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 вЂ“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 TonyвЂ™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 AвЂ”National Taiwan University ChildrenвЂ™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 ChildrenвЂ™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 BвЂ”Chang Gung ChildrenвЂ™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 MapвЂ”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 вЂњONE-DAY PASSвЂќ 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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”Sep. 24 Infection in Taiwan Day 3 Friday, September 24 Detailed Scientific ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 ProgramвЂ”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 вЂ“ 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 CalmetteвЂ“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 WenвЂ™en LIU, Zhen-hua CHEN, Zi-Juan JIAN, Qian GAO, Ming-Xiang ZOU, Xiang-Hui LIANG, Yuan-Yuan LIU 31 Detailed Scientific ProgramвЂ”Sep. 25 13:30-15:30 Day 4 Saturday, September 25 (China) Detailed Scientific ProgramвЂ”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 ProgramвЂ”Sep. 25 SS17-04 Long-term Immune Memory of Hepatitis B Vaccine Day 5 Sunday, September 26 Detailed Scientific ProgramвЂ”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 ChildrenвЂ”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 ProgramвЂ”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 PirГ§on, 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 CatheterвЂ“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 InfantsвЂ™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 peopleвЂ™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 TaiwanвЂ™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 50вЂ“54 year age range, and dengue hemorrhagic fever in the 60вЂ“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 2004вЂ“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 ChildrenвЂ™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 в‰Ґ5/5X104 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 recipientsвЂ™ 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 weвЂ™re unable to mimic it to develop a HIV vaccine. Per Jose Esparza, we have to be вЂњbetter than natureвЂќ. 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 вЂњrationalistвЂќ 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 вЂњempiricistsвЂќ. 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 ChildrenвЂ™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 100вЂ“200 cases per 100,000 children aged <1 or 2 years. Incidences of preventable disease are estimated to be 6вЂ“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 вЂ“ 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 вЂњnewвЂќ 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 вЂњherd immunityвЂќ). 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 ChildrenвЂ™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 вЂњsalvage therapy.вЂќ 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 16вЂ“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 вЂњtoday's CA-MRSA may become tomorrowвЂ™s HA-MRSAвЂќ 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 вЂњhumanвЂќ 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 ChildrenвЂ™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 вЂ“ 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 вЂ“ 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 1920вЂ™s and numerous approaches have been considered. Today, the most advanced vaccine candidateвЂ”a tetravalent, live attenuated, YF17D-based recombinant dengue virus vaccineвЂ”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 вЂњmatureвЂќ with high immunization rates and successfully reduce the incidence of their target VPDвЂ™s, however, adverse events following immunizations (AEFIвЂ™s) become relatively more prominent. AEFIвЂ™s can be either caused by the vaccine or purely coincidental. Such vaccine safety concerns вЂ” if not properly studied and managed вЂ” 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 1970вЂ™s, measles-containing vaccine in the United Kingdom in the 1990вЂ™s, hepatitis B vaccine in France in the 1990вЂ™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 groupвЂ™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: 1.12вЂ“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 BellвЂ™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 countryвЂ™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 вЂ�asymptomaticвЂ™ colonizer of its human host (the carrier state), with transmission occurring exclusively from this reservoir of commensal organisms. Thus, it is unclear how the organismвЂ™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 вЂњjudicious use of antibioticsвЂќ. A second method is the recommendation of вЂњwatchful waitingвЂќ 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, UniversitГ degli Studi di Milano, Fondazione IRCCS CaвЂ™ 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 patientвЂ™s temperature, cough, anterior cervical adenopathy, tonsillar swelling or exudates and childвЂ™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 вЂ“ 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 вЂ“ 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 вЂ“ 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 вЂ“ 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 worldвЂ™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 вЂ“ 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 вЂњto ensure that no child will ever again be paralysed by either a wild or vaccine-derived poliovirus.вЂќ 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 1980вЂ™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 вЂ“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 ChildrenвЂ™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 weeksвЂ™ 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 вЂ“ 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, в‰Ґ30 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 вЂ“ 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 вЂ�probioticвЂ™. 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 ChildrenвЂ™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 hostвЂ™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 intestineвЂ™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 toвЂќMTCT-Plus InitiativeвЂќ 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 vaccinesвЂ™ 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 вЂ�conflictingвЂ™ 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 вЂ“ Polysaccharide conjugate vaccines may overcome these deficiencies. In the late 1990вЂ™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 titerв‰§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 вЂ“ 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 (в‰Ґ 4 days), the more severe dengue infection and age (в‰¤ 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, ChildrenвЂ™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 ChildrenвЂ™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 ChildrenвЂ™s Hospital, Linkou, Taoyuan; 4. National Cheng-Kung University Hospital, Tainan; 5. Mackay Memorial Hospital, Taipei; 6. Department of Pediatrics, Chang-Gung ChildrenвЂ™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 в‰Ґ5/5X104 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 recipientsвЂ™ 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 в‰¤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 в‰Ґ3 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 в‰Ґ3 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 в‰Ґ3 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 ChildrenвЂ™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 12вЂ“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 5вЂ“22 fold higher post-booster than pre-booster (12.4 fold higher for 18C; Co-ad group). All children reached antibody concentrations в‰Ґ0.2 Вµg/mL, except for 6B (в‰Ґ96.0%) and 23F (в‰Ґ97.5%), and в‰Ґ92.9% of children reached OPA titres в‰Ґ8 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 в‰Ґ0.2 Вµg/mL, and at least 82.4% and 70.2% of children reached OPA titres в‰Ґ8. 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 12вЂ“23 months. FP4-01 Disseminated Bacillus CalmetteвЂ“GuГ©rin 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 CalmetteвЂ“GuГ©rin (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, childrenвЂ™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 в‰¦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 вЂњNeonatal bacterial infections screening scoresвЂќ for each new patient admitted to the neonatal intensive care unit (NICU) to guide antibiotics use. METHODS: вЂњNeonatal bacterial infections screening scoresвЂќ 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 вЂњNeonatal bacterial infections screening scoresвЂќ 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 WenвЂ™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 (в‰Ґ256Вµg). 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 ChildrenвЂ™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 ChildrenвЂ™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 вЂ“ 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 ChildrenвЂ™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 в‰¦ 20 mg/dL and 43.7% (121/277) reported CSF to blood glucose ratio в‰¦ 66.7%. Furthermore, 47.6% (132/277) had CSF protein level в‰§250 mg/dL and 89.5% (256/286) had WBC count в‰§ 5/HPF microscopically. Therefore, patients with low CSF glucose level (в‰¦20 mg/dL), high CSF protein (в‰§ 250 mg/dL), and low Serum Na+ levels (в‰¦ 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 (в‰¦20 mg/dL), high CSF proteins (в‰§ 250 mg/dL), and low Serum Na+ levels (в‰¦ 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 ChildrenвЂ™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 JapanвЂ™s most common causative agent for pyogenic arthritis. 121 P1-017 Bacterial Infection Epidemiology of Burn Unit Infection in a ChildrenвЂ™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 WomenвЂ™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 childrenвЂ™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 вЂњstrongly considered вЂќfor infants aged <12 months and вЂњconsideredвЂќ 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 в‰¤ 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 в‰¤ 12 months and 12-18 months of age. From all febrile seizure patients, 9 children (11,4%) experienced в‰Ґ 15 min seizure, 2 of them were diagnosed having bacterial meningitis. There was no difference in в‰Ґ 15 min seizure between bacterial meningitis group and no bacterial meningitis. (FisherвЂ™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. (FisherвЂ™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 PirГ§on6, 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 в‰Ґ3 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 ChildrenвЂ™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 authorвЂ™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 ChildrenвЂ™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 (MICв‰¦1Ојg/mL) and seventy-five isolates were intermediate resistant (1Ојg/mL <MIC<4Ојg/mL). There were only six isolates with MICв‰¦0.1Ојg/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 в‰Ґ39.0В°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 в‰Ґ40 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 в‰Ґ39.0В°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 в‰Ґ 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 в‰Ґ39.0В°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 вЂ“ Jan 8, 2009), in children from 28d to 60m old. Eligibility criteria: children residing within the catchment area with temperature в‰Ґ39.0В°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 в‰¤ 5 years can be protected by the available PCV7, PCV10 and PCV13 respectively. The coverage rate is higher for children в‰¤ 2 years, 53.66%, 68.29% and 95.12% by PCV7, PCV10 and PCV13 respectively. Penicillin MIC ranged from в‰¤ 0.016 to 4.0Ојg/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 в‰Ґ 2Вµg/m). However based on individual isolateвЂ™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) (в‰Ґ10 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 в‰Ґ10 94.0 96.1 mIU/mL (88.6;97.4) (91.1;98.7) 90.7 97.8 Anti-PRP в‰Ґ0.15 Вµg/mL (84.6;95.0) (93.8;99.5) Anti-Diphtheria в‰Ґ0.01 99.3 97.1 IU/mL (96.2;100.0) (92.7;99.2) Anti-Tetanus в‰Ґ0.01 100.0 100.0 IU/mL (97.5;100.0) (97.4;100.0) 97.7 97.9 Anti-Polio 1 в‰Ґ8 (1/dil) (91.9;99.7) (92.5;99.7) 94.7 94.0 Anti-Polio 2 в‰Ґ8 (1/dil) (86.9;98.5) (86.5;98.0) 97.4 100.0 Anti-Polio 3 в‰Ґ8 (1/dil) (90.8;99.7) (95.4;100.0) Anti-PT (EU/mL) 93.6 94.2 в‰Ґ4-fold increase (88.2;97.0) (89.0;97.5) Anti-FHA (EU/mL) 81.9 83.1 в‰Ґ4-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 (в‰Ґ10 mIU/mL) and PRP (в‰Ґ0.15 Вµg/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 в‰Ґ0.15 Вµg/mL (92.6;98.5) 97.4 (93.9;99.1) 100.0 Anti-Diphtheria в‰Ґ0.01 IU/mL (98.1;100.0) 100.0 100.0 Anti-Tetanus в‰Ґ0.01 IU/mL (98.1;100.0) (98.1;100.0) 100.0 100.0 Anti-Polio 1 в‰Ґ8 (1/dil) (98.0;100.0) (98.0;100.0) 100.0 100.0 Anti-Polio 2 в‰Ґ8 (1/dil) (98.0;100.0) (98.0;100.0) 100.0 99.5 Anti-Polio 3 в‰Ґ8 (1/dil) (98.0;100.0) (97.0;100.0) Anti-PT (EU/mL) в‰Ґ4-fold 93.7 (89.2;96.7) 93.7 increase (89.2;96.7) Anti-FHA (EU/mL) в‰Ґ4-fold 94.7 (90.4;97.4) 95.2 increase (91.1;97.8) Anti-Hep B в‰Ґ10 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 в‰Ґ100 mIU/mL was 98.4 and 99.5% (GMTs 2477 and 2422 mIU/mL) and for antiвЂ“PRP в‰Ґ1.0 Вµg/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 infantвЂ™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 PeoplesвЂ™ 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 в‰Ґ0.15 Вµg/mL (RIA) Anti-PT titer в‰Ґ4-fold increase (EIA) Anti-FHA titer в‰Ґ4-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* вЂ 100 95.2* вЂ 97.4 80.4* вЂ 98.0 89.9* вЂ 99.6 85.5* вЂ 89.1 92.4* вЂ 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; вЂ 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 в‰Ґ0.01 IU/mL (SN) Anti-Tetanus в‰Ґ0.01 IU/mL (EIA) Anti-Polio 1 в‰Ґ8 (1/dil) (SN) Anti-Polio 2 в‰Ґ8 (1/dil) (SN) Anti-Polio 3 в‰Ґ8 (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 вЂ�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=0.97вЂ“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 вЂ�horizontalвЂ™ 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 ChildrenвЂ™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.1вЂ“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 в‰Ґ0.2 Ојg/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 GSKвЂ™s 22F-inhibition ELISA and opsonophagocytic assays (OPA).1вЂ“3 MAIN RESULTS: For common vaccine serotypes, antibody concentrations в‰Ґ0.2Ојg/mL were observed in в‰Ґ91.2% of PHiD-CV and в‰Ґ86.3% of 7vCRM vaccinees (Table 1); and OPA titres в‰Ґ8 were observed in в‰Ґ87.3% of PHiD-CV and в‰Ґ90.2% of 7vCRM vaccinees in each study (Table 2).1вЂ“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 (в‰Ґ0.15 Ојg/mL) [anti-PRP antibody GMCs: PHiD-CV, 20.131 Ојg/mL (16.775вЂ“24.158); 7vCRM, 11.844 Ојg/mL (8.542вЂ“16.424)]. All PHiD-CV subjects, except one each in Korea and Taiwan trials, were seropositive (в‰Ґ100 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 (1.5вЂ“3вЂ“6 months) N = 219 99.5 (97.5вЂ“10 0) 95.4 (91.8вЂ“97. 8) 100 (98.3вЂ“10 0) 99.5 (97.5вЂ“10 0) 100 (98.3вЂ“10 0) 100 (98.3вЂ“10 0) 1 5 7F 6A 19A 97.2 (94.1вЂ“99. 0) 100 (98.3вЂ“10 0) PHiD-CV Philipp ines (6вЂ“10вЂ“ 14 weeks) N= 285 99.3 (97.5вЂ“9 9.9) 91.2 (87.3вЂ“9 4.2) 99.6 (98.1вЂ“1 00) 100 (98.7вЂ“1 00) 99.6 (98.1вЂ“1 00) 100 (98.7вЂ“1 00) 97.2 (94.5вЂ“9 8.8) 100 (98.7вЂ“1 00) 7vCRM Korea (2вЂ“4вЂ“6 month s) N= 344 Philipp ines (6вЂ“10вЂ“ 14 weeks) N = 95 99.7 (98.4вЂ“1 00) 100 (96.2вЂ“1 00) 92.4 (89.1вЂ“9 5) 99.7 (98.4вЂ“1 00) 99.4 (97.9вЂ“9 9.9) 99.7 (98.4вЂ“1 00) 98.8 (97.0вЂ“9 9.7) 96.2 (93.6вЂ“9 8.0) 100 (98.9вЂ“1 00) 86.3 (77.7вЂ“9 2.5) 100 (96.2вЂ“1 00) 100 (96.2вЂ“1 00) 100 (96.2вЂ“1 00) 98.9 (94.3вЂ“1 00) 94.7 (88.1вЂ“9 8.3) 3.2 (0.7вЂ“9. 0) 100 (98.3вЂ“10 0) 100 (98.7вЂ“1 00) 100 (98.9вЂ“1 00) 3.2 (0.7вЂ“9. 0) 100 (98.3вЂ“10 0) 78.5 (72.5вЂ“83. 8) 99.6 (98.1вЂ“1 00) 63.2 (57.3вЂ“6 8.8) 100 (98.9вЂ“1 00) 67.4 (62.2вЂ“7 2.4) 9.5 (4.4вЂ“17 .2) 56.8 (46.3вЂ“6 7.0) PHiD-CV Pne um oco ccal Ser oty pes Korea (2вЂ“4вЂ“6 months) N = 123 100 (97вЂ“100) 4 98.4 (94.2вЂ“99. 8) 6B 9V 99.2 (95.6вЂ“100 ) 14 18C 100 (97.0вЂ“100 ) 19F 23F 100 (97.0вЂ“100 ) 100 (97.0вЂ“100 ) 98.4 (94.2вЂ“99. 8) 5.7 (2.3вЂ“11.4) 1 14.6 (8.9вЂ“22.1) 5 3.3 (0.9вЂ“8.1) 7F 69.1 (60.1вЂ“77. 1) 64.7 68.4 59.0 45.3 26.8 (57.9вЂ“71. (62.7вЂ“7 (53.6вЂ“6 (35.0вЂ“5 (19.2вЂ“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 (1.5вЂ“3вЂ“ 6 month s) N= 103 100 (96.5вЂ“1 00) Philip pines (6вЂ“10вЂ“ 14 weeks) N= 142 Korea (2вЂ“4вЂ“6 month s) N= 165 Philip pines (6вЂ“10вЂ“ 14 weeks) N = 46 Korea (2вЂ“4вЂ“6 month s) N = 63 99.3 (96.0вЂ“1 00) 98.1 (94.7вЂ“9 9.6) 100 (91.8вЂ“1 00) 100 (94.3вЂ“1 00) 87.3 (79.2вЂ“9 3.0) 93.0 (87.4вЂ“9 6.6) 93.8 (88.9вЂ“9 7.0) 93.0 (80.9вЂ“9 8.5) 100 (94.3вЂ“1 00) 100 (96.3вЂ“1 00) 100 (97.2вЂ“1 00) 99.4 (96.7вЂ“1 00) 100 (91.8вЂ“1 00) 98.4 (91.5вЂ“1 00) 99.0 (94.7вЂ“1 00) 97.2 (92.9вЂ“9 9.2) 98.8 (95.7вЂ“9 9.9) 93.5 (82.1вЂ“9 8.6) 98.4 (91.5вЂ“1 00) 98.0 (93.0вЂ“9 9.8) 99.3 (96.1вЂ“1 00) 89.3 (83.4вЂ“9 3.6) 100 (92.1вЂ“1 00) 96.8 (89.0вЂ“9 9.6) 98.1 (93.2вЂ“9 9.8) 98.6 (94.9вЂ“9 9.8) 97.0 (93.0вЂ“9 9.0) 91.3 (79.2вЂ“9 7.6) 90.2 (79.8вЂ“9 6.3) 96.1 (90.3вЂ“9 8.9) 96.1 (90.3вЂ“9 8.9) 100 (97.4вЂ“1 00) 82.4 (75.1вЂ“8 8.3) 97.6 (93.9вЂ“9 9.3) 92.6 (87.4вЂ“9 6.1) 97.7 (87.7вЂ“9 9.9) 2.2 (0.1вЂ“11 .5) 98.4 (91.5вЂ“1 00) 12.9 (5.7вЂ“23 .9) 99.0 (94.7вЂ“1 00) 99.3 (96.1вЂ“1 00) 97.6 (93.9вЂ“9 9.3) 0.0 (0.0вЂ“7. 7) 9.7 (3.6вЂ“19 .9) 100 (96.5вЂ“1 00) 89.7 (81.9вЂ“9 4.9) 100 (97.3вЂ“1 00) 71.7 (63.0вЂ“7 9.3) 100 (97.8вЂ“1 00) 84.8 (78.2вЂ“9 0.0) 22.7 (11.5вЂ“3 7.8) 79.1 (64.0вЂ“9 0.0) 67.8 (54.4вЂ“7 9.4) 90.0 (79.5вЂ“9 6.2) 39.2 25.5 32.7 2.3 11.7 (29.4вЂ“4 (18.5вЂ“3 (25.6вЂ“4 (0.1вЂ“12 (4.8вЂ“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 StudentвЂ™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 worldвЂ™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 5вЂ™ UTR primers. For parechovirus typing, samples positive by the 5вЂ™ 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 вЂ“ 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, ChildrenвЂ™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 ChildrenвЂ™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 parentsвЂ™ 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 childвЂ™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 childвЂ™s gastro-enteritis has a serious impact on the parentsвЂ™ 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 ChildrenвЂ™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 ChildrenвЂ™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 5вЂ™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, McNemarвЂ™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 patientвЂ™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 вЂ“ 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 childrenвЂ™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 motherвЂ™s blood and vaginal samples. On day 4, the patientвЂ™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 ChildrenвЂ™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, itвЂ�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 в‰§ 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: 0.3вЂ“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 CoombsвЂ™ 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-EBVвЂ“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, physicianвЂ™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 nГ¤ive) 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 patientsвЂ™ 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 ChildrenвЂ™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 workersвЂ™ 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 вЂњCytokines and NOSynthasesвЂќ, 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 worldвЂ™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 hostвЂ™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) вЂ• 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 DulbeccoвЂ™s modified EagleвЂ™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, itвЂ™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 havenвЂ™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 в‰Ґ15.500/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 в‰Ґ 38В°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 StudentвЂ™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 в‰Ґ39oC 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 в‰Ґ15.500/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 "BerriesвЂњ 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 InfantsвЂ™ 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. ItвЂ™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 (в‰Ґ256Вµg). 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 PirГ§on, 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 FishermanвЂ™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$465 per person. Tourist Information for Sun Moon Lake: http://www.sunmoonlake.gov.tw/ Taroko National Park, in the northeastern part of the island вЂ“ Hualien County, faces the Pacific Ocean to the east. Spectacular Taroko Gorge and the scenic beauty of the Liwu River can be viewed conveniently from the Central Cross-Island Highway. The many waterfalls, diverse forms of plant and animal life, and the indigenous people, together create the rich texture of this unique natural ecosystem. From Taipei to Hualien: Tzu-chiang (express train): The price is NT$ 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