A Newborn Baby with Cyanosis and Persistent Lung Infiltration (SNUCH CPC-37)

(Clinicopathologic Conference)This female newborn baby was transferred from a private OB/GY Clinic to SOWHA Children's Hospital NICU on her second day of life, because of low birth weight and cyanosis. She was born via vaginal route at the gestational age of 29 weeks to a 28-year-old primigradiva on Nov. 21, 1987. On physical examination, the body weight was 1,900gm, height 46cm, head circumference 30cm and chest circumference 28cm. The estimated gestational age was 30-32 weeks by Ballard scoring system. The body temperature was 36.8C, pulse rate 140/min and respiratory rate 64/min. The baby cried weakly. Peripheral cyanosis was noticed. The anterior fontanel was open and flat. The neck was supple. Chest wall retraction was prominent. Breathing sounds were coarse. Heart beats were regular, and no murmur was audible. The abdomen was soft without distension. The liver and the spleen were not palpable. General activity, Mora and sucking reflexes were poor

Immunization decision-making in the Republic of Korea: The structure and functioning of the Korea Advisory Committee on Immunization Practices

AbstractThe Korea Advisory Committee on Immunization Practices (KACIP), established by law in the early 1990s, makes recommendations on a range of issues related to the National Immunization Program. The Committee consists of 15 members and always includes the two government officials who belong to the Korea Centers for Disease Control and Prevention and the Korea Food and Drug Administration. Other members usually come from affiliated organizations and serve for 2-year terms. The KACIP depends on special-topics sub-committees or temporary advisory committees to gather and analyze data and to make recommendations which are normally reached by consensus and implemented by public sector health providers and private providers

Immunogenicity of Haemophilus influenzae Type b Conjugate Vaccines in Korean Infants: A Meta-analysis

A meta-analysis was performed on the immunogenicity of Haemophilus influenzae type b (Hib) conjugate vaccines after 2 (2 and 4 months) and 3 doses (2, 4, and 6 months) in Korean infants. A database search of MEDLINE, KoreaMed, and Korean Medical Database was done. The primary outcome measure was the proportion of infants with anti-polyribosylribitol phosphate (PRP) concentrations >= 1.0 mu g/mL. Eight studies including eleven trials were retrieved. One trial reported on the diphtheria toxoid conjugate vaccine (PRP-D) and 2 trials each on the mutant diphtheria toxin (PRP-CRM) and Neisseria meningitidis outer-membrane protein (PRP-OMP) conjugate vaccine. Heterogeneity in study designs between trials on PRP-CRM was noted and one trial reported on a monovalent and another on a combination PRP-OMP vaccine. Thus, a meta-analysis was conducted only on the tetanus toxoid conjugate vaccine (PRP-T). After a primary series of 2 doses and 3 doses, 80.6% (95% confidence interval [CI]; 76.0-85.1%) and 95.7% (95% CI; 94.0-98.0%) of infants achieved an antibody level >= 1.0 mu g/mL, respectively. The immunogenic response to the PRP-T vaccine was acceptable after a primary series of 3 doses and also 2 doses. A reduced number of doses as a primary series could be carefully considered in Korean infants.Kim KH, 2008, J KOREAN MED SCI, V23, P929, DOI 10.3346/jkms.2008.23.6.929Rossi IA, 2007, VACCINE, V25, P7075, DOI 10.1016/j.vaccine.2007.07.058Obonyo CO, 2006, EUR J CLIN MICROBIOL, V25, P90, DOI 10.1007/s10096-006-0092-4*WHO, 2006, WKLY EPIDEMIOL REC, V81, P445CHUNG EH, 2006, KOREAN J PEDIAT INFE, V13, P163Kelly DF, 2004, IMMUNOLOGY, V113, P163, DOI 10.1111/j.1365-2567.2004.01971.xKim JS, 2004, VACCINE, V22, P3952, DOI 10.1016/j.vaccine.2004.04.003WENGER JD, 2004, VACCINES, P229Makela PH, 2003, VACCINE, V22, P287, DOI 10.1016/S0264-410X(03)00524-3CHUNG EH, 2003, KOREAN J PEDIAT INFE, V10, P71YANG PS, 2002, J KOREAN PEDIAT SOC, V45, P987*CDCP, 2002, MMWR-MORBID MORTAL W, V51, P234Granoff DM, 2001, CLIN INFECT DIS, V33, pS278Peltola H, 2000, CLIN MICROBIOL REV, V13, P302Moher D, 1999, LANCET, V354, P1896Peltola H, 1999, J INFECT DIS, V179, P223CHOI SY, 1999, J KOREAN PEDIAT SOC, V42, P771Heath PT, 1998, PEDIATR INFECT DIS J, V17, pS117Lagos R, 1998, LANCET, V351, P1472Mulholland K, 1997, LANCET, V349, P1191Kurikka S, 1996, J PEDIATR, V128, P524KIM JS, 1996, KOREAN J INFECT DIS, V28, P225YOO ES, 1995, J KOREAN PEDIAT SOC, V38, P1201DECKER MD, 1992, J PEDIATR, V120, P184SANTOSHAM M, 1991, NEW ENGL J MED, V324, P1767ESKOLA J, 1990, NEW ENGL J MED, V323, P1381LAIRD NM, 1990, INT J TECHNOL ASSESS, V6, P5DERSIMONIAN R, 1986, CONTROL CLIN TRIALS, V7, P177ANDERSON P, 1984, J INFECT DIS, V149, P1034KAYHTY H, 1983, J INFECT DIS, V147, P1100

Prevalence and Genetic Structures of Streptococcus pneumoniae Serotype 6D, South Korea

To determine prevalence and genetic structures of new serotype 6D strains of pneumococci, we examined isolates from diverse clinical specimens in South Korea during 1991–2008. Fourteen serotype 6D strains accounted for 10.4% of serogroup 6 pneumococci from blood, sputum, nasopharynx, and throat samples. Serotype 6D strains consisted of 3 sequence types

Active Surveillance of Adverse Events Following Immunization against Pandemic Influenza A (H1N1) in Korea

SUMMARY: Surveillance of vaccine safety is one of the public health interventions used to investigate the causal relationship between vaccines and adverse events. Using active surveillance data, we aimed to compile a detailed summary describing the safety of the pandemic influenza A (H1N1) vaccine. Computer-assisted telephone interview was used to investigate adverse events for 9,000 subjects who ha

Outbreak of Shewanella algae and Shewanella putrefaciens infections caused by a shared measuring cup in a general surgery unit in Korea

OBJECTIVE: To control an outbreak of Shewanella algae and S. putrefaciens infections by identifying the risk factors for infection and transmission. DESIGN: Matched case-control study. SETTING: A university-affiliated tertiary acute care hospital in Seoul, Republic of Korea, with approximately 1,600 beds. PATIENTS: From June 20, 2003, to January 16, 2004, a total of 31 case patients with Shewanella colonization or infection and 62 control patients were enrolled in the study. INTERVENTIONS: Requirement to use single-use measuring cups and standard precautions (including hand washing before and after patient care and use of gloves). RESULTS: S. algae or S. putrefaciens was isolated from blood, for 9 (29.0%) of 31 patients who acquired one of the organisms; from bile, for 8 (25.8%), and from ascitic fluid, for 8 (25.8%). The attack rate of this outbreak was 5.8% (31 patients infected or colonized, of 534 potentially exposed on ward A) and the pathogenicity of the two species together was 77.4% (24 patients infected, of 31 who acquired the pathogens). The estimated incubation period for Shewanella acquisition was 3-49 days. Using logistic analysis, we identified the following risk factors: presence of external drainage catheters in the hepatobiliary system (odds ratio [OR], 20; P < .001), presence of hepatobiliary disease (OR, 6.4; P < .001), admission to the emergency department of the hospital (OR, 2.9; P = .039), wound classification of "contaminated" or "dirty or infected" (OR, 16.5; P = .012), an American Society of Anesthesiologists score of 3 or higher (OR, 8.0; P = .006), duration of stay in ward A (OR, 1.1; P < .001), and, for women, an age of 60-69 years (OR, 13.3; P = .028). A Shewanella isolate was recovered from the surface of a shared measuring cup, and 12 isolates of S. algae showed the same pulsed-field gel electrophoresis pattern. CONCLUSIONS: This Shewanella outbreak had a single-source origin and spread by contact transmission via a contaminated measuring cup. Shewanella species are emerging as potentially serious human pathogens in hospitals and could be included in hospital infection surveillance systems

Pulmonary tuberculosis in infants: radiographic and CT findings

OBJECTIVE: As complications of tuberculosis are frequent in infancy, correct diagnosis of tuberculosis in infants is important. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and to determine the radiologic features frequently seen in infants with this disease. CONCLUSION: Frequent radiologic findings of pulmonary tuberculosis in infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within the consolidation. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT is a useful diagnostic technique in infants with tuberculosis because it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected

Detection of genetic mutations associated with macrolide resistance of Mycoplasma pneumoniae

Purpose : The aim of this study was to identify mutations associated with macrolide resistance in Mycoplasma pneumoniae (MP) and to establish a cultural method to determine antimicrobial susceptibility. Methods : Nasopharyngeal aspirates (NPAs) were collected from 62 children diagnosed with MP pneumonia by a serologic method or polymerase chain reaction. The 23S rRNA and L4 ribosomal protein genes of MP were amplified and sequenced. To identify mutations in these 2 genes, their nucleotide sequences were compared to those of the reference strain M129. MP cultivation was carried out for 32 (28 frozen and 5 refrigerated) NPAs and M129 strain using Chanock’s glucose broth and agar plate in a 5&#37; CO2 incubator at 37?#608;and examined at 2-3 day intervals for 6 weeks. Results : Among the 62 specimens, 17 had M144V mutations in ribosomal protein L4. The A2064G mutation was observed in 1 specimen&#59; its 23S rRNA gene was successfully sequenced. Culture for MP was successful from the M129 strain and 2 of the 5 NPAs that were refrigerated for no longer than 3 days. However, MP did not grow from the 28 NPAs that were kept frozen at -80?#608;since 2003. Conclusion : We found the M144V mutation of L4 protein to be common and that of domain V of 23S rRNA gene was relatively rare among MP. Studies on the prevalence of macrolide-resistant MP and the relationship between the mutations of 23S rRNA gene and ribosomal protein L4 will aid in understanding the mechanism of macrolide resistance in MP

Streptococcus pneumoniae Serotype 19A in Children, South Korea

A single, multidrug-resistant strain was responsible for increased incidence of this serotype before introduction of the pneumococcal 7-valent conjugate vaccine