Paediatric, invasive pneumococcal disease in Switzerland, 1985-1994

Background Costeffectiveuse of new vaccines against pneumococcal disease in children requires detailed information about the local epideniiology of pneumococcal infections. Methods Data on 393 culture-confirmed cases of invasive pneumococcal infection in children (<17 years) hospitalized in Swiss paediatric clinics were collected retrospectively for the years 1985-1994. Results Meningitis (42%) was most frequent, followed by pneumonia (28%) and bacteraeniia (26%). The overall annual incidence was 2.7 cases per 100 000 children <17 years old and 11 cases per 100 000 children <2 years old. Annual incidence rates were stable over the study period. Lethality was high for meningitis (8.6%) and bacteraemia (8.9%). A history of basal skull fracture was reported in 3.3% of children with pneurnococcal meningitis. Residence in a rural region was associated with an increased risk of pneumococcal infection (relative risk = 1.45, 95% confidence interval: 1.01-2.00). Conclusions Paediatric, invasive pneumococcal disease seems to be less frequent in Switzerland than in other European and non-European countries. This may be due to differences in diagnostic strategies and lower frequency of risk factors such as the use of day care. Children with a history of basal skull fracture are at increased risk for pneurnococcal meningitis. Further investigation of the association of invasive pneumococcal infection with rural residence and the use of antibiotics for upper respiratory tract infections might give new insight into the dynamics of Streptococcus pneumoniae infection and the development of antibiotic resistanc

Risk Factors for Invasive Haemophilus influenzae Disease among Children 2-16 Years of Age in the Vaccine Era, Switzerland 1991-1993

Mūhlemann K (Institute of Medical Microbiology, Friedbūhistrasse 51, University of Berne, CH-3010 Berne, Switzerland), Alexander E R, Weiss N S, Pepe M, Schopfer K and the Swiss H.Influenzae Study Group. Risk factors for invasive Haemophilus influenzae disease among children aged 2-16 years of age in the vaccine era, Switzerland 1991-1993. International Journal of Epidemiology 1996; 25: 1280-1285. Background Continued surveillance, and detailed investigation of direct and indirect effects of conjugated vaccines and risk factors for invasive H. Influenzae serotype b (Hib) disease in the vaccine era are important Methods 143 cases with invasive disease between 1991 and 1993 aged 2-16 years were selected retrospectively from a large incidence trend study. Controls (n = 336) were recruited from local vital registries and matched to cases for age, gender, and residence. Hib vaccination histories among study subjects and their siblings and other sociodemographic variables were obtained by questionnaires completed by the parents of these children. Adjusted odds ratio (OR) estimates were calculated by conditional logistic regression analysis. Results Most vaccinated subjects had received the Polysacchande-Diphtheria Toxoid vaccine and estimated vaccine efficacy was high (95%; 95% confidence interval [Cl] 60-99%). Also, the results suggested that protection afforded by vaccination against Hib extended to the family members of vaccinated children. School attendance was found to be protective against invasive Hib disease (OR : 0.33; Cl : 0.14-0.75). Cases more often than controls reported sufferring from asthma and allergies (OR : 4.8; Cl: 1.2-19 4). Conclusions Post-licensure vaccine efficacy is high among children ≥2 years of age. The observed association between asthma and epiglottis is novel and deserves further investigatio

The sensitivity of an interferon-γ release assay in microbiologically confirmed pediatric tuberculosis

This study aimed at determining the sensitivity of a whole blood interferon-γ release assay (IGRA) among children with microbiologically confirmed tuberculosis in a high-burden country. Children with a diagnosis of tuberculosis based on clinical and radiographic assessment were tested with an IGRA in addition to microbiologic examination of appropriate specimens for acid-fast bacilli, mycobacterial rRNA, and observation for growth of Mycobacterium tuberculosis on appropriate culture media. Of the 405 children with a clinical diagnosis of tuberculosis, 91 (22.5%) had microbiologically confirmed tuberculosis, of whom 81 were tested with an IGRA. A positive result was obtained in 43 (sensitivity 53.1%, 95% confidence interval 42.3 to 63.6%), uninfluenced by age, sex, or disease manifestation. Conclusions: The sensitivity of a whole blood interferon-γ release assay in microbiologically confirmed pediatric tuberculosis was low. An IGRA cannot, thus, be used as rule-in test, but it might be useful to rule in tuberculosis among children in whom tuberculosis is notoriously difficult to confirm microbiologically

The sensitivity of an interferon-γ release assay in microbiologically confirmed pediatric tuberculosis

This study aimed at determining the sensitivity of a whole blood interferon-γ release assay (IGRA) among children with microbiologically confirmed tuberculosis in a high-burden country. Children with a diagnosis of tuberculosis based on clinical and radiographic assessment were tested with an IGRA in addition to microbiologic examination of appropriate specimens for acid-fast bacilli, mycobacterial rRNA, and observation for growth of Mycobacterium tuberculosis on appropriate culture media. Of the 405 children with a clinical diagnosis of tuberculosis, 91 (22.5 %) had microbiologically confirmed tuberculosis, of whom 81 were tested with an IGRA. A positive result was obtained in 43 (sensitivity 53.1 %, 95 % confidence interval 42.3 to 63.6 %), uninfluenced by age, sex, or disease manifestation. Conclusions: The sensitivity of a whole blood interferon-γ release assay in microbiologically confirmed pediatric tuberculosis was low. An IGRA cannot, thus, be used as rule-in test, but it might be useful to rule in tuberculosis among children in whom tuberculosis is notoriously difficult to confirm microbiologically

The sensitivity of an interferon-γ release assay in microbiologically confirmed pediatric tuberculosis

This study aimed at determining the sensitivity of a whole blood interferon-γ release assay (IGRA) among children with microbiologically confirmed tuberculosis in a high-burden country. Children with a diagnosis of tuberculosis based on clinical and radiographic assessment were tested with an IGRA in addition to microbiologic examination of appropriate specimens for acid-fast bacilli, mycobacterial rRNA, and observation for growth of Mycobacterium tuberculosis on appropriate culture media. Of the 405 children with a clinical diagnosis of tuberculosis, 91 (22.5 %) had microbiologically confirmed tuberculosis, of whom 81 were tested with an IGRA. A positive result was obtained in 43 (sensitivity 53.1 %, 95 % confidence interval 42.3 to 63.6 %), uninfluenced by age, sex, or disease manifestation. Conclusions: The sensitivity of a whole blood interferon-γ release assay in microbiologically confirmed pediatric tuberculosis was low. An IGRA cannot, thus, be used as rule-in test, but it might be useful to rule in tuberculosis among children in whom tuberculosis is notoriously difficult to confirm microbiologically