The Pediatric infectious disease journal
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Pediatr. Infect. Dis. J. · Jan 2004
Review Comparative StudyVaccination for pandemic influenza: a six point agenda for interpandemic years.
The demand for influenza vaccine is driven by recognition of its health and economic benefits. Vaccine reduces all cause mortality in the elderly by 30 to 50% and prevents > or =30% of hospital admissions for influenza-related respiratory disease, heart disease and stroke. However, because most influenza vaccine (85%) is produced in only eight countries, adequate production and equitable distribution of vaccine throughout the world will pose a serious challenge when the next influenza pandemic appears. ⋯ Planning for pandemic vaccination must begin during the interpandemic period to ensure a vaccine supply that will be adequate to meet demand in all countries. This will require the skills not only of experts in virology, epidemiology and public health but also those in politics, economics and law. The task will be complex, but its promised benefits will be immense.
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Acute wheezing secondary to viral infection is common in children. Whereas many children suffer primarily mild to moderate symptoms, others develop severe coughing and wheezing. ⋯ In infants factors that predispose to severe disease and lower respiratory airway effects include small lung size, passive smoke exposure, virus-induced immune responses, severe disease and infection at a young age. Acute asthma symptoms have been correlated with a variety of viral pathogens, most commonly respiratory syncytial virus bronchiolitis in infancy and rhinovirus in older children. Epidemiologic and biologic factors that influence development of asthma include repeated exposure to infectious disease during early childhood, early exposure to pets, a farming lifestyle, alterations in bacterial flora of the intestine and increased use of antibiotics. Thus the likelihood of asthma is related to the specific pathogen, severity of infection, cumulative number of infections and stage of immunologic development. Progress is also being made in understanding how viruses can adversely affect lung or immune development. In asthmatic children viral infections initiate bronchospasm and airway obstruction. It is hoped that research on virus-induced airway alterations and the host factors that lead to severe clinical illnesses can help clinicians to identify children whose wheezing is an early sign of asthma.
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Pediatr. Infect. Dis. J. · Jan 2004
Review Comparative StudyTuberculosis screening in immigrant children.
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Pediatr. Infect. Dis. J. · Jan 2004
Comparative StudyPredicting bacteremia in children with fever and chemotherapy-induced neutropenia.
Fever and neutropenia are common clinical problems in pediatric oncology and frequently necessitate emergency hospitalization and immediate empiric broad spectrum antimicrobial therapy. Estimating the risk of bacteremia in fever and neutropenia is a challenge. The purpose of this study was to develop an algorithm predicting the risk of bacteremia and Gram-negative bacteremia in children and adolescents with fever and neutropenia, based on information accessible at presentation. ⋯ Based on this retrospective analysis, it appears that bacteremia can be predicted with clinically useful specificity at a high level of sensitivity, using clinical information available at presentation in pediatric cancer patients with fever and neutropenia.
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Pediatr. Infect. Dis. J. · Jan 2004
Comparative StudyAre economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines.
In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings. ⋯ There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.