL, Nirun VANPRAPAR (Thailand)
FP4-06 The Strategy for Reduction of Antibiotics Use in New Patients Admitted to
Neonatal Intensive Care Unit
Yung-Ning YANG, Hsing-I TSENG, San-Nan YANG, Chu-Chong LU, Hsiu-Lin CHEN (Taiwan)
FP4-07 Antimicrobial-Lock Therapy for Catheter-Related Infections in Children
Chen-Yin LAI, Ping-Ing LEE, Chao-Yi WU, Yin-Hua FANG, Po-Ren HSUEH,Chun-Yi LU, Li-Min HUANG, Jong-Min
CHEN, Chin-Yun LEE (Taiwan)
FP4-08 Detection of Carbapenemases and Analysis of Epidemiology in
Acinetobacter Baumannii
Wen’en LIU, Zhen-hua CHEN, Zi-Juan JIAN, Qian GAO, Ming-Xiang ZOU, Xiang-Hui LIANG, Yuan-Yuan LIU
31
Detailed Scientific Program—Sep. 25
13:30-15:30
Day 4
Saturday, September 25
(China)
Detailed Scientific Program—Sep. 25
FP4-09 Comparison of Three Methods for the Detection of Biofilm Forming
Microorganisms Isolated from a Tertiary Care Hospital of Pakistan
Afreenish HASSAN, Javaid USMAN, Fatima KALEEM (Pakistan)
FP4-10 Lumbar Puncture Rules for Diagnosing Bacterial Meningitis in Children
Anggraini ALAM, Nelly Amalia RISAN, Cissy B. KARTASASMITA (Indonesia)
FP4-11 An Investigation of Measles Outbreak in Junior High School Students with
High Second Dose MMR Vaccination Coverage with an Emphasis on
Vaccine Failure
Young June CHOE, Jae Kyung HU, Sang Taek LEE, Kyung Min SONG, Heeyeon CHO, Geun-Ryang BAE, Kisoon
KIM, Hee Sook YOON, Jina LEE, Eun Hwa CHOI, Hoan Jong LEE, and Jong-Koo LEE (Korea)
15:30-16:00
Coffee Break
Sponsored by Sandoz
16:00-17:30 Satellite Symposium 2
Sponsored by Roche Products Limited
Moderator: Tzou-Yien LIN (Taiwan)
SaS-01 Pandemic Influenza: Epidemiology, Prevention and Treatment
101, 1F
102, 1F
Robert BOOY (Australia)
SaS-02 Influenza in Children: Epidemiology, Manifestations and Treatment
Yhu-Chering HUANG (Taiwan)
16:00-17:30
Simultaneous Symposium 16
201ABC, 2F
Pediatric AIDS
Moderator: Li-Min HUANG (Taiwan), Usa THISYAKORN (Thailand)
SS16-01 Advances in Maternal-to-Child Transmission of HIV-1 Infection
Usa THISYAKORN (Thailand)
SS16-02 Management of Pediatric HIV Infection: Long Term Perspectives
Gareth TUDOR-WILLIAMS (UK)
SS16-03 New Molecular Insights into HIV-1 / AIDS with Pediatric Relevance
Kuan-Teh JEANG (USA)
16:00-18:00
Simultaneous Symposium 17
201DEF, 2F
Adolescent Vaccines
Moderator: Kao-Pin HWANG (Taiwan), Somsak LOLEKHA (Thailand)
SS17-01 Current Understanding of the Two Prophylactic HPV Vaccines
Consolidated
Eng-Hseon TAY (Singapore)
SS17-02 Adolescent and Adult Pertussis Vaccination Programs: Are They Having an
Impact?
Tina Q. TAN (USA)
SS17-03 Meningococcal Vaccines: Newly Developed Potential for Disease Control
32
Day 4
Saturday, September 25
Heinz-Josef SCHMITT (Germany)
Chun-Yi LU (Taiwan)
18:30-21:30
Farewell Dinner (tickets required)
3F, Silks Palace
at the National Palace Museum
33
Detailed Scientific Program—Sep. 25
SS17-04 Long-term Immune Memory of Hepatitis B Vaccine
Day 5
Sunday, September 26
Detailed Scientific Program—Sep. 26
07:30-17:30
Registration of Delegates
07:45-08:30
Meet the Expert 5
Lobby, 1F
201ABC, 2F
ME5 Management of Community-acquired Pneumonia
Ron DAGAN (Israel), Tzou-Yien LIN (Taiwan)
07:45-08:30 Meet the Expert 6
201DEF, 2F
ME6 Treatment and Prevention of Tuberculosis in Children—Case Illustrations
Ben J MARAIS (South Africa), Toru MORI (Japan)
09:15-10:00
Plenary Lecture 3-2
Moderator: Feng-Yee CHANG (Taiwan)
PL3-2-01 Identification of New Viral Respiratory Pathogens
201ABC, 2F
Albert .D.M.E. OSTERHAUS (The Netherlands)
08:30-10:00
Plenary Lecture 4
Moderator: Tzou-Yien LIN (Taiwan)
PL4-01 Unmet Challenges in Pneumococcal Conjugate Vaccines
201DEF, 2F
Ron DAGAN (Israel)
PL4-02 Genetic Susceptibility to Infectious Diseases
Chiea Chuen KHOR (Singapore)
10:00-10:30
10:30-12:00
Coffee Break
101, 1F
Satellite Symposium 3
201DEF, 2F
Applications of Slightly Acidic Hypochlorous Acid Water on Microbial
Control
Sponsor by Want Pu Trading Limited, Taiwan Branch
SaS3-01 Nosocomial Infection Control in 21th Century: New Strategy in
Approaching Zero Tolerance
Muh-Yong YEN (Taiwan)
SaS3-02 A New Approach to Sanitation for the 21st Century: Slightly Acidic
Hypochlorous Acid Water
Mamoru TOMITA (Japan)
SaS3-03 Applications of Slightly Acidic Hypochlorous Acid Water for The
Prevention of Hospital Infection
Yu Xing NI (China)
10:30-12:00
Simultaneous Symposium 18
201ABC, 2F
Laboratory Diagnosis
Moderator: Pornthep CHANTHAVANICH (Thailand), Bin CAO (China)
SS18-01 Molecular Differential Diagnosis of Viral Respiratory Pathogens in
Pediatric Patients
Chris WONG (Hong Kong)
SS18-02 Procalcitonin as a Marker of Severe Bacterial Infection in Children
34
Day 5
Sunday, September 26
SS18-03 Better Diagnosis of Sepsis
Bin CAO (China)
10:30-12:30
Simultaneous Symposium 19
102, 1F
Enterovirus 71
Moderator: Luan-Yin CHANG (Taiwan), Ching-Chun LIU (Taiwan)
SS19-01 Antibacterial and Antiviral Activity and Toxicological Study of Slightly
Acidic Hypochlorous Acid Water
Kanki KOMIYAMA (Japan)
SS19-02 EV71 Epidemiology and Vaccine Development
Min-Shi LEE (Taiwan)
SS19-03 Clinical Manifestations and Long Term Outcome of EV71
Luan-Yin CHANG (Taiwan)
SS19-04 Development of Antiviral Agents against Enterovirus 71
Shin-Ru SHIH (Taiwan)
12:00-13:30
Luncheon Symposium 6
201ABC, 2F
Sponsored by PFIZER Limited
Moderator: Tzou-Yien LIN (Taiwan)
LS6-01 Update on the Epidemiology and Burden of Pneumococcal Disease in Asia
Cheng-Hsun CHIU (Taiwan)
LS6-02 The Treatment and Prevention Strategy for IPD Caused by 19A
Ron DAGAN (Israel)
12:00-13:30
Luncheon Symposium 7
201DEF, 2F
Sponsored by GlaxoSmithKline Far East B.V.
Moderator:Li-Min HUANG (Taiwan)
LS7-01 Defeating Diarrheal Disease: A Case for Rotavirus Vaccination
John WECKER (USA)
LS7-02 Experience of Vaccination against Rotavirus: Efficacy, Effectiveness and
Impact
Mathuram SANDTOSHAM (USA)
LS7-03 Pertussis: Protection beyond the Childhood
Li-Min HUANG (Taiwan)
13:30-14:00
14:00-17:30
Closing Ceremony
Local Session
201ABC, 2F
201ABC, 2F
35
Detailed Scientific Program—Sep. 26
Chien-Chang LEE (Taiwan)
Detailed Poster Program
Poster Session
Set-up
Poster Session I - September 24
8:30
Poster Session II - September 25
8:30
Presentation
10:00-10:30
15:30-16:00
10:30-11:00
15:30-16:00
Poster Overview
Poster Session I
Category
Poster Number
Antimicrobial Resistanceand New Antibiotic
Bacterial Infection
P1-001~P1-008
P1-009~P1-020
Epidemiology
P1-021~P1-025
Influenza
P1-026~P1-032
Pneumococcal Diseases
P1-033~P1-043
Vaccination
P1-044~P1-056
Poster Session II
Category
Poster Number
Dengue
P2-001
Enteric Infection
P2-002~P2-008
Enterovirus, Poliomyelitis
P2-009~P2-011
Fungal Infection
P2-012
HIV
P2-013~P2-014
Hospital Infection
P2-016~P2-018
Laboratory Diagnosis
P2-019~P2-022
Neonatal Infection
P2-023~P2-028
Other Viral Infection
P2-029~P2-033
Others
P2-034~P2-041
Pathogenesis, Mechanism
P2-042~P2-046
Respiratory Tract Infection
P2-047~P2-049
Sepsis
P2-050
Tuberculosis, Leprosy
P2-051~P2-052
36
Tear-down
17:30
17:30
Poster Paper ID
Number
P1-001
#00012
P1-002
#00024
P1-003
#00027
P1-004
#00040
P1-005
#00087
P1-006
#00090
P1-007
#00104
P1-008
#00171
P1-009
#00017
P1-010
#00021
P1-011
#00031
P1-012
#00079
P1-013
#00113
P1-014
#00118
P1-015
#00128
P1-016
#00139
Paper Title
Antibacterial Effect of Four Herbal Plants Hydro-Alcoholic Extracts
Ali Jyhuni Khani, MH Meshkibaf, M Fasihi Ramandi, M Qolami Nedjad, F Adjdari, N Qayoor,
A Rahimian (Iran)
Imipenem Resistance among Gram-Negative and Gram-Positive Bacteria
in Hospitalized Patients: A Report from Iran
A Khorshidi, A Sharif, Gh Shajary, Gh Mossavi (Iran)
Integrons and Multi-Drug Resistance among Nontyphoidal Salmonella
Strains Isolated from Clinical Cases
Naghoni Ali, Ranjbar Reza, Tabaraie Bahman (Iran)
Antimicrobial Photodynamic Therapy (PDT) in Multidrug Resistant
Pathogens (MDRP)
CMN Yow (Hong Kong), RWK Wu, MR Hamblin (USA)
A Report of a Klebsiella Pneumoniae with Multi Antibacterial(Drug)
Resistance
Ali Khani Jyhuni-Abbas Abdollahi (Iran)
Multidrug Resistant, Extended Specturm Beta-Lactamases and AmpC Beta
Lactamases Producing Uropathogenes among Children: Hospital Based
Study
Janak Lal Pathak, Bharat mani pokherel, Pankaj Deo, Bal Krishna Awal, Suyog Raj Kadel
(China)
A High Rate of Inducible Clindamycin Resistance in Staphylococcus aureus in
Pediatric Hospital in Japan
Kensuke Shoji, Akihiko Saitoh (Japan)
In Vitro Efficacy of Tigecycline Against Metallo-ОІ-Lactamase Producing
Carbapenem Resistant Acinetobacter Species
Fatima Kaleem, Javaid Usman, Afreenish Hassan (Pakistan)
Differential Transcriptomic Profiling and Pathogenicity of Invasive and
Colonization Strains of Community-associated Methicillin-resistant
Staphylococcus aureus ST59
Sung-Tsan Wei, Chih-Jung Chen, Hisn-Ju Chang, Cheng-Hsun Chiu (Taiwan)
Acute Tonsillitis as a Risk Factor for Infective Endocarditis
Vladimir Krcmery, Andrea Demitrovicova, Eva Horvathova, Erich Kalavsky, Peter Kisac
(Slovakia)
The Incidence of Pediatric Invasive Haemophilus Influenzae Diseases and
Invasive Pneumococcal Diseases in Chiba Prefecture, Japan (2007-2009)
Naruhiko Ishiwada, Junko Tanaka, Haruka Hishiki, Tadashi Hoshino, Tomomichi Kurosaki,
Yoichi Kohno (Japan)
Prognostic Factors in Bacterial Meningitis: a 24 Years Retrospective Study
Biwen Cheng (Taiwan)
Clonal Dissemination with Particular Phenotype of Methicillin-resistant
Staphylococcus aureus Isolates from Patients Diagnosed of Mastitis in
Central Taiwan
Wei-Yao Wang, Tzong-Shi Chiueh, Jun-Ren Sun, Jang-Jih Lu (Taiwan)
Evaluation of the BD GeneOhm StaphSR Assay for Detection of
Staphylococcus aureus in Patients in Intensive Care Units
Tai-Hua Ho, Yhu-Chering Huang, Tzou-Yien Lin (Taiwan)
Bacteriological Study of Staphylococcus aureus Isolates Causing
Community-Acquired Infection in Children
Naohiko Moriguchi, Haruka Kodama, Fumika Miyajima, Taysuo Yamamoto (Japan)
Pyogenic Arthritis in Childhood: A 13-Year Review
Eiji Ohta, Shinichi Hirose (Japan)
37
Poster Paper ID
Number
P1-017
#00158
P1-018
#00167
P1-019
#00174
P1-020
#00176
P1-021
#00022
P1-022
#00083
P1-023
#00101
P1-024
#00131
P1-025
#00149
P1-026
#00023
P1-027
#00063
P1-028
#00071
P1-029
#00100
P1-030
#00112
P1-031
#00125
Paper Title
Epidemiology of Burn Unit Infection in a Children's Burn Center
Seon-Hee Shin, Chang-Hwi Kim, Kwang-Nam Kim, Hea-Soon Shin (Korea)
Frequency of AmpC Beta Lactamase Producing Bacteria Isolated from a
Tertiary Care Hospital
Afreenish Hassan, Javaid Usman, Fatima Kaleem (Pakistan)
Therapeutic Monitoring of Vancomycin according to the Initial Dosing
Regimen in Pediatric Patients
EY Cho, DI Kim, JH Lee, JY Sung, MA Yang, KW Yun, Hong KB, J Lee, CHOI EH, HJ Lee
(Korea)
The Possibility of Bacterial Meningitis among Febrile Seizure Children
Younger Than 18 Months of Age
Nelly Amalia Risan, Anggraini Alam, Cissy B. Kartasasmita
Seroprevalence of HTLV among Kidney Graft Recipients
Zakieh Rostam-Zadeh Khameneh, Ali Tagizadeh, Zahra Shirmohammadi, Nariman
Sepehrvand, Sima Masudi (Iran)
Bacterial Aetiology and Antibiotic Resistance of Acute Otitis Media in
Young Children in Thailand
JP Intakorn, N Sonsuwan, S Noknu, G Moungthong, LF Peruski, JY Pirçon, Y Liu, MK Van Dyke,
WP Hausdorff
Risk Factor Analysis of Salmonella Infection in Taiwan
Ting-Fang Chiu, Ping-Ing Lee, Po-Ren Hsueh, Kun-Mei Lee, Hsin-Lin Wu, Jung-Chieh Du,
Ya-Chi Yang, Hsu-Yeh Shu, Chung-Shu Sun, Betau Hwang (Taiwan)
Changing Epidemiology of Mastoiditis in Children in the Era of Emerging
Antibiotic-Resistant Bacteria in Taiwan
Tsung-Pei Tsou, Ping-Ing Lee, Boon Fatt Tan, Chun-Yi Lu, Po-Ren Hsueh, Pei-Lan Shao, Li-Min
Huang, Jong-Min Chen, Luan-Yin Chang, Chin-Yun Lee (Taiwan)
Bordetella pertussis, Mycoplasma pneumoniae and Chlamydia pneumoniae
Associating with Prolonged Cough in Children
Chien-Yu Lee, Jia- Yi Lin, Jen-Sheng Pei (Taiwan)
Influenza and Parainfluenza Associated Pediatric ICU Morbidity
Kam Lun Ellis Hon, Paul Kay-sheung Chan, Ting-fan Leung (Hong Kong)
Significance of Seasonal Influenza Viruses in the Stool of Pediatric Patients
Daisuke Tamura, Motoko Fujino, Makoto Ozawa, Kiyoko Iwatsuki-Horimoto, Hideo Goto,
Yuko Sakai-Tagawa, Taisuke Horimoto, Mari Nirasawa, Yoshihiro Kawaoka, Kou Ichihashi
(Japan)
Lower Respiratory Tract Infection in Hospitalized Thai Infants, Influenza
and Respiratory Syncytial Virus (RSV)
Sarunya Srijuntongsiri, Piyarat Suntarattiwong, Kanokwan Sojirarat, Pranee Sitaposa, Malinee
Chittaganpitch, Tawee Chotpitayasunondh (Thailand)
Preexisting Antibodies Against Pandemic (H1N1) 2009 in Older People in
Taiwan
Shih-Cheng Chang, Yuh-Chering Huang, Cheng-Hsun Chiu, Shin-Ru Shih, Tzou-Yien Lin
(Taiwan)
Comparison of an ELISA to QuickVue Influenza A+B Test and RT-PCR for
Diagnosis of Pandemic 2009 Influenza A (H1N1) Virus Infections
Chun-Yi Lu, Luan-Yin Chang, Li-Min Huang (Taiwan)
Clinical Characteristics of Children Hopitalized for the 2009 Pandermic
Influenza A/H1N1 Virus Infection in Four Tertiary Care Hospitals in
Thailand
Songkiat Udompornwattana, Pimpanada Chearskul, Krissada Srajai, Pongsan Suwan, Auchara
Tangsathapornpong, Orasi Wittawatmongkol, Wanatpreeya Phongsamart, Nirun Vanprapar,
Kulkanya Chokephaibulkit (Thailand)
38
Poster Paper ID
Number
P1-032
#00138
P1-033
#00030
P1-034
#00036
P1-035
#00046
P1-036
#00054
P1-037
#00059
P1-038
#00076
P1-039
#00089
P1-040
#00094
P1-041
#00095
P1-042
#00096
P1-043
#00119
Paper Title
Factors Associated with Rapid Disease Progression of Pandemic 2009
Influenza A(H1N1) Virus Infection in Children-Focusing on Initial Chest
Radiographic Findings
Takanori Funaki, Kensuke Shoji, Nobuyuki Yotani, Tomohiro Katsuta, Osamu Miyazaki,
Shunsuke Nosaka, Hidekazu Masaki, and Akihiko Saitoh (Japan)
Childhood Pneumococcal Diseases and Serotypes: Can Vaccines Protect?
Kam Lun Hon, Margaret IP, Kenneth Lee, Ting-fan Leung (Hong Kong)
Invasive Pneumococcal Infection in Urban Thai Children: A10-Year Review
Supichaya Netsawang, Warunee Punpanich, Vipa Treeratweeraphong, Tawee
Chotpitayasunondh (Thailand)
Demographic and Bacterialogical Characters of Sinusitis Caused by
Streptococcus Pneumoniae in Children
Yi-Chuan Huang, Yu-Chia Hsieh, Hsin-Ching Lin (Taiwan)
Incidence of Community Acquired Pneumonia and Distribution of
Serotypes and Sequence Types of Streptococcus Pneumoniae among
Japanese Children Prior to the Introduction of Pneumococcal Conjugate
Vaccine
Junko Oikawa, Naruhiko Ishiwada, Junko Tanaka, Haruka Hishiki, Tomomichi Kurosaki,
Yoichi Kohno, Yoshiko Honda, Akihito Wada, Bin Chang (Japan)
Identification of Pneumococcal Serotypes in Nasopharyngeal Aspirates of
Hospitalized Children With Lower Respiratory Infection in Korea
Jong Gyun Ahn, Jung Soo Kim, Heui Og Kim, Dong Won Baek, Ki Hwan Kim and Dong Soo
Kim (Korea)
Safety, Tolerability and Efficacy of Heptavalent Pneumococcal Conjugate
Vaccine among Low Birth Weight Infants and Infants with Underlying
Heart Diseases
Hattasingh W, Liulak W, Pengsaa K, Thisyakorn U (Thailand)
Active Hospital-Based Epidemiological Surveillance to Estimate the
Burden of Pneumonia and Invasive Pneumococcal Disease (IPD) in
Children Under 5 Years of Age in Bali, Indonesia
Ni Putu Siadi Purniti, Sri Rezeki Hadinegoro, I Komang Kari, Ida Sri Iswari, Nyambat
Batmunkh, Paul E. Kilgore, Sharon Gray, Jay Graepel, Dennis Brooks, Robin Hubler
(Indonesia)
Active
Hospital-Based
Epidemiologic
Surveillance
for
Invasive
Pneumococcal Disease and Pneumonia Burden in Children in Bangkok,
Thailand
C. Chomchai, S.W. Kim, W. Kriengsoonthornkij, S.Sutchritpongsa, B.Manaboriboon, 1
R.Ungcharoen,1 P. Kilgore, S.A. Kim, J. Graepel, S. Gray, D. Brooks, R. Hubler (Thailand)
Estimating the Burden of Pneumonia and Invasive Pneumococcal
Disease(IPD) in Children Under Five Years of Age: An Active
Hospital-Based Epidemiological Surveillance
Cissy B. Kartasasmita, Sri Rezeki Hadinegoro, Sri Sudarwati, Sunaryati Sudigdo-Adi, Nyambat
Batmunkh, Paul E. Kilgore, Sharon Gray, Jay Graepel, Dennis Brooks, Robin Hubler
(Indonesia)
Active Hospital-Based Epidemiological Surveillance to Estimate the
Burden of Invasive Pneumococcal Disease (IPD) in children Under 5 Years
of Age in Surabaya, Indonesia
Ismoedijanto Moedjito, Lindawati Alimsardjono, Landia Setiawati Agung-Margono, Sri
Rezeki Hadinegoro, Nyambat Batmunkh, Paul E. Kilgore, Sharon Gray, Jay Graepel, Dennis
Brooks, Robin Hubler (Indonesia)
Current Trend of Pneumococcal Disease Serotypes in Malaysian Hospitals
MY Rohani, MZ Norni, HN Salbiah, MH Suhailah, AW Zubaidah, B Ganeswarie, H Azura,
AM Nazri, M Nurahan, S Norazita, PP Ng, SM Jamilah, M Azmi, A Norazah, K. Rina
(Malaysia)
39
Poster Paper ID
Number
P1-044
#00014
P1-045
#00041
P1-046
#00042
P1-047
#00045
P1-048
#00061
P1-049
#00062
P1-050
#00084
P1-051
#00091
P1-052
#00098
P1-053
#00127
P1-054
#00133
P1-055
#00122
P1-056
#00175
Paper Title
DTP Vaccination as Problem During Vaccination in Bosnia
Adnan Bajraktarevic (Bosnia and Herzegovina)
Immunogenicity and Safety of an Investigational Hexavalent Fully Liquid
DTaP-IPV-Hep B-PRP-T Vaccine Given at 2, 3, 4 Months of Age with a
Booster at 15, 18 Months Compared to Licensed Vaccines in Turkish
Infants
Mehmet Ceyhan, Eduardo Santos-Lima (Turkey)
Immunogenicity and Safety of an Investigational Hexavalent Fully Liquid
DTaP-IPV-Hep B-PRP-T Vaccine and a Licensed Comparator,
Concomitantly Administered with Pneumococcal Conjugate Vaccine at
2,4,6 Months of Age in Thai Infants
Pope Kosalaraska, Usa Thisyakorn, Suwat Benjaponpitak, Kulkanya Chokephaibulkit,
Eduardo Santos-Lima (Thailand)
BCG Vaccination Status of Internally Displaced Children in the North of Sri
Lanka
Dilini Vasana Kiridana (Sri Lanka)
Antibody Response in Healthy Infants Receiving Either Oral Monovalen
Polia Vaccine Type 1 or Oral Trivalen Polio Vaccine after Primed with
Trivalent OPV at Birth
Ismoedijanto Moedjito, Edim Hartati, NoviliaSjafri Bachtiar (Indonesia)
Immunogenicity of Trivalent Oral Polio Vaccine (tOPV) and Enhanced
Inactivated Polio Vaccine (eIPV) in Healthy Infants Primed with Neonatal
OPV
Ismoedijanto Moedjito, Ivijanthi Meriastuti, Novilia Sjafri Bachtiar (Indonesia)
Antibody Persistence at 18-20 Months of age Following Primary
Vaccination of Healthy Infants with a Combined DTaP-IPV/PRP~T Vaccine
Compared to Separate Vaccines (DTaP, PRP~T AND IPV) and
Immunogenicity and Safety of Booster Vaccination in the People's Republic
of China
Rong Cheng Li, Feng Xiang Li, Yan Ping Li, Qi Ming Hou, Chang Gui Li, Ya Nan Li, Fu Sheng
Chen, Xue Zhong Hu, Wen Bin Su, Shu Min Zhang, Han Hua Fang, Qiang Ye, Tian De Zeng,
Tao Xuan Liu, Xiu Bi Li, Yun Neng Huang, Yun Neng Huang, Yan Ping Zhang, Esteban Ortiz
(China)
A Review of Heratitis B Vaccine Administration Schedules in Infants
Usa Thisyakorn, May Montellano, Esteban Ortiz, Andrew Lane (Thailand)
Immunogenicity of a 10-Valent Pneumococcal Non-Typeable Haemophilus
Influenzae Protein D-Conjugate Vaccine (PHiD-CV) and Co-Administered
Vaccines Following Primary Vaccination Asian Infants
Chang-Hwi Kim, Kyung-Hyo Kim, Hwang-Min Kim, Nancy Bermal, Li-Min Huang, Tzou-Yien
Lin, Ta-Wen Yu, Salvacion Gatchalian, Haiwen Tang, Patricia Lommel, Dorota Borys (Korea)
Immunogenicity and Safety of ADACEL Polio (TdcP-IPV Vaccine)
Administered at 6 to 8 Years of Age as a Fifth Dose (Pre-School Booster) in
Healthy Children in Taiwan
Hsin-Yu Chang, Ping-Ing Lee, Chun-Yi Lu (Taiwan)
Polyribosylribitol Phosphate Antibody of the Pediatric Patients with
Haemophilus Influenzae Type b Systemic Infection
Yoshiko Honda, Naruhiko Ishiwada, Junko Tanaka, Haruka Hishiki, Yoichi Kohno (Japan)
High Vacuolation Formation Induced by Helicobacter Pylori Isolates From
Children With Dyspepsia
Mun Fai LOKE, Bee Ling NG, Seng Hock QUAK, Bow HO (Singapore)
Biofilm Forming Ability of Helicobacter Pylori Pediatric Isolates
Hassanbhai Ammar Mansoor, Ng Bee Ling, Loke Mun Fai, Quak Seng Hock, Ho Bow
(Singapore)
40
Poster Paper ID
Number
P2-001
#00099
P2-002
#00060
P2-003
#00073
P2-004
#00097
P2-005
#00151
P2-006
#00156
P2-007
#00163
P2-008
#00172
P2-009
#00032
P2-010
#00109
P2-011
#00140
P2-012
#00159
P2-013
#00020
P2-014
#00051
P2-015
#00052
P2-016
#00142
Paper Title
Changing Epidemiology of Dengue Patients un Bangkok Metropolitan,
Thailand
Liulak W, Sonthichai C, Saosarn S, Thisyakorn U (Thailand)
A Hospital Based Randomized, Double-Blinded, Placebo-Controlled Study
on the Efficacy and Safety of Bacillus Clausii as Adjunct Treatment in Acute
Gastroenteritis in Pediatric Patients Ages 6 Months to 12 Years Old
Ranjelyn C. Robielos, William C. Bayhon Jr., Rosario Khamil P. Carrion (Philippines)
Prevalence and Types of Human Parechovirus (HPeV) in Stool Samples in
Shanghai, China
Jin Xu, Huaqing Zhong, Yi Yang (China)
Etiology of Acute Gastroenteritis in Children Less than 5 Years of Age in
Northern Taiwan
Wei-Chen Tseng, Fang-Tzy Wu, Yhu-Chering Huang (Taiwan)
Impact of Gastroenteritis on Parents of Child Hospitalized for Acute
Gastroenteritis in Taiwan
Lung-Huang Lin, Shih-Pin Kuo, Chao-Jen Lin, Min-Sheng Lee, Hsiang-Hung Shih, Hung-Chang
Lee (Taiwan)
Klassevirus Infection in Children with Acute Gastroenteritis
Tae-Hee Han, Ju-Young Chung, Cheol-Hwan Kim, Sang-Hun Park, Eung-Soo Hwang (Korea)
Norovirus is a Significant Pathogen of Acute Sporadic Diarrhea in Children
Hsiao-Chuan Lin, Mei-Chi Su, Tsung-Hsueh Hsieh, Tzu-Yao Chuang, Hsin-Yang Hsieh1,
Meng-Kung Yu, Chih-Feng Chang, Shu-Fen Wu, An-Chyi Chen, Hsiao-Yu Chiu, Chang-Ching
Wei, Walter Chen, Ching-Tien Peng (Taiwan)
In Vitro Efficacy of Tigecycline against Multidrug Resistant and Nalidixic
Acid Resistant Typhoidal Salmonellae
Fatima Kaleem, Javaid Usman, Afreenish Hassan (Pakistan)
Innate Antiviral Immunity is Impaired in Young Patients with Hand Food
and Mouth Diseases
Jiande Chen, Bingbing Wu, Yi Yang (China)
The Outbreak of Neurologically Complicated Hand-Foot-Mouth Disease
Caused by Enterovirus 71 in Republic of Korea, 2009
Jong-Hyun Kim, Seong-Joon Kim, Kyung Hyo Kim, Dong Soo Kim, Chang Hwi Kim, Doo-Sung
Cheon, Jin Han Kang (Korea)
Comparison of Classic and Molecular Approaches for the Identification of
Human Enteroviruses from Throat Swabs in Outpatients
Pai-Shan Chiang, Shu-Ting Luo, Sheng-Chi Chen, Mei-Liang Huang, Guan-Yuan Liou,
Kuo-Chien Tsao, Tzou-Yien Lin, Min-Shi Lee (Taiwan)
Voriconazole Therapeutic Drug Level Monitoring in Korean Children
Ji-Young Hwang, Soo Han Choi, Soo-Youn Lee, Eunhye Kong, Heewon Chueh, Soohyun Lee,
Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Yae-Jean Kim (Korea)
Experience of the Newly Developed Pediatric National HIV/AIDS
Treatment Registry (pNHATR) Observational Database in Kuala Lumpur,
Malaysia
MZA Hamid, NA Aziz, Thahira JM, Kamarul AMR (Malaysia)
Growth and Development of Children Borne to HIV-Positive Pregnant
Women in 4 Provinces in Thailand
Voramongkol Nipunporn, Chailai Leartvanangkul (Thailand)
The Examination of Infection in Peritioneal Dialysis Patients
Morteza Ghasemi Bonehi (Philippines)
Nosocomial Blood Stream Infection in Neonatal Intensive Care Unit: An
Eight-Year Study in a Medical Center of Northern Taiwan
Mei-Hui Tang, Nan-Chang Chiu , Hsin Chi, Fu-Yang Huang, Jui-Hsing Chang, Chyong-Hsin
Hsu, Hsin-An Kao, Han-Yang Hung, Chun-Chih Peng (Taiwan)
41
Poster Paper ID
Number
P2-017
#00145
P2-018
#00008
P2-019
#00009
P2-020
#00010
P2-021
#00047
P2-022
#00157
P2-023
#00035
P2-024
#00066
P2-025
#00077
P2-026
#00078
P2-027
#00129
P2-028
#00146
P2-029
#00055
P2-030
#00115
P2-031
#00117
P2-032
#00162
P2-033
#00169
Paper Title
Healthcare-Associated Bloodstream Infection in a Neonatal Intensive Care
Unit in Southern Taiwan
Tzong-Shiann Ho, Shih-Min Wang, Yi-Hui Wu, Ching-Fen Shen and Ching-Chuan Liu (Taiwan)
Antimicrobial Prophylaxis with Anti-Biofilm Azithromycin for Prevetion of
Ventilator Associated Pneumonia in Pediatric Cardiac Surgery Patients
Yung-Feng Huang, Po-Yen Liu, Chia-Wan Tang, Chiun-Yen Pan, Kai-Sheng Hsieh (Taiwan)
Evaluation of SHV and CTX-M Extended Spectrum ОІ-Lactamase in
Salmonella Enterica by Using Multiplex PCR
A Abdollahi, M Fasihi R, SJ Adnani S (Iran)
Evaluation of bla-ctx-m-type Gene in Multi Drug Resistant Klebsiella
Pneumoniae Species, Isolated from Clinical Samples: First Determination in
Iranian Patients
Abdollahi A., Behzadian Nejad Q., Najjar Peerayeh Sh. , Forouhesh Tehrani H. (Iran)
Diagonostic Value of Apolipoprotein Mesurement for Central Nervous
System Infection in Children
Chuanqing Wang, Yi Wang, Aimin Wang, Zhimin Feng, Pan Fu, Yi Yang (China)
Predictive Values of Urine Dipstick and Microscopy Examination for UTI in
Children with Different Ages
Wei-Chuan Chen, Hsun-Hui Hsu, Hsiu-Chen Lin (Taiwan)
Comparative Study of Single and Double Phototherapy in Different Cases
of Neonatal Hyperbilirubinemia
Mahfuz M Junaid, Mahmood A Chowdhury, Wazir Ahmed (Bangladesh)
Analysis of Cytokine Levels in the Cerebrospinal Fluid of a Newborn with
Enterococcus Faecalis Meningitis
N.Ikeda, N.Tanaka, K.Matsui, T.Iwasaki, N.Ohkawa, H.Suganuma, S.Nagata, T.Shimizu
(Japan)
Evaluation of Once a Day of Arbekacin Administration to Neonates as a
New Object of Peak Concentration
Daisuke Kinoshita (Japan)
Reduction of Nosocomial Infection by Implementing Evidence-Based
Practices in a Neonatal Intensive Care Uint
Cai Xiaodi, Yan Gangfeng, Cao Yun, Jiang Siyuan, Wang Chuanqing (China)
A Paired Comparison of Urine Cultures from Bag-Obtained Specimens
Versus Catheter–Obtained Specimens in the Young Infants Suspected of
Urinary Tract Infection
Chiu Tzu-Hsuan, Hsiu Lin Chen, Yung Ning Yang, Hsieh ,Shu-Chuan, Hsing-I Tseng, San-Nan
Yang (Taiwan)
A Case of Premature Infant with Congenital Measles
Yasufumi HIDAKA (Japan)
The Effect of Plants on Viral Diseases: Results from a Cross-Sectional Study
in Sirajganj District of Bangladesh
Md. Ariful Haque Mollik (Bangladesh)
Clinical Features of Hospitalized Children with Adenoviral Pneumonia
Shih-Perng Chen, Yhu-Chering Huang, Cheng-Hsun Chiu, Chung-Guei Huang, Kuo-Chien Tsao,
Tzou-Yien Lin (Taiwan)
Adenovirus Infection Associated with Central Nervous System Dysfunction
in Children
Sun-Lin Huang, Yhu-Chering Huang, Shih-Perng Chen, Chung-Guei Huang, Kuo-Chien Tsao,
Tzou-Yien Lin (Taiwan)
Kawasaki Disease Associated with Epstein-Barr Virus and Mycoplasma
Pneumoniae and Complicated with Autoimmune Haemolytic Anaemia
Fang-Liang Huang, Po-Yen Chen, Chun-Yi Lee, Fang-Ching Liu, Cheng-Chieh Wang (Taiwan)
Cytomegalovirus Causing Acute Hepatitis in an Adolescent
Hsiang-Hung Shih (Taiwan)
42
Poster Paper ID
Number
P2-034
#00016
P2-035
#00050
P2-036
#00053
P2-037
#00082
P2-038
#00105
P2-039
#00120
P2-040
#00148
P2-041
#00150
P2-042
#00064
P2-043
#00065
P2-044
#00121
P2-045
#00154
P2-046
#00160
P2-047
#00108
P2-048
#00116
P2-049
#00153
P2-050
#00114
Paper Title
Parental Attitude on Lumber Puncture of Their Sibling in Mofid Children
Hospital (2008-9)
Shirvani F, Sannai A, Ganbarpor MH (Iran)
Two Familial Cases of Congenital Neutropenia with Mutations in the Ela2
Gene.
Kamata Ayako, Obinata Kaoru, Naoki Watanabe, Kinoshita Keiji, Ohishi Tsutomu (Japan)
Antibiotic Prescribing Pattern In Children With Exacerbation Of Bronchial
Asthma
Mia-Tuang Koh, Woan-Lin Tan, Hussain Samsinah, Pei-Zhi Koh (Malaysia)
Antimicrobial Agents Related Adverse Drug Reactions in Taiwan from
1999 to 2009
Mu-Chun Lin, Hsiu-Chiung Yen, Hsin Chi, Nan-Chang Chiu, Fu-Yuan Huang (Taiwan)
Determine The Role Of Pulse Status In Pediatric Acute Illness By
Embedded Intelligent Continuous Pulse Monitor (Eicpm)
Sung-Lien Lin (Taiwan)
PPARОі Inhibits Inflammatory Reaction In Oxidative Stress Induced Human
Diploid Fibloblast
Jun-Won Yang, Jung-Soo Kim, Ho-Keun Yi, Sung-Ho Cha3, Pyoung-Han Hwang (Korea)
Kawasaki Disease Associated with Transient Encephalopathy in an Infant
Shih-Hsuan Lo, Yhu-Chering Huang (Taiwan)
Superficial Bacterial Contamination of Bovine carcasses in One Slaughter
Houses around Tehran
Tannaz Moosavi, Peyman Fardesaneii, Majid Yazdani Borji (Iran)
Interleukin 17 Stimulates Mononuclear Cells to Kill Echinococcus
Granulosus by Nitric Oxide-Dependent Pathway
Manel Amri, Chafia Touil-Boukoffa (Algeria)
Evasion Strategies of Echinococcus Granulosus to TH1 Protective Reponse
during Human Infection: IFN-Оі/NO Design in Anti-Hydatic Therapy
Manel Amri, Chafia Touil-Boukoffa (Algeria)
Panton-Valteine Leukocidin is the Virulent Determinant for
Community-Associated
Methicillin-Resistant
Staphylococcus
aureus
Infecting Human Keratinocyte
Chia-Yu Chi, Chia-Chun Lin, Yi-Chuan Yao, Chiou-Feng Lin, and Ching-Chuan Liu (Taiwan)
Hepatic Damage Caused by Coxsackievirus B3 is Dependent on
Age-Related
Tissue
Tropisms
Associated
with
the
Coxsackievirus-Adenovirus Receptor
Chih-Yuan Kuo, Jung-Yen Liu, Shih-Min Wang, Chun-Keung Yu, Huan-Yao Lei1, Ching-Chuan
Liu (Taiwan)
Synergistic Effects of NOD2 and Toll-Like Receptor 5 on Inflammatory
Responses in Intestinal Epithelial Cells
Fu-Chen Huang (Taiwan)
Pertussis Like Syndrome Or Pertussis? : A Delay Diagnosis
Heda Melinda Nataprawira, Finia Cahayasari, Arifin Kashmir (Indonesia)
Life-Threatening Pneumonia Caused by Macrolide-Resistant Mycoplasma
Pneumoniae
Yu-Chia Hsieh, Kuo-Chien Tsao, Chung-Guei Huang, Ya-Ling Huang, Suxiang Tong, Jonas
Winchell, Yhu-Chering Huang, Shao-Hsuan Shia, Shen-Hao Lai, Tzou-Yien Lin (Taiwan)
Mortality of Severe Pneumonia in Under-Five Children
Diah Asri Wulandari, Sri Sudarwati, Adi Utomo Suardi, Reni Ghrahani DM, Cissy B
Kartasasmita (Indonesia)
Axillary Temperature and Leukocyte as Predictors of Sepsis in Children 1
to 60 Months of Ages
Enny Harliany Alwi, Reni Ghrahani Dewi Majangsari, Stanza Uga Peryoga (Indonesia)
43
Poster Paper ID
Number
P2-051
#00019
P2-052
#00068
P2-053
#00011
P2-054
#00013
P2-055
#00130
P2-056
#00134
P2-057
#00137
Paper Title
Additional Antituberculosis Activity of Juniper Communis "Berries" in
Younger between 16 to 20 Years Old with Clasiccal Therapy
Bajraktarevic Adnan, Gusic Mornjakovic Saida, Penava Semira, Boldic Dragana, Frankic
Teodora (Bosnia and Herzegovina)
The Survay of Infants’Tuberculosis
Rassol Aalahi (Iran)
The Efficiency Comparison of Culture and PCR Methods in Detection of
Mycoplasma Hominis in Individuals with Genitourinary Tract Infection
A.Abdollahi, M.Fasihi R (Iran)
Epidemiology of Urinary Infections in Children during Last Fifteen Years
Adnan Bajraktarevic (Bosnia and Herzegovina)
Treatment of Pyelonephritis with Extended-Spectrum Beta-Lactamase
(ESBL)-Producing Enterobacteriaceae in Children
Tomohiro Katsuta, Kensuke Shoji, Shinya Kamiyama, Akihiko Saitoh (Japan)
Comparison of Guidelines for Chronic Prostatitis/Chronic Pelvic Pain
Syndrome Between China and Singapore
Chih-Cheng Lu, Tse-Chou, Cheng (Taiwan)
Empiric
Antibiotic
Regimen
for
Hospitalized
Children
with
Community-acquired Febrile Urinary Tract Infections in Taiwan
Yu-Hsiu Huang, Meng-Chang Lee, Pei-Ju Huang, Yhu-Chering Huang (Taiwan)
44
Abstracts of Special Session
S-001
Pandemic Influenza 2009 in Japan
S-002
Novel H1N1 Influenza in Taiwan
Nobuhiko Okabe
Director, Infectious Disease Surveillance Center,
National Institute of Infectious Diseases, Tokyo,
Japan
Luan-Yin Chang
Department of Pediatrics, National Taiwan
University Hospital, Taiwan
Since April 15 and 17, 2009, when the first two cases of
novel influenza A (H1N1) infection were identified in
two southern California counties, as of 12 March 2010,
the virus has spread to more than 213 countries and
overseas territories or communities where it has caused
the deaths of at least 16713 people.
In Japan, the first case of Pandemic Influenza H1N1
2009 (PI) was detected from high school student
who came back to Japan from Canada via USA, at
Narita Air Port Quarantine through entry screening,
on 8th May 2009. Three students in a group were
identified as PI and were hospitalized in the
designated hospital for isolation.
Form April to June, Taiwan government tried to prevent
novel H1N1 importation from abroad by enhanced
screening and quarantine, which included checking
people’s temperature through customs or border,
isolating febrile people and checking their influenza
status. However, novel H1N1 was still imported to
Taiwan on May 29, 2009 when a non-citizen who had
been living in Taiwan returned from the United States
via Hong Kong. Since then, Taiwan CDC strengthened
the influenza viral and clinical surveillance systems
including surveillance of complicated influenza,
virological, outpatient/ER influenza-like illness (ILI),
pneumonia and influenza mortality surveillance,
advocated rapid influenza diagnosis and early antiviral
therapy as well as preventive measures such as aerosol
precaution and keeping novel H1N1 influenza patients
at home until 24 hours after they were illness free.
About 15 million doses of vaccine were bought from
two manufacturers (Adimmune and Novartis), covering
60% of the population in Taiwan, and mass vaccination
began on November 1. On December 12, 2009,
vaccination was opened up to everyone. However,
media reported some severe adverse reactions in
Mid-Dec 2009, most of which were proven not related
to vaccine later, people were reluctant to receive
vaccine since then. The overall immunization rate of
the population reached about 25%.
On 16th May, three cases of PI cases were reported
from Kobe City, Hyogo, Japan. More cases have
been reported from north and west part of Hyogo
prefecture, and nearby prefecture (Osaka) following
to the first report.
More cases have continuously been reported from
two prefectures, Hyogo and Osaka. On May 19, a
total of 163 confirmed cases have been reported
from Japan to WHO in accordance with the
International Health Regulation 2005. Public health
interventions that were implemented include strict
school closure and advice for cancelling or
postponing of large gatherings.
The initial outbreaks were diminished and virus
transmission was stopped once, however, confirmed
PI cases increased up again from middle June to July
and total PI patient number was reached nearly
5,000 from all over the country. In the initial stage,
cased based surveillance with confirmation with
PCR had been implemented but the policy was
changed to cluster, severe cases and sentinel
surveillance system (ILI surveillance). Virus
isolation is also implemented among sentinels.
According to the outpatient/ER ILI consultation rate,
the first peak of pandemic influenza A (H1N1) infection
in Taiwan was in the 36th week of 2009, followed by
the second peak in the 48th week, the trend went down
after the mass vaccine and it ended in the late Feb, 2010.
The incidences of both pneumonia and influenza
mortality during the pandemic influenza outbreak were
lower than those of the same months in 2008. In
addition, the pandemic influenza mortality rate in
Taiwan was one of the lowest in the world. Therefore,
pandemic influenza in Taiwan did not cause more
severe influenza-related complication or mortality than
seasonal influenza and the preventive/management
measures were effective through aerosol precaution,
isolation of patients, mass immunization, early
diagnosis as well as early antiviral therapy.
The peak of ILI in 2009 was early Dec. and low
level of ILI was seen in Jan-March 2010, although
Jan-March is influenza season in Japan. Estimated
total PI patient was more than 200 thousands, which
is higher than maximum patient number of seasonal
influenza (180 thousands) in Japan. Fatality rate was
0.15 among 100,000 population and percentage of
hospitalized pregnant woman was 0.4%, and no
death among pregnant women.
These index
numbers were lowest group in the world. In the
symposium,
I
would
like
to
introduce
epidemiological situation of PI in Japan.
45
S-03
Current Immunization Issues in Japan:
Current
Situation
and
Future
Challenges
S-04
Characteristic of Dengue Disease in
Taiwan
Ching-Chuan Liu
Department of Pediatrics, College of Medicine,
National Cheng Kung University and Hospital,
Tainan City, Taiwan
Hajime Kamiya
National Institute of Infectious Diseases
Infectious Disease Surveillance Center, Japan
Taiwan’s dengue outbreaks have a unique type of
transmission: starting by import from abroad in
early summer, spreading out locally, and ending
in the winter. This pattern repeats every year.
Most of the dengue patients are adults, with
dengue fever peaking in the 50–54 year age range,
and dengue hemorrhagic fever in the 60–64 year
age range. Two patterns of dengue infection were
found: DENV-2 in 2002 with 74% of secondary
infection in contrast to non-DENV-2 (DENV-1 or
DENV-3) in 2004–2007 with ~70% of primary
infection. Secondary dengue virus infection
increases disease morbidity, but not mortality in
adults. The active serological surveillance shows
two-thirds of the dengue-infected adults are
symptomatic post infection. A comparative
analysis of clinical and laboratory data for DF,
DHF/DSS and fatal DSS found that high fatality
from dengue infection was associated with the
following patient conditions: (1) age above 55
years, (2) underlying diseases with hypertension,
chronic renal insufficiency, or diabetes, (3)
abnormal thrombocytopenia, APTT and PT
prolongation, low hematocrit (<30%) and
leukocytosis, (4) abnormal elevation of AST, ALT
and BUN. In a non-endemic area like Taiwan,
dengue should be considered as an adult
infectious disease and the dengue-infected elders
will have higher morbidity or mortality. The
Taiwanese experience of adult dengue should be
valuable for countries or areas where, although
dengue is not endemic, the Aedes aegypti vector
exists and dengue virus can be introduced by
travelers.
Immunization is one of the most effective public
health interventions available. However, how the
recommendations are established is different
around the world as well as the utilization of the
vaccine and the number of patients with vaccine
preventable diseases (VPDs).
Currently in Japan, we give routine vaccination
for 8 antigens (DTap, MR, BCG, Japanese
Encephalitis and Polio) for children. After the
pandemic of influenza A(H1N1) 2009, vaccine for
influenza became the talk of the Nation. In
addition, several new vaccines are recently
approved (Hib, PCV, HPV) and continuous debate
is ongoing related to establishment for National
Immunization Technical Advisory Group
(NITAGs).
In my presentation, I will describe Japanese
immunization system as well as current VPD
situation in Japan. In addition, I will point out
problems and future challenges of Japanese
immunization program.
46
S-05
Infections after Liver Transplantation
S-06
Current status of Community associated methicillin-resistant
Staphylococcus aureus in Taiwan, 2000s
Akihiko Saitoh
National Center for Child Health and
Development, Tokyo, Japan
Yhu-Chering Huang
Division of Pediatric Infectious Diseases, Chang
Gung Children’s Hospital and Chang Gung
Memorial Hospital at Linko, Kweishan, Taoyuan,
Taiwan
Live-donor liver transplantation (LDLT) has
become an important treatment option for some
serious pediatric liver and metabolic diseases.
Clinical outcomes have improved significantly as
a result of recent advances in surgical techniques,
newer immunosuppressives, and preventive and
treatment strategies for various infections;
however, infections after LDLT are challenging
field given their impaired immune status.
Our institution is the largest tertiary pediatric
hospital in Japan and has performed more than
120 LDLT (success rate: 91.7%) since November,
2005.
Several approaches to prevent and treat
infections have contributed to the excellent
prognosis. First, preemptive approach for CMV
infection (monitoring CMV antigenemia weekly
and gancyclovir therapy when CMV antigenemia
was positive ≥5/5X104 cells) has been successful
to control CMV diseases in children, even in the
recipients with high risk for CMV diseases.
Second, monitoring Epstein-Barr virus (EBV) by
polymerase chain reaction has been successful to
prevent
EBV-related
diseases
such
as
post-transplant lymphoproliferative disorders.
Third, active vaccination program preoperatively
and postoperatively at the Vaccine Center has
been protecting recipients from vaccine
preventable diseases.
Lastly, all recipients’
antimicrobial use has been determined by the
pediatric infectious disease specialists and an
appropriate use of perioperative and postoperative
antimicrobials has been conducted under the
antimicrobial stewardship program.
These
approaches need to be continued and updated to
protect children from various infections.
Methicillin-resistant
Staphylococcus
aureus
(MRSA) has been increasingly identified as the
major cause of community-associated (CA)
infections in previously healthy hosts since late
1990s. CA-MRSA strains were recognized as a
novel pathogen, which is genetically different
from healthcare-associated MRSA, and there
were five major epidemic clones identified
worldwide. In Taiwan, a significantly increasing
rate of MRSA carriage and infection among
healthy subjects was found in the past decade. Up
to 9.5% of healthy Taiwanese children carried
MRSA in the nares and over 50% of pediatric CA
S. aureus infections were MRSA. Adult
population were also affected, but relatively
limited. A majority of CA-MRSA isolates in
Taiwan belonged to sequence type (ST) 59 linage,
defined by multilocus sequence typing, and were
multiple resistant to non-beta-lactams. The clone
of ST59 linage can be further classified into at
least two major clones by pulsed-field gel
electrophoresis (PFGE) typing, staphylococcal
chromosomal cassette mec (SCCmec) elements
and Panton-Valentine leukocidin (PVL) genes.
The clone characterized as ST59/PFGE type
C/SCCmec IV/PVL-negative was prevalent
among the colonizing isolates whereas
ST59/PFGE type D/SCCmecVT/PVL-positive
was prevalent among the clinical isolates.
Evidence suggested that the ST59 CA-MRSA
clone was not only circulating in this island but
also in other areas of the world.
47
Abstract of Keynote Lecture
KL
Hepatitis B Virus Infection - Host and Virus Interaction
Mei-Hwei Chang
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Hepatitis B virus (HBV) infection is an important health problem world wide, particularly in Asia and
Africa where most HBV infection occurs since early childhood. Mother to infant transmission is the most
important transmission route. HBV infection during early childhood may lead to high chronicity rate,
high viral replication, and more serious consequences of long-term infection and liver injury. Our study of
the long-term natural history of HBV infection since childhood revealed that host immunity is a dominant
factor in HBV evolution. While the host immunity is feeble in young children, viral nucleotide diversity is
low and viral copy number is increased. As the disease progresses toward the immuno-clearance phase,
viral diversity increased but viral copy number is decreased. HBV mutation may occur during the natural
course spontaneously to avoid the host immune surveillance. It may also contribute to the
hepato-carcinogenesis. HBV pre-S deletion is an independent risk factor for HCC in children. Pre-S2
deletion was detected in nearly half of our children with HCC, in contrast to its absence in children with
chronic HBV infection. Integration of the HBV genome can be found in the liver cancer tissues of
children.
Spontaneous HBeAg seroconversion is an important event in the natural history of chronic HBV infection.
Positive serum HBeAg is a marker of active viral replication and infectivity. Prolonged HBeAg
sero-positivity is correlated with prolonged liver injury and higher rates of liver cirrhosis and HCC.
HBeAg seroconversion from HBeAg seropositive to anti-HBe seropositive implicates reduction of viral
replication and liver inflammation. Our long term follow-up study revealed that earlier-onset of puberty is
associated with earlier HBeAg seroconversion, higher serum ALT levels, and a greater HBV viral load
increment. Further more, IL-10 (1082 G/G) and IL-12 (10993 C/G) genotypes and higher levels of serum
IL-12 and IL-10 predicted earlier spontaneous HBeAg seroconversion.
Understanding the host and viral interaction may help to make better strategies for the control of chronic
HBV infection.
48
Abstracts of Plenary Lectures
PL1-01
Childhood Tuberculosis --- Old
Wisdom and New Challenges
(What We Can Learn From the
Natural History of Disease)
Ben Marais
Stellenbosch University, South Africa
Childhood tuberculosis (TB) remains a
neglected disease in most TB endemic areas,
since National TB Control Programmes focus
almost exclusively on adults with sputum
smear-positive disease. However, children suffer
severe TB-related morbidity and mortality in
these areas, despite the misperception that they
only develop mild forms of disease. This talk
provides an overview of well-documented
concepts
and
principles
from
the
pre-chemotherapy literature and demonstrates
how this "old wisdom" applies to current and
future challenges in the field of childhood TB.
This should provide a rational framework for
management of children with TB and also
stimulate thoughts for future scientific study.
The natural history of disease descriptions in
children identified three central concepts; 1) the
need for accurate case definitions, 2) the
importance of risk stratification, and 3) the
diverse spectrum of disease which necessitates
accurate disease classification. The relevance of
these concepts and their application to pertinent
issues such as the diagnosis of childhood
tuberculosis are discussed. The concepts are
also linked to the basic principles of TB
management. Better targeted interventions,
combined with slightly improved resources and
greatly improved political commitment, may
lead to a dramatic reduction in TB-related
morbidity and mortality amongst children.
PL1-02
HIV Vaccine: The Spring after a Long
Winter?
Robert Chen
Centers for Disease Control & Prevention (CDC),
USA
The HIV pandemic continues to take a fearful toll
worldwide. Since the beginning of the epidemic, almost
60 million people have been infected with HIV and 25
million people have died of HIV-related causes. The
last few years have seen great strides in screening and
treating HIV-infected persons worldwide. But <50% of
those in need of life saving treatment have access and for
two persons placed on treatment, five others are infected.
The need for a safe, effective, and affordable HIV
vaccine remains great -- especially as waiting lists for
HIV treatment start to form worldwide in wake of the
recession. This goal has remained elusive since HIV was
first isolated in 1983, however. Unlike other infectious
diseases where successful vaccines have been developed,
most humans do not develop effective natural immunity
to HIV and therefore we’re unable to mimic it to develop
a HIV vaccine. Per Jose Esparza, we have to be “better
than nature”.
Despite major advances in understanding of virology,
immunology, genetics, and other relevant fields during
the last decades, however, HIV continues to surprise us
and confound the “rationalist” approach. STEP, a Phase
2b adenovirus vector HIV vaccine trial sponsored by
Merck, was stopped early in 2008 by the Data Safety
Monitoring Board for futility. Subsequent analysis
suggested that vaccinees that were uncircumcised and/or
had pre-existing immunity to adenovirus were at
increased risk of acquiring HIV compared to placebo
recipients. Last year, a pleasant surprise occurred on the
opposite direction. Despite opposition from many senior
scientists in the HIV vaccine field originally, the RV144
trial in a low risk population in Thailand using
combination canarypox vector prime followed by gp120
protein vaccine boost unexpected showed a 31% efficacy
last year. While this was considered too low an efficacy
to push to licensure, it was an important proof of concept
that a protective HIV vaccine was possible. Both trials
highlight the importance of clinical trials for advancing
our scientific knowledge, a longstanding argument of the
“empiricists”. More recently, progress has also been
made in defining the 3D configuration of antibodies that
are broadly neutralizing to many HIV strains. The
results of CAPRISA 004, an anti-retroviral containing
vaginal microbicide have also just been announced (39%
efficacy) at the 2010 International AIDS conference.
This talk will provide more details on both the above
issues and how the HIV vaccine field might move
forward in the next few years.
49
PL2-01
The Threat of Influenza: The Past
and the Future
Ping-Ing Lee
Department of Pediatrics, National Taiwan
University Hospital, Taiwan
Influenza virus is a major viral respiratory
pathogen that can cause a severe illness in all
age groups. Influenza infections in children
usually present as lower respiratory tract
infections. As compared with adults, central
nervous system involvement is more common in
children. The presence of influenza-like illness
in adults with close contact is an important
diagnostic clue for children with influenza. The
pandemic 2009 H1N1 virus had a high attack
rate and a high mortality rate in children. Rapid
test for antigen detection had a high specificity
and a limited sensitivity for the diagnosis of
influenza A infection. Use of antiviral agents
may be helpful to improve the clinical outcome.
Targeted social distancing, such as class
suspension, may have only a limited effect to
control the epidemic. Mass vaccination is the
most effective measure to halt the spread of
influenza virus. Being an important vehicle for
transmission of influenza virus in the
community, children should be among the
priority populations to receive influenza
vaccines. Recent studies of influenza
vaccination in students show that vaccinating
students may be able to protect more people
from the threat of influenza through the effect of
herd immunity. However, several issues have
emerged with the implementation of mass
influenza vaccination program, including the
occurrence of mass psychogenic illness, safety
concerns, criticisms on the vaccination policy,
etc. Lessons learned form the pandemic 2009
H1N1 virus may help us to deal with the next
pandemic more effectively in the future.
PL2-02
Invasive Pneumococcal Disease in Asia
Tzou-Yien Lin
Chang Gung Children’s Hospital, Taiwan
Streptococcus pneumoniae (pneumococcus, SP) is a
major cause of invasive and noninvasive bacterial
disease worldwide, and pneumococcal diseases are
a significant public health problem globally. SP is
recognized as a common cause of illness in
developing countries, especially in Asia. We review
the epidemiology and Streptococcus pneumoniae
(SP)
serotype
distribution
of
invasive
pneumococcal disease (IPD) in children in the
Asia-Pacific region from studies published from
1999 to 2010. IPD incidence varies widely in
Asia-Pacific countries depending on the method of
surveillance, the population studied, and the time
period. Incidences are highest for younger children,
with rates near 100–200 cases per 100,000 children
aged <1 or 2 years. Incidences of preventable
disease are estimated to be 6–200 cases per 100,000.
Heptavalent pneumococcal conjugate vaccine
(PCV7) serotype coverage shows a very wide range
over the Asia-Pacific region. Ten countries have
high vaccine serotype coverage (>70%), and six
countries have low vaccine serotype coverage
(50%). PCV10 or PCV13 providing the additional
potential coverage will be required to reduce the
incidence of IPD in countries, such as Bangladesh,
India, Malaysia, Nepal, Pakistan, and Papua New
Guinea. Resistance is a significant problem for
some countries in the Asia-Pacific region. The
majority of SP serotypes in children with IPD in
most countries in the Asia-Pacific region are
susceptible to penicillin (intermediate and resistant
<50%); a few countries have SP serotypes with
high level resistance to penicillin (intermediate and
resistant >50%). Japan, Taiwan, and Thailand have
high PCV7 serotype coverage. Countries with low
pneumococcal resistance to antimicrobials have
shown increasingly higher nonsusceptibility with
time. National vaccination programmes that include
PCV7, 10-valent pneumococcal conjugate vaccine
(PCV), or 13-valent PCV would significantly
reduce the burden of penicillin-nonsusceptible IPD,
as well as IPD burden in children aged <5 years in
the Asia-Pacific region. Prevention is particularly
desirable in developing countries in this region that
lack the resources and facilities to rehabilitate
children
who
experience
significant
neurodevelopmental deficits as a result of
pneumococcal meningitis.
50
PL3-01
The Role of Probiotics in Infectious
Disease
PL3-02
Identification of New Viral Respiratory
Diseases
Gregor Reid
Lawson Health Research Institute and
University of Western Ontario, London, Canada
Albert D.M.E. Osterhaus
Department of Virology, Erasmus University
Medical Centre, The Netherlands
Over 9.5 million people, mostly children, die each
year from infectious diseases – nearly all in
developing countries. Pneumonia, diarrhea,
malaria and HIV are particularly problematic.
Infectious diseases cause disability, a diminished
quality of life, decreased productivity or death. The
rationale for use of probiotics (live microorganisms
which when administered in adequate amounts
confer a health benefit on the host) is threefold.
A. We are running out of pharmaceutical
options and microbial resistance is mounting.
B. The preference from a human perspective,
and economical, is for disease to be prevented, and
ideally using non-toxic, non-chemical means.
C. Microbes have lived together for millions
of years, and they may be better at counteracting
each other than man-made chemicals.
The clinical evidence to date indicates that
probiotics can counter infectious diseases directly
in the mouth, stomach, intestine, and vagina, and
indirectly in the respiratory tract, bloodstream and
urinary tract. Modes of action include direct
interference with pathogens and their virulence
factors; modulation of immunity to better fight
infection; lowering the risk of infection through
changing the microbiota-host interface; and
reducing side-effects and improving efficacy of
antimicrobial agents.
In order for this area to progress, five key
factors need to be addressed.
1. Only products formulated and clinically
proven to provide a benefit to the host should be
termed probiotic. This requires government and
industry legislation and commitment.
2. Companies making false claims should be
penalized and products removed from the market.
3. Well-designed and sized clinical trials
must be funded by government and industry, and
carried out to document success. Studies that
compare different products could be valuable.
4. Products proven to provide benefits,
should be permitted to have wording to this effect
on their label, even if it currently falls outside the
traditional food-supplement-drug policies.
5. Education programs need to be developed
for schools, and for medical and science programs,
so as to develop a core knowledge and expertise
that allows integration of probiotics, microbiota
and nutrition into personal health management.
Acute respiratory viruses are a major cause of
morbidity and mortality in humans and most acute
respiratory infections are primarily caused by
viruses. Many of these viruses cause the highest
burden of disease in specific risk groups such as
young
infants,
the
elderly,
and
immune-compromised individuals. Although the
most important respiratory viruses of humans have
been identified in the last century, in the last decade
about a dozen “new” viruses have been discovered
that may cause a high burden of disease in humans.
Not only viruses were discovered that must have
been with humans for decades or centuries, such as
human metapneumovirus and two new human
coronaviruses, but also viruses that have recently
emerged as a result of interspecies transmissions
from avian or mammalian reservoirs. The latter
include avian influenza viruses, SARS coronavirus,
and Nipah virus. The discovery of new human
respiratory viruses, their etiologic role, the burden
of disease they cause and the development of
intervention strategies will be discussed.
51
PL4-01
Unmet Challenges in Pneumococcal
Conjugate Vaccines
PL4-02
Genetic Susceptibility to Infectious
Diseases
Ron Dagan
Pediatric Infectious Disease Unit, Soroka
University Medical Center and the Faculty of
Health Sciences, Ben-Gurion University of the
Negev, Beer-Sheva, Israel
Chiea Chuen Khor
Genome Institute of Singapore, Singapore
Until recently, the 7-valent pneumococcal
conjugate vaccine (PCV7) has proved to be a
great vaccine with an impressive effectiveness
against multiple outcomes of pneumococcal
disease. This included invasive pneumococcal
diseases (IPD), pneumonia and otitis media.
Furthermore, the reduction of nasopharyngeal
carriage of the PCV7 serotypes resulted in the
reduction of transmission of these serotypes, and
thus, in the reduction in disease in contacts,
including non-vaccinated individuals of all ages
(termed “herd immunity”). In addition, some
of the most antibiotic-resistant pneumococcal
serotypes could be reduced or eliminated by
PCV7. However, important needs are still
unmet, and thus it is important to test whether
the new generation extended spectrum PCVs
(PCV10 and PCV13) can improve overall
effectiveness against pneumococcal diseases.
Several entities and conditions have shown
less-than-expected effectiveness with PCV7.
Pleuropneumonia has been found to be
universally caused mainly by serotypes 1, 3, 5,
7F, 14 and 19A (of which only serotype 14 is a
PCV7 serotype). Furthermore, pneumonia in
general, mainly in older children, is often caused
by serotypes not included in PCV7. In otitis
media, serotypes such as 3, 6A and 19A are
important. In addition, extensive antibiotic use
has resulted in increased pressure and promotion
of several antibiotic-nonsusceptible non-PCV7
serotypes, mainly 19A, but also 15 B/C. 35B,
6C and more. Thus, the combined pressure by
antibiotic use on the one hand, and some
replacement in nasopharyngeal carriage by
PCV7 on the other hand, has resulted in
increased carriage of and disease from some
strains such as serotype 19A, 6C and a few
others.
Understanding the dynamics in
pneumococcal carriage and disease, together
with extensive variation with the new generation
extended-spectrum vaccines on the one hand
and reducing antibiotic pressure on the other
hand, need to be emphasized to contribute to the
success of reducing pneumococcal disease in
children.
Large-scale
genetic
studies,
particularly
genome-wide association studies in infectious
diseases have been lagging behind that of other
complex disease phenotypes such as diabetes,
malignancies,
and
autoimmune
diseases.
Furthermore,
these
comprehensive
genetic
approaches have only begun to be deployed in the
Asian context relatively recently (2008-2009
onwards) compared to Western cohorts, which have
pioneered the GWAS approach since 2005. Here, I
will attempt to discuss the common infectious
etiologies plaguing both Asia and the world,
focusing on examples such as meningococcal sepsis,
dengue, and Kawasaki disease. Data on a
genome-wide scale is now being obtained for these
conditions and robust, reproducible disease
associations are beginning to emerge.
52
Abstract of Simultaneous Symposia
SS1-01
Overview of Pneumococcal Disease in
the Asia Pacific
SS1-02
Pneumococcal Disease and Flu
Pandemics
Lulu Bravo
National Institutes of Health, University of the
Philippines, Manila, Philipines
Ping-Ing Lee
Department of Pediatrics, National Taiwan
University Hospital, Taipei, Taiwan
Data on pneumococcal disease burden was
collected by members of the Asian Strategic
Alliance for Pneumococcal Disease Prevention
(ASAP) and was collated for publication and
presentation.It
was
confirmed
that
pneumococcal disease is an important cause of
morbidity and mortality in the Asian region.
Case Fatality rates range from about 6 to 24%
from the countries of India, Indonesia,
Singapore and Taiwan. WHO reports that among
the countries with the biggest number of
pneumonia cases, 6 are in Asia, India, China,
Indonesia, Pakistan,Bangladesh and Philippines.
It is also reported that Strep pneumonia is
identified as the leading pathogen for
pneumonia causing deaths in children below 5
years of age.
Streptococcus pneumoniae is a major cause of
morbidity and mortality among children. The
seasonal nature of invasive pneumococcal disease
has been well recognized and the disease activity
peaks in the colder months. Such a phenomenon
may be related to increased activity of respiratory
viruses, especially influenza virus. Animal
experiments showed that the influenza virus
infection may make the respiratory epithelial cells
more susceptible to pneumococcal invasion.
The high antimicrobial resistance of S
pneumonia in Asia contributes to both the
treatment and economic burden caused by
invasive pneumococcal disease.Korea, Taiwan
and Thailand have consistently shown high rates
of penicillin resistance as shown by the
ANSORP studies.The judicious use of
antibiotics and inclusion of pneumococcal
conjugate vaccine in national immunization
program would lead to a substantial reduction in
incidence of IPD with a projected 260,000
deaths prevented annually in Asia alone. With
development of herd protection, not only
children but adults and elderly stand to benefit
from
pneumococcal
vaccination.
More
substantial and specific studies with continued
surveillance are being recommended by the
ASAP members in order to develop strategies
for control of pneumococcal disease.
Evidences showed that pneumococcal infection
played a major role in the 1918 influenza pandemic.
Culturable pneumococci could be found in the
peripheral blood from both the survivors and the
victims of pandemic influenza. About one thirds of
deaths during the 1918 pandemic occurred more
than 2 weeks after the onset of symptoms. These
data suggest that S. pneumoniae caused a
substantial fraction of morbidity and mortalligy
during the pandemic. Recent studies also showed
that severe pandemic 2009 H1N1 virus infections
were also frequently associated with S. pneumoniae
infection.
The preparedness plan for pandemic influenza
should take into consideration the contribution of S.
pneumoniae to morbidity and mortality. Practical
measures
should
include
the
conjugate
pneumococcal vaccination in children and
provision of pneumococcal polysaccharide vaccine
to adults.
53
SS1-03
Treatment and Antibiotic-Resistance
Patterns of Pneumococcal Disease
SS2-01
An Update on Prophylaxis of Invasive
Fungal Infection in Pediatric Patients
Somsak Lolekha
Pediatric Society of Thailand, Bangkok,
Thailand
Hoan-Jong Lee
Seoul National University College of Medicine,
Korea
More than half of Streptococcus pneumoniae isolated
in Asian countries were not susceptible to 0.06
mcg/ml of penicillin. The common serotypes of
penicillin-non-susceptible S. pneumoniae in Asian
countries were 23F, 19F, 6B, and 14 which were
included in the pneumococcal conjugate vaccine. The
most significant risk factor for acquisition of
penicillin-resistant Streptococcus pneumoniae was
previous or recent antibiotic use. The percentage of
penicillin and macrolide resistant S. pneumoniae
varied from country to country. In 2008, Clinical and
Laboratory Standards Institute has changed criteria
for susceptible, intermediate and resistant MIC for
penicillin were <0.06, 0.12-1 and >2 mcg/ml for all
pneumococcal isolates to new criteria which depends
on the site of infection either meningeal or
nonmeningeal infections. Gradually increased in MIC
of S. pneumoniae to penicillin and macrolides are
observed in most countries that pneumococcal
conjugate vaccine has not been widely used. For
patients with meningitis whose organism is
nonsusceptible to penicillin, cefotaxime, ceftriaxone,
susceptibility testing of vancomycin and rifampicin
should be performed. For nonmeningeal infection
caused by nonsusceptible to penicillin, cefotaxime
and ceftriaxone, susceptibility testing to clindamycin,
erythromycin,
trimetroprim-sulfamethoxazole,
chloramphenicol,
linezolid,
meropenem
and
vancomycin should be considered. Treatment for
bacterial meningitis possibly or proven to be caused
by S. pneumoniae should be the combination of
vancomycin and cefotaxime or ceftriaxone as an
initial therapy until susceptibility of the organism is
known. For children with hypersensitivity to beta
lactam antibiotics, the combination of vancomycin
and rifampicin should be considered. For
nonmeningeal pneumococcal infection in previously
well children who are not critically ill, high dose of
penicillin or amoxicillin can be used as an initial
therapy. If pneumococcal conjugate vaccine is widely
used in Asian children, the morbidity and mortality
from invasive pneumococcal infection will be greatly
reduced. We can avoid using expensive antibiotics for
drug resistant S. pneumoniae, reduce the use of
antibiotics and decrease the prevalence of
drug-resistant S. pneumoniae in Asian countries.
Invasive fungal infection (IFI) is a serious condition in
pediatric patients. Increasing number of patients are at
risk for IFI due to advancement of intensive treatment
modality for higher risk diseases. Increased risk for IFI in
infants and children include conditions such as prolonged
neutropenia due to cancer treatment, hematopoietic stem
cell transplantation (HCT), solid organ transplantation,
being very low birth weight (VLBW) infants, certain
primary immunodeficiencies (PIDs), and HIV infection.
IFI causes higher morbidity and mortality either due to
fungal infection itself and/or deterioration of primary
condition. IFI is difficult to diagnose and treat. Therefore,
antifungal prophylaxis for these patients is a topic of
interest. Antifungal prophylaxis and therapy is a rapidly
evolving field with newer antifungal agents.
HCT: Antifungal drugs are administered prophylactically
in patients with increased risk for IFIs. Guidelines are
continuously updated with more information from recent
studies with newer agents. While some information can
be used equally as in adult population or extrapolated
from adult studies, there are fewer data in pediatric
population with newer agents. For children at standard
risk for fungal infections, fluconazole is the drug of
choice as a recommended prophylaxis agent against
invasive yeast infection. These include allogeneic HCT
recipients and certain autologous HCT recipients who
have or will have prolonged neutropenia and mucosal
damage, graft manipulation, or who have received purine
analogues within 6 months. Risk of mold infection is
increased in HCT recipients with prolonged neutropenia
and recipients with severe GVHD. These conditions
include bone marrow recipients, umbilical cord recipients,
patients with aplastic anemia, having unrelated donor,
mismatched transplant, and having haploidentical donor.
Micafungin and posaconazole are recommended as the
first choice for prophylaxis in the setting of prolonged
neutropenia and GVHD, respectively, in adults. In
children, voriconazole can be considered in the setting of
severe GVHD as an alternative. In addition, patients with
prior invasive aspergillosis can be candidates for
secondary
prophylaxis
during
subsequent
immunosuppressive therapy.
VLBW infants: Invasive fungal infection is an important
cause of mortality and morbidity in VLBW infants. A
recent meta-analysis showed a statistically significant
reduction in the risk of IFI in the fluconazole prophylaxis
group [typical relative risk: 0.23 (95% confidence
interval 0.11, 0.46)] without significant difference in the
risk of death.
54
SS2-02
Advance in Diagnosis and Treatments of
Invasive Fungal Disease in Pediatric
Hematology Oncology
Theoklis Zaoutis
Divison of Infectious Diseases, The Children’s
Hospital of Philadelphia, USA
PIDs: Patients with chronic granulomatous disease
(CGD) or hyper-IgE syndrome have increased risk for
lung infection due to Aspergillus. Patients with
defects in the IL-12/IFN-gamma axis are also found
to have higher risk for endemic mycosis. Guidelines
for antifungal prophylaxis in patients with PIDs are
not solidified. However many experts use
itraconazole prophylaxis in CGD patients as a part of
their routine care since itraconzaole prophylaxis
showed marked efficacy in a placebo-controlled
cross-over study. Certain conditions of hyper-IgE
patients can be considered for antifungal prophylaxis.
IFI is a great health threat to infants and children with
immunocompromised conditions. New chapters are
continuously opening in the field of IFI management.
Prophylaxis is an important and effective option for
high risk patients. More data are needed in each
pediatric clinical setting.
The presentation will provide data on the
epidemiology and risk factors for invasive fungal
infections (IFI) in pediatric hematology oncology
patients. The presentation will focus on candidiasis
and aspergillosis, the most common IFI in this
population. Less common causes of IFI in this
population (e.g., zygomycosis) will be discussed
briefly. Data on the utility of various diagnostic
modalities for IFI will be presented including
radiologic techniques (e.g., CT scans) with the
emphasis on newer non-invasive technologies such
as the galactomannan and beta-glucan assays. The
test characteristics, sensitivity and specificity, of
these assays in the pediatric population will be
presented. Finally, a review of the data regarding
newer antifungals and their role in the pre-emptive,
prophylaxis, and therapy of IFI in pediatric
hematology oncology patients will be presented.
55
SS2-03
Diagnosis & Treatment Strategies of
IA in Pediatric Patients
William J. Steinbach
Division of Pediatric Infectious Diseases,
Department of Pediatrics,Duke University, USA
Invasive aspergillosis (IA) remains a complicated
infectious disease. IA suffers from the shortcoming
that there is no easy diagnostic methodology for
either accuracy or timeliness.
For years, the
mainstay was imaging, but now twice weekly
screening with serum galactomannan (GM) offers
earlier and non-invasive diagnostic options. It was
initially thought that the GM assay was not useful in
children due to an unacceptably elevated
false-positive rate, but two more recent studies have
shown that it works well in pediatric patients. The
therapeutic mainstay for IA has historically been
amphotericin B deoxycholate, but over the last decade
there have been substantial advances in antifungal
therapy. In 2002, a large trial showed a clear
response benefit for voriconazole vs. AmB against IA
and a subsequent analysis of other licensed therapy
used in that trial proved that for this disease the
triazole therapy, especially when utilized first, was
best. The recent Infectious Diseases Society of
America guidelines highlight the importance of
initiating therapy with a triazole antifungal. One
key question surrounds the optimal therapy for
recalcitrant disease if this initial agent fails, termed
“salvage therapy.” Here, firm data are sparse, and
options include switching antifungal classes (such as
an echinocandin or an amphotericin B-based agent),
or combination therapy with drugs active against
multiple cellular targets. While the debate here
rages forward, what is very clear is the importance of
immune reconstitution.
Recovery of immune
function, through decreased immunosuppression
coupled with administration of exogenous stimulating
factors or possibly donated granulocytes, is key to
disease resolution.
While voriconazole is the
treatment of choice for IA, the pharmacokinetics of
voriconazole in children are fundamentally different
than in adult patients. In adults the dosing is
non-linear, while in pediatric patients it is linear and
therefore larger doses are required to achieve similar
serum concentrations.
The optimal dosing for
children is to begin with 7 mg/kg/dose twice daily,
but even that may not be an appropriate amount for a
specific patient. Much has been written regarding
the utility of therapeutic drug monitoring (serum
levels) of voriconazole in the management of IA, but
these are neither as straight-forward nor as
well-studied as aminoglycoside levels. However,
they do have a role in complicated patients.
SS3-02
Infection with Streptococcus
Dysgalactiae Subsp. Equisimilis:
Children- and Asia- Relevant Issues
Takashi Takahashi
Laboratory of Infectious Diseases, Graduate
School of Infection Control Sciences, Kitasato
University, Tokyo, Japan
Among
clinically
isolated
гЂЂ-hemolytic
streptococci, Streptococcus pyogenes and S.
agalactiae were considered the main pathogens in
humans until recently. In 1996, S. dysgalactiae
subsp. equisimilis (SDSE) was proposed as a novel
taxon among human-derived streptococcal isolates.
SDSE has Lancefield group C or G antigens (rarely
A antigen), exhibits strong гЂЂ-hemolysis, and exerts
streptokinase activity upon human plasminogen and
proteolytic activity upon human fibrin. Similarly to
group A streptococci, SDSE possesses virulence
factors including M protein, streptolysin O,
streptolysin S, streptokinase, hyaluronidase, C5a
peptidase, and others. SDSE may exist among the
normal flora of skin, oropharynx, and
gastrointestinal and genitourinary tracts. In the 21st
century, invasive SDSE infection (i.e., cellulitis,
urosepsis, and pneumonia) leading to varied
disseminated diseases is being diagnosed
increasingly in Japan, elsewhere in Asia, Europe,
and America. These invasive diseases are
encountered increasingly in hospital emergency
departments. Analysis of the part of the emm gene
encoding the amino acid sequence at the N-terminal
end of the M protein is used to determine the
molecular epidemiology of SDSE. Distribution of
the emm types from patients with invasive or
non-invasive
infections
differs
between
surveillance results from different countries. This
presentation focuses on children- and Asia- relevant
issues regarding SDSE infection.
56
SS3-03
The Changes of Clone, Susceptibility
and Macrolide Resistance
Mechanisms in GAS from Chinese
Children over a 16-year Period, a
Report from Mainland of China
Xuzhuang Shen
Beijing Children's Hospita, Beijing, China
To investigate the change in the epidemiologyпјЊ
characteristicsпјЊantimicrobial susceptibility and
resistant mechanisms of Streptococcus pyogenes
isolates over a 16–year period. Group A
streptococci(GAS) isolates were collected from
Chinese pediatric patients among 1993-1994
and 2005-2008. The emm types and the eight
super-antigens
(SAg)
genes
were
preformed .Susceptibilities to antibiotics were
performed using agar dilution methods. The
macrolide resistance genes ermB, ermTR, mefA
and tetracycline resistant gene tetM and the int
and xis genes of Tn916 family were detected.
This study demonstrated that emm1 and emm12
were consistently the prevalent types during the
two periods, while variations in the frequencies
of the other types were noted. The SAg gene
profiles were closely associated with the emm
type, and the same emm type strains could carry
different SAg gene profiles. The GAS isolates
carried six SAg genes or more than six SAg
genes
increased
from
1993-1994
to
2005-2008.The resistance rates of erythromycin
and clindamycin both significantly increased
during the two sample periods. Among the
macrolide resistance strains, the rate of strains
with the genes int, xis, tetM and ermB increased
with time. The emm1 and emm12 isolates had
high rates of ermB gene, which increased after
16 years. In addition, no significant differences
in emm-type distribution and SAg gene profile
were noted between the isolates obtained from
different diseases. This study demonstrates the
increase in macrolide resistance in S. pyogenes
in Chinese children over a 16-year period. The
phenomenon may not only be related with the
shift in the emm types, but also with the change
of macrolide resistant mechanisms. The change
of Tn916 family among the isolates may be
related with the increased resistance.
SS4-01
Community Associated MRSA Epidemiology and Consequence for
Containment of MRSA
Robert Skov
Staten Serum Institute, Copenhagen, Denmark
The worldwide emergence of community-associated
methicillin-resistant Staphylococcus aureus (CA-MRSA)
during the last decade represents a significant change in
the biology of MRSA strains.
CA-MRSA strains is distinct from traditional health care
associated MRSA (HA-MRSA strains), they carry the
small SCCmec IV and V and appear to have less/no cost
of fitness compared to sensitive S. aureus. This promotes
carriage in the community including in otherwise healthy
persons and thereby increasing the possibility to
transmission especially to close contacts. CA-MRSA
affects children and young adults much more frequently
than HA-MRSA and children is probably an important
factor in the transmission of CA-MRSA.
Most CA-MRSA lineages are PVL positive and
associated with skin and soft tissue infections. These
infections quite often require surgery/incision and or
systemic treatment even in otherwise healthy children. In
addition CA-MRSA strains increasingly causes health
care acquired infections including surgical site infections,
ventilator associated pneumonia and bacteraemia.
The perspective of an increased prevalence of MRSA
build in the community including in people without
traditional risk factors for MRSA, is that this lead to
introduction into hospitals through patients colonised
with MRSA, but not identified on admission. In hospitals
this may lead to development of infections in the patient
itself or transmission of the MRSA to other patients or
health care workers. Thus “today's CA-MRSA may
become tomorrow’s HA-MRSA” as have been
experienced in USA. This is supported by mathematical
modelling which indicate that spread of MRSA in the
community may impair or even render control of MRSA
in hospitals impossible.
The new and potentially very large reservoir of MRSA in
production animals with subsequent transmission to
humans represents at this time primarily a problem for
people working with MRSA positive livestock and their
families. However, this creates an enormous pool of
MRSA which can be donors of the mecA gene to
“human” MSSAs or it may itself be humanized and thus
spread from person to person and thus become a serious
threat to the control of MRSA.
In conclusion, CA-MRSA cause disease even in
otherwise healthy children as well as is a threat for
control for MRSA in genera. CA-MRSA should therefore
be taken seriously and countermeasures to prevent the
dissemination of CA-MRSA should be taken.
57
SS4-02
MRSA in Asian Countries: Current
Epidemiology and Treatment Issues
SS4-03
Panton-Valentine Leukocidin and other
Staphylococcal Toxins
Doo-Ryeon Chung
Samsung Medical Center, Sungkyunkwan
University School of Medicine, Korea
Graeme R Nimmo
Microbiology Department, Queensland Health
Pathology Service, Brisbane, Australia
Methicillin-resistant Staphylococcus aureus (MRSA)
has become endemic in many hospitals worldwide
and has been a major pathogen responsible for
nosocomial infections. Especially, Asian region has
been an area where the rate of methicillin resistance
of S. aureus isolates from hospitals is the highest in
the world, and treatment of MRSA infections has
been a major challenge. Sequence type 239 (ST239),
which is multi-drug resistant, has accounted for the
majority of HA-MRSA in many Asian countries
including China, Taiwan, Hong Kong, Thailand,
Philippines, Vietnam, Indonesia, India, and Sri Lanka.
ST5 is an important nosocomial pathogen in Japan
and Korea. Recently, these hospital strains have been
spreading into the communities and have increasingly
caused community-onset infections. In addition,
various strains of CA-MRSA have emerged in Asian
countries during the last few years, and have been
changing an epidemiology of S. aureus infections.
Staphylococcus aureus is one of the commonest
causes of bacterial disease in children and is
responsible for a variety of infections. It produces an
impressive variety of toxins, some of which are
associated with specific clinical syndromes and some
whose contribution to pathogenesis is less certain.
Some protein toxins produced by S. aureus behave as
superantigens. These include exfoliatins A and B
responsible for scalded skin syndrome, toxic-shock
toxin-1 responsible for toxic shock syndrome, and the
large family of staphylococcal enterotoxins
responsible for food poison and also toxic shock
syndrome. The toxin genes form part of the variable
genome and tend to be clonally distributed. The
superantigens activate T cells by binding to the Major
Histocompatibility Complex Class II of antigen
presenting cells and to the T cell Receptor, thus
releasing chemokines and proinflamatory cytokines.
Recently, the emergence of virulent strains of MRSA
in the community causing frequent furunculosis and
less frequent life-threatening invasive disease such as
necrotising pneumonia has focused attention on the
role of toxins in the pathogenesis of these infections.
Panton-Valentine leukocidin (PVL), a two component
toxin that causes lysis or apoptosis of leukocytes, has
attracted attention as a possible cause of virulence.
While
it
is
not
commonly
present
in
methicillin-susceptible S. aureus clones, in
healthcare-associated
MRSA
or
in
some
community-associated MRSA (CA-MRSA) clones, it
is almost invariably found in the epidemic clones of
CA- MRSA causing the above infections. The
age-distribution of infection due to PVL-positive
CA-MRSA is strikingly different from PVL-negative
CA-MRSA and from healthcare-associated MRSA, as
it occurs predominantly in children and your adults.
Due to conflicting evidence from clinical studies and
animal models, including those in mice, rabbits and
non-human primates, the role of PVL, particularly in
necrotising pneumonia, has been controversial.
Leukocytes of mice are less sensitive to PVL than
those of primates and rabbits and this appears to
explain, at least in part, the lack of consistency of
results of various studies. Other cytolytic toxins,
namely О±-haemolysin and phenol-soluble modulins,
have also been implicated in CA-MRSA infection as
have other virulence factors.
New strains of MRSA emerged in the community
setting that caused infections in healthy persons
without any exposure to the health care setting.
Unlike HA-MRSA strains, CA-MRSA strains are
SCCmec type IV or V, and usually susceptible to
non-beta-lactam agents. In contrast that ST8 has
spread in North America and ST80 has spread in
European countries, distinct strains of CA-MRSA
have
been
reported
in
Asian
countries.
ST59-MRSA-IV is the most prevalent in China,
Taiwan, and Hong Kong, ST30-MRSA-IV in
Philippines, and ST72-MRSA-IVA in South Korea.
Similar to USA300 clone, which has been infiltrating
hospitals and replacing the traditional HA-MRSA
strains in North America, CA-MRSA strains in Asia
also have transmitted into the hospitals.
A recent emergence and spread of CA-MRSA as well
as frequent transmission of CA-MRSA and
HA-MRSA strains between community and hospitals
has become a big public health threat in Asian
countries. Continuous efforts to understand the
changing epidemiology of S. aureus infection are
necessary for appropriate antimicrobial treatment.
Furthermore, more effective control of the spread of
MRSA should be addressed.
58
SS4-04
New Antibiotics for
Methicillin-Resistant Staphylococcus
aureus (MRSA) Infections
Ian M. Gould
NHS Grampian, Scotland, UK
The glycopeptide antibiotics, while still regarded
as the gold standard agents for the treatment of
MRSA infections, have serious problems. These
include poor innate activity, increasing resistance,
laboratory testing issues and toxicity. Clinical
treatment failures are increasingly reported while
their widespread clinical use inevitability results in
inappropriate treatment of methicillin sensitive
Staphylococcus aureus (MSSA) infections with
glycopeptides. This has long been accepted as
suboptimal.
Hence the need for new drugs, both to treat MRSA
and also, at the same time, adequately cover
MSSA. Two agents have become available in the
past 5 years. The first is linezolid, a new class of
bacteriostatic
agents,
the
oxazolidinones.
Available in both intravenous and oral forms, with
excellent bioavailability, this drug has become first
line for MRSA pneumonia and is also appropriate
for bone and joint infection and Skin and Soft
Tissue Infection (SSTI). Unfortunately, myelo
and neurotoxicity makes prolonged use risky.
The second agent daptomycin, a lipoglycopeptide
but a highly bactericidal drug unlike vancomycin
and teicoplanin, has become first line for MRSA
bacteraemia and endocarditis and is also indicated
for SSTI and bone and joint infection. It is not
nephrotoxic but does have potential for muscle
toxicity and is contraindicated in pneumonia due to
binding to surfactant. Both drugs are probably
equivalent to semi synthetic penicillins for MSSA.
Many other new MRSA drugs have been
investigated in phase II and III trials, including
glycopeptide type drugs orativancin, televancin,
dalbavancin, cephalosporins such as ceftibiprole
and ceftaroline, trimethoprim analogue iclaprim
and other oxazalidinones but the only agents likely
to become widely available in the foreseeable
future are televancin and ceftaroline. Televancin
is again highly bactericidal but may have prolems
of nephrotoxicity. Ceftaroline, a ОІ lactam, may
have rapid emergence of resistance due to further
modification of penicillin binding proteins.Both
linezolid and daptomycin should be used carefully
in appropriate dosage as resistance is already
emerging. In the case of linezolid there is
plasmid mediated resistance, linked to resistance to
pleuromutilins, a new class of topical agent that
may be appropriate for MRSA decolonization.
SS5-01
Molecular Epidemiology
Virus in Asia
of
Dengue
Pei-Yun Shu
Centers for Disease Control, Department of Health,
Taiwan
Dengue viruses are the most prevalent arboviruses in
tropical and subtropical regions of the world. With the
worldwide increase in travel, the rapid expansion of
DENV strains to different parts of the world has been
well documented. In this study, we presented our
surveillance results on imported and indigenous dengue
cases in Taiwan.
During 2003-2009, a total of 973 imported dengue cases
were identified. Among them, 472 cases were identified
by fever screening at airports. The travelers were infected
in 19 countries in Southeast Asia, Indian subcontinent,
East African islands, South Pacific islands and Central
America. Phylogenetic analyses were conducted to
examine imported DENV strains introduced from 16
countries. DENV stains circulated in these countries.
Further analyses showed that the genotype distribution of
epidemic DENV strains in Southeast Asian countries can
be divided into two geographic regions. The northern
region contains countries including Vietnam, Thailand,
Cambodia, and Myanmar, and the southern region
contains countries including Indonesia, the Philippines,
Malaysia, and Singapore. The DENV strains circulated in
each of these two regions usually locate in closely related
clades in the same genotypes, suggesting close genetic
relationship and frequent flow of viruses in these
countries.
However, discordant genotype distribution were observed,
such as DENV-1 genotype I strains in Indonesia,
Malaysia and Singapore and DENV-4 genotype I strains
in the Philippines, suggesting multiple introductions and
expansion of epidemic strain resulting genotype
co-circulation or shift in some of these countries.
Although the geographic distributions of genotypes of
DENV-3 isolated from Southeast Asian countries remain
unchanged, the introductions and local expansions of
epidemic DENV-1, DENV-2 and DENV-4 strains into
new areas in Asia were observed. These findings
highlight the importance to strengthen laboratory based
dengue surveillance for better understanding of
transmission dynamics and molecular evolution of
DENVs.
The DENV strains isolated from imported and
indigenous cases in Taiwan and the establishment of a
DENV genomic database may provide essential
information of global expansion and genetic evolution
useful for disease surveillance, laboratory diagnosis,
pathogenesis investigation, and vaccine development.
Understanding the epidemiological situations of the
diseases and the phenotypic and genotypic characteristics
of viruses contributes to the development of new
strategies for control and prevention.
59
SS5-02
Immunopathogenesis in Dengue
Disease
Huan-Yao Lei
Department of Microbiology & Immunology,
College of Medicine, National Cheng Kung
University, Tainan, Taiwan
Dengue virus infection causes a broad spectrum
of disease from mild dengue fever (DF) to
severe dengue hemorrhagic fever (DHF). The
progression from DF into DHF is not
predictable and the treatment is limited, with
only supportive care of fluid supplement. No
commercial licensed dengue vaccines are
available yet. Taiwan dengue outbreaks have
their own unique transmission process, starting
with imported cases from abroad, then spreading
out locally, followed by the outbreak ending in
the winter. This pattern repeats every year. The
epidemiology in Taiwan is also different from
that in Southeast Asia. Most of dengue patient in
Taiwan are adult with the peak of age 50 while
dengue is a children disease in Southeast Asia.
Several issues will be addressed in this talk. The
antibody-dependent enhancement theory plays a
central role in the dengue disease. The
enhancing antibody can be either anti-prM or
anti-E antibody. For anti-E Ab-mediated
enhancement on monocytic cells, it can be
concentration-dependent:
enhancing
at
sub-neutralization level or enhance regardless of
concentration by Fc and FcR interaction. For
anti-prM
Ab-mediated
enhancement,
it
enhanced the dengue virion binding on both FcR
or non-FcR bearing cells with dual specificity.
Dengue virus infection can induce autoantibody
production, a molecular mimicry exist between
dengue virus proteins and self antigens such as
platelet and endothelial cells. The anti-dengue
antibodies seem to be either enhancing antibody
or the pathogenic antibody, and play a major
role in the DHF pathogenesis. A hypothesis of
transient hemophagocytic activity is proposed to
participate in the inflammatory disease process
of DHF/DSS and contribute to the high fatality
of the elderly dengue infected patients with
other underlying diseases.
SS5-03
Fluid Management in Dengue
Nguyen Thanh Hung
Children’s Hospital, Ho Chi Minh City, Vietnam
Dengue is a serious public health problem worldwide.
Dengue hemorrhagic fever (DHF)/ dengue shock
syndrome (DSS) are severe forms of dengue virus
infections. The main feature of DHF/DSS is an increase
in vascular permeability in the critical/leakage phase
resulting in plasma leakage of fluid from the
intravascular compartment to the extravascular space. In
less severe cases (nonshock DHF) plasma leakage is mild
to moderate, and patients will recover spontaneously or
shortly after intravenous fluid administration. In more
severe cases (DSS), when plasma loss is critical,
hypovolemic shock ensues and can progress rapidly to
profound shock. The patient in shock may die within 1224 hours if appropriate treatment is not promptly
administered. Volume replacement is the mainstay of
treatment of DSS. In this report the basic management
for DSS will be reviewed, with particular emphasis on
fluid therapy.
Early detection of shock, proper treatment and careful
monitoring are vitally important. DSS patients should be
admitted immediately to an emergency/ intensive care
ward. Prompt and adequate fluid resuscitation is the basic
treatment for DSS. The recommended regimen for the
treatment of DSS patients is as follows: a/ Immediate and
rapid replacement of the plasma loss with electrolyte or,
in case of profound shock, colloid solutions; b/
Continued replacement of further plasma losses to
maintain effective circulation for 24 - 48 hours; c/
Correction of metabolic and electrolyte disturbances; and
blood transfusion – only to cases with severe bleeding.
The majority of children with DSS can be treated
successfully with isotonic crystalloid solutions. If a
colloid is judged to be necessary a medium molecular
weight preparation which combines good initial plasma
volume support with good intravascular persistence and
an acceptable side effect profile is probably the
preparation of choice.
With the improvement of case management of DSS
patients, the case fatality rate of DHF has been reduced
significantly during the last 20 years. However, there are
some questions related to dengue management which
need to be clarified: whether early fluid therapy will
reduce severity of shock; whether early treatment with a
colloid confers a true advantage in those with severe
shock; and which colloid solution is most effective for
resuscitation in DSS patients?
60
SS5-04
Dengue: From Disease to Vaccination
RГ©my TEYSSOU
Travel and Endemic Vaccines Franchise – GMA,
Paris, France
Dengue virus infects 230 million individuals per year,
2 million of whom develop severe hemorrhagic
symptoms. The availability of a safe and effective
vaccine would be of substantial benefit to public
health. Efforts to develop a dengue vaccine started in
the 1920’s and numerous approaches have been
considered. Today, the most advanced vaccine
candidate—a tetravalent, live attenuated,
YF17D-based recombinant dengue virus vaccine—is
being evaluated for efficacy in a clinical trial in
Thailand and first results are expected in 2012.
The challenges of developing a successful vaccine are
multiple (including the absence of animal models and
immunological correlates of protection, the need for
long-term protection against the four distinct
pathogenic viral serotypes, and the need to
demonstrate clinical protection in large-scale trials),
but the challenges do not stop there. Indeed, vaccine
licensure of is just the first step to protecting
populations at risk. We must also ensure the
accessibility of the vaccine for the populations living
in endemic regions. It is thus necessary to identify
and overcome numerous geographic, epidemiologic,
economic, regulatory and logistical barriers.
Complete and accurate dengue epidemiological data,
which are critical to determining vaccination
cost-effectiveness and thus the desirability of
introducing dengue vaccination into immunization
programs, are presently lacking in many countries. As
the epidemiology may differ between regions
according to geography, vaccination programs may
need to be tailored to regional and national
specificities. Furthermore, the feasibility and impact
of introducing dengue immunization into existing
national programs must be evaluated.
SS6-01
Global Trends and Challenges in
Vaccine Safety
Robert Chen
Centers for Disease Control & Prevention (CDC),
USA
Given few vaccine-preventable disease (VPD) are
eradicable, continued immunization of new birth
cohorts will be needed indefinitely. Whenever
immunization programs “mature” with high
immunization rates and successfully reduce the
incidence of their target VPD’s, however, adverse
events following immunizations (AEFI’s) become
relatively more prominent. AEFI’s can be either
caused by the vaccine or purely coincidental.
Such vaccine safety concerns — if not properly
studied and managed — can destabilize
immunization programs and result in resurgence of
the VPD. This has been a lesson that several
countries have painfully experience: whole cell
pertussis vaccine in Japan, Sweden, United
Kingdom in the 1970’s, measles-containing vaccine
in the United Kingdom in the 1990’s, hepatitis B
vaccine in France in the 1990’s, and H1N1 vaccine
in Taiwan in 2009. Pharmacoepidemiologic
principles can be applied to various aspects of the
pre-licensure and post-licensure processes for
vaccines to enhance our scientific understanding of
vaccine safety. This understanding can provide
better quantification of the attributable risk to guide
risk-benefit decisions at the individual and societal
levels and ideally, prevent such vaccine risks in the
future.
A scientific forum was created in 2009 specifically to
ensure the successful introduction and use of a future
licensed dengue vaccine in endemic countries. This
forum (the name of which reflects the group’s
fundamental objective: v2V, vaccine to vaccination),
is led by vaccinologists, virologists, epidemiologists,
public health and infectious disease specialists from
all over the world and will operate in synergy with
organizations such as the PDVI and the WHO. The
objectives of v2V include: documenting the human
and economic burden of dengue; raising awareness of
the public health benefit of dengue vaccination;
advocating funding for broad access to the dengue
vaccination, and provide recommendations and
guidance regarding adoption strategies.
61
SS6-03
Monitoring the Safety of Influenza A
(H1N1) 2009 Monovalent Vaccines,
United States, October 2009 through
June 2010
Claudia Vellozzi
The Immunization Safety Office, Centers for
Disease Control and Prevention, USA
The emergence of pandemic (H1N1) 2009
influenza virus prompted the rapid licensure and
use of H1N1 vaccines. Because the licensure
and manufacturing processes were the same, the
2009-H1N1 vaccines were expected to have
similar safety profiles as seasonal influenza
vaccines, which have a well-established safety
record. Ongoing monitoring of potential adverse
events (AEs) associated with vaccination is
critical to a robust immunization program;
therefore, enhanced post-licensure 2009-H1N1
vaccine safety monitoring was implemented in
the U.S.
Objectives for 2009-H1N1 vaccine safety
monitoring were to rapidly identify and evaluate
serious and clinically significant (AEs)
following vaccination and communicate
findings transparently. At the Centers for
Disease Control and Prevention (CDC) the
Vaccine Adverse Event Reporting System
(VAERS), and the Vaccine Safety Datalink
project (VSD), have been monitoring vaccine
safety since 1990 and were enhanced for
2009-H1N1 vaccine safety monitoring and two
new systems were established: The Real-Time
Immunization Monitoring System (RTIMS)
web-based
active
surveillance
and
Guillain-BarrГ© syndrome (GBS) active case
finding in 10 U.S. states. Other U.S. federal
systems monitored the safety of 2009-H1N1
vaccines: the Department of Defense (DoD), the
Department of Veteran Affairs (VA), the Indian
Health Service (IHS), the Centers for Medicare
and Medicaid Services (CMS) and a new
network of managed care organizations, the
Post-Licensure Rapid Immunization Safety
Monitoring (PRISM) system.
rigorously using other data sources. Limitations
include biased reporting, inconsistent data and lack
of denominator data. VAERS demonstrated the
2009-H1N1 vaccine AE profile was consistent with
that of seasonal influenza vaccines. RTIMS
enrolled vaccinees at the time of vaccination and
showed AE reporting rates were no different
following 2009-H1N1 as compared to 2009-10
seasonal
influenza
vaccines.
The
GBS
population-based (45 million people) case-finding
project compared vaccinated to unvaccinated cases
using survey coverage data to determine the
denominators for incidence rates. Preliminary data
revealed a small but significant increase risk for
GBS following H1N1 vaccination (rate ratio =1.77
[95% CI: 1.12–2.56]). No other federal systems
have detected a signal for a risk of GBS. VSD,
representing ~9 million people, can assess an
association between adverse outcomes and
vaccination using automated data and can do
medical chart review. Rapid assessments occurred
weekly to monitor 2009-H1N1 vaccine safety.
The VSD detected a potential signal for Bell’s
Palsy which was not confirmed in additional
analyses. A weak signal for thrombocytopenia was
found in three other federal systems (VA, IHS and
DoD); medical record reviews are underway to
verify automated data results. A multidisciplinary
working group reviewed and synthesized data from
all U.S. vaccine safety systems routinely and
provided reports to the public.
U.S. 2009-H1N1 vaccine safety monitoring was
comprehensive. Findings suggest two weak signals
(GBS, thrombocytopenia) that require further
validation. Final analyses are in progress and will
be important for determining whether these signals
represent a true association.
VAERS, co-administered by the Food and Drug
Administration
and
CDC,
a
national
spontaneous reporting system, accepts AE
reports following receipt of any US-licensed
vaccine. VAERS is a signal detection system
that can generate hypotheses to be tested more
62
SS6-04
Surveillance of 2009 Pandemic
Influenza A (H1N1) Vaccine Safety in
Taiwan
Wan-Ting Huang
Epidemic Intelligence Center, Centers for
Disease Control, Department of Health, Taiwan
On November 1, 2009, Taiwan began a
nationwide
pandemic
A(H1N1)
2009
vaccination program to vaccinate target priority
groups. Integral to the country’s H1N1 vaccine
program is a multifaceted postlicensure safety
surveillance strategy with the following
component infrastructures:
1. Background incidence of diseases
We
conducted a retrospective cohort study using the
National Health Insurance (NHI) databases from
January 2004 through July 2008 to calculate
locally relevant background incidence of
prioritized adverse events in persons at least 6
months of age. The incidence was 1.97 per
100,000 person-years for Guillain-BarrГ©
syndrome (GBS) and 5.00 per 100,000
person-years for anaphylaxis.
2. Monitoring vaccine utilization
The
National Influenza Vaccine Information System
(IVIS) collects daily numbers on H1N1 vaccine
doses administered. As of April 3, 2010,
5,667,176 doses of H1N1 vaccine were
administered. The cumulative percentage of
residents who had received at least one dose of
H1N1 vaccine reached 22%, of which 8% of
pregnant women had been vaccinated (14,456
doses).
3. Voluntary reporting of programmatic errors
Programmatic errors that occurred in the H1N1
vaccine program was voluntarily reported,
through local health authorities, to Taiwan
Centers for Disease Control (TCDC). For each
report, public health staff conducted site visits
and process review to identify the preventable
cause. Types of reported errors as of February
24, 2010 included wrong vaccine (n=22), wrong
dose (n=7), repeated vaccinations (n=2), and
others (n=2).
4. Passive surveillance of adverse events
following immunization
The TCDC and
Taiwan Food and Drug Administration (TFDA)
co-managed the enhanced national passive
surveillance system. As of April 3, 2010, we
received 1,386 reports of adverse events after
H1N1 vaccination (403 categorized as serious),
a reporting rate of 24.5 per 100,000 doses
administered. No epidemiologic pattern has been
identified for the 50 deaths and 31 pregnancy
complications that occurred following the receipt of
H1N1 vaccines. We verified 4 GBS reports within
42 days (8 expected) and 0 anaphylaxis report
within 2 days (2 expected) of vaccination.
5. Record-linkage surveillance for H1N1 vaccine
safety
TCDC, in collaboration with Bureau of
National Health Insurance, developed a large linked
database (LLDB) of computerized H1N1
vaccination data and NHI outcome files for H1N1
vaccine safety hypothesis testing. As of April 3,
2010, the LLDB had recorded 1,797,861 doses of
H1N1 vaccines. Preliminary analyses had observed
2 cases of GBS within 42 days (6 expected) and 0
case of anaphylaxis within 2 days (1 expected) after
receipt of H1N1 vaccine.
As new vaccines are introduced and new
recommendations are issued in Taiwan, there will
be an ongoing need for postlicensure surveillance
systems that routinely detect vaccine adverse events
to inform public health policy. This robust
framework created for H1N1 vaccine safety
surveillance shows good potential for eventual
transformation
into
a
routine
vaccine
pharmacovigilance tool in Taiwan.
63
SS7-01
Why the Pneumococcus Remains a
Problem
Jeffrey N. Weiser
Microbiology and Pediatrics, University of
Pennsylvania, USA
Several characteristics of Streptococcus
pneumoniae (the pneumococcus) combine to
make it a particularly problematic pathogen.
Firstly, the pneumococcus has the capacity to
cause disease through the expression of
virulence factors such as its polysaccharide
capsule and pore-forming toxin. In addition,
the pneumococcus is highly adaptable as
demonstrated by its ability to acquire and
disseminate resistance to multiple antibiotics.
Although the pneumococcus is a major cause of
disease, the organism is most commonly an
�asymptomatic’ colonizer of its human host (the
carrier state), with transmission occurring
exclusively from this reservoir of commensal
organisms.
Thus, it is unclear how the
organism’s virulence and adaptability promote
its persistence or host to host spread during its
carrier state. This presentation will summarize
current
understanding
of
how
these
characteristics may contribute to the commensal
lifestyle of the pneumococcus
SS7-02
Risk Factors and Histopathologic
Features of Pneumococcal Pneumonia
Complicated by Bronchopleural Fistula
in Children
Yu-Chia Hsieh
Division of Pediatric Infectious Diseases,
Department of Pediatrics, Chang Gung Children's
Hospital, Taiwan
Severe necrotizing pneumococcal pneumonia
would progress to the development of
bronchopleural fistula. Between January 2001 and
March 2010, we collected a total of 112 cases of
culture-proven pneumococcal pneumonia in
children to identify risk factors for the development
of bronchopleural fistula. During the study period,
serotype 19A significantly caused necrotizing
pneumonia (P=0.005). All serotype 19A isolates
belonged to clonal complex 320. Pneumococcal
pneumonia in 18 children (18/112, 16.1%) was
complicated by bronchopleural fistula. Children
with bronchopleural fistula had significantly lower
WBC counts at admission (P=0.03) and
significantly longer durations of fever and
hospitalization (P<0.001). Multivariate analysis
revealed that acute respiratory failure (OR =8.9;
95% CI = 2.6-30.9; P=0.001) and serotype 19A
infection (OR = 5.0; 95% CI = 1.2-22.1; P=0.03)
were risk factors for the development of
bronchopleural fistula. Histopathologic analyses in
twelve children receiving surgical lung resections
because of bronchopleural fistula showed 91.7%
(11/12 of cases) had pulmonary infarction.
64
SS7-03
Relations between Antibiotic Use in
the Community and Resistance to
Streptococcus pneumoniae
David Greenberg
The Pediatric infectious Disease Unit, Soroka
University Medical Center and the Faculty of Health
Sciences, Ben Gurion University of the Negev,
Beer-Sheva, Israel
The global spread of antibiotic-resistant S.
pneumoniae is a pressing concern, owing to the
importance of this organism in causing
community-acquired pneumonia and acute otitis
media and its propensity to acquire resistance to
multiple classes of antibiotic. Moreover, there
has been a rise in the prevalence of
macrolide-resistant S. pneumoniae, often
associated with penicillin non-susceptibility.
Approximately 25% of S. pneumoniae isolates
from the United States and Western Europe are
macrolide- resistant, whereas the prevalence in
some regions in Asia exceeds 90%.
The relationship between antibiotic consumption
and resistance is complex. Some antimicrobial
agents select resistant S. pneumoniae strains
more effectively than others. Increased carriage
of S. pneumoniae resistant to multiple
antibiotics is possibly associated to increased
macrolide usage, in particular of azithromycin.
Thus, reduction of total antibiotic use may not
be sufficient as long as antibiotics with high
potential to promote multi-drug resistance, given
their pharmacokinetics and pharmacodynamics
characteristics, are widely used. A study from
Canada demonstrated that adult patients who
had previously received macrolides or
TMP-SMX or fluoroquinolones were at least 4
times more likely to have antibiotic resistant S.
pneumoniae invasive infection resistant to these
antibiotics than patients who had not received
such
antimicrobials.
Studies
worldwide
demonstrated an association between carriage
and infection with resistant S. pneumoniae and
recent antibiotic use.
pneumoniae, to recognize risk factors that would
identify those likely to have anantibiotic-resistant
isolate. These risk factors might assist clinicians in
choosing the most appropriate empirical therapy.
Introduction
of
the
7-valent
conjugate
pneumococcal vaccine reduces the risk of carriage
and transmission of serotypes included in the
vaccine. The recent increase in carriage and disease
caused by antibiotic-resistant and multidrugresistant S. pneumoniae serotypes not included in
the vaccine, such as serotype 19A, demonstrated
that the use of conjugate vaccines alone does not
solve the problem of resistant S. pneumoniae.
It is unclear whether reducing antibiotic
prescriptions can reduce rates of resistance once
resistance becomes prevalent. A rapid seasonal
decrease in resistance associated with markedly
reduced antibiotic use that was demonstrated in a
study from southern Israel, suggests that
drug-resistant S. pneumoniae may pay a fitness
cost.
Efforts to reduce the spread of antibiotic resistant S.
pneumoniae have been made. The first modality is
the “judicious use of antibiotics”. A second method
is the recommendation of “watchful waiting”
strategy for children with acute otitis media. A third
policy is controlled intervention for monitoring
inappropriate antibiotic prescribing. The fourth
intervention is the initiation of routine infant
immunization with pneumococcal conjugate
vaccine.
Using antimicrobials properly necessitates an
accurate diagnosis, timely administration of the
drug, and use at the optimal dosage and duration.
It is not clear for example, which is the
appropriate duration of antimicrobial treatment
for some diseases such as community-acquired
pneumonia. It is also important in patients
presenting with infection possibly related to S.
65
SS8-01
The Throat Microbiota and the
Resistance Patterns of Bacterial
Pathogens
Pentti Huovinen
National Institute of Health and Welfare,
Finland
Studies done with new molecular methods, like high
throughput sequencing, show that the human
microbiota has numerous different functions.
According to recent findings throat microbiota seems
to be more similar between individuals and more
stable after antibiotic treatment and over long periods
than the intestinal microbiota. The most common
genera in the throat and oral cavity are members of
the Streptococcus, Gemella, Veillonella, Actinomyces,
Rothia, Neisseria and Prevotella. What is the specific
role of these bacteria is still open. However, replacing
nasopharyngeal alpha-haemolytic streptococci has
shown to have importance in the prevention not only
of repeating tonsillitis but also of otitis media.
Bacteriotherapy, however, has not been widely
studied or used, yet.
Antibiotic treatment has several disadvantages. In
addition to allergic reactions and antibiotic diarrhea,
development of bacterial resistance and disturbance
of normal microbiota are of clinical importance.
Streptococcus pyogenes, the most significant
pharyngeal pathogen, is always susceptible to
penicillins and cephalosporins. However, resistance
has widely emerged to macrolides. Increasing use of
macrolide antibiotics has been linked to unwanted
resistance development.
Antibiotic treatment causes always changes in the
human microbiota, including throat. In a recent study,
a common one-week antimicrobial treatment regimen
with clarithromycin and metronidazole resulted in
marked ecological disturbances in the throat with
potential long-term consequences (Jakobsson et al.
PLos One 2010;5:e9836). These observations
underline the importance of restrictive and proper use
of antibiotics in order to prevent long-term ecological
disturbances of the indigenous microbiota.
Changes in the gut microbiota during routine
outpatient antibiotic treatment may also have
unforeseeable results. Gut bacteria produce health
promoting substances that have importance to cellular
health not only in the gut but also elsewhere in the
body. Gut bacteria also regulate fat metabolism at
least by two different ways.
SS8-02
Etiology, Clinical Features and
Prognostic Factors of Acute Sore Throat
Susanna Esposito
Department of Maternal and Pediatric Sciences,
Università degli Studi di Milano, Fondazione IRCCS Ca’
Granda Ospedale Maggiore Policlinico, Milano, Italy
Sore throat is one of the most common symptoms for
which children and adults visit primary care
physicians. Respiratory viruses represent the main
etiologic agents and group A Streptococcus has been
considered by far the most common bacterial cause of
pharyngitis and the only etiological agent for which
antibiotic administration is debated. Among the other
bacteria, group C and G streptococci as well as
Mycoplasma pneumoniae and Chlamydia pneumoniae
have been in some cases detected. Clinical features of
the different etiologic agents (both viruses and
bacteria) are very similar and it is not possible to
differentiate on the basis of signs and symptoms the
different etiologies. This is the reason why in clinical
practice Centor score (based on patient’s temperature,
cough, anterior cervical adenopathy, tonsillar swelling
or exudates and child’s age) with its modified versions
is often used for assessing the probability of
streptococcal infection. The need of a simple clinical
score for the identification of group A Streptococcus is
due to the fact that several reviews and national
guidelines consistently indicated that pharyngitis due
to this pathogen had potential adverse outcomes
including both suppurative (i.e., quinsy, acute otitis
media, cervical lymphadenitis, mastoiditis, acute
sinusitis) and non-suppurative (i.e., acute rheumatic
fever, acute glomerulonephritis) complications. On the
contrary, there is insufficient evidence that the other
etiologic agents (viruses as well as bacteria) cause
severe or recurrent pharyngitis or other adverse
outcomes. However, in recent years it has been
codified that in wealthy countries the risk groups for
acute rheumatic fever following group A streptococcal
pharyngitis include only subjects with personal or
family history of rheumatic fever or rheumatic heart
disease, and impoverished populations. Male patients
aged 21-40 years who are smokers are significantly
more likely to develop quinsy following sore throat.
Evidence to define other clinical risk groups at risk of
complications following pharyngitis is insufficient.
This means that clinicians do not need to treat most
cases of acute sore throat to prevent possible
complications. Moreover, it is not necessary on
current evidence to routinely use biomarkers to predict
potential complications of pharyngitis.
In conclusion, every antibiotic treatment has effects
not only on the target bacterial pathogen but also on
our normal body functions. These effects are more
pronounce in young children, who do not yet have
fully developed normal microbiota.
66
SS8-03
Diagnostic Tools and Clinical
Scores/Decision Rules: The Use of
Rapid Streptococcal Antigen Tests
Paul Little
University of Southampton, UK
The literature will be reviewed regarding the use
of both clinical scores and rapid antigen tests
(RADTs).
1) Clinical scores. Although clinical scores in
the management of acute pharyngitis are not
precise diagnostic tools, the most well known,
the Centor criteria (of purulent tonsils, cervical
nodes, fever and the absence of cough) can
nevertheless be useful indentifying individuals
individual
with
>50%
probability
of
streptococcal infection (4 criteria) or conversely
unlikely to have streptococcal infection (0-1
criteria; <10% probability).
2) RADTs. A number of criteria need to be
considered to determine whether near patient
tests are used: ease of use by clinicians and
acceptability to patients; validity; and cost
effectiveness compared to alternative strategies
taking into account both short term
(symptoms;complications) and long term
considerations (antibiotic resistance). Although
the sensitivity of these tests compared with
throat swabs is normally 90% or better, there are
concerns regarding validity: the main problem
with throat swabs or rapid tests is that they are
unable to distinguish carriage from true invasive
infection, and rapid antigen tests will not detect
Lancefield Group C and G streptococci. There is
also a paucity of good trial data on the
effectiveness and cost-effectiveness of using
rapid tests (in contrast with the trial evidence for
the use of most medications – which is regarded
as mandatory); nevertheless there is encouraging
preliminary trial evidence that using rapid
antigen tests can be a useful tool in helping to
appropriately reduce antibiotic prescribing.
SS8-04
Treatment of Acute Sore Throat in
Primary Care
Theo J. M. Verheij
UMC Utrecht, Julius Center for Health Science and
Primary Care, Netherlands
Acute sore throat is a common condition in primary care
with an incidence of around 20 cases per 1000 person years.
Both symptomatic treatment and antibiotic management of
this illness are applied very frequently in daily practice
despite considerable discussion over these strategies.
Especially antibiotic use is associated with substantial costs
and frequent side effects, most notably the development of
bacterial resistance.
While making guidelines for the management of acute sore
throat for the European Society for Clinical Microbiology
and Infectious Diseases (ESCMID) a review of the existing
literature was performed. Medline was searched from 1966
until mid 2009 for publications in English, using a
predefined list of MESH terms. Initially 3970 publications
were selected. Then publications were screened for setting
and type of publication. When a Cochrane review was
published, publications that were published on that specific
topic before the date of the review were discarded. 41
publications were used in the final review.
Symptomatic treatment
The literature on alternative treatments like Pelargonium
sidoides and herbal teas was generally of poor quality and
done in selected groups of patients. No conclusions on the
use of these treatments could be drawn. The studies on the
effects of zinc gluconate showed conflicting results and clear
side-effects. Analgetics like paracetamol and ibuprofen
consistently showed a clear beneficial effect in several
studies. Also corticosteroids showed a beneficial effect in
eight clinical trials, mainly in more severely ill patients, and
can therefore be considered in this subgroup.
Antibiotic treatment
1. to prevent complications. Serious complications like
rheumatic fever and glomerulonephritis are extremely rare in
the Western world and therefore the effects of antibiotic
treatment on the occurrence of these complications are
difficult to assess. There are some studies that showed that
antibiotic treatment does prevent quinsy, but numbers
needed to prevent are 27 and higher.
2. to relieve symptoms. A meta-analysis on all available
clinical trials done in this field showed that on average
antibiotic treatment could shorten the natural course of
approximately one week by one or two days. The effect was
more clear in patients with more severe presentation. The
modest beneficial effects should be weighted against side
effects, medicalisation and costs. Delayed prescription can
be considered as a feasible option.
67
SS9-01
Epidemiology of Rotavirus and
Norovirus Infection in Asia
Fang-Tzy Wu
Centers for Disease Control, Department of Health,
Taiwan
Choice of antibiotic
Trials comparing different types of antibiotics in acute
sore throat showed some differences between the effects
of cephalosporins compared to penicillin, but these
effects were small and probably not relevant. The
conclusion is that the preferred treatment in acute sore
throat is penicillin or, when not available, amoxicillin
(especially in children). The optimal length of treatment
is still unclear. One trial showed that a 7 day treatment
was superior to a three day treatment and other trials
showed no differences in clinical outcome between
10-day treatments and 7 days regiments. The guidelines
will therefore recommend a seven day course of
penicillin as first choice treatment.
Acute gastroenteritis (AGE) plays a great impact because of
significant high morbidity and mortality worldwide. The
major symptoms are vomiting, diarrhea and dehydration.
According to the WHO estimation, nearly nine million
children under five years of age die each year. Diarrhea is
second to pneumonia as the cause of this death.
Bacterial infection was the major etiology in food-borne
outbreaks over the past few years. Until 1972, lots pathogens
of the diarrheal episodes were unknown. Recently, more than
20 viruses have been recognized as important causes of this
illness. Group A rotavirus and calicivirus were the major
etiologies cause AGE. Prevention strategies and program
vaccination will be important methods to reduce the risks.
Therefore, background surveillance and strains identification
are essential before recommendations.
US CDC, with support from WHO, PATH and the
International Vaccine Institute, initiated Rotavirus
Surveillance Network since 1999. The Asian Rotavirus
Surveillance Network (ARSN) was one of six regional
surveillance networks. Phase I, nine regions and countries
were collecting rotavirus disease and /or economic burden
data in the period of 2001-2004. A finding from these data
was the unexpectedly high proportion (45%) of AGE
admissions in children less than 5 were attributable to
rotavirus. Phase II, the network was launched with
expansion of actives to more countries and focus on disease,
economic burden, cost-effectiveness evaluation and vaccine
development. Taiwan was a member in both phase I and II.
Since rotavirus vaccines were licensed and used in infant
since late 2006. Surveillance will facilitate and support the
introduction of vaccination. Through hospitalized-based
surveillance, the prevalent G genotypes of rotavirus group A
were G1P[8], G2P[4], G3P[8] and G9P[8] in Taiwan during
2001-2007. Though, the changing distribution patterns of
major G genotypes were observed every year.
Noroviruses (NoVs) belong to the family Caliciviridae. NoV
is a major cause of AGE in both children and adults, which
was estimated account for more than 267 million annual
infections in sporadic cases and outbreaks worldwide. This
virus displays a broad genomic diversity with approximately
40 genotypes in 5 genogroups. NoV research has been
hindered by the lack of small-animal models and a reliable
cell culture system. Diagnosis of NoV infection was relied
on a RT-PCR with broadly reactive primer sets which
established in the early 2000. There were few
epidemiological studies of NoV in Asia except Japan. In
Taiwan, most NoV outbreaks were happened in nursing care
center and were transmitted primarily through the fecal-oral
route, either by direct person-to-person spread or fecally
contaminated food or water. GII/4 was the dominant
circulating strain in Taiwan as the same of the world.
68
SS9-02
Bacterial Enterocolitis in Asian
Children
Naveen Thacker
Deep Children Hospital and Research Centre,
India
World Health Organization estimates of
mortality from 34 studies published between
1992 and 200 suggest that 4.9 children per 1000
per year in developing areas and countries died
as a result of diarrheal illness in the first 5 years
of life. Data from WHO indicates that diarrheal
diseases account for 15-34% of all deaths in
certain countries. Bacterial enteric pathogens
have been implicated in a significant proportion
of diarrheal cases especially in the Asian
population. Poor hygiene, inadequate sanitation
facilities, overcrowding and a largely vulnerable
pediatric population act as contributing factors.
Conventionally, bacterial diarrhea are classified
into - non-inflammatory diarrhea and
inflammatory diarrhea. Pathogenic bacteria
causing the inflammatory diarrhea syndrome
include Salmonella, Vibrio cholerae, Shigella
sp., enteroinvasive and enterohemorrhagic
Escherichia coli, Campylobacter, Yersinia,
Chlamydia, and Clostridium difficile. This
presentation focuses on bacterial enterocolitis in
Asian children especially Shigella, Vibrio
cholerae, Campylobacter and Salmonella.
Shigella appears to be more ubiquitous in Asian
impoverished populations than previously
estimated. Shigellosis may cause as many as 167
million episodes of diarrhea and over a million
deaths
annually.
Emergence
of
antibiotic-resistant strains has become a major
problem in recent years. The development of a
vaccine protective against shigellosis is a highly
desirable public health goal, but the
development of such a vaccine is complicated
by the variation in species and serogroups
between sites, years, and age groups.
useful when considering where and amongwhom
interventions such as vaccination would be most
needed. Protecting children against cholera may not
only decrease the burden in this age group but
decrease transmission of the disease to their family
members and the community.
Campylobacter has shown an increase in incidence
worldwide. It is the leading bacterial cause of
gastroenteritis in both developed and developing
countries and is responsible for 5 – 14% of diarrhea
worldwide. In developing countries campylobacter
is most commonly isolated in children <2 yrs of age.
Campylobacter jejuni has been found to be resistant
to commonly used antibiotics, so it is important to
know the antibiotic sensitivity pattern region wise.
S. typhi leads the list of invasive Salmonella
infections in Asia. Invasive Non-typhoidal
salmonellosis infections are also on the rise in
Asian settings. Thus, there is a need for careful
consideration of treatment and preventive
approaches for non-typhoidal salmonelloses.
Although antimicrobial agents are being used there
is still a risk of side effects. Many new preventive
interventions such as enteric vaccines are being
developed which could provide a solution. There is
need for continued research aimed at a better
understanding of the pathogenesis, diagnosis,
treatment and prevention of bacterial enteric
infections.
In 2006, 52 countries officially reported a total
of 236,896 cholera cases including 6,311 deaths
with a CFR of 2.7%, to the World Health
Organization. Oral and intravenous rehydration
therapy has markedly decreased case fatality
rates in cholera cases. Though cholera is
endemic in most Asian countries, there is lack of
data on age specific incidence of cholera in
various communities. Burden estimates are
69
SS9-03
Host-Salmonella Interaction: Control
of Inflammatory Response and Host
Cell
Death
by
Salmonella
Pathogenicity Island
Tomoko Yamamoto
Department of Microbiology and Molecular
Genetics, Graduate School of Pharmaceutical
Sciences, Chiba University,Chiba,Japan
Salmonella enterica are pathogens capable of
infecting humans and animals and causing
significant global morbidity and mortality. S.
enterica serovar Typhi causes approximately 22
million cases of typhoid fever and over 200,000
deaths annually. Non-typhoidal Salmonella
serovars are a leading cause of acute food borne
disease worldwide. The most common human
clinical isolates are serovars Typhimurium and
Enteritidis. They are also a common cause of
bacteraemia and sepsis in immunocompromised
individuals and in children.
During infection, Salmonella interacts with a
variety of host cell types, including
macrophages, dendritic cells and epithelial cells,
and surviving this encounter is the key to the
successful infection for the organism.
Salmonella induces intestinal epithelial cell
death via apoptosis, a cell death with a notably
non-inflammatory outcome, by activation of
caspase-3. In contrast, macrophage infection by
Salmonella triggers rapid caspase-1 dependent
proinflammatory programmed cell death termed
pyroptosis. Macrophage pyroptosis depends on
the Salmonella pathogenicity island-1 type III
secretion system (SPI1-T3SS). Recently, we
have found that Salmonella activates caspase-8
by SPI1-T3SS-dependent pathway in the
infected macrophages and that the increased
expression of SPI1 excessively activates
caspase-8, leading to the induction of apoptosis.
In this talk, I will discuss the mechanism by
which Salmonella controls inflammatory
response and induction of host cell death to the
successful infection.
SS9-04
Post Marketing Surveillance data after
RGE vaccines
Keith S. Reisinger
Primary Physicians Research, Pittsburgh,
Pennsylvania, USA
Virtually every child in the world becomes infected
with rotavirus at least once in the first 5 years of
life. Rotavirus infection has a large global impact
with an estimated 500,000 deaths every year. The
vast majority of these deaths occur in low-income
countries.
Although deaths from rotavirus
infection are uncommon in high-income countries,
these countries still bare very high health care costs
with millions of health care visits and
hospitalizations.
Pharmaceutical companies have been working for
many years to develop a vaccine to protect against
rotavirus infection.
In 1998 Wyeth received
approval in the United States to distribute a
rhesus-based quadravalent vaccine, Rotashield.
Although this vaccine was highly effective against
severe disease, its association with intussusceptions
caused Wyeth to voluntarily withdraw the vaccine
from the market.
In 2004 GlaxoSmithKline
received approval for its rotavirus vaccine, Rotarix.
Rotarix is a singe-component attenuated vaccine
derived from a human GI P(8) strain. In 2006
Merck received approvals for RotaTeq, a
pentavalent human-bovine reassortment vaccine.
Both of these vaccines were evaluated in very large
studies (>70,000 each) that demonstrated very high
efficacy with an excellent safety profile. These
two vaccines are now approved for use in most
countries.
Since approval in 2006, > 30 million doses of
RotaTeq have been distributed in the US as of
December, 2009. Eight hospital-based studies and
2
laboratory-based
studies
have
shown
effectiveness with hospitalizations reduced by
85-95%. A large scale national US surveillance
study conducted by Centers for Disease Control
and Prevention showed that the number of rotavirus
positive tests immediately after RotaTeq approval
and moderate vaccine coverage decreased by 59 –
64%.
In the U.S. vaccine effectiveness has
exceeded what could be predicted based upon the
coverage rates, indicating a probable herd
immunity effect.
70
SS10-01
Diagnosis of Tuberculosis in Children
Rajeshwar Dayal
Department of Pediatrics, SN Medical College,
Agra, India
In Australia the data from Queensland have
shown
that
RV-positive
tests
and
hospitalizations for rotavirus gastroenteritis have
declined significantly since introduction of
RotaTeq. Additionally, a recently conducted
study in France showed a 95% reduction in
hospitalizations in the year after vaccine
utilization.
There have been a number of studies of Rotarix
and RotaTeq conducted in low-income countries.
The effectiveness of these vaccines has been less
than that observed in high-income populations
(40 – 50%). Despite the reduced effectiveness
in low-income countries, the overall impact of
rotavirus vaccines will still be substantial as
85% of all rotavirus-related deaths occur in
these countries. Based upon the effectiveness
data and the significant potential impact upon
the health of the world’s children, the World
Health Organization recommended in 2010 that
these vaccines be given to all children.
Worldwide, an estimated 9.4 million new cases of
tuberculosis were diagnosed in 2008 of which 55% of them
where in Asia. Prevention of Tuberculosis in children can be
achieved by prmary prevention and secondary prevention.
Primary prevention includes immunization of the child
where as secondary prevention includes diagnosis and
treatment. Establishing the diagnosis of tuberculosis in
children is challenging because mycobacterium is detected
in samples of <50% pediatric patients. The diagnosis of TB
is traditionally made on the basis of H/O Contact, clinical
evidence, roentgenographic examination & results of
Mantoux test. With the advent of newer diagnostic
modalities like BACTEC, PCR, Quantiferon and Serological
tests, the diagnosis of tuberculosis in children has improved.
In our studies using ELISA PGLTb1, PCR IS 6110 & PCRMPB64,ZN staining and LJ Medium, sensitivity was found
to be 66% with ELISA PGLTb1 in comparison to
PCR-IS6110, PCR MPB64, ZN staining and LJ Medium
which showed a sensitivity of 61% , 34%, 27% & 18%
respectively. The results of ELISA PGLTb1 were
comparable with PCR IS 6110 (p>0.005). ELISA PGLTb1 is
therefore a simple, inexpensive & reliable test and is of
value in resource poor countries of Asia.
In another study, we found that ELISA Ag85 had a better
sensitivity (59.1%) than ZN staining, LJ medium and
BacT/Alert whose sensitivities were 16.9%, 19.3% and
24.1% respectively. The diagnostic yield could be further
enhanced if the ELISA test was used in combination with
Mantoux test. Thus in developing countries, it would be
advisable to carry out larger surveys to further evaluate the
efficacy of ELISA in the diagnosis of childhood TB.
In our recent study, comparing Quantiferon (QFT-G in Tube)
with other tests, we found that the sensitivity of QFT – G
in Tube to be higher (51.2%) in comparison to ELISA
PGLTb1, ELISA (ESAT6 & CFP 10), PCR IS 6110,
BacT/Alert 3 D system, LJ culture and ZN staining whose
sensitivities were 17%,44%,45.1%, 12.1%, 11% and 19.5%
respectively. However the specificity of QFT-G in tube was
lower (48%) in comparison to the ELISA PGLTb1, ELISA
(ESAT6 & CFP 10), PCR IS 6110, BacT/Alert 3 D system,
LJ culture and ZN staining whose specificities were
87.5%,56.3%, 100%,100% 100% & 100% respectively. The
latent infection in the study population was responsible for
the low specificity of QFT-G in tube. QFT-G may be
negative in patients with active tuberculosis at the time of
diagnosis particularly in those with more advanced disease
and malnutrition. . In a clinical setting, the QFT-G In Tube
will be highly sensitive but unable to differentiate between
latent and active disease. Children
showing
positive
results with both ELISA & QFT-G in Tube should be
considered for follow up. To conclude, the traditional
methods of diagnosis are still extremely important and
should be used with caution with the newer diagnostic
modalities available.
71
SS10-02
Evidence Based latent TB Infection
Diagnosis in Children Conact
Toru Mori
Leprosy Research Center, National Institute of
Infectious Diseases, Tokyo, Japan
The epidemiological situation of TB in children
is more favourable than in USA where however
the case rate for all ages is almost one fifth of
that of Japan. This is supposed to be due to
intensive BCG vaccination policy combined
with chemoprophylaxis (treatment of latent TB
infection). With the continuous improvement of
TB epidemiology in general, the LTBI treatment
will be more and more prioritised than
prevention with BCG.
In the past the identification of those with LTBI
among contacts was hampered by the past BCG,
but this problem is being solved with the
introduction of a new modality of diagnostics of
infection, i.e., interferon-gamma release assays
(IGRAs) using M. tuberculosis specific antigens.
Similar to the case of adults, the sensitivity of
the QuantiferonВ®, one of the IGRAs, in children
is as high as 82% according to our meta-analysis
(to be updated) as shown in clinically diagnosed
active TB patients as surrogates of for the
infected subjects.
However, at the same time we have shown that,
at least in case of children, especially in younger
children less than 5 years, a considerable part of
those with LTBI without active disease may fail
to show positive response to IGRA. What is the
cause of difference in responses between those
with and without active disease? Should a
different cut-off be used for chilren? Is it
possible that lower immunological response in
LTBI is due to weaker infection than in those
ultimately developing active TB, so that those
with negative IGRA are at lower risk, not
requiring LTBI treatment? What is the value of
tuberculin skin test in these cases? These
questions are remaining to be answered, and
discussions will be made on the issues.
SS10-03
Contact Investigation and Latent TB
Infection Treatment at National Level:
Taiwan and Other Countries
Anita P.C. Chan
Centers for Diseases Control, Department of
Health, Taiwan
In Taiwan, a country with moderate burden of TB has
experienced a 20% decline of TB incidence in the past 5
years. The national TB program implemented Directly
Observed Treatment Strategy (DOTS) in the beginning
with full-time observers. DOT was not a new strategy but
universal DOT by full-time out-reach workers was very
difficult for Asia countries. The prioritized TB cases for
the DOT program launched in April 2006 were
smear-positive TB cases. Subsequently, the program were
then expanded to include culture-positive cases from
2007, and special risk groups including aboriginal
populations, uncooperative patients, and homeless people,
irrespective of their smear or culture status, from January
2008. Significant improvement of indicators for TB
control included increasing treatment success rate and
decreasing mortality were noted. With strengthening of
case management system and engagement of
public-private mixed TB care, the sustained increase in
successful treatment, decreasing number of TB cases and
mortality under the DOTS may achieve a bottle neck.
Contact investigation is a very important strategy for
active TB case finding. It is not only the most efficient
way to find active TB cases, block further transmission
and cure the clusters, but also can identify latent TB
infection (LTBI) contacts and provide proper treatment to
prevent further new cases. Although contact investigation
and management is recommended by most national TB
programs (NTP), routine LTBI treatment usually only
occurs in countries with a low TB burden.Contact
investigation program existed in Taiwan NTP for more
than 2 decades already. In 2006, the average contact
numbers per index TB case was less than 3. Inadequate
resources and no incentive for contacts were the main
cause of the phenomenon. A study performed for the
2006 contact cohort revealed that contacts in age group
younger than 12 years had 200~300 times of incidence to
become active TB cases within 24 months compared to
age-specific population. Even for the age group elder
than 65 years, this relative risk was still high up to 8
times. Therefore, contact investigation was promoted by
NTP since June, 2007 and LTBI treatment for children
contacts was endorsed since April, 2008.
The diagnosis and treatment of LTBI among contacts
may accelerate countries with moderate burden into
low-burden countries in the long round. Some facts about
Taiwan will be shared in this talk and information from
countries around Taiwan in Asia will be summarized and
reported.
72
SS10-04
New Treatment and Prevention
Options for Childhood TB
SS11-02
Multidrug-Resistance in Gram-Negative
Pathogens
Ben J. Marais
Department of Pediatrics and Child Health,
Desmond Tutu Tuberculosis Centre
Health Sciences, Stellenbosch University, South
Africa
Gian Maria Rossolini
Clinical Microbiology and Virology Unit,
Antimicrobial Resistance Surveillance Program,
Siena University Hospita, Italyl
Pediatric tuberculosis (TB) continues to be a
neglected disease in many endemic areas where
limited resources restrict the focus to treatment
of only the most infectious TB cases. However,
appreciation that children contribute a
significant proportion to the global TB disease
burden and suffer severe TB-related morbidity
and mortality is growing. The World Health
Organization (WHO) published guidelines on
the management of pediatric TB in 2006 and
child friendly drug formulations have been made
available to deserving low income nations via
the Global Drug Fund (GDF) since 2008.
Increased awareness and improved drug
availability re-emphasized the considerable
programmatic barriers that remain and the
difficulty of establishing an accurate diagnosis
in resource-limited settings. This talk provides
an overview of current treatment practices,
factors that influence the provision of effective
TB therapy to children in endemic areas and
potential future advances. It also discusses TB
preventive therapy and the need for pragmatic
public health approaches to improve feasibility
in resource limited settings.
Gram-negative pathogens, including members of
the family Enterobacteriaceae, Pseudomonas
aeruginosa and Acinetobacter baumannii, are a
major
cause
of
both
nosocomial
and
community-acquired infections also for pediatric
patients. Resistance against the most important
anti-gram-negative
agents
(fluoroquinolones,
aminoglycosides and beta-lactams) is now
widespread on a global scale, and an increasing
prevalence of strains showing complex multidrug
resistance phenotypes is observed, leaving often
very few therapeutic options. The presentation will
briefly review the most relevant issues of multidrug
resistance
currently
encountered
among
Gram-negative pathogens, their trends, and the
available therapeutic options.
73
SS11-03
Multidrug Resistant and Extensively
Drug Resistant Tuberculosis: Current
Status and Future Prospects
Emmanuelle Cambau
Universit of, Paris, France
Tuberculosis is one of the world leader diseases
in term of mortality and morbidity. Its active
transmission is both due to the pathogenicity of
the
causing
bacteria,
Mycobacterium
tuberculosis (known also as M. tuberculosis
complex since several variants are causing
tuberculosis such as M. bovis and M. africanum)
and its specific resistance to common antibiotics.
Decades of tuberculosis treatment failures led to
acquired
resistance
to
the
first-line
antituberculous drugs, isoniazid and rifampicin,
resulting in multidrug resistant tuberculosis
(MDR-TB). These latter cases of MDR-TB can
be hopefully treated by second-line drugs which
included at least one fluoroquinolone such as
levofloxacin
or
moxifloxacin,
one
aminoglycoside such as amikacin, kanamycin or
capreomycin, ethionamide, cycloserin and PAS.
These treatments are long-term (24 months at
least) and possibly deleterious (injections,
toxicity). Failure is observed in 20 to 50% cases.
Failure is often linked with acquisition of
resistance to these second-line drugs. This was
brought up some years ago as extensively drug
resistance tuberculosis (XDR-TB). The XDR
strains are MDR strains with additional
resistance to fluoroquinolones and to
aminoglycosides or relatives such as
capreomycin. XDR tuberculosis cases may
represent about 2 to 10% of MDR cases in
endemic countries, and depends on the use and
availability of the antituberculous drugs.
Although the extensive use of fluoroquinolones
and aminoglycosides outside TB, such as for
urinary tract and respiratory infections, might
select for XDR TB in an endemic MDR TB
tuberculosis setting, most frequently XDR is the
result of either non compliance to the second
line treatment or bad prescription or false
susceptibility results (five really active drugs are
necessary at the first stage of MDR treatment).
Beyond the untreated communicable disease
which brings a real threat for contact living
populations, the MDR and the XDR cases need
to be rapidly detected to eventually benefit of
recently developed antituberculous drug.
SS12-01
Review of Global Measles Situation and
Way Forward
Muhammad Ashraf Sultan
Department of Paediatrics, King Edward Medical
University / Mayo Hospital, Lahore, Pakistan
Measles remains one of the ten leading causes of
morbidity and mortality in children despite the
availability of a very effective, safe and cheap vaccine,
in national programmes since the 1970s. There has
been significant reduction in measles related deaths
from more than 6 million before introduction of
measles vaccine to 2.6 million in 1980, 873,000 in
1999 and 164,000 in 2008. More than 98% of the
cases and measles related deaths are now occurring in
47 priority countries. Developed countries have been
able to prevent indigenous transmission of the virus
through a two dose schedules of measles containing
vaccines (MCV) and keeping sustained high coverage
of immunization. WHO & UNICEF have adopted
various strategies and have set different goals from
time to time. In order to achieve the targets of MDG, a
joint comprehensive strategy was adopted to reduce
measles related deaths in 2010 by 90% of those
estimated in 2000.
The WHO-UNICEF accelerated strategy focusing on
the 47 priority countries has helped to increase the
routine coverage of MCV1 to 83% in 2008 and has
led to reduction in Measles related deaths by 78%.
However the coverage varies by geographical regions.
Americas and Europe have been able to eliminate
indigenous virus transmission. After a successful
campaign in Africa, paradigm has now shifted to
South East Asia, which reports 77% of the total
estimated number of Measles deaths globally. Six
large countries India, Nigeria, China, Democratic
Republic of Congo, Pakistan and Ethiopia still have
low coverage for MCV1. Three of these historically
fall in Asia. From 2007 the Measles mortality began to
level off which is a major cause of concern for
stakeholders.
Concerted efforts to improve routine immunization,
strengthening of diseases surveillance system,
National Political commitment and adequate funding
is required to eliminate this rather easy to prevent
disease from this region and to set targets to eradicate
measles from the globe.
74
SS12-02
Ongoing Challenges with Polio and
the Use of Vaccines to Address Them
SS12-03
New Opportunities for the Control of
Japanese Encephalitis by Vaccination
Nitin Shah
Hinduja National Hospital, Mumbai, India
Alain Bouckenooghe
Clinical R&D Sanofi Pasteur, Singapore
The live-attenuated oral poliovirus vaccine
(OPV) and the inactivated poliovirus vaccine
(IPV) have been remarkably successful, with
major regions of the world declared polio free.
However, global eradication has clearly not yet
been achieved. For the period January through
May 2010, over 200 wild poliovirus cases have
been confirmed from 13 countries, including
several in Asia and the formerly polio-free
country of Tajikistan.
The mosquito-borne Japanese encephalitis virus (JEV)
causes an acute infection of the central nervous system.
The case fatality rate approaches 30% with up to 50% of
survivors exhibiting neurological sequellae. Nearly 3
billion people are at risk, living in the endemic region of
Southeast Asia and the Indian subcontinent. There is no
antiviral treatment for the disease and the prevention of
Japanese encephalitis can be achieved either by
controlling the vector, which is almost impossible in
many affected areas, or by active immunization, which
has proven to be effective.
India continues to report paralytic cases. Low
(9%) trivalent OPV effectiveness against
poliovirus types 1 & 3 has been reported in
Utttar Pradesh. In addition, because the OPV
viruses can mutate to neurovirulent forms, the
use of this vaccine creates major risks:
vaccine-associated
paralytic
poliomyelitis
(VAPP) and circulating vaccine-derived
polioviruses (cVDPV). In India, 83 VAPP cases
can be expected each year at current levels of
OPV use, including dedicated National
Immunization Days. Also, India has reported 11
cases of cVDPV in 2009-1010.
These risks are avoided with the use of IPV. The
goal of the Global Polio Eradication Initiative
(GPEI), as stated in December 2008, is “to
ensure that no child will ever again be
paralysed by either a wild or vaccine-derived
poliovirus.” The value of IPV is often
underestimated. Switching from OPV to IPV
may be even cost saving when considering the
total cost of OPV use, including routine as well
as all supplementary immunization activities.
The WHO recommends global OPV cessation
after interruption of WPV transmission. With the
aim of avoiding VAPP and VDPV while still
effectively
preventing
wild
poliovirus
transmission, 60 countries (including in the
Asian Pacific region Australia, Hong Kong,
Malaysia, New Zealand and South Korea) have
already implemented the use of IPV, mainly in
combination vaccines. All countries should
consider gradually switching to IPV to ensure a
smooth and effective transition.
First generation JE vaccines were developed after the
isolation of JEV in the 1930s. Most of these vaccines
were mouse brain-derived inactivated vaccines (Biken,
Japan and local manufacturers) based on the Nakayama
or Beijing-1 vaccine strains. The vaccination regimen
used in endemic countries varies, but a two-dose primary
vaccination with one month between doses, followed by
booster doses is common. The recommended schedule
for international travelers with these vaccines was three
doses.
In the late 1980’s, Chinese manufacturers developed
inactivated and live attenuated virus vaccines using
Primary Hamster Kidney (PHK) cell substrate. Since
1989 the Chengdu Institute of Biological Products in
China has produced more than 300 million doses of the
live attenuated vaccine (SA14-14-2 strain), mainly for
domestic supply. This vaccine has also been used
recently against epidemics in Nepal and India.
New inactivated non-MBDV Vero cell vaccines have
been recently approved either in the USA, Europe,
Canada,
Australia
for
adult
travelers
(IXIAROВ®-JESPECTВ® Novartis-Intercell) with the
SA14-14-2 strain or in Japan only for pediatric use
(Biken) with the Beijing-1 strain.
Sanofi Pasteur has developed a new, single-dose,
live-attenuated recombinant vaccine (IMOJEVв„ў). The
vaccine virus comprises a genomic ribonucleic acid
(RNA) encoding the pre-membrane and envelope
proteins of the SA14-14-2 live-attenuated JE vaccine
strain, and the capsid and non-structural proteins of the
YF-17D live-attenuated yellow fever vaccine virus. The
vaccine is produced in serum-free Vero cell culture.
Clinical trial results support the administration of a single
injection of this new vaccine for the protection of both
adults and children as young as 12 months of age. It is
expected that the availability of second-generation,
cell-cultured-derived vaccines, will boost vaccination
programs and reduce the impact of JE in affected areas.
75
SS13-01
Prevention of Nosocomial Infection of
the Neonate
Hiroyuki Kitajima
Osaka Medical Center and Research Institute
for Maternal and Child Health, Japan
Most of the neonates are born in a sterile
cindition. The main purpose of prevention of
nosocomial infenction in the neonates is the
earlier colonization of noramal bacterial flora in
the neonates.
1. Essential principals of prevention of MRSA
transmission:
1) Early skin to skin contact and early
breast-feeding by the mother should be
carried out immediately after delivery.
2) The practice of rooming the mother and
infant in and lieing down her child
3) The growth of bifidobacteria in the
intestines of the neonates by immediate
maternal care and breast milk feeding
should be promoted.
4) The practice of handwashing and rubing
with alchool before and after contact with
the newborns and also, separately, before
and after bathing the infants should be
enforced. (The bathtub should be
disinfected after each use.)
5) The individualization and thorough
sterilization
of
all
instruments
(thermometers, stethoscopes, etc. should
also all be placed individually.) and the
routine cleaning up incubators after each
use should be carried out.
6) In the case of a nosocomial MRSA
infection, carrier staff and patients should
be screened and treated with mupirocin
cleaning.
2. The colonization with Bifidobacterium breve
of the bowels of very low birth-weight
(VLBW) infants and the effects of B. breve on
the enteric infections. A prospective
randomized clinical study of 91 VLBW
infants including quintuplets was completed
and these infants were followed up for 6 years.
The colonization rates of the administered
bacteria were 73% at 2 weeks of age, but only
12% in the control group. Early
administration of B. breve significantly
decreased aspirated air volume from the
stomach and improved weight gain in
well-colonized infants. The incidences of
enteric infections decreased in the
administered infants.
3. Protective factors against E.coli O157 infection
in school-age children of Sakai City in summer
1996. We analyzed their daily bowel habit before
the outbreak of an E.coli O157 infection and the
feeding pattern of E.coli O157 –culture positive
students during their neonatal period and early
infancy. A questionnaire was given to 587
school-age children and 259 (44%) answered.
E.coli O-157 was cultured from the stools of only
65 children. Those school children who opened
their bowels at a regular time each day, especially
in the morning experienced less serious symptoms
than those who opened their bowels at varying
times. 59 culture-positive infants respond to
questions about milk feeding in infancy. Breast
milk feeding for more than four months was
associated with a milder form of illness than those
who received artificial milk or mixed feeding.
Infants with rooming-in showed fewer symptoms
than infants without rooming-in in those infants
who had breast-milk feeding less than four months.
Breast feeding may accelerate the growth of the
bifidobacterium sp. and rooming-in also promote
the breast feeding. The early full growth of
bifidobacterium may stabilize the intestinal flora
and protect the intestines from pathogenic bacteria
in the later life.
76
SS13-02
New Treatment Strategies in the
NICU: Targeting the Right Patients
with Early Antifungal Therapy
Theoklis Zaoutis
Pediatrics and Epidemiology, University of
Pennsylvania School of Medicine, Divison of
Infectious Diseases, The Children’s Hospital of
Philadelphia, USA
The presentation will focus on the latest
treatment guidelines for neonatal candidiasis,
approaches to pre-emptive therapy for neonatal
candidiasis, and recent developments in
prophylaxis. The review of treatment guidelines
will in large part be based on the recent
Infectious Diseases Society of America for
treatment of candidiasis. In addition, the role of
newer antifungal agents in the treatment of
neonatal candidiasis will be discussed.
Regarding pre-emptive therapy, a review of the
literature regarding the identification of patients
at high risk who may benefit from pre-emptive
therapy and data regarding the outcomes of
patients managed with pre-emptive therapy.
Finally, an review of the literature regarding
antifungal prophylaxis in the NICU will be
presented including the efficacy, safety, and
impact on resistance of fluconazole prophylaxis.
SS13-03
The Prevention of RSV Infection in
High Risk Neonates and Children
Jaime E. Fergie
Pediatrics Texas A&M University College of
Medicine College Station, Texas, USA
Respiratory Syncytial Virus (RSV) is the principal cause
of respiratory tract infections in children. RSV has been
found in every geographical area of the world were
respiratory viral infections have been studied. RSV
infections have a clear seasonal pattern in temperate
climates were the outbreaks occur usually in the winter
months. In warmer climates RSV infections tends to be
more prolonged. RSV is the most important cause of
bronchiolitis and pneumonia in children. Bronchiolitis is
the most frequent cause for children to be hospitalized in
the United States. RSV is reported to be responsible for
approximately 120,000 hospitalizations a year in the
United States. Estimates from the World Health
Organization place the global burden of RSV disease at
approximately 64 million cases and 160,000 deaths every
year. Beyond the acute complications caused by RSV,
this viral infection has also been associated to the
development of long term wheezing.
RSV infections are particularly severe and are associated
with more complication in premature neonates and
infants, and in children with congenital heart disease,
with chronic lung disease and a variety of other
underlying anatomical and functional conditions. The
prevention of RSV infection in these infants and children
who are at higher risk for complications and death has
evolved over the past two decades. Initial studies
demonstrated the value of passively administered
RSV-specific antibodies. The initial product utilized for
the prevention of RSV infection was a high titer
intravenous polyclonal RSV immunoglobulin obtained
from donors selected because of their high serum titers of
RSV neutralizing antibodies. Although this polyclonal
product provided a 41% reduction in RSV hospitalization
the monthly intravenous administration made it difficult
to use. Shortly after the licensure in the United States of
the polyclonal RSV preparation, a humanized IgG1
monoclonal antibody (Palivizumab, SynagisВ®) that binds
to the F protein of RSV was developed, tested and
licensed. The pivotal trial of the monoclonal antibody
demonstrated an overall 55% reduction in RSV related
hospitalization in high risk children (premature infants or
children with bronchopulmonary dysplasia) who received
five monthly injection of the monoclonal antibody versus
those who received the placebo. Following this study, a
similar clinical trial was completed that demonstrated a
45% reduction in RSV hospitalization in children with
hemodynamically significant congenital heart disease.
After the licensure of Synagis В® in the United States
effectiveness studies have demonstrated a progressive
decrease in the frequency of RSV related hospitalizations
in children who received prophylaxis to approximately
1%.
77
SS13-04
Prevention of Perinatal Group B
Streptococcus (GBS) Disease
SS14-01
Pandemic Influenza A, 2009: Why
H1N1 but not H5N1?
Yun F (Wayne) Wang
Emory University School of Medicine, Grady
Memorial Hospital, Atlanta, GA, USA
Albert D.M.E. Osterhaus
Department of Virology, The Netherlands
Group B Streptococcus (GBS) is the infectious
cause of early neonatal morbidity and mortality.
Consensus recommendations for intrapartum
antibiotic prophylaxis to prevent perinatal GBS
disease were issued by the Centers for Disease
Control and Prevention (CDC) in 1996. Revised
consensus guidelines for the prevention of
early-onset GBS disease issued in 2002
recommended universal culture-based screening
of all pregnant women at 35-37 weeks’ gestation
to optimize the identification of women who
should
receive
intrapartum
antibiotic
prophylaxis. The continued burden of disease
and newly available data relevant to early-onset
GBS disease prevention from the fields of
epidemiology,
obstetrics,
neonatology,
microbiology,
molecular
biology
and
pharmacology prompted the current revision of
the guidelines for early-onset GBS disease
prevention.
Key changes in the new
guidelines include: revised recommendations for
GBS prevention in the setting of threatened
preterm labor, updated recommendations on
antibiotic choices for intrapartum GBS
prophylaxis, expanded laboratory methods for
the detection of GBS, and revised
recommendations for the management of
neonates.
Three major influenza pandemics of the last
century – the 1918 Spanish flu, the 1957 Asian flu
and the 1968 Hong Kong flu - that together cost the
lives of tens of millions of people, indicated that
also in the future influenza pandemics may occur
and cause major morbidity and mortality worldwide.
Outbreaks of highly pathogenic avian influenza of
the H5N1 subtype (HPAI-H5N1) in poultry that
also caused hundreds of often fatal human cases in
Asia, the Middle East, Europe and western Africa
from 2003 onwards, once again highlighted the
need for the implementation of national pandemic
preparedness plans. This prompted the development
of pre-pandemic and pandemic vaccines based
predominantly on the H5 subtype.
The major problems associated with the generation
of pre-pandemic and pandemic vaccines were
associated with response time, production capacity
and vaccine efficacy. It became clear that the
regular formulations with doses used for seasonal
influenza vaccines did not elicit adequate immune
responses against this influenza subtype in naive
ferrets and humans. Especially the novel generation
oil-in-water adjuvants allowed significant dose
sparing, broadening of the protective immune
response and prolonged memory responses towards
this subtype H5 influenza virus. When the influenza
H1N1v influenza pandemic emerged, the
production of vaccines against the pandemic virus
was rapidly initiated and the experience obtained
with the adjuvanted pre-pandemic H5 vaccines
proved to be very useful in this effort. Adjuvanted
H1N1v vaccines proved to be highly successful in
inducing protective immune responses against this
virus in the human population that did not prove to
be completely naГЇve to this virus. Studies on the
level, breadth and duration of the induced immune
response are currently still ongoing.
78
SS14-02
Influenza, Inflammation and
Immunomodulation: from H5N1 to
H1N1
Patrick WOO
The University of Hong Kong, Hong Kong
The mortality of patients suffering from
pneumonia and multiorgan involvement caused by
influenza A/H5N1 virus (H5N1) varies between
45% and 81%. Despite the use of oseltamivir, the
mortality associated with this virus has not been
reduced. This unsatisfactory outcome was
attributed to the induction of a severe, uncontrolled
virus-induced cytokine storm. Attempts to use
anti-inflammatory doses of corticosteroids to
control excessive inflammation were associated
with severe side effects without any improvement
in survival. In our studies, we challenged BALB/c
mice
with
1000
LD50
of
influenza
A/Vietnam/1194/04. Survival, body weight,
histopathology, inflammatory markers, viral loads,
T lymphocyte counts, and neutralizing antibody
response were documented in infected mice treated
individually or in combination with zanamivir
(viral
neuraminidase
inhibitor),
celecoxib
(cyclooxygenase-2 inhibitor), mesalazine (inhibitor
of inflammation widely used for treatment of
inflammatory bowel disease) and gemfibrozil. To
imitate the real-life scenario, treatment was
initiated 48 h after viral challenge. There were
significant improvements in survival rate (P =
0.02), survival time (P < 0.02), and inflammatory
markers (P < 0.01) in the group treated with a
triple combination of zanamivir, celecoxib and
mesalazine when compared with zanamivir alone.
Zanamivir with or without immunomodulators
reduced viral load to a similar extent. Zanamivir
alone reduced viral load but not inflammation and
mortality. Insignificant prolongation of survival
was observed when individual agents were used
alone. Significantly higher levels of CD4+ and
CD8+ T lymphocytes and less pulmonary
inflammation were also found in the group
receiving zanamivir, celecoxib and mesalazine.
The survival benefits of adding celecoxib and
mesalazine to zanamivir could be caused by their
synergistic effects in reducing cytokine
dysfunction
and
preventing
apoptosis.
Combinations of a neuraminidase inhibitor with
these immunomodulators should be considered in
randomized controlled trials of patients suffering
from H5N1 infection.
SS14-03
Clinical Perspective of Novel Influenza
(H1N1) in Children
Bin Cao
Beijing Chaoyang Hospital, China
On April 17, 2009, the United States identified the
first cases of novel influenza A (H1N1) in 2 California
children. Very rapidly, this virus spread through the
world: on June 11, 2009, the WHO raised the
influenza pandemic alert level to phase 6.
The incubation period appears to be approximately 1.5
to 3 days. Clinical symptoms of illness with novel
influenza A (H1N1) are similar to those with seasonal
influenza. The most common symptoms are fever,
cough, sore throat and fatigue. Many patients,
especially in the pediatric age group, have also been
presenting with vomiting and diarrhea. The principal
clinical syndrome leading to hospitalization and
intensive care is viral pneumonia associated with
severe hypoxemia, ARDS, and sometimes shock and
renal failure; other described complications are
dehydration, encephalopathy, and exacerbation of
underlying chronic disease. Rapid progression is
common, typically starting on day 4 to 5 after the
onset of illness. Epidemiologic data shows that
individuals who are pregnant, children aged <5ys,
elderly aged >65ys, and who have underlying chronic
disease or immunosupression are at risk for severe or
fatal influenza illness. An additional risk factor that
has become apparent with this pandemic influenza is
obesity (body mass index, ≥30 kg/m2).
Viral shedding may be longer in young infants and
immunocompromised children. Study of initial cases
of novel A (H1N1) viral infections from mainland
China showed three independent risk factors for
prolonged real-time RT-PCR virus positivity: age of
less than 14 years, male sex, and a delay from the
onset of symptoms to treatment with oseltamivir of
more than 48 hours. Early therapy with oseltamivir in
patients with 2009 H1N1 virus infection may reduce
the duration of hospitalization and the risk of
progression to severe disease requiring ICU admission
or resulting in death.
In conclusions, even though the majority of
cases of 2009 pandemic influenza A H1N1 are mild,
severe disease has been reported in children,
particularly in young children and those with high-risk
medical conditions. Early antiviral therapy may be
necessary and even life-saving.
79
SS14-04
Seroepidemiologic
Studies
on
H1N1-2009 Infections in Singapore:
Lessons Learned and Clinical
Implications
Vincent T.K. Chow, V.J.M. Lee, M.I.C. Chen
Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Singapore detected its first imported cases of
influenza A H1N1-2009 in late May 2009. Virologic
surveillance documented sustained community
transmission from the latter half of June 2009,
followed by a single epidemic wave peaking in the
first week of August and subsiding by September
2009. From 22 June to 15 October 2009, we
conducted a study to determine antibody levels
against H1N1-2009 influenza in 4 different
population groups (n =
2909), i.e. general
population, military personnel, staff from an acute
care hospital, and staff as well as residents from
long-term care facilities. H1N1-2009 seroconversion
was defined as a 4-fold or greater increase in antibody
titers between any of the 3 serologic samples.
Baseline titers of 40 or more were observed in 2.6%
of members of the community, 9.4% of military
personnel, 6.6% of hospital staff, and 6.7% of
long-term care participants. In subjects with 1 or
more follow-up serum samples, seroconversion
occurred in 29.4% of military personnel, 13.5% of
community members, 6.5% of hospital staff, and
1.2% of long-term care participants. Having another
household member who seroconverted was associated
with a higher likelihood of infection. Younger age
groups and military personnel exhibited much higher
infection rates. The lower infection rates in older
subjects corroborate other epidemiologic studies.
Only 13% of the community cohort seroconverted,
supporting the case for targeted vaccination in
populations for which protection is desired. This
study revealed wide variation in serologically
determined infection rates by cohorts and age groups,
suggesting that context-specific risks of infection
need to be considered, and that interventions should
be tailored to the population at risk. A large proportion of the Singapore adult population remained
susceptible to the H1N1-2009 virus after the first epidemic wave. A significant second wave requires an
adequate number of susceptible children for efficient
transmission. These and other factors need to be taken
into account in determining the optimal pandemic
H1N1-2009 vaccination strategies (JAMA 2010; 303:
1383- 1391).
In June 2009, a separate prospective study was conducted
on 51 military personnel to ascertain their serologic
responses before and following receipt of the 2009
Southern Hemisphere seasonal influenza vaccine. Paired
sera were obtained before and 3-4 weeks after
vaccination. Virus microneutralization assays were
performed to quantify antibodies against H1N1 strains,
i.e. A/Brisbane/59/2007, pandemic H1N1-2009, and
A/Puerto Rico/08/34 or PR8. Post-vaccination, 43%,
12% and 24% displayed a 4-fold or greater rise in
neutralizing antibody titers against the three strains,
respectively. There was a positive correlation among
individuals who showed increased titers to both
pandemic H1N1-2009 and PR8 (p<0.001). However, this
correlation was not observed for A/Brisbane/59/2007
with either strain. These results suggest that seasonal
influenza vaccination confers a certain degree of
cross-protection to other H1N1 strains. The correlation in
cross-reactive antibody titers to PR8 and pandemic
H1N1-2009 implies that previous exposure to pre-1957
H1N1 strains may confer some protection against the
2009 pandemic strain.
80
SS15-01
Manipulation of the Microbiota – A
Critical New Era of Managing
Pediatric Infectious Diseases
Gregor Reid
Lawson Health Research Institute, Canada
Infectious diseases remain a major cause of
death and morbidity in Asian children. The basic
management of most infections has essentially
been unchanged for over 50 years. The depleted
numbers of new classes of antimicrobials on the
pipeline, side effects from current therapies and
increasing pathogen drug resistance and
virulence have accelerated the exploration of
new ways to manage disease. The recognition of
the important role that beneficial microbes play
in health, the emergence of tools to uncover the
composition of the microbiome, and efficacious
data on probiotics have opened up new
possibilities to prevent and treat infectious
diseases. The plethora of ways in which
microbes can restore and maintain health, or
reduce the risk and damage caused by diseases
provides an exciting new paradigm for
pediatricians. Three major issues stand in front
of further progress.
Firstly, too many products are on the market that
are called probiotic but do not fulfil the
WHO/UN mandate of being shown in humans
to confer a tangible health benefit. This makes it
difficult for physicians and consumers to know
what to take and for what purpose. This can only
change with a commitment from manufacturers
to do the necessary clinical studies, and from
regulatory agencies to enforce minimum
standards for using the term �probiotic’.
This poses a problem especially in practicing
primary care for newborns and children.
Thirdly, regulatory agencies are beginning to
regulate probiotic foods as if they were
pharmaceutical agents, because they have
applicability to diseases. This makes it more and
more difficult to perform clinical studies, especially
as the financial resources of food and supplement
companies are not at the same level as drug
companies, nor are their profit margins anywhere
near as high.
The future holds much promise for breakthroughs
in using microbes to influence host immunity,
quality of life, conception and reproductive health,
as well as longevity itself. Government and
philanthropic funds are needed to supplement the
limited industry support, to undertake the studies
needed to understand which microbiota changes
can optimally benefit which individual subject. For
now, the challenge is to bring efficacious probiotics
to people in all parts of society.
Secondly, of the efficacious probiotics available
around the world, relatively few have been
tested in children, and even fewer are available
in the developing world. The lack of a suitable
cold chain network means that well-researched
dairy products containing Bifidobacterium
animalis DN 173 010 for regularity,
Lactobacillus casei DN 114 001, L. casei
Shirota or L. plantarum 299V for gut health and
immunity are not available in rural areas where
several billion people live. Likewise, dried
strains such as L. rhamnosus GG or 35, L.
acidophilus NCFM, Saccharomyces cerevisiae
subsp boulardii Lyo, or VSL#3 are also not
widely available.
81
SS15-02
Prevention and/or Alleviation of
Infection in Preterm Babies and
Oncology Patients
Yuichiro Yamashiro
Department of Laboratory for Probiotics
Research, Juntendo University School of
Medicine, Tokyo, Japan
The gastrointestinal (GI) tract mucosa forms an
important organ of host defense, in addition to
its principal physiological function of digestion,
absorption and endocrine.
The development of the immunological
regulatory mechanisms in the GI tract mucosa
depends on the establishment of a normal
intestinal microflora and the introduction of
nutrition as well as various antigens.
The GI tract mucosal defense mechanisms,
including immune exclusion, elimination, and
regulation, are not fully developed in preterm
babies, and are damaged in children undergoing
chemotherapy for their malignancy. These
subjects are also frequently received broad
spectrum antibiotics therapy leading to
inadequate colonization of the intestinal
microflora resulting in a breakdown of the GI
tract mucosal defense mechanisms.
To prevent and/ or alleviate infection and its
clinical consequences the enteral administration
of Bifidobacterium breve was performed in very
and extremely low birth weight infants, and in
cancer patients on chemotherapy.
And the probiotic administration produced
favorable
results.
Several
suggestive
mechanisms on the results investigated will be
presented, including safety of B. breve in
immune deficiency states.
SS15-03
Effect of Probiotics on Gastrointestinal
Infection
James Chen (Chien-Chang Chen)
Chang Gung Children’s Hospital, Taiwan
Probiotics are live flora given in oral quantities that
allow for colonization of the colon. The possible
functions of probiotics are varied and include the
production and secretion of antimicrobial
substances, a stimulus to the host’s immune
responses, and displacement of pathogen
colonization. They provide health benefits to the
host by a stimulation of metabolic activities or by
protection against conditions such as intestinal
infection, food allergies and colon cancer.
Probiotics are considered to be beneficial in the
management and prevention of viral gastroenteritis.
Previous literature had reported that feeding an
infant formula with Streptococcus thermophilus and
Bifidobacterium bifidum can reduce the incidence
of diarrhea and rotavirus shedding in infants.
Another study suggests that children receiving a
bifidobacteria-supplemented milk-based formula
may be protective against symptomatic rotavirus
infection.
Several pathogens, such as Salmonella spp.,
enteroinvasive
Escherichia
coli
and
enterohemorrhagic E. coli spp., Campylobacter
spp., Shigella spp., can cause invasive diarrhea.
These pathogens have the capacity to invade the
mucosa of the distal small intestine and colon,
stimulate local and systemic inflammatory
responses, and sometimes causing hemorrhage and
ulceration of the mucosa. Probiotics have been
shown to be effective in the treatment of these
conditions.
Helicobacter pylori is the major pathogen causing
gastritis, peptic ulcers, and is a risk factor for
gastric malignancies. Most of the ulcers of the
duodenum and gastric mucosa are recognized as a
consequence of Helicobacter pylori infection.
However, Lactobacilli have the capacity to adhere
and even transiently reside in the human upper
gastrointestinal tract and may compete for
adherence and even down-regulate Helicobacter
pylori infection.
The effectiveness of
antibiotic-based triple therapies may be improved
by the addition of selected probiotic strains to the
treatment regimen.
82
SS16-01
Advances in Maternal-to-Child
Transmission of HIV-1 Infection
Usa Thisyakorn
Chulalongkorn University, Thailand
Probiotics offer a broad range of potential health
benefits, such as protection against infectious
diarrhea, necrotizing enterocolitis, inflammatory
bowel disease, and H. pylori infection.
Probiotics can help stabilize the intestinal
microbial
environment,
the
intestine’s
permeability barrier and modulate protective
systemic and mucosal immune responses.
There is also additional in vitro and in vivo data
to support that probiotics provide a health
benefit. Moreover, further studies to determine
the mechanisms and clinical benefits of
probiotics on gastrointestinal tract are needed.
With additional multicenter clinical trial
confirmations, probiotics may become more
popular in the care of infants and children, even
adults.
Mother-to-child transmission (MTCT) of human
immunodeficiency virus (HIV) is the major cause
of HIV infection in children worldwide.
Transmission can occur inutero, during delivery, or
through breastfeeding. Global research has found a
vertical transmission rate of 13-52% in the absence
of any intervention.
In 1994, the success of the clinical trial of
zidovudine (ZDV) in reducing the risk of MTCT of
HIV transmission by the Pediatric AIDS Clinical
Trials Group protocol 076 (PACTG 076) opened
the door to a major preventive effort. Since then, in
the majority of industrialized countries, zidovudine
or multiple antiretroviral therapies are proposed for
HIV-infected pregnant women. However, in
developing countries where most perinatal
transmission of HIV occurs, preventive treatments
are more difficult to implement. In Thailand,
Antiretroviral Donation Program has developed
to”MTCT-Plus
Initiative”
Program
which
HIV-infected pregnant women receive highly
active antiretroviral therapy (HAART) for
prevention of MTCT of HIV with the goal of
providing care and support not only to the
HIV-infected mother and her infant, but also to
other members of the family.
Since the rapid spread of HIV is by heterosexual
contact which has led to the increase in MTCT of
HIV, public education about risky behavior in child
bearing age people is the most important preventive
strategy.
83
SS16-02
Management of Pediatric HIV
Infection: Long Term Perspectives
SS16-03
New Molecular Insights into HIV-1 /
AIDS with Pediatric Relevance
Gareth Tudor-Williams
Section of Paediatrics, Division of Infectious
Diseases, Department of Medicine Imperial
College London, UK
Kuan-Teh Jeang
NIAID, NIH, USA
This talk will provide a historical overview of
where the management of paediatric HIV
infection has come from: over a period of 20
years, it has moved from largely palliative and
terminal care to a chronic treatable condition.
Milestones in improvements in treatment
outcomes internationally will be reviewed.
Perinatally infected children are surviving in to
adulthood, requiring paediatricians to become
adept at providing adolescent and transitional
care. The long-term challenges for young people
who have been living with HIV all of their lives
will be considered, particularly cardiovascular
risks and neurocognitive functioning. Current
approaches to management of children of all
ages presenting with HIV will be outlined.
Potential new paradigms for treatment including
novel immunotherapeutic approaches will be
discussed.
Recent evidence suggests that HIV-1 infection is
restricted by several cellular factors. In both
pediatric and adult individuals these factors should
be operative to moderate viral infection in cells.
In this presentation, I will go over some of the
mechanisms used by cells to control viral
replication. Nevertheless, it should be noted that
these conserved cellular mechanisms are
insufficient unto themselves in fully ameliorating
HIV-1 disease progression.
84
SS17-01
Current Understanding of the Two
Prophylactic HPV Vaccines
Consolidated
Eng-Hseon TAY
Thomson Women Cancer Centre, Thomson
Medical Centre, Singapore
Following the widespread introduction of the
two HPV vaccines since 2006, Gardasilв„ў in
2006 and Cervarixв„ў in 2007, new data
regarding each of the vaccines’ biological
potency and safety were announced at
competing pace and pitch.
Many questions have been raised namely: (1)
Are the vaccines effective and safe? ; (2) What
is cross-protection and how important is it? ; (3)
Should there be any age limit? ; (4) Will they
stay effective with time? and (5) Is one better
than the other or would any one be?
Because some of the answers to these questions
have been conflicting, as such we have become
unclear about the similarities and differences of
the two vaccines, sometimes to the point of
confusion. This presentation to present the data
and current understanding of the HPV vaccines
in a consolidated manner and hopes to clarify
some �conflicting’ issues or understand the basis
of their existence in the first place.
SS17-02
Adolescent and Adult Pertussis
Vaccination Programs: Are They Having
An Impact?
Tina Q. Tan
Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, USA
Pertussis disease in infancy remains a significant
problem, with a high risk of serious morbidity and
mortality in both developed and developing
countries. Improved disease prevention strategies
are imperative. In countries with established
childhood vaccination programs, studies have
shown that adults are the predominant source of
infection for infants. Therefore strategies to protect
infants now emphasize vaccination of adults,
particularly those (eg, parents, close household
contacts and health-care workers) at high risk of
transmitting infection to infants. A cocoon strategy,
in which all potential adolescent and adult contacts
of infants are vaccinated, is probably the most
cost-effective solution. Postpartum vaccination
programs of new mothers are ongoing in the US.
The introduction of booster doses in adolescents
has been an important step toward decreasing
disease burden. For example, in areas of Canada
where Tdap vaccine has been administered to 14- to
16-year-olds, marked reductions of pertussis have
been observed in adolescents and younger age
groups, possibly due to herd immunity.
Adult disease in itself is a concern, with the true
adult burden estimated at more than 600,000 cases
annually in the United States. Adults commonly
have a persistent cough for up to 4 months, often
requiring medical treatment for the associated
morbidity and to reduce the risk of infection to
others. Furthermore, it can have significant
financial implications for the patient and society.
Evidence suggests that implementation of adult
vaccination programs could be highly cost-effective
and even cost-saving. This presentation will review
available data on pertussis vaccination of adults and
adolescents, and assesses the potential impact of
such vaccination, both now and in the future.
85
SS17-03
Meningococcal Vaccines: Newly
Developed Potential for Disease
Control
Heinz-Josef Schmitt
Novartis Vaccines &
Germany
Diagnostics
GmbH,
The gram negative diplococcus Neisseria
meningitidis is the cause of a variety of clinical
syndromes, most devastatingly septicemia and
meningitis. Of the 13 known serogroups of N.
meningitidis serogroups A,B, C,W-135 and Y
are the most clinically important, of which A, C,
W-135 and Y are vaccine preventable at the
present time. The illness is often devastating
with overall mortality rates of 8-10%. Age
specific case fatality rates are among the highest
in adolescence and may approach 20%. Many
survivors suffer severe sequellae such as soft
tissue necrosis, hearing loss, learning disabilities
renal failure and amputation.
The epidemiology of invasive meningococcal
disease is best characterized by the capacity for
genetic change. Dynamic shifts in serogroup
prevalence have occured in recent years in the
United States, Latin America, the Middle East
and Africa.
Incidence rates of Invasive meningococcal
disease are highest in infants and toddlers but a
second spike in rates is found among
adolescents. Across the entire age spectrum
higher risk individuals include persons in
crowded
living
facilities
and
the
immunocompromised such as those with
complement component deficiencies, functional
or
anatomic
splenic
dysfunction,
hypogammaglobulinemia, HIV infection and
others.
control of serogroup C invasive disease in the
United Kingdom and Canada. Since that time
Quadrivalent Conjugate meningococcal vaccines
have been developed to increase the spectrum of
coverage to the epidemiologically important
serogroups A, W-135 and Y.
MenveoВ®, a
CRM197-conjugated
ACWY
meningococcal
vaccine has recently been licensed in the United
States and in Europe for use in adolescents and
adults. Clinical trials indicate that it is both well
tolerated and highly immunogenic across a wide
spectrum of age groups.
Serogroup B disease remains an important
pathogen in many countries. The polysaccharide
capsule of serogroup B is poorly immunogenic and
attempts to develop polysaccharide or conjugate
vaccines based upon the capsule have failed. There
has been some limited success with serogroup B
vaccines based upon Outer Membrane Vessicles.
However the vaccines created are highly serotype
specific and cannot be used across a broad
geographic range.
Using a technique known as Reverse Vaccinology
Novartis Vaccines has developed a Serogroup B
vaccine which is based upon immunogenic, well
conserved outer membrane protiens. The vacacine
is progressing through late phase 3 trials currently.
Until recent years the only option for
meningococcal disease protection for children
has been plain polysaccharide vaccine.
Polysaccharide meningococcal vaccines have
drawbacks including poor immunogenicity in
children < 2 years of age, lack of a memory
response, little effect on carriage of
meningococci and hyporesponsivness upon
repeat immunization. Protein – Polysaccharide
conjugate vaccines may overcome these
deficiencies. In the late 1990’s monovalent
serogroup C conjugate vaccines were developed
and have been extraordinarily effective in the
86
SS17-04
Long-term Immune Memory of
Hepatitis B Vaccine
Chun-Yi Lu
Department of Pediatrics, National Taiwan
University Hospital, Taiwan
Although hepatitis B vaccines have shown good
efficacy and safety profiles, the duration of
protection provided by the vaccine remained
unclear. This issue has drawn more and more
attentions in the past few years as the early
vaccinated cohorts have grown into their young
adulthoods. Concerns of HBV breakthrough
infections in subjects who lost vaccine-induced
immunity increased with time. In 2000, a
consensus was reached among European experts
that booster vaccination for HBV is not
necessary up to 15 years after the primary
course of hepatitis B vaccination. This
consensus was mainly based on the fact that no
clinically significant breakthrough HBV
infections and chronic carriage were observed
up to 10-15 years after the primary vaccination
course. Most of the follow-up studies showed
good protection among vaccinees even though
the antibodies might wane to be less than
protective (10 mIU/mL). A recently published
meta-analysis on long-term follow up studies
including 34 cohorts involving 9,356 subjects
showed the overall cumulative incidence of
HBV breakthrough infection 5-20 years
post-primary vaccination was 0.007 [95% CI:
0.005 to 0.010]. However, some studies have
shown evidence of lost of immune memory in a
small proportion of vaccine recipients. In a
study involving high school students aged 15-21
years who had been vaccinated with
plasma-derived hepatitis B vaccine as infants,
the vaccine remained highly efficacious in
reducing HBsAg carrier rate. However, a
booster dose of hepatitis B vaccine given to
seronegative subjects failed to elicit protective
anti-HBs antibody in 28.7% (158/551) of the
subjects who had received complete HB
vaccination (4 doses) during infancy. It was
estimated that 10.1% of the total vaccinated
population had lost their HB vaccine-conferred
immune memory. Another booster study was
done in 127 seronegative college students aged
18-23 years and had completed HB vaccination.
Three doses of HB vaccine were given at
enrollment, 1 and 6 months after enrollment.
Anti-HBs titers assayed at enrollment, 7 days, 1
month, 6 months, and 7 months following the first
dose of booster showed 20.5%, 75.6%, 94.5%, and
99.2% were positive of anti-HBs, respectively.
Immune memory to HB vaccine evidenced by early
seroconversion was present in only 20% of
vaccinees in the present study, suggesting a
substantial proportion of study subjects have lost
their immune memory. In summary, although the
duration of immunity conferred by hepatitis B
vaccine remained unknown, evidence has emerged
that it can not last forever. In a small proportion of
subjects, the immune memory will disappear 15-20
years after the primary vaccination. Whether
booster doses are needed is another question. As the
chance of getting clinically significant HBV
infection and/or become chronic carriers remained
extremely low, there seems no urgency for booster
vaccinations. Continuous monitoring of HBV
epidemiology is warranted to ensure a successful
long-term control of HBV infections.
87
SS18-01
Molecular Differential Diagnosis of
Viral Respiratory Pathogens in
Pediatric Patients
WONG LEI PO
Division of Molecular Pathology, Department of
Pathology, Hong Kong Sanatorium & Hospital,
Village Road, Happy Valley, Hong Kong
BACKGROUND
Children are extremely susceptible to respiratory
infections and the majority of patients required
hospitalization is due to respiratory infection. In
2009, pneumonia also ranked the third and the
fourth leading cause of death in Hong Kong and
Taiwan respectively. Early and correct diagnosis
is important for individual clinical management
as well as for control of institutional infection.
OBJECTIVE
In children, rhinoviruses, influenza viruses,
parainfluenza viruses, respiratory syncytial virus,
enteroviruses, and certain strains of adenovirus
are the main cause of viral respiratory infection.
Limitations of rapid antigen detection and viral
cell culture prompt the development of rapid,
sensitive and specific assay for differential
detection of these viruses. This study evaluated
a newly developed multiplex PCR assay for
laboratory diagnosis of pediatric viral infections
which allows simultaneous detection of 20
different virus targets and differentiation of
seasonal influenza A from pandemic influenza
H1.
METHODS
During the H1N1 pandemic in 2009, 239
nasopharyngeal samples collected in viral
transport medium from patients (mean age 6.1
years) were subjected to total nucleic extraction
using NucliSENS EasyMag system. Multiplex
PCR amplification and differential detection is
achieved with the novel amplicon rescued
multiplex PCR technology (iCubate Respiratory
Panel-V) and subsequent detection of PCR
product using the Luminex xMAP beads array.
Roche real-time RT-PCR was used for the
detection of pandemic influenza H1 virus.
Samples positive for pandemic influenza H1
were confirmed by the WHO reference
laboratory in Hong Kong.
RESULTS
Out of the 239 samples, 109 were found to be
influenza A positive, with 80 pandemic
influenza H1 and 29 seasonal influenza A by
real-time RT-PCR. On the other hand, by icubate
multiplex PCR assay, 104 were positive for
influenza A, with 78 pandemic influenza H1 and 26
seasonal influenza A. The five samples with
discrepant results were confirmed positive by
conventional one-step RT-PCR. Nine patients were
found to have co-infection with other respiratory
viruses. Four patients had co-infected with human
bocavirus, 3 had rhinovirus, 1 had coxsackie virus/
echovirus and one patient has an infection due to
rhinovirus and coxsackie virus/ echovirus, in
addition to the novel influenza A H1N1. There were
44 patients suffering from non-influenza viral
respiratory tract infections (Table 1).
CONCLUSION
In summary, the multiplex PCR assay showed high
sensitivity and specificity in detecting pandemic
influenza A/ H1N1 2009. This assay is also capable
of detecting 18 different respiratory viruses and
their subtypes simultaneously.
TABLE 1
Non-influenza
Virus
Respiratory
coxsackie
virus/
echovirus
coxsackie
virus/
echovirus + rhinovirus
rhinovirus
parainfluenza virus 1
coxsackie
virus/echovirus
+
bocavirus
bocavirus
parainfluenza virus 3
respiratory
syncytial
virus B
coronavirus NL63
human metapneumovirus
coronavirus OC43
parainfluenza virus 2
88
Number
Positive
samples
9
8
6
5
4
3
2
2
2
1
1
1
of
SS18-02
Procalcitonin as a Marker of Severe
Bacterial Infection in Children
Chien-Chang Lee
Department of Emergency Medicine, National
Taiwan University Hospital, Taiwan
Procalcitonin (PCT) is a 116-amino acid
prohormone of calcitonin normally produced by
thyroid C cells. Circulating levels of PCT are
elevated among patients with severe bacterial
infections but are normal among patients with
noninfectious inflammatory conditions of viral
origin. A recent meta-analysis concludes that
procalcitonin may offer some advantages over
C-reactive protein (CRP) for discriminating
bacterial from nonbacterial infections.
In the field of pediatric infectious disease, the
clinical differentiation between acute bacterial
meningitis and aseptic meningitis, acute
pyelonephritis and uncomplicated UTI, or
serious bacterial infection and uncomplicated
viral infection in young infants is often difficult.
Recent studies proposed PCT as a useful marker
for distinguishing between these clinical
conditions. The aim of this lecture is to review
the recent literature on the usefulness of PCT as
marker of severe bacterial infection in pediatric
patients and compared with traditional its
performance with the traditional inflammatory
marker CRP.
SS18-03
Better Diagnosis of Sepsis
Bin Cao
Beijing Chaoyang Hospital, China
Sepsis is defined as the presence of bacteria or their
toxic products in the circulation, together with
clinical manifestations of infection, such as fever,
leukocytosis and even shock. Early diagnosis and
treatment of sepsis is associated with better patient
outcomes.
In the last few years many new techniques have
entered into the better diagnostic process of sepsis.
The first and ultimate step in the diagnosis of sepsis
is isolation of bacteria. With the proper diagnostic
tools, such as automated blood culturing systems,
hospitals can now more easily substantiate a
diagnosis of bacteremia. But this process usually
requires 24 hours, but another 24 hours are needed
to achieve more detailed information in order to
identify the bacteria. Thus the identification of
bacteria has to be accelerated. And it is well known
that a large proportion of patients who appear to be
clinically septic have negative blood cultures.
A variety of additional helpful biomarkers is
presently available in the identification and
characterization of the bacteria and the diagnosis of
sepsis. Procalcitonin is a well-established
biomarker of sepsis that responds both to infection
and severity of inflammation and thus has an
impact on therapy. With the new tools the physician
is able to rapidly acquire the prerequisite and
detailed information about septic patients. Many
studies have shown the advantages of PCR
compared to classical culture methods in
identifying different types of bacteria.
Taken together, choosing the most sensitive
diagnostic procedures helps clinicians make quick,
precise diagnoses and initiate appropriate antibiotic
therapy, resulting in better patient outcomes.
89
SS19-01
Antibacterial and Antiviral Activity
and Toxicological Study of Slightly
Acidic Hypochlorous Acid Aater
Kanki Komiyama
Kitasato Research Center for Environmental
Sciences, Japan
The aim of this study was to evaluate the
efficacy of slightly acidic hypochlorous acid
water (SAHW) on various kinds of
microorganisms including enterovirus 71, which
play important role in the epidemiology for viral
disease of children. In addition, this study was
conducted to determine the toxicity of SAHW.
Activity was assessed against Gram positive
and negative bacteria, fungi, yeasts and viruses.
SAHW demonstrated excellent antibacterial
activity (>6 log10 reduction) at less 1 min on
most food borne bacteria. SAHW also possessed
antiviral activity on enterovirus 71 and influenza
virus (H1N1) in a short time.
The temperature of SAHW appeared to be an
important factor for the activity. SAHW stared
to reduce bacterial count at 10В°C for 10 minutes
incubation. When the temperature was raized, it
showed a marked activity, and complete
bacterial elimination was observed at 40В°C for
only 2 min incubation. On the other hand, the
presence of organic matter had a negative
impact on the antibacterial activity of SAHW.
The activity decreased when the concentration
of organic matter was increased.
Studies on toxicity of SAHW have been
extensively performed in vitro as well as in
various laboratory animals. No abnormal
findings
in
necropsy,
urinalysis,
and
dermatological, ophthalmologic, hematological
or histopathological tests have been observed.
Ames test has observed no mutagenic evidence.
Thus, SAHW appeared to be safe and have
strong antibacterial activity, and useful
disinfectant in food and agricultural industries,
and other applications.
SS19-02
EV71 Epidemiology and Vaccine
Development
Min-Shi Lee
Vaccine Research and Development Center,
National Health research Institutes, Taiwan
Enterovirus 71 (EV71), a member of Enterovirus
genus and Picornaviridae family, was first isolated in
l969 in California, USA. Clinical spectrum of EV71
infection ranges from asymptomatic infection, mild
infection with herpangina and hand-foot-mouth
disease, to severe infection with neurological and
cardiopulmonary complications. Several epidemics
with high mortality rates have occurred in European
and Asian Countries (Bulgaria in 1975, Hungary in
1978, Malaysia in 1997, Taiwan in 1998 and China in
2008). EV71 infection with cardiopulmonary
involvement may be associated with neurological
sequelae, delayed neurodevelopment and reduced
cognitive functioning. Recently, several EV71 vaccine
candidates including live-attenuated virus, inactivated
whole virus, recombinant viral protein, virus-like
particle, and DNA vaccines have been evaluated in
animals but no clinical trial has been conducted.
Based on historical experiences with poliovirus
vaccines and animal studies, the inactivated whole
virus vaccines are feasible and could be licensed
readily so they are targeted for preparing clinical trials
in several organizations in Asia. Here are the key
points to be discussed in my presentation.
z EV71 is highly contagious and causing
life-threatening EV71 infections in Asian
children.
z Enterovirus surveillance systems in Asia vary
country by country. Harmonization of enterovirus
surveillance will help to understand the disease
burden of EV71 in this region.
z EV71 tends to mutate quicker in the last 20 years
and more genotypes are spreading globally.
Longitudinal serological studies are desirable to
monitor antigenic variability of EV71 viruses,
which is critical to selection of vaccine strains.
z Two human cellular receptors of EV71 have been
identified recently. Transgenic mice bearing these
cellular receptors may facilitate monitor
immunogenicity and safety of EV71 vaccine
candidates.
International pharmaceutical companies should
consider partnering with Asian organizations to speed
up the licensure and delivery of EV71 vaccines in this
region, which could be profitable in a long run.
90
SS19-03
Clinical Manifestations and Long
Term Outcome of EV71
SS19-04
Development of Antiviral Agents against
Enterovirus 71
Luan-Yin Chang
Department of Pediatrics, National Taiwan
University Hospital, College of Medicine,
National Taiwan University, Taiwan
Shin-Ru Shih
Research Center for Emerging Viral Infections,
Department of Medical Biotechnology &
Laboratory Science, Chang-Gung University,
Clinical Virology Laboratory, Chang-Gung
Memorial Hospital, Taiwan
The enterovrius 71 (EV71) outbreak in Taiwan in
1998 is very well-known to cause a lot of fatal
children cases. In 1998 epidemic, there were 405
severe cases with 78 deaths. In 2000 to 2002,
there were still dozens of fatal EV71 cases each
year. Symptomatic enterovirus 71 (EV71)
infection can progress through four stages:
HFMD/herpangina (Stage 1), CNS involvement
(Stage 2), cardiopulmonary failure (Stage 3), and
convalescence (Stage 4). Most EV71 cases in
those studies stayed at stage 1, some progressed
to Stage 2 and a few would advance to the most
severe condition, Stage 3.
A stage-based management was thus developed
to reduce the case-fatality but most survivors of
brainstem encephalitis plus cardiopulmonary
failure might have neurologic sequelae and
impaired cognition. Nine (56%) of the 16
polio-like cases and 1 (20%) of the 5
encephalomyelitis cases had sequelae involving
limb weakness/atrophy. Eighteen (64%) of the 28
cases with cardiopulmonary failure after CNS
involvement had limb weakness and atrophy, 17
(61%) required tube feeding, and 16 (57%)
required
ventilator
support.
Delayed
neurodevelopment was found in only 1 (5%) case
with severe EV71 CNS involvement and in 21
(75%) cases with cardiopulmonary failure
(p<0.001). Children with cardiopulmonary failure
after CNS involvement scored lower on
intelligence tests than children with CNS
involvement alone (p=0.003). Among patients
with CNS involvement alone, children infected at
ages younger than 2 had lower verbal
comprehension than children infected at older
ages (p=0.009).
Enteroviruses (EVs) are important and common
human pathogens, and EV infections can cause a
wide spectrum of acute diseases, including CNS
complications. Some EV infections result in CNS
syndromes, containing acute flaccid paralysis,
aseptic meningitis and encephalitis and even deaths.
As no vaccine is currently available for most EVs
and the lack of clinical antiviral drugs can be used
to treat EV-related infections, it indicates the need
to develop a potent compound. This talk will
summarize the development of drugs for EV-related
infections based on molecular targets blocking
various steps in the viral replication cycle.
EV71 CNS involvement with cardiopulmonary
failure may be associated with neurological
sequelae, delayed neurodevelopment and reduced
cognitive functioning. Children with CNS
involvement without cardiopulmonary failure did
well in neurodevelopment. Continuous EV71
disease and laboratory surveillance is warranted.
91
Abstract of Free Paper Oral Presentations
FP1-01
Clinical Course and Cost of Seasonal
and Pandemic Influenza in Healthy
Children in an Outpatient Setting
Pukpen Sirikut, Piyarat Suntarattiwong,
Supichaya Netsawang, Tawee
Chotpitayasunondh
Thailand
BACKGROUND: Influenza in healthy children
is generally a self-limited disease, but may result
in school absenteeism, caregiver loss of
productivity and may have economical impact.
In Thailand the pandemic influenza A/H1N1
2009 started in June 2009 when school children
were most affected. We did a study to
investigate clinical course and burden from
seasonal and pandemic influenza in healthy Thai
children.
METHODS: A prospective descriptive study
was conducted at Outpatient Department at
Queen Sirikit National Institute of Child Health
from January 1st 2009 to January 1st 2010.
Inclusion criteria were healthy children age 1
month-15 years who presented with influenza
like illness that were RT-PCR positive for
influenza and antiviral drugs were not
prescribed. Clinical course and direct costs
including medication and travel cost, indirect
costs including school absenteeism, caregiver
work absenteeism and income loss were
obtained by direct and telephone interview.
RESULTS: There were 107 patients enrolled
with mean age of 5.8 В± 3.6 years. Forty-two
(39.3%) were pandemic influenza. The mean
age of seasonal influenza patients was lower
than pandemic influenza (5.2 В± 3.5 vs 6.7 В± 3.6
years). The mean duration of fever was
significantly longer in seasonal influenza
patients (5.2 vs 4.3 days, p=0.04). Two
pandemic influenza patients (4.8%) later were
admitted, prescribed oseltamivir and improved
without complications, all seasonal influenza
patients neither required hospitalization nor
antivirus. Among 105 outpatients, 31 (29.6%)
had revisited medical care facilities. The total
direct cost (medication and travel) per one child
ranged from 147 to 1,404 Thai Baht with mean
of 492.3 Thai Baht (32 Thai Baht is approximately
1 USD) and was not significantly different between
seasonal and pandemic influenza. The seasonal
influenza patients reported school absenteeism in
75.4% with the mean duration of 4.3 В± 3.4 days,
while 82.5% of pandemic influenza patients missed
school with mean duration of 5.1 В± 2.6 days. Sixty
percent of caregivers in both group reported
absence from work due to their children illness with
the mean duration of 3.8 В± 3.2 days and 3.0 В± 1.8
days in seasonal and pandemic influenza
respectively. The caregiver income loss was higher
in seasonal than pandemic influenza (735.8 versus
309.1 Thai Baht, p=0.07).
CONCLUSION: An influenza infection in healthy
children has impacts in term of cost including
medication, travel cost, school absenteeism, and
income loss. The cost was similar in healthy
children infected with seasonal or pandemic
influenza in this outpatient setting.
92
FP1-02
Pandemic (H1N1) 2009 Vaccination
and School Closure Following
Outbreaks in Taipei City, Taiwan
Wen-Chan Huang1, Ping-Ing Lee1, Po-Ren Hsueh2,
Muh-Yong Yen3, Chun-Yi Lu1, Jong-Min Chen1,
Luan-Yin Chang1, Li-Min Huang1, Chin-Yun Lee1.
1
Department of Pediatrics, National Taiwan University
Hospital, College of Medicine, National Taiwan
University, Taiwan; 2Department of Internal Medicine,
National Taiwan University Hospital, College of
Medicine, National Taiwan University; 3Department of
Internal Medicine, Taipei City Hospital, Taipei, Taiwan
OBJECTIVE: Starting in the early phase of the
pandemic (H1N1) 2009 outbreak, the health and
education administrations in Taiwan issued a decree of
class suspension and school closure criteria to prevent
further transmission in schools. This study evaluated the
effect in Taipei City of a city-wide class suspension and
school closure strategy since September 2009, and
subsequent implementation of pandemic (H1N1) 2009
vaccination, particularly among school students, on the
mitigation of the pandemic (H1N1) 2009 outbreak.
METHODS: Between June 2009 and January 2010,
total 3,159 patients in Taiwan infected with pandemic
(H1N1) 2009 were reported to the Taiwan Centers for
Disease Control. Over 3% of the patients were resided in
Taipei City. We analyze the H1N1 vaccine-coverage rate,
and the changes of H1N1 infection and hospitalization
cases under the school closure intervention and after the
administration of H1N1 vaccination.
RESULTS: Over a quarter of the hospitalized
H1N1-infected patient (887/3,159) in Taiwan, 4.4% died
during the pandemic period. Among the 117 hospitalized
patients in Taipei City, 4 patients (3.4%) died during the
pandemic period. Patients aged < 18 years accounted for
51.9% and 47.9% of all hospitalized patients in Taiwan
and Taipei City, respectively. Two peaks in incidence
among patient groups were found for age 1-12 years and
25-49 years old. The overall coverage of H1N1 influenza
vaccine was 24.3% in Taiwan and 21.8% in Taipei City.
The vaccine coverage was 74.7% (271,460/363,603)
among school students aged 7 to 18 years and 92.7%
(36,561/39,425) among medical personnel in Taipei City.
The number of class suspensions or school closures also
decreased concurrently with the declining trend of
hospitalized patients with pandemic (H1N1) 2009.
However, the number of confirmed cases rose in October
2009 as the number increased of class suspension and
school closure. The epidemic curve went down only after
the vaccine had become available, suggesting that mass
vaccination is far more effective than targeted social
distancing to mitigate pandemic influenza.
CONCLUSION: High coverage rate of the vaccine
among school students aged 6 to 18 years as well as the
intervention policy of class suspension and school
closure might have contributed to the cessation of the
outbreak.
FP1-03
Clinical Analysis of 304 Hospitalized
Pediatric Patients with Influenza A
(H1N1) 2009 Virus Infection Confirmed
by PCR
Yumi Mizuno, Hiroe Yoshida, Jun Abe, Takashi
Morita, Tomonobu Aoki.
Department of Pediatric Infectious Diseases,
Fukuoka Children's Hospital and Center for
Infectious Diseases, Japan
OBJECT: The aim of this research is to analyze the clinical
characteristics, treatment, and outcome of children with
influenza A(H1N1)2009.
METHODS: We retrospectively reviewed the clinical chart
and analyzed the clinical feature of 304 pediatric patients
with influenza A(H1N1)2009 virus infection confirmed by
PCR who were hospitalized to Fukuoka Children's Hospital
and Center for Infectious Diseases between June and
December 2009.
RESULTS: The median age on admission was 7 years old
(range, 36 days old to 15 years old) , 203 were males. 99 of
304 patients had one or more underlying conditions that
included asthma (63 patients), neurological disease(12),
congenital heart disease (12), chromosomal anomaly (9),
renal disease (4), immunosupression (4), hematological
disorder (1), endocrine disease (1). The median day of
admission was 1 day after the onset of high fever (range, 0-6
days), and 83 patients and 154 patients were hospitalized on
the day and one day after the onset of high fever,
respectively. The overall median length of hospital stay was
5 days (range, 2-34 days). Major clinical symptoms were as
follows: fever (100%), cough.(93%), rhinorrhea (24%),
dyspnea (18%), vomiting (25%) diarrhea(7%). Of the 304
patients, 134 (44%) had respiratory complications and 86
(28%) had neurological complications. Respiratory
complications included pneumonia (108 patients) and
bronchitis or asthma attack(26). Of 108 patients with
pneumonia, 49 patients had asthma as underlying condition.
Neurological complication included febrile seizure (42
patients), delirious behavior (40), decreased consciousness
(2). 301 of the 304 patients were treated with antiviral drugs
oseltamivir (223 patients), zanamivir (47) or combination of
them (31). Almost patients with pneumonia had fever, cough
and half of them had dyspnea and their symptoms
deteriorated rapidly after the onset of fever. 84 of 108
patients with pneumonia were hospitalized within one day
after the onset of high fever and immediately treated with
antiviral drug, 105 patients were treated with antibiotics, 72
with oxygen supplementation and 34 with medium dose of
steroid. Fever of the patients with pneumonia subsided 3.4
days after onset on average. None of 304 patients required
mechanical ventilation nor died. All patients recovered fully
after treatment.
CONCLUSIONS:108(36%)of 304 hospitalized patients had
pneumonia, the symptoms of them got worse rapidly after
onset or fever, and 45%of them had asthma as underlying
condition. Early treatment with antiviral drug was effective
for the treatment of children with influenza A(H1N1)2009,
including patients complicated with pneumonia.
93
FP1-04
Seroepidemiologic Study on 2009
Pandemic Influenza A (H1N1)
Infections among Health Care
Personnel
Ting-Yu Yen1, 2, Luan-Yin Chang1, Li-Min
Huang1, Chun-Yi Lu1*
1
Department of Pediatric, National Taiwan University
Hospital, College of Medicine, National Taiwan
University, Taipei, Taiwan
2
Department of Pediatrics, Children's Hospital,
China Medical University & Hospitals, Taichung,
Taiwan
CONTEXT: Taiwan experienced two epidemic
waves of 2009 pandemic influenza A (H1N1).
The first epidemic wave started in late August
and ended in September 2009. The second
epidemic wave was from mid October 2009 to
February 2010.
OBJECTIVE:
To
investigate
the
seroepidemiology of 2009 pandemic influenza A
(H1N1) among health care personnel before,
during and after the 2009-2010 influenza A
(H1N1) pandemic.
METHODS: This is a prospective study of
antibodies against 2009 pandemic influenza A
(H1N1) on serial serum samples from a distinct
cohort: health care personnel in the National
Taiwan University Hospital (NTUH) from mid
August 2009 to late March 2010. Serum samples
were taken before the pandemic, before
vaccination for the virus, and after the pandemic
respectively. Hemagglutination inhibition (HAI)
assay was used to determine the antibody levels.
Seroprotective titer was defined as a HAI
antibody titer≧40. A HAI titer with a 4-fold or
greater increase was defined as H1N1
seroconversion. Characters including personal
protective equipment usage, influenza-like
illness history, and vaccination history of the
study subjects during study period were
recorded.
MAIN RESULTS: Totally, 150 health care
personnel were enrolled in the study, and 147 of
them (98%) completed the serologic follow-up.
Among them, 93 persons (62%) had direct
contact with influenza A (H1N1) patients and/or
their clinical samples (high risk group). The
other 57 (38%) study subjects were designated
as usual risk group. Among high risk group,
personal protective equipment and vaccination
were taken more frequently (surgical mask:
100% vs 70%; hand washing: 100% vs 88%;
2009 influenza A (H1N1) vaccination: 57% vs
12%, all p values <0.005). The pre-pandemic
seroprotective rate was 4.7% for total health care
personnel. The pre-vaccination seroconversion rates
were 4%, 5%, and 2% for total, high risk, and usual
risk groups respectively. The post-pandemic
seroconversion rates were 27%, 37%, and 11% for
total group, high risk group, and usual groups
respectively. The increases were mainly due to
vaccination effect (67%). The post-pandemic
seroconversion rate due to natural infection among
high risk and usual risk groups were 12% and 7%
(P=0.3).
CONCLUSION: Our study showed that relatively
low proportion of health care workers was infected
during the 2009 influenza A (H1N1) pandemic in
NTUH. The post-pandemic seroprotective rate was
35% among health care personnel. The importance
of vaccination among health care personnel should
not be ignored. Under adequate personal protective
equipment and vaccination, health care personnel
could avoid the extra risk to get influenza infection
in their working environment.
94
FP1-05
Monovalent Vaccine for the Pandemic
Influenza A (2009 H1N1) in Children
with Cancer Receiving Chemotherapy
1, 2
1
Ting-Yu Yen , Shiann-Tarng Jou , Yung-Li
Yang1, Hsiu-Hao Chang1, Meng-Yao Lu1,
Dong-Tsamn Lin1, Kai-Hsin Lin1 Li-Min
Huang1, Luan-Yin Chang1, *
1
Department of Pediatric, National Taiwan University
Hospital, College of Medicine, National Taiwan
University, Taipei, Taiwan
2
Department of Pediatrics, Children's Hospital,
China Medical University & Hospitals, Taichung,
Taiwan
PUSPOSE: This study investigated the immune
response to 2009 pandemic influenza virus A
(H1N1) monovalent inactivated vaccine in
pediatric
cancer
patients
receiving
chemotherapy..
METHODS: Twenty-five children aged 6
months to 18 years were enrolled in the study.
We checked hemagglutintin-inhibition (HAI)
antibody titers in sera of patients before and 3-4
weeks after vaccination. Ten patients aged less
than 10 years old received two doses of
vaccination. Fifteen patients aged older than 10
years old received one dose vaccination.
RESULTS: For all patients, the seroprotective
rates were 52% and 72% for pre- and
post-vaccination,
respectively.
The
post-vaccination sero-response rate was 32%.
The seroresponse was significantly associated
with lymphocyte counts keeping more than
1500/гЂЂL during vaccination period (P = 0.008).
The geometric mean titer (GMT) significantly
increased in patients younger than 10 years, who
received two doses of vaccination (pre- and
post- vaccination GMT were 21.4 and 60.6
respectively, P = 0.025).
CONCLUSION: Monovalent vaccine for the
2009 pandemic influenza virus A (H1N1) was
tolerated well in children with cancer receiving
chemotherapy,
the
seroresponse
was
significantly
associated
with
absolute
lymphocyte count. To improve the immune
response, we recommended that vaccination is
better to be administered when patients absolute
lymphocyte count returned more than 1500/L.
FP1-06
Clinical Spectrum of Human Rhinovirus
Infections in Hong Kong Children
TF Leung, LY Tse, GWK Wong, PKS Chan1
Departments of Paediatrics and 1Microbiology;
The Chinese University of Hong Kong, Prince of
Wales Hospital, Shatin, Hong Kong
OBJECTIVE: Human rhinovirus (HRV) is the
commonest viral cause of respiratory tract infections
(RTIs). HRV consists of over 100 serotypes, which can
be classified into A, B and C genogroups. HRVs are
traditionally believed to cause upper RTIs, but recent
findings suggested HRV-C genogroup to be associated
with asthma exacerbation in Caucasian populations. Our
group identified by multiplex polymerase chain reactions
(PCRs) that HRV was the major respiratory virus for
childhood asthma exacerbations in Hong Kong. Relevant
data on disease associations for HRV genogroups is
limited in Asian children. This study elucidated the roles
of HRV infections in local children with asthma
exacerbation.
METHODS: This cross-sectional, case-control study
recruited 128 children < 18 years old who were
hospitalised for asthma exacerbations between October
2008 and March 2009. The controls consisted of 192 ageand sex-matched children without asthma history who
were admitted for respiratory illnesses within the same
weeks as our cases. All subjects stayed in the only two
regional hospitals with paediatric inpatient service in the
New Territories East District of Hong Kong. Their
clinical data was obtained from computerised hospital
record, and nasopharyngeal aspirates (NPAs) were
retrieved for HRV detection. Reverse-transcription PCRs
were performed with primers that targeted the consensus
VP4/VP2 coding regions of HRVs. Positive isolates were
then sequenced to determine HRV genogroups.
MAIN RESULTS: The mean (SD) age of cases and
controls was 5.6 (3.6) years and 5.4 (3.8) years
respectively (P=0.601). Three subjects did not have
sufficient NPA for analysis. HRV was detected in 107
(84.9%) cases and 63 (33.0%) controls (P<0.0001).
Specifically, HRV-C was identified more commonly in
cases (69.8%) than controls (18.8%) (P<0.0001). The
detection of HRV-A and HRV-B did not differ between
these two groups (P>0.15). More subjects with HRV
infection needed oxygen supplementation (12.8% versus
2.5%; P=0.004). The length of hospitalisation, need for
intensive care and mortality did not differ among patients
with and without all HRVs (P>0.1 for all). Among the
controls, acute bronchiolitis was associated with HRV
(P<0.0001), HRV-A (P=0.021) and HRV-C (P=0.003);
upper RTI with HRV (P=0.048) and HRV-C (P=0.014);
and acute bronchitis with HRV (P=0.038).
CONCLUSION: HRV and its genogroup C are
associated with asthma exacerbation, wheezing lower
RTIs and upper RTI in Hong Kong children. HRV-A is
also associated with acute bronchiolitis in our controls.
These results highlight HRVs to be the major respiratory
virus causing childhood wheezing illnesses.
95
FP1-07
Seasonality and Risk Factor Analysis
of Respiratory Syncytial Virus
Infection in Taiwan
FP1-08
Epidemiology and Clinical
Manifestations of Adenoviral Infection
in Hospitalized Children
Chun-Fu Tai1, Ping-Ing Lee1; Ching-Chuan
Liu2, Chun-Yi Lu, Jong-Min Chen, Luan-Yin
Chang, Li-Min Huang, Chin-Yun Lee.
1
Department of Pediatrics, National Taiwan
University Hospital, Taipei, Taiwan;
2
Department of Pediatrics, National Cheng
Kung University Hospital, Tainan, Taiwan
Hyo Jin Kwon,Yun-Kyung Kim
Department of Pediatrics, College of Medicine,
Korea University, Korea
OBJECTIVE: This study is aimed to
investigate the seasonality of respiratory
syncytial virus (RSV) infection in Taiwan, and
to delineate the risk factor for severe RSV
infections.
METHODS: A total of 1740 RSV-infected
children aged under 18 years were enrolled in
this study, including 1453 from National Taiwan
University Hospital in Northern Taiwan (1995 to
2005), and 287 from National Cheng Kung
University Hospital in Southern Taiwan (2000 to
2005).
RESULTS: The need for intensive care or
ventilator support was significantly associated
with congenital heart disease (CHD), chronic
lung disease and neuromuscular disorders. Age
< 1 year is also a significant predictor for the
need of intensive care. Only the presence of
CHD, especially acyanotic CHD, was
significantly associated with a fatal outcome.
RSV infection occurred all year round. Monthly
distribution of RSV infections in Northern
Taiwan showed a bimodal pattern with one peak
from March to May, and another from August to
October. The distribution in Southern Taiwan
showed a single peak from April to July. The
occurrence of RSV infection appeared to
correlate positively with temperature and rain.
CONCLUSIONS: RSV infections occur all
year round in Taiwan. Prophylactic use of
antibodies against RSV should not be limited to
certain months. It may be more feasible to
recommend using RSV antibodies for a certain
period after birth for high-risk infants, such as
those with CHD and preterm delivery.
OBJECTIVE: Adenovirus infection is an
important cause of acute respiratory illness in
children, but the epidemics of adenoviral infection
in Korean children has not well described in reports
published elsewhere. The objective of our study
was to know the epidemiologic and clinical features
of adenoviral infection among children experienced
in a single center during the several years, and to
help diagnosis, treatment and prevention.
METHODS: From January 2005 through April
2009, 1,836 children <15 years of age who had
been admitted at Korea University Medical Center
were tested for acute respiratory infection. The
patients confirmed with adenovirus infection were
enrolled in this study and their medical records
were reviewed retrospectively.
MAIN RESULTS: Adenoviruses were isolated
from 310 patients, which constituted 16.9% of the
total isolates during the study period. Male to
female ratio was 1.6:1 and mean age was 32В±24
months. The most prevalent age group was children
under 5 years of age. Adenovirus infection occurred
endemically throughout the year or made epidemics
in 2007. The clinical diagnoses were URTI (32.3%),
LRTI (51.3%), neurologic disease (5.2%) and any
other diseases. Associated symptoms, signs and
abnormal laboratory findings included fever
(91.9%), cough (83.9%), pharyngeal injection
(62.3%), rale (32.6%) and elevated CRP (93.9%).
The most common abnormalities in radiologic
findings were perihilar infiltrates and peribronchial
infiltrates (42.6%). Coinfections were observed in
29cases. The mean duration of hospitalization and
fever were 6.2В±6.5 days and 4.8В±3.1 days,
retrospectively.
Empirical
antibiotics
were
administered to 281cases and six patients were
transferred to the pediatric intensive care unit.
Patients who have underlying disease had
significantly longer duration of fever. URTI
patients of adenovirus have had severe morbidity
with the length of hospitalization being similar to
that of patients admitted for LRTI. No child died.
CONCLUSIONS: Our study demonstrated that
adenovirus is an important cause of hospitalization
in young children, which contributed to a
significant morbidity.
96
FP2-01
Kidney Involvement in Dengue
Patients: Is It Significant?
Prayong Vachvanichsanong1, Usa
Thisyakorn2, Chule Thisyakorn2
1
Department of Pediatrics, Chulalongkorn
University, Thailand.
2
Department of Pediatrics, Chulalongkorn
University, Bangkok, Thailand.
OBJECTIVE: To determine the prevalence of
kidney involvement in children with dengue infection
Thai children.
PATIENTS AND METHODS: A retrospective
review of the medical records of children diagnosed
with dengue infection aged less than 15 years in
Chulalongkorn Memorial Hospital, Bangkok,
Thailand, from 1987 – 2007 was conducted.
RESULTS: The records of 2221 patients (1106 boys
and 1115 girls) with mean age 8.4+3.8 (range 1
mo-15 yrs) were examined. All were confirmed as
having dengue infection by serologic and/or virologic
tests. Urinalysis had been performed in 1324 patients,
with abnormal findings in 377 patients (28.5%): 293
proteinuria (22.1%), 84 hematuria (6.3%), and 49
glycosuria (3.7%). Serum sodium and potassium had
been measured in 1249 patients. Electrolyte
imbalance was detected in 425 patients (34.0%): 248
hyponatremia (19.9%), 4 hypernatremia (0.3%), 145
hypokalemia (11.6%) and 63 hyperkalemia (5.0%).
AKI was detected in 3 cases (0.2%).The percentage
of patients with abnormal urinalysis increased with
dengue severity (p-value<0.001): dengue fever (DF)
(19.4%), dengue hemorrhagic fever (DHF) (27.0%)
and dengue shock syndrome (DSS) (36.7%). Higher
electrolyte imbalances were also associated with
dengue severity (p<0.001): DF (25.1%), DHF
(33.5%), DSS (39.8%).
CONCLUSIONS: Kidney involvement in children
with dengue infection is not rare, but is mostly mild
and non-specific, with main manifestations of
abnormal urinalysis and electrolyte imbalance. AKI is
very rare.
FP2-02
C-type Lectin Receptors Associated with
Dengue Hemorrhagic Fever Correlated
to Viral Replication and Immune
Augmentation
Kuender D. Yang, Lin Wang, Rong-Fu Chen,
Chiu-Ping Lee, Ya-Ting Lo, Yu-Ni Su, Ho-Chang
Kuo, Ing-Kit Lee, and Jien-Wei Liu
Departments of Pediatrics, Medical Research, and
Internal Medicine, Chang Gung Memorial
Hospital-Kaohsiung Medical center, Chang Gung
University, Kaohsiung, Taiwan
OBJECTIVE: Pathogenesis of dengue hemorrhagic
fever (DHF) is not fully understood. We have previously
found that DHF was significantly associated with
secondary dengue infections and type 2 T helper (Th2)
immune reactions both in cytokine profile and
transcription factor expression (Yang et al. J Med Virol
63:150-6, 2001 FEMS ImmunolMed Microbiol. 48:84-90,
2006). Further analysis identified another subclass of
dengue fever with bleeding manifestation, which is not
fulfilled with DHF, called DF w/B, had a similar Th1/Th2
cytokine profile to patients with DHF, but lower levels of
sVCAM-1 than the patients with DHF (Chen & Yang et
al. Trans R Soc Trop Med Hyg 101:1106-13, 2007). This
study was conducted to investigate whether human
genetic polymorphisms of C-type lectin receptors were
associated with DHF, viral replication and/or C-type
lectin receptor-mediated immune augmentation.
METHOD: Employing plasma and leukocytes from
patients with and without dengue fever in the 2002-2003
dengue-2 outbreak, we studied the viral load, immune
responses, polymorphisms of C-type lectin receptors:
DC-SIGN (CD209) and L-SIGN (CD299) and
receptor-mediated signal transduction.
MAIN
RESULTS:
We
found
that
certain
polymorphisms of C-type lectin receptors: DC-SIGN and
L-SIGN were significantly associated with DHF.
DC-SIGN promoter -336 A/G polymorphisms were not
only associated with the susceptibility of DHF but also
virus load and lower Th1 response. Studies of L-SIGN
neck tandem repeat polymorphisms showed that the neck
9-tandem-repeat polymorphism of L-SIGN was
significantly associated with the susceptibility of DHF,
and correlated to augmented MCP-1 and IL-6 production
mediated by Ras/Raf-1 signaling pathway.
CONCLUSION: We have demonstrated the unique
immunopathogenesis of DHF at C-type lectin
receptor-mediated immune augmentation over viral load,
which is different from other emerging infections
including enterovirus 71, SARS and pandemic
A(H1N1)09 flu that we encountered in the past
decade.
97
FP2-03
Diagnosing Chikungunya in Children
on the Basis of Fever and Arthralgia
Can Lead to A Misdiagnosis of
Dengue Viral Infection or Other
Febrile Illness
Kamolwish
Laoprasopwattana1;
Lamy
1
Keawjungwad , Roongrueng Jarumanokul2;
Alan Geater3
1
Department of Pediatrics, Prince of Songkla University,,
Thailand.
2
Department of Pathology, Prince of Songkla University,
Thailand
3
Epidemiology Unit, Prince of Songkla University, Thailand.
OBJECTIVE: To differentiate dengue viral
infection (DVI) from chikungunya (CHIK)
during a CHIK endemic and to determine
clinical outcomes and complications of DVI and
CHIK.
METHOD: A prospective cohort study in
children <15 years. Patients presenting with
fever <7 days with rash or limitation of activity,
arthralgia/arthritis or myalgia and living in the
CHIK endemic area in southern Thailand during
April-July 2009 were enrolled. Patients were
evaluated daily during the first week and then
weekly to determine the duration of fever,
arthralgia/arthritis,
skin
lesions
and
complications. Polymerase chain reaction (PCR)
or serology test were used to confirm CHIK and
DVI. Patients with negative results from PCR or
serology for CHIK or DVI were classified as
having another acute febrile illness (AFI).
RESULTS: During the CHIK endemic, 50
patients were suspected of having CHIK, of
whom 32 were confirmed to have CHIK, with
co-infection with DVI, DVI alone, and other
AFI in 1, 10, and 7 patients, respectively. Of the
32 patients who had CHIK, arthralgia/arthritis
was mild but 3 had complications - 1 with
mortal encephalitis, 1 with acute disseminated
encephalomyelitis, and 1 with chronic arthritis.
No serious complications were found in the DVI
and other AFI cases. When compared to the DVI
and other AFI cases, patients with CHIK were
more likely to see a physician sooner after
developing their fever (1.4 + 0.9, 2.6 + 1.3, and
4.0 + 2.8 days, p<.01), to have a shorter period
of fever (2.8 + 2.0, 4.2 + 1.5, and 4.9 + 3.9 days,
p=.06), higher number of limitations of
activity/arthralgia/arthritis (84.4%, 70.0%, and
57.1%, p<.01), skin rash (87.5%, 40.0%, and
28.6%, p<.01), higher white blood cell count (8,295
+ 5,194, 3,895 + 1,836, and 6,200 + 1,867
cells/mm3, p=.02), and higher platelet count
(258,656 + 67,577, 127,200 + 67,899, and 239,000
+ 71,450 cells/mm3, p<.01). Multivariate analysis
found that children who had fever <4 days, skin
rash, and white blood cell count (WBC) >5,000
cells/mm3 were more likely to have CHIK than
DVI with relative risk ratios (RRR) of 7.14, p=0.02;
RRR 25.14, p<.01, and 20.0, p<.01, respectively.
CONCLUSION: During a CHIK endemic, to
differentiate CHIK from DVI and other AFIs is
important. Clinical diagnosis based only on fever
and arthralgia/arthritis could lead to over-diagnosis
of CHIK. Patients who have fever >4 days, skin
rash, and WBC >5,000 cells/mm3 are more likely to
have CHIK than DVI.
98
FP2-04
Multiple Dengue Serotypes and High
Frequency of Dengue Hemorrhagic
Fever during 2008, Dengue Virus
Outbreak in Punjab, Pakistan
Malik Asif Humayun, Tariq Waseem, Javed
Akram
Pakistan
OBJECTIVE: The objective of the study is to
investigate the clinical and pathological profile
of the patients with Dengue viral infection
during the 2008 Dengue outbreak in the
Pakistan to see the disease severity and hence
better understand the changing clinical and
endemic pattern of the disease in this region of
the world.
METHODS: We collected and analyzed the
clinical and laboratory characteristics of 110
patients from special dengue ward of
two tertiary care hospitals of Lahore from
September to December 2008, after obtaining
informed consent. Clinically suspected cases
were confirmed by dengue virus serotyping on
PCR or positive serology for anti IgM, IgG or
both. Only confirmed cases of dengue were
included in our study. Laboratory investigations
carried out on admission and then followed
subsequently during their hospital stay included
FBC, PT, APTT, B/urea, S/Cr., S/Billirubin,
AST, ALT, S/Protein, S/Albumin, S/ electrolytes,
Urinalysis. All confirmed cases of dengue viral
infection were further classified, on the basis of
their clinical and pathological profile into
undifferentiated fever, classic dengue fever,
dengue hemorrhagic fever and dengue shock
syndrome.
RESULTS: Out of total of 110 patients, 70
were male and 40 were female. Common
symptoms included fever (100%), myalgia
(68.5%), headache (55.4%), nausea (39%) skin
rash (53.7%), and ocular pain (20%).
Hemorrhagic manifestations noted in 58.2% of
the patients and included, skin rash (51.8%),
epistaxis (15.5%), bruises (10%), hematuria
(9.1%), gingival bleed (8.2%), hemoptysis
(5.5%), hematemesis (2.7%), vaginal bleed
(2.7%),
hematochezia
(2.7%)
and
subconjuctival haemorrhage in only one patient.
Only 3.5% cases had severe hemorrhagic
complications, but responded well to
intravenous fluids, platelet concentrates and
whole blood transfusions.Classic DF was seen
in 36.4% of the patients whereas 63.6% had
DHF, and only 1.8% developed DSS. Mean
duration of fever was 6 days. Thrombocytopenia,
leucopenia and abnormal AST/ALT were more
severe in DHF and DSS as compared to DF. Viral
RNA detection was done by RT-PCR in 17
patients. Ten had DEN 4, five had DEN 2 and two
had DEN 3 serotypes.
CONCLUSIONS: Even though Dengue infection
has contributed to a significant proportion of
tropical illnesses in Pakistan, it has not received its
due share of attention by the government. High
frequency of DHF during 2008 outbreak and the
presence of three different dengue serotypes is
alarming and emphasizes upon prevention and
control of dengue infection, Health authorities
should consider strengthening the surveillance for
dengue infection, given the potential for future
outbreaks with increased severity. Primary care
physicians should be educated regarding early
recognition of DHF and to identification of the
patients at high risk.
99
FP2-05
Unusual Hepatic Manifestations of
Pediatrics Dengue Infection and
Significant Potential Risk Factors in
Thailand
Chokejindachai W.1, Supradish P.2,
Buensuceso JI.1, Chanthavanich P.1,
Kaewkungwal, J.1, Kalayanarooj, S.2
1
Department of Tropical Pediatrics, Mahidol
University, Bangkok, Thailand.
2
Queen Sirikit National Institute of Child Health,
Bangkok, Thailand.
Dengue infection has emerged as the most important
arboviral disease transmitted globally with increasing
severity and unusual manifestations. The objectives of
this study were to describe the incidence of unusual
and severe clinical manifestations of dengue infection,
describe the clinical course and to determine the
associated risk for unusual dengue.
Unusual dengue in this study refers to the unusual
hepatic manifestations of dengue, defined as Grade C
and Grade D liver damage or AST level of 3-10 times
and more than 10 times the normal reference value
for age and /or ALT of more than 100 U/L.
This case-control study was conducted at Queen
Sirikit National Institute of Child Health, Bangkok,
Thailand. Data were derived from the 469 in-patients
who had serology proven dengue infection and
admitted to the hospital and were further classified
into 112 unusual (hepatic) dengue infection and 357
classic dengue infection, during the period 1st January
2008-31st August 2008. Potential risk factors,
demographics, clinical manifestations, laboratory data,
outcome and diagnosis were collected.
The incidence of unusual (hepatic) dengue infection
was 22.4%, all fulfilled the inclusion criteria for
unusual gastrointestinal/hepatic manifestations in
dengue as used in this study. Those classified as
unusual hepatic dengue had more bleeding
manifestations, lower mean platelet level on
admission, and had higher number of shock cases. On
further analysis, duration of fever prior to admission
(≥ 4 days), the more severe dengue infection and age
(≤ 11 months old) were found to be a significant
factor to develop unusual (hepatic) dengue infection.
Lastly, due to the retrospective nature of this study
and the non-standardized set criteria used to define
unusual dengue, more studies should be done to
define the growing number of unusual manifestations
in dengue.
FP2-06
Analysis of Immune Function in
Patients with Hand, Foot and Mouth
Disease in Shanghai in 2009
YU Hui, Xiu-Feng Yan, Yi Yang
Department of Infection Diseases, Children’s
Hospital, Fudan University, Shangha, China
OBJECTIVE: To analyze the changes in immune
function of hospitalized children with hand, foot
and mouth disease during 4-7 months in 2009 in
Shanghai and its relationship with disease severity
and clinicalпјЋ
METHODS: We analyzed the levels of serum
immunoglobulin of 540 patients and lymphocyte
immunophenotypes of 286 patients in Fudan
University Children's Hospital, combing with
clinical and laboratory data for analysis.
RESULTS: The levels of IgG, IgA and IgM in 540
children of all age groups are higher than the
reference value of the same age group(P<0.05).As
the disease severity gradually increase the level of
the three immunoglobulin increase (P<0.05).Of all
the 286patients made routine detection of
peripheral
blood
lymphocyte,
he
CD3+,CD4+,CD8+,CD19+,
CD16+/56+absolute
count in 1-6 year-old male children and CD4+:CD8+
ratio are higher than the reference value of the same
age (P<0.05),the same as in 1-6 year-old female
children except CD8+,With disease progression,
CD3+, CD4+, CD8+ absolute count gradual
decline(P<0.05).
CONCLUSION: When suffering with hand, foot
and mouth disease, the humoral and cellular
immune are activated in the acute phase serum. But
immune function changed with different illness
phases. The humoral immunity are hyperfunction in
Children with severe cases, while the cell-mediated
immunity is lack of activation, Tipping that the
immune disorders may be may be related to the
disease development.
100
FP2-07
Inciedence Rates of Enterovirus 71
Infections in Young Children in
Taiwan, 2008-09
1,2
1,2
Min-Shi Lee , Pai-Shan Chiang , Shu-Ting
Luo1,2, Mei-Liang Huang1,2, Guan-Yuan
Liou1,2, Kuo-Chien Tsao3,4, Tzou-Yien Lin5
1
Vaccine Research and Development Center, National
Health Research Institutes (NHRI), Taiwan
2
Division of Infectious Diseases, NHRI, Taiwan
3
Department of Medical Biotechnology and Laboratory
Science, Chang Gung University, Taoyuan, Taiwan
4
Clinical Virology Laboratory, Department of Clinical
Pathology, Chang Gung Memorial Hospital (CGMH),
Taoyuan, Taiwan
5
Division of Pediatric Infectious Diseases, Department of
Pediatrics, Chang Gung Children’s Hospital (CGCH),
Taoyuan, Taiwan
OBJECTIVE: Enterovirus 71 (EV71) is causing
life-threatening disease in Asia. In Taiwan, nationwide
EV71 epidemics occurred cyclically but age-specific
incidence rates of EV71 infections that are critical to
estimate disease burden and design vaccine trials are not
clear. A nationwide EV71 epidemic occurred again in
2008-09, which provided a unique opportunity to
estimate age-specific incidence rates of EV71 infections
in Taiwanese young children.
METHODS: We prospectively recruited 749 healthy
neonates and conducted follow-ups from June 2006 to
December 2009. Sera were obtained from participating
children at 0, 6, 12, 24, and 36 months of age for
measuring EV71 neutralizing antibody titers. If the
participants developed suspected enterovirus illnesses,
throat swabs were collected for virus isolation.
Laboratory evidence of EV71 infection was defined as
the isolation of EV71 from a throat swab; or a
seroconversion in EV71 neutralizing antibody titers in
paired sera samples. Asymptomatic EV71 infection was
defined as a seroconversion in EV71 neutralizing
antibody titers in paired sera samples without
experiencing clinical symptoms during the period of
collection of paired sera.
RESULTS: Between January 2008 and December 2009,
307, 391, 294, and 66 children returned for follow-ups at
6, 12, 24, and 36 months of age, respectively. We
detected 28 EV71 infections including 20 symptomatic
and 8 asymptomatic infections. Age-specific incidence
rates of EV71 infection increased from 0.14 per 100
person-months at 0-6 months of age to 0.34, 0.48, and
0.41 per 100 person-months at 7-12, 13-24 and 25-36
months of age, respectively. Cumulative incidence rates
were 0.33, 1.28, 4.08, and 15.15 per 100 persons at 6, 12,
24 and 36 months of age, respectively.
CONCLUSION: Risk of EV71 infections in Taiwan
increased after 7 months of age during EV71 epidemics.
Cumulative incidence rate was about 15% by 36 months
of age and 29% of EV71 infections were asymptomatic
in young children, which are critical for designing
vaccine clinical trials and estimating disease burden.
FP2-08
Risk Factors Analyses of Enterovirus
Infection
Chia-Yunn Chuang, Ping-Ing Lee, Chun-Yi Lu, ,
Jong-Min Chen, Luan-Yin Chang, Li-Ming
Huang, Chin-Yun Lee
Department of Pediatrics, National Taiwan
University Hospital, Taiwan
OBLECTIVE:
Since the endemic outbreak of
severe enterovirus (EV) 71 infections in 1998, EV
infection has become a major issue in public health in
Taiwan. Several case-control studies had discussed the
risk factors of death in severe EV infections, but the
results were all inconclusive. The present study
analyzed the epidemiological data in different
administrative areas to delineate whether the local
features and public health risk factors contributed to
different incidence of severe EV infection. Besides,
we also investigated the serology data in some specific
areas to see the distributive tendency of EV 71
infection.
METHODS: We collected the whole severe EV
infection patients in all counties in Taiwan from 1998
to 2006 and the clinical presentation and serotypes
including EV 71 or others were recorded. Meanwhile,
we collected the cases of scarlet fever, dengue fever,
shigellosis and other statutory infectious diseases to
analyze the transmitting patterns and risk factors
compared with the enterovirus infection.
RESULTS: There was a significant difference among
the incidences of severe EV infections in children
under 5 years of age in different cities and counties.
The incidence of severe EV infections correlated
positively with the incidence of acute flaccid paralysis
(P=0.034) and Japanese encephalitis (P=0.039), but
not shigellosis (representative of fecal-oral
transmission) dengue fever (representive of
mosquitoes bite transmission). Severe EV infection
correlated positively with the number of peoples per
house (P=0.026), while it correlated negatively with
the foreign spouse (P=0.026) and the rate of literacy
(P=0.003).
CONCLUSION: The distribution of severe EV
infection in different counties was similar to acute
flaccid paralysis syndrome which hinted that the
enterovirus is important pathogen for acute paralysis
syndrome. The relationship of the severe EV infection
and the Japanese encephalitis may be explained by
similar tendency in rural areas. These results hinted
the transmission of the severe EV infection was not
only by the simple fecal-oral route. From the public
health viewpoint, the most important risk factors for
severe EV infection are the crowdedness of living
environment and poor socioeconomic condition.
101
FP2-09
Predictive Effect of Serial Serum
Alanine Aminotransferase Levels on
Spontaneous Hepatitis B Virus e
Antigen Seroconversion
FP2-10
Clinical Outcome and Risk Factors in
Hepatitis B Virus Related Hepatitis in
Infancy after Universal Hepatitis B
Vaccination
Jia-Feng Wu, Huey-Ling Chen, Yen-Hsuan
Ni, Hong-Yuan Hsu, Mei-Hwei Chang
Department of Pediatrics, National Taiwan
University Hospital, Taipei, Taiwan
Yu-Ru Tseng1, Huey-Ling Chen1, Fu-Chang Hu2,
Jia-Feng Wu1, Yen-Hsuan Ni1, Man-Shan Kong3,
Yao-Jong Yang4, Hung-Chang Lee5, Fu-Chen
Huang6, I-Fei Huang7, Wan-Hsin Wen8,
Hong-Yuan Hsu, 1, Mei-Hwei Chang1
BACKGROUND & AIMS: The study aimed to
investigate the association between serial serum
ALT and the occurrence of spontaneous hepatitis
B e antigen (HBeAg) seroconversion in chronic
hepatitis B virus (HBV) infected subjects.
METHODS:
One hundred and four
HBeAg-positive chronic HBV infected patients
were included into this long-term prospective
cohort study (mean initial age, 7.20 years).
Serial serum alanine aminotransferase (ALT)
levels and HBV serology markers were
measured at an interval of 6-12 months. The 104
subjects made a total of 2525 visits during the
study period, and the majority (93.6%) of visits
was within a 1-year interval apart from previous
medical visits. The Cox proportional hazards
model with time-dependent covariates adjusted
for the sampling plan of left-truncation and
right-censoring and a shared gamma-frailty term
among family members was used in the survival
analysis of HBeAg in these subjects.
RESULTS: During the chronic course of HBV
infection, the median remaining times to
spontaneous HBeAg seroconversion were 3.95,
3.42, 2.80 and 2.80 years after the serum ALT
levels crossed 60, 80, 150, and 200 IU/L,
respectively. The incidence rate of spontaneous
HBeAg seroconversion within 6 months when a
subject entered the phase of ALT between 60
and 150 IU/L was 5.57 times that of the phase
with ALT < 60 IU/L. The incidence rate of
HBeAg seroconversion once ALT levels were
above 150 IU/L was 9.87 times that of the phase
of ALT < 60 IU/L.
CONCLUSIONS: Serial serum ALT levels in
chronic HBV infected subjects offer a predictive
effect on the occurrence of spontaneous HBeAg
seroconversion.
1: Department of Pediatrics, National Taiwan University
Hospital, Taipei, Taiwan; 2. College of public health, National
Taiwan University, Taipei, Taiwan; 3. Department of Pediatrics,
Chang-Gung Children’s Hospital, Linkou, Taoyuan; 4. National
Cheng-Kung University Hospital, Tainan; 5. Mackay Memorial
Hospital, Taipei; 6. Department of Pediatrics, Chang-Gung
Children’s Hospital, Kaohsiung; 7. Department of Pediatrics,
Veterans General Hospital, Kaohsiung; 8. Department of
Pediatrics, Cardinal Tien Hospital, Taipei, Taiwan
OBJECTIVE:
Fulminant hepatitis (FH) caused by
hepatitis B virus (HBV) remained an important cause of
hepatic failure in infancy after universal vaccination. This
study aimed to analyze the clinical outcome and risk factors
in infants presenting with HBV -related hepatitis after
universal vaccination.
METHODS: Clinical data and outcome of 41 infants (32
males and 9 females) with hepatitis and positive hepatitis B
surface antigen (HBsAg) recruited from 6 tertiary referral
centers in Taiwan during 1986 to 2006 were analyzed
retrospectively.
RESULTS: Among the 41 case, 21 (51%) cases presented
with FH; 20 (49%) cases manifested with non-fulminant
hepatitis (NFH). Among the FH cases, 11 (55%) survived.
Eight (38 %) had seroclearance of HBsAg and 3 (14 %)
became chronic HBsAg carriers. Among the NFH cases, 13
(65%) had HBsAg clearance and 7 (35%) became chronic
carriers. Multivariate regression analyses was applied to
identify factors associated with the development of FH and
factors associated with prognosis (recovery, carrier and
mortality). Higher initial international normalized ratio
(INR), younger age of enrollment and negative maternal
hepatitis B e antigen (HBeAg) were associated with the
development of FH (p=0.03, p=0.03, p=0.01 respectively).
In the FH group, higher initial INR was associated with poor
prognosis (OR= 1.3, p=0.04). In the NFH group, high initial
alanine aminotransferase level was associated with HBsAg
clearance. (OR= 0.987, p=0.04).
CONCLUSION: Infants manifesting HBV-related hepatitis
may run a fulminant, acute-resolving, or acute-on-chronic
course. High initial international normalized ratio (INR),
young age of enrollment and negative maternal hepatitis B e
antigen (HBeAg) were independent important risk factors
associated with the development of FH in infants acquiring
HBV-related hepatitis.
102
FP2-11
Preemptive Therapy for
Cytomegalovirus Infections in
Children after Live Donor Liver
Transplantation
FP3-01
A Phage Gene PHLB Contributing to
Virulence in a Successful, Endemic
Clone Causing Pneumonia among
Children
Akihiko Saitoh, Seisuke Sakamoto, Shinya
Kamiyama, Akinari Fukuda, Takanobu
Shigeta, Tomohiro Katsuta, Kensuke Shoji,
Chikara Ogimi, Mureo Kasahara
Japan
Yu-Chia Hsieh,1 Tzu-Long Lin,2 Cheng-Hsun
Chiu,1 Yhu-Chering Huang,1 Jin-Town Wang2
1
Department of Pediatrics, Chang Gung Children's
Hospital, Chang Gung University, College of
Medicine, Taoyuan, Taiwan; 2Department of
Microbiology, National Taiwan University College
of Medicine, Taipei, Taiwan
INTRODUCTION: Controlling cytomegalovirus
(CMV) infection is the key to improve the
morbidity and mortality in children after liver
transplantation (LTx). The use of antivirals and
preventive strategies, including preemptive therapy
and universal prophylaxis, have led to a decrease
in the incidence of CMV diseases in adults;
however, little information is available regarding
the clinical outcome of preemptive therapy for
CMV infections in children after LTx.
METHODS: We retrospectively reviewed 96
children who received live donor LTx at the
National Center for Child Health and Development
in Tokyo between November, 2005 and August,
2009. CMV pp65 antigenemia (CMV-Ag) was
monitored weekly in all recipients despite their
CMV serostatus during the hospitalization and
monthly thereafter until 6 mo after LTx.
Ganciclovir (GCV, 5mg/kg/day every 12 hr for the
first 2 wk, followed by every 24 hr if necessary)
was initiated when CMV-Ag was positive
≥5/5X104 cells, or 1-4/5X104 cells along with any
symptoms and signs suspecting CMV diseases.
GCV was discontinued when CMV-Ag was
negative.
RESULTS: Median age of the recipients was 16
mo (range: 1 mo-21 yr). The success rate of LTx
was 91.7% and no death related to CMV diseases
was reported. Among 96 children, 36 (38%)
patients developed CMV-Ag and 31 (86%) patients
received GCV. The incidence of CMV-Ag
positivity based on recipients’ CMV serostatus was
as follows; D (Donor) +/R (Recipient)- 62%
(18/29), D+/R+ 36% (16/44), D-/R+ 11% (1/9),
D-/R- 8% (1/12). CMV diseases (n=6) including
CMV mononucleosis syndrome (n=3), hepatitis
(n=1), colitis (n=1), and pneumonia (n=1) were
reported; however, all patients were treated with
GCV successfully with excellent clinical
outcomes.
CONCLUSION: Preemptive therapy for CMV
infection after live donor LTx is successful to
control CMV diseases in children, even in the
recipients with high risk for CMV diseases.
OBJECTIVE: Streptococcus pneumoniae serotype 14
ST46 has been reported to spread and cause
pneumonia among children in a medical center in
Taiwan. It was also the most common clone associated
with complicated pneumococcal pneumonia. Genetic
factors contributing to clonal success of this particular
clone was not well understood.
METHODS: We collected cases of culture-proven
pneumococcal pneumonia between January 2001 and
December 2005 in Chang Gung Children's Hospital to
describe the molecular epidemiology of childhood
pneumococcal pneumonia. Using DNA microarray
constructed from a clinical isolate of serotype 14
ST46, genomic differences between serotype14 ST46
and three non-ST46 clones (serotype 14 ST329,
serotype 23F ST83, and serotype 19F ST236) were
analyzed.
MAIN RESULTS: A total of 81 cases of
culture-proven pneumococcal pneumonia were
identified during the study period. Serotype 14 ST46
was the largest clone among cases of culture-proven
pneumococcal
pneumonia
and
complicated
pneumococcal pneumonia. Microarray comparison
revealed 9 clones with significantly increased
hybridization signals in the serotype 14 ST46 strain. A
phage virulence gene pblB, encoding a large surface
protein, was studied the role in virulence. All isolates
of serotype 14 ST46 carried pblB gene by PCR
analysis. PblB deficient mutant showed significantly
decreased adherence to and invasion of epithelial cell
lines A549 and HEp-2. Competitive experiments
showed pblB deficient mutant was out-competed by
wild type in murine models of nasopharyngeal
carriage and pneumonia.
CONCLUSION: Our results suggest that PblB play
a role in pneumococcal colonization and pneumonia.
PblB promote S. pneumoniae adherence and invasion
to host cell, contributing to the clonal expansion of
serotype 14 ST46 in children in Taiwan.
103
FP3-02
Invasive Pneumococcal Disease in
Children Caused by Non 7-Valent
Pneumococcal Vaccine (PCV7)
Coverage Serotype
Ching-Fen Shen1, Kuan-Hsien Lee1,
Tzong-Shiann Ho2, Shih-Min Wang2, and
Ching-Chuan Liu1, 3
Department of Pediatrics 1, Emergency Medicine 2
and Center for Infection Control3, National Cheng
Kung University and Hospital, Taiwan
OBJECTIVE: The most common pneumococcal
serotypes found in the pediatric population are also
the serotypes that are the most likely to develop
antibiotic resistance and complications. The 7-valent
pneumococcal conjugate vaccine (PCV-7) had been
introduced into Taiwan since 2005 and successfully
reduced the incidence of invasive pneumococcal
diseases (IPD). The aim of this study is to evaluate
the change of serotype distribution of IPD and
compare the clinical manifestation of IPD caused by
PCV-7 coverage serotypes and non PCV-7 coverage
serotypes.
METHODS: All children under 18 years who was
diagnosed as IPD at National Cheng Kung University
Hospital from Feb. 1998 to Feb. 2010 were enrolled.
All invasive isolates (including blood, cerebral spinal
fluid, pleural effusion, ascites and synovial fluid)
were collected. The isolates were tested for penicillin
susceptibility by agar dilution method and interpreted
by Clinical Laboratory Standard Institute guidelines
(2008). Serotypes were determined using the capsular
swelling method (Quellung reaction). Demographic
and clinical information were collected from chart
review.
MAIN RESULTS: One hundred and five patients
with IPD were identified, including 75 PCV-7
coverage isolates and 30 non PCV-7 coverage isolates.
PCV-7 coverage IPD isolates was 77.1% from 1998
to 2005, but decreases to 55% after 2006. The overall
incidence of IPD also decreased after 2006. There is
no difference among demographic data, underlying
diseases or vaccination history between children
infected with PCV-7 coverage serotypes and non
PCV-7 coverage serotypes. Pneumonia (63.3%)
accounts for the majority of IPD in non PCV-7
coverage group. Non PCV-7 coverage serotype
pneumonia had higher complication rate (68.4%),
such as empyema, necrotizing pneumonia or lung
abscess than those caused by PCV-7 coverage
serotypes (50%, P=0.02). Among the non PCV-7
coverage serotypes, serotype 3 is responsible for the
major complicated pneumonia, whereas serotype 19A
is associated with increased penicillin resistance.
CONCLUSION: Although PCV-7 coverage serotype
is responsible for 71.4% pediatric IPD. Serotype 3
and 19A, which are not included in PCV-7, are now
becoming the important serotypes responsible for
pediatric complicated pneumonia.
FP3-03
Changes in the Nasal Colonization with
Staphylococcus Aureus in Children:
2004-2009
Wen-Tsung Lo, Ching-Feng Huang, Shyi-Jou Chen,
Chih-Chien Wang
Department of Pediatrics, Tri-Service General
Hospital, National Defense Medical Center, Taipei,
Taiwan
OBJECTIVE: Staphylococcus aureus is an
important cause of infection, particularly in persons
colonized with this organism. We sought to define
the prevalence of and risk factors for
methicillin-resistant S. aureus (MRSA) nasal
colonization in the Taiwanese pediatric population
from 2004 through 2009.
METHOD: Children from birth to ≤14 years of
age presenting for health maintenance visits or
attending 1 of 57 kindergartens were recruited.
Nasal swabs were obtained, and a questionnaire
was administered. The prevalence and molecular
characteristics of MRSA colonization were
calculated for two 3-year periods: first period,
2004-2006 and the second period, 2007-2009.
MAIN RESULTS: A total of 824 (25.8%) of 3200
children had nares cultures positive for S. aureus,
and 371 (11.6%) were colonized with MRSA. The
prevalence of colonization with S. aureus decreased
from 28.1% in 2004-2006 to 23.3% in 2007-2009
(p < 0.01), whereas the prevalence of colonization
with MRSA increased from 8.1% to 15.1% (p <
0.0001). By multivariate analysis, independent risk
factors for MRSA carriage were different for male
and female children with various age groups. Most
MRSA isolates belonged to sequence type 59
(ST59) (86.3%), however, a multiresistant MRSA
clone with ST338 background emerged among
community children in 2007-2009. Ten (66.7%) of
the 15 MRSA isolates expressed the genotypic
profile ST338/staphylococcal cassette chromosome
mec
VT/Panton-Valentine
leukocidin-positive/staphylococcal
enterotoxin
B-positive, and differed only by their antimicrobial
susceptibility patterns.
CONCLUSION: Nasal colonization with MRSA
has increased among healthy Taiwanese children in
the past three years, despite an overall decrease in
nasal colonization with S. aureus. A multiresistant
MRSA clone characterized as ST338 was identified
from these children in Taiwan
104
FP3-04
Factors Associated with Nasal
Colonization of Methicillin-Resistant
Staphylococcus Aureus among
Healthy Children in Taiwan
Chih-Jung Chen1,2, Kuang-Hung Hsu3,
Tzou-Yien Lin1,2, Kao-Pin Hwang4, Po-Yen
Chen5, Yhu-Chering Huang1,2
1
Divisions of Pediatric Infectious Diseases, Department of
Pediatrics, Chang Gung Memorial Hospital, 2College of
Medicine, Chang Gung University, 3Laboratory for
Epidemiology and Department of Health Care Management,
Chang Gung University, 333 Taoyuan Taiwan
4
Department of Pediatrics, Chang Gung Memorial Hospital,
Kaohsiung branch, Kaohsiung, Taiwan
5
Department of Pediatrics, Taichung Veterans General
Hospital, Taichung, Taiwan
BACKGROUND:
Methicillin-resistant
Staphylococcus aureus (MRSA) has been
identified
as
a
major
cause
of
community-associated (CA) S. aureus infections in
the past decade. The main reservoir in the
community for MRSA and the factors contributing
to its worldwide spread remained poorly defined.
METHODS: A total of 6057 healthy children 2 to
60 months of age were screened for carriage of S.
aureus and Streptococcus pneumoniae in Taiwan
between July of 2005 and June of 2008. The
prevalence and epidemiological factors influencing
MRSA carriage were determined. MRSA strains
were tested for antimicrobial susceptibility.
RESULT: The overall prevalence of MRSA and S.
aureus carriage were 7.8% and 23.2%, respectively.
A majority (88.8%) of MRSA isolates were
resistant to multiple non-beta-lactam antibiotics.
The carriage rate of MRSA was higher among
subjects 2-6 months old (p<0.0001), residing in
northern Taiwan (p=0.0003), and enrolled later in
the study (p<0.0001). MRSA colonization was
associated with number of children in the family
(odds ratio [OR] 1.114, 95% confidence interval
[CI] 1.002-1.240, p=0.0463) and day-care
attendance (OR 1.530, 95% CI 1.201-1.949,
p=0.0006). Breast feeding (p<0.0001) and
colonization with S. pneumoniae (p=0.0170) were
protective against MRSA colonization.
CONCLUSIONS: Epidemic CA-MRSA strains
increasingly colonized Taiwanese children between
2005 and 2008. The carriage rate varied
significantly across different demographical
features. Crowding was an independent
environmental risk factor which might accelerate
CA-MRSA transmission in the community.
FP3-05
Antimicrobial Susceptibility and
Molecular Characterization of
Streptococcus Pyogenes from Children
in Southern Taiwan: Trend of
Erythromycin-Resistance
Kuan-Hsien Lee1, Tzong-Shiann Ho2, Ching-Fen
Shen1, Shih-Min Wang2, and Ching-Chuan Liu1,3
Department of Pediatrics 1, Emergency Medicine 2
and Center for Infection Control3, National Cheng
Kung University and Hospital, Taiwan
OBJECTIVE: High erythromycin resistance rates of
Streptococcus pyogenes (group A streptococci, GAS)
have been reported since mid-1990s in Taiwan. The
present study was conducted to determine the
antimicrobial susceptibility profiles of isolates in
southern Taiwan, and to identify mechanisms and
molecular characterization of erythromycin-resistant
isolates.
METHODS: Isolates were collected from clinical
specimens of children (<18 years) by a longitudinal,
hospital-based surveillance of GAS from 1997 through
2009. Susceptibility test of antimicrobial agents was
determined
by
agar
diffusion
method.
Erythromycin-resistant phenotypes were determined by a
double disk-diffusion test, genotypes were detected by
polymerase chain reaction (PCR) assay, and emm
genotyping were further accessed for epidemiology
survey.
RESULT: Among 277 GAS clinical isolates recruited,
susceptibility test for erythromycin, azithromycin,
clindamycin, tetracycline, and chloramphenicol was
interpreted by Clinical Laboratory Standard Institute
guideline (2010). Of 71 (25.6%) erythromycin
non-susceptible strains, emm12 (38.0%) and emm4
(32.4%)
were
the
predominant
subtypes.
Erythromycin-resistant genotype of these isolates showed
that 50 (70.4%) exhibited mefA, 13 (18.3%) exhibited
ermB, 7 (5.7%) exhibited ermTR and one (1.4%)
exhibited mefA/ermB. The prevalence of erythromycin
resistance decreased from 79.2% during 1998-1999 to
11.1% during 2002-2003 but increased to 14% during
2006-2009. The similar trend of antibiotics resistance to
clindamycin, chloramphenicol, and tetracycline was also
observed and all above antibiotics resistance were
increased in 2008. Conclusion Although the rate of
erythromycin resistance among GAS decline to10% from
1997 to 2005, increased resistance rate to 14% was
observed in recent four years from 2006 to 2009 in
southern Taiwan during 13-year study. Among
erythromycin resistant strains, mefA type remained the
major mechanism and emm4 and emm12 were the main
subtypes. The changes in the incidence of erythromycin
resistance observed warrants periodic surveillance of
antibiotic susceptibility of GAS.
105
FP3-06
Excess Morbidity of Pertussis among
Japanese Infants: Analysis Using an
Administrative Database
FP3-07
Treatment of Children with Typhoid
Fever: A Comparative Trial of
Cotrimoxazole and Ampicillin
Masato Takeuchi, Hideo Yasunaga, Hiromasa
Horiguchi, Shinya Matsuda
Japan
Dilini
Vasana
Kiridana,
Jeysuda
Sudharman, Nusra Mam Begum
BACKGROUND: Data on the epidemiology of
pertussis are not fully available in Japan. The
aims of this study were to clarify the incidence
and clinical features of pertussis among
Japanese infants using an administrative
database.
METHODS:
We
examined
pertussis
hospitalization among infants aged 0 to 11
months between 2006 and 2008 using a
nationally
representative
hospitalization
discharge database (Diagnosis Procedure
Combination database: DPC database). We also
examined
pertussis
complications
and
procedures using the DPC database.
RESULTS: A total of 660 infants hospitalized
for pertussis were identified. The peak incidence
was 1 month of age and 44.5% (294/660) of
pertussis hospitalizations involved infants aged
0 to 2 months who were too young to be
vaccinated. However, 55.5% (366/660) of
hospitalizations were infants aged ≥3 months
who were eligible to have received at least one
dose of pertussis vaccine. Complications were
found in 165 patients (25.0%). However, the age
at admission did not differ significantly between
patients with and without complications (mean
age: 4.1 vs. 4.5 months, P = 0.12). Seventeen
patients required mechanical ventilation. Among
the 17 patients requiring mechanical ventilation,
14 infants were <3 months of age while 3
infants were ≥3 months of age and thus eligible
for pertussis vaccination. We found one
pertussis-related death (1 month of age).
CONCLUSIONS:
Our data show that,
compared with previous reports in other
countries, excess morbidity of pertussis was
observed among Japanese infants, especially in
infants aged ≥3 months who were eligible for
the first dose of pertussis vaccine. Despite the
lack of information of vaccination status in our
data, this excess morbidity is most probably
explained by delays in receiving the first dose of
diphtheria-tetanus-pertussis
vaccine.
The
vaccination strategy against pertussis in Japan
should be reevaluated based on our data.
OBJECTIVE: The launch of the humanitarian rescue
operation in the north of Sri Lanka which lasted 14 months
in the process of ending up the civil war between the
government and the LTTE resulted in displacement of nearly
300,000 civilians who were placed in temporary settlement
camps in Vavuniya district. Suboptimal living conditions
resulted in several outbreaks of infections. General Hospital
Vavuniya experienced an outbreak of typhoid fever and the
paediatric ward housed about 500 patients with the infection.
General Hospital Vavuniya does not have microbiological
facilities. We depend on the standard agglutination test(SAT)
for the diagnosis of typhoid fever. With the help of a tertiary
hospital, we were able to isolate the causative organism
Salmonella typhi in some blood cultures which was sensitive
to cotrimoxazole, ampicillin, cefotaxime and ceftriaxone.
Since several patients developed allergic reactions to
cefotaxime and ceftriaxone treatment was confined to
cotrimoxazole and ampicillin. We observed incidentally that
patients improve earlier when treated with cotrimoxazole.
Therefore we decided to investigate this scientifically by
carrying out a randomized controlled trial.
METHODS: A total of 124 cases of typhoid were included
in this study consisting of an age range from 1 to 12 years.
All patients with the most likely clinical diagnosis is typhoid
fever were randomly allocated either to oral cotrimoxazole
or intravenous ampicillin. All patients underwent SAT.
Blood culture was performed in a limited number. Sixty one
patients received ampicillin and 63 received cotrimoxazole.
The primary outcome measure was taken as the duration
taken for complete resolution of fever. Development of
disease related complications was considered the secondary
outcome measure.
RESULTS: The mean number of days taken for fever to
decline was 8.02В±4.02 days for cotrimoxazole and 5.43В±3.13
days for ampicillin (p=0.000). The percentages suffered from
complications during ampicillin therapy and cotrimoxazole
was 14.8% and 6.3% respectively with a significant
difference between proportions (P<0.05).
CONCLUSION: Treatment with cotrimoxazole was found
to be significantly better compared to treatment with
ampicillin.
RECOMMENDATION: Typhoid fever is a preventable
disease by improving water and food sanitation and also by
vaccination. Implementation of personal hygienic practices
in the setting of temporary settlement camps with limited
facilities is not an easy task. Therefore, vaccination of
children at the earliest opportunity has to be considered as a
more suitable option in such situations.
devi
Sri Lanka
106
FP3-08
Immunogenicity and Safety of a
PHID-CV Booster Dose
Co-Administered with A Candidate
Meningococcal Tetanus Toxoid
Conjugate Vaccine (MENACWY-TT)
in Children Previously Primed with
PHID-CV
LM Huang,1 G Ruiz-Palacios,2 TY Lin,3 L
Hernandez,4 ML Guerrero,2 A
Lavalle-Villalobos,4 M Moreira,5 V Bianco,5 D
Borys,5 M Van Der Wielen,5 J Miller5
1
National Taiwan University Hospital, Taiwan; 2Instituto
Nacional de Ciencias MГ©dicas y NutriciГіn Salvador ZubirГЎn,
Mexico; 3Chang Gung Children’s Hospital, Chang Gung
University College of Medicine, Taiwan; 4Hospital General
Dr. Manuel Gea GonzГЎlez, Mexico; 5GlaxoSmithKline
Biologicals, Wavre, Belgium
OBJECTIVE: To investigate a booster dose of
pneumococcal non-typeable H. influenzae protein D
conjugate vaccine (PHiD-CV) co-administered with a
candidate meningococcal tetanus toxoid conjugate
vaccine (MenACWY-TT) vs PHiD-CV alone (both GSK
Biologicals, Belgium).
METHODS: In an open study, Mexican and Taiwanese
children aged 12–23 months primed with 3 doses of
PHiD-CV in the first year of life were randomised 2:1:1
to receive PHiD-CV + MenACWY-TT (Co-ad group),
MenACWY-TT then PHiD-CV (MenACWY group), or
PHiD-CV then MenACWY-TT (PHiD-CV group), 1
month apart. Anti-pneumococcal immune responses were
measured 1 month post-booster using 22F-inhibition
ELISA and opsonophagocytic activity (OPA) assay.
Non-inferiority was achieved if the lower limit (LL) 95%
CI of the antibody geometric mean concentration (GMC)
ratio between the Co-ad and PHiD-CV groups was >0.5
for
each
vaccine
pneumococcal
serotype.
Solicited/unsolicited symptoms were recorded for 4 and
31 days post-vaccination, respectively.
MAIN RESULTS: The pre-defined criterion for
non-inferiority was met for all vaccine pneumococcal
serotypes apart from 18C (LL=0.41). However, for all
vaccine pneumococcal serotypes, antibody GMCs were
5–22 fold higher post-booster than pre-booster (12.4 fold
higher for 18C; Co-ad group). All children reached
antibody concentrations ≥0.2 µg/mL, except for 6B
(≥96.0%) and 23F (≥97.5%), and ≥92.9% of children
reached OPA titres ≥8 in each group post-booster. In each
group, for cross-reactive serotypes 6A and 19A,
respectively, at least 85.5% and 90.8% of children
reached antibody concentrations ≥0.2 µg/mL, and at least
82.4% and 70.2% of children reached OPA titres ≥8. No
vaccine-related SAEs were reported and all SAEs
resolved without sequelae.
CONCLUSIONS: PHiD-CV elicited robust booster
responses for all vaccine pneumococcal serotypes and
cross-reactive serotypes 6A/19A when co-administered
with MenACWY-TT, and was well tolerated in children
aged 12–23 months.
FP4-01
Disseminated Bacillus Calmette–Guérin
Infection: Description and Report of
Sixteen Cases
Anahita Sanaei Dashti, Abdollah Karimi
Mofid Children Hospital,Shahid Beheshti
University of Medical Sciences,Tehran ,Iran.
BACKGROUND AND AIMS: There is some
evidence that hematogenous dissemination of the
bacilli
does
occur
following
Bacillus
Calmette–Guérin (BCG) vaccination to many
organs, a process that may lead to disseminated
BCG infection in certain instances. The aim of this
study was to assess the epidemiologic, clinical and
laboratory characters of the patients with
disseminated BCG infection
METHODS: Patients with the final diagnoses of
disseminated BCG infection, admitted in Mofid
Children Hospital, during a 5 yr period from
mid-2003 to mid 2009, were studied.
RESULTS: Sixteen patients, with the age range of
1 to 32 months were enrolled. Male to female ratio
was 5:3. All were vaccinated with BCG at
birth .The most common symptoms were fever,
malaise and FTT, respectively in 90%, 75% and
75% of cases. Hepatosplenomegaly and various
skin
lesions,
generalized
and
axillary
lymphadenopathy were present in 50%, 62%, 95%,
and 50% of patients respectively.All the patients
had anemia, elevated ESR and positive CRP and
liver function tests were abnormal in half of them.
Immunologic work up revealed a variety of
deficiencies including humoral abnormalitities,
IL-12
deficiency,
severe
combined
immunodeficiency and chronic granuloma to us
disorder. Microbiologic and histologic tests had
56.5% yield that reached to 68.7% after
autopsy .Treatment strategy was to
Prescribe
at least four anti-mycobacterium drugs beside
Gamma-Interferon , IVIG and GM-CSF in some
instances В·
CONCLUSIONS: Disseminated BCG infection
should be considered in any child presenting with
fever, malaise and hepatosplenomegaly.
107
FP4-02
Medicinal
Plants
in
Treating
Multi-drug Resistant Tuberculosis:
An Ethnographic Case Study from
Kishoreganj District in Bangladesh
Md. Ariful Haque Mollik
Peoples Integrated Alliance, Epidemiology, Biostatistics,
Community Nutrition and Noncommunicable Diseases,,
Bangladesh
Tuberculosis is an age-old contagious disease, which
often leads to fatality if not treated properly. Recently,
there has been increasing concerns because the organism
causing this disease has become multi-drug resistant. As
a result, searches are underway throughout the world for
discovery of novel compounds, which can be used
successfully to treat multi-drug resistant tuberculosis.
Since this disease is prevalent in Bangladesh and is often
treated with medicinal plants by the traditional medicinal
practitioners, it has become essential to gather
information on medicinal plants used in multi-drug
resistant tuberculosis for such medicinal plants can form
novel sources of new drugs and important
pharmacological constituents or lead compounds.
Towards obtaining such information, the present
ethnopharmacological survey was carried out in
Kishoreganj district of Bangladesh. Extensive interviews
were conducted of the traditional medicinal practitioners
and information collected as to medicinal plants or plant
parts used and the ailments treated. The interview
schedule was prepared, tested on a small sample, and
then data collection was done. The traditional medicinal
practitioners described the signs, symptoms, and causes
of multi-drug resistant tuberculosis. All medicinal plants
were identified and vouchers were stored at the
Bangladesh National Herbarium; under the author's
collector series. Information on twenty-four medicinal
plants was obtained. The collected information indicates
that the following medicinal plants are used to treat
multi-drug resistant tuberculosis: Acorus calamus (L.),
Eucalyptus globulus Labill., Aloe vera (L.) Burm.f.,
Justicia adhatoda (L.), Plantago ovata Forssk., Madhuca
longifolia (J.Konig) J.F.Macbr., Cocos nucifera (L.),
Ocimum gratissimum (L.), Saccharum officinarum (L.),
Ricinus communis (L.), Abrus precatorius (L.), Swertia
chirata Buch.-Ham., Citrus acida Roxb., Allium sativum
(L.), Emilia sonchifolia (L.) DC. ex Wight, Piper longum
(L.), Cinnamomum camphora (L.) Sieb., Piper betle (L.),
Cymbopogon citratus (DC.) Stapf, Scoparia dulcis (L.),
Vitis vinifera (L.), Nigella sativa (L.), Millettia pinnata
(L.) Panigrahi, and Maranta arundinacea (L.). It was
noted in this ethnopharmacological survey that the
patients were quite satisfied with treatment by the
traditional medicinal practitioners. It is important that
modern scientific studies be conducted on these
medicinal plants towards isolation and identification of
compounds through which multi-drug resistant
tuberculosis can be effectively treated.
FP4-03
Two Independent Cases of Interferon-Оі
Receptor 1 Deficiency with Mutiple
Osteomyelitis
Obinata Kaoru1,2, Kamata Ayako1, Lee Tsubasa1,
Niizuma Takahiro1,Kinoshita Keiji1, Mihara
Yuka3
1.Department of Pediatrics, Koshigaya Municipal Hospital,
Saitama, Japan; 2.Department of Pediatrics, Juntendo Urayasu
Hospital, Chiba, Japan; 3.Department of Pediatrics, Graduate
School of Medical Science, Kyushu University, Fukuoka, Japan
INTRODUCTION: Interferon (IFN)-Оі mediated
immunity plays an important role in host defense
against
intracellular
pathogens,
especially
mycobacteria. We experienced two unrelated Japanese
children with Bacille Calmette-GuГ©rin (BCG)
osteomyelitis and partial dominant IFN-Оі receptor 1
deficiency.
PATIENTS AND CLINICAL DETAILS: Case 1. An
18-month-old girl developed lymphadenitis 2 months
after BCG inoculation, and multiple skin eruptions
and abscesses appeared 9 months after the vaccination.
X-ray films and MR imaging showed multiple
osteolytic lesions in the skull, ribs, femur and
vertebrae. Cultures from a bone biopsy grew M.bovis.
A combination therapy of isoniazid, rifampicin, and
streptomycin was started, but osteolytic lesions
appeared
recurrently.
Additional
ethanbutol,
clarithromycin and interferon-Оі administration were
necessary to control the intractable osteomyelitis.
Case 2. A 2-year-old boy presented with limitation in
rotation of the neck and persistent fever nine months
after BCG vaccination. Radiographic studies showed
multiple destructive bone lesions, and the cultures
from a bone biopsy grew M.bovis. The BCG
osteomyelitis was successfully treated with
antimycobacterial therapy for one and half years. He
has been well, since then, without evidence of
recurrence.
METHODS: Genomic DNA was obtained from
peripheral blood mononuclear cells. cDNA sequences
were analyzed by polymerase chain reaction.
Two-color flow cytometric analysis was performed.
RESULTS: Heterozygous small deletions with frame
shift (Case 1: 811del4 and Case 2: 818del4) were
detected, which were consistent with the diagnosis of
partial dominant INF-Оі receptor 1 deficiency. IFN-Оі
receptor 1 expression on the monocytes was increased
significantly in both cases.
DISCUSSION: IFN-Оі receptor 1 deficiency is a rare
disorder that should be considered when the patients
exhibit BCG lymphadenitis and disseminated
osteomyelitis. This type of immunodeficiency tends to
exhibit recurrent mycobacterial infection and
resistance to antimycobacterial therapy.
108
FP4-04
Body Mass Index as a Significant
Predictor for Survival of Children on
Antiretroviral Treatment: A
Five-Year Follow-Up Study in Malawi
FP4-05
The Pharmacokinetics of
Lopinavir/Ritonavir Twice Versus Once
Daily in Treatment-Experienced
HIV-Infected Children
Solomon Chih-Cheng Chen1,2, Joseph
Kwong-Leung Yu1, Jung-Der Wang2
1
Pingtung Christian Hospital, Pingtung, Taiwan
2
Institute of Occupational Medicine and
Industrial Hygiene, College of Public Health,
National Taiwan University, Taipei, Taiwan
Kulkanya Chokephaibulkit1, Maneeratn
Nuntarukchaikul1, Tim R. Cressey2,
Wanatpreeya Phongsamart1, Orasri
Wittawatmongkol1, Nirun Vanprapar1
OBJECTIVES: Among children on antiretroviral
treatment (ART) (1) to identify risk factors
associated with their mortality; and (2) to assess
body mass index (BMI) as a prognostic indicator
and to determine any threshold for premature
mortality.
DESIGN AND SETTING: An observational
follow-up study of ART clinic at Mzuzu Central
Hospital, Malawi.
METHODS: Children with age less than 15 years
who started ART during September 2004 and
December 2006 were followed up until August
2009; mortality was determined and risk factors
were explored through construction of Cox
proportional hazards model.
RESULTS: Among 505 children (263 boys), there
were a total of 82 (16.2%) deaths, of which 69
(84.1%) died in the first year of initiating ART.
After starting ART, children’s nutrition seemed to
improve within three months. The receiver
operating characteristic curves analysis found BMI
14.7 kg/m2 at the beginning of starting ART has the
best predictability for children mortality. The Cox
model found BMI ≦14.7 kg/m2 and WHO stage
IV were two significant risk factors both with
about three times of higher risk of mortality.
Furthermore, Kaplan-Meier survival analysis for
the cohort stratified by the WHO staging and BMI
showed that stage IV children did not suffer from
any more premature mortality if their BMI were
>14.7 kg/m2.
CONCLUSIONS: Malnutrition is a prerequisite
for children with advanced clinical disease to die.
Severe malnutrition, indicated by BMI <14.7
kg/m2, may be the most significant prognostic
indicator for premature mortality in children on
ART. The first three months after ART is the
golden period for nutrition assessment and
intervention, especially for malnourished children.
Early and proper nutrition support should be
integrated with ART management in order to avoid
some early deaths of children.
1
Department of Pediatrics, Faculty of Medicine Siriraj
Hospital, Mahidol University, Bangkok, Thailand
2
Department of Medical Technology, PHPT-IRD, Faculty
of Associated Medical Sciences, Chiang Mai University,
Thailand
OBJECTIVE: To evaluate the pharmacokinetic of
lopinavir/ritonavir (LPV/r) in once daily dosing
schedule. This is the pilot study of once daily LPV/r
dosing in HIV-infected children on stable Highly
Active Antiretroviral Therapy (HAART) in order to
simplify salvage treatment in children.
METHODS: HIV-infected children who had an
HIV-1 RNA viral load < 40 copies/mL for at least 6
months while receiving a LPV/r, twice daily, HAART
regimen were enrolled. Intensive PK blood sampling
to assess LPV/r pharmacokinetics was performed and
then the LPV/r dose was changed to once daily, in the
evening, at the equivalent daily dose. Intensive PK
blood sampling was repeated 2 weeks later. PK
parameters were calculated using non-compartment
methods.
RESULTS: Eight children (3 males) were enrolled.
Median (range) age was 12.9 (9.3-17.7) years weight
37.5 (26.8-50.2) kg, and CD4 cell count was 819
cells/mm3 (23.53%) six children were also
concomitantly receiving efavirenz. Area under the
concentration-time curve (AUC0-24h) was 148.4
(94.8-181.7) mcg*hr/mL and 169.7 (123.8-200.4)
mcg*hr/mL for once and twice daily, respectively.
Median LPV peak concentrations were 13.1 (8.5-15. 6)
mcg/mL once daily versus 9.8 (8.6-12.9) mcg/mL
twice daily. LPV minimum concentrations (Cmin) were
significantly lower following once daily compared to
twice daily dosing 0.2 (0.08-2.0) mcg/mL versus 3.0
(1.2-6.5), respectively. All children maintained a
HIV-1 RNA viral load <40 copies/mL after 12 weeks
of once daily dosing. No adverse event related to the
LPV/r once daily dosing schedule were reported.
CONCLUSION: Our study suggests that LPV/r once
daily dosing results in adequate LPV drug exposure
and short term virologic response. A larger efficacy
trial with longer virologic and immunological
follow-up is warranted.
109
FP4-06
The Strategy for Reduction of
Antibiotics Use in New Patients
Admitted to Neonatal Intensive Care
Unit
Yung-Ning Yang1, Hsing-I Tseng1, San-Nan
Yang1, Chu-Chong Lu1, Hsiu-Lin Chen1,2
1
Department of Pediatrics, Kaohsiung Medical University
Hospital, Kaohsiung, Taiwan; 2Department of Respiratory
Therapy, College of Medicine, Kaohsiung Medical
University, Kaohsiung, Taiwan
OBJECTIVE: To reduce unnecessary antibiotics use,
we developed a “Neonatal bacterial infections screening
scores” for each new patient admitted to the neonatal
intensive care unit (NICU) to guide antibiotics use.
METHODS: “Neonatal bacterial infections screening
scores” was designed based on maternal risk factors,
clinical presentations, and laboratory data, total 24 items.
Each item gained one point if it was positive. The total
scores for each new patient were calculated at the time of
admission. The first period of study (Jan. 2009 to Dec.
2009) was an observational survey. The bacterial
infection (BI) group was defined by positive blood
culture, urine culture, CSF culture, or pneumonia which
diagnosed by chest X ray. Receiver-operating
characteristic (ROC) curves was used to determine the
best cut-off values of “Neonatal bacterial infections
screening scores” for diagnosis of BI. In the second
period of study (Jan. 2010 to May 2010), the cut-off
values of scores would be provided to guide antibiotics
use. Physicians could be able to adjust their decision
making with using this guideline.
RESULTS: Of 253 neonates admitted to NICU, 240
(94.9%) received antibiotics during the first period of
study. There were 29 (11.5%) patients in BI group and
224 (88.5%) in non-BI group. The original total scores
were not statistically different between BI and non-BI
groups (total scores, meanВ±SD, 4.0В±2.6 vs. 3.6В±2.3,
p=0.35). For increasing difference of scores between
these two groups, we weighted the item of CRP (by 8
times), the presentation of bulging fontanelle, pus from
ear canal, redness around umbilicus, reduced movement,
and not able to feed (each by 5 times). The weighted
scores revealed significant difference between BI and
non-BI groups (total scores, meanВ±SD, 7.2В±5.9 vs.
5.2В±4.7, p=0.046). The weighted scores higher than 8
points had best diagnostic accuracy for indicating BI.
Therefore, a new patient with weighted scores higher
than 8 points was suggested to prescribe antibiotics. In
the second period of study, 40 (54.5%) of 73 new
patients with weighted scores higher than 8 points have
received antibiotics, although there were 7 (9.6%)
patients had BI. Patients with weighted scores less than 8
points were all proved to not have BI finally. No
unfavorable outcome was found by using this strategy
during study period.
CONCLUSION: Through this simple screening strategy,
we achieved a clinically reduction in unnecessary
antibiotics use and the cost of health care.
FP4-07
Antimicrobial-Lock Therapy for
Catheter-Related Infections in Children
Chen-Yin Lai1 , Ping-Ing Lee1, Chao-Yi Wu1,
Yin-Hua Fang2, Po-Ren Hsueh1, Chun-Yi Lu1,
Li-Min Huang1, Jong-Min Chen1, Chin-Yun
Lee1
1
Department of Pediatrics, National Taiwan University Hospital
and National Taiwan University College of Medicine, Taipei,
Taiwan; 2Department of Pediatrics, Min-Sheng General
Hospital, Tao-Yuan, Taiwan; 3Department of Laboratory
Medicine and Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan
OBJECTIVE: The use of antimicrobial lock
therapy (ALT) in children has been limited. This
study analyzes the results of ALT used to treat
central venous catheter (CVC)-related infections in
children in a tertiary hospital in Taiwan.
METHODS: Fifty-three pediatric patients under
18 years of age were enrolled. ALT therapy
consisted of a 24-hour lock of effective
antimicrobial agents for 10~20 days. Successful
ALT was defined as absence of the same pathogen
cultured from blood drawn via either CVC or
peripheral vessels for 3 months without CVC
removal.
MAIN RESULTS: The overall successful rate was
54.7% (29/53), and was 64.1% (25/39) after
excluding children with risk factors including
insertion site infection, complicated CRBF and
hemodynamic instability at diagnosis. The success
rate was higher in patients with a tunneled catheter
than in those with a total implant device (73.9%
and 40.0%, respectively, P = 0.025). All second
ALT treatments failed, and all three CVC-related
candidemia caused by Candida parapsilosis were
cured. Multivariate logistic regression indicates that
both the CVC type and the presence of risk factors
are significant predictive variables of treatment
success. ( P = 0.023 and 0.040, respectively ).
CONCLUSIONS: ALT may be helpful to treat
some CVC-related infections in children. The type
of CVC and the presence of risk factors have a
great influence on the success rate.
110
FP4-08
Detection of Carbapenemases and
Analysis of Epidemiology in
Acinetobacter Baumannii
Liu Wen’en, Chen Zhen-hua, Jian
Zi-Juan,Gao Qian, Zou Ming-Xiang, Liang
Xiang-Hui, Liu Yuan-Yuan
Clinical Laboratory, Xiangya Hospital, Central South
University,China
BACKGROUND: Acinetobacter baumannii
has become animportant pathogens in
nosocomial infection, following Pseudomonas
aeruginosa. Their drug resistance were serious
increasingly, and much of them were resistant to
all the commonly used antibiotics including
imipenem, which led to difficulty in clinical
treatment. Analyse the resistance and
epidemiology of A. baumannii in our hospital, in
order to provide theoretical basis for using
antimicrobial drugs rationally and controlling
infections.
OBJECTIVE: To investigate drug resistance
and carbapenemases in clinical isolates of
Acinetobacter baumannii, study molecular
epidemiological characteristics and resistance
mechanism
of
carbapenemase-producing
isolates.
METHODS: 179 clinical isolates of
nonrepetitive Acinetobacter baumannii were
collected from January to June 2009 in Xiangya
Hospital of Central South University.
Antimicrobial susceptibility test was performed
by disk diffusion method and results were
assessed
according
to
the
standands
recommended by CLSI (2009). Modified Hodge
test was used to screen the strains producing
carbapenemases. Carbapenemase genes were
amplified using PCR and sequenced. Plasmid
conjugation experiments were done to study the
transfer of carbapenemase genes, and the
homology of these isolates was analyzed by
typing of ERIC-PCR in order to explain the
molecular mechanism of drug resistance and
epidemiology characteristics.
RESULTS: In all 179 isolates, the rates of
resistance
to
imipenem,
meropenem,
ampicillin-sulbactam, cefoperazone-sulbactam,
and minocycline were 49.2%, 48.0%, 45.3%,
6.7% and 7.8% respectively, the rates of
resistance to all other tested antimicrobial agents
were more than 50.0%. 74 of 179 strains were
positive in modified Hodge test and 71 of 74 strains
positive in modified Hodge test carried blaOXA-23
gene , but blaOXA-24 like, blaIMP-1 like,
blaIMP-2 like, blaVIM-1 like or blaVIM-2 like
genes were not found in these 74 bacteria.
Conjugation experimentation including the broth
method and plate method were not successful in
many times. ERIC-PCR typing results showed that
DNA fingerprint bands number was 1-4, and the
size was 200bp- 2000bp in 74 Acinetobacter
baumannii. They could be divided into A, B, C and
D 4 genotypes by cluster analysis in the light of the
number and size of DNA fragments, and there was
19, 17, 33and 5 clones respectively .
CONCLUSIONS:(1)
The
resistance
of
Acinetobacter baumannii was serious and
carbapenem susceptibility was low in our hospital,
Cefoperazone/sulbactam and minocycline alone or
in combination with other antimicrobial agents
against
multi-drug
resistant
Acinetobacter
baumannii including imipenem-resistant strains
causing infection, may be a better treatment in our
hospital. (2) Many Acinetobacter baumannii
produced carbapenemase and OXA-23 gene was
the popular carbapenemase genotype in our hospital.
(3) The spread of carbapenemase-producing
isolates clone resulted in the high rate of
carbapenem resistance in Acinetobacter baumannii.
Much more attention should be taken to take
effective measures to control the spread of resistant
strains for clinic.
111
FP4-09
Comparison of Three Methods for the
Detection of Biofilm Forming
Microorganisms Isolated from a
Tertiary Care Hospital of Pakistan
Afreenish Hassan, Javaid Usman, Fatima
Kaleem
National University of Sciences and Technology/
Army Medical College, Rawalpindi, Pakistan
INTRODUCTION: Biofilms are described as a
matrix of extrapolymeric substances in which
are embedded bacterial cells. Microorganisms
growing in a biofilm are highly resistant to
antimicrobial agents and associated with several
human diseases. There are various methods to
detect biofilm production. These include tissue
culture plate (TCP), tube method (TM), congo
red agar method (CRA), bioluminescent assay
and fluorescence microscopic examination.
OBJECTIVE: This study was conducted to
detect the biofilm forming microorganisms
isolated from clinical specimens by three
different methods, and to compare these three
methods for biofilm detection.
Place and duration of study: The study was
carried out at the Department of Microbiology,
Army Medical College/ National University of
Sciences and Technology, Rawalpindi, Pakistan,
from October 2009 to March 2010.
MATERIALS AND METHODS: A total of
110 organisms isolated from blood, pus,
intravenous and urinary catheter tips, urine, and
sputum were investigated for biofilm production.
Isolates
were
identified
by
standard
microbiological procedures. Biofilm detection
was done by the tissue culture plate method,
tube method and the congo red agar method.
RESULTS: From the total 110 clinical isolates,
the tissue culture plate method detected 23% as
high, 41% moderate and 36% as weak or non
producers of a biofilm. This method also
remained superior to the tube method and the
congo red agar method. High resistance to the
routine used antibiotics was also seen by biofilm
producers.
CONCLUSION: Tissue culture plate is an
accurate, reliable and quantitative method for
the
detection
of
biofilm
forming
microorganisms.
FP4-10
Lumbar Puncture Rules for Diagnosing
Bacterial Meningitis in Children
Anggraini Alam, Nelly Amalia Risan, Cissy B.
Kartasasmita
Child Health Department, Hasan Sadikin General
Hospital/Medical Faculty of University,
Padjadjaran Bandung, Indonesia
OBLECTIVES: Distinguishing between bacterial
meningitis and febrile seizure in children sometimes is
difficult meanwhile bacterial meningitis is an
emergency condition, need to perform a lumbar
puncture to ascertain the diagnosis and give prompt
broad spectrum of antibiotic.
AIM: This study ensures the importance of lumbar
puncture as a diagnostic procedure for diagnosing
community-acquired bacterial meningitis in children.
METHODS: A prospective cohort study was
performed of all febrile and seizure children from
community came to ER Department in Hasan Sadikin
GH and underwent a lumbar puncture from December
2007 to January 2009.
RESULTS: 99 patients had febrile seizure;. The male
to female ratio was 1.3:1; age range was 2-57 months
with a mean age of 21.4 (SD 17.3) months and a
median age of 17.5 months. 80 (80.8%) patients
shows fully allert (GCS=15). 50 patients could not
perform LP (nonbacterial meningitis group/nBM).
49 patients perform LP and blood puncture (bacterial
meningitis group/BM). Culture result (+)ve from LCS
fluid but (-)ve from blood: 10 (20.4%). Culture result
(-)ve from LCS fluid but (+)ve from blood: 8 (16.3%).
6 patients had culture positive from blood and LCS
fluid among them 3 had same results: S. pneumoniae,
S. typhi, and S. epidermidis. 25 (51.0%) patients had
no m.o growth. 16 (32.7%) LCS fluid cultures result
are S. pneumoniae (1), S. aureus (2), S. hemolyticus
(2), S. saprophyticus (2), S. viridans (1), Enterococcus
sp. (1), E. aerogenes (2), K. pneumoniae (1), A.
baumannii (1), M. catarrhalis (2), and S. typhi (1). 8
patients died, culture from blood and/or LCS fluid are:
S. pneumoniae, H. influenzae B, S. aureus, S.
epidermidis , and S. viridans; 3 had no growth.
No significance differences between BM and nBM: in
consciousness level (Glasgow Coma Scale) at
admission in hospital (p= 0.482), cerebrospinal fluid
pleocytosis (p = 0.188), cerebrospinal protein analysis
(p= 0.097). CFR BM vs nBM = 8 (16.3%) vs 7
(14.0%).
CONCLUSION: Distinguishing bacterial meningitis
and febrile seizure in children below 5 years is
difficult. It should be better to perform lumbar
puncture and broad spectrum antibiotic could be given
immediately..
112
FP4-11
An Investigation of Measles Outbreak
in Junior High School Students with
High Second Dose MMR Vaccination
Coverage with An Emphasis on
Vaccine Failure
Young June Choe1, Jae Kyung Hu5, Sang
Taek Lee1, Kyung Min Song1, Heeyeon Cho1,
Geun-Ryang Bae1, Kisoon Kim2, Hee Sook
Yoon2, Jina Lee4, Eun Hwa Choi4, Hoan Jong
Lee4, and Jong-Koo Lee3
1
Division of Vaccine Preventable Disease Control and
National Immunization Program, 2Division of Respiratory
Viruses, 3Korea Centers for Disease Control and Prevention,
4
Department of Pediatrics, Seoul National University
College of Medicine, Seoul, 5Incheon Metropolitan City,
Health Social Bureau, Incheon, Republic of Korea
Background: Measles was declared eliminated
from the Republic of Korea in 2006, but small
regional outbreak continued to sustain. An
outbreak of measles in a junior high school
involving 88 confirmed cases occurred from
May 15 to July 5, 2010 provided an opportunity
to study regarding vaccine-modified measles
and VF.
Methods: An enhanced surveillance was
implemented,
clinical
and
serological
investigation was reviewed, and molecular
typing of viral isolates was performed.
Results: Vaccine coverage rate of the school
was 97.6% (857/878). Of 878 students, 127
suspected measles cases were reported and 88
were confirmed either by laboratory methods
(n=71), or by epidemiologic linkage (n=17). Of
88 confirmed cases, 86 (97.7%) had
documentation of two-dose MMR vaccination.
Of 69 laboratory-confirmed cases with
documentation of two-dose vaccination, 40
(58.9%) were classified as primary vaccine
failure (VF), and 29 (42.0%) were classified as
secondary VF. Secondary VF cases had
significantly milder illness than primary VF
cases. The outbreak was contained within the
school, and the outbreak ended 8 weeks after
onset of symptoms in the index case.
Conclusions: VF may contribute to limited
outbreaks of measles even in countries with high
two-dose vaccination coverage. A prompt
identification and reporting of vaccine-modified
measles is crucial in early control of measles
outbreak.
113
Abstract of Poster Presentations
P1-001
Antimicrobial Resistance
and New Antibiotic
Antibacterial Effect of Four Herbal
Plants Hydro-Alcoholic Extracts
Ali Jyhuni Khani, MH Meshkibaf, M Fasihi
Ramandi, M Qolami Nedjad, F Adjdari, N
Qayoor, A Rahimian
Fasa University of Medical Science (FUMS),
Department of Microbiology, Fasa, Iran; Young
Researchers Club, Islamic Azad University, Iran
OBJECTIVE: Because of being natural, less
dangerous, easy access and less expensive, rather
than chemical synthetic drugs, herbal plant is
more acceptable and usable with people. Since,
antibacterial drug resistance were seen,
researchers tend to obtain drugs, which derived
from herbal plants.
METHODS: 4 genus of domestic plants from
Fars, Fasa, Iran, containing: Ziziphora, Stachys,
Teucrium and Barberry were collected in spring,
dried and then extracted. Antibacterial effects
were examined with disk diffusion method and
serial broth dilution; For standardization of study,
we used standard antibiogram disks and ATCC
bacteria.
MAIN RESULTS: Teucrium extract in 1/8
dilution and Barberry extract in 1/4 dilution had
antibacterial effect in serial dilution method.
Evaluation of disk diffusion method which
compared with antibiotic disks: amoxicillin,
ciprofloxacin, vancomycin and imipenem, shown
the antibacterial effect of these extracts.
CONCLUSION: With complement studies about
herbal plants on in vivo and in vitro, and attention
to time consuming and hard work, to design and
product a chemical antibacterial drug, we can
easily (with less problems) distribute of using
herbal plants.
P1-002
Antimicrobial Resistance
and New Antibiotic
Imipenem Resistance among
Gram-negative and Gram-positive
Bacteria in Hospitalized Patients: a
Report from Iran
A Khorshidi, A Sharif, Gh Shajary, Gh
Mossavi.
Department of Microbiology, School of Medicine,
Kashan University of Medical Science, Iran
BACKGROUND: Recent analyses of hospital
outbreaks have documented the spread of
resistance to Imipenem and it is currently a major
problem among gram positive and gram negative
bacteria. The aim of this study was to describe the
rates of gram- positive and gram-negative isolates
resistance to Imipenem as an antibiotic that is
widely used in Iran.
METHODS: Recorded files of 242 hospitalized
patients with at least one sample of positive
culture specimens in one of the two general
hospitals of Shahid Beheshti and Naghavi in
Kashan, Iran in 2005 were randomly selected and
reviewed. All strains were tested for antibiotic
susceptibility by Disk Diffusion and were
designated for Imipenem.
RESULTS:
Escherichia Coli (21.9%),
Kelebciella (19.8%) and Coagulase-negative
Staphylococci (17.8) were the most common
isolated organisms. Imipenem had coverage
against 96.2% of Escherichia Coli, 58.4% of
Kelebsiella, 79.1% of Coagulase-negative
Staphylococci, 81.8% of Pseudomonas aeruginosa,
and 85.7% of Entrococci isolates. Proteus and
Salmonella isolates susceptibility to Imipenem
was 100%.
CONCLUSIONS: Susceptibility of Escherichia
Coli, Salmonella and Proteus to Imipenem is
satisfactory; however, the susceptibility of
Pseudomonas aeruginosa to this antibiotic was
dramatically lower in our region. Because of the
major health problems caused by Imipenem
resistance, attempts have been made to organize a
national surveillance program in our country.
114
P1-003
Antimicrobial Resistance
and New Antibiotic
P1-004
Antimicrobial Resistance
and New Antibiotic
Integrons and Multi-Drug Resistance
among Nontyphoidal Salmonella
Strains Isolated from Clinical Cases
Antimicrobial Photodynamic Therapy
(PDT) In Multidrug Resistant
Pathogens (MDRP)
Naghoni Ali1, Ranjbar Reza2, Tabaraie
Bahman3
CMN Yow1, RWK Wu, MR Hamblin2
1
Young Researchers Club, Islamic Azad
University-Karaj Branch, Karaj, Iran; 2Molecular
Biology Research Center, Baqiyatallah University of
Medical Sciences, Tehran, Iran; 3Research and
Production Complex, Pasteur Institute of Iran, Karaj,
Iran
OBJECTIVE: Integrons are genetic elements,
which usually confer antibiotic resistance. The
aim of this study was to screen multi-drug
resistant nontyphoidal Salmonella strains and its
relation with integron class 2.
METHODS: Salmonella strains were isolated
from several hospitals in Tehran, Iran. The
isolates were identified by standard biochemical
tests and agglutination using specific antisera.
Their susceptibility to 10 antibiotics were tested
by disc diffusion method. Correlation of
multi-drug resistance and existence of Integron
class 2 was studied by PCR.
MAIN RESULTS: In this research, 103
Salmonella strains were isolated. The most
common resistance phenotypes detected were to
nalidixic acid (64%), tetracycline (50%),
streptomycin
(42%),
sulfamethoxazole-trimethoprim
(29%),
kanamycin (24%), ampicillin (16%) and
chloramphenicol (13%). 75 (72.8%) of bacteria
were resistant to two or more antibiotics that is
considered as MDR. Twenty-seven (26.2%) of the
103 isolates had a 2161 bp class 2 integron.
CONCLUSIONS: Our findings showed that
class 2 integrons are widely spread among
Salmonella enterica isolated in Iran. Integron
positive isolates were included into five different
serotypes of S. enterica: S. albany, S. infantis, S.
muenchen, S. reading and S. typhimurium. In the
present study, the widespread occurrence of
resistance to several groups of antibiotics in
Salmonella isolates was demonstrated. It may be
due to inappropriate and incorrect administration
of antimicrobial agents in empiric therapies. This
problem indicates importance of performing
antibiotic susceptibility testing before blind
antibiotic therapy.
1
Medical Laboratory Science section, Department of Health
Technology & Informatics, Hong Kong Polytechnic University,
HKSAR; 2Wellman Center for Photomedicine, Harvard
Medical School, USA.
INTRODUCTION: Infectious diseases caused by
multidrug resistant pathogens (MDRP) are emerging in
Hong Kong and worldwide. The major concern of bacteria
that confer multidrug resistance is the presence of the
membrane transport proteins - multidrug efflux pumps.
Efflux mechanisms have been recognized as major
components of microbial resistance to many classes of
antibiotics. The relentless increase of multi-drug resistant
pathogens (MDRP) together with the limited development
of novel antibiotics makes it imperative to discover new
antimicrobial strategies to combat diseases caused by
MDRP. Antimicrobial Photodynamic Therapy (PDT) can
be one of the target therapies to MDRP by employing
visible light irradiation on non toxic photosensitizer (PS),
with the generation of reactive oxygen species (ROS) to
eradicate the MDRP. This pilot study aimed to determine
the anti-microbial efficacy of Toluidine Blue O (TBO)
mediated PDT in the MDRP.
OBJECTIVE: To evaluate the killing efficacy of TBO
mediated PDT on wild type strain, MDR-deficient mutant
stain and multidrug resistant strain of Staphylococcus
aureus and Pseudomonas aeruginosa.
METHODOLOGY: Killing efficacy of Toluidine Blue
(TBO) mediated PDT on selected bacteria stains were
determined by minimum bactericidal concentration and
colony count. A wild type strain, a MDR-deficient mutant
(gene knockout stain) and a MDR efflux pump
over-expressed strain of Staphylococcus aureus and
Pseudomona.
aeruginosa
were
included.
The
over-expressed MDR efflux pump in S. aureus and P.
aeruginosa were NorA and MexAB-OprM respectively.
RESULT: TBO mediated PDT is unaffected by MDR
phenotype in S. aureus stains. All three tested stains gave
4.8 log killing at 20ОјM/2Jcm-2 and reached 5 log killing at
20ОјM/5Jcm-2. However, the MexAB-OprM expression
protects against TBO phototoxicity in P. aeruginosa strains.
Only 0.4 log killing was obtained in P. aeruginosa
(MexAB-OprM) at 50ОјM/5Jcm-2 while 3.9 log killing at
50uM/5 Jcm-2 and 5 log killing at 50ОјM/10 Jcm-2 was
obtained in both wild type and MDR-deficient mutant stain.
Comparatively, the S. aureus (NorA) was more susceptible
to TBO mediated PDT than the P. aeruginosa
(MexAB-OprM).
CONCLUSION: TBO mediated PDT is effective on both
tested wild type and MDR strains bacteria. This study
offered new insights of TBO mediated photoinactivation
on MDRP. Further studies in the modulation of MDR
efflux pumps by TBO mediated photoinactivation in MDR
strains deserve investigation.
115
P1-005
Antimicrobial Resistance
and New Antibiotic
A Report of a Klebsiella pneumoniae
with Multi Antibacterial (Drug)
Resistance
Ali Khani Jyhuni-Abbas Abdollahi
Deptartment of Microbiology, Fasa University of
Medical Sciences, Fasa- Fars, Iran
P1-006
Antimicrobial Resistance
and New Antibiotic
Multidrug Resistant, Extended
Spectrum Beta-Lactamases and Ampc
Beta Lactamases Producing
Uropathogenes among Children:
Hospital Based Study
Janak Lal Pathak11, Bharat mani pokherel2, Pankaj
Deo1, Bal Krishna Awal2, Suyog Raj Kadel3
1
We recognized one strain of Klebsiella
pneumoniae which has multi antibacterial (Drug)
resistance (MDR), during a study of extended
spectrum beta-lactamase (ESBL) evaluation. The
strain was isolated from the urine of a
patient(5days old) at one hospital university,
Tehran, Iran. The isolated K. pneumoniae
presented an unusual resistance to all of examined
drugs including: ceftazidime, ceftriaxone,
cefotaxime, cefixime, cephalotin, ceftizoxime,
amoxicillin, amikacin, tetracycline, gentamycin,
co-trimoxazole, nalidixic acid, imipenem,
nitrofurantoin and ciprofloxacin (notify to MDR
phenotype); and elevated MIC to cefotaxime
(≥256µg). The strain also tested positive for
ESBL production with double-disk methodology.
To proving this phenotypic resistance we
amplified extracted plasmid with universal
primers of bla-ctx-m type genes.
Department of Clinical Test and Diagnostics, Union Hospital,
Tongji Medical College, Huazhong University of Science and
Technology, Hubei, China., 2 Department of Clinical Microbiology,
Tribhuvan University Teaching Hospital (TUTH), Kathmandu,
Nepal, 3 Department of Clinical Medicine, Tongji Medical College,
Huazhong University of Science and Technology, Hubei, China.
OBJECTIVES: Urinary tract infections (UTI) are
common in children. Gram negative bacilli are the
common isolates from UTIs. Extended spectrum
beta-lactamases (ESBL) and AmpC beta-lactamases
(AmpC) are the most significant enzymes involved in
conferring resistance to Beta-lactam antibiotics in Gram
negative bacteria. This study was aimed at finding out the
prevalence of multidrug resistant (MDR), ESBL and
AmpC beta-lactamases producing isolates among children
with UTI in Nepal.
METHODS: A prospective study was carried out from
July 2006 to March 2008 at the Department of
Microbiology (Institiute of Medicine, Trivuwan University
Teaching Hospital, Kathmandu, Nepal). 820 urine
specimens were obtained from clinically suspected UTI
children (age<12 years, female to male ratio 2.1:1). Most
of the samples were midstream urine, 25 from supra pubic
aspiration and 4 from catheter. Culture, organism
identification and antibiotic susceptibility test were done
by following the protocol of American Society for
Microbiology (ASM). Isolates resistant to two or more
antibiotics were defined as MDR, among them resistant to
third generation cephalosporins were further tested for
ESBL and AmpC phenotypes.
RESULTS: Among 820 urine samples, 24.51% (201/820)
had significant bacterial growth with 184 (91.54%)
non-repeat gram-negative isolates in which most were E.
coli (58.15%) followed by Klebsiella species (15.2%).The
prevalence of MDR, ESBL and AmpC were 115 (62.5%),
43 (23.36%) and 15 (8.15%) respectively. Maximum
incidence of ESBL producer was E. coli (39.5%) followed
by Klebsiella (16.2%) and Pseudomonas species (13.9%).
High AmpC producing species were Klebsiella (40%) and
Pseudomonas (26.6%). ESBL producers and non
producers MDR isolates were highly resistant to
amoxycillin-clavulanic acid, aztreonam, cefepime and
ceftazidime-clavulanic acid. Imipenum and piperacillin
were the most effective drug among ESBL producers and
non producers. Infection was more common in age group
6В±2.3 years with female to male ratio 2.04:1.
CONCLUSION: Result shows high percentage (62.5%)
of MDR pathogens in childhood UTI. High prevalence of
ESBL and AmpC enzymes has significant role in MDR.
Routine screening method for ESBL and AmpC is strongly
recommended for phenotypic screening. This is the first
study to detect AmpC beta lactamases phenotypes in
Nepal.
116
P1-007
Antimicrobial Resistance
and New Antibiotic
A High Rate of Inducible Clindamycin
Resistance in Staphylococcus Aureus in
Pediatric Hospital in Japan
Kensuke Shoji, Akihiko Saitoh
National Center for Child
Development, Tokyo, Japan
Health
and
P1-008
Antimicrobial Resistance
and New Antibiotic
In Vitro Efficacy of Tigecycline against
Metallo-О’-Lactamase Producing
Carbapenem Resistant Acinetobacter
Species
Fatima Kaleem1, Javaid Usman2, Afreenish
Hassan3
National University of Sciences and Technology, Pakistan; 2
Pathology. NUST Pakistan; 3 National University of Sciences
and Technology, Pakistan
1
OBJECTIVE: Although clindamycin is an
alternative choice for the treatment of
Staphylococcus aureus infection in children, the
strains
with
inducible
macrolide-lincosamide-streptogamin B (iMLSB)
resistance phenotype may lead to clinical failure
during clindamycin therapy.
However, the
information about iMLS B resistance in
Staphylococcus aureus has been limited. The
objective of this study is to investigate the rate of
iMLS B resistance in Staphylococcus aureus in
Japan where macrolides have been overused in a
clinical setting.
METHODS: We retrospectively reviewed the
number of inducible clindamycin resistance in
Staphylococcus aureus at the National Center for
Child Health and Development between April,
2009 and April, 2010.
MAIN
RESULTS:
We
found
619
Staphylococcus aureus isolates during this study
period. The number of methicillin-susceptible
Staphylococcus aureus (MSSA) was 449 (72.5%)
and MRSA was 170 (27.5%). Erithromycin
non-susceptible strains were 145 (32.3%) in
MSSA and 134 (78.8%) in MRSA. Among
MSSA and MRSA, erithromycin non-susceptible
and clindamycin susceptible isolates were 120
(82.8%) and 29 (21.6%), respectively. All of
these isolates were performed D-test to detect
inducible resistant for clindamycin and 115/120
(95.8%) of MSSA and 24/29 (82.6%) of MRSA
isolates were positive for D-test, suggesting these
isolates can develop resistant to clindamycin
during the therapy.
CONCLUSION: A high rate of iMLSB
resistance in Staphylococcus aureus could limit
the use of clindamycin where erythromycin
non-susceptible isolates are dominant strain.
INTRODUCTION: The rapid spread of acquired
Metallo-ОІ-lactamases (MBLs) among major Gram
negative pathogens and their highly resistant
antibiogram is an emerging threat and matter of
particular concern worldwide.
MATERIALS
AND
METHODS:
This
descriptive study was carried out from Aug 09Jan 10 in the department of Microbiology, Army
Medical College, National University of Sciences
and Technology Rawalpindi, Pakistan to find out
in vitro efficacy of tigecycline against metallo
beta lactamase producing Acinetobacter species
from clinical isolates of a tertiary care Hospital.
All clinical samples were dealt by standard
microbiological methods, isolated Acinetobacter
species were subjected to susceptibility testing
against various antibiotics by disc diffusion
method as per the Clinical and Laboratory
Standards Institute guidelines.
Carbapenem
resistant isolates were subjected to the detection
of metallo beta lactamase production by E-test
metallo beta lactamase strip method. All metallo
beta lactamase producers were subjected to
susceptibility testing of tigecycline by minimum
inhibitory
concentrations
using
E-strips.
Minimum inhibitory concentrations 50 and
minimum inhibitory concentrations 90 were
calculated.
RESULTS: Among 50 metallo beta lactamase
producing Acinetobacter species, Acinetobacter
baumannii were most frequent. Around 88 % of
the
metallo
beta
lactamase
producing
Acinetobacter species were sensitive to
tigecycline. Most of the Acinetobacter species
were isolated from nasobronchial lavage samples.
CONCLUSION: Our study showed that
tigecycline is effective against metallo beta
lactamase producing Acinetobacter species.
117
P1-009
Bacterial Infection
Differential Transcriptomic Profiling
And Pathogenicity of Invasive and
Colonization Strains of
Community-Associated
Methicillin-Resistant Staphylococcus
Aureus ST59
Sung-Tsan Wei, Chih-Jung Chen, Hisn-Ju
Chang, Cheng-Hsun Chiu
Department of Pediatrics, Chang Gung Children’s Hospital,
Chang Gung University College of Medicine, Taoyuan, Taiwan
Staphylococcus aureus is one of the common organism
colonizing on skin and and mucosa. It is also an
important human pathogen. The emergence of
community-associated
methicillin-resistant
Staphylococcus aureus (CA-MRSA) has become a
world-wide problem. In Taiwan, the most common
miltilocous sequence type of CA-MRSA is ST59. In
this study, we used ST59 CA-MRSA collected from
Chang Gung Children’s Hospital to check the
differential gene expression between invasive and
colonization CA-MRSA ST59 strains. All the invasive
strains of ST59 carried Panton-Valentine Leukocidin
(PVL) gene, while colonization strains did not. All the
ST59 strains used in microarray experiments showed
similar growth rate in LB as well as in medium
containing human serum. Microarray was used to study
global gene expression in S. aureus grown in serum.
About 70% of the genes showed similar level of
expression, but notably the two component
system-related genes ksd and agr, and capsular
synthesis genes capD and capE showed higher
expression in invasive strain CB957 relative to
colonization strain; however the arginine catabolic
mobile element gene arcA and the hyaluronate lyase
gene hysA showed significantly higher expression in
colonization strain SA40 relative to invasive strain.
This result was confirmed by the quantitative real-time
PCR: the hysA gene expression was up-regulated in the
serum in all invasive isolates tested, compared to
colonization isolates. To evaluate the activity of
hyaluronate lyase, the hyaluronate-containig agar plate
assay was used. The hyaluronic acid lysis zone by
invasive strains was significantly reduced in the
presence of serum compared to colonization strains. In
animal tests, BALB/C nude mice infected by invasive
CA-MRSA strains with subcutaneous injection showed
significant abscess 3 days post-infection. In contrast,
healing of the lesion caused by subcutaneous injection
of colonization strain was faster. The ST59 colonization
and invasive strains showed different pathogenicity to
mice in this soft tissue infection model. Whether the
difference is due to the differential gene expressions
including hysA gene or the difference in the presence of
PVL required further studies.
P1-010
Bacterial Infection
Acute Tonsillitis as a Risk Factor for
Infective Endocarditis
Vladimir Krcmery, Andrea Demitrovicova,
Eva Horvathova, Erich Kalavsky, Peter Kisac
Slovakia
OBJECTIVE: Within 606 cases of infective
endocarditis, commonest risk factors preceding
infective endocarditis were catheter insertion
(99%), rheumatic fever (22.3%), prior abdominal
surgery due to intraabdominal infection (20%)
and dental surgery (8.6%).
METHODS: We reviewed all patients with acute
tonsilitis in a nationalwide 23 years survey of
infective endocarditis (606 cases) in Slovakia.
Acute tonsillitis within 10 days before infective
endocarditis appeared in 15 patients (2.5% of 606
cases infective endocarditis).
RESULTS: Only six patients of 15 cases with
acute tonsillitis received antibiotic therapy and
only 2 with betalactam antibiotic, 4 patients
received macrolides. Ten of 15 cases (66.7%)
were due to Streptococcus pyogenes, 3 due to
Staphylococci, 1 due to Enterococcus faecalis and
1 due to Corynebacterium spp.. Comparing the
group of 15 infective endocarditis after acute
tonsillitis to 606 cases from our database,
rheumatic fever (53.3% vs. 22.3% p<0.009),
inappropriate antibiotic therapy (80% vs. 16.3%,
p<0.008), streptococcal etiology (66.7% vs.
15.2%, p< 0.001) and vitium cordis congenital
heart disease (26.7% vs. 3.2%, p<0.01) were more
frequently observed among infective endocarditis
after acute tonsilitis. Alarming was high mortality
on infective endocarditis after tonsillitis. In those,
who had acute tonsilitis, the mortality was
higher – 33.3% in comparison to 15% of the
overall mortality on infective endocarditis (606
cases).
CONCLUSIONS: However this difference was
not significant. Appropriate therapy of acute
tonsillitis with betalactam antibiotics (penicillins
and cephalosporins) is a major protective factor
against developing of infective endocarditis after
acute tonsillitis.
118
P1-011
Bacterial Infection
The Incidence of Pediatric Invasive
Haemophilus Influenzae Diseases
and Invasive Pneumococcal
Diseases in Chiba Prefecture, Japan
пј€2007-2009пј‰
Naruhiko Ishiwada1, Junko Tanaka1, Haruka
Hishiki1, Tadashi Hoshino2, Tomomichi
Kurosaki3, Yoichi Kohno1
1
Department of Pediatrics, Chiba University Graduate School
of Medicine; 2Division of Infectious diseases, Chiba Children’s
Hospital;3Kurosaki Child Clinic, Japan
OBJECTIVE: Haemophilus influenzae type b (Hib)
conjugate vaccine was introduced in December,
2008 as voluntary vaccine in Japan. Heptavalent
pneumococcal conjugate vaccine (PCV7) was also
introduced in February, 2010 as voluntary vaccine in
Japan. It is necessary to clarify the disease burden of
invasive Haemophilus influenza diseases and
invasive pneumococcal diseases in Japan for
evaluating Hib conjugate vaccine and PCV7.
METHOD: To determine the precise incidence of
invasive H.influenzae diseases and invasive
pneumococcal diseases in Chiba prefecture, Japan,
we implemented the survey during 2007 to 2009.
Chiba prefecture is one of the 47 prefectures in
Japan and is located in the middle of Japan. The
population in Chiba prefecture is about 6 million,
which represents about 5 % of the population of
Japan.
MAIN RESULTS: During the 3 study years, 89
patients with invasive H.influenzae disease were
diagnosed. The annual incidences of invasive
H.influenzae diseases in 2007, 2008, 2009 were 6.4,
13.5, 11.2 per 100,000 children less than 5 years of
age, respectively. Serotyping was performed 85.4%
of the isolated strains, 98.7% of were Hib. During
the 3 study years, 176 patients with invasive
pneumococcal disease were diagnosed. The annual
incidence of invasive pneumococcal diseases in
2007, 2008, 2009 was 13.5, 21.3, 26.1 per 100,000
children less than 5 years of age, respectively.
Serotyping was performed 34.1% of the isolated
strains, 65.0 % of were covered by PCV7.
CONCLUSION: The incidence of pediatric
invasive H. influenzae diseases has not been
dramatically decreasing after introduction of Hib
conjugate vaccine, because of insufficient vaccine
supply. The incidence of invasive pneumococcal
diseases has been increasing. Routine immunization
of Hib conjugate vaccine and PCV7 is the emerging
issues in Japan.
P1-012
Bacterial Infection
Prognostic Factors in Bacterial
Meningitis: A 24 Years Retrospective
Study
Biwen Cheng
Department of Pediatrics, Mackay Memorial
Hospital, Taipei, Taiwan
INTRODUCTION:
In spite of the availability of
antibiotics and the introduction of vaccines, bacterial
meningitis continues to be an important cause of mortality
and morbidity in neonates and children throughout the
world. Unlike adults with common triad of fever, neck
stiffness, and altered mental status, children including
infants and neonates often have a subtle presentation with
nonspecific signs and symptoms. Therefore clinical
presentations and laboratory analysis may foresee the
outcome of the disease. We revised cases within 24 years
period and suggested some common manifestations had
important prognostic significance.
METHODS: All subjects from newborn period to 18
years of age with culture proved bacterial meningitis, dated
in between 1984 to 2008 in Mackay Memorial Hospital
were retrospectively reviewed. The collective data was
interpreted according to age, sex, clinical presentations,
pathogens, and cerebrospinal fluid (CSF) findings. Their
prognosis was categorized into 3 groups: complete
recovery, recovery with sequelae, and death.
RESULTS: There were 298 subjects enrolled, among
them were 186 males (40.6%) where 9 of them loss
follow-up. Years of age including 121 (42.6%) were < 1
month, 205 (68.8%) of them < 6 months, 235 (78.9%)
were < 1 year, and 274 (91.9%) were < 5 years. Fever
remained the most common clinical appearances within the
study, however nearly one fifth (19.1%) were afrebrile.
There were 43.6% (130/298) of subjects with complete
recovery, 16.8% (50/298) had sequelae, and 13.1% (39/298)
died.
Group B streptococcus (19.5%) was the
commonest pathogen followed by S. pneumococcus
(12.1%), and E. coli (9.1%). The cerebral spinal fluid
analysis indicated 51.9% (144/277) had glucose level ≦
20 mg/dL and 43.7% (121/277) reported CSF to blood
glucose ratio ≦ 66.7%. Furthermore, 47.6% (132/277)
had CSF protein level ≧250 mg/dL and 89.5% (256/286)
had WBC count ≧ 5/HPF microscopically. Therefore,
patients with low CSF glucose level (≦20 mg/dL), high
CSF protein (≧ 250 mg/dL), and low Serum Na+ levels
(≦ 130 mEq/L) demonstrated poor outcomes.
CONCLUSION: With advances in antibiotic therapies
and vaccine programs, the morbidity and mortality rate in
bacterial meningitis continue to remain high.
Presentations of shock and comatose upon admission with
associated duration of the illness, or accompany factors
such as low CSF glucose levels (≦20 mg/dL), high CSF
proteins (≧ 250 mg/dL), and low Serum Na+ levels (≦
130 mEq/L) resulted in poor prognosis.
However,
primitive recognition of signs and symptoms follow by
early interventions and administration of appropriate
antibiotics, may lead to improved survival.
119
P1-013
Bacterial Infection
Clonal Dissemination with Particular
Phenotype of Methicillin-resistant
Staphylococcus aureus Isolates from
Patients Diagnosed of Mastitis in
Central Taiwan
Wei-Yao Wang1,2,3, Tzong-Shi
Jun-Ren Sun1, 2, Jang-Jih Lu4,5
Chiueh1,2,
1
Graduate Institute of Medical Science Tri-Service General
Hospital and National Defense Medical Center, Taipei, Taiwan
2
Division of Clinical Pathology, Tri-Service General Hospital
and National Defense Medical Center, Taipei, Taiwan
3
Division of Infectious Disease, Da-Chien General Hospital,
Miao-Li, Taiwan
4
Department of Laboratory Medicine, China Medical
University, Taichung, Taiwan
5
China Medical University Hospital and Graduate Institute of
Clinical Medical Science, China Medical University, Taichung,
Taiwan
BACKGROUND
AND
PURPOSE:
Staphylococcus aureus is the major nosocomial
pathogen and rapid detection of colonized patients
with subsequent precaution is needed to prevent
transmission. A new assay, the BD GeneOhmTM
SaphSR assay (BD GeneOhmTM , San Diego, CA), is
a multiplex real-time polymerase chain reaction
(PCR)
for
rapid
detection
of
both
methicillin-sensitive Staphylococcus aureus (MSSA)
as well as methicillin-resistant Staphylococcus
aureus (MRSA).
MATERIAL AND METHODS: Anterior nasal
swab specimens of 273 pediatric and adult patients
hospitalized in intensive care units at Chang Gung
Memorial Hospital were collected for this assay in
parallel with conventional cultures as standard.
RESULTS: Overall, 71 (26.0%) patients were
colonized with Staphylococcus aureus by
conventional culture and MRSA accounted for 67.6
% of all isolates. For the detection of MRSA, 79
patients (28.9%) were positive by PCR and 48
(17.6%) were positive by conventional cultures. The
sensitivity, specificity, positive and negative
predictive values were 95.9, 85.3, 58.5, 99.0%,
respectively. For the detection of MSSA, 48 patients
(17.6%) were positive by PCR and 23 (8.4%) were
positive by conventional culture. The sensitivity,
specificity, positive and negative predictive values
were 91.3, 89.2, 43.8, 99.1%, respectively.
CONCLUSION: As a screening method, the BD
GeneOhmTM StaphSR assay could rapidly detect and
differentiate
between
MRSA and
MSSA
colonization. A negative result of the assay could
almost exclude S. aureus colonization.
P1-014
Bacterial Infection
Evaluation of the BD GeneOhm
StaphSR Assay for Detection of
Staphylococcus aureus in Patients in
Intensive care units
Tai-Hua Ho1, Yhu-Chering Huang1,2,
Tzou-Yien Lin1,2
1
Division of Infectious Diseases. Department of
Pediatrics, Chang Gung Children’s Medical
Center, and Chang Gung Memorial Hospital,
Taoyuan, Taiwan
2
Chang Gung University College of Medicine,
Taoyuan, Taiwan
BACKGROUND
AND
PURPOSE:
Staphylococcus aureus is the major nosocomial
pathogen and rapid detection of colonized patients
with subsequent precaution is needed to prevent
transmission. A new assay, the BD GeneOhmTM
SaphSR assay (BD GeneOhmTM , San Diego,
CA), is a multiplex real-time polymerase chain
reaction (PCR) for rapid detection of both
methicillin-sensitive
Staphylococcus
aureus
(MSSA) as well as methicillin-resistant
Staphylococcus aureus (MRSA).
MATERIAL AND METHODS: Anterior nasal
swab specimens of 273 pediatric and adult
patients hospitalized in intensive care units at
Chang Gung Memorial Hospital were collected
for this assay in parallel with conventional
cultures as standard.
RESULTS: Overall, 71 (26.0%) patients were
colonized with Staphylococcus aureus by
conventional culture and MRSA accounted for
67.6 % of all isolates. For the detection of MRSA,
79 patients (28.9%) were positive by PCR and 48
(17.6%) were positive by conventional cultures.
The sensitivity, specificity, positive and negative
predictive values were 95.9, 85.3, 58.5, 99.0%,
respectively. For the detection of MSSA, 48
patients (17.6%) were positive by PCR and 23
(8.4%) were positive by conventional culture. The
sensitivity, specificity, positive and negative
predictive values were 91.3, 89.2, 43.8, 99.1%,
respectively.
CONCLUSION: As a screening method, the BD
GeneOhmTM StaphSR assay could rapidly detect
and differentiate between MRSA and MSSA
colonization. A negative result of the assay could
almost exclude S. aureus colonization.
120
P1-015
Bacterial Infection
Bacteriological Study of Staphylococcus
Aureus Isolates Causing
Community-Acquired Infection in
Children
Naohiko Moriguchi, Haruka Kodama, Fumika
Miyajima, Taysuo Yamamoto
Japan
OBJECTIVE: We investigated Staphylococcus aureus
isolates that caused community-acquired infection of
children for the frequencies of methicillin-resistant
Staphylococcus aureus (MRSA), coagulase types, and
production of various toxins.
METHODS: A total of 68 Staphylococcus aureus isolates
were obtained from the nasal mucus (30 strains) and
impetigo of the skin (38 strains) between July 2008 and
October 2009. The minimum inhibitory concentrations
(MICs) of antibacterial agents were determined for these
isolates using the trace broth dilution method. MRSA
strains were subsequently identified according to Clinical
and Laboratory Standards Institute (CLSI) criteria.
Moreover, the productivity of exfoliative toxin (EXT) and
toxic shock syndrome toxin-1 (TSST-1) was examined
employing the reversed passive latex agglutination (RPLA)
method. Coagulase types were determined using
Staphylococcus coagulase-typing immune sera, and the
Panton-Valentine leukocidin (PVL) gene was detected by
polymerase chain reaction (PCR).
RESULTS: Of the 68 Staphylococcus aureus isolates,
MRSA accounted for 26.7%. Production of EXT-A,
EXT-B, TSST-1 was detected in 29.4%, 8.8%, 14.7% of
the isolates, respectively. The productivity of EXT-A and
-B was noted at a significantly higher frequency in isolates
from impetigo of the skin than those from the nasal mucus.
Staphylococcus aureus isolates were divided into
methicillin sensitive staphylococcus aureus (MSSA) and
MRSA; MSSA belonged to any one of coagulase types
I-VII, but MRSA belonged to any one of types I, II, and III.
Notably, more than 50% of MRSA belonged to type III.
EXT-A-producing strains were only MSSA, and related to
coagulase type V. EXT-B-producing strains were related to
coagulase type I. Nearly all TSST-1-producing strains were
MRSA, and related to coagulase type III. Of EXT-A or
B-producing strains, no TSST-1 producing strain was
found. MSSA strains and MRSA strains were examined for
the presence of the PVL gene. No strain carried this gene.
Regarding resistance to non-ОІ-lactam antimicrobial agents,
MRSA strains exhibited resistance to gentamycin at 55.6%,
erythromycin at 46.7%, clindamycin at 27.7%,
levofloxacin at 16.7%. On the other hand, these strains
were
susceptible
to
minocycline,
sulfamethoxazole-trimethoprim, and vancomycin.
DISCUSSION: Staphylococcus aureus isolates from
community-acquired infection in children comprised
EXT-A-producing
coagulase
type
V
strains,
EXT-B-producing coagulase type I strains, and
TSST-1-producing coagulase type III strains, suggesting
the possible spread of specific clones in the community.
P1-016
Bacterial Infection
Pyogenic Arthritis in Childhood: A
13-Year Review
Eiji Ohta, Shinichi Hirose
Japan
OBJECTIVE: To investigate the causative
pathogens, complications, and outcomes for
pyogenic arthritis cases.
METHODS & PATIENTS: We retrospectively
reviewed records of 30 pyogenic arthritis cases
admitted to Fukuoka University Hospital from
January, 1997 to December, 2009. Patient age
ranged from 1 month to 14 years and 15 patients
(50%) were less than two years old. The
male/female ratio was 2:1.
Twenty-seven
patients (90%) had only a single affected joint;
these included hip (17), knee (9), ankle (1),
shoulder (1), elbow (1), sacroiliaca (1).
RESULTS: Pathogens were identified in 19
(63%) of the 30 cases, with Staphylococcus
aureus (11/30, 37%). Six of these 11 were
methicillin-sensitive S. aureus (MSSA) and 5
methicillin- resistant S. aureus (MRSA). MSSA
is concentrated from 1997-2002 and MRSA is
concentrated from 2003-2009. The 8 non-S.
aureus pathogens included 5 Hemophilus
influenzae type b (Hib), 1 penicillin resistant
Streptococcus
pneumoniae
(PRSP),
1
Streptococcus pyogenes, and 1 Pantorea
agglomerans.
Concomitant
complications
included meningitis (1/30, 3%) and osteomyelitis
(2/30, 7%). In addition, 4 patients had sequelae:
limping gait (2), limb length discrepancy (1), and
stiffness (1). There was a significantly increased
risk of sequelae for those patients less than one
year old and for those with concurrent
osteomyelitis (relative risk, 12.6, 95% CI, 1.1-148;
relative risk, 53.0, 95% CI, 1.95-1439).
CONCLUSION: This study finds S. aureus and
Hib to be the two most common causes of
pyogenic arthritis (as was the case in Western
countries before Hib vaccination). In addition,
MRSA is concentrated in the period from
2003-2009. Hib vaccination began in Japan in
April, 2009; this being so, MRSA will in future
probably be Japan’s most common causative
agent for pyogenic arthritis.
121
P1-017
Bacterial Infection
Epidemiology of Burn Unit Infection in
a Children’s Burn Center
Seon-Hee Shin1, Chang-Hwi Kim2,
Kwang-Nam Kim1, Hea-Soon Shin3
1
Department of Pediatrics, Hangang Sacred
Heart Hospital, Hallym University Medical
Center, Seoul, Korea
2
Department of Pediatrics, College of Medicine,
Soonchunhyang University, Bucheon, Korea
3
College of medicine, Duksung Women’s
University, Seoul, Korea
OBJECTIVE: The aim of this study was to
determine the epidemiology of burn unit infection
about the type of burn injury, age differences and
resistance patterns of the predominant bacteria
isolated from children.
METHODS: We reviewed the hospital records of
patients admitted to children’s burn center of
Hallym University Medical Center from 2003 to
2009. The total number of admitted patients was
3850 and the number of patients with bacterial
infection was 387(10.1%). We reviewed the
hospital records of patients with bacterial
infection.
RESULTS: The average age of patients with
bacterial infection was 18months. The most
common type of burn injury was scalding burn
(62.5%). Most common time of infection
occurred 3~6 days after injury. The causative
organism was P.aeruginosa (31.2%), coagulase
negative Staphylococcus (18.9%), S. aureus
(17.0%) and A.baumannii (6.8%). The resistance
patterns of these organisms were increasing with
the lapse of time. The rate of multi-durg resistant
were P.aeruginosa (95.3%), coagulase negative
Staphylococcu (80.9%), S. aureus (85.0%) and
A.baumannii (94.5%) in 2009.
CONCLUSION: The major pathogens of burn
infection changed to be drug-resistant organism.
Strict infection control guidelines and active
surveillance are needed for the preventing and
treatment of burn infection.
P1-018
Bacterial Infection
Frequency of AmpC Beta Lactamase
Producing Bacteria Isolated from a
Tertiary Care Hospital
Afreenish Hassan, Javaid Usman, Fatima
Kaleem
National
University
Of
Sceineces
And
Technology/Army Medical College, Rawalpindi,
Pakistan
INTRODUCTION/BACKGROUND:
AmpC
class beta lactamases are cephalosporinases that
are poorly inhibited by clavulanic acid. They are
different from other ESBLs by their ability to
hydrolyze cephamycins in addition to other
extended spectrum cephalosporins. Plasmid
mediated AmpC beta lactamases differ from
chromosomal AmpCs in being uninducible and
are typically associated with broad multi drug
resistance.
OBJECTIVE: To detect the frequency of AmpC
beta lactamase producing bacteria isolated from a
tertiary care hospital of Pakistan.
PLACE AND DURATION OF STUDY: The
study was carried out from October 2009 to
March 2010, at the Department of Microbiology,
Army Medical College/ National University of
Sciences and Technology, Rawalpindi, Pakistan.
METHODS: Clinical specimens were received
form various wards. Organisms were identified by
standard microbiological procedures. Screening of
the isolates was done by using cefoxitin disc.
Screen positive organisms were subjected to three
dimensional extract test for detection of AmpC
beta lactamases. Antimicrobial susceptibility of
isolates against aminoglycosides, monobactams,
fluoroquinolones, cotrimoxazole, tetracyclines,
carbapenems and beta-lactam/beta-lactamase
inhibitor combination was tested by using Kirby
Bauer disc diffusion technique, according to CLSI
guidelines.
RESULTS: We evaluated 64 screen positive
isolates for AmpC production. Among these 64,
40 were positive for AmpC beta-lactamases. The
frequency of AmpC producing isolates was 62.5%.
This is the first study to determine the occurrence
of AmpC beta lactamases from Pakistan.
122
P1-019
Bacterial Infection
Therapeutic Monitoring of
Vancomycin according to the Initial
Dosing Regimen in Pediatric Patients
P1-020
Bacterial Infection
The Possibility of Bacterial Meningitis
among Febrile Seizure Children
Younger Than 18 Months of Age
EY Cho, DI Kim, JH Lee, JY Sung, MA Yang,
KW Yun, Hong KB, J Lee, CHOI EH, HJ Lee
Nelly Amalia Risan, Anggraini Alam, Cissy B.
Kartasasmita
Department of Pediatrics, Seoul National University College
of Medicine, Republic of Korea
Child Health Department Hasan Sadikin Hospital/Medical
Faculty of Universitas Padjadjaran, Indonesia
BACKGROUND: Recently a consensus has been
made to treat MRSA infections in adults, trough
vancomycin concentrations always need to be above
10 mg/L to avoid development of resistance. This
study was performed to find out the optimal initial
vancomycin dose to achieve appropriate trough level
in pediatric patients.
METHODS: Clinical data of 443 children who
were treated with intravenous vancomycin during
2004-2009 in 2 hospitals located in Seoul and
Seongnam, Korea, were analyzed. Patients were
aged 1-16 years-old, all were in normal renal
function. Patient data including reason for treatment
and initial dosing regimen were reviewed
respectively. Two subgroups were compared
according to initial vancomycin dose, 40 (35~45)
mg/kg/day group and 60 (55~65) mg/kg/day group.
Trough levels were obtained at steady-state, after at
least three doses of vancomycin.
RESULTS: Vancomycin was frequently used in 161
patients with post-operation or wound-related
infections (36.3%), meningitis (41 cases, 9.3%),
catheter-related infections (34 cases, 7.7%) and
endocarditis (32 cases, 7.2%). Pathogen was
confirmed in 81 cases, 29 cases were MRSE (36%)
and 31 cases were MRSA (31%). 201 patients
(45.4%) out of 443 received vancomycin of 40
mg/kg/day and 108 patients (24.4%) received 60
mg/kg/day. Trough concentration of 40 mg/kg/day
group was 6.58 В± 3.52 mg/L, and trough of 60
mg/kg/day group was 12.17 В± 6.34 mg/L (p<0.001).
28 patients (14%) in 40 mg/kg/day group and 53
patients (49%) in 60 mg/kg/day group achieved
trough levels over 10 mg/L (p<0.001). Troughs in 60
mg/kg/day group were higher, and no decreases in
renal function were observed in both groups.
CONCLUSIONS: Commonly used vancomycin
dosing regimen with 40 mg/kg/day for children was
not enough to achieve trough level of over 10 mg/L.
Careful drug monitoring has to be performed and
increasing initial dose of vancomycin would be
considered in pediatric patients.
OBJECTIVE: Seizure and fever are common
presenting symptoms of bacterial meningitis. The usual
sign of meningitis are often absent in children
especially in infants. The 1996 AAP guideline for
evaluation of children with febrile seizures (FS)
recommends that lumbar puncture (LP) be “strongly
considered ”for infants aged <12 months and
“considered” for children aged 12-18 months. To
examine the rate of bacterial meningitis among children
< 18 months age and compliance with AAP
recommendations, we reviewed records of children <18
months who presented between December 2008 and
December 2009 to Child Health Department Hasan
Sadikin Hospital with febrile seizure.
METHODS: A retrospective cohort review was
performed for patients < 18 months of age who were
evaluated for febrile seizure in a Child Health
Department between December 2008 and December
2009
RESULTS: There were 79 febrile seizure patients,
range of age was 1-18 months (mean 11,85В±3.45
months). From them 59 (74,7%) were ≤ 12 months and
20 (25,3%) were 12-18 months of age. Lumbar
puncture was performed to 23 children (29,1%), 56
children (70,9%) refused it. The result, there were 9
children diagnosed with bacterial meningitis. Children
younger than 12 months of age are not tend to be
bacterial meningitis. There is no difference in bacterial
meningitis between children ≤ 12 months and 12-18
months of age. From all febrile seizure patients, 9
children (11,4%) experienced ≥ 15 min seizure, 2 of
them were diagnosed having bacterial meningitis.
There was no difference in ≥ 15 min seizure between
bacterial meningitis group and no bacterial meningitis.
(Fisher’s Exact test p=0,271). From 17 children
younger than 12 months of age who had undergone LP,
7 (40%) were found having bacterial meningitis. Level
of consciousness decreased in 4 (66,7%) out of 9
children with bacterial meningitis. There was a
difference in level of consciousness between bacterial
meningitis and no bacterial meningitis children.
(Fisher’s exact test p=0.001)
CONCLUSIONS: There is a risk of bacterial
meningitis among children < 18 months of age
presenting as febrile seizure. Refusal of LP in patients
with febrile seizure is a common and difficult problem
in our hospital. It can be a hindrance to the proper
management of a child presenting with febrile seizure.
123
P1-021
Epidemiology
Seroprevalence of HTLV-I among
Kidney Graft Recipients: A Single
Center Study
Zakieh
Rostam-Zadeh
Khameneh,
Ali
Tagizadeh, Zahra Shirmohammadi, Nariman
Sepehrvand, Sima Masudi
Iran
Background: Renal transplant recipients are
susceptible to viral infections because of their
immunocompromised background. HTLV-1 is a
retrovirus which leads to adult T-cell
Leukemia/Lymphoma or myelopathies. This study
aimed to evaluate HTLV-1 antibody among renal
transplant recipients of Urmia-Iran.
Methods: Serum samples of 91 renal transplant
recipients from Urmia, Iran were examined
serologically for antibodies against HTLV type 1
using an Enzyme-linked Immunosorbent Assay
(ELISA).
Results: Mean Age was 37.26В±14.22 years old.
Only one patient had a positive anti -HTLV-1
ELISA test which was confirmed by western blot.
The HTLV-1 positive case had no one of HTLV
associated clinical manifestations. This patient
was a 45 years old male and had no history of
blood transfusion, but history of hemidialysis
prior to transplantation.
Discussion: the frequency of HTLV-1 among
renal transplant recipients of our region in the
northwest of Iran was not so high, and it is similar
to
the
HTLV-1
seroprevalence
among
hemodialysis patients, but more than its frequency
among healthy blood donors as a representative of
general population in our region.
P1-022
Epidemiology
Bacterial Aetiology and Antibiotic
Resistance of Acute Otitis Media in
Young Children in Thailand
JP Intakorn1, N Sonsuwan2, S Noknu3, G
Moungthong4, LF Peruski5, JY Pirçon6, Y Liu7, MK
Van Dyke6, WP Hausdorff6
1
Queen Sirikit National Institute of Child Health; 2Chiang Mai
University; 3Hatyai Hospital; 4Phramongkutklao Hospital of
the Royal Thai Army, Thailand; 5CDC International Emerging
Infections Program; 6GSK Biologicals, Belgium; 7GSK
Biologicals, Singapore
OBJECTIVE: Acute otitis media (AOM) is an important
cause of childhood morbidity and driver of antibiotic use in
children worldwide. Bacterial conjugate vaccines have
demonstrated some efficacy in preventing AOM, but results
vary according to underlying pathogen and serotype
distribution in the population. Studies elsewhere have detected
bacteria in 50-90% of AOM cases, but there is limited AOM
aetiological information from Asian children. We therefore
characterized the aetiology, serotype distribution, and
antibiotic susceptibility pattern of bacterial AOM cases in
Thailand.
METHODS: Children aged ≥3 months to <5 years diagnosed
with AOM by Ear, Nose, and Throat (ENT) specialists were
eligible to participate. New episodes of AOM (onset of signs
and symptoms <3 days) and treatment failures (symptomatic
2-3 days after initiation with physician-prescribed antibiotics)
were included. To determine aetiology, ENTs collected middle
ear fluid (MEF) samples by tympanocentesis or by careful
sampling of spontaneous otorrhea (<20% of all cases).
Samples were cultured within 48 hours and recovered bacterial
pathogens were further assessed for antibiotic susceptibility
and serotype.
MAIN RESULTS: From April 2008 to August 2009, 118
MEF (107 from tympanocentesis and 11 from otorrhea)
samples were collected from 112 children. The median age of
participants was 36.0 months (range: 5-59 months), and 55%
of subjects were female. Bacteria were cultured from 57 of
118 (48%) samples, and of the 57 culture-positive samples, 26
were S. pneumoniae (46%), 20 were H. influenzae (35%), 6
were M. catarrhalis (11%), 4 were S. pyogenes (7%), and 2
were mixed (S. pneumoniae+H. influenzae and H.
influenzae+M. catarrhalis (2%)). All pneumococcal isolates
were susceptible to amoxicillin/clavulanate (100%), but most
were non-susceptible to penicillin (19%-resistant (R);
52%-intermediate
(I)),
trimethroprim/sulfamethoxazole
(59%-R; 19%-I), cefuroxime (59%-R; 4%-I), tetracycline
(63%-R; 4%-I), erythromycin (63%-R, 4%-I), and
azithromycin (85%-R; 11%-I). Multidrug resistance was
identified in 81% of pneumococcal isolates. Pneumococcal
serotypes were 19F (26%), 14 (22%), 3 (15%), 23F (7%), 6
(7%), and 18C (4%); 19% of samples had an unknown
serotype by multiplex PCR serotyping. All H. influenzae
samples were susceptible to amoxicillin/clavulanate (100%),
but some were resistant to trimethroprim/sulfamethoxazole
(33%). Typing results are pending.
CONCLUSION: As seen in other regions of the world, S.
pneumoniae and H. influenzae were the major bacterial causes
for AOM. Pneumococcal isolates were often resistant to
multiple antibiotics. A vaccine with efficacy against both
pathogens would be useful in further prevention of AOM and
reduction of antibiotic use.
124
P1-023
Epidemiology
Risk Factor Analysis of Salmonella
Infection in Taiwan
Ting-Fang Chiu1, Ping-Ing Lee2, Po-Ren
Hsueh3, Kun-Mei Lee1, Hsin-Lin Wu1,
Jung-Chieh Du1, Ya-Chi Yang1, Hsu-Yeh Shu1,
Chung-Shu Sun1, Betau Hwang1,4
1
Department of Pediatrics, Taipei City Hospital, Zhongxiao
Branch, Taipei, Taiwan; 2Department of Pediatrics, National
Taiwan University Hospital, Taipei, Taiwan; 3Departments of
Laboratory Medicine and Department of Internal Medicine,
National Taiwan University Hospital, Taipei, Taiwan;
4
National Yang-Ming University, Taipei, Taiwan
OBJECTIVE: Salmonellosis is highly prevalent
and is an important issue of public health in Asian
countries. Some data suggested that poultry and
meat are important sources of the infection, and
fresh meats are frequently contaminated by
gastrointestinal pathogens. This study is aimed to
explore the risk factors associated with salmonella
infection.
METHODS: This study is a retrospective
questionnaire study. Cases were patients with a
positive stool culture of nontyphoidal Salmonella
species during 2001-2005. Three groups of cases
served as controls: patients with a positive stool
culture of Campylobacter jejuni, patients with a
positive rotavirus antigen in the stool, and healthy
subjects. Factors included in the questionnaire are
underlying diseases, medications taken in previous
four weeks, breast milk in infancy, play in sandbox,
source of drinking water and eggs, pets at home,
occupations of family member, dining and cooking
habits, day care attendance, etc.
MAIN RESULTS: The response rate were there are
14.7% (151/1030) in patients with salmonella
infection, 13.3% (14/105) in patients with
Camylobacter infection, 20% (200/1000) in patients
with rotavirus infection, and 83% (166/200) in
healthy controls. Among 151 patients with
salmonella infection, the male to female ratio was
82:69 and the median age is 2.6 years old.
Multivariate backward stepwise logistic regression
analysis revealed that risk factor for salmonella
infection are buying pork in wet market and those
with underlying medical conditions. Breast feeding
in infancy and pre-washed eggs predispose to
salmonella infection.
CONCLUSIONS: Buying pork in wet market and
patients with immunocompromised conditions are
associated with increased risk of salmonella
infection.
P1-024
Epidemiology
Changing Epidemiology of Mastoiditis
in Children in the Era of Emerging
Antibiotic-Resistant Bacteria in
Taiwan
Tsung-Pei Tsou1, Ping-Ing Lee1, Boon Fatt Tan1,
Chun-Yi Lu1, Po-Ren Hsueh2, Pei-Lan Shao1,
Li-Min Huang1, Jong-Min Chen1, Luan-Yin
Chang1, Chin-Yun Lee1
1
Department of Pediatrics, National Taiwan University
Hospital and National Taiwan University College of Medicine,
Taipei, Taiwan; 2 Department of Laboratory Medicine and
Internal Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, Taipei,
Taiwan
BACKGROUND: With increasing prevalence of
resistant bacteria in Taiwan, it is known that the
incidence of complicated pneumonia and pleural
empyema has increased in children recently. It is not
known whether there is a similar impact on the
epidemiology of complicated otitis media.
PATIENTS AND METHODS: Records of all
children less than 18 years of age with a diagnosis of
mastoiditis from 1996 to 2006 were reviewed. The
diagnosis was confirmed by the presence of local
inflammatory sign and/or image studies.
RESULTS: Seventy-eight episodes of mastoiditis
were diagnosed in 76 patients aged between 1 month
and 18 years. The incidence of mastoiditis has
increased steadily after the year 2000. Local
swelling tended to be more frequently observed in
children younger than 3 year-old (p=0.03), while
otalgia was more commonly reported by children
older than that age (p=0.059). Although
computerized tomography was the most commonly
used image study, magnetic resonance image was
shown to be a more sensitive diagnostic tool that can
disclose
details
of
pathologic
changes.
Mastoidectomy was performed in 8 (10.2%) patients.
In contrast to etiological agents of acute otitis media
without complication, Staphylococcus aureus was
the most commonly (34.5%) isolated pathogen in
mastoiditis, and most of the strains isolated after the
year 2003 were resistant to oxacillin. The next
commonly seen pathogen was Streptococcus
pneumoniae (27.5%). Other etiological agents
include Candida species, Pseudomonas aeruginosa,
Mycobacterium chelonae, Klebsiella pneumoniae,
viridans streptococcus, Acinetobacter baumannii and
group A streptococcus.
CONCLUSIONS: This study shows that the
incidence of mastoiditis had increased dramatically
in children in recent years. This phenomenon may be
related to the emergence of penicillin-resistant S.
pneumoniae and oxacillin-resistant S. aureus in
Taiwan.
125
P1-025
Epidemiology
Bordetella pertussis, Mycoplasma
pneumoniae and Chlamydia
pneumoniae Associating with
Prolonged Cough in Children
Chien-Yu Lee1, Jia- Yi Lin2, Jen-Sheng Pei1
1
Department of Pediatrics and Department of Laboratory
Medicine, Tao-Yuan, Taiwan; 2Tao-Yuan General Hospital,
Tao-Yuan, Taiwan
OBJECTIVE: To estimate the proportion of
children with a prolonged cough who have evidence
of a recent Bordetella pertussis, Mycoplasma
pneumoniae or Chlamydia pneumoniae infection.
METHODS: A prospective cohort study was
conducted to recruit children who had been
coughing for 14 days or more and consented to have
a blood test during February 2009 and February
2010. Serological study of a recent Bordetella
pertussis, Mycoplasma pneumoniae or Chlamydia
pneumoniae infection was performed by enzyme
linked immunosorbant assay (ELISA) technique and
complement fixation test. Vaccination history,
contact history and clinical features were collected
for these patients.
MAIN RESULTS: One hundred and nine children
were recruited and consented for a blood test. One
hundred and one (92.7%) cases had been immunized
with at least 3 doses of pertussis vaccines. Three
patients (2.8%) had serological evidence of a recent
Bordetella pertussis infection (pertussis toxin IgA
was positive) and they all are adolescents. Protective
pertussis toxin IgG had waned in 32(29.4%) of cases
with prolonged cough. Pertussis toxin IgM was
positive in 68 (62.4%) cases. Twenty-five (22.9%)
patients had evidence of a recent Mycoplasma
pneumoniae infection and 2 (1.8%) patients had a
recent Chlamydia pneumoniae infection. One patient
(0.9%) has mixed infection of Mycoplasma
pneumoniae and Chlamydia pneumoniae. The
clinical symptoms such as whooping cough and
cough-induced headache were more significant in
cases with Bordetella pertussis infection than in
cases without Bordetella pertussis infection.
CONCLUSION: For children with prolonged
cough, a diagnosis of pertussis should be considered
in patients with whooping cough or cough-induced
headache even if the child has been immunized.
More than one fourth of patients who had prolonged
cough need treatment with macolides. However,
antibiotics should be judiciously used in patients
with prolonged cough according to the clinical
features and adequate evaluations.
P1-026
Influenza
Influenza and Parainfluenza
Associated Pediatric ICU Morbidity
Kam Lun Ellis Hon, Paul Kay-sheung Chan,
Ting-fan Leung
Hong Kong
OBJECTIVES: We investigated if morbidity had
increased in young children admitted to a
pediatric intensive care unit (PICU) with a
laboratory proven diagnosis of influenza and
parainfluenza infection.
METHODS: Retrospective study between
January 2003 and December 2009 was carried out.
Every
child
in
the
PICU
with
a
laboratory-confirmed influenza or parainfluenza
infection was included.
RESULTS: 18 influenza (influenza A=13 and
influenza B=5) and 17 parainfluenza admissions
were identified over the 7-year period.
Parainfluenza type 3 (n=9) was the commonest
subtype of parainfluenza infection. The median
age of children admitted with influenza was
higher than parainfluenza (4.5 versus 1.7 years, p
= 0.044). Admissions associated with proven
influenza and parainfluenza infections accounted
for 2% of PICU annual admissions. There was
only one death in 2003. 51% of these patients
required ventilatory support, 45% received
systemic corticosteroids, and 91% received initial
broad spectrum antibiotic coverage. Bacterial
co-infections were identified in 25% of these
patients. The incidence of influenza admissions
had not increased significantly in 2009 (H1N1
pandemic) when compared with 2003 (SARS
epidemic) (p=0.3). There were only two PICU
cases of pandemic H1N1 in 2009 and both
survived. The annual incidence of severe PICU
cases of influenza and parainfluenza were 0.94
and 0.88 per 100,000 children, respectively.
CONCLUSIONS: There is no evidence to
suggest that PICU mortality and severe morbidity
associated with the pandemic H1N1 and other
influenza and parainfluenza viruses has increased
dramatically in recent years.
126
P1-027
Influenza
Significance of Seasonal Influenza
Viruses in the Stool of Pediatric
Patients
P1-028
Influenza
Lower Respiratory Tract Infection in
Hospitalized Thai Infants: Influenza
and Respiratory Syncytial Virus
Daisuke Tamura1, 2, Motoko Fujino3, Makoto
Ozawa4,5, Kiyoko Iwatsuki-Horimoto2, Hideo
Goto2, Yuko Sakai-Tagawa2, Taisuke
Horimoto2, Mari Nirasawa3, Yoshihiro
Kawaoka2,4,5,6, Kou Ichihashi1,
Sarunya Srijuntongsiri1, Piyarat
Suntarattiwong1, Kanokwan Sojirarat1, Pranee
Sitaposa1, Malinee Chittaganpitch2, Tawee
Chotpitayasunondh1
1
Department of Pediatrics, Saitama Medical Center, Jichi
Medical University, Saitama, Japan; 2Division of Virology,
Department of Microbiology and Immunology, Institute of
Medical Science, University of Tokyo, Tokyo, Japan;
3
Department of Pediatrics, Tokyo Saiseikai Central Hospital,
Tokyo, Japan; 4International Research Center for Infectious
Diseases, Institute of Medical Science, University of Tokyo,
Tokyo, Japan; 5Influenza Research Institute, School of
Veterinary Medicine, University of Wisconsin-Madison,
Madison, USA; 6ERATO Infection-Induced Host Responses
Project, Japan Science and Technology Agency, Saitama,
Japan
BACKGROUND: Seasonal influenza viruses
cause respiratory disorders with significant
morbidity and mortality in children and are
occasionally associated with gastrointestinal
symptoms. Although seasonal influenza viral
RNA has been detected in stool specimens from
influenza patients, the virological significance is
unknown.
METHODS: To detect influenza viral genes, 28
stool specimens were collected from 18 pediatric
influenza patients and subjected to one step
RT-PCR. To isolate infectious virus from stool
samples, the stool specimens were inoculated into
Madin-Darby
canine
kidney
cells
and
embryonated chicken eggs.
RESULTS: Although more than 60% of the stool
specimens were tested positive by RT-PCR, an
infectious virus was recovered from only one
sample.
CONCLUSIONS: Further studies are needed to
evaluate the possibility of infectious virus in the
stool of patients infected with the 2009 pandemic
virus. These results indicate that fecal excretion of
seasonal influenza viruses does not appear to be a
public health concern.
1
Department Of Pediatrics, Queen Sirikit National Institute Of
Child Health, Bangkok, Thailand; 2Natinal Influenza Center,
Department Of Medical Science, Ministry Of Public Health,
Thailand
BACKGROUND: Respiratory syncytial and influenza
viruses are among common causes of acute lower
respiratory
tract
infections
(ALRI)
requiring
hospitalization in young children.
OBJECTIVES: To determine a hospital-based incidence,
clinical manifestations, severity, length of hospital stay,
and medical costs of ALRI caused by influenza virus and
Respiratory syncytial virus (RSV) in hospitalized infants at
Queen Sirikit National Institute of Child Health
(QSNICH).
METHODS: An observational prospective study was
conducted in hospitalized children less than one year of
age at QSNICH, with ALRI between December 2007 and
August 2009. Clinical data were obtained from patient
interviews, physical examination, and laboratory
investigation (Reverse transcription polymerase chain
reaction/RT-PCR) for influenza A/B and RSV. Disease
severity, length of hospital stay, and associated medical
costs were evaluated.
RESULTS: In the total of 363 episodes of ALRI
investigated, there were nine in which the nasopharyngeal
swab specimens were considered inadequate for viral study
(RT-PCR) and thus excluded. The average age was 6.9
months (range, 1-12 months). One hundred and four
(29.5%) were found to be positive for RSV, whereas 26
(7.3%) were positive for influenza. Clinical diagnosis of
pneumonia, bronchiolitis, croup, and bronchitis were
identified in 73.4%, 17.6%, 6.5%, and 2.5%, respectively.
RSV-infected patients were more likely to have
crepitations on chest auscultation and concomitant diarrhea
compared to RSV-negative ALRI patients (p <0.05). There
were 2 fatal cases: both were RSV-infected patients, 7
patients from RSV and 1 patient from influenza group
needed mechanical ventilation. The average length of stay
among patients tested positive for influenza virus, RSV,
and those tested negative for both virus were 12.3, 8.3, and
8.9 days, respectively. Total hospital costs for patients
hospitalized with LRTI from influenza, RSV, and those
tested negative for these two viruses were not significantly
different: 808.5, 910, and 576 US dollars, respectively.
CONCLUSION: RSV and influenza virus accounted for
29.5% and 7.3% of hospitalized ALRI among children
younger than one year of age, respectively. Influenza or
RSV-infected ALRI patients tend to have a higher total
hospital costs compared to those tested negative for these
two viruses.
127
P1-029
Influenza
Preexisting Antibodies against
Pandemic (H1N1) 2009 in Older People
in Taiwan
Shih-Cheng Chang1,2, Yuh-Chering Huang1,2,4,
Cheng-Hsun Chiu1,4, Shin-Ru Shih2,3, Tzou-Yen
Lin1,2,4
1
Division of Infectious Diseases, Department of Pediatrics,
Chang Gung Children’s Hospital, Chang Gung Memorial
Hospital, Taoyuan, Taiwan; 2Research Center for Emerging
Viral Infections, Chang Gung University, Taoyuan, Taiwan;
3
Department of Medical Biotechnology and Laboratory
Science, Chang Gung University, Taoyuan, Taiwan; 4College
of Medicine, Chang Gung University, Taoyuan, Taiwan
BACKGROUND: Serological studies of pandemic
(H1N1) 2009 in USA and UK indicated that a
proportion of older persons had preexisting
cross-reactive antibodies to this virus. However, recent
data reported in Asian countries such as China and
Japan showed inconsistent trends in the age-related
antibody response.
OBJECTIVE: The aim of the present study is to know
the level of preexisting antibody titer to 2009 H1N1
virus in the elderly in Taiwan and to evaluate the
strategy of 2009 H1N1 monovalent vaccine.
METHODS: Antibody responses to 2009 H1N1 and
seasonal
H1N1
virus
were
detected
by
hemagglutination inhibition assay in serum sample
collected from 79 persons aged 60 years or older during
February to March 2009 before the present pandemic,
and also from 169 health workers aged 22-60 years
during October to November 2009 before receiving
2009 H1N1 monovalent vaccine.
RESULTS: The proportion of samples with antibody
titer 1:40 or more were approximately 36.7% (29 of 79)
in persons aged 60 years or older, and increased to
41.5% (22 of 53) among persons aged 60-69 years. In
contrast, there was only 8.3% (14/169) of health
workers aged 22-60 years with titer 1:40 or more and
no significant difference between frontline and other
health workers. Besides, our results also showed that
health workers aged 22-60 years had relative high
proportion of titers 1:40 or more to seasonal H1N1
virus (94.9%), while in the elderly, the proportion in
H1N1 were only 51.9%.
CONCLUSIONS: Instead of seasonal influenza
vaccination, previous exposure to or infection with
influenza virus similar to 2009 H1N1 virus has been
suggested to induce the cross-reactive antibodies in the
elderly. The discrepancy in preexisting immune status
was probably present among geographic regions. Our
serological data in Taiwan consistent with those in USA
and UK can support the significance of prior
vaccinating people under 60 years of age.
P1-030
Influenza
Comparison of an ELISA to Quickvue
Influenza A+B Test and RT-PCR for
Diagnosis of Pandemic 2009 Influenza
a (H1N1) Virus Infections
Chun-Yi Lu, Luan-Yin Chang, Li-Min Huang
Department of Pediatrics, National
University Hospital, Taipei, Taiwan
Taiwan
A 2009 pandemic influenza A (H1N1)-specific
enzyme-linked immunosorbent sssay (ELISA)
developed by Xiamen University was tested with
selected clinical samples. An antibody against
hemagglutinin antibody of the virus was used in
the assay. A selection of 90 throat swab samples
with various 2009 pandemic influenza A (H1N1)
virus loads were tested. Using RT-PCR as a
golden standard, the overall sensitivity (0.57) was
comparable with that of the QuickVue Influenza
A+B Test. The specificity of the ELISA was 1.0
using the selected sample set. The specificity was
higher than that for the QuickVue Influenza A+B
Test. The positive and negative predictive values
were 1 and 0.4, respectively. A strong correlation
between viral load and specificity were found for
both diagnostic methods. When the logarithm of
the viral load (copies/ml) was higher than 5, the
sensitivity was 100%. The 2009 pandemic
influenza A (H1N1)-specific ELISA is an
easy-to-perform, highly specific and fairly
sensitive diagnostic tool for the 2009 pandemic
influenza A (H1N1) virus infections.
128
P1-031
Influenza
Clinical Characteristics of Children
Hospitalized for the 2009 Pandermic
Influenza A/H1N1 Virus Infection in
Four Tertiary Care Hospitals in
Thailand
P1-032
Influenza
Factors Associated with Rapid Disease
Progression of Pandemic 2009
Influenza A (H1N1) Virus Infection in
Children - Focusing on Initial Chest
Radiographic Findings
Pimpanada
Songkiat
Udompornwattana1,2,
1
Chearskul , Krissada Srajai2, Pongsan Suwan3,
Orasi
Auchara
Tangsathapornpong4,
Wittawatmongkol1, Wanatpreeya Phongsamart1,
Nirun Vanprapar1, Kulkanya Chokephaibulkit1
Takanori Funaki, Kensuke Shoji, Nobuyuki Yotani,
Tomohiro Katsuta, Osamu Miyazaki, Shunsuke Nosaka,
Hidekazu Masaki, and Akihiko Saitoh
Division of Infectious Diseases, Department of Pediatrics,
Faculty of Medicine Siriraj Hospital, Mahidol University,
2
Department
of
Pediatrics,
Bangkok,
Thailand;
Buddhachinaraj Phisanulok Hospital, Phisanulok, Thailand;
3
Department
of
Pediatrics,
Pranungklao
Hospital,
Nonthaburi , Thailand; 4 Division of Infectious Diseases,
Department of Pediatrics, Thammasart University Hospital,
Pathumthani, Thailand
OBJECTIVE: Most illnesses caused by the pandemic 2009
influenza A (H1N1) virus infection have been acute and
self-limited with the highest attack rates reported among
children.
However, some children demonstrated rapid
disease progression, required hospitalization, transfer to
pediatric intensive care unit (PICU), and mechanical
ventilation. This study investigates factors associated with
rapid disease progression among admitted children for
A/H1N1 influenza infection focusing on initial chest
radiographic findings.
METHODS: This is a retrospective study of children who
were laboratory or clinically diagnosed as pandemic 2009
influenza A (H1N1) virus and admitted to the National Center
for Child Health and Development in Tokyo (the largest
pediatric hospital in Japan with 460 beds) between May, 2009
and March, 2010. Medical records were reviewed for age,
underlying diseases, vital signs, initial chest radiographic
findings, time from the onset of illness, and clinical outcomes
including PICU transfer and requirement of mechanical
ventilation. Factors associated with the clinical outcomes
were analyzed using the logistic regression.
MAIN RESULTS: Two hundreds and three patients (median
age: 6.8 years, range: 0.0-13.8 years) were enrolled in this
study. Fifteen percent (31/203) of patients were admitted to
PICU, and 39% (12/31) of patients required mechanical
ventilation at PICU. All hospitalized patients were treated
with neuraminidase inhibitors and clinical outcome was
excellent without any death case. Age, respiratory rates, and
time from the onset of disease were not associated with
transfer to PICU (P > 0.17) or requirement of mechanical
ventilation (P > 0.28).
The pattern of initial chest
radiographs were classified as follows: 1) normal (22.7%, n =
46), 2) hilar and/or peribronchial pattern alone (31.5%, n = 64),
3) consolidation (31.5%, n = 64), 4) others (14.3%, n = 29).
When the radiographic findings were divided into 1) with
consolidation (n = 64) and 2) without consolidation (n = 139),
higher percentage of patients (34.3%, 22/64) with
consolidation were admitted to PICU compared to those
without consolidation (6.5%, 9/139) (P < 0.001). In addition,
those with consolidation were frequently required mechanical
ventilation (18.8%, 12/64) compared to those without
consolidation (0%) (P < 0.001). Using the logistic regression
analysis, consolidation on chest radiographs was the only
significant factor associated with PICU transfer and
requirement of mechanical ventilation (P < 0.001 and P <
0.001, respectively).
CONCLUSION: Consolidation on initial chest radiographs
was the important factor to predict clinical course of admitted
children with the pandemic 2009 influenza A (H1N1)
infection.
1
OBJECTIVE: The pandemic H1N1 2009 (pH1N1)
was spreading in Thailand and many countries in Asia
from June 2009. The information of the infections in
children in the region was limited available. We
describe the clinical characteristics of hospitalized
children with pH1N1 infections in Thailand.
METHODS : We conducted a retrospective chart
reviews of children hospitalized in 4 tertiary care
hospitals in Thailand (Siriraj Hospital, Buddhachinaraj
hospital, Pranungklao Hospital and Thammasat
University Hospital) from June 1 to September 30,
2009, with laboratory-confirmed pH1N1 using a
standardized case record form. Household contact data
were obtained by telephone.
RESULTS : There were 115 children, 58 female
(50.4%), with the mean age 5.2 years (range, 6
months-15 year). 49.6% had at least one underlying
disease, 25% of these were asthma. Preadmission
illness duration was 2 (range, 1-10) day. 87 (76%) had
chest radiography confirmed pneumonia. Oseltamivir
was prescribed in 90.4%, of which 46.2% received
within 48 hours of illness. 60.8% received antibiotics.
The median duration of hospitalization was 3 days
(1-93 days). Five (4.3%) children required mechanical
ventilator and intensive care unit (4 had ARDS and 1
had encephalopathy), of which 2 children died causing
the case fatality rate 1.7%. Of the 109 children who
recall the contact history, 63 (57.8%) had contact with
suspected or confirmed cases of pH1N1 before the
illness, and 18 (16.5%) reported secondary household
confirmed pH1N1. 75% of the secondary household
cases were less than 16 years.
CONCLUSION: Hospitalized children with pH1N1
infection were mostly uneventful. Severe cases with
ARDS were uncommon. Secondary cases in household
were more likely to be children.
National Center for Child Health and Development, Tokyo,
Japan
129
P1-033
Pneumococcal Diseases
Childhood Pneumococcal Diseases and
Serotypes: Can Vaccines Protect?
Kam Lun Hon1, Margaret IP2, Kenneth Lee3,
Ting-fan Leung1
1
Departments of Paediatrics, The Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, Hong Kong;
2
Departments of Microbiology, The Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong;
3
Departments of Pharmacy, The Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, Hong Kong
OBJECTIVES: We reviewed cases of
pneumococcal disease in the last 3 years
(2007-2009) and describe serotypes and antibiotic
resistance patterns in these cases.
METHODS: Retrospective study between
January 2007 and December 2009 was carried out.
All children admitted to the pediatric wards
(including PICU) of a university-affiliated
teaching hospital with pneumococcal isolates
were included. Children with pneumococcal
isolates in general pediatric admissions were
identified by using the principal author’s database.
Additional cases were identified by using the
DSM III codes of 041.06 and 041.2.
RESULTS: We reported 12 cases of
pneumococcal disease in children between 2007
and 2009. Five patients were admitted to PICU
and 7 were general pediatric admissions. Four
patients (2 PICU and 2 general pediatric) had
received full or partial 7-valent pneumococcal
vaccinations. All four patients recovered
following systemic antibiotic treatment without
sequelae. The serotypes of all PICU and some
general pediatric cases were available and
included 3, 6B, 19A, 19B and 19F. All isolates
were sensitive to vancomycin. 50% were
intermediate resistant/resistant to penicillin and
17% resistant to cefotaxime. PICU cases required
longer total hospital stay (23 days versus 5 days,
p=0.013). Three patients were ventilated and one
received inotrope. There was no death in this
series. The expanded coverage with the 10-valent
or 13-valent pneumococcal vaccines might have
covered some of these resistant serotypes.
CONCLUSION: Cefotaxime appears to be an
appropriate first line antibiotic if pneumococcal
disease is suspected. Vancomycin may be added if
the presenting symptoms are severe. The newer
13-valent pneumococcal vaccine covers both 3
and 19A serotypes. It may substitute for the
existing 7-valent pneumococcal vaccinations.
P1-034
Pneumococcal Diseases
Invasive Pneumococcal Infection in
Urban Thai Children: a 10-Year
Review
Supichaya Netsawang1, Warunee Punpanich1,
Vipa Treeratweeraphong2, Tawee
Chotpitayasunondh1
1
Department of Pediatrics, Queen Sirikit National
Institute of Child Health, Bangkok, Thailand;
2
Department of Pathology, Queen Sirikit National
Institute of Child Health, Bangkok, Thailand
OBJECTIVE: To determine the disease
frequency, demographic characteristics, clinical
manifestations, laboratory findings and drug
susceptibility patterns of childhood invasive
pneumococcal infections in a hospital setting in
Thailand.
MATERIALS
AND
METHODS:
A
retrospective review was conducted of invasive
pneumococcal infections among children aged
<18 years from January 1, 1998 - December 31,
2007 at the Queen Sirikit National Institute of
Child Health. Medical records of case-patients
were reviewed to collect information on
demographics, clinical manifestations, laboratory
findings, and drug susceptibility patterns of
infecting isolates.
RESULTS: Among the 745,983 children
receiving care at QSNICH during the study period,
culture-proven invasive pneumococcal infections
were identified in 126 patients for an estimated
incidence of 17 cases per 100,000 patients. Patient
diagnoses
included
bacteremia
(59.4%),
meningitis (29.3%), and pneumonia (11.3%). Of
the 31 pneumococcal meningitis cases, 54.8%
were caused by penicillin-nonsusceptible S.
pneumoniae (PNSSP), while 25.3% of 75
non-meningitis cases were PNSSP (records not
available for the remaining 20 cases). Of 126
PNSSP, 8.2% were resistant to cefotaxime and
12.3% were resistant to ceftriaxone. All of the
isolates were susceptible to vancomycin. The case
fatality rate was 12.3%; 23.1% of fatal cases were
associated with HIV infection. Outcomes did not
differ significantly between patients infected with
penicillin-susceptible
and
non-susceptible
pneumococcal strains.
CONCLUSIONS:
The
results
of
this
hospital-based study indicate that the incidence of
invasive pneumococcal infection in QSNICH
remains relatively low, but the case fatality rate is
high, especially among those with HIV infection.
130
P1-035
Pneumococcal Diseases
Demographic and Bacterialogical
Characters of Sinusitis Caused by
Streptococcus Pneumoniae in Children
Yi-Chuan Huang1, Yu-Chia Hsieh2, Hsin-Ching
Lin3
1
Division of Infectious Diseases, Department of Pediatrics,
Chang Gung Memorial Hospital-Kaohsiung Medical Center,
Chang Gung University College of Medicine; 2Division of
Pediatric Infectious Diseases, Department of Pediatrics,
Chang Gung Children’s Hospital, Chang Gung University
College of Medicine, Taoyuan; 3Department of Otolaryngology,
Chang Gung Memorial Hospital-Kaohsiung Medical Center,
Chang Gung University College of Medicine, Taiwan
OBJECTIVE: Streptococcus pneumoniae is the
leading cause of acute sinusitis. Antimicrobial
resistance in S. pneumoniae has been an important
clinical problem for several decades. Along with the
increases in penicillin-nonsusceptible S. pneumoniae,
the role of penicillin in the treatment of pneumococcal
sinusitis was debated. The aim of this study is to
evaluate clinical epidemiology and microbiology of
pneumococcal sinusitis.
METHODS: We analyzed the pneumococcal isolates
cultured from patients smaller than 15-year-old with
sinusitis from Aug 2004 to April 2007. We also
retrospectively reviewed the charts for demographic
and clinical information. These pneumococcal isolates
were test for antimicrobial susceptibility, minimal
inhibitory concentration (MIC) of penicillin and
serotypes. The MIC of penicillin was determined by the
broth dilution method, and the results were interpreted
according to the Clinical and Laboratory Standards
Institute (CLSI) guidelines. The serotypes of isolates
were determined using the capsular swelling method
(Quellung reaction).
MAIN RESULTS: A total 117 pneumococcal isolates
cultured from the orifice opening of maxillary sinuses
of patients with sinusitis. Seventy-five patients were
male and forty-two patients were female. The most
common age group were age of 4y/o (n=26), followed
in descending order was 5y/o (n=19), 1y/o (n=14), 3y/o
(n=14), 6y/o (n=14), 2y/o (n=11), 7y/o (n=9), 9y/o
(n=3), 8y/o, 10y/o, 13y/o (n=2, respectively), and 11y/o
(n=1). The major serotypes responsible for
pneumococcal sinusitis are 6B (n=29) and followed by
19F (n=26), 23F (n=26), 14 (n=11) and others. The
MIC of penicillin showed forty-two isolates were
susceptible (MIC≦1μg/mL) and seventy-five isolates
were intermediate resistant (1Ојg/mL <MIC<4Ојg/mL).
There were only six isolates with MIC≦0.1μg/mL.
CONCLUSION: Serotype 6B, 19F and 23F are
responsible for majority of sinusitis in children. No
penumococcal isolate was high-level resistant to
penicillin
(non-meningitis
criteria).
Therefore,
penicillin remains the first line drug in treating
pneumococcal sinusitis.
P1-036
Pneumococcal Diseases
Incidence of Community Acquired
Pneumonia and Distribution of
Serotypes and Sequence Types of
Streptococcus Pneumoniae among
Japanese Children Prior to the
Introduction of Pneumococcal
Conjugate Vaccine
Junko Oikawa, Naruhiko Ishiwada, Junko
Tanaka, Haruka Hishiki, Tomomichi Kurosaki,
Yoichi Kohno, Yoshiko Honda, Akihito Wada,
Bin Chang
Japan
OBJECTIVE: The introduction of 7-valent pneumococcal
conjugate vaccine (PCV7) has dramatically decreased the
incidence of invasive pneumococcal disease in the United
States and Europe. PCV7 was also found to be effective
for reducing the risk of pneumonia in young children.
PCV7 just has been introduced in Japan at February, 2010.
This study aimed to determine the incidence of community
acquired pneumonia (CAP) and evaluated the distribution
of serotype and sequence type of Streptococcus
pneumoniae among Japanese children prior to the
introduction of PCV7.
METHOD: We conducted a study at 6 major hospitals in
Chiba city from 1 April 2008 to 31 March 2009 and
investigated the rate of S. pneumoniae isolated from
sputum and blood among CAP children. These S.
pneumoniae were evaluated serotype, sequence type
distribution and the antimicrobial susceptibility. A written
questionnaire was sent to all hospitals where pediatric
patients in Chiba city admit to determine annual CAP
incidence in the same study period.
MAIN RESULT: In the study period, 626 patients
admitted with the diagnosis of CAP in the 6 hospitals. Five
(0.80%) had S. pneumoniae isolated from blood culture,
and 92 (14.7%) had S. pneumoniae dominantly isolated
from sputum culture. The most frequent serotypes isolated
from sputum were 6B, 23F, 19F, and 66.7 % of the isolated
strains were covered by PCV7. Serotypes of the 5 isolates
from blood were 6B (3 cases), 19F (1 case), 19A (1 case),
and 80% of the isolated strains were covered by PCV7.
Twenty-three isolates from sputum and 2 isolates from
blood had sequence types identical to 6 Pneumococcal
Molecular Epidemiology Network (PMEN) clones; Spain
6B-2, Taiwan 19F-14, Taiwan 23F-15, Netherlands 7F-39
Spain 23F-1, Colombia 23F-26. The annual incidence of
CAP among children <5 year old was 17.6 episodes per
1,000. The annual incidence of CAP with pneumococcal
bacteremia among the same population was 11.7 episodes
per 100,000.
CONCLUSION: The result of serotype distribution with S.
pneumoniae from blood and sputum culture revealed that
PCV7 has a good coverage rate. PCV7 is expected for
the prevention of not only bacteremic pneumococcal
pneumonia but also non-bacteremic pneumococcal
pneumonia in Japanese children. After introduction of
PCV7, the evaluation of the efficacy of PCV7 on pediatric
CAP would be continued.
131
P1-037
Pneumococcal Diseases
Identification of Pneumococcal
Serotypes in Nasopharyngeal Aspirates
of Hospitalized Children with Lower
Respiratory Infections in Korea
Jong Gyun Ahn, Jung Soo Kim1, Heui Og Kim,
Dong Won Baek2, Ki Hwan Kim and Dong Soo
Kim2
1
Department of Pediatrics, Yonsei University
College of Medicine, Seoul, and Department of
2
Pediatrics, Jeonju, Korea
Chonbuk National University, Medical School,
Jeonju, Korea
OBJECTIVE: The purpose of this study was to
identify
pneumococcal
serotypes
in
nasopharyngeal isolates after the introduction of
heptavalent conjugate pneumococcal vaccine
(PCV7) by using sequential multiplex PCR.
METHODS: Nasopharyngeal secretions were
obtained from 558 pediatric patients admitted
with lower respiratory infections at Severance
children`s hospital in Korea from March 2009 to
January 2010. We applied the multiplex PCR
technique for the identification of pneumococci
and determinations of their serotypes from the
samples, with them cultured conventionally.
Thirty five serotype-specific primers were
arranged in 7 multiplex PCR sets.
MAIN RESULTS: Among the samples, 115
specimens (20.6%) were S. pneumoniae-PCRpositive. 2 samples contained 2 serotypes. The
predominant serotypes, in order of decreasing
frequency, were 19A (23.9%), 6A/B (19.7%), 19F
(10.3%),15B/C (6.0%), 15A (5.1%), and 11A
(4.3%), nontypable (21.4%). 74 isolates (63.2%)
belonged to the non-PCV7 serotypes. 19A
accounted for 37.8% (28 of 74) of the non-PCV7
serotypes. Only 37 cases of 115 PCR-positive
cases were culture-positive.
CONCLUSIONS: Distribution of serotypes of S.
pneumoniae isolated from nasopharyngeal
secretions in the post-PCV7 era will be important
data in understanding of epidemiology changes
before the 13-valent pneumococcal conjugate
vaccines release. And the surveillance for
pneumococcal serotypes should be continued to
monitor changes in serotype distribution
necessary for the pneumococcal vaccine policy. In
that point, the PCR-based serotyping can provide
an accurate and rapid distribution of
pneumococcal serotypes compared to the
conventional microbiology.
P1-038
Pneumococcal Diseases
Safety, Tolerability and Efficacy of
Heptavalent Pneumococcal Conjugate
Vaccine among Low Birth Weight
Infants and Infants with Underlying
Heart Diseases
Hattasingh W1, Liulak W2, Pengsaa K1,
Thisyakorn U3
1
Department of Tropical Pediatrics, Faculty of
Tropical Medicine, Mahidol University; 2Disease
Control Division, Health Department, Bangkok
Metropolitan Administration, Bangkok, Thailand;
3
Department of Pediatrics, Faculty of Medicine,
Chulalongkorn University
OBJECTIVE: Data on the safety, tolerability and
efficacy of pneumococcal conjugate vaccines in
very preterm infants and children with underlying
heart diseases is limited. We evaluated safety,
tolerability and efficacy of heptavalent
pneumococcal conjugate vaccine in 50 infants
with very low birth weight and children with
underlying heart diseases.
METHODS: Fifty children aged 2 months to 8
years with very low birth weight and children
with underlying heart diseases received
heptavalent pneumococcal conjugate vaccine at
the dosage and interval according to their age as
follow:
Age of first dose
2-6 months
7-11 months
2-8 years
Timing of immunization
3 doses, 6-8 weeks apart,
then 1 dose at 12-15 months
2 doses, 6-8 weeks apart,
then 1 dose at 12-15 months
1 dose.
All vaccinees were included in the reactogenicity
and safety evaluation. The protective efficacy of
the vaccine against invasive pneumococcal
diseases was evaluated by follow up of all the
vaccinees after vaccination.
MAIN
RESULTS:
The
heptavalent
pneumococcal conjugate vaccine was well
tolerated in very preterm infants and children with
underlying heart diseases. None of the vaccinees
developed invasive pneumococcal diseases during
the follow up period.
CONCLUSION: Heptavalent pneumococcal
conjugate vaccine given to very preterm infants
and children with underlying heart diseases is safe
and efficacious in prevention of invasive
pneumococcal diseases.
132
P1-039
Pneumococcal Diseases
Active Hospital-based Epidemiological
Surveillance to Estimate the Burden of
Pneumonia
and
Invasive
Pneumococcal Disease (IPD) in
Children under 5 Years of Age in Bali,
Indonesia
1
2
Ni Putu Siadi Purniti , Sri Rezeki Hadinegoro , I
Komang Kari1, Ida Sri Iswari1, Nyambat
Batmunkh3, Paul E. Kilgore3, Sharon Gray4, Jay
Graepel4, Dennis Brooks4, Robin Hubler4
1
Sanglah Hospital, Bali, Denpasar, Indonesi; 2Cipto
Mangunkusumo Hospital, Jakarta, Indonesia; 3International
Vaccine Institute, Seoul, South Korea; 4Pfizer Inc, Collegeville,
Pennsylvania, USA
OBJECTIVES: Streptococcus pneumoniae (SP) is a major
cause of meningitis, pneumonia and bacteremia among infants
and children. It is the leading cause of vaccine preventable
death in children under 5 years old. In Indonesia, data on IPD
incidence and pneumococcal pneumonia are limited. This
study was conducted to estimate pneumonia and IPD burden
from a defined target population served by Sanglah Hospital in
Bali, Denpasar, Indonesia.
METHODS: One-year active prospective multicenter
hospital-based surveillance study (12/3/2007-12/2/2008), in
children from 28d to 60m old. Eligibility criteria: children
residing within the catchment area with temperature ≥39.0°C
in 24 hours prior to screening and/or clinical suspicion of IPD.
RESULTS: 662 subjects enrolled, median age 10 m (82.8%
28d to <24m). SP was detected in no subjects. Of the 661
blood cultures performed, 114 showed growth (17.2%). Most
common organisms identified were: Staphylococcus sp. 50
(43.9%), S. lugdunensis 12(10.5%), S. hominis 11 (9.6%) and
coagulase-negative staphylococci 6 (5.3%). Antibiotic use
within 7 days prior to enrollment was reported in 378 (58.7%)
subjects. Pneumonia clinical syndrome was the most common
enrollment diagnosis: 378 (57.1%). Overall incidence of
clinical pneumonia and in children 28d to <24m was
309.1/100,000 and 737.3/100,000, respectively. The highest
incidence of clinical pneumonia occurred in children from 28d
to <6m: 1474.2/100,000. Overall incidence of chest
radiograph-confirmed pneumonia (CXR+Pn) and in children
28d to <24 m was 13.1/100,000 and 34.1/100,000, respectively.
The highest incidence of CXR+Pn was in children from 28d to
<6m: 99.8/100,000. Overall incidence of C-reactive protein
CXR+Pn (CRP CXR+Pn, defined as having CXR+Pn or
clinical pneumonia with an abnormal CXR plus a C-reactive
protein value ≥40 mg/L) and in children 28d to <24m was
174.6/100,000 and 393.7/100,000, respectively. The highest
incidence of CRP CXR+Pn was in children from 28d to <6m:
742.6/100,000.
CONCLUSIONS: Pneumonia causes considerable burden of
disease in the region served by Sanglah Hospital. Estimating
the burden of pneumococcal pneumonia is challenging but can
be enhanced through standardized CXR interpretation and
considering CRP values in children with clinical pneumonia.
Significant use of antibiotics prior to culture and high yield of
contaminant organisms reduce the likelihood of successfully
isolating pneumococcus in epidemiologic surveillance
activities.
P1-040
Pneumococcal Diseases
Active Hospital-Based Epidemiologic
Surveillance
for
Invasive
Pneumococcal Disease and Pneumonia
Burden in Children in Bangkok,
Thailand
C. Chomchai1, S.W. Kim2, W. Kriengsoonthornkij1,
S.Sutchritpongsa1, B.Manaboriboon,1 R.Ungcharoen,1
P. Kilgore3, S.A. Kim3, J. Graepel4, S. Gray4, D. Brooks4,
R. Hubler4
1
Siriraj Hospital, Mahidol University, Bangkok, Thailand;
formerly, The International Vaccine Institute, Seoul, Republic
of Korea; 3The International Vaccine Institute, Seoul, Republic
of Korea; 4 Pfizer, Inc., Collegeville, PA, USA
2
OBJECTIVE: Streptococcus pneumoniae is a
leading cause of vaccine-preventable disease in
children. Invasive pneumococcal disease (IPD)
incidence data are critical to evaluate the impact
of pneumococcal conjugate vaccine (PCV), but
data are limited. We report estimated IPD and
pneumonia burden from a defined target
population served by Siriraj Hospital, Bangkok,
Thailand.
METHODS:
Prospective
hospital-based
surveillance was conducted from January 2, 2008
to January 1, 2009. Subjects were eligible if they
were aged 28d to <60m, resided within the
predefined catchment area, presented to Siriraj
Hospital, and had fever ≥39.0°C (within 24 hours
preceding presentation) and/or presented with
clinical pneumonia syndrome or clinically
suspected IPD. Blood cultures were obtained from
all subjects, spinal fluid from children with
suspected meningitis, and chest radiographs
(CXRs) in suspected pneumonia.
RESULTS: 1262 subjects were enrolled from an
estimated 116,241 target population served by
Siriraj Hospital. Median age was 18m; 65.1%
were aged 28d to <24m. 959 (76%) subjects had
initial diagnosis of fever and/or suspected
bacteremia. Of 1263 blood cultures tested, 70
(5.5%) yielded bacterial isolates: 24 (34.3%)
coagulase-negative staphylococci; 19 (27.1%)
Salmonella species; 11 (15.7%) Micrococcus
luteus; 6 (8.6%) S. pneumoniae. S. pneumoniae
was detected in 6 blood cultures from 6 subjects.
Overall IPD incidence was 5.16/100,000. The
highest rate was 21.11/100,000 among children
aged 12m to <24m. Final IPD diagnoses were
pneumonia in 2 (33.3%), sepsis in 2 (33.3%),
probable pneumococcal meningitis in 1 (16.7%),
and bacteremia in 1 (16.7%). S. pneumoniae
serotypes were 23F, 3 (50%); 14, 2 (33.3%); and
23A, 1 (16.7%). Coverage by both 7-valent and
13-valent PCV was 83.3%.
133
P1-041
Pneumococcal Diseases
Estimating the Burden of Pneumonia
and Invasive Pneumococcal Disease
(IPD) in Children under Five Years of
Age: An Active Hospital-based
Epidemiological Surveillance
All isolates were susceptible to amoxicillin,
ampicillin,
ceftriaxone,
levofloxacin
and
vancomycin. Five (83.3%) were resistant to
trimethoprim/sulfasoxazole, 4 (66.7%) were
resistant to erythromycin, and 1 (16.7%) was
resistant to penicillin. Five isolates (83.3%)
demonstrated intermediate susceptibility to
penicillin. 397 (31.7%) subjects reported
antibiotic use within 7 days before enrollment.
Clinical pneumonia (CP) incidence among
children aged 28d to <60m and 28d to <24m was
274.4/100,000 and 461.3/100,000, respectively.
Highest CP incidence was 647.6/100,000 in
children 6m to <12m of age. Incidence of
CXR-confirmed pneumonia with CRP ≥ 40
mcg/mL was 87.8/100,000 (highest among
children 6m to <12m, 225.3/100,000; and
children 28d to <24m, 124.6/100,000).
CONCLUSION: IPD and pneumonia occurred in
the region served by Siriraj Hospital; however,
inappropriate use of antibiotics and limitations of
culture-based diagnosis may have resulted in
substantial underestimation of the incidence of
IPD. More than 80% of pneumococcal isolates
were serotypes included in PCVs.
Cissy B. Kartasasmita,1 Sri Rezeki Hadinegoro,2
Sri Sudarwati,1 Sunaryati Sudigdo-Adi,1
Nyambat Batmunkh,3 Paul E. Kilgore,3 Sharon
Gray,4 Jay Graepel,4 Dennis Brooks,4 Robin
Hubler4
1
Hasan Sadikin General Hospital/Medical School,
Padjadjaran University, Bandung, Indonesia; 2Cipto
Mangunkusumo Hospital/Medical School, Indonesia
University, Jakarta, Indonesia; 3International Vaccine
Institute, Seoul, South Korea; 4Pfizer Inc, Collegeville,
Pennsylvania, USA
OBJECTIVES: Streptococcus pneumoniae (SP) is the leading
cause of vaccine preventable death in children under 5 years
old. In Indonesia, data on IPD incidence and pneumonia are
lacking. This study was conducted to estimate the incidence
rates of IPD and pneumonia from a defined target population
served by Hasan Sadikin Hospital in Bandung, Indonesia, and
to identify the serotypes.
METHODS: One-year active prospective, multicenter,
hospital-based surveillance study from November 2007 to
November 2008 in children from 28d to 60m old. Eligibility
criteria: children residing within the catchment area with
temperature ≥39.0°C within 24 hours prior to screening and/or
clinical suspicion of pneumonia.
Results: This study included 466 subjects; 52.4% boys, 47.6%
girls, median age: 9 m (83.7% 28d to <24m). SP was detected
in 3 samples from 2 subjects (2 blood cultures, 1 CSF culture).
Final diagnoses were: definite pneumococcal meningitis 1
(50%), bacteremia 1 (50%). Of 464 blood cultures performed,
140 (30.2%) showed growth. Most common organisms
identified were: Staphylococcus epidermidis 63 (45%);
Staphylococcus aureus 21 (15%) and coagulase-negative
staphylococci (CoNS) 11 (8%). The incidence of IPD overall
and in children from 28d to <24m was 1.0/100,000 and
2.8/100,000, respectively. The highest incidence of IPD was in
children from 6m to <12 m (10.9/100,000). One of 2 children
with IPD died (CFR 50%).Overall incidence of clinical
pneumonia and in children 28d to <24m was 145.5/100,000
and 338.1/100,000, respectively. The highest incidence of
clinical pneumonia was in children from 6m to <12m
(443.0/100,000). The
overall
incidence
of
chest
radiograph-confirmed pneumonia (CXR+Pn) and in children
28d to <24m was 3.1/100,000 and 8.4/100,000, respectively.
The highest incidence of CXR+Pn was in children from 28d to
<6m (25.8/100,000). The serotypes were: 14: 1 (50%), 23F: 1
(50%). Both SP isolates demonstrated susceptibility to
penicillin and both demonstrated intermediate susceptibility to
TMP/Sulfa.
CONCLUSIONS: Pneumonia and IPD occurred in children
under 5 years of age, especially those less than 24 months old,
in the region served by Hasan Sadikin Hospital.The significant
presence of contaminant organisms such as S. epidermidis and
other coagulase-negative staphylococci (CoNS) may have
limited the isolation of pneumococci and contributed to an
underestimation of overall IPD burden.
134
P1-042
Pneumococcal Diseases
Active Hospital-based Epidemiological
Surveillance to Estimate the Burden of
Invasive Pneumococcal Disease (Ipd)
in Children under 5 Years of Age in
Surabaya, Indonesia
Ismoedijanto Moedjito,1 Lindawati
Alimsardjono,2 Landia Setiawati
Agung-Margono,2 Sri Rezeki Hadinegoro,3
Nyambat Batmunkh,4 Paul E. Kilgore,4 Sharon
Gray,5 Jay Graepel,5 Dennis Brooks,5 Robin
Hubler5
1
Member of PneumoNet Study Group, Dr Soetomo Hospital,
Surabaya, Indonesia; 2Member of PneumoNet Study Group,
Indonesia; 3Cipto Mangunkusumo Hospital, Jakarta,
Indonesia; 4International Vaccine Institute, Seoul, South Korea;
5
Pfizer Inc, Collegeville, Pennsylvania, USA
OJECTIVES: Streptococcus pneumoniae (SP) is a major
cause of meningitis, pneumonia and bacteremia among infants
and children. It is the leading cause of vaccine preventable
death in children under 5 years old. In Indonesia, data on IPD
incidence and pneumococcal pneumonia are limited. This
study was conducted to estimate IPD and pneumonia burden
from a defined target population served by Dr. Soetomo
Hospital in Surabaya, Indonesia.
METHODS: One-year active prospective, multicenter,
hospital-based surveillance study (Jan 9, 2008 – Jan 8, 2009),
in children from 28d to 60m old. Eligibility criteria: children
residing within the catchment area with temperature ≥39.0°C
in 24 hours prior to screening and/or clinical suspicion of IPD.
RESULTS: 1040 subjects enrolled; median age 12 m (78.0%
28d to <24m). SP was detected in 6 samples from 5 subjects (4
blood cultures; 2 pleural fluid cultures). Final diagnoses
among IPD cases were: probable meningitis 3 (60%),
pneumonia clinical syndrome 2 (40%). Antibiotic use within 7
days prior to enrollment was reported in 476 (46.7%) subjects.
IPD incidence overall and in children 28d to <24m was
2.2/100,000 and 6.4/100,000, respectively. The highest
incidence of IPD occurred in children 6m to <12m:
9.2/100,000. One of 5 children with IPD died (CFR 20%)
Overall incidence of clinical pneumonia and in children 28d to
<24m was 188.3/100,000 and 577.6/100,000, respectively. The
highest incidence of clinical pneumonia occurred in children
from 28d to <6m: 845.9/100,000. Overall incidence of chest
radiograph-confirmed pneumonia (CXR+Pn) and in children
28d to <24 m was 5.8/100,000 and 19.3/100,000, respectively.
The highest incidence of CXR+Pn was in children from 28d to
<6m: 22.4/100,000 and in children from 12m to <24m:
22.2/100,000. The n (%) of serotypes were: 14: 2 (40%), 23F:
2 (40%), 5: 1 (20%). Penicillin susceptibility was 100%
among SP isolates. Three isolates (60%) were resistant to
TMP/Sulfa.
CONCLUSIONS: Pneumonia and IPD represent considerable
burden of disease in children under 5 years of age in the region
served by Dr. Soetomo Hospital. IPD burden reported in this
study may have been affected by the high rate of preculture
antibiotic use and likely underestimates the true burden of
vaccine-preventable disease in this study population.
P1-043
Pneumococcal Diseases
Current Trend of Pneumococcal
Diseases Serotypes in Malaysian
Hospitals
MY Rohani1, MZ Norni1, HN Salbiah3, MH
Suhailah4, AW Zubaidah5, B Ganeswarie6, H
Azura7, AM Nazri8, M Nurahan9, S Norazita10,
PP Ng11, SM Jamilah12, M Azmi13,
A
Norazah2, K. Rina14
1
Specialised Diagnostic Centre, Institute for Medical Research,
Bacteriology Unit, IMR, 3Hospital Selayang, 4Hospital Tunku
Jaafar, 5Hospital Sungai Buloh, 6Hospital Sultanah Aminah,
7
8
Hospital Queen Elizabeth,
Hospital Kuala Lumpur,
9
Hospital Raja Perempuan Zainab II, 10Hospital Sultanah Nur
Zahira, 11Hospital Tunku Bahiyah, 12Hospital Ampang,
13
Hospital Pulau Pinang, 14University Malaya Medical Centre,
Malaysia
2
From January 2008 to December 2009, 433
Streptococcus pneumoniae strains were subjected to
serotyping.
More than 50% of the isolates were
isolated from sterile sites.
About 32.71% were
isolated from children below 5 years.
The
majority was isolated from blood (48.85%) and
sputum (13.13%).
Pneumococcal diseases
occurring in all age group with pneumonia (31.83%)
being the most common diagnosis followed by fever
(8.45%) and sepsis (7.60%). Serotyping was done
using Pneumotest Plus-Kit and antibiotic
susceptibility pattern was determined by modified
Kirby-Bauer disk diffusion method and minimum
inhibitory concentration (MIC) using E-test method.
Ten most common serotypes were 19F (17.71%), 6B
(12.53%), 19A (8.17%), 14 (7.90%), 1 (6.00%), 6A
(6.00%), 23F (5.72%), 18C (4.63%), 3 (2.45%) and
5 (2.18%). About 50.41%, 59.13%, 75.75% and
77.63% of the S. pneumoniae isolates belonged to
serotypes included in the PCV7, PCV10, PCV13 and
the 23PPV respectively.
Based on the current
serotype distribution, about 54.69%, 64.06% and
87.50% of the S. pneumoniae associated with
invasive diseases in children ≤ 5 years can be
protected by the available PCV7, PCV10 and
PCV13 respectively. The coverage rate is higher for
children ≤ 2 years, 53.66%, 68.29% and 95.12% by
PCV7,
PCV10
and
PCV13
respectively.
Penicillin MIC ranged from ≤ 0.016 to 4.0μg/ml and
MIC50 and MIC90 was 0.023Ојg/ml and 1.0Ојg/ml
respectively.
Based on the oral penicillin
breakpoint, about 33.89% with 5.44% were
penicillin resistant (MIC ≥ 2µg/m).
However
based on individual isolate’s MIC and its related
breakpoint penicillin intermediate resistant was
0.84% (2 of non-meningitis isolates) and penicillin
resistant was 1.67% (4 of isolates associated with
meningitis).
The majority of penicillin less
susceptible strains belonged to serotype 19F
followed by 19A and 6B.
135
P1-044
Vaccination
DTP Vaccination as Problem during
Vaccination in Bosnia
Bajraktarevic Adnan
Public Health Institution of Canton,
Sarajevo-Department for children, Bosnia and
Herzegovina
INTRODUCTION: Vaccination is very effective
in preventing and reducing the impact of serious
illness. The objective of our study was to show a
profile and complications of the perceived
vaccination status among a population of
preschool children in Sarajevo for tetanus,
pertussis,diphteria and /or poliomyelitis and Hib
vaccinations on different ways which usually take
place in childhood.
METHODS: The aim of this retrospective data
analyses was to assess the level of vaccination
coverage in children in Bosnia, to determine
possible differences in the cover-age between
preschool-aged (6 years of age) and school-aged
(16 years of age) children and to compare this
results with the average other national coverage
level.
RESULTS: Older age cohorts have not received
routine vaccinations with most DTP vaccines. For
example there is a marked decrease with
increasing age in the proportion of children
reporting, vaccinated for DTP vaccination, in
accordance with its late introduction. The current
DTP mass immunisation rate for infants (all doses)
in Bosnia of approximately 88%.
DISCUSSIONS: Adverse reactions, rarely
serious, may occur from each component of the
DTP or DTP-IPV-Hib vaccine.
CONCLUSIONS: No evidence exists to show
that this decreases the frequency of uncommon
severe adverse events, such as seizures and
hypotonic-hyporesponsive
episodes.
Complications comparing several types of
vaccines showed adventage for newer mixed
vaccine with accelular components. The decision
to administer or delay DTP vaccination because
of a current or recent febrile illness depends
largely on the severity of the symptoms and their
etiology.
P1-045
Vaccination
Immunogenicity and Safety of an
Investigational
Hexavalent
Fully
Liquid
DTap-IPV-Hep
B-PRP-T
Vaccine Given At 2, 3, 4 Months of Age
with a Booster at 15-18 Months
Compared to Licensed Vaccines in
Turkish Infants
Mehmet Ceyhan1, Eduardo Santos-Lima2
1
Hacettepe University Medical Faculty, Ankara, Turkey;
2
Sanofi Pasteur, Lyon, France.
BACKGROUND AND AIMS: Assessment of primary
and booster vaccination with a new, fully liquid,
hexavalent
DTaP-IPV-Hep B-PRP-T
vaccine
(Hexaximв„ў, Sanofi Pasteur), containing the same
antigens as PentaximВ® (DTaP-IPV//PRP-T) with a new
Hansenula
polymorpha-derived
recombinant
Hepatitis B surface antigen (Sanofi Pasteur), in Turkey.
METHODS: Randomized, open-label, monocentre
study;
310
subjects
received
either
DTaP-IPV-Hep B-PRP-T (Group 1) or PentaximВ® plus
Engerix Bв„ў (Group 2) at 2,3,4 months of age, and a
DTaP-IPV-Hep B-PRP-T booster at 15-18 months of
age. According to local recommendations no subject
received Hep B vaccination at birth. Non-inferiority
analysis was performed for Hep B seroprotection (SP)
(≥10 mIU/mL) 1 month after the primary series. For
the remaining antigens after the primary series, and for
all antigens before and after the booster,
SP/seroconversion (SP/SC) rates and GMTs were
analysed descriptively. Safety was evaluated from
parental reports.
RESULTS: 1 month post-primary series:
SP/SC rate (% subjects
[95%CI])
Group 1
Group 2
Anti-Hep B ≥10
94.0
96.1
mIU/mL
(88.6;97.4)
(91.1;98.7)
90.7
97.8
Anti-PRP ≥0.15 µg/mL
(84.6;95.0)
(93.8;99.5)
Anti-Diphtheria ≥0.01 99.3
97.1
IU/mL
(96.2;100.0) (92.7;99.2)
Anti-Tetanus ≥0.01
100.0
100.0
IU/mL
(97.5;100.0) (97.4;100.0)
97.7
97.9
Anti-Polio 1 ≥8 (1/dil)
(91.9;99.7)
(92.5;99.7)
94.7
94.0
Anti-Polio 2 ≥8 (1/dil)
(86.9;98.5)
(86.5;98.0)
97.4
100.0
Anti-Polio 3 ≥8 (1/dil)
(90.8;99.7)
(95.4;100.0)
Anti-PT (EU/mL)
93.6
94.2
≥4-fold increase
(88.2;97.0)
(89.0;97.5)
Anti-FHA (EU/mL)
81.9
83.1
≥4-fold increase
(74.7;87.9)
(75.7;89.0)
136
P1-046
Vaccination
Immunogenicity and Safety of an
Investigational
Hexavalent
Fully
Liquid Dtap-Ipv-Hep B-Prp-T Vaccine
and
a
Licensed
Comparator,
Concomitantly Administered with
Pneumococcal Conjugate Vaccine at 2,
4, 6 Months of Age in Thai Infants
Anti-Hep B SP was high and non-inferiority was
demonstrated for Group 1, the lower 95%CI limit for
the difference being >-10% (Group 1 minus Group 2
[95%CI]: -2.06 [-7.88;3.65]). For the remaining
antigens, SP/SC rates were high and similar in each
group. At 15-18 months, persistence for each antigen
was similar between groups (overlapping 95%CIs),
except for Hep B (lower in Group 1 [SP: 80.7%] than
Group 2 [99.0%]). After the booster, anti-Hep B SP
was 97.3 and 100% in Groups 1 and 2. SP/SC rates
were also high and similar for the other antigens in each
group irrespective of the primary series vaccine,
indicating appropriate priming by the DTaP-IPV-Hep
B-PRP-T vaccine. Anti-Hep B GMTs were 149, 44.2
and 1379 mIU/mL post-primary series, pre- and
post-booster, respectively, in Group 1. Reactogenicity
was low and comparable for each group following the
primary series and booster vaccination. There were
no vaccine-related SAEs.
CONCLUSIONS: For both primary and booster
vaccination the DTaP-IPV-Hep B-PRP-T vaccine was
immunogenic and safe, and comparable to licensed
vaccines meriting further clinical development of this
fully-liquid hexavalent vaccine
Pope Kosalaraska1, Usa Thisyakorn2, Suwat
Benjaponpitak3, Kulkanya Chokephaibulkit4, Eduardo
Santos-Lima5
1
Khon Kaen University, Khon Kaen, Thailand;
2
Chulalongkorn Hospital, Bangkok, Thailand; 3 Faculty of
Medicine, Ramathibodi Hospital Mahidol University, Bangkok,
Thailand; 4 Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand; 5Sanofi Pasteur, Lyon, France
OBJECTIVE: Assessment of a new, fully liquid, hexavalent
DTaP-IPV-Hep B-PRP-T vaccine (Hexaximв„ў, sanofi pasteur
AcXim family) compared to Infanrix hexaв„ў following
primary series vaccination in combination with Prevnarв„ў in
Thai infants.
METHODS: Randomized, blind-observer, controlled,
multicentre
study;
412
subjects
received
either
DTaP-IPV-Hep B-PRP-T (Group 1) or Infanrix hexaв„ў (Group
2) at 2, 4, 6 months of age, co-administered with Prevnarв„ў.
All subjects received Hep B vaccination at birth to comply
with local recommendations. Non-inferiority analysis was
performed on seroprotection for Hep B (≥10 mIU/mL) and
PRP (≥0.15 µg/mL) 1 month after the primary series; the
remaining antigens for Hexaximв„ў and the comparator were
analysed descriptively (SP/seroconversion [SC] rates and
GMTs). Safety was evaluated from parental reports.
MAIN RESULTS: Summary of SP/SC rate (% subjects
[95%CI]) 1 month post-primary series (per protocol analysis
set):
Group 1
Group 2
99.5 (97.1;100.0) 99.5
(97.1;100.0)
97.9 (94.7;99.4) 96.3
Anti-PRP ≥0.15 µg/mL
(92.6;98.5)
97.4 (93.9;99.1) 100.0
Anti-Diphtheria ≥0.01 IU/mL
(98.1;100.0)
100.0
100.0
Anti-Tetanus ≥0.01 IU/mL
(98.1;100.0)
(98.1;100.0)
100.0
100.0
Anti-Polio 1 ≥8 (1/dil)
(98.0;100.0)
(98.0;100.0)
100.0
100.0
Anti-Polio 2 ≥8 (1/dil)
(98.0;100.0)
(98.0;100.0)
100.0
99.5
Anti-Polio 3 ≥8 (1/dil)
(98.0;100.0)
(97.0;100.0)
Anti-PT (EU/mL) ≥4-fold 93.7 (89.2;96.7) 93.7
increase
(89.2;96.7)
Anti-FHA (EU/mL) ≥4-fold 94.7 (90.4;97.4) 95.2
increase
(91.1;97.8)
Anti-Hep B ≥10 mIU/mL
137
P1-047
Vaccination
BCG Vaccination Status of Internally
Displaced Children in the North of Sri
Lanka
Dilini Vasana Kiridana
Sri Lanka
Anti-Hep B and anti-PRP SP rates were high.
Non-inferiority (Group 1 minus Group 2) was demonstrated as
the lower bound of the 95%CI for the difference was above the
pre-specified non-inferioirty margin (-10%): -2.46 for
anti-Hep B and -2.15 for anti-PRP. The SP/SC rates for all
other antigens were high and similar in each group.
The percentage of subjects with anti-Hep B ≥100 mIU/mL was
98.4 and 99.5% (GMTs 2477 and 2422 mIU/mL) and for
anti–PRP ≥1.0 µg/mL was 85.2 and 71.1% (GMTs 5.07 and
2.41 Вµg/mL) in Groups 1 and 2 respectively.
Overall safety profiles were good and similar in each group
and there were no vaccine-related SAEs.
Conclusions: In a 2, 4, 6 month schedule, the new, fully liquid
DTaP-IPV-Hep B-PRP-T vaccine provided comparable
immunogenicity and a similar safety profile to a licensed
hexavalent vaccine when co-administered with Prevnarв„ў.
OBJECTIVE: To study the BCG vaccination
status among the under 5 year old internally
displaced children in Vavuniy a district.
STUDY DESIGN: Cross sectional descriptive
study.
SETTING: Temporary settlement camps in
Vavuniya district
METHOD: All children between 6 to 60 months
attended to paediatric clinics held in the
temporary settlement camps from1st April to 15th
May 2009 were included in the study. The
interviewer administered questionnaire and
examination of the child for the BCG scar were
used to collect data.
RESULTS: One thousand and six patients
attended the clinics during the study period and
all were analyzed. Nine hundred and seventy five
children received BCG vaccination and
vaccination data for 31 patients were not available
due to unavailability of parents. 839 had BCG
scars while 153(15.2%) did not have a visible
scar.
CONCLUSION: There was a significant number
of children without BCG scars indicating the need
for a larger scale study and to consider
implementation of a re vaccination programme.
Prospective studies are needed to observe scar
disappearance and non development.
138
P1-048
Vaccination
Antibody Response in Healthy Infants
Receiving either Oral Monovalent
Polio Vaccine Type 1 or Oral Trivalent
Polio Vaccine after Primed with
Trivalent OPV at Birth
P1-049
Vaccination
Immunogenicity of Trivalent Oral
Polio Vaccine (tOPV) and Enhanced
Inactivated Polio Vaccine (eIPV) in
Healthy Infants Primed with Neonatal
tOPV
Ismoedijanto Moedjito1, Edim Hartati1,
NoviliaSjafri Bachtiar2
1
Departement of Child Health, Faculty of
Medicine, Airlangga University, Surabaya,
Indonesia; 2Biofarma, Bandung, Indonesia
Ismoedijanto Moedjito1, Ivijanthi Meriastuti1,
Novilia Sjafri Bachtiar2
1
Child Health departement, Fac of Medicine,
Airlangga University, Surabaya, Indonesia; 2Bio
Farma, Bandung, Indonesia
BACKGROUND: Oral monovalent polio
vaccine type 1 (mOPV1) suppose to have a
quicker responds and higher protection than the
trivalent polio vaccine (tOPV), since the OPV has
a sequential immune responds to the three types
of polio virus. OPV at birth serve as a trigger to
arouse the immune responds afterwards.
OBJECTIVE: to compare the neutralizing
antibody response to type I polio virus in healthy
infants primed with tOPV at neonates, receiving
either mOPV1 or oral trivalent Polio Vaccine
(tOPV), given with other basic vaccination
(DTP/HB),
METHODS: Randomized single blinded
controlled clinical trial was done on healthy
infant’s age 42 to 80 days who had primed with
oral polio trivalent vaccine before 1 month of age.
Trial group received mOPV1 and control group
tOPV, each group had 3 doses of vaccines. Blood
samples were taken at pre vaccination, post
second and third vaccination to measure the
neutralizing antibody.
RESULTS: Antibody from mOPV1 group (30)
and from tOPV group (29) was analyzed. After
the second vaccination, mOPV1 group had more
increase in geometric mean titer of neutralizing
antibody than tOPV group, but not statistically
significant. After third vaccination the level of
neutralizing antibody titer was almost equal in
both groups. The similar antibody responds
signify the importance of polio vaccination given
at birth. The antibody response to the polio 3 was
signicantly lower than the tOPV , since the
monovalent OPV1 vaccine contain no poliovirus2
or poliovirus3 antigen.
CONCLUSION: The antibody responds to type
1 polio virus in healthy infants primed with OPV
at birth, in infants vaccinate with mOPV1 was
similar to the group receiving tOPV.
BACKGROUNDS: There were 46 acute flaccid
paralysis cases due to VDPV during polio
outbreak in 2005 in Indonesia. These cases can be
prevented by using the inactivated polio vaccine.
Objective: The aim of this study is to compare the
immunogenicity of eIPV (single and in
combination) with tOPV in healthy infant primed
with neonatal tOPV.
METHOD: Randomized controlled open-label
clinical trial in healthy infants aged 42 to 80 days,
who have had their first oral polio vaccine before
1 month of age. Trial group received eIPV either
in single antigen or in combined vaccine and
control group received tOPV, each group had 3
doses of vaccine. Blood samples were taken
before the first vaccination (after the prime dose)
and after the second and third vaccination to
measure the neutralizing antibody against 3
serotype of polio virus. Statistical analyses used
were t-test and Mann-Whitney test.
RESULT: Titer of neutralizing antibody from 29
subjects vaccinated with single eIPV group, 28
subjects with combined eIPV group and 29 with
tOPV group were analyzed. Before intervention,
seropositivity against 3 type Polio virus were
>79% in three groups. After second vaccination,
eIPV single group had higher increase in GMT
neutralizing antibody against type-2 and type-3
polio virus than tOPV group, which however, was
statistically insignificant (p>0, 05) but for
neutralizing antibody against type-1, tOPV had
higher increased than eIPV groups which was also
insignificant (p>0, 05). After the third vaccination,
proportion of antibody seroconversion (4-fold
rises in antibody titer from base line) against
type-3 polio virus was higher in eIPV single
group (p<0, 05). All groups were 100% protected
after the second dose to all polio types.
CONCLUSION: Immunogenicity of eIPV
vaccine, whether in single or combination was
similar as to the tOPV vaccine if primed with
tOPV at birth.
139
P1-050
Vaccination
Antibody Persistence at 18-20 Months
of Age Following Primary Vaccination
of Healthy Infants with a Combined
DTacP-IPV/PRP~T Vaccine Compared
to Separate Vaccines (DTaP, PRP~T
and IPV) and Immunogenicity and
Safety of Booster Vaccination in the
Peoples’ Republic of China
Rong Cheng Li, Feng Xiang Li, Yan Ping Li, Qi
Ming Hou, Chang Gui Li, Ya Nan Li, Fu Sheng
Chen, Xue Zhong Hu, Wen Bin Su, Shu Min
Zhang, Han Hua Fang, Qiang Ye, Tian De
Zeng, Tao Xuan Liu, Xiu Bi Li, Yun Neng
Huang, Yun Neng Huang, Yan Ping Zhang,
Esteban Ortiz
China
BACKGROUND
AND
AIMS:
The
DTacP-IPV//PRP~T
combined
vaccine
(Pentaximв„ў, Sanofi Pasteur AcXim Family) is
used in many countries worldwide. This clinical
study assessed the immunogenicity and safety of a
booster dose of the pentavalent vaccine in
Chinese infants versus separate vaccines.
METHODS: Participants previously primed with
DTaP-IPV//PRP~T at 2,3,4 months (Group A,
N=255), 3,4,5 months (Group B, N=233), or
DTaP (Wuhan Institute of Biological Products),
PRP~T (Act-HibВ®) and IPV (ImovaxВ® Polio) at
3,4,5 months (Group C, N=231) received a
booster of the same vaccine(s) at 18-20 months of
age. Seroprotection (SP) and seroconversion (SC)
were determined before and 1 month after the
booster. Safety was evaluated from parental
reports.
RESULTS: SP/SC rate (% subjects):
Group A
Anti-PRP
≥0.15 µg/mL
(RIA)
Anti-PT titer
≥4-fold
increase
(EIA)
Anti-FHA
titer ≥4-fold
increase
(EIA)
100 100 100 100 100 100 100 100 100
94.
93.
94.
100 100
100 100
100
0
9
2
100
88.
89.
96.
100 100
100 99.6
100
4
5
5
100
87.
89.
89.
100 99.6
100 99.6
100
6
1
8
99.
100 99.1 100 100 100 100 100
6
100
97.6*
†100
95.2*
†97.4
80.4*
†98.0
89.9*
†99.6
85.5*
†89.1
92.4*
†Pre-booster SP rates were high in each group,
showing good persistence at approximately 1 year
after the primary series. Following the booster
vaccination, SP rates were 100% in each group
for each antigen. For anti-PT and anti-FHA,
respectively, GMTs increased 14.3- and 11.0-fold
(Group A), 13.3- and 9.7-fold (Group B), and 6.9and 13.3-fold (Group C). Reactogenicity was low
for each group. No SAE was considered to be
vaccine-related and no hypotonic hyporesponsive
episode or seizure was reported.
CONCLUSIONS: Antibody persistence and the
booster response were high and similar in each
group, and each booster vaccination was well
tolerated.
100 100 100 100 100 100 100 100 100
100
Group C
Po-P=post-primary series; Pr-B=pre-booster;
Po-B=post-booster; for Po-P N=254, 229, 232 and
for Pr-B and Po-B N=250, 230, 227 for Groups A,
B, C (primary series and booster per-protocol
analysis sets); *increase from pre-booster;
†increase from pre-primary series
Group A
Group B
Group C
Po- Pr- Po- Po- Pr- Po- Po- Pr- PoP
B B
P
B B
P
B B
Anti-Diphth
eria
≥0.01
IU/mL (SN)
Anti-Tetanus
≥0.01 IU/mL
(EIA)
Anti-Polio 1
≥8
(1/dil)
(SN)
Anti-Polio 2
≥8
(1/dil)
(SN)
Anti-Polio 3
≥8
(1/dil)
(SN)
97.6
Group B
140
P1-051
Vaccination
A Review of Hepatitis B Vaccine
Administration Schedules in Infants
Usa Thisyakorn, May Montellano, Esteban
Ortiz, Andrew Lane
Thailand
OBJECTIVE: More than 360 million individuals
are chronically infected with hepatitis B. Vertical
transmission is the major route of infection. In
2009, WHO stated that �All infants should receive
their first dose of hepatitis B vaccine as soon as
possible after birth, preferably within 24 hours.
This study reviews the risks and benefits of various
hepatitis B vaccination schedules in newborns.
METHODS: PubMed review of original articles
and data and review of hepatitis B epidemiology,
mode of transmission and vaccine effectiveness in
high-risk newborns (i.e. hepatitis B surface
antigen-positive mothers).
MAIN RESULTS: Hepatitis B vaccination is
important in high-risk infants with the first two
doses given at birth and at 1 month of age, followed
by either one or two subsequent doses.
Administering the 2nd dose at 1 month after the birth
dose counters the high risk of infection and
minimises the risk of chronic carriage. An analysis
of the effect of delaying the second dose
demonstrated that the risk of developing chronic
hepatitis B infection was 3.74 times higher in infants
with intervals >10 weeks between the first two doses
than for those with intervals <10 weeks
(95%CI=0.97–14.39). Giving the 2nd dose at 1
month of age also offers the advantage of promoting
protective antibodies at an early age, thus
minimising early �horizontal’ transmission. The
interval between the 2nd and 3rd doses has the
greatest impact on final hepatitis B antibody
concentrations. A shorter interval (eg 3rd dose at 2
months of age) results in linear response kinetics,
whereas administration at 6 months of age results in
a true anamnestic response. In Taiwan, mass
vaccination against hepatitis B using the standard
0,1,6 or 0,1,2,12 months of age schedule was
effective in preventing hepatitis B chronic carriage
and resulted in a significant decline childhood
hepatocellular carcinoma.
CONCLUSIONS: A birth dose followed by a
second dose at 1 month of age is ideal to minimize
vertical and horizontal transmission of hepatitis B.
The WHO considers the birth dose mandatory
regardless of endemicity, and the 2nd dose given 1
month later reduces the risk of chronic carriage in
high-risk newborns. At least 4 months between the
last two doses is important to ensure longer-term
protection.
P1-052
Vaccination
Immunogenicity
of
a
10-Valent
Pneumococcal Non-Typeable Haemophilus
Influenzae Protein D-Conjugate Vaccine
(PHiD-CV) and Co-Administered Vaccines
Following Primary Vaccination in Asian
Infants
Chang-Hwi Kim1, Kyung-Hyo Kim2, Hwang-Min Kim3,
Nancy Bermal4, Li-Min Huang5, Tzou-Yien Lin6, Ta-Wen
Yu7, Salvacion Gatchalian7, Haiwen Tang7, Patricia
Lommel7, Dorota Borys7
1
Department of Pediatrics, College of Medicine,
Soonchunhyang University, Bucheon, South Korea;
2
Department of Pediatrics, College of Medicine, Ewha
Womans University, Seoul, South Korea; 3Department of
Pediatrics, Wonju College of Medicine, Yonsei University,
Wonju, South Korea; 4Research Institute for Tropical Medicine,
Muntinlupa, Philippines; 5National Taiwan University
Hospital, Taiwan; 6Chang Gung Children’s Hospital, Chang
Gung University College of Medicine, Taiwan;
7
GlaxoSmithKline Biologicals, Wavre, Belgium
OBJECTIVE (AIM OF THE STUDY): Immunogenicity
profile of PHiD-CV (SynflorixTM, GlaxoSmithKline
Biologicals) and co-administered vaccines was assessed in
three Asian clinical trials.1–3
METHODS: In Korea, 503 infants were randomised to
receive either PHiD-CV or 7vCRM (Pfizer) co-administered
with Hib vaccine (HiberixTM) in a multicentre, single-blind
study (110808/NCT00680914) to evaluate non-inferiority of
PHiD-CV compared to 7vCRM in terms of post-dose III
percentage of subjects with pneumococcal antibody
concentrations ≥0.2 μg/mL.1 In the Philippines, 400 healthy
infants were randomised to receive either PHiD-CV or
7vCRM co-administered with DTPw-HBV/Hib (TritanrixTM
Hep B/Hib) + OPV (Polio SabinTM) in a double-blind study
(107007/NCT00344318).2,4 In Taiwan, 230 healthy infants
received PHiD-CV co-administered with DTPa-HBV-IPV/Hib
(Infanrix hexaTM) and human rotavirus vaccine (RotarixTM) in
a single arm study (109861/NCT00533507).3,4 In all trials,
immune responses were assessed one month post-dose III for
pneumococcal vaccine serotypes, and cross-reactive 6A and
19A serotypes using GSK’s 22F-inhibition ELISA and
opsonophagocytic assays (OPA).1–3
MAIN RESULTS: For common vaccine serotypes, antibody
concentrations ≥0.2μg/mL were observed in ≥91.2% of
PHiD-CV and ≥86.3% of 7vCRM vaccinees (Table 1); and
OPA titres ≥8 were observed in ≥87.3% of PHiD-CV and
≥90.2% of 7vCRM vaccinees in each study (Table 2).1–3
Immune responses to co-administered vaccines from
Philippines and Taiwan trials have been reported.4,5 All Korean
subjects had seroprotective levels of antibodies against Hib
polysaccharide PRP antigen (≥0.15 μg/mL) [anti-PRP
antibody GMCs: PHiD-CV, 20.131 μg/mL (16.775–24.158);
7vCRM, 11.844 μg/mL (8.542–16.424)]. All PHiD-CV
subjects, except one each in Korea and Taiwan trials, were
seropositive (≥100 EL.U/mL) for antibodies against
non-typeable Haemophilus influenzae protein D, with
antibody GMCs of 1622.4, 3800.0 and 2277.6 EL.U/mL in
Korea, Philippines and Taiwan, respectively.
Table 1. Percentage of subjects reaching antibody
concentrations of 0.2 Вµg/mL* (GSK 22F- ELISA) against
individual pneumococcal serotypes one month after primary
vaccination (ATP cohort for immunogenicity)
141
Pne
um
oco
ccal
Ser
oty
pes
4
6B
9V
14
18C
19F
23F
Taiwan
(1.5–3–6
months)
N = 219
99.5
(97.5–10
0)
95.4
(91.8–97.
8)
100
(98.3–10
0)
99.5
(97.5–10
0)
100
(98.3–10
0)
100
(98.3–10
0)
1
5
7F
6A
19A
97.2
(94.1–99.
0)
100
(98.3–10
0)
PHiD-CV
Philipp
ines
(6–10–
14
weeks)
N=
285
99.3
(97.5–9
9.9)
91.2
(87.3–9
4.2)
99.6
(98.1–1
00)
100
(98.7–1
00)
99.6
(98.1–1
00)
100
(98.7–1
00)
97.2
(94.5–9
8.8)
100
(98.7–1
00)
7vCRM
Korea
(2–4–6
month
s)
N=
344
Philipp
ines
(6–10–
14
weeks)
N = 95
99.7
(98.4–1
00)
100
(96.2–1
00)
92.4
(89.1–9
5)
99.7
(98.4–1
00)
99.4
(97.9–9
9.9)
99.7
(98.4–1
00)
98.8
(97.0–9
9.7)
96.2
(93.6–9
8.0)
100
(98.9–1
00)
86.3
(77.7–9
2.5)
100
(96.2–1
00)
100
(96.2–1
00)
100
(96.2–1
00)
98.9
(94.3–1
00)
94.7
(88.1–9
8.3)
3.2
(0.7–9.
0)
100
(98.3–10
0)
100
(98.7–1
00)
100
(98.9–1
00)
3.2
(0.7–9.
0)
100
(98.3–10
0)
78.5
(72.5–83.
8)
99.6
(98.1–1
00)
63.2
(57.3–6
8.8)
100
(98.9–1
00)
67.4
(62.2–7
2.4)
9.5
(4.4–17
.2)
56.8
(46.3–6
7.0)
PHiD-CV
Pne
um
oco
ccal
Ser
oty
pes
Korea
(2–4–6
months)
N = 123
100
(97–100)
4
98.4
(94.2–99.
8)
6B
9V
99.2
(95.6–100
)
14
18C
100
(97.0–100
)
19F
23F
100
(97.0–100
)
100
(97.0–100
)
98.4
(94.2–99.
8)
5.7
(2.3–11.4)
1
14.6
(8.9–22.1)
5
3.3
(0.9–8.1)
7F
69.1
(60.1–77.
1)
64.7
68.4
59.0
45.3
26.8
(57.9–71. (62.7–7 (53.6–6 (35.0–5
(19.2–35.
0)
3.8)
4.3)
5.8)
6)
N=number of vaccinees with ELISA results for at least one
serotype, based on ATP cohort for immunogenicity.
* An antibody concentration (IgG) of 0.2 Вµg/mL was used as
the GSK 22F-ELISA threshold for data analysis as it was
shown to be equivalent to the value of 0.35 Вµg/mL obtained
using the WHO reference laboratory non-22F ELISA.6,7
Table 2. Percentage of subjects reaching opsonophagocytic
titres of 8 against individual pneumococcal serotypes one
month after primary vaccination (ATP cohort for
immunogenicity)
6A
19A
7vCRM
Taiwa
n
(1.5–3–
6
month
s)
N=
103
100
(96.5–1
00)
Philip
pines
(6–10–
14
weeks)
N=
142
Korea
(2–4–6
month
s)
N=
165
Philip
pines
(6–10–
14
weeks)
N = 46
Korea
(2–4–6
month
s)
N = 63
99.3
(96.0–1
00)
98.1
(94.7–9
9.6)
100
(91.8–1
00)
100
(94.3–1
00)
87.3
(79.2–9
3.0)
93.0
(87.4–9
6.6)
93.8
(88.9–9
7.0)
93.0
(80.9–9
8.5)
100
(94.3–1
00)
100
(96.3–1
00)
100
(97.2–1
00)
99.4
(96.7–1
00)
100
(91.8–1
00)
98.4
(91.5–1
00)
99.0
(94.7–1
00)
97.2
(92.9–9
9.2)
98.8
(95.7–9
9.9)
93.5
(82.1–9
8.6)
98.4
(91.5–1
00)
98.0
(93.0–9
9.8)
99.3
(96.1–1
00)
89.3
(83.4–9
3.6)
100
(92.1–1
00)
96.8
(89.0–9
9.6)
98.1
(93.2–9
9.8)
98.6
(94.9–9
9.8)
97.0
(93.0–9
9.0)
91.3
(79.2–9
7.6)
90.2
(79.8–9
6.3)
96.1
(90.3–9
8.9)
96.1
(90.3–9
8.9)
100
(97.4–1
00)
82.4
(75.1–8
8.3)
97.6
(93.9–9
9.3)
92.6
(87.4–9
6.1)
97.7
(87.7–9
9.9)
2.2
(0.1–11
.5)
98.4
(91.5–1
00)
12.9
(5.7–23
.9)
99.0
(94.7–1
00)
99.3
(96.1–1
00)
97.6
(93.9–9
9.3)
0.0
(0.0–7.
7)
9.7
(3.6–19
.9)
100
(96.5–1
00)
89.7
(81.9–9
4.9)
100
(97.3–1
00)
71.7
(63.0–7
9.3)
100
(97.8–1
00)
84.8
(78.2–9
0.0)
22.7
(11.5–3
7.8)
79.1
(64.0–9
0.0)
67.8
(54.4–7
9.4)
90.0
(79.5–9
6.2)
39.2
25.5
32.7
2.3
11.7
(29.4–4 (18.5–3 (25.6–4 (0.1–12 (4.8–22
9.6)
3.7)
0.5)
.0)
.6)
N=number of vaccinees with OPA results for at least one
serotype, based on ATP cohort for immunogenicity.
CONCLUSIONS: PHiD-CV used in different immunisation
schedules and co-administered with routine paediatric
vaccines in Asian infants was shown to be highly
immunogenic for each vaccine pneumococcal serotype. In
Korea, PHiD-CV demonstrated non-inferiority to 7vCRM for
all vaccine serotypes. PHiD-CV also elicited OPA titres to
cross-reactive serotypes, comparable for serotype 6A and
higher for serotype 19A to that of 7vCRM. No evidence was
found for negative immunological interference between
PHiD-CV and co-administered routine childhood vaccines in
Asian infants.
142
P1-053
Vaccination
Immunogenicity and Safety of
ADACEL Polio (TdcP-IPV Vaccine)
Administered at 6 to 8 Years of Age as
a Fifth Dose (Pre-School Booster) in
Healthy Children in Taiwan
Hsin-Yu Chang1, Ping-Ing Lee1, Chun-Yi Lu2
1
Department of Pediatrics, National Taiwan University
Hospital and National Taiwan University College of Medicine,
Taipei, Taiwan; 2Department of Laboratory Medicine and
Internal Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, Taipei,
Taiwan
OBJECTIVE:ADACEL Polio was given as a booster
dose (fifth dose) among previously immunized children
aged 6 to 8 years in Taiwan .The primary objective of the
present study was to describe the immunogenicity profile
of ADACEL Polio in terms of GMTs and seroprotection
rates for diphtheria, tetanus and polio 1, 2, and 3, and in
terms of GMTs, post- / pre-vaccination GMTR, and
booster response for pertussis antigens .The secondary
objective of the present study was to describe the safety
profile of ADACEL Polio in terms of injection site
reactions, solicited systemic reactions, unsolicited adverse
events and adverse reactions.
METHODS: This was a one-armed, monocenter trial
performed in Taiwan, in 132 children aged between 6 and
8 years. Children were sequentially enrolled in the study to
receive one dose of ADACEL Polio on Day 0 of the study
and followed-up for one month after vaccination. The trial
included two visits and two blood samples for antibody
titration.
MAIN RESULTS: Regarding immunogenicity results, all
the subjects who received ADACEL Polio as a fifth dose
developed antibody titers greater than the seroprotection
thresholds defined for diphtheria, tetanus and polio 1, 2,
and 3. Anti-PT, anti-FHA, anti FIM 2 and 3, and anti-PRN
antibody titers obviously increased one month after
ADACEL Polio administration. Post- / pre-GMTRs ranged
from 6.53 (PT) to 24.4 (PRN), and respectively, 77.2%,
96.9%, 89.2%, and 99.2% of subjects developed a booster
response against PT, FHA, FIM 2 and 3, and PRN.
Regarding safety results, between Day 0 and Day7, 112
subjects (86.8%) reported at least one injection site
reaction. Solicited injection site reactions always occurred
between Day 0 and Day3, and commonly were of mild or
moderate intensity. Between Day 0 and Day7, 63subjects
(48.5%) reported at least one solicited systemic reaction.
Myalgia which was reported by 46 subjects (35.4%) was
the most frequently reported once. 10 subjects (7.6%)
reported a total of 12 unsolicited adverse reactions. 2
subjects (1.5%) each reported one unsolicited SAE during
the study.
CONCLUSION: 100% of the healthy children in Taiwan
who received ADACEL Polio at 6 to 8 years of age as a
fifth dose were seroprotected against diphtheria, tetanus
and poliomyelitis one month after injection. Between
77.2% and 99.2% of them have a booster response to the
PT, FHA, FIM 2 and 3, and PRN pertussis antigens one
month after injection. The safety profile of ADACEL Polio
given was satisfactory.
P1-054
Vaccination
Polyribosylribitol Phosphate Antibody
of the Pediatric Patients with
Haemophilus Influenzae Type B
Systemic Infection
Yoshiko Honda, Naruhiko Ishiwada, Junko
Tanaka, Haruka Hishiki, Yoichi Kohno
Japan
OBJECTIVE: Polyribosylribitol phosphate (PRP)
antibody is a important protective antibody against
invasive Haemophilus influenzae type b (Hib) disease.
Invasive Hib disease was eradicated in many countries
that introduce Hib conjugate vaccine as routine
immunization. On the other hand, Hib conjugate
vaccine is recently introduced in Japan as voluntary
immunization. Therefore, Hib is still a leading cause of
pediatric invasive infections, especially meningitis, in
Japan. The purpose of this study is to determine
whether the Hib conjugate vaccine is immunogenic in
children with a history of invasive Hib disease.
METHOD: Sixty-four children who had a history of
invasive Hib disease were enrolled in this study.
Diagnoses included: meningitis (38), epiglottitis (13),
sepsis (4), cellulitis (3), arthritis (3), pneumonia (1),
endocarditis (1) , osteomyelitis (1). Serum samples
from 64 patients with Hib systemic infection in acute
phase and in convalescent phase (two to three weeks
after admission) were analyzed. Nineteen of 64 patients
received the single dose of Hib conjugate vaccine and a
follow-up serum was taken and analyzed. Informed
consent was obtained from the parents. The protocol
was approved by the Chiba University Institutional
Review Board for Clinical Investigations. PRP antibody
titers
were
analyzed
with
a
Bindazyme
Anti-Haemophilus B Enzyme Immunoassay Kit (The
Binding Site Ltd., Birmingham, UK).
MAIN RESULTS: PRP antibody titers of the 40 of 64
patients with invasive Hib disease in acute phase were
less than 0.15Ојg/mL. All 5 patients over 4 years of age
responded with more than 1Ојg/mL of PRP antibody
titer after invasive Hib disease. PRP antibody titers of
the 42 of 59 patients younger than 4 years of age with
invasive Hib disease in convalescent phase were less
than 1Ојg/mL. Serum PRP antibody responses of
patients younger than 2 years of age were poorer than
those observed in patients over 2 years of age. Eighteen
of 19 patients had more than 1Ојg/mL of PRP antibody
titer after the first dose of Hib conjugate vaccine.
CONCLUSION:
Hib
conjugate
vaccine
is
immunogenic in children with invasive Hib disease.
Children younger than 4 years of age with invasive Hib
disease should be subsequently immunized with a Hib
conjugate vaccine.
143
P1-055
Vaccination
High Vacuolation Formation Induced
by Helicobacter Pylori Isolates from
Children with Dyspepsia
Mun Fai LOKE1, Bee Ling NG1, Seng Hock QUAK2,
Bow HO1
1
Department of Microbiology, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore;
2
Department of Paediatrics, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
Neutral red uptake (OD 540 nm)
OBJECTIVE: Helicobacter pylori has been reported
to cause gastroduodenal infections in both children and
adults.
Current
preliminary
study
compares
characteristics of local H. pylori isolates obtained from
children and from adults, with dyspepsia.
METHODS: A total of 11 strains of H. pylori isolates
obtained from children (mean age, 8.5 years) with
random abdominal pain (RAP) and equal number of H.
pylori isolates from adult patients with gastroduodenal
diseases served as the basis for this study. H. pylori was
cultured on chocolate blood agar plates incubated at
37ВєC in a 10% CO2 atmosphere. These isolates were
genotyped by PCR while -Glutamyl-transpeptidase
(GGT) activity was measured enzymatically.
Interleukin-8 production and degree of vacuolation
induced by H. pylori post-infection in human gastric
epithelial cell line (AGS) was determined by ELISA
and neutral red assay, respectively.
RESULTS: Majority of the paediatric H. pylori isolates
were found to be cagA, cagE, vacA, iceA1 and babA2
positive while ggt was detected in all strains analysed.
Most of these paediatric isolates belong to vacAs1c/m2
(45.5%) and s1c/m1T (36.4%) genotypes. It was found
that GGT level of paediatric H. pylori isolates were not
significantly different from that of isolates from adult
patients (P=0.24). Similarly, IL-8 production by AGS
cells infected with H. pylori isolates derived from
symptomatic children and adults were not significantly
different (P=0.25) either. However, the paediatric H.
pylori isolates caused significantly higher degree of
vacuolation in AGS cells than adult isolates (P=0.0007)
(Figure 1). Furthermore, two statistically significant
clusters causing different level of vacuolation were
observed in the paediatric group (P=0.0013). Cluster 1
also induced significantly higher vacuolation than adult
H. pylori isolates (P=8.5X10-7).
1.2
Figure 1. H. pylori-induced vacuolation in AGS cells.
Vacuolation in AGS cells was quantified using neutral
red uptake assay 24 hours post-infection with H. pylori
(multiplicity of infection: 100:1). Statistical analysis
was conducted using Student’s t-test. P<0.001 is
considered as significant.
CONCLUSION: Results from this study suggest that
H. pylori has a definitive role in causing
gastroduodenal diseases and its ability to induce high
degree of vacuolation may serve as useful indicator of
H. pylori infections in children with RAP. However,
this preliminary set of data needs to be verified with a
study on larger number of isolates.
Cluster 1
1.0
DU
0.8
Duodenitis
Gastritis
0.6
GU
Normal
0.4
Mean
0.2
0.0
Cluster 2
Children
(n=11)
Adult
(n=11)
144
P1-056
Vaccination
Biofilm Forming Ability of
Helicobacter Pylori Pediatric Isolates
Hassanbhai Ammar Mansoor1, Ng Bee Ling1,
Loke Mun Fai1, Quak Seng Hock2, Ho Bow1
1
Department of Microbiology, Yong Loo Lin School of
Medicine, NUS, Singapore; 2Department of Paedetrics, Yong
Loo Lin School of Medicine, NUS; Singapore
OBJECTIVE:It is estimated that >50% of the world’s
population is infected with H. pylori (HP), which is
nearly always acquired within the first 5 years of life
[1]. Recent studies have demonstrated the ability of HP
forming biofilms both in vitro [2] and in vivo [3]. This
study aims to characterize the biofilm formation of HP
isolates obtained from pediatric patients.
METHODS: The HP isolates from pediatric patients
with duodenal ulcer (#297 and #299) and gastritis
(#504) were genotyped. Their biofilm forming ability
was quantified using a crystal violet staining method.
Correspondingly, the viability of the planktonic and
biofilm bacterial populations were enumerated over 28
days. The characteristics of the pediatric strains were
compared with 3 strains (NCTC11637, 26695 and SS1)
isolated from adults. Structural development of biofilm
was observed under scanning electron microscopy
(SEM).
MAIN RESULTS: All 3 pediatric strains belong to
similar genotype. They are positive for cagA, cagE,
iceA1, babA2 and negative for iceA2. However, their
vacA alleles differed slightly. The laboratory adapted
strains were positive for cagA, cagE and babA2 but
varied in regard to iceA1 and iceA2. Strains #299 and
#297 demonstrated better biofilm formation than #504.
The laboratory strains however, were observed to form
more amounts of biofilm, with strain NCTC 11637
forming the most followed by 26695 and SS1. Under
SEM, the biofilm showed a mixture of spirals and
coccoids combined together in an assemblage.
CONCLUSION: Our studies demonstrated that
laboratory adapted strains form more copious amounts
of biofilm when compared with pediatric strains,
indicating that biofilm formation is strain dependent.
Biofilm formation is also shown to be independent of
the genotype and disease status of the patients. It was
reported that biofilm renders the bacteria 100-1000 fold
increase in antibiotic resistance compared to the
non-sessile, planktonic counterparts such that
anti-helicobacter treatments are not as effective in
children as they are in adults [4]. We therefore
hypothesize that the ability of the bacteria to form
biofilms confers protection and aids in its survival in
the young human hosts, resulting in chronic H. pylori
infections. Further studies on more pediatric isolates
will be needed to support such claim.
P2-001
Dengue
Changing Epidemiology of Dengue
Patients in Bangkok Metropolitan,
Thailand
Liulak W1, Sonthichai C1, Saosarn S1,
Thisyakorn U2
1
Disease Control Division, Health Department, Bangkok
Metropolitan Administration, Bangkok, Thailand; 2Department
of Pediatrics, Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
OBJECTIVE: Dengue is the most common
mosquito-borne virus causing disease in several
countries. In Thailand, dengue patient was first
seen in Bangkok in 1958 and was then seen in
other part of the country. This study describes the
changes in the epidemiological pattern of dengue
patients in Bangkok.
METHODS: Analysis of dengue patients data
reporting to Disease Control Division, Health
Department,
Bangkok
Metropolitan
Administration from 1991 to 2010 was done. The
diagnosis of dengue patients adhered to clinical
and laboratory criteria for the diagnosis of dengue
patients as established by the World Health
Organization.
MAIN RESULTS: During the past 20 years the
rate of dengue patients in Bangkok varied from
27.99 per 100,000 population in 1992 to 292.24
per 100,000 population in 2001 with the case
fatality rate less than 0.21%. The incidence by age
group has shown that rates in older children and
adults have dramatically increased during the last
decade.
CONCLUSION: Dengue infection is a
significant problem in Bangkok. The trend of
increasing age in dengue patients has been
evident.
145
P2-002
Enteric Infection
A Hospital Based Randomized,
Double-Blinded,
Placebo-Controlled
Study on the Efficacy and Safety of
Bacillus Clausii as Adjunct Treatment
in Acute Gastroenenteritis in Pediatric
Patients Ages 6 Months to 12 Years Old
P2-003
Enteric Infection
Prevalence and Types of Human
Parechovirus (HPeV) in Stool Samples
in Shanghai, China
Ranjelyn C. Robielos, William C. Bayhon Jr., Rosario
Khamil P. Carrion
Victor R. Potenciano Medical Center, Philippines
OBJECTIVE: Human parechoviruses (HPeV)
are widespread pathogens belonging to the
Picornavirus family. Eight genotypes, which have
predominantly been isolated from children, are
known. In order to gain insight into the
prevalence and genetic diversity of HPeV within
Shanghai, China in recent years, we
retrospectively screened and directly typed stool
samples from children with acute diarrhea under
the age of 5 years during the year of 2008 and
2009.
METHODS: Testing for HPeV was carried out
using the highly conserved 5’ UTR primers. For
parechovirus typing, samples positive by the 5’
UTR were amplified by nested PCR using primers
from the VP3/VP1 junction region.
MAIN RESULTS: Of the 200 rotavirus negative
samples selected for HPeV testing, 57.5%
пј€115/120пј‰ were positive. The prevalence of
HPeV infection was not significantly different
between males (77/138, 55.8%) and females
(38/62, 61.3%). The median age of children
infected with HPeV was 3 months. The frequency
of HPeV infection was 60.8% (31/51) in neonates,
63.1% (41/65) in infants 1-5 months. Prevalence
of HPeV declined to 21.4% (3/14) in children
24-60 months old. Circulation of HPeV was low
in January and February, then it increased
gradually and peaked in summer and autumn,
with high prevalence in July (13/16, 81.3%) and
August (14/15, 93.3% ). HPeV1 was the most
predominant genotypeпј€92.7%, 51/55пј‰between
2008 and 2009. A total of 4 samples were
characterized as HPeV4 (2/55, 3.6%), HPeV5
(1/55, 1.8%), HPeV6 (1/55, 1.8%) respectively
and all these 4 genotypes were detected in the
year of 2009. HPeV1 was present through the
year but HPeV4, HPeV5 and HPeV6 were only
observed from July to October.
CONCLUSIONS: This study provided useful
data for epidemiology features of HPeV infection
by documenting genotypes distribution as well as
age and seasonal pattern in Shanghai, China.
BACKGROUND: Acute gastroenteritis is a common disease
among children especially in developing countries. An adjunct
treatment that will help reduce the duration of this illness is
needed to help reduce morbidity and mortality in the pediatric
age group.
OBJECTIVE: To determine the efficacy and safety of
Bacillus clausii as adjunct treatment for pediatric patients with
acute gastroenteritis with some dehydration as compared to
placebo.
Study
Design:
Randomized,
Double-Blinded,
Placebo-Controlled Trial.
METHODS: All patients 6 months – 12 years old who were
admitted for acute gastroenteritis in the tertiary hospital were
randomized to receive either Bacillus clausii, 5 ml suspension
(2 billion spores), per orem, 2x a day for 5 days or 5 ml
sterilized water (placebo), per orem, 2x a day for 5 days.
Primary study end points were resolution of diarrhea
determined by decreasing stool frequency and improving stool
consistency. Secondary study endpoints were development of
adverse reactions such as onset of vomiting, fever, abdominal
pain and urticaria that were first noted after initiation of
interventional therapy.
RESULTS: A total of 80 patients were randomized in the 2
treatment groups: Bacillus clausii group had 41 subjects and
the control group had 39 subjects. All patients presented with
acute non-bloody diarrhea. There was no significant difference
between the mean age (p=0.73) and sex distribution (p=0.08).
However, the duration of diarrhea prior to admission was
significantly (p=0.05) longer in the Bacillus clausii group
compared to the control group. The Bacillus clausii group
showed a shorter duration for a change in stool consistency
(from entirely liquid up to the first appearance of soft stools)
(p=0.004), shorter number of days for stool change in stool
frequency (p=0.05) and shorter number of days for resolution
of diarrhea (defined as soft to semi-formed stools in
consistency and frequency of stools is less than 3 times per
day) (p=0.01) compared to the control group. For all variables,
the Bacillus clausii group was significantly faster compared to
the control group. No adverse reaction has been reported in the
course of the study and all the subjects tolerated the treatment
given.
CONCLUSIONS: The probiotic Bacillus clausii as the
adjunct treatment in diarrhea in children was significantly
effective compared to the control group. In all three treatment
effects: improvement in stool consistency, decrease frequency
of bowel movement and resolution of diarrhea, given with
Bacillus clausii was effective. Overall improvements were
already seen in children in less than 2 days given the Bacillus
clausii.
Jin Xu, Huaqing Zhong, Yi Yang
Pediatric Institute, Children’s Hospital of Fudan University,
Shanghai, China
146
P2-004
Enteric Infection
Etiology of Acute Gastroenteritis in
Children Less than 5 Years of Age in
Northern Taiwan
P2-005
Enteric Infection
Impact of Gastroenteritis on Parents of
Child Hospitalized for Acute
Gastroenteritis in Taiwan
Wei-Chen Tseng, Fang-Tzy Wu, Yhu-Chering
Huang
Taiwan
Lung-Huang Lin1, Shih-Pin Kuo2, Chao-Jen
Lin2, Min-Sheng Lee3, Hsiang-Hung Shih3,
Hung-Chang Lee4
OBJECTIVES: To investigate and monitor the
etiology of acute gastroenteritis in children less than
5 years of age in northern Taiwan
METHODS: From January 1st 2009 to April 12th
2010, children less than 5 years of age hospitalized
at Chang Gung Children’s Hospital due to acute
gastroenteritis were eligible for this study.
Approximate 35 stool specimens per month from
these children were randomly selected for
microbiologic analysis.
RESULTS: A total of 546 specimens were analyzed.
The monthly specimens ranged from 26 in Feb. 2010
to 44 in May 2009 with a mean of 36. 317 (58.1%)
patients are male and 322 (59%) patients aged
between 6 months and 2 years. Of the 546
specimens, probable pathogens were identified in
415 specimens (76%). Rotavirus was the most
common identified pathogen (25.8%), followed by
salmonella (24.7%). Viral pathogens alone were
identified in 161 specimens, including rotavirus
alone in 88, adenovirus alone in 11, norovirus alone
in 37, astrovirus alone in 7 and mixed viruses in 18.
Bacterial pathogens alone were identified in 183
specimens, including Salmonella alone in 70,
Staphylococcus aureus with toxin release in 29,
Escherichia coli in 20, Campylobacter sp. in 9 and
mixed bacteria in 55. Mixed viral-bacterial
pathogens were identified in 71 specimens.
Rotavirus accounted for > 30% of the specimens
from February to April in 2009, while Salmonella
was prevalent from May to December. For the 110
(114) rotavirus strains undergoing genotyping, G1
type was the most common G type and accounted
for 80%; P8 was the most common P type and
accounted for 86%. 63% of 141 patients with
rotaviral AGE had the triad of fever, vomiting and
diarrhea. In contrast, children with norovirus AGE
had a longer duration of vomiting. Children with
salmonella AGE had a significantly longer duration
of fever, a higher serum C-reactive protein level, a
lower rate of vomiting and a higher rate of bloody
stool and mucoid stool.
CONCLUSIONS: In northern Taiwan, rotavirus
and Salmonella were the two most common
pathogen of AGE in children less than 5 years of age
requiring hospitalization. Rotavirus prevailed from
February to April, while Salmonella between May to
December during the study period.
1
Cathay General Hospital, Taiwan; 2Changhua Christian
Hospital, Taiwan; 3Kaohsiung Medical University Hospital,
Taiwan; 4 Mackay Memorial Hospital, Taiwan
INTRODUCTION: Acute gastroenteritis is a
common clinical problem among children
worldwide with rotavirus infection as its leading
cause. Collecting data on the impact of
gastroenteritis on costs and emotional distress on
parents of children with acute gastroenteritis is part
of the overall medical/economic assessment of
rotavirus vaccination.
OBJECTIVES: To assess the burden on parents in
terms of quality of life and costs, of having a child
hospitalized for acute gastroenteritis.
Methods: The study took place in Taiwan in 4
centers (Mackay Memorial Hospital; Cathay General
Hospital; Changhua Christian Hospital; Kaohsiung
Medical University Hospital) to measure the impact
on the parents’ quality of life and costs related to the
care of a child hospitalized with acute gastroenteritis
by means of a self-administered quality of life
questionnaire. Children had to correspond to the
following criteria.(1)Children must be aged between
0 and 36 months (2)
Children
must
be
hospitalized with acute gastroenteritis defined as: 3
or more loose stools in 24 Hours.
RESULT: The study was conducted between Mar
19, 2010 and June 8, 2010 and 120 cases were
included. The mean age of the children was 399.6
days (SD: 177). The mean length of the hospital stay
was 3 days (SD: 1.8). The majority of parents
(70.8%) were overall very worried regarding their
child’s gastro-enteritis, and most of them felt upset
(67.5%) and helplessness (55%). For those parents
reporting to have their children kept out of day-care
the average number of days was 4.9 days (SD: 2).
Nearly half (47%) of the parents answered to have
an income loss. The average daily income loss for
those reporting an income loss is NTD 504. A mean
of 3.3 missed days at work were reported by the
parents who were working. The average traffic cost
is NTD 206.
CONCLUSION: Data from this study supports that
the child’s gastro-enteritis has a serious impact on
the parents’ quality of life as well as on their income.
147
P2-006
Enteric Infection
Klassevirus Infection in Children with
Acute Gastroenteritis
Tae-Hee Han1, Ju-Young Chung2, Cheol-Hwan Kim3,
Sang-Hun Park4, Eung-Soo Hwang5
1
Department of Pediatrics, Sanggyepaik Hospital, Inje
University College of Medicine, Seoul, Korea; 2Department of
Laboratory Medicine, Sanggyepaik Hospital, Inje University
College of Medicine, Seoul, Korea; 3Department of Family
Medicine, Sungkyunkwan University School of Medicine,
Seoul, Korea; 4Seoul Metropolitan Government Research
Institute of Public Health and Environment, Virus Team, Seoul,
Korea; 5Department of Microbiology and Immunology, Seoul
National University College of Medicine, Seoul, Korea
OBJECTIVE: Recently, a new picornavirus, kobu-like
virus associated with stool and sewage (klassevirus)-1 was
identified in stool sample from children with
gastroenteritis (GE). The prevalence of klassevirus-1 and
its clinical role in GE remain still unclear. The purpose of
this study was to investigate the prevalence of
klassevirus-1 in Korea.
METHODS: Between September 2007 and April 2009,
archived virus-negative stool samples from 342 children
<6 years of age hospitalized with GE at Sanggyepaik
Hospital were included in the study. From May 2009 to
February 2010, 294 stool samples were prospectively
collected from hospitalized children of <17 years of age
with GE at Sanggyepaik Hospital. The identification of
rotavirus and -adenovirus 40 and 41 was performed using
the ELISA kits. RT-PCR for NoV, human astrovirus
(HAstV), and Aichi virus were performed. PCR for
HBoV-1 and HBoV-2 were performed. To detect
klassevirus-1 the first reactions of two nested RT-PCR
assays were performed using the following primers:
LG0118 and LG0117 for 3D region; LG0119 and LG0136
for VP0/VP1 gene. The second reactions of each RT-PCR
assay were carried out using newly designed primers:
KL3DF and KL3DR for 3D region; KLVPF and KLVPR
for VP0/VP1 region. A third RT-PCR assay for 2C region
of klassevirus-1 was carried out using modified primers.
Nucleotides sequences were aligned using BioEdit V7.0
and presented in a topology tree, prepared in MEGA 4.1.
RESULTS: In 342 of common enteric virus-negative stool
samples, 15 samples (4.4%) were positive for klassevirus-1
by RT-PCR. Klassevirus-1 positive samples were most
frequently found in February 2009 and March 2009. A
total of 294 stool samples collected prospectively between
May 2009 and Feb 2010, were tested for the presence of
klassevirus-1 RNA. Rotavirus (13.7%) and norovirus
(10.6%) were the most frequently detected viral agents.
Aich virus was not detected. Klassevirus was detected in
11 patients (3.74%) of the prospective group and most
frequently detected in June 2009 and August 2009.
Co-detection with other viral agents was in three (27.3%).
Phylogenetic analysis showed that Korean isolates in this
study clustered into reference strains, KV US/2002 (NC
012986) and KV AU/1984 (GQ 253930), and the sequence
variation was limited. The range of nucleotide differences
between Korean strains and reference strains were 7-8% in
average (max: 11%).
CONCLUSION: We have detected klassevirus-1 in 3.7%
of children hospitalized children with GE suggesting an
association between klassevirus-1 and GE, although
further studies are needed to prove causality of this virus.
P2-007
Enteric Infection
Norovirus is a Significant Pathogen of
Acute Sporadic Diarrhea in Children
Hsiao-Chuan Lin1, Mei-Chi Su2, Tsung-Hsueh
Hsieh1, Tzu-Yao Chuang1, Hsin-Yang Hsieh1,
Meng-Kung Yu1, Chih-Feng Chang1, Shu-Fen
Wu1, An-Chyi Chen1, Hsiao-Yu Chiu1,
Chang-Ching Wei1, Walter Chen1, Ching-Tien
Peng1
1
Department of Pediatrics, China Medical University Hospital,
Taichung, Taiwan; 2Department of Laboratory Medicine,
China Medical University Hospital, Taichung, Taiwan
OBJECTIVE: Viruses are the most common causes of
acute infectious diarrhea in children. During the last flu
season, patients with viral gastroenteritis increased. The
study investigated clinical manifestations of novorirus
infection in the pediatric population.
METHODS: During a period of 4 months (from July
2009 to October 2009), 375 stool samples were
obtained from children from birth to 18 years old
visited the emergency department or admitted to the
pediatric ward. Enzyme-linked immunosorbent assay
(ELISA) was used for rotavirus and norovirus detection.
Clinical information of patients with positive norovirus
ELISA was retrospectively reviewed.
MAIN RESULTS: During the study period, forty-four
(11.7%) patients had norovirus infection. Coinfection
with Salmonella or rotavirus was detected in five and
one, respectively. Thirty-two patients were admitted,
twelve visited ER. Twenty-seven (61%) were male,
with a mean age of 46.6 months (range, 2 days-188
months). Symptoms were diarrhea (n=44; 100%), fever
(n=27; 84%), vomiting (n=21; 48%), abdominal pain
(n=16; 36%), cough (n=9; 20%), rhinorrhea (n=7, 16%),
myalgia (n=3; 7%), malaise (n=3; 7%), headache (n=2;
5%), and nausea (n=2; 5%). Eight patients had
conditions in addition to gastroenteritis; two infants
aged eight and nine months with clinical manifestations
fulfilling roseola, one with bronchopneumonia, one
with Kawasaki disease, two with acute lymphoblastic
leukemia, one with lymphoma, and one with
neuroblastoma in remission. Regarding age group, 13
(30%) patients were younger than 12 months, 8 (18%)
aged 13-23 months, 5 (11%) aged 24-35 months, 4 (9%)
aged 36-47 months, and 3 (7%) aged 48-59 months,
and 11 (25%) older than 60 months. Thirty-eight
(10.1%) patients had rotavirus infection.
CONCLUSION: Norovirus is the most common viral
pathogen of sporadic diarrhea in children, with
predominant symptoms of diarrhea, fever, vomiting and
abdominal pain. Norovirus infection is common in
children aged < 1 year and > 5 years.
148
P2-008
Enteric Infection
In Vitro Efficacy of Tigecycline gainst
Multidrug Resistant and Nalidixic Acid
Resistant Typhoidal Salmonellae
P2-009
Enterovirus, Poliomyelitis
Innate Antiviral Immunity Is Impaired
in Young Patients with Hand Food and
Mouth Diseases
Fatima Kaleem, Javaid Usman, Afreenish Hassan
National University of Sciences and Technology,
Department of Microbiology, Army Medical College,
Rawalpindi, Pakistan
Jiande Chen, Bingbing Wu, Yi Yang
Children’s Hospital of Fudan University,
Shanghai, China
INTRODUCTION: Antimicrobial resistance in
Salmonella species is of grave concern, more so in
quinolone-resistant
and
extended-spectrum
beta-lactamase (ESBL)-producing isolates that cause
complicated infections. The timely appropriate
management of typhoid fever can considerably reduce
both morbidity and mortality. Since late 1980s
Salmonella
typhi
has
developed
resistance
simultaneously to all the drugs used in first line
treatment (chloramphenicol, cotrimoxazole and
ampicillin) and are known as multidrug resistant
(MDR). Fluoroquinolones are widely regarded as the
most effective drugs for the treatment of typhoid fever.
Unfortunately there are reports of treatment failure with
fluoroquinolones and nalidixic acid resistance is a
marker of reduced susceptibility to fluoroquinolones.
Recently, azithromycin is being used as an alternative
agent, but sporadic reports of resistance to these
antibiotics are already being reported so we are left
with little options and tigecycline proves to be a
promising alternative.
MATERIAL AND METHODS: This descriptive
study was carried out in the Department of
Microbiology, Army Medical College, National
Uuiversity of Sciences and Technology, Pakistan. All
the specimens received with suspicion of typhoid fever
for blood culture were dealt with standard
microbiological procedures. Typhoidal salmonellae
were isolated and were subjected to the determination
of antimicrobial sensitivity. All typhoidal salmonellae
that were resistant to first line drugs (Multi drug
resistant) and nalidixic acid resistant (NAR) isolated
were subjected to susceptibility testing of tigecycline
using E-test method. Minimum inhibitory concentration
50 and 90 were calculated.
RESULTS: Among 50 Multi drug resistant and
nalidixic acid resistant isolates all of the isolates had
minimum inhibitory concentrations well within
sensitive range. Twenty six isolates were Salmonella
typhi and 24 were Salmonella paratyhpi A.
CONCLUSION: Our study concludes that tigecycline
a new gylcylcycline has good in vitro activity against
MDR and NAR typhoidal salmonellae and it can be
used as a last effective resort against multi drug
resistant and nalidixic acid resistant salmonellae where
other options lag behind.
OBJECTIVE: Induction of the antiviral innate immune
response depends on recognition of viral components by
host pattern-recognition receptors, some members of the
Toll-like receptors (TLRs) and cytoplasmic RNA helicases
including retinoic acid inducible gene-I (RIG-I) and
Melanoma differentiation-associated gene 5 (MDA5) have
been shown to respond to viral RNA by inducing
interferon (IFN) production. This study was designed to
explore the expressions of these receptors and association
of the antiviral innate immune response with different
severity of Hand, foot and mouth disease (HFMD).
METHODS: Ninety-eight HFMD patients (aged of 1-5
years) and fifty-five age-matched non-infection children
were enrolled in this study; the patients were divided into
two groups according to clinical characteristics - with or
without complications. The expressions of TLR3, RIG-I,
MDA5, IRF-1 (IFN-beta promoter stimulator, an adaptor
triggering RIG-I- and Mda5-mediated type I interferon
induction) and IFN-alpha mRNA in peripheral blood
leukocytes of these children were detected by Real-Time
PCR.
MAIN RESULTS: The expression levels (calculated and
expressed with log 10 copies per 100 ng of total RNA) of
TLR3 mRNA in HFMD patients were significantly
reduced (6.05В±1.26) compared with the non-infection
children (7.05В±0.96), P<0.001, and the furthermore
decreased was found in the patients with complications
(5.79В±1.15). While, the expressions of MDA5 mRNA in
all patients including without complications (4.64В±0.49)
and with complications (4.60В±0.48) were markedly higher
than the non-infection children (4.16В±0.35), P<0.001.
However, RIG-I mRNA was detected only in 72/98
patients, which was not found in the non-infection children.
IFN-alpha, a major antiviral cytokine, was lower in the
patients without complications (5.71В±1.26) than the
non-infection children (6.19В±0.86), and significantly
decreased IFN-alpha mRNA transcriptions were found in
the patients with complications (5.54В±1.18), compared
with the non-infection children P<0.05. Moreover, the
changes of IRF-1 mRNA were similar with IFN-alpha, an
evidently reduced level of IRF-1 was in the patient with
complications
(4.89В±0.66)
compared
with
the
non-infection children (5.32В±0.64), P=0.001.
CONCLUSION: TLR3, MDA5 and RIG-I were involved
into the antiviral innate immune responses of HFMD. The
reduction of IRF-1 and IFN-alpha, important antiviral
immune components, in the patients with complications
indicated the innate antiviral immunity were impaired in
HFMD patients, and which is possibly associated with the
severity of the disease.
149
P2-010
Enterovirus, Poliomyelitis
The Outbreak of Neurologically
Complicated Hand-Foot-Mouth
Disease Caused by Enterovirus 71 in
Republic of Korea, 2009
P2-011
Enterovirus, Poliomyelitis
Comparison of Classic and Molecular
Approaches for the Identification of
Human Enteroviruses from Throat
Swabs in Outpatients
Jong-Hyun Kim1, Seong-Joon Kim1, Kyung Hyo Kim2,
Dong Soo Kim3, Chang Hwi Kim4, Doo-Sung Cheon5, Jin
Han Kang1,
1
Department of Pediatrics, College of Medicine; 2The Catholic
University of Korea; 3Ewha Womans University; 4Yonsei
University; 5 Soonchunhyang University; Division of Enteric
and Hepatitis Viruses, National Institute of Health, Korea
Centers for Disease Control and Prevention, Seoul, Republic
of Korea
Pai-Shan Chiang1,2, Shu-Ting Luo1,2,
Sheng-Chi Chen1,2, Mei-Liang Huang1,2,
Guan-Yuan Liou1,2, Kuo-Chien Tsao3,4,
Tzou-Yien Lin5 ,Min-Shi Lee1,2
OBJECTIVE: Since the late 1990s, particularly in many
countries of the Western Pacific region, there have been
large outbreaks of hand-foot-mouth disease (HFMD)
mainly caused by enterovirus 71 (EV71) associated with
severe neurological diseases and even deaths. In Republic
of Korea, after the first fatal case of HFMD caused by
EV71 announced in May 2009, much more cases of
neurologically complicated HFMD had been reported until
November 2009. Therefore, we described the clinical
manifestations and characteristics of etiologic viruses in
these cases.
METHODS: The inclusion cases of neurologically
complicated HFMD and herpangina (HP) were reported
into the Division of Enteric and Hepatitis Viruses, National
Institute of Health, Korea Centers for Disease Control and
Prevention during the period of April through October,
2009. The clinical specimens were collected to
demonstrate the etiologic viral types. Real-time RT-PCR
for EV71 and pan-EV were performed. Also, semi-nested
RT-PCR for pan-EV was done for sequencing.
RESULTS: Total number of reported cases with
neurologically complicated HFMD and HP was 110
(HFMD, n=99; HP, n=11). The number of male and female
was 67 and 43. More than 90% of cases were under 6
year-old-age. Sixty-eight cases (61.8%) showed mild
neurologic
signs
and
symptoms
or
aseptic
meningoencephalitis with complete recovery. Forty-one
cases (37.3%) showed severe neurologic manifestations
(e.g. acute flaccid paralysis, encephalitis, seizure, ataxia,
tachycardia, hypertension, hypotension and coma), while
there was one death. Viruses were isolated from 98 cases
(89.1%). The most commonly isolated EV71 subgenotype
from the cases was C4a, isolated in 65 cases (66.3%). C4a
had a 98% homology with Chinese strains that circulated
in 2008 (based on VP1 sequences of this EV71 strain).
There were 23 cases (23.5%) of EV71 which were
confirmed by real-time PCR but the subgenogroups were
not determined. EV71 C1 subgenogroup, Coxsackievirus
A2, B1, and untypable enterovirus were also detected.
Viruses were isolated in 3 out of 65 (4.6%) cerebrospinal
fluid, 31 out of 67 (46.3%) throat swabs, and 88 out of 98
(89.8%) stool specimens.
CONCLUSION: In 2009, the first outbreak of
neurologically complicated HFMD caused by EV71
occurred in Republic of Korea. More concrete and better
designed enteroviral surveillance system and early
detection protocol for HFMD should be re-built.
1
Vaccine Research and Development Center, National Health
Research Institutes (NHRI), Taiwan; 2Division of Infectious
Diseases, NHRI, Taiwan; 3Department of Medical
Biotechnology and Laboratory Science, Chang Gung
University, Taoyuan, Taiwan; 4Clinical Virology Laboratory,
Department of Clinical Pathology, Chang Gung Memorial
Hospital (CGMH), Taoyuan, Taiwan; 5Division of Pediatric
Infectious Diseases, Department of Pediatrics, Chang Gung
Children’s Hospital (CGCH), Taoyuan, Taiwan
OBJECTIVE: Human enterovirus infections are
common in children and include over 90
serotypes. With the exceptions of polioviruses and
enterovirus 71 (EV71), which frequently cause
neurologic complications, human enteroviruses
usually cause self-limited infections. Therefore,
early detection and serotyping of enteroviruses
infections are critical in clinical management and
disease surveillance. The current standard
methods for detection and serotyping of
enterovirus infections are virus isolation and
immunofluorescence
assay,
which
are
time-consuming and labor-intensive. Several
studies have documented that molecular diagnosis
are sooner and more sensitive than virus isolation
for detection and serotyping of enterovirus
infections in hospitalized patients but few studies
have been conducted in outpatients. In this study,
we compare reverse transcription-polymerase
chain reaction (RT-PCR) and virus isolation for
detection and serotyping of enterovirus infections
in clinical samples of outpatients.
METHODS: Previous studies have shown that
throat swabs are the most sensitive clinical
specimens for detection of EV71 in acute patients.
In a children cohort study, throat swabs were
collected for virus isolation and molecular
diagnosis in participants who developed suspected
enterovirus illnesses (herangina, hand-foot-mouth
disease and non-specific febrile illness). The
specimens were inoculated onto susceptible cells
(Hep-2, Hela, MRC-5, RD, GMK, and/or Vero)
and inoculated for 14 days or until cytopathic
effects were observed, and then cells were
harvested
for
virus
identification.
For
enteroviruses identification, the cells were stained
150
P2-012
Fungal Infection
Voriconazole Therapeutic Drug Level
Monitoring in Korean Children
by immunofluorescent assay using commercial
Pan-entero antibody and type-specific monoclonal
antibodies from 23 serotypes, including Polio1-3,
CA2, CA4-6, CA9-10, CA16, CA24, CB1-6,
Echo4, Echo6, Echo11, Echo30, EV70, and EV71.
In the molecular diagnosis, semi-nested RT-PCR
was used to detect the 5’UTR gene of EV.
Products of positive RT-PCR were sequenced and
genotyped by the BLAST search and
phyologenetic analysis.
RESULTS: Between January 2008 and
December 2009, 111 throat swabs were available
for comparison. 40 and 54 enteroviruses were
detected by virus isolation and semi-nested
RT-PCR, respectively (detection rate = 36.04% vs.
48.65%, p<0.0001, П‡2 test) (Table 1). The
agreement rate between the two diagnostic
methods is 76.58% (85/111) in detecting
enterovirus infection (p=0.006, McNemar’s test).
Among the 34 cases who were positive by the
virus isolation and semi-nested RT-PCR, seven
had mismatched serotype classifications. The
molecular diagnosis required 1 day for RT-PCR
and 2 days for sequencing.
CONCLUSIONS: The RT-PCR is faster and
more sensitive than the virus isolation for
detection and typing of enterovirus infections in
outpatients. In addition, the molecular diagnosis
can be used to provide early alarm of EV71
circulation during enterovirus seasons in
surveillance systems.
Table 1. Comparison of virus isolation and RT-PCR for
detecting enterovirus infections in throat swabs
Enterovirus detection
RT-PCR
Enterovirus No enterovirus Total
Enterovirus
34
Virus
No enterovirus 20b
isolation
Total
54
6a
40
51
71
57
111
a Virus isolation: CA6 (2 cases), CA10 (2 cases), CA2 (1
case), EV71 (1 case)
b Virus isolation: negative (6 cases), CMV (5 cases), HSV-1
(5 cases), adenovirus (1 case), parainfluenza virus (1 case),
RSV-1 (1 case), coinfection with andenovirus and influenza
virus (1 case)
Ji-Young Hwang1, Soo Han Choi1, Soo-Youn
Lee2, Eunhye Kong1, Heewon Chueh1, Soohyun
Lee1, Keon Hee Yoo1, Ki Woong Sung1, Hong
Hoe Koo1, Yae-Jean Kim1
1
Department of Pediatrics, Sungkyunkwan University School
of Medicine, Samsung Medical Center, Seoul, Republic of
Korea; 2Department of Laboratory Medicine, Sungkyunkwan
University School of Medicine, Samsung Medical Center,
Seoul, Republic of Korea
BACKGROUND: Voriconazole has been widely
used for the treatment of serious invasive fungal
infections. It is metabolized by cytochrome P450
pathway and its level can be greatly influenced by
drug interaction and genetic predisposition.
Therefore, voriconazole drug level monitoring is
of importance in clinical practices. Little data
exist in Korean children.
METHODS: Pediatric patients (pts) who
received voriconazole were included at Samsung
Medical Center, Seoul, Korea from September
2009 to April 2010. Serum concentrations of
voriconazole
were
determined
by
high-performance liquid chromatography/tandem
mass spectrometry. The limit of quantitation was
0.1 Ојg/mL and intra- and interassay imprecisions
(%CV) were less than 10%. Retrospective chart
review was performed to collect clinical
information.
RESULTS: Twelve pts were identified. Median
age was 10.9 yrs (range, 2.9-18.4 yrs) and male to
female ratio was 9:3. Ten pts had cancer and two
were non-cancer pts. Median initial maintenance
dosage was 5.97 mg/kg/dose (range, 2.75-6.09
mg/kg/dose) and its trough level was measured
after 5 median days. Median initial trough level
was 1.18 Ојg/mL (range, 0.26-5.42 Ојg/mL). Values
were variable among pts even on the similar
dosages as well as various dosages were used to
achieve similar concentrations. Pts who had
multiple drug levels, the values were variable in
the same patient according to each patient’s
condition or changes in co-administrating
medication.
CONCLUSION: Voriconazole therapeutic drug
levels were monitored in Korean pediatric pts.
Drug levels were variable among pts as well as
different occasions in the same patient.
Continuous careful drug level monitoring is
important to ensure the antifungal therapeutic
effect.
151
P2-013
Experience of the Newly
Pediatric
National
Treatment
Registry
Observational Database
Lumpur, Malaysia
HIV
Developed
HIV/AIDS
(pNHATR)
in Kuala
MZA Hamid, NA Aziz, Thahira JM, Kamarul
AMR
Malaysia
Introduction: Cases of HIV infections in Malaysia are
increasing, with estimated of 6,000 reported new cases
yearly. Despite the growing numbers of HIV cases,
there is no precise data on pediatric HIV cases in our
country. This raised a concern among practitioners as
projected prevalence of HIV infection in Malaysia
estimated at 1.3% in 2015. We report the observation
data from Kuala Lumpur Hospital, the centre with the
highest number of HIV positive children in Malaysia.
METHODOLOGY: An observational study over one
year period involving all HIV-positive cases in Kuala
Lumpur
Hospital.
Data
pertaining
to
socio-demographic characteristics, CD4 count, RNA
and outcome of the patients were reviewed and entered
to the registry. Descriptive analysis used for both
categorical and continuous data. A p value of < 0.05
was considered significant.
RESULTS: A total of 116 patients were registered in
the cohort, with 113 were under follow-up.
The
mean age was 8.60 years (SD 4.11 years), the youngest
being one year old and the oldest still under follow-up
was 18 years 11 months, with 51.30% were male.
Major route of infection was vertical transmission
(97.4%), followed by blood product (0.9%) and breast
milk (0.9%). Overall 41.0% received first-line therapy
with 78.0% in this group demonstrated a CD4 count of
more than 500cell/mm3, while 36.0% second-line
therapy and 23.0% were on salvage therapy. The mean
CD4 count was 808.4 cells/Вµ l (SD 452.4) and the mean
viral load was 36476.2copies/ml (SD 14555.6). In the
categorization of the CD4 counts to disease severity, it
demonstrated that 7.3% of our cohorts were in severe
stage or stage 3(CD4 counts less than 200) during their
last 6-months follow-up
and forty-two children
(36.2%) have undetected viral load (HIV RNA copies
below 40) in the last 6-months of their follow-up.
CONCLUSION: Mother to child transmission remains
the main transmission route, with majority of the
patients had received first-line anti-retro viral therapy
suggesting good control of their disease status. This
registry is important as it is the initial step towards
strengthening the management of pediatric HIV
infection in Malaysia.
P2-014
HIV
Growth and Development of Children
Borne to HIV-Positive Pregnant
Women in 4 Provinces in Thailand
Voramongkol Nipunporn, Chailai
Leartvanangkul
Bureau of Health Promotion, Department of
Health, Ministry of Public Health, Thailand
BACKGROUND: Thailand implements PMTCT
Program as nationwide since 1999. The most
effective way to prevent mother-to-child
transmission of HIV composes of voluntary
testing and Counseling, a long course of
antiretroviral
drugs
and
avoidance
of
breastfeeding. There are many children were
safe from this risk while their mothers still
infected. Knowing the status of growth and
development of the children we can identify the
problems and improving maternal and child
health services for healthy child care
implementation.
METHODS: A cross sectional survey was done
during September 2007 – May 2008 in 4
provinces by cluster random sampling. Samples
are children 0-5 years old borne from HIV
positive mothers and their parents. Collecting data
by interview with caregiver and use Denver II
tools to assess development of children.
RESULTS: Of 381 children borne from HIV
positive mother, 70.6 %
know result of HIV
testing negative, 22.9% unknown status and there
was HIV positive 6.6%. Evaluation of growth and
development 86.2 % has appropriate weight for
age, 84.5 % has appropriate height for age, and
71.8 % has normal development. The major area
of delay development was social and self help
28.2%, language 17.3% fine motor 6.0% and
gross motor 5.5%. Factors related to Growth and
development of children borne to HIV positive
mothers was appropriate height for age, to live
with their own father and mothers and maternal
age equal or less than 30 years old(P<0.05).
CONCLUSIONS: It was found that children
borne from HIV positive mother had delay growth
and development when compare to the situation in
Thailand. It is thus recommended that efforts
should be made to enhance family practice in
child rearing, Encourage parents to play and
interact with their children. Educate parents about
the benefit of stimulation of child growth and
development.
152
P2-015
Hospital Infection
The Examination of Infection in
Peritoneal Dialysis Patients
Morteza Ghasemi Bonehi
Philippines
INTRODUCTION AND AIMS: Peritoneal
dialysis started in the 19th century by WEGNER
which was based on the semi-permeability of the
peritoneam memberance. FINE was able to
successfully perform this method on acute renal
failure patients. There are several indications for
peritoneal dialysis compared to hemodialysis and
it seems that there are more advantages and
benefits for peritoneal dialysis. Treatment of
infection in peritoneal dialysis patients depends
on clinical findings and microbiologic studies.
MATERIALS AND METHODS: A descriptive
study was done in 6 peritoneal dialysis patients in
2009 at shahid beheshti hospital.
RESULT: 1. Patient with abdominal pain and
vomiting, severe cloudy peritoneal dialysate
effluent showing WBC=400mm3, negative for
bacterial culture.
2. Patient with diarrhea, severe cloudy peritoneal
dialysate effluent, bacterial culture were not taken
because of financial problems.
3. Patient with abdominal pain severe cloudy
peritoneal
dialysate
effluent,
showing
WBC=800mm3, negative for bacterial culture.
4. Patient with diarrhea, sever cloudy peritoneal
dialysate effluent, showing WBC >100mm3
PMN=80%, negative for bacterial culture.
5. Patient with abdominal pain, severe cloudy
peritoneal
dialysate
effluent,
showing
WBC=1500mm3, negative for bacterial culture,
but positive for candida albicans fungi remove of
catheter.
6. Patient with diarrhea, severe cloudy peritoneal
dialysate effluent, showing WBC=3600mm3,
positive for staph epidermis.
The primary treatment for staph was taken
vancomycin, for candida remove of catheter and
taken fluconazole or flucytozine and others were
taken keflin and ceftazidime.
CONCLUSION AND DISCUSSION: There are
several indication for peritoneal dialysis compare
to hemodialysis, it seems that there are more
advantages and benefits for peritoneal dialysis
which can be done to the patients.Hence control
and treatment of the common infection in
peritoneal dialysis in necessary. Clinical finding,
cloudy peritoneal dialysate, bacterial culture and
isolated causes of infection can help for treatment.
P2-016
Hospital Infection
Nosocomial Blood Stream Infection in
Neonatal Intensive Care Unit: an
Eight-Year Study in a Medical Center
of Northern Taiwan
Mei-Hui Tang, Nan-Chang Chiu , Hsin Chi,
Fu-Yang Huang, Jui-Hsing Chang,
Chyong-Hsin Hsu, Hsin-An Kao, Han-Yang
Hung, Chun-Chih Peng
Department of Pediatrics, Mackay Memorial
Hospital, Taipei, Taiwan
OBJECTIVE: To know the condition of
nosocomial infections in neonatal intensive care
unit (NICU), we reviewed the prevalence,
causative microorganisms and outcomes in our
NICU.
METHODS: From 2002 to 2009, there were
4606 infants hospitalized in the NICU of Mackay
Memorial Hospital. We enrolled patients with
nosocomial blood stream infection, defined as
positive blood culture obtained after 72 hours of
admission, into the study. Their clinical features
and laboratory data were collected via chart
review. We also compared the data with previous
results of the same ward during the period from
1992 to 2001.
MAIN RESULTS: Total 133 infants with 152
episodes and 161 pathogens were enrolled. The
prevalence of nosocomial blood stream infection
was 2.9%, lower than the earlier period (3.4%).
The incidences of nosocomial infection in each
year
were
around
2.2
to
4.9
per
thousand-person-day. Sixty percent of the patients
were male. Gram-positive bacteria occupied
42.2% of the pathogens, Gram-negative bacteria
41.7% and fungi 16.1%. Coagulase-negative
staphylococcus and Staphylococcus aureus were
the most common Gram-positive pathogens.
Klebsiella pneumoniae, Acinetobacter baumanii
and Escherichia coli were the most common
Gram-negative pathogens. Compared with the
earlier period (1992-2001), the proportion of
Gram-positive bacteria remained similar (44.1%
vs. 42.2%) and Gram-negative bacteria decreased
(50.8% vs. 41.6%), while fungi increased (5.2%
vs. 16.1%). Most of the infections occurred
between the third and fourth week of
hospitalization (43.4%). The mortality rate was
10.4% that was lower the earlier period.
CONCLUSIONS: The study revealed lowered
prevalence and mortality of nosocomial blood
stream infection in our NICU. However, fungal
infection became a more important part.
153
P2-017
Hospital Infection
Healthcare-Associated
Bloodstream
Infections in a Neonatal Intensive Care
Unit in Southern Taiwan
Tzong-Shiann Ho1, Shih-Min Wang1, Yi-Hui Wu3,
Ching-Fen Shen2 and Ching-Chuan Liu2, 3
1
Department of Emergency Medicine, National Cheng Kung
University Medical College and Hospital; 2Department of
Pediatrics, National Cheng Kung University Medical College
and Hospital; 3Center for Infection Control, National Cheng
Kung University Medical College and Hospital, Taiwan
OBJECTIVE: Healthcare-associated infections are
associated with increased morbidity and mortality,
prolonged hospitalization, and increased healthcare
costs. Bloodstream infection serves as the single
most important type of infection because of their
frequency and potential for life-threatening
consequences. Timely and accurate epidemiological
information on nosocomial pathogens are essential
to infection control and appropriate empiric
antibiotics. This study is aimed to analyze
antimicrobial susceptibilities of pathogens of
healthcare-associated bloodstream infections in the
neonatal intensive care unit (NICU).
METHODS: Infants who were < 30 days of age,
and had positive blood cultures during
hospitalization at the NICU of National Cheng Kung
University Hospital from July, 1989 to June, 2008
were recruited.
MAIN RESULTS: The average incidence of
healthcare-associated bloodstream infections was 5.4,
ranged from 1.5 (1989) to 9.4 (1995) per 1000
patient-days during the study period. Totally 836
organisms and episodes were identified. 27.6% of
them had indwelling central venous catheters within
48 hours before the time of infection. 5.6% of these
bloodstream infections could be attributed to
catheter-related.
Gram-positive
organisms,
Gram-negative organisms and fungi constituted 567
(67.8%), 159 (19%) and 110 (13.2%) of the
pathogens.
Among
Gram-positives,
coagulase-negative Staphylococcus (CONS) (73.8%)
and Staphylococcus aureus (20%) were major
pathogens. Most isolated CONS were resistant to
oxacillin but sensitive to ampicillin/sulbactam,
whereas 46.4% of S. aureus was oxacillin-resistant.
As to the Gram-negatives, Klebsiella pneumoniae
(36.2%), Escherichia. coli (20.1%) and Enterobacter
cloacae (16.1%) dominated.
CONCLUSION:
Commensal
species
play
important roles in the healthcare-associated
bloodstream infections in NICU. Coagulase-negative
staphylococci, S. aureus, K. pneumonia, and E. coli
were leading pathogens. These finding signified the
need of refining empirical antibiotics for
bloodstream infections in NICU.
P2-018
Hospital Infection
Antimicrobial
Prophylaxis
with
Anti-Biofilm
Azithromycin
for
Prevention of Ventilator Associated
Pneumonia in Pediatric Cardiac
Surgery Patients
Yung-Feng Huang1, Po-Yen Liu1, Chia-Wan
Tang 1, Chiun-Yen Pan2, Kai-Sheng Hsieh1
1
Department of Pediatrics, Department of Surgery,
Kaohsiung Veterans General Hospital, Taiwan;
2
Division of Cardiac Surgery, Department of
Surgery, Kaohsiung Veterans General Hospital,
Taiwan
BACKGROUND:
Ventilator
associated
pneumonia (VAP) is a frequent cause of
nosocomial infection after cardiac surgery in
pediatric patients and produces significant
prolongation of pediatric intensive care unit stay.
METHODS: We collect open heart surgery from
January 1, 2005 to August, 2007 before schedule
change (CHD goup). We give perioperative
conventional antimicrobial prophylaxis (Cefazolin
and Gentamicin) for 3 days. After period they
receive perioperative antimicrobial prophylaxis
(Cefazolin and Gentamicin) combination with
intravenous azithromycin for 3 days were
included from September to November, 2007
(AZI group).
RESULTS: The CHD group had higher rates of
VAP infection (odds ratio: 3.2, 95% confidence
interval (CI) = 0.4-24.8) and longer period of
ventilator dependence (6.7 В± 19.8 days vs.
5.9В±19.3days) and length of post-operative stay in
hospital than the AZI group (30.6 В± 28.7 days
vs.27.8 В± 25.6 days). Nosocomial infection in 181
CHD group patients were found to be
significantly higher than those in 22 AZI group
patients. (odds ratio: 4.5, 95% CI = 1.0-19.8,
p-value: 0.043)
CONCLUSIONS: This study has two limitations:
(1) The sample size (AZI group) was small for
adequate comparison. (2) The validity of sample
representations is questionable because the data
were based on two different periods. We suggest
that conventional antimicrobial prophylaxis have
different clinical characteristics from pediatric
cardiac surgery patients. Compared to add
azithromycin,
conventional
antimicrobial
prophylaxis are found more likely to have VAP
and NI.
154
P2-019
Laboratory Diagnosis
Evaluation of SHV and CTX-M
Extended Spectrum ОІ-Lactamase in
Salmonella Enterica by Using
Multiplex PCR
A Abdollahi, M Fasihi R, SJ Adnani S
Fasa University of Medical Science (FUMS),
Department of Microbiology, Fasa, Iran
Young Researchers Club, Islamic Azad University.
OBJECTIVE: Infectious disease due to extended
spectrum ОІ-lactamases producing Salmonella
enterica is distributing word wild. Therefore
detection of ESBLs in epidemiologic programs
for prevention of resistance spreading is necessary.
ESBL have extended activity on more
cephalosporins and these enzymes have many
variations and one bacterium can harbor
difference kind of ESBLs. A method for rapid and
accurate detection of ESBLs is necessary.
METHODS: Initially, we collect 25 isolates of
Salmonella enterica family that have difference
kind of SHV and CTX-M. A pair of primers for
detection
of
CTX-M-1
(including:
CTX-M-1,3,10,11,12,15,22,23,28), a pair of
primers for detection of CTX-M-9 (including:
CTX-M-9,13,14,16,17,18,19,21,24,27) and a pair
of primers for detection of SHV1,2,2a,5,11,12
was used (designed later by researchers). These
primers amplified fragments with 479bp, 355bp
and 141bp. PCR process was designed on
denaturation: 95Щ’c for 15secends, annealing 71Щ’c
for 15s, extension 72Щ’c for 40s, for 50 cycles.
MAIN RESULTS: Every of these isolates were
standard; Means that these isolates have certain
ESBLs genes. After electrophoresis, that was
obvious, that the primers and PCR program have
high accuracy, because of that, results of PCR on
our isolates were as same as results that must be.
CONCLUSION: Nowadays, extension of ESBL
and needs of epidemiological study in addition of
time and cost importance in laboratory diagnosis,
show the importance of finding study new
methods. So that experts try to find new method
to decrease time and cost and have the high ability
and accuracy in identifying some under study
characteristics.
P2-020
Laboratory Diagnosis
Evaluation of bla-ctx-m-type Gene in
Multi Drug Resistant Klebsiella
pneumoniae Species, Isolated from
Clinical Samples: First Determination
in Iranian Patients
Abdollahi A., Behzadian Nejad Q., Najjar
Peerayeh Sh. , Forouhesh Tehrani H.
Fasa University of Medical Science (FUMS),
Department of Microbiology, Fasa, Iran
Young Researchers Club, Islamic Azad University.
OBJECTIVE: Klebsiella pneumoniae is one of
the most important infectious agents in
hospitalized patients. Recently, some studies
showed that multi-drug resistance (MDR) of
Klebsiella pneumoniae can play as a virulence
factor in bacteria. In this research we studied
evaluation of bla-ctx-m-type Gene in MDR
Klebsiella pneumoniae Species, Isolated from
Clinical Samples.
METHODS: This study was cross-sectional. We
isolated 280 cases of Klebsiella pneumoniae from
patients. Their antibiotic susceptibility were
determined by disc diffusion test and E-test(for
determination of MIC). ESBL discs were used for
evaluation of beta- lactamase enzyme by double
disc method, and finally the resistance was
determined by PCR and at last was confirmed by
Sequencing.
MAIN RESULTS: 62 cases out of 280 (22.14%)
were MDR, and 40 cases were resistant to all of
cephalosporins. All of these cases were positive
for ESBLs production, and were confirmed by
PCR and Sequencing.
CONCLUSION:
22.14%
of
Klebsiella
pneumoniae cases were resistant, and ESBL in
resistant strains implicated that use of wide
spectrum cephalosporins should be considered.
155
P2-021
Laboratory Diagnosis
Diagonostic Value of Apolipoprotein
Measurement for Central Nervous
System Infection in Children
P2-022
Laboratory Diagnosis
Predictive Values of Urine Dipstick and
Microscopy Examination for UTI in
Children with Different Ages
Chuanqing Wang1, Yi Wang2, Aimin Wang1,
Zhimin Feng1, Pan Fu1, Yi Yang3
Wei-Chuan Chen, Hsun-Hui Hsu, Hsiu-Chen
Lin
1
Department of Clinical Microbiology, Children Hospital of
Fudan University;2Department of Neurology, Children
Hospital of Fudan University; 3Department of pediatric
research institute, Children Hospital of Fudan University,
Shanghjai, China
OBJECTIVE: Apolipoprotein-E protein (apoE) is
an endogenous immunomodulatory agent that affects
both the innate and the adaptive immune responses.
Moreover, as an acute phase protein, plasma apoE
levels were significantly elevated during septic
infections. But the changes apoE levels in
cerebrospinal fluid (CSF) during central nervous
system infections are unclear. Therefore, this study
was designed to evaluate the potential diagnostic
value of apoE measurement for central nervous
system infection in children.
METHODS: Total 47 children patients were
enrolled in this study. According to the results of
series examination, including CSF routine, and
biochemistry test, bacterial culture, and virus
detection, electroencephalogram, and iconography,
all subjects were divided into four groups: the group
of bacterial meningitis; the group of viral meningitis,
the group of system bacterial infections (excluded
meningitis) , and group of non-infection (epilepsy
and central nervous system tumor). CSF samples
were collected from these patients and apoE
concentrations were detected by transmission
immunoturbidimetry.
RESULTS: The CSF apoE level was significantly
increased in the bacterial meningitis group (0.32В±
0.22mg/dl, n=8) compared with others three groups,
which was not only markedly higher than that in the
non-infection
groups
(0.06 В± 0.02mg/dl,
n=11),P=0.01, but also higher than that in the viral
meningitis group (0.08В±0.03mg/dl, n=8), P=0.04.
Moreover, the CSF apoE level in other system
bacterial infection (non-meningitis) group (0.12 В±
0.06mg/dl, n=20) was also higher than that in the
non-infection group, P=0.02. However, there were
no different in the CSF apoE levels between the
bacterial meningitis group and the non-meningitis
system bacterial infection group (P=0.22).
CONCLUSION: Our data indicates that the
detection of apoE level in CSF maybe act as
diagnostic marker for central nervous system
bacterial infection. And which is also a potential
differential diagnosis target between bacterial
meningitis and viral meningitis.
Department of Pediatrics, Taipei Medical University Hospital,
Taiwan
OBJECTIVE: The UTI is a common disease in
children with different ages. The gold standard test for
diagnosis of UTI is the culture yielding a colony count
of greater than 105 CFUвЃ„ml. However, this culture result
requires more than 2 days and may delay the
antimicrobial treatment of these acutely sick children.
Prompt diagnosis of UTI in children is clinically
needed, urine dipsticks are often used as an alternative
to microscopy, although the diagnostic performance of
dipsticks at different ages has not been established
systematically. In this study, we compare urine dipstick
with/without microscopy tests in infants versus older
children for UTI diagnosis. We calculate the AUROC
and several parameters to compare the predictive value
of different combinations of these urine tests.
METHODS: We collect reports of urine
dipsticks/microscopy and accompanied urine cultures
from April 2008 to May 2010. These laboratory tests
results were not duplicated, only patients under
18-years-old with one pair of urine analysis and urine
culture were collected. There were 436 patients
enrolled, 49.1% (214) cases were under 1 year-old. The
other patients were between 1 to 5 years-old (17.9%)
and 5 to 18 years-old (33.0%). The report of urine
analysis included urine dipstick (nitrite, leucocyte
esterase) and microscopy sediment (WBC, Bacteria).
The confirmed test of UTI was urine colony > 105/CFU
with pathogenic microorganisms.
MAIN RESULTS: In all ages of children (o to 18
years-old), the leucocyte-esterase or microscopy WBC
had the highest predictive value for UTI, but did not
perform well (AUROC= 0.632 and 0.646, respectively).
In infant group, there was no significant difference of
predictive values between single urine dipstick or
microscopy and combination of above tests, the
AUROCs were all around 0.6. The predictive value of
nitrite test in dipstick was almost equal to the
microscopy bacteria seen in each age groups. Both of
these two tests performance were poor than
leucocyte-esterase and microscopy WBC. The most
best performance of urine tests was combination of
urine dipstick and microscopy results in 5-18 years-old
group (AUROC=0.82).
CONCLUSION: Although urine analysis, include
urine dipstick and microscopy examination, provide
much information, only the leucocyte-esterase and
microscopy WBC were the most informative tests
about children’s UTI, even in infants group.
156
P2-023
Neonatal Infection
Comparative Study of Single and
Double Phototherapy in Different
Cases of Neonatal Hyperbilirubinemia
P2-024
Neonatal Infection
Analysis of Cytokine Levels in the
Cerebrospinal Fluid of a Newborn with
Enterococcus Faecalis Meningitis
Mahfuz M Junaid, Mahmood A Chowdhury,
Wazir Ahmed
N.Ikeda1, N.Tanaka1, K.Matsui1, T.Iwasaki1,
N.Ohkawa1, H.Suganuma1, S.Nagata1, T.Shimizu2
Bangladesh
OBJECTIVE: Neonatal infection associated with
neonatal jaundice is an important determinant of infant
survival in developing countries, since brain damage is
a cause of concern to paediatricians. Therefore,
effective management is essential to keep away from
kernicterus. The purpose of this study was to find out
the decrement rate of serum bilirubin in conventional
single phototherapy and double phototherapy in the
treatment of neonatal hyperbilirubinemia.
METHODS: 40 newborns were enrolled with
hyperbilirubinemia. 25 babies were associated with
physiological jaundice and 15 were suffering from
neonatal sepsis. Single phototherapy was given to 15
babies of neonatal sepsis and 9 babies of physiological
jaundice. Remaining babies undergo double photo
therapy. Total serum bilirubin was measured before
and after phototherapy. In single phototherapy, 5
fluorescent white tube light of 40 watts with wave
length of 450 nm was used at a distance of 45 cm from
body surface. In double phototherapy, high irradiance
used under surface of the body and single phototherapy
is given from above.
Results: In physiological jaundice group, serum
bilirubin levels before and after phototherapy were
19.5В±2.90 mg/dl and 13.4В±2.4 mg/dl respectively in
conventional single phototherapy (MВ±SD, p<0.001).
Decline rate of serum bilirubin was 0.19 В±0.10 mg/dl/hr
and 4.58В±2.43 mg/dl/day. In double phototherapy,
serum bilirubin levels before and after phototherapy
were 26.4 В±5.5 mg/dl and 13.4В±3.4 mg/dl respectively
(MВ±SD, p<0.001). Decline rate of serum bilirubin was
0.26 В±0.09 mg/dl/hr and 6.27В±2.26 mg/dl/day. In
neonatal sepsis group, serum bilirubin levels before and
after phototherapy were found 16.1 В±1.75 mg/dl and
12.7В±1.26 mg/dl respectively (MВ±SD, p<0.001) in
conventional single phototherapy. Decline rate of serum
bilirubin was 0.09 В±0.03 mg/dl/hr and 2.07В±0.84
mg/dl/day. In double phototherapy, serum bilirubin
levels before and after phototherapy was found 23.3
В±3.46 mg/dl and 13.96В±2.07 mg/dl respectively (MВ±SD,
p<0.001). Decline rate of serum bilirubin was 0.20
В±0.08 mg/dl/hr and 4.74В±2.08 mg/dl/day.
CONCLUSION: Double phototherapy was found
more safe and effective than conventional single
phototherapy
in
patients
with
neonatal
hyperbilirubinemia. However, the rate of fall of
bilirubin was higher in physiological jaundice group
compared to neonatal sepsis group.
1
Department of Neonatology, Juntendo University Shizuoka
Hospital, Shizuoka, Japan; 2Department of Pediatrics,
Juntendo University Faculty of Medicine, Tokyo, Japan
BACKGROUND: Neonatal bacterial meningitis
requires an early diagnosis and appropriate treatment. E.
faecalis meningitis is rarely a pathogen involved in
neonatal meningitis. Several studies have indicated that
the cytokines related to bacterial infections can induce
nerve cell damage, and thus cytokine levels in
cerebrospinal fluid (CSF) can represent a valuable
hallmark for the rapid recognition of the disease and the
evaluation of the degree of neurological involvement.
We analyzed the cytokine levels in the CSF of a
neonate with E. faecalis meningitis over time.
PATIENT: The boy was born by natural delivery at 40
weeks of gestation weighing 3,484g. Before the
delivery, there was no sign of any infection in his
mother. The newborn baby had a fever, was irritable,
and was not doing well from 16 hours after birth, and
therefore was admitted to our hospital. Laboratory
investigations revealed his white blood cell count to be
8,700/Вµl, with a shift to the left, and C reactive protein
levels were markedly increased, suggesting possible
bacterial meningitis. The spinal fluid white blood cell
count was 69,120/3 with a low level of glucose (1mg/dl)
and a high value for protein (360mg/dl). On the basis of
these findings, the infant was diagnosed as having
bacterial meningitis, and was immediately treated with
intravenious
ampicillin,
cefodizime,
and
immunoglobulin. E. faecalis was isolated from the CSF
and blood, which led us to change the antibiotic from
cefodizime to vancomycin. E. faecalis cultures were
negative from both the mother’s blood and vaginal
samples. On day 4, the patient’s CSF and blood cultures
became negative. On day 91, the white blood cell count
in the CSF showed normal values. Analysis of spinal
fluid cytokine levels revealed that the values for tumor
necrosis factor-alpha (TNF-alpha) on day 1, 3, 91 were
3,066pg/ml, 5.5pg/ml, and 3.3pg/ml, respectively.
Those for interleukin-6 (IL-6) were 671,301pg/ml,
78,324pg/ml and 25.5pg/ml on the same days,
respectively. The cytokine levels tended to be elevated
during the acute phase of infection and then decreased
during the convalescent stage reacting to the treatments.
CONCLUSION: The measurement of the spinal fluid
inflammatory cytokine levels may provide important
clues for predicting the development of complications
in the host, because some of these cytokines, such as
TNF-alpha, can injure neurons. Further investigation
will be needed to determine the cut-off values for these
cytokines, and to examine whether or not a correlation
exists between the cytokine levels and the patient
outcome.
157
P2-025
Neonatal Infection
Evaluation of Once a Day of Arbekacin
Administration to Neonates as a New
Object of Peak Concentration
Daisuke Kinoshita
Japan
OBJECTIVE: To evaluate efficacy and safety of
once a day of Arbekacin (ABK) administration to
neonate based on a new object of peak
concentration setting on 9-20 Ојg/ml.
METHODS: Once a day of ABK was
administered to 14 neonates infected by
Methicillin-resistant Staphylococcus aureus or
Coagulase-negative Staphylococcus. Gestational
age and birth weight were 27.3В±4.2 weeks and
1024.1В±757.8g. Postconceptional age and
postnatal age at initial ABK administration were
32.4В±3.9 weeks and 35.3В±22.7 days respectively.
In the preparing initial dosage, Therapeutic Drug
Monitoring Program soft was used (gifted from
Meiji Seika Co. Ltd. A one-compartment open
model. Systemic clearance linearly increased with
increasing
height/serum
creatinine
and
distribution volume changed as an exponential
function of age). Mean daily dose of 6.2В±0.4
mg/kg bodyweight was administered every 24 to
48h by 30 min intravenous infusion.
RESULTS: Mean serum peak concentrations of
ABK and those of trough concentrations were
15.2В±4.3Ојg/ml and 2.0В±1.4Ојg/ml respectively.
The relationship between the measured values(y)
and predicted values(x) showed the regression
equation y=0.969+0.931x (R2=0.769, n=35),
which suggested the usefulness of the dosage
design. Overall clinical effectiveness was 78.9%
(11/14). There were no adverse effects including
abnormal auto auditory brainstem responses and
serum creatinine increase.
CONCLUSIONS: Highly effectiveness rate and
no adverse effects suggested that once a day of
ABK therapy in neonate including extremely
preterm infant was preferable regimen.
P2-026
Neonatal Infection
Reduction of Nosocomial Infection by
Implementing
Evidence-based
Practices in a Neonatal Intensive Care
Unit
Cai Xiaodi, Yan Gangfeng, Cao Yun, Jiang
Siyuan, Wang Chuanqing
Children’s Hospital of Fudan University,
Shanghai, China
OJECTIVE: To observe the effect of the
evidence-based practice in preventing nosocomial
infections in NICU.
METHODS: Clinical data of NICU patients with
mechanical ventilation (MV) and peripherally
inserted central catheter (PICC) of two stages
(2006.2.1~2007.1.31 and 2008.8.1~2009.7.31)
were collected. In the new NICU, a series of
comprehensive preventive measures against
nosocomial infections (NI) were taken.
Device-related infection rates were calculated and
the incidence of nosocomial infection (NI) in old
hospital was compared with that of the new
hospital.
RESULTS: A total of 275 patients were
ventilated, 106 were from the old NICU and had
accepted MV for 778 patient-days. The other 169
patients were from the new NICU and had
accepted MV for 855 patient-days; of them, 22
developed VAP. The incidence of VAP was
48.8/1000 MV-days in the old hospital, and
25.7/1000 MV-days in the new hospital,
respectively. Most of the isolated organisms of
VAP were multi-drug resistant pathogen in the old
hospital, but no multi-drug pathogen was found in
the new hospital. There were 72 infants (66 of
them were very low birth weight) accepted PICC.
The incidence of PICC-BSI was 10.2/1000
PICC-days as a whole, with 16.1/1000 PICC-days
in the old hospital and, 7.7/1000 PICC-days in the
new hospital, respectively. Eleven organisms were
isolated
including
Coagulase
negative
staphylococcus (CoNS) (4 strains), Acinetobacter
baumannii (3 strains), Klebsiella pneumonia (2
strains), Enterococcus (1 strain), and Candida
parapsilosis (1 strain). The incidence of PICC-BSI
in the new hospital was lower compared with that
of the old hospital.
CONCLUSIONS: The incidence of NI in NICU
can be reduced by implementing comprehensive
bundle of strategies.
158
P2-027
Neonatal Infection
A Paired Comparison of Urine
Cultures
from
Bag-Obtained
Specimens versus Catheer-Obtained
Specimens in the Young Infants
Suspected of Urinary Tract Infecion
Chiu Tzu-Hsuan, Hsiu Lin Chen, Yung Ning
Yang, Hsieh ,Shu-Chuan, Hsing-I Tseng,
San-Nan Yang
Taiwan
OBJECTIVE: The prevalence of urinary tract infection (UTI)
in infants and young children 2 months to 2 years of age who
have no fever source evident from history or physical exams is
high, up to 5%. Urine culture by bag-obtained specimen (BOS)
is considered technically easily and not invasive. However, it�s
false positive rate is too high. Less articles reports between
catheterization and bag.
METHODS: All young infants below four months of age with
suspected of urinary tract infection (UTI) who were admitted
to Complete Nursing Unit were enrolled from March 2009 to
February 2010. Urine cultures were collected by using urine
bag and catheter before antibiotics treatment. Demographic
features, urinalysis, blood exams were recorded. We used JMP
as the statistical software for data analysis. It was considered
significant in statistics while P value below 0.05.
MAIN RESULTS: There were 67 young sick infants were
recruited for the prospective study. Their mean age was 49
day-old (S.D.=42). Among the young infants who had positive
COS cultures (n=17), the male infants were predominant
(76%). The most common pathogen is E. coli. Afebrile infants
were more than febrile infants. The BOS urine cultures had
high false positive rate (43%) with sensitivity 77% and
specificity 80% while COS was considered as the reference
However, there were no significantly differences between the
two groups in the percentage of sex, age, prematurity, and low
birth body weightIn our study, all parameters of urinalysis (e.g.
protein, nitrite, leukocyte esterase, numbers of leukocyte per
high-power-field, bacteria) were statistically significant. All of
them can reach the specificity of 80% at least. However, in the
positive cultures of COS group, the increasing level in each
parameter, the more percentage of positive cultures. There
were no significance in statistics in blood exams, including
leukocyte count, immature-to-total ratio, C-reactive protein,
glutamyl oxaloacetic transaminase, glutamyl pyruvic
transaminase.
CONCLUSION: In this report, we showed urine culture by
BOS is not a reliable method because of high false positive
rate. UTI is male-predominant below four month-old of infants.
The increasing level in each urinalysis parameter, the more
probability in positive urine cultures. Urinalysis is a useful
tool for prediction of UTI. However, the diagnosis of UTI
cannot be established only by a culture of urine collected in a
urine bag or by urine dipstick. For diagnosis of urine culture in
young infants, COS is better than BOS for urine culture,
although catheterization is more invasive.
P2-028
Neonatal Infection
A Case of Premature Infant with
Congenital Measles
Yasufumi Hidaka
Japan
OBJECTIVE: From 2007 to 2008 in Japan we
experienced a measles outbreak not only in
children but also in young adults.
We
experienced a case of premature infant with
congenital measles. It is a very rare case and we
report the clinical and immunological course for
over 2 years.
METHODS: Case report of a 26 year-old woman
with measles during pregnancy and her baby with
congenital measles.
MAIN RESULTS: At 27 weeks 1 day of
gestation, she complained of nausea and vomiting.
Four days later, she showed a rash and a fever and
she was suspected to be measles because she was
a nurse and measles patients had existed in her
hospital. But the body temperature returned to
normal next day. At 28 weeks 1 day of gestation,
her labor pain began suddenly and she delivered
in an ambulance. Because her measles-specific
IgM was positive at 2 days before delivery, her
diagnosis was confirmed to be measles although
her clinical course was atypical for measles. The
baby was 1242 gm of very low birth weight infant
female and had respiratory distress syndrome.
She received surfactant therapy and mechanical
ventilation. Although she showed no signs of
measles at birth, immunoglobulin was
prophylactically injected. Two days after birth, a
maculopapular rash appeared on the abdominal
region. Several days later the rash disappeared
without pigmentation. She discharged at 74
days after birth and her growth and development
was within normal range at one corrected-year-old.
Her measles-specific IgM was negative (EIA
value 0.21) at birth and turned positive (EIA value
5.5) at 40 days after birth. Her measles-specific
IgG was positive (EIA value 4.6) at 9 month-old,
but it gradually decreased and it was plus-minus
range (EIA value 2.4) at 21 month-old. She
received measles vaccination for booster
immunity at 31 month-old.
CONCLUSIONS: A very low birth weight infant
with congenital measles is very rare. It is not
well known about long prognosis. Measles
during immature immunological status is
considered a high risk of developing to SSPE.
159
P2-029
Other Viral Infection
The Effect of Plants on Viral Diseases:
Results from a Cross-Sectional Study
in Sirajganj District of Bangladesh
Ariful Haque Mollik
Peoples Integrated Alliance, Epidemiology,
Biostatistics, Community Nutrition and
Noncommunicable Diseases, Bangladesh
Viral diseases are infectious diseases caused by the virus
pathogen. There are very few drugs available to treat
various viral diseases which are prevalent amongst the
people of the world and particularly the developing
countries. Every-year, the people of Bangladesh is
subjected to viral infections like hepatitis, poliomyelitis,
dengue, rabies, measles, mumps, smallpox, rotavirus
diarrhea, herpes, chickenpox, conjunctivitis, influenza, and
other viral diseases. In absence of effective modern
antiviral medications, the patients rely mostly on the
treatment with plants administered by the traditional health
practitioners of the country. The present study were
conducted an ethnopharmacological survey amongst the
traditional health practitioners of Sirajganj district in
Bangladesh and noted that their formulations contain a
number of plants not usually used by the traditional health
practitioners in other regions of Bangladesh. Informed
consent was obtained from the traditional health
practitioners and the ethnopharmacological survey was
conducted with the help of a semi-structured questionnaire
and the field-walk method. Plant specimens as pointed out
by the traditional health practitioners were photographed,
collected, deposited and identified at the Bangladesh
National Herbarium. It was observed that thirty-nine plants,
which are used to treat viral diseases in Sirajganj district of
Bangladesh.
The
plants
obtained
in
this
ethnopharmacological survey included Tamarindus indica
(L.), Averrhoa carambola (L.), Curcuma longa (L.),
Lantana camara (L.), Citrus acida (Roxb.), Sida cordifolia
(L.), Abrus precatorius (L.), Calotropis gigantea (L.)
W.T.Aiton, Euphorbia hirta (L.), Justicia adhatoda (L.),
Ocimum gratissimum (L.), Tagetes erecta (L.),
Hydrocotyle asiatica (L.), Datura metel (L.), Mimusops
elengi (L.), Morus alba (L.), Clerodendrum indicum (L.)
Kuntze, Plumbago zeylanica (L.), Aloe vera (L.) Burm.f.,
Tinospora crispa (L.) Hook. f. & Thomson, Paederia
foetida (L.), Vitex negundo (L.), Aegle marmelos (L.)
Corr.Serr., Allium sativum (L.), Caesalpinia bonduc (L.)
Roxb., Carica papaya (L.), Croton tiglium (L.), Zingiber
officinale Roscoe, Melia azadirachta (L.), Cassia alata
(L.), Brassica napus (L.), Achyranthes aspera (L.),
Gendarussa vulgaris Nees., Bombax ceiba (L.),
Heliotropium indicum (L.), Andrographis paniculata
(Burm.f.) Wall. ex Nees., Sesamum indicum (L.), Nigella
sativa (L.), and Chenopodium ambrosioides (L.). Since the
patients of Sirajganj district in Bangladesh mostly does not
have access to primary medical facilities; the above-plants
can form the basis of treatment for viral diseases without
resorting to costly urban visits or allopathic medical
practitioners. The results suggest that modern scientific
studies have the potential of discovering new antimicrobial
compounds in the above-mentioned plants, which can be
effective against microorganisms causing viral illnesses.
P2-030
Other Viral Infection
Clinical Features of Hospitalized
Children with Adenoviral Pneumonia
Sun-Lin Huang, Yhu-Chering Huang,
Shih-Perng Chen, Chung-Guei Huang,
Kuo-Chien Tsao, Tzou-Yien Lin
Taiwan
PURPOSE: To describe the epidemiology and
clinical features of adenovirus induced pneumonia
in children
METHODS: A total of 3298 patients with throat
virus cultures positive for adenovirus were treated
at a university-affiliated hospital from January
2000 to June 2008. Eighty hospitalized children
(2.4%) less than 18 years of age with at least
segmental pneumonia were included. From four
children with incomplete medical charts, only
demographics were analyzed. Serotypes were
determined for 46 randomly selected strains.
RESULTS: The median age was 2.97 years,
ranging from 25 days to 14 years. The
male-to-female ratio was 1.05. The median length
of hospital stay was 7 days (range, 3 ~ 65 days).
Seventy-three patients (96%) had fever, with a
median duration of 7 days. The three most
common respiratory symptoms were cough (99%),
rhinorrhea
(82%)
and
dyspnea
(42%).
Gastrointestinal symptoms were reported in 80%
of the patients, and neurologic symptoms in 4
children. Leukopenia (WBC < 5,000/microliter )
was noted in five (6.6%) patients, while
leukocytosis (WBC ≧ 15,000/microliter) in 19
(25%) patients. Only six o patients (8%) had a
normal serum C-reactive protein (CRP) value
(<5mg/L), while 48 patients (63%) had a high
CRP level greater than 40 mg/L. Three children
had documented pneumococcal co-infection and
six children had Mycoplasma pneumoniae
co-infection. Seventeen children were ever
admitted to intensive care unit and 16 patients had
disseminated diseases. Seventy-three patients
(96%) recovered uneventfully. Sequelae were
seen in two patients and death in 1. Of the 46
isolates for serotyping, 6 serotypes were identified,
with a predominant serotype (type 3)
CONCLUSION: The occurrence of chest
radiology-documented pneumonia among the
children with adenoviral infection was less
common than previously recognized. The severity
of pneumonia caused by adenovirus was similar
to that caused by typical bacterium; however, the
outcomes of theses patients were not
indispensably serious.
160
P2-031
Other Viral Infection
Adenovirus Infection Associated with
Central Nervous System Dysfunction
in Children
Sun-Lin
Huang,
Yhu-Chering
Shih-Perng Chen, Chung-Guei
Kuo-Chien Tsao, Tzou-Yien Lin
Taiwan
Huang,
Huang,
BACKGROUND
AND
OBJECTIVE:
Adenovirus is a common pathogen in the pediatric
population. However, there are few reports
regarding central nervous system (CNS)
dysfunction associated with adenovirus. To
delineate
the
clinical
features
of
adenovirus-associated CNS dysfunction, we
conducted this study.
PATIENTS AND METHODS: Patients less than
18 years of age with virus culture confirmed
adenovirus infection were identified from the
virology laboratory database of Chang Gung
Memorial Hospital, Taiwan, between January
2000 and June 2008. Medical charts of these cases
were retrospectively reviewed and those with
CNS dysfunction were included in this analysis.
RESULTS: During the study period, a total of
3,298 patients with adenovirus infection were
identified; 107 (3.2%) had signs or symptoms of
CNS dysfunction at the time of admission (mean
age: 3.61 years; range: 0.3–12.4 years) and 81 of
them (75.7%) were less then 5 years old. The ratio
of males to females was 1.44. The most
frequently cited CNS symptoms were seizure
(63.6%), altered state of consciousness (13.1%),
visual hallucination (9.3%) and lethargy (7.5%).
For the 107 patients, 50 (46.7%) had a diagnosis
of febrile seizure, 30 (28%) had encephalitis, 10
(9.3%) had aseptic meningitis, 2 (1.9%) had acute
flaccid paralysis and one (0.9%) had cerebellitis.
Ninety-nine of 107 children (92.5%) returned to
normal health, 6 (5.6%) recovered with minor
sequelae, 2 (1.9%) recovered with major sequelae
and 0 died. 67 patients received a examination of
EEG and 31 (46.2%) of them had cortical
dysfunction or epileptiform discharge. 35 patients
had brain image studies and 12 (34.3%) of them
had brain swelling, subdural effusion or brain
atrophy.
CONCLUSION: CNS involvement can be
identified in a substantial proportion of children
with adenoviral infection and most occurred in
those < 5 years old. The clinical prognosis seems
well. However, CNS dysfunction is a potentially
serious complication of adenovirus infection.
P2-032
Other Viral Infection
Kawasaki Disease Associated with
Epstein-Barr Virus and Mycoplasma
Pneumoniae and Complicated with
Autoimmune Haemolytic Anaemia
Fang-Liang Huang1, Po-Yen Chen1, Chun-Yi Lee2,
Fang-Ching Liu3, Cheng-Chieh Wang4
1
Department of Pediatrics, Taichung Veterans General
Hospital, Taichung, Taiwan; 2Department of Pediatrics, Chang
Bing Show-Chwan Memorial Hospital, Chang-Hua, Taiwan;
3
Department of Pediatrics, Jen Ai Hospital, Taichung, Taiwan;
4
Department of Pediatrics, Miao-Li General Hospital,
Miao-Li, Taiwan
OBJECTIVE: Despite more than four decades of
investigation, the aetiology of Kawasaki disease (KD)
remains obscure, and none of the proposed etiologic
theories for the disease have achieved independent
confirmation.
METHODS AND MAIN RESULTS: We present a case
of KD associated with serologically proven Epstein-Barr
virus and Mycoplasma pneumoniae infection in a
3.5-year-old boy. The boy admitted due to intermittent
fever and a skin rash. A physical examination revealed
bilateral non-exudative conjunctival congestion, lip
fissures, palpable cervical lymph nodes and generalised
erythematous maculae over the trunk. Echocardiography
showed left coronary artery dilation. KD was diagnosed
and IVIG (2g/kg) was administered. His fever subsided
two days later. On day 4, the patient was observed to have
anaemia with a haemoglobin level of 7.8 g/dL.
Autoimmune haemolytic anaemia was diagnosed by means
of peripheral blood smear for fragmented red blood cells
and positive results of both direct and indirect Coombs’
tests. Intermittent high fever developed again on day 7 of
admission. Bacterial cultures of blood, urine and throat
were all negative. The second dose of IVIG was
administered on day 9 because of spiking fever. His
haemoglobin concentration decreased to 6.9 g/dL two days
after the second dose of IVIG administration. The serum
titres of EBV anti-VCA IgM and IgG, were 1:160 and
1:1280, respectively (both negative titres at a ratio of
<1:10). His anti-EBV–determined NA IgG was negative.
The PCR for EBV from peripheral blood mononuclear cell
DNA samples and the specimens of cervical lymph nodes
biopsy were positive. Test for the cold agglutinin reaction
was positive on day 9. The serum titre of M. pneumoniae
PA was 1:160 initially and 1:2560 two weeks later. He was
treated with azithromycin (10 mg/kg/day) for his
successive febrile illness. His fever completely subsided
two days later. He was discharged on day 20.
CONCLUSION: Mycoplasma pneumoniae and EB virus
infections may occur simultaneously in a child with KD,
indicating the complex aetiology of KD, and it is
suggested to treat the combined disease (e.g., mycoplasma
pneumonia) in patients with a prolonged clinical course of
KD. In addition, autoimmune haemolytic anaemia may be
noted in KD patients after IVIG administration. To our
knowledge, this is the first report of KD with EB virus and
Mycoplasma pneumoniae in the English-language
literature.
161
P2-033
Other Viral Infection
Cytomegalovirus
Causing
Acute
Hepatitis in an Adolescent
Hsiang-Hung Shih
Taiwan
BACKGROUND: Cytomegalovirus (CMV) is a
well-known cause of infectious mononucleosis in
children, which is usually presented as prolonged
fever, cervical adenopathy, elevated liver enzymes,
and/or maculopapular rash. However, icteric
hepatitis is rarely associated with acute CMV
infection.
METHOD: Review of the chart record and
characteristic clinical manifestation of an
adolescent who had acute viral hepatitis syndrome,
caused by CMV.
RESULT: A 17-year-old male, previously healthy
patient was diagnosed as acute viral hepatitis with
the presentation of fatigue, epigastralgia, jaundice,
and tea-color urine. Review of the history, there
was 11-day duration of preceding fever, sorethroat,
and swollen lymph nodes in the neck and inguinal
area. Physical examination showed pus-coated
tonsils, yellowish sclera, and tender hepatomegaly.
Laboratory data demonstrated leukocytosis,
atypical lymphocytosis, direct-type jaundice
(total/direct bilirubin levels, 5.5/3.6 mg/dL,
respectively), and moderate elevation of liver
enzymes. No clay-color stool or skin rash was
found during the hospitalization. Further workup
excluded hepatitis A, B, C, fatty liver, and Wilson
disease. Jaundice lasted for 12 days and the
patient recovered totally without a sequel.
CONCLUSION: Cytomegalovirus is a rare but
still possible cause of acute viral hepatitis in
immune-competent children. Good outcome is
expected under experienced supportive care.
P2-034
Others
Parental Attitude on Lumber Puncture
of their Sibling in Mofid Children
Hospital (2008-9)
Shirvani F MD1,Sannai A MD2,Ganbarpor MH
1
Imam Hossein General Hospital (Pediatric
Ward), Shaheed Beheshti University of medical
sciences and health Services; 2Mofid Chikdren
Hospital, Shaheed Beheshti University of medical
sciences and health Services, Iran
BACKGROUND: All medical procedures, either
minor or major, causes a great sense of anguish in
almost every patient. This problem is specially
important in pediatric medicine for parentral
anxiety and fear of harm and calls for specific
strategies.
MATERIALS AND METHODS: In this trial,
we filled out a questionnaire on 100 patients in
need of LP(Lumbar Puncture) in Mofid Children
Hospital(Tehran-IR IRAN, 2007-8). The first part
of the questionnaire gathered information like
parent`s sex, age, education, socioeconomic level
by the questioner. The second part comprised 15
test or short answer questions.
RESULTS: 100 (22 male,78 female )filled the
questionnaire .mean age 32В±8 and17-49 years age
range,42 were undereducated(under diploma) and
66 were in low socioeconomic status,29 out of
100 did not agree with the procedure.9 had history
of previous LP 15 patients had an experience of
aggressive procedure, among which 12 had a very
bad impression. 16 had no history of description
or advice on this procedure,29 parents admitted
that the procedure was not necessary for final
diagnosis, and 32 believed the procedure harmful
for their child.
DISCUSSION
AND
CONCLUSION:
Superstition rectification and patient knowledge
accretion on medical necessities improves access
to better treatment and medical services in public
hospitals.
162
P2-035
Others
Two Familial Cases of Congenital
Neutropenia with Mutations of the
Ela2 Gene
P2-036
Others
Antibiotic Prescribing Pattern in
Children
with
Exacerbation
of
Bronchial Asthma
Kamata Ayako1,2, Obinata Kaoru1,3, Naoki
Watanabe2, Kinoshita Keiji1, Ohishi Tsutomu4
Mia-Tuang Koh1, Woan-Lin Tan, Hussain
Samsinah2, Pei-Zhi Koh3
1
Department of Pediatrics, Koshigaya Municipal Hospital,
Saitama, Japan; 2 Department of Pediatrics, Juntendo Nerima
Hospital, Tokyo, Japan; 3Department of Pediatrics, Juntendo
Urayasu Hospital, Chiba, Japan; 4Department of Infectious
Diseases, Immunology and Allergy, Saitama Children's
Medical Center, Saitama, Japan
INTRODUCTION:
Congenital
neutropenia
is
characterized by static neutropenia accompanied by a
promyelocytic maturation arrest in the bone marrow.
Recently, mutations in the ELA2 gene encoding human
neutrophil elastase have been reported in cases of sporadic
and autosomal dominant congenital neutropenia.
PATIENTS AND CLINICAL DETAILS: This report
describes 6 cases that met the diagnostic criteria of
persistent severe neutropenia and showed maturation arrest
at the myelocyte-promyelocyte stage in bone marrow
aspirates. Furthermore antineutrophil antibody was not
detected in each case.
Family 1
Patient 1 is a 6-year-old girl who had some episodes of
subcutaneous indurations and otitis media at infancy; but
the clinical courses were not refractory. Her mother
(Patient 2) and aunt (Patient 3: monozygous twin sister of
patient 2) were also diagnosed with agranulocytosis during
their infancy. Although their neutrophil counts are always
extremely low, they have not suffered from severe
infections.
Family 2
Patient 4 is a 9-year-old girl who has had recurrent
episodes of subcutaneous indurations and pneumonia, but
the frequency has decreased and she seldom requires
G-CSF administration. Her 17-year-old sister (Patient 5)
has exhibited repeated intractable subcutaneous induration
around the umbilicus and otitis media.
She has
occasionally been treated with G-CSF. Until adolescence
their mother (Patient 6) had frequently been hospitalized
for gingivitis, paradentitis, or pneumonia; however
recently, she rarely experience episodes of the infectious
disease.
Methods: DNA was extracted from peripheral blood
leukocytes isolated from each of the subjects. All 5 exons
of ELA2 were amplified using PCR and the products were
sequenced.
RESULTS: The same mutations affecting the 3rd exon at
the Arg74Leu site were detected in family 1. Furthermore,
the same mutations affecting the 4th exon at the Leu94Val
site were detected in family 2.
DISCUSSION: There are many reports of sporadic cases
of congenital neutropenia, but familial congenital
neutropenia with mutations of the ELA2 gene is rare. The
clinical features of ELA2 mutations in severe congenital
neutropenia are usually severe, but in the current cases,
their expression was mild despite exaggerated neutropenia.
It is also interesting to note that symptomatic differences
were apparent among the families with the same mutation.
1
Department of Paediatrics, University of Malaya, , Kuala
Lumpur, Malaysia; 2Department of Pharmacy, University of
Malaya, , Kuala Lumpur, Malaysia; 3Pharmacy Unit
University of Malaya Medical Centre, Kuala Lumpur,
Malaysia
While the cause(s) of an acute exacerbation of
bronchial asthma (AEBA) remains controversial,
a number of studies have shown that a
concomitant respiratory tract infection is present
with about 80% being due to a viral agent, mainly
rhinovirus. Only about 20% of AEBA appears to
be non-viral in aetiology (mainly Mycoplasma
pneumoniae and Chlamydia pneumoniea).
However, antibiotics are frequently prescribed for
such episodes. About 1 in 5 asthmatics presenting
to the emergency department in the United States
is prescribed antibiotics (Vanderweil et al., 2008)
and asthmatic children received significantly
more antibiotics than non-asthmatic children
(Stallworth, 2005). A study in Canada also found
that there was fifteen-fold increase in the use of
wide spectrum macrolides from 1995 to 2001 in
preschool asthmatic children during wheezing
episodes (Kozyrskyj et al., 2006).
OBJECTIVES: This study was conducted to
determine the pattern of antibiotics prescription in
asthmatic children with AEBA and to identify the
factors influencing such prescription.
METHODOLOGY: This is a retrospective study
in a tertiary teaching hospital with subjects 17
years and below diagnosed previously with
bronchial asthma (ICD-10 code J45) for at least
12 months and were followed up in the same
hospital. The study period was two years from Jan
1, 2008 to December 31, 2009. These asthmatic
children prescribed antibiotic(s) for their
exacerbation were compared to a matched, control
group of asthmatic children who were not
prescribed any antibiotic during the same period.
Data was analysed using SPSS version 17 with
mean number of antibiotics prescribed per patient
per year (PPPY) as primary outcome. Factors like
age, gender, obesity, duration of symptoms and
severity of asthma, number of prior visits, prior
hospitalisation, physician’s perception of presence
of infection were deemed likely to influence
antibiotic prescription. These were used as
variables to compare the two groups of asthmatic
163
children and univariate analysis employed to
determine the likelihood (odd ratio) of such an
association.
RESULTS: There were 242 children with asthma
(116 antibiotic exposed and 126 näive) in the
two-year study. The 116 subjects were prescribed
at least an antibiotic in at least one medical visit
giving a mean of 1.47 antibiotic PPPY compared
to the whole cohort of asthmatic children (n=242)
where the mean was only 0.35 antibiotic PPPY. In
terms of mean antibiotic prescribed per medical
visit, it was 0.5 for the antibiotic group versus 0.3
for the entire group of asthmatic children. There
were 552 medical visits in total with 61.5% (mean
of 1.5 visits PPPY) and 39.5% (0.8 visits PPPY)
of all visits from the antibiotic and non-antibiotic
group respectively. Patients diagnosed to have
moderately severe persistent or uncontrolled
asthma were more likely to be prescribed an
antibiotic (OR 4.88 (0.9-26.42)) compared to
those with controlled asthma. Other factors
included 3 or more visits in the past (OR 4.16
(1.52-11.4)) and fever of 2 or more days (mean
0.8 days versus 0.38 days, p < 0.001) prior to
hospital visit.
CONCLUSION: The prescribing of antibiotic for
a perceived concomitant respiratory tract infection
for AEBA is a common practice in this two-year
study. Those with 3 or more prior hospital visits,
fever of 2 or more days and severe asthma were
more likely to be prescribed an antibiotic during
hospital visits for an AEBA.
P2-037
Others
Antimicrobial Agents Related Adverse
Drug Reactions in Taiwan from 1999 to
2009
Mu-Chun Lin1, Hsiu-Chiung Yen2, Hsin Chi1,3,
Nan-Chang Chiu1,3, Fu-Yuan Huang1
1
Department of Pediatrics, Mackay Memorial
Hospital, Taipei, Taiwan; 2Taiwan Drug Relief
Foundation, Taipei, Taiwan; 3Mackay Medicine,
Nursing and Management College, Taipei, Taiwan
OBJECTIVE: Adverse drug reaction (ADR) is a
serious and important issue in medical practice.
To assess the difference, incidence and
seriousness of antimicrobial agents related ADRs,
we performed this study.
METHODS: The applications claimed for
antimicrobial agents related ADRs from the data
base of Taiwan Drug Relief Foundation (TDRF)
between 1999 and 2009 were collected and
analyzed. Antimicrobial agents were separated
into 4 groups: antibacterial, anti-tuberculous
(anti-TB), antiviral and antifungal agents. The
ADRs resulted from antimicrobial agents were
also grouped according to the involved
organ-system classification.
RESULTS: There were 246 applications claimed
for the relief of antimicrobial agent related ADRs,
and 199 episodes met the criteria made by TDRF.
Antibacterial agents were the most common
etiology of antimicrobial agents related ADRs
(49.0%). Seventy-four patients (37.2%) died.
Cutaneous side effects were on the largest
proportion (56.8%), and most of them were
caused by antibacterial agents (87.4%). Most
common
cutaneous
side
effect
was
Stevens-Johnson syndrome (53.4%). Anti-TB
drugs (65.6%) and antifungal agents (28.1%)
resulted in most of the hepatic adverse effects.
Anti-TB drug therapy played an important role in
multiple drug induced ADRs (39.0%). The
patients’ age ranged from 1 to 96 years old, and
only 9 patients (3.1%) were below 18 years old.
No significant difference was noted between sex
and different age groups.
CONCLUSONS: Antimicrobial agents are
common causes of ADRs. These ADRs can cause
serious illness or even death. Among them, the
most common one is cutaneous manifestation. To
avoid making serious harm, careful use of the
antimicrobial agents and regular follow up of are
mandatory.
164
P2-038
Others
Determine the Role of Pulse Status in
Pediatric Acute Illnesses by Using the
Embedded Intelligent Continuous
Pulse Monitor
Sung-Lien Lin
Children Clinic Center, Keelung City, Taiwan
BACKGROUND: Caregivers are used to depending
on tympanic temperature (TT) and appearance in caring
for children with acute illnesses. Since fever and many
acute-ill conditions are frequently associated with an
abnormal pulse status (PS) due to the pre-optic
regulation or compensatory mechanism. We have
conducted a pilot study to determine the role of PS as
another indicator of monitoring acute illness by using
the embedded intelligent continuous pulse monitor
(EICPM), a portable interactive pulse monitor.
METHOD: In our clinic waiting room, patients were
checked with TT, their appearance was recorded, and
wore an EICPM to evaluate PS. After inputting their
age, the EICPM started to alarm, whether it was
tachycardia or bradycardia, lasting over 2 minutes.
Definition of borderline fever in this study means
tympanic temperature rising up between 37В°C to 37.9В°C
with the chief complaint of fever at home. The
correlation of PS, febrile status, and appearance were
compared.
RESULT: In 7 months, 603 children were enrolled into
6 groups: group 1, 1-11 moths old, group 2, 1 year and
6 months - 1 year and 11 months old, group 3, 2 years
old, group 4, 3 years old, group 5, 4 years old, group 6,
5-6 years old. Fever, borderline fever and acute-ill
appearance were assumed as positive findings; no fever
with a normal appearance as a negative finding. The
results are listed in table 1 to table 2, following.
Table 1 Correlations among the EICPM (pulse rate)
status, fever, mild fever and the appearance of all
groups
borderline
fever
fever
no fever
with
acute-ill
appearance
no fever
and
normal
appearance
group
1
group
2
group
3
AP = 1
NP = 1
AP = 2
NP = 1
AP = 3
NP = 3
AP = 1
NP = 0
AP = 1
NP = 0
AP = 0
NP = 1
AP = 0
NP = 37
AP = 0
NP = 39
AP = 1
NP = 136
group
4
AP = 5
NP = 3
AP = 4
NP = 1
AP = 3
NP = 1
AP =
13
NP = 2
AP = 3
NP = 0
AP = 0
NP = 1
AP = 0
NP = 75
group
5
AP = 3
NP = 1
AP = 7
NP = 1
AP = 1
NP = 0
AP = 0
NP = 82
group
6
AP = 7
NP = 4
AP =
12
NP = 2
AP = 1
NP = 1
AP = 1
NP = 143
AP: patient number of a silent (not alarmed) EICPM
(abnormal pulse rate)
NP: patient number of an alarmed EICPM (normal
pulse rate)
Table 2 EICPM positive predicting rates and negative
predicting rates of all groups.
positive
predicting
rate
negative predicting
rate
group 1
100%
94.6%
group 2
100%
95.1%
group 3
100%
95.8%
group 4
100%
94.9%
group 5
100%
97.6%
group 6
95.2%
95.1%
CONCLUSION: In children, the elevation of the heart
rate is the most important compensatory mechanism for
acute illnesses demanding increasing cardiac output,
such as significant fever, dehydration, early shock etc.
In this study we find the pulse rate status is a sensitive
indicator for febrile condition and appearance in
pediatric acute illnesses. However continuous serving
of the EICPM rather than a spot check, may contribute
more towards acute homecare. Besides, further studies
are needed to determine the value of the EICPM in
predicting deteriorating acute illnesses such as flu
complicated with acute myocarditis.
165
P2-039
Others
PPARОі
Inhibits
Inflammatory
Reaction in Oxidative Stress Induced
Human Diploid Fibroblast
Jun-Won Yang1, Jung-Soo Kim1, Ho-Keun Yi2,
Sung-Ho Cha3, Pyoung-Han Hwang1
1
Department of Pediatrics School of Medicine,
Chonbuk National University, Jeonju, Seoul,
Korea; 2Department of Biochemistry School of
Dentistry, Chonbuk National University, Jeonju,
Seoul, Korea; 3Department of Pediatrics, Kyung
Hee University Medical School, Seoul, Korea
Peroxisome
proliferator-activated
receptors
(PPARs) are members of the nuclear hormone
receptor family. PPARОі plays an important role in
regulating several metabolic pathways. Recently,
PPARОі has been implicated in inflammatory
responses and age-related diseases. The aim of
this study was to determine the anti-inflammatory
reaction of PPARОі in an induced ageing progress.
The late passage of human diploid fibroblasts
(HDF), an in vitro ageing model, reveals the
biological index materials of ageing. Aged cells
showed decreased PPARОі expression and elevated
levels of intracellular adhesion molecule-1
(ICAM-1), an inflammatory molecule. To induce
the aged cell phenotype, the middle stage of HDF
cells (PD31) were induced to undergo stress
induced premature senescence (SIPS) with 200
ОјM H2O2 for 2 hours. SIPS-HDF cells showed
high levels of ICAM-1, extracellular signal
regulated kinase (ERK1/2) activity and matrix
metallomatrix protease (MMP-2, -9) activity, and
low levels of PPARОі expression. A reconstitution
of PPARОі in SIPS-HDF cells by adenoviral
PPARОі
transfection
resulted
in
the
down-regulation of ICAM-1, ERK1/2, MMP-2
and -9, and normalized growth of SIPS-HDF cells.
Moreover, PPARОі in aged HDF cells reduced
pro-inflammatory molecules and eliminated the
formation of reactive oxygen species (ROS)
through the ERK1/2 pathway. These results
strongly suggest that PPARОі plays a key role in
age-related inflammation and may have clinical
applications as a molecular target in the treatment
of age-related inflammation.
P2-040
Others
Kawasaki Disease Associated with
Transient Encephalopathy in an Infant
Shih-Hsuan Lo1, Yhu-Chering Huang1,2
Department of Pediatrics, Chang Gung
Children’s Hospital and Chang Gung Memorial
Hospital, Taoyuan, Taiwan; 2College of Medicine,
Chang Gung University, Taoyuan, Taiwan
1
A previous healthy 6-month-old girl presented
with fever for four days, bilateral conjunctivitis,
and maculopacular rashes over trunk and limbs.
After hospitalization, injected and fissured lips
and erythematous change over BCG scar were
also noted. She became lethargy and had
excessive sleep more than 20 hours per day since
hospital day 4 and recovered two days later.
Pleocytosis in cerebrospinal fluid was noted and
electroencephalography
recording
indicated
abnormal
findings
compatible
with
encephalopathy. Fever was not gone until
intravenous immunoglobulin (2gm/kg) was
administered on 7th hospital day under the
impression of Kawasaki disease. Desquamation
over fingertips developed later. The neurologic
outcome of the patient was excellent. Kawasaki
disease associated with central nervous system
involvement was reviewed.
166
P2-041
Others
Superficial Bacterial Contamination of
Bovine Carcasses in One Slaughter
House around Tehran
P2-042
Pathogenesis, Mechanism
Interleukin 17 Stimulates Mononuclear
Cells to Kill Echinococcus Granulosus
by Nitric Oxide-Dependent Pathway
Tannaz Moosavi, Peyman Fardesaneii, Majid
Yazdani Borji
Iran
Manel Amri, Chafia Touil-Boukoffa
Food borne diseases often follow the consumption
of contaminated food-stuffs especially from
animal products such as meat from infected
animals or carcasses contaminated with
pathogenic bacteria as Salmonella spp., and
Escherichia coli O157: H7.The majority of these
germs result from contamination occurring at the
slaughterhouse , where conventional veterinary
inspection cannot detect the presence of these
bacteria on apparently healthy carcasses .The
different stages of the conversion from live
animals into meat make the microbial
contamination of carcasses an unavoidable and
undesirable result. During the slaughtering
process, main sources of contamination are the
slaughtered animals themselves, the staff and the
work environment. The contamination of
equipment, material, and workers’ hands can
spread pathogenic bacteria to non-contaminated
carcasses. The purpose of our work is to study the
degree of superficial bacterial contamination of
bovine
carcasses
at
a
slaughterhouse;
quantitatively by counting the total viable and
fecal coliform counts, and qualitatively by the
research for Salmonella spp. at 3 different bovine
carcasses sites. Carcasses were examined just
after eviscerating. Wet-dry double swab sampling
was used. The results showed that the brisket area
and the posterior side of the foreleg were the most
contaminated areas. Salmonella wasn't isolated
from carcasses and Escherichia coli O157: H7
was isolated from one sample.Our results reflect
poor conditions of slaughtering and handling of
carcasses.
Team “Cytokines and NOSynthases”, Laboratory of Cellular
and Molecular Biology (BCM), Faculty of Biological Sciences
(FSB), University of Sciences and Technology Houari
Boumediene (USTHB), Algiers, Algeria
BACKGROUND: Human echinococcosis is
one of the world’s major zoonotic infections
which affect the children in most cases. It usually
manifests as unilocular cyst(s) mainly located in
the liver. Surgery is the main therapeutic approach;
however dissemination of protoscoleces (infective
form in cyst) constitutes a source of relapse. More
recently, we have highlighted an evident role of
IFN-Оі in protoscoleces killing by NOS2 (Nitric
Oxide Synthase2) induction (Amri et al., 2007)
and Arginase inhibition. Of note, NOS2 and
Arginase are known to compete for the common
substrate, L-Arginine. Discovery of the Th17 cell
lineage and functions in immune responses of
man prompted us to investigate the role of IL-17
in host defense during human echinococcosis.
METHOD: We have investigated the effect of
IL-17 on protoscoleces co-cultured with
mononuclear cells. These cells (PBMC) are
prepared from peripheral blood of hydatic patients
(before and after surgery) and healthy donors.
After 20h, protoscoleces viability is evaluated.
NO and urea production are also evaluated in the
supernatant (respectively for NOS2 and Arginase
activities).
RESULTS: Our results demonstrated that IL-17
decrease protoscoleces viability (from 53.37В±7.96
to 17.7В±3.99 %, p<0.0001). Moreover, we
observed a concomitant elevation of NO levels
(from 77.36В±18.18 to 133.85В±22.59 ВµM,
p<0.0001) and a decrease in Urea levels (from
50.26В±8.35 to 18.08В±2.99 mM, p<0.001).
Interestingly, inhibition of the IL-17 responses
enhanced protoscoleces survival. This effect is
associated with a decrease in NO level and an
elevation in Urea level. Similar findings are
observed in cocultures performed with PBMC of
patients and healthy donors.
CONCLUSION: the results reported here show
that IL-17 plays a relevant role in the protective
immune response during human echinococcosis.
This role may be mediated by NOS2
up-regulation and Arginase inhibition. Our
findings provide useful tools for development of
therapeutic strategies.
167
P2-043
Pathogenesis, Mechanism
Evasion Strategies of Echinococcus
Granulosus to Th1 Protective Response
during Human Infection: IFN-Оі/No
Design in Anti-Hydatic Therapy
Manel Amri, Chafia Touil-Boukoffa
Cytokines and NOSynthases, Laboratory of Cellular and
Molecular Biology, Faculty of Biological Science, Algiers,
Algeria.
BACKGROUNDS:
Echinococcus
granulosus
infections are among the most common infections in
the entire Mediterranean zone particularly in Algeria. In
human, the larval form develops into large cysts
especially in the liver and lung. Surgery is the main
therapeutic approach, however, dissemination of
protoscoleces (PSC: cystic components) constitutes a
source of relapse in some cases. There has been
significant work characterizing the immune response
against this macroparasite, but little is known regarding
the precise mechanisms responsible for parasite evasion
to host’s defense. More recently, we have highlighted
an evident role of IFN-Оі (Th1 cytokine) in PSC killing
by NOS2 (nictric oxide synthase 2) induction (Amri et
al., 2007). Indeed, more researches are required to
identify factors present in parasite cyst, which affect
protective Th1 response in E. g. human infection.
METHODS: We have investigated the effect of
different parts of hydatic cysts: cyst fluid (CF),
germinal layer (GL, cellular layer of cyst),
protoscoleces (PSC, infective form of cyst) and
laminated-layer (LL, accelullar layer of hydatic cyst) on
IFN-Оі and NO production by mononuclear cells
(PBMC) in vitro. PBMC are prepared from peripheral
blood of hydatic patients (before and after surgery) and
healthy donors. Furthermore, we have investigated the
effect of LL on parasite viability in PBMC-parasite
cocultures.
RESULTS: We have found that extracts from cyst fluid,
germinal layer and protoscoleces increase IFN-Оі and
NO production. However, laminated layer extract
reduced IFN-Оі and NO production. Moreover, we have
purified from CF, GL and PSC the major antigenic
protein F5 (68 kDa), by chromatography on Sephadex
G200. Interestingly, F5 has the same effect as CF, GL
and PSC. LL is F5-free and contains another antigenic
protein; F4 (12 kDa). This protein has the same effect
as LL. Finally, in PBMC-parasite-cocultures, LL
enhanced parasite survival.
CONCLUSIONS: Collectively our findings underline
a strong host-parasite interaction. Moreover, this result
demonstrates that the parasite laminated layer impairs
Th1 protective response and allow the parasite to
survive in hydatic patients. Inhibition of these
mchanisms seems to be important issue to address
during the design of anti-hydatic treatment.
P2-044
Pathogenesis, Mechanism
Panton-Valteine Leukocidin Is the
Virulent
Determinant
for
Community-Associated
Methicillin-Resistant
Staphylococcus
aureus Infecting Human Keratinocyte
Chia-Yu Chi,1,2 Chia-Chun Lin,1 Yi-Chuan Yao,1
Chiou-Feng Lin,2 and Ching-Chuan Liu3
1
Division of Infectious Diseases, National Health Research
Institutes, Tainan, Taiwan; 2Graduate Institute of Clinical
Medicine, National Cheng Kung University, Tainan, Taiwan;
3
Departments of Pediatrics, National Cheng Kung University
and Hospital, Tainan, Taiwan
OBJECTIVES:
Community-associated
methicillin-resistant Staphylococcus aureus (CA-MRSA) is
a major public health problem in many areas of the world
and primarily to cause skin and soft tissue infections (SSTI)
― manifestations strongly associated with the presence of
Panton-Valteine leukocidin (PVL). However whether or
not PVL contributes directly to epidermal cell damage
caused by CA-MRSA remains to be determined. Here we
evaluated the virulence of PVL-positive (PVL+) strain of
the most common pulse-field type and multilocus
sequencing type isolated from patients with SSTI in
Taiwan, and we generated isogenic PVL-negative strain
(О”pvl) of that major epidemic CA-MRSA clone with which
to test directly the involvement of PVL in the pathogenesis
of CA-MRSA in human keratinocyte.
METHODS: CA-MRSA strain, coded S2-1696 (ST59,
SCCmec type VT, pvl+) was isolated from a patient with
cellulitis in National Cheng Kung University Hospital.
Construction of isogenic lukF/S-PV deletion mutant was
performed and modified as described elsewhere. The
nontumorigenic human epidermal keratinocyte RHEK-1
cells were used through the study. Confocal fluorescence
microscopy was used for observation of bacteria invasion
at m.o.i. 50. The occurrence of host cell death was
evaluated at the indicated time points by microscopic
observation of morphological changes in the cells and was
analyzed by flow cytometry using FITC-conjugated
annexin V and propidium iodide.
MAIN RESULTS: Our data showed that the invasion
patterns were similar for the PVL+ CA-MRSA strain and
its isogenic О”pvl strain. After attaching to RHEK-1 cells,
both CA-MRSA strains were engulfed into endosome
observed 1hr after infection under confocal microscopic
examination of the infected cells. Notably, following
destruction of endosome, PVL+ CA-MRSA strain escaped
more easily into cytoplasm than О”pvl strain did.
Furthermore, О”pvl strain replication drastically fell behind
to PVL+ strain since 2.5hr post-infection (P<0.05).
Eventually, PVL+ CA-MRSA strain caused significantly
higher level than О”pvl strain of keratinocyte cell damage,
including necrotic and apoptotic cell death as determined
by microscopic observation and flow cytometer at 7 hr
post-infection (P<0.05).
CONCLUSIONS: The results of this study suggest that
after internalization, PVL is an important virulence
determinant of CA-MRSA for escaping from endosome
into cytoplasm, intracellular replication, and host cell
killing in human keratinocytes.
168
P2-045
Pathogenesis, Mechanism
Hepatic
Damage
Caused
by
Coxsackievirus B3 Is Dependent on
Age-Related
Tissue
Tropisms
Associated
with
the
Coxsackievirus-Adenovirus Receptor
Chih-Yuan Kuo1, Jung-Yen Liu1, Shih-Min
Wang2, Chun-Keung Yu1, Huan-Yao Lei1,
Ching-Chuan Liu3
1
Department of Microbiology & Immunology,
National Cheng Kung University Medical College
and Hospital, Tainan, Taiwan National Cheng
Kung University Medical College; 2Departments
of Emergency Medicine, National Cheng Kung
University Medical College and Hospital, Tainan,
Taiwan; 3Departments of Pediatrics, National
Cheng Kung University Medical College and
Hospital, Tainan, Taiwan
OBJECTIVES: Coxsackievirus B (CVB) is an
important cause of severe infectious diseases in
neonates or young children in Taiwan. It can
cause myocarditis, meningoencephalitis and
fulminant hepatitis. This study is aim to explore
the mechanism of tissue tropism of CVB infection
via in vitro and animal models.
METHODS: CVB3 (CVB3/2630) was isolated
from a neonate with fulminant hepatitis. Cell lines
A549, RD, HeLa, HEp2 and Huh-7 were
maintained in Dulbecco’s modified Eagle’s
medium. Seven-day-old mouse progeny were
used in all experiments.
MAIN RESULTS: A clinical isolated CVB3
strain was found to induce more cytopathic and
apoptotic effects on the Huh-7 hepatoma cell line
than EV71 or coxsackievirus A16. Viremia was
noted in seven-day-old ICR mice within 2 hours
of an intraperitoneal injection. Thereafter the
highest viral titers were detected in blood, liver,
spleen, heart and brain. Histopathological studies
of the liver demonstrated neutrophilic infiltration,
massive hepatocyte necrosis and apoptosis. The
coxsackievirus-adenovirus receptor (CAR) was
more expressed in liver than other tissues.
Expression of CAR decreased with mouse age.
Anti-CAR monoclonal antibody prevented
infection of Huh-7 cells from CVB3.
CONCLUSION: These findings indicate that
CAR plays an important role in the initiation of
CVB infections and is closely associated with
hepatotropisms and age-specific susceptibility.
P2-046
Pathogenesis, Mechanism
Synergistic Effects of NOD2 and
Toll-like Receptor 5 on Inflammatory
Responses in Intestinal Epithelial Cells
Fu-Chen Huang
Department of Pediatrics, Chang Gung Memorial
Hospital - Kaohsiung Medical Center, Chang
Gung University College of Medicine, Kaohsiung,
Taiwan
OBJECTIVES: Following oral infection,
intestinal epithelial cells are the first barrier to be
crossed by Salmonella in order to invade the
intestinal tissues. In addition to serving as a
protective barrier, the epithelium plays an active
role in the intestinal immune response through its
secretion of inflammatory cytokines, chemokines,
and antimicrobial peptides. Toll-like receptors
(TLRs) and nucleotide-binding oligomerization
domains (NODs) proteins are two classes of
pattern recognition receptors (PRRs) involved in
innate immune detection. Recently, cooperation
between NODs and TLRs signaling has been
demonstrated in the recent literatures. However to
our knowledge, little literature has been
documented the interaction of TLR5 and NOD2,
especially in intestinal epithelial cells.
METHODS: We use flagellin (TLR5 ligand) and
Muramyldipeptide (MDP, NOD2 ligand) to
stimulate 3 intestinal epithelial cell cultures (T84,
SW480 and SW620) and collect supernatant and
total RNA for ELISA (secreted protein) and
RT-PCR (mRNA expression), respectively.
Nuclear transportation of NF-ОєB and activation of
MAPKs signaling pathways were assayed by
Western blot in nuclear and cytosolic extract of
the cells.
MAIN RESULTS: Here we demonstrate the
synergistic effect of flagellin and MDP is seen on
IL-8 production, either protein secretion or
mRNA expression, in SW480 and SW620 cells
while the concentration of flagellin is high enough.
But the synergistic effect of flagellin and MDP on
IL-8 production was not found in T84 cells.
Enhanced nuclear transportation of NF-ОєB was
found in SW620 cells stimulated by the
combination of MDP and flagellin compared to
flagellin or MDP alone, but the activation of
MAPKs ERK or p38 was not enhanced.
CONCLUSION: We conclude that the
synergistic effect of TLR5 and NOD2 in intestinal
epithelial cells are cell type- specific. Besides, the
synergic effect may be mediated by NF-ОєB but
not MAPKs signaling pathway.
169
P2-047
Respiratory Tract Infection
Pertussis Like Syndrome or Pertussis? :
A Delay Diagnosis
Heda Melinda Nataprawira, Finia Cahayasari,
Arifin Kashmir
Department of Child Health, Faculty of Medicine,
University of Padjadjaran-Hasan Sadikin Hospital,
Bandung, Indonesia
BACKGROUND: Recent reports of pertussis
epidemiology from Asia, Africa and South America are
limited but World Health Organization (WHO)
estimation demonstrate that these countries have the
highest disease burden. Estimating rates of pertussis is
difficult, because lack of access to diagnostic method,
misdiagnosis, under-reporting, and different reporting
criteria between countries. Pertussis like syndrome is a
syndrome characterized by severe episodes of coughing
resembling whooping cough (pertussis). Pertussis-like
coughing can also be observed during infections with
other microorganisms.
OBJECTIVE: To report eleven cases of pertusis like
syndrome documented in Hasan Sadikin hospital.
Method. Retrospective study conducted from reviewed
medical records since 2008 until 2010, documented of
eleven pertusis like syndrome infants. We documented
their age, gender, history of pertussis immunization,
clinical manifestations, laboratory findings, initial
diagnosis, treatment and clinical response to therapy
given. To identify the microorganism we performed
isolation of Bordetella pertussis using Bordet-Gengou
agar, performed mostly on the second week. Based on
symptoms findings we diagnosed based on three
classifications that is suspect, probable, and confirmed
pertussis. We then administered clarithromycin to all
patients.
RESULTS: We reported eleven infants diagnosed as
pertussis like syndrome. There were five boys and six
girls; all of them were less than 6 months of age. All
infants did not have pertussis immunization before, but
one. Dyspnea, paroxysms cough and fever presented on
all infants and they initially diagnosed as suspected
bacterial severe pneumonia and later diagnosed as
probable pertussis. Only three infants showed
post-tussive vomiting and cyanosis. None showed
apneic symptom. From laboratory finding we found
only 5 infants with absolute lymphocytosis. The
isolation of Bordetella pertussis yielded negative
results to all of infants. Initially we gave antibiotics
ampicillin or cephalosporin due to severe bacterial
pneumonia. Clarithromycin was given on the second
weeks of initial symptoms to most of the infants and
showed good clinical response.
CONCLUSIONS: Eventhough we performed isolation
of Bordetella pertusis, it’s noted that its still difficult to
confirm pertussis diagnosis which might be due to the
timing of the isolation collection. So far, all infants
were likely considered as pertussis while mostly
haven’t got any pertussis immunization.
P2-048
Respiratory Tract Infection
Life-threatening Pneumonia Caused by
Macrolide-resistant
Mycoplasma
Pneumoniae
Yu-Chia Hsieh1, Kuo-Chien Tsao2, Chung-Guei
Huang2, Ya-Ling Huang2, Suxiang Tong3, Jonas
Winchell4, Yhu-Chering Huang1, Shao-Hsuan
Shia1, Shen-Hao Lai1, Tzou-Yien Lin1
1
Department of Pediatrics, Chang Gung
Children's Hospital, Taoyuan, Taiwan;
2
Department of Laboratory Medicine, Chang
Gung Memorial Hospital, Chang Gung University,
College of Medicine, Taoyuan, Taiwan; 3Division
of Viral Disease and 4Division of Bacterial
Disease, Centers for Disease Control and
Prevention, USA
Two siblings had pneumonia caused by
Mycoplasma
pneumoniae
determined
by
polymerase chain reaction and serology. One of
them developed adult respiratory distress
syndrome and required extracorporeal membrane
oxygenation therapy. M. pneumoniae real-time
PCR assay from nasopharygeal aspirate, lung
tissue and pleural fluid of the brother and
nasopharygeal aspirate of the sister were all
positive (Figure 1). Sequencing of the 23S rRNA
in both cases identified an A2064G transition in
domain V (Figure 2), which is indicative of a
macrolide-resistant phenotype. For finding other
possible concomitant infections in two cases,
extensive viral studies including PCR test for
adenovirus, influenza A, influenza B, human
coronavirus
229E,
OC43,
NL-63,
and
SARS-coronavirus were all negative in both our
laboratory and CDC of US. Throat swab for virus
isolation, blood culture, and urine pneumococcal
antigen (Binax NOW) were all negative. For the
first time, we documented a case of adult
respiratory distress syndrome caused by
macrolide-resistant M. pneumoniae. Animal
models and clinical experiences suggest that the
use of both antimicrobial therapy and
immunomodulatory agents are important to
improve the outcome of severe M. pneumoniae
pneumonia.
Given
the
increase
of
macrolide-resistant M. pneumoniae in recent
years, effective antimicrobial treatment should be
a critical component of managing severe cases of
macrolide-resistant strains infection. Our cases
warrant more studies on the prevalence of
macrolide-resistant M. pneumoniae and to
evaluate the optimal treatment in severe cases of
macrolide-resistant M. pneumoniae pneumonia.
170
P2-049
Respiratory Tract Infection
Mortality of Severe Pneumonia in
Under-Five Children
Diah Asri Wulandari, Sri Sudarwati, Adi Utomo
Suardi, Reni Ghrahani DM, Cissy B
Kartasasmita
Pediatric Department Hasan Sadikin
Hospital/Medical Faculty of Padjadjaran University
Bandung, Indonesia
INTRODUCTION: Pneumonia is one of the
leading causes of morbidity and mortality in children
worldwide, mainly in developing countries.
Mortality from pneumonia is approximately 10-15
times higher in developing countries than in
developed countries.
OBJECTIVE: To know the mortality rate and the
risk factors of mortality among under-five children
hospitalized due to severe pneumonia.
METHODS: A descriptive study on age, sex,
severity of pneumonia, risk factors and co-morbidity
of all children age of 1 to 59 months admitted due to
pneumonia in the Pediatric Department Hasan
Sadikin Hospital from November 2007
to
January 2009 were included in this study.
RESULT: Three hundred and eighteen children
were enrolled in this study. Median age was 11.16
months (range: 1 to 58 months), 237 (74.5%) were
less than 12 months of age. Very severe pneumonia
diagnosed in 93 (29.2%) and severe pneumonia in
225 (70.8%) children. Twenty three children (7.2%)
died during hospitalization, 20 of 93 (21.5%) with
very severe pneumonia (p<0.001; OR 20.274;
95%CI: 5.855-70.197). Congenital heart disease and
leucocytosis (white blood count ≥15.500/mm3) was
significantly associated to the mortality (p=0.002;
OR 5.795; 95%CI: 2.115-15.407) and (p=0.002; OR
3.879; 95%CI: 1.547-9.727), respectively. Chest
X-ray showed infiltrate in 94.97% patients.
Pathogen was identified in 11 (47.8%) of 23 patients.
Bacteria
identifications
were
Streptococcus
pneumonia (1), Staphylococcus aureus (2),
Staphylococcus epidermidis (4), Haemophilus
influenzae (1), Enterobacter aerogenes (2), and
coagulase negative Staphylococcus (CONS) (1).
There were no significant differences regarding risk
factors such as age, sex, birth weight, prematurity,
HIV infection, tuberculosis, asthma, passive
smoking, malnutrition, breast feeding < 2 month,
previous antibiotics treatment, indoor air pollution,
home occupancies, and C-reactive protein reaction
findings between patients who died and survived.
CONCLUSION: The mortality of severe
pneumonia is still high. Very severe pneumonia and
congenital heart disease are risk factors, and
leucocytosis is co-factor of mortality among
under-five children hospitalized due to pneumonia.
P2-050
Sepsis
Axillary Temperature and Leukocyte
as Predictors of Sepsis in Children 1 to
60 Months of Age
Enny Harliany Alwi, Reni Ghrahani Dewi
Majangsari, Stanza Uga Peryoga
Department of Child Health School of Medicine,
Padjadjaran University/Hasan Sadikin General
Hospital, Bandung, Indonesia
OBJECTIVE: Sepsis in pediatric, was defined as
systemic inflammatory response syndrome (SIRS) in
the presence of or as a result of suspected or proven
infection, requires that core temperature or leukocyte
abnormalities be present. The aim of this study
was to determine the diagnostic properties of
axillary temperature and leukocyte as predictor of
sepsis in children 1 to 60 months of age.
METHODS:We conducted a prospective study of
consecutive febrile (axillary temperature ≥ 38°C)
children aged 1 to 60 months, living in Bandung,
who came to pediatric emergency department of
Hasan Sadikin General Hospital from January to
December 2008. Demographic information and
temperature were recorded at the time of the initial
evaluation. The leukocyte count was measured at the
same time and the blood culture was done. The
differences in the proportions were compared by
chi-square test and the differences in the means were
compared using Student’s t test. The p value less
than 0.05 were considered statistically significant.
Strength of association was determined by
estimating relative risk (RR) and 95% Confidence
Intervals (CI) around relative risk.
RESULTS: One hundred and thirty two patients
were enrolled in the study; consisted of 72 (54.5%)
boys and 60 (45.5%) girls, with the mean age of
13.73 В± 10.14 months. Twenty nine (22%) had a
sepsis
and 103 (78%) had no sepsis. Both groups
were indistinguishable in temperature (38.7 В± 1.0oC
vs. 38.8 В± 0.9oC; p= 0.773), but there were
significant differences in age (9.3 В± 7.3 vs. 15 В± 10.5
months; p= 0.007) and leukocyte count (17,462 В±
10,678/mm3 vs. 12,655 В± 6,981/mm3; p= 0.005). Chi
square analysis showed axillary temperature ≥39oC
was not associated with sepsis (П‡2= 1.804; p= 0.179)
with RR= 1.583 (95% CI: 0.798-3.140), meanwhile
leukocyte count ≥15.500/mm3 was associated with
sepsis (П‡2= 5.684; p= 0.017) with RR= 2.147, 95%
CI: 1.147-4.017.
CONCLUSION: Our data suggest that, in infants
and children presenting with fever, axillary
temperature is not associated with sepsis. Leukocyte
count of greater than 15.500/m3 is a good predictor
for sepsis.
171
P2-051
Tuberculosis, Leprosy
Additional Antituberculosis Activity of
Juniper Communis "Berries" in
Younger between 16 to 20 Years Old
with Clasiccal Therapy
Bajraktarevic Adnan1,2, Gusic Mornjakovic Saida1,
Penava Semira1, Boldic Dragana2, Frankic Teodora2
1
Department of Pediatrics, Public Health Institution of
Canton Sarajevo; 2Department for Pediatric
Pharmacology, Institute for Clinical Pharmacology and
Pharmacognosy, Pharmacy Faculty Sarajevo, Bosnia
and Herzegovin
INTRODUCTION: Juniper is an evergreen
shrub or small tree in the cypress or Cupressaceae,
family. Juniperus communis species have been
used to various pulmonary inflammatory and
infectious diseases such as bronchitis, colds,
cough,flu, tuberculosis as additional therapy in
Bosnian folk medicine. Juniper berries have long
been used as medicine for tuberculosis by many
cultures specially in Bosnia and Herzegovina.
AIMS: Author's aim s were to show possibility of
additional antituberculosis therapy in older
children then sixteen years and benefits of using
Berries, Juniperus communis.
METHODS: All compounds were identified
following analysis of NMR and their structures
were established based on spectroscopic studies.
The main chemical components of juniper
communis berries juice or tea needles and barries
were two eudesmanes, two abietanes, two
podocarpanes, invert sugar, flavoinds glucozide,
biflavonoids,
protoantocyanids,
tanins,
pectines,minerals, wax, resin, and other twenty
four known compounds were isolated from the
dried fruits of Juniperus communis as a-pinene,
camphene,
b-pinene,
sabinene,
myrcene,
a-phellandrene,
a-terpinene,
y-terpinene,
1,4-cineole,
b-phellandrene,
p-cymene,
terpinen-4-ol, bornyl acetate, cayophyllene and
trace amounts of limonene, camphor, linalool,
linalyl acetate, borneol, nerol, and the most
active longifene, totarol and iso and
trans-communic acid.
RESULTS: A comparison between the headspace
of fresh and bottled black Juniper communis
berries shows a significant loss of the
monoterpenoid fraction with time. The
antimycobacterial activity of Juniperus communis
extracts, fractions and constituents was
determined against Mycobacterium tuberculosis,
and against rifampicin-, isoniazid-, streptomycinand moxifloxacin-resistant variants in sick
children older then 16 years and younger adults
under 21 years in 36 cases during the period
1993-2009 year divided in two groups with using
"Berries“ and without Junniper Communis as
aditional therapy.
CONCLUSIONS: Common juniper was used by
Bosnian and Herzegovian people as a blood
tonic to treat colds, cough, flu, arthritis, muscle
aches, tuberculosis, hypoglicemic activity and
kidney problem. Safety and effectiveness have not
always been proven for children under sixteen
years. The antimycobacterial activity of Juniperus
communis was attributed to a sesquiterpene
identified as longifolene and two diterpenes,
characterised as totarol
and iso and
trans-communic
acid.
Bosnian
Juniperus
communis is one of the best in its category in the
world and Europe and its using can be useful in
future as antituberculosis additional therapy older
then sixteen years-aged.
172
P2-052
Tuberculosis, Leprosy
The Survey of Infants’ Tuberculosis
Rasool Salahi
Iran
INTRODUCTION: The infants, tuberculosis
forms 5-15 % of the Whole cases of clinical
tuberculosis, however this ratio can be different in
various communities affected by factors like
frequency and assembling the existing disease
store houses in the society ( the patients suffering
form pulmonary tuberculosis with positive
sputum esmir)and also the age mean of
population .on the other hand, failure of
treatment in the adults means the failure of
treating the disease spreading sources, so ,
clearly, increased subjects of treatment failure
also heightens the rate of disease spreading in
the society and especially the children.
METHODS: The type of study is cross sectional.
The study data extracted using the questionnaire
and by referring to the file of patients suffering
from tuberculosis who had profiles in the center
of tuberculosis coordinate of kalale district
during the years of 2000-2009. The analysis of
data was accomplished using spss17 software and
Descriptive statistics.
RESULTS: The number of all patients suffering
from tuberculosis is 876 for ten years. Of this
number, 43 cases were infants (3.9%). The infants,
mean age was 10.6В±4.6. the age extent of
sufferers was between 9 months and 15 years.
There were 61.8% female and 38.2% male of
these infants, there were 10 cases (29.4%)
suffered from positive esmir pulmonary
tuberculosis, 11 cases (32.4%) suffered from
negative esmir pulmonary tuberculosis , and 13
cases (38.2%) suffered from extra pulmonary
tuberculosis.
64.7 % of sufferers were
inhabitants. Esmir pulmonary tuberculosis and
negative esmir accomplished their treatment
sufferers from extra pulmonary tuberculosis,
84.6% had a perfect treatment period and also
15.4% died during treatment.
DISCUSSION AND CONCLUSION: From the
whole cases suffering from tuberculosis only
3.9% were infants which is less than expected
limit of the country. It’s necessary that regarding
to the importance of infants tuberculosis ,the
5-number criteria of tuberculosis diagnosis in
this group are assessed more carefully sensitively
to discover and cure the whole suffering infant
properly.
P2-053
Urinary Tract Infection
The Efficiency Comparison of Culture
and PCR Methods in Detection of
Mycoplasma Hominis in Individuals
with Genitourinary Tract Infection
A.Abdollahi, M.Fasihi R
Fasa University of Medical Science, Department of
Microbiology, Fasa-Iran. Young Researchers Club,
Islamic Azad University, Iran
OBJECTIVE: It is almost 50 years that the
pathogenesis importance of mycoplasma is approved in
human and animals. Mycoplasma hominis is one of the
species of this genius, which has caused serious
problems in the individuals who have sexual activities.
These problems are like infertility and genitourinary
tract infections. Our aim in this survey is reveal that the
PCR method is more useful method in compare by
culture assays using specific primers for this species.
METHODS: We have collected 113 genitourinary tract
samples from men and women who have symptoms.
We have picked up 2 swabs of each place. One has
maintained in freezer (in PPLO broth) for PCR assay
and the other has transferred to PPLO medium
immediately. Then we have transferred the culture on
the PPLO to H broth which contain arginine (amino
acid) and incubated at 37В°C and 5% CO2 for one week
and has checked frequently. After a week the bacteria
have transferred to H Agar to investigate the colonies
forms. We have used specific primers to performed
PCR assays. These primers are used to amplify a 334
base pair sequence of 16srRNA region. Primer
sequences and PCR conditions are presented below:
RNA H1 : F : 5' CAA TGG CTA ATG CCG
GAT ACG C 3'
RNA H2 : R : 5' GGT ACC GTC AGT CTG
CAA T 3'
35 cycles/
Initial denaturation
95oc
6 min,
50 s,
Denaturation
95oc
Annealing
61oc
50 s,
50 s,
Extension
73oc
Final extension
73oc
6 min.
MAIN RESULTS: 24 samples among the 113 samples
(21/23%) were positive for Mycoplasma hominis. One
of these samples was positive just in culture, 12 cases
were positive just by PCR method and 15 cases were
positive both by PCR and cultures methods.
CONCLUSION: There are very considerations for
Mycoplasma, but main problem is the diagnosis of
bacteria which is time-consuming and costly and also it
needs a professional labor worker to detect this
organism. Considering to time and costs in one hand
and the decisive diagnosis and treatment in other hand
and the results of this survey, we suggest the PCR
method (using specific primers for species and genius)
is favorable method to diagnosis of Mycoplasma.
173
P2-054
Urinary Tract Infection
A Report of a Klebsiella pneumoniae
with Multi Antibacterial (Drug)
Resistance
Bajraktarevic Adnan
Deptartment of Microbiology, Fasa University of
Medical Sciences, Fasa- Fars
Bosnia and Herzegovina
We recognized one strain of Klebsiella
pneumoniae which has multi antibacterial (Drug)
resistance (MDR), during a study of extended
spectrum beta-lactamase (ESBL) evaluation. The
strain was isolated from the urine of a patient
(5days old) at one hospital university, Tehran, Iran.
The isolated K.pneumoniae presented an unusual
resistance to all of examined drugs including:
ceftazidime, ceftriaxone, cefotaxime, cefixime,
cephalotin, ceftizoxime, amoxicillin, amikacin,
tetracycline,
gentamycin,
co-trimoxazole,
nalidixic acid, imipenem, nitrofurantoin and
ciprofloxacin (notify to MDR phenotype); and
elevated MIC to cefotaxime (≥256µg). The strain
also tested positive for ESBL production with
double-disk methodology. To proving this
phenotypic resistance we amplified extracted
plasmid with universal primers of bla-ctx-m type
genes.
P2-055
Urinary Tract Infection
Treatment of Pyelonephritis with
Extended-Spectrum Beta-Lactamase
(ESBL)-Producing Enterobacteriaceae
in Children
Tomohiro Katsuta, Kensuke Shoji, Shinya
Kamiyama, Akihiko Saitoh
National Center for Child Health and Development,
Tokyo, Japan
OBJECTIVES: Rapid spread of extended-spectrum
ОІ-lactamase (ESBL)-producing Enterobacteriaceae has
been a major issue worldwide. Carbapenem is known to be
the treatment of choice for serious infections with
ESBL-producing Enterobacteriaceae; however, little data
are available to treat pyelonephritis caused by the organism
using other antibiotics in children.
METHODS: We retrospectively reviewed treatment
options for children who suffered from pyelonephritis with
ESBL-producing Enterobacteriaceae at the National
Center for Child Health and Development in Tokyo (the
largest pediatric tertiary care hospital in Japan with 460
beds) between April, 2009 and July, 2010. Patients who
developed bacteremia with the organism were excluded
from the study.
MAIN RESULTS: We found 21 patients with
pyelonephritis
caused
by
ESBL-producing
Enterobacteriaceae during the study period. The mean age
of the patients was 6.1 years (range: 2 month-18.6 years),
and 71% (15/21) were girls. Sixty-seven percents (14/21)
of patients had a history of pyelonephritis. Klebsiella
pneumoniae and Escherichia coli were isolated 7/21 (33%)
and 14/21 (67%), respectively. As an empiric therapy, 13
patients (62%) were treated with cephalosporins (n = 12)
or cephamycin (n = 1) that were non-susceptible to
ESBL-producing organisms. These initial antibiotics were
changed to the following antibiotics based on the
susceptibility results, including cefmetazole (n = 4),
piperacillin/tazobactam
(n
=
2),
sulfamethoxazole/trimethoprim (S/T, n = 2), ciprofloxacin
(n = 2) and fosfomycin (n = 2). The rest of 8 patients (38%)
were treated with empiric antibiotics including
piperacillin/tazobactam (n = 5) and cefmetazole (n = 3)
that were susceptible to ESBL-producing organisms and
subsequently change to narrow-spectrum and susceptible
antibiotics such as S/T (n = 5), cefmetazole (n = 2) and
fosfomycin (n = 1). The mean duration of therapy was 13.6
days (range, 10-16 days) and the majority of patients (71%)
became afebrile within two days although they were
receiving antibiotics which were non-susceptible to
ESBL-producing Enterobacteriaceae. All patients
recovered from the infection without any sequelae and no
relapse of the infection was observed within 4 weeks after
the completion of therapy.
CONCLUSION: Children with pyelonephritis caused by
ESBL-producing Enterobacteriaceae can be successfully
treated with antibiotics other than carbapenems.
174
P2-056
Urinary Tract Infection
Comparison of Guidelines for Chronic
Prostatitis/Chronic
Pelvic
Pain
Syndrome
between
China
and
Singapore
P2-057
Urinary Tract Infection
Empiric Antibiotic regimen for
Hospitalized
Children
with
Community-acquired Febrile Urinary
Tract Infections in Taiwan
Chih-Cheng Lu, Tse-Chou, Cheng
Division of Urology, Department of Surgery, Chi
Mei Medical Center, Liouying, Tainan, Taiwan
Yu-Hsiu Huang, Meng-Chang Lee, Pei-Ju
Huang, Yhu-Chering Huang
Taiwan
BACKGROUND: To analyze the updating
guidelines or consensus in managing chronic
prostatitis/chronic
pelvic
pain
syndrome
(CP/CPPS) between regions. The regions of
interest were China and Singapore.
METHODS: The printed and online materials in
guidelines or consensus for CP/CPPS by Chinese
Urological Association (CUA), and Singapore
Ministry of Health (SMOH) were reviewed.
Several statements were compared including
published date, revision editions, patient selection,
diagnostic methods, and treatment options.
RESULTS: The online guidelines for CP/CPPS
by CUA were available in 2007. The online
guideline by SMOH was accessible in 2006.
CP/CPPS was a subdivision of Guidelines of
Urologic Diseases by CUA and a subcategory in
Guidelines of Use of Antibiotics in Adults by
SMOH. The classification of prostatitis by CUA
was according to National Institutes of Health
(NIH) Classification in 1995 while the definitions
by SMOH were not well informed. Patient
education brochure was provided by SMOH and
recommendation was rated based on the levels of
the evidence (Level I-IV) and the grades of
recommendation (A, B, C, Good Practice Points).
No clear level of evidence was applied by CUA.
In treatment, the duration of possible antibiotic
use was 2 to 4 weeks by CUA and 4 weeks by
SMOH. No antibiotics were suggested in
CP/CPPS by SMOH. The duration of
alpha-blockers was 12 weeks by CUA.
Phytotherapy, non-steroid anti-inflammatory
drugs and muscarinic-receptor antagonist was
suggested by CUA. Instead of alpha-blocker,
thermotherapy was suggested by SMOH.
CONCLUSIONS: In this limited study, we
demonstrated some varieties of the guidelines
between both Asian regions. Since the consensus
by Taiwanese specialists remains fragmented, this
comparison may help to build the official practice
guidelines in Taiwan.
BACKGROUND AND OBJECTIVES: The
antibiotic regimen of ampicillin plus gentamicin has
been suggested and widely used for years as empiric
treatment
for
children
hospitalized
with
community-acquired urinary tract infection (UTI).
Since the distribution as well as the antibiotic
resistant patterns of uropathogens may vary with
time, it is necessary to re-evaluate which antibiotic
regimen(s) is appropriate for empiric treatment.
METHODS: We retrospectively reviewed urine
culture database and hospital records of the patients
aged < 18 years who were admitted to Chang Gung
Memorial Hospital between 2004 and 2008. Those
with urine culture yielding single pathogen, and >
100,000 colony forming units/mL were extracted.
Only those with first febrile community-acquired
UTI and without immunosuppressed, or known
urologic anomaly were included.
RESULTS: A total of 968 children were included.
Two-thirds were < 1 year of age, and 54% male. E.
coli (84.4%, including extended beta-lactamase
producing strains in 2.0%) was the most common
pathogen identified, followed by K. pneumoniae
(4.1%), P. mirabilis (2.3%) and E. faecalis (2.3%).
The in vitro study showed 84.9% (777) of 916
isolates were susceptible to gentamicin, 82.5%
susceptible to cefazolin, and 18.7% of 920 isolates
susceptible to ampicillin. For those resistant to
gentamicin, 94 (10.2%) isolates were susceptible to
cefazolin, while only 2 (0.2%) isolates were
susceptible to ampicillin. Among 872 patients (90%)
receiving empiric antibiotic therapy, 520 patients
(60%) received cefazolin plus gentamicin and 257
patients (30%) received ampicillin plus gentamicin.
Of these patients, defeveresce was noted in around
50% within 24 hours, and around 90% within 3 days,
regardless of receiving in vitro sensitive or resistant
antibiotic regimens.
CONCLUSION: For children with first febrile UTI
in Taiwan, the empiric antibiotic regimen with
cefazolin plus gentamicin provides a broader
bacterial coverage than the regimen with ampicillin
plus gentamicin from the in vitro susceptibility test.
However, the clinical response was not affected by
the regimen used. A prospective study is needed.
175
Index of Authors
Chan, Paul Kay-sheung
A
Abdollahi, Abbas
112,114,153,171
Chan, Pei-Chun
124
71
Adi, Sunaryati Sudigdo
132
Chang, Chih-Feng
146
Ahmed, Wazir
155
Chang, Ching Wei
146
Ahn, Jong Gyun
130
Chang, Hsin Yu
141
Alwi, Enny Harliany
169
Chang, Hsin-Ju
116
Amri, Manel
165,166
Chang, Luan-Yin
44,89,123,126
Awal, Bal Krishna
114
Chang, Mei-Hwei
47
Azhar, Mohd Razali Kamarul
150
Chang, Shih-Cheng
126
Aziz, Muhammad Nazri
133
Chen, An Chyi
146
Aziz, Noor Azah
150
Chen, Chien-Chang
B
81
Chen, Chih-Jung
116
Bachtiar, Novilia Sjafri
137
Chen, Fu Sheng
138
Baek, Dong Won
130
Chen, Hsiu Lin
157
Chen, Jiande
147
Bajraktarevic, Adnan
134,170,172
Batmunkh, Nyambat
132
Chen, Jong-Min
123
Bayhon, William, JR. Carbrera
144
Chen, Po-Yen
159
Benjaponpitak, Suwat
135
Chen, Robert T
Bermal, Nancy
140
Chen, Shih-Perng
Boldic, Dragana
170
Chen, Walter
146
Bonehi, Morteza Ghasemi
151
Chen, Wei-Chuan
154
Borji, Majid Yazdani
165
Cheng, Biwen
117
Borys, Dorota
140
Cheng, Tse-Chou
173
Bouckenooghe, Alain
74
Cheon, Doo Sung
148
Bravo, Lulu
52
Chi, Chia-Yu
166
Chia-Chun Lin
166
Chiang, Pai-Shan
148
Chittaganpitch, Malinee
125
Brooks, Dennis
131, 132
C
Cai, Di Xiao
Cambau, Emmanuelle
156
73
Chiu, Cheng-Hsun
48,60
158,159
116,158
Chiu, Hsiao-Yu
146
156
Chiu, Ting-Fang
123
Carrion, Rosario Khamil Parial
144
Chiu, Tzu-Hsuan
157
Ceyhan, Mehmet
134
Cho, Eun Young
121
Cha, Sung Ho
164
Choi, Eunhwa
121
Cao, Bin
78,87
Cao, Yun
176
Choi, Soo Han
149
Gray, Sharon
Chomchai, Chulathida
131
Greenberg, David
Chotpitayasunondh, Tawee
125,128
131,132
64
H
79
Hadinegoro, Sri Rezeki
132
Chowdhury, Mahmood A
155
Hamid, Mohd Zaini Abd
150
Chuang, Tzu-Yao
146
Han, Tae Hee
146
Chueh, Heewon
149
Hanapiah, Suhaila Md
133
Hartati, Edim
137
Haruka Hishiki
141
Chow, Vincent TK
Chung, Doo-Ryeon
57
Chung, Ju-Young
146
Hassan, Afreenish
D
115,120,147
Dagan, Ron
51
Hassanbhai, Ammar Mansoor
143
Dayal, Rajeshwar
70
Hattasingh, Weerawan
130
Demitrovicova, Andrea
116
Hausdorff, William
122
Deo, Pankaj
114
Hidaka, Yasufumi
157
Du, Jung-Chieh
123
Hirose, Shinichi
119
Hishiki, Haruka
117,129
Ho, Bow
142,143
E
Eduardo, Santos-Lima
134,135
Eiji, Ohta
119
Esposito, Susanna
65
F
Ho, Taihua
118
Ho, Tzong-Shiann
152
Hon, Kam Lun Ellis
124,128
129,141
Fang, Han Hua
138
Honda, Yoshiko
Fardesaneii, Peyman
165
Hong, Ki Bae
121
Feng, Zhimin
154
Horimoto, Kiyoko
125
76
Horimoto, Taisuke
125
Fergie, Jaime Eduardo
Frankic, Teodora
170
Horvathova, Eva
116
Fu, Pan
154
Hoshino, Tadashi
117
Fujino, Motoko
125
Hou, Qi Ming
138
Funaki, Takanori
127
Hsieh ,Shu-Chuan
157
Gatchalian, Salvacion
140
Hsieh, Tsung-Hsueh
146
Ghanbarpoor, Mohammah
160
Hsieh, Yu-Chia
Ghasemi Bonehi, Morteza
151
Hsin-Yang Hsieh
146
Ghrahani, Reni
169
Hsu, Hsun Hui
154
Goto, Hideo
125
Hsu, Shu-Yeh
123
58
Hsueh, Po-Ren
123
131,132
Hu, Xue Zhong
138
Gould, Ian Malcolm
Graepel, Jay
Grahani, Reni
169
Huang, Chung-Guei
177
63,168
158,159
Huang, Fu-Chen
167
Huang, Li-Min
123,126,140
Kartasasmita, Cissy Rachiana
Karunakaran, Rina
133
168
Huang, Pei-Ju
173
Kashmir, Arifin Kurniawan
Huang, Sun-Lin
159
Katsuta, Tomohiro
Huang, Wan-Ting
62
Huang, Yhu-Chering
158,159,168,173
132,169
Kawaoka, Yoshihiro
Khani, Ali Jyhuni
127,172
125
112,114
Huang, Yi-Chuan
129
Khor, Chiea Chuen
51
Huang, Yu-Hsiu
173
Khorshidi, Ahmad
112
Huang, Yun Neng
138
Kim, Chang-Hwi
Huang, Yung-Feng
152
Kim, Dae Il
Hubler, Robin
131,132
Huovinen, Pentti Olavi
65
Kim, Dong Soo
120,140,148
121
130,148
Kim, Heui Og
130
Hussain, Samsinah
161
Kim, Hwang-Min
140
Hussin, Azura
133
Kim, Jong-Hyun
148
Hwang, Betau
123
Kim, Jung Soo
164
Hwang, Ji-Young
149
Kim, Ki Hwan
130
Hwang, Pyoung Han
164
Kim, Kwang-Nam
120
Kim, Kyung-Hyo
I
140,148
Ichihashi, Kou
125
Kim, Seok Woo
131
Ikeda, Naho
155
Kim, Seong-Joon
148
Intakorn, Pavinee
122
Kim, Yae-Jean
149
Ip, Margaret
128
Kinjo, Yoko
157
Kinoshita, Daisuke
156
Kinoshita, Keiji
161
Kiridana, Dilini Vasana
136
Kisac, Peter
116
Ishiwada, Naruhiko
117,129,141
Iwasaki, Tomohiro
155
J
Jeang, Kuan-Teh
84
Jiang, Yuan Si
156
K
Kitajima Hiroyuki
75
Kiyoaki Sumi
156
Kadel, Suyog Raj
114
Kodama, Haruka
119
Kai, Akihiko
156
Koh, Mia-Tuang
161
Kalavsky, Erich
116
Koh, Pei-Zhi
161
Kaleem, Fatima
115,120,147
Kohno, Yoichi
117,129,141
Kamata, Ayako
161
Kong, Eunhye
149
Kamiya, Hajime
45
Komiyama Kanki
88
Kamiyama, Shinya
172
Koo, Hong Hoe
149
Kang, Jin Han
148
Kosalaraska, Pope
135
178
Krcmery, Vladimir
116
Lin, Muchun
162
Kriengsoonthornkij, Worapan
131
Lin, Sung-Lien
163
Kuo, Chih-Yuan
167
Lin, Tzou-Yien
140,158,159
Kuo, Shih-Pin
145
Lin, Tzou-Yien
49
Little, Paul Stephen
66
Kurosaki, Tomomichi
117,129
Liu, Ching-Chuan
L
Lane, Andrew
139
45,152,166,167
Liu, Po-Yen
152
87
Liu, Tao Xuan
138
Lee, Chien-Yu
124
Liu, Yanfang
122
Lee, Chun-Yi
159
Liulak, Wongwat
Lee, Chien-Chang
Lee, Hoan Jong
53,121
130,143
Lo, Shih-Hsuan
164
Lee, Hung-Chang
145
Loke, Mun Fai
Lee, Jina
121
Lolekha, Somsak
53
Lee, Jun Ho
121
Lommel, Patricia
140
Lee, Kenneth
128
Lu, Chih-Cheng
173
Lee, Kun-Mei
123
Lu, Chun-Yi
86,123,126
Lee, Meng-Chang
173
Lu, Jang-Jih
118
Lee, Min-Sheng
145
142,143
M
Lee, Min-Shi
88
Lee, Ping-Ing
49,52,123
Lee, Soohyun
149
Marais, Ben J
Lee, Soo-Youn
149
Masaki, Hidekazu
127
Lei, Huan-Yao
59,167
Matsui, Kotoko
155
Leung, Ting-fan
124,128
Matsumoto, Naoko
157
Manaboriboon, Boonying
131
Maning, Nurahan
133
48,72
Li, Chang Gui
138
Md Yasin, Rohani
133
Li, Feng Xiang
138
Meriastuti, Ivijanthi
137
Li, Rong Cheng
138
Miyajima, Fumika
119
Li, Xiu Bi
138
Miyazaki, Osamu
127
Li, Ya Nan
138
Moedjito, Ismoedijanto
Li, Yan Ping
138
Mollik, Md. Ariful Haque
158
Lin, Chao-Jen
145
Montellano, May
139
Lin, Chiou-Feng
166
Moosavi, Tannaz
165
Lin, Hsiao Chuan
146
Mori, Toru
Lin, Hsiu-Chen
154
Moriguchi, Naohiko
119
Lin, Jia-Yi
124
Mornjakovic, Saida Gusic
170
Lin, Lung-Huang
145
Mossavi, Gholamabbas
112
179
133,137
71
Moungthong, Greetha
122
Q
Qiang, Ye
N
138
Quak, Seng Hock
142,143
Nagata, Satoru
155
Naghoni, Ali
113
Nataprawira, Heda Melinda
168
Raj, Ganeswarie
133
Nawi, Salbiah Hj
133
Ranjbar, Reza
113
Netsawang, Supichaya
128
Reid, Gregor
Ng, Bee Ling
142,143
R
50,81
Reisinger, Keith S
69
Ng, PP
133
Risan, Nelly Amalia
121
Nirasawa, Mari
125
Robielos, Ranjelyn Castillo
144
Noknu, Suwiwan
122
Rossolini, Gian Maria
Nosaka, Shunsuke
127
Rostamzadeh, Zakieh Zakieh
O
72
122
S
Obinata, Kaoru
161
Saitoh, Akihiko
Ohishi, Tsutomu
161
Salahi, Rasool
171
Ohkawa, Natsuki
155
Salleh, Mohd. Azmi Mohd.
133
Ohta, Eiji
119
Sanaei, Anahita
160
Oikawa, Junko
129
Sasaki, Yuka
157
Okabe, Nobuhiko
44
Ortiz, Esteban
138,139
Osterhaus, Albert D.M.E.
Ozawa, Makoto
50,77
125
P
Schmitt, Heinz-Josef
Shafie, Norazita
Shah, Nitin
46,115,127,172
86
133
74
Shajary, Gholamreza
112
Shao, Pei-Lan
123
Pan, Chiun-Yen
152
Sharif, Aliraza
112
Pathak, Janak Lal
114
Shen, Ching Fen
152
Paul, Kilgore
131,132
Shih, Hsiang-Hung
145,160
Pei, Ren-Sheng
124
Shih, Shin-Ru
Penava, Semira
170
Shimizu, Toshiaki
155
Peng, Ching-Tien
146
Shin, Hea-Soon
120
Pengsaa, Krisana
130
Shin, Seon-Hee
120
Peruski, Leonard
122
Shirvani, Fariba
160
Peryoga, Stanza Uga
169
Shoji, Kensuke
Pirçon, Jean-Yves
122
Shu, Pei-Yun
Pokherel, Bharat Mani
114
Sitaposa, Pranee
125
Punpanich, Warunee
128
Skov, Robert Leo
56
Purniti, Ni Putu Siadi
131
Sojirarat, Kanokwan
180
89
115,127,172
58
125
Sonsuwan, Nuntigar
122
Tsao, Kuo-Chien
Srijuntongsiri, Sarunya
125
Tseng, Hsing-I
157
55
Tseng, Wei Chen
145
Su, Mei-Chi
146
Tsou, Tsung-Pei
123
Su, Wen Bin
138
Tudor-Williams, Gareth
Suardi, Adi Utomo
169
Steinbach, William J
Sudarwati, Sri
132,169
Suganuma, Hiroki
155
Sultan, Muhammad Ashraf
73
158,159
84
U
Udompornwattana, Songkiat
127
Ungcharoen, Ratchadaporn
131
Usman, Javaid
115,120,147
Sun, Chung-Shu
123
Sun, Jun-Ren
118
Van-Dyke, Melissa
Sung, Ji Yeon
121
Vellozzi, Claudia
61
Sung, Ki Woong
149
Verheij, Theo J. M.
66
Suntarattiwong, Piyarat
125
Voramongkol, Nipunporn
Sutchritpongsa, Sureelak
131
T
V
122
150
W
Wahab, Zubaidah Abdul
133
Tabaraie, Bahman
113
Wang, Aimin
154
Tagawa, Yuko
125
Wang, Cheng-Chieh
159
55
Wang, Chuanqing
154
Tamura, Daisuke
125
Wang, Qing Chuan
156
Tan, Boon Fatt
123
Wang, Shih-Min
152,167
85
Wang, Wei-Yao
118
Wang, Yi
154
Takahashi, Takashi
Tan, Tina Q
Tan, Woan-Lin
Tanaka, Junko
161
117,129,141
Wang, Yun F (Wayne)
77
Tanaka, Noboru
155
Wei, Sung-Tsan
116
Tang, Chia-Wan
152
Weiser, Jeffrey N
63
Tang, Haiwen
140
Wong, Chris
86
Tang, Mei Hui
151
Woo, Patrick
78
Tanuwidjaja, Finia Cahayasari
168
Wu, Bingbing
147
Tay, Eng-Hseon
85
Wu, Fang-Tzy
67
Teyssou, RГ©my
60
Wu, Hsin-Lin
123
Thacker, Naveen Hariram
68
Wu, RWK
113
Wu, Shu Fen
146
Wu, Yi-Hui
152
Wulandari, Diah Asri
169
Thahirah, Jamal Mohd
Thisyakorn, Usa
Touil-Boukoffa, Chafia
Treeratweeraphong, Vipa
150
83,130,135,139
83,165
128
181
X
Yoo, Keon Hee
149
Yotani, Nobuyuki
127
Yow, CMN
113
69,82
Yu, Chun-Keung
167
Yan, Feng Gang
156
Yu, Meng-Kung
146
Yang, Jun Won
164
Yu, Ta-Wen
140
Yang, Mi Ae
121
Yun, Ki Wook
121
Yang, San-Nan
157
Xu, Jin
144
Y
Yamamoto, Taysuo
Yamashiro, Yuichiro
Yang, Yi
119
144,147,154
Z
Zaoutis, Theoklis
54,76
Yang, Yung Ning
157
Zeng, Tian De
138
Yao, Yi-Chuan
166
Zhang, Shu Min
138
Yasin, Rohani Md
133
Zhang, Yan Ping
138
Yi, Ho Keun
164
Zhong, Huaqing
144
Yoneda, Syoko
156
182
Taiwan Attraction
Tour information will be provided at the information counter, 1st floor of the Congress
Venue. You could get detailed information at this counter, including tour options,
opening hours, public transportation to the locations, train and bus schedules. In
Taiwan, you could find many appealing and exciting sights and locations that are
definitely worth visiting.
Taipei 101, the landmark of Taipei city, is also one of the tallest skyscrapers in the
world. It houses stylish fashion boutiques, fine restaurants and top corporate offices. It is
also known as the Taipei Financial Center, which is a consortium of local banking,
financial firms, and even the Taiwan Stock Exchange
The Lungshan (Dragon Mountain) Temple, first built 200 years ago covering a large
area in the old Wanhua section of Taipei, is deservedly one of the most famous landmarks
and tourist attractions on the island of Taiwan. So large are the crowds sometimes that
they interfere with religious ceremonies, in particular the Fahui, which requires a solemn
atmosphere for the nuns to pray for the dead and ask for good fortune and safety from
disaster for the worshippers. Many shops and stands in the Lungshan Temple market serve
all kinds of cheap but delicious Taiwanese food, particularly seafood. Peak business hours
are in the evening, as they are in the nearby Huahsi Street, or the "Snake Alley" as it has
come to be known.
Danshuei is located in northwest of Taipei basin and surrounded by mountains and
rivers. Walking on the old streets along Danshuei riverbank, visitors may view the old
buildings, try the tasty local dishes, and take the boat ride along the river. Fisherman's
Wharf is a multi-purpose leisure fishing port developed by the Taipei County
Government. In the evening, this is the best place to watch the view of the sunset.
Tourists can take MRT Danshuei Line, get off at the Danshuei Station to Danshuei town,
and take a "Red 26" bus to get to Fisherman’s Wharf. For more information, please visit
http://202.39.225.132/jsp/Eng/html/search/index.jsp
Yangmingshan National Park is renowned for its wealth of unusual volcanic features
and topography. Being so accessible and close to Taipei City, the park attracts a very
large number of visitors every year. Over the years the National Park Headquarters has
put considerable energy into managing the park's resources. A national park of such kind
is not only unique in Taiwan but also rare in the world. For more information, please visit
http://www.ymsnp.gov.tw/HTML/ENG/INDEX.ASP
183
Shi Lin Night Market is one of the most famous night markets in Taipei, making it a
long-time favorite among residents and tourists, locals and foreigners. The food there is
just simply too delicious to pass up. Almost any imaginable product, not to mention any
kind of food, can be found there. The products are of good quality and quite inexpensive,
so that you're sure to get your money's worth.Visitors can reach there by MRT- Danshui
Line, and get off at Jiantan Station. For more information, please visit
http://202.39.225.132/jsp/Eng/html/attractions/index.jsp
The Alishan National Scenic Area, situated in Chiayi County, is home to at least
two indigenous aboriginal tribes whose language, culture and history differs vastly from
the majority of Taiwan's residents. The Alishan Forest Railway was built between 1906
and 1915 for the purpose of logging. Even though the logging has stopped, the train still
operates, mainly as a tourist attraction for its spectacularly scenic, and a marvel of
engineering. With a length of 72km, the narrow-gauge tracks climb from an elevation of
30m to 2274m, passing through 50 tunnels and crossing 80 bridges, and it actually
executes three 360 degree turns as snakes around the mountain in a spiral arc. Please
contact +886-5-276-8094 (International) or 05-276-8094 (domestic) for tickets
reservations. For more information about schedules and prices, please visit
http://www.ali.org.tw/en/train/train.php
Sun Moon Lake, the largest lake in Taiwan as well as a popular tourist attraction, is
situated in Yuchih, Nantou. The area around the lake is home to the Thao tribe, one of
thirteen aboriginal tribes in Taiwan. Surrounded by green mountains, Sun Moon Lake is
the pearl of Central Taiwan. The Eastern part of the lake is round like the sun, while the
Western part is shaped like a crescent moon, hence the name "Sun Moon Lake". From
Taipei to Sun Moon Lake, you can take the direct bus (Kuo-kuang Bus) near the Taipei
Train Station from 06:00 AM~ 22:00 PM daily for NT$465 per person. Tourist
Information for Sun Moon Lake: http://www.sunmoonlake.gov.tw/
Taroko National Park, in the northeastern part of the island – Hualien County, faces
the Pacific Ocean to the east. Spectacular Taroko Gorge and the scenic beauty of the
Liwu River can be viewed conveniently from the Central Cross-Island Highway. The
many waterfalls, diverse forms of plant and animal life, and the indigenous people,
together create the rich texture of this unique natural ecosystem. From Taipei to
Hualien: Tzu-chiang (express train): The price is NT$ 445 / person for one way. It takes
2.5 hrs to 3 hrs depending on the type of train. The Hualien train station is 26k m / 15.6
miles from the Park Headquarters. It takes you 30 ~ 40 minutes to get to the Park
Headquarters. You can also take Hualien Bus to the Park Headquarters. The bus stop is
to the right of Hualien Train Station exit (front station). Internet ticketing (from 6:00AM
to 21:00PM): http://railway.hinet.net/
184
Sponsor Acknowledgement
Government & NGO
Diamond
Platium
Gold
Others
185
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