Incidence of intussusception in Singaporean children aged less than 2 years: A hospital-based prospective study

10.1186/1471-2431-13-161BMC Pediatrics131-BPME

Rotavirus vaccine RIX4414 efficacy sustained during the third year of life: A randomized clinical trial in an Asian population

RIX4414 (Rotarix (TM)), has shown high efficacy during the first 2-years of life. A 2-year randomized, double-blind, placebo-controlled trial in Singapore, Hong Kong, and Taiwan was extended for another year. Infants (6-17 weeks) received 2-doses (1-2 months apart) of RIX4414 (n = 5359) or placebo (n = 5349). During the third-year follow-up, 4359 (RIX4414) and 4328 (placebo) infants were monitored. 64 (1.2%) and 2 (0.04%) infants in the placebo and RIX4414 groups, respectively, reported severe rotavirus-gastroenteritis (RVGE), resulting in a vaccine efficacy of 96.9% (95% CI [88.3-99.61). Efficacy was 100% (67.5-100) in the third-year. RIX4414 was efficacious against G1 (100.0% [84.8-100]) and pooled non-G1 RV types (94.9% 180.2-99.4]). This study shows that the vaccine is highly efficacious, regardless of circulating RV-types, up to the first 3 years of life in affluent Asian urban populations. (c) 2012 Elsevier Ltd. All rights reserved

Urinary reducing substances in neonatal intrahepatic cholestasis caused by citrin deficiency

Neonatal cholestasis due to citrin deficiency is an autosomal recessive metabolic disorder caused by mutations in SLC25A13 gene. Mutations in this gene have a relatively high prevalence in East-Asian races compared to European or Afro-Caribbean races. Mutations in both sets of chromosomes often lead to self-limiting early onset cholestasis and growth retardation referred as neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). It is associated with a wide range of metabolic derangements including galactosemia and aminoacidemia, which can be detected on the newborn blood spot screening. Galactose, being a reducing sugar, can also be detected using Clinitest® (Clinitest® Reagent Tablets, Bayer Corporation, Diagnostics Division, Elkhart, IN, USA), a common screening test used in the work up of metabolic and hepatic diseases. In the western population classical galactosemia is often suspected when non glucose reducing substances are detected in the urine of infants with cholestasis. However in East-Asian races the prevalence of classical galactosemia is very low whilst galactosemia due to altered uridine diphosphate-galactose epimerase activity in NICCD is more common. We present a case of NICCD in an East-Asian infant with cholestasis and persistently positive urine reducing substance. Conclusion: NICCD deficiency should be considered as a differential diagnosis in any infant with cholestasis and persistently positive urinary reducing substances

A Case of Kawasaki Disease With Concomitant Leptospirosis

A 7-year-old Malay girl was admitted to our institution presenting with fever for 4 days that was persistently above 38°C, with a maximum temperature of 39.9°C. This was associated with a papular and pruritic rash over her chest and limbs for 4 days, as well as a tender right neck swelling for 3 days, diarrhea, and bitemporal headaches for 2 days. This was accompanied by early morning vomiting and nausea, but no blurring of vision or other neurological deficits. She also had red eyes and a dry cough that was not accompanied by coryzal symptoms for 1 day. She initially presented to a family physician and was given 3 days of oral azithromycin. However, her right neck swelling grew in size and redness over the last 2 days prior to admission. It was reported that she did not have contact with any sick persons. However, she had travelled to South India a month ago.Published versio

A case of Kawasaki Disease with concomitant leptospirosis

A 7-year-old Malay girl was admitted to our institution presenting with fever for 4 days that was persistently above 38°C, with a maximum temperature of 39.9°C. This was associated with a papular and pruritic rash over her chest and limbs for 4 days, as well as a tender right neck swelling for 3 days, diarrhea, and bitemporal headaches for 2 days. This was accompanied by early morning vomiting and nausea, but no blurring of vision or other neurological deficits. She also had red eyes and a dry cough that was not accompanied by coryzal symptoms for 1 day. She initially presented to a family physician and was given 3 days of oral azithromycin. However, her right neck swelling grew in size and redness over the last 2 days prior to admission. It was reported that she did not have contact with any sick persons. However, she had travelled to South India a month ago.Published versio

Obstructive Uropathy in a Child with Severe Chronic Constipation

Urinary symptoms are well-described in children with chronic constipation which include enuresis, urgency and recurrent urinary infections. Renal tract obstruction is a rare complication of severe chronic constipation. We describe a case of a 10-year-old boy with a history of long-standing constipation who presented with obstructive uropathy. Treatment strategies involved intensive medical therapy, parental education, behaviour modification strategies and close follow-up in a specialised constipation clinic. The obstruction was reversed and medications were discontinued after six months. Successful management of children with chronic constipation involves a multi-disciplinary approach in a specialised constipation clinic

A rotavirus vaccine for prophylaxis against rotavirus gastroenteritis

Glaxo SmithKline Biologicals. Rixensart, Belgium.University of Tampere. Medical School. Tampere, Finland.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Universidad de Carabobo. Dr. Enrique Tejera. Ciudad Hospitalaria. Insalud, Valencia, Venezuela.Universidad Central de Venezuela. Instituto de Biomedicina. Caracas, Venezuela.Instituto Nacional de Ciencias Medicas y Nutricion. Mexico.Instituto Nacional de Ciencias Medicas y Nutricion. Mexico.KK Women’s and Children’s Hospital. Singapore.Glaxo SmithKline Biologicals. Rixensart, Belgium.Glaxo SmithKline Biologicals. Rixensart, Belgium.The need for safe and efective vaccines to reduce morbidity and mortality caused by rotavirus gastroenteritis in children is weel-known. A live attenuated monovalent ratavirus vaccine (Rotarix) containing human rotavirus strain RIX4414 of G1P1A P[8] specificity is being developed to meet the global need. An overview of RIX4414 trials in developed and developing sttings is presented for 3 selected trials conducted in Finland (pilot study), Latin America (Brazil, Mexico and venezuela) and Singapore involving 5024 infants. The vaccine was well-tolerte, with no increase in any solicited symptoms as compared with the placebo. After 2 doses, 61-91 per cent of vaccineted infants developed rotavirus-specific IgA antibodies. There was no interference with immunogenicity of coadministere routine pediatric vaccines. Rotarix significantly reduced rotavirus gastroenteritis episodes and rotavirus related hospitalizations in vaccinated infants compared wiyh placebo recipients (p0.05), Vaccine efficacy was observed against severe rotavirus gastroenteritis caused by G1 and non-G1 types including the emerging G9 tyoe (p0.05) in Latin America. these results show prospects for widespread us of Rotarix to reduce raotavieus disease burden ans warrant continued worldwide evaluation