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Discrepancies between Vaccine Documentation and Serologic Status for Diphtheria, Tetanus, and Hepatitis B in Internationally Adopted Children. Vaccines (Basel) 2020; 8:vaccines8030489. [PMID: 32872676 PMCID: PMC7563378 DOI: 10.3390/vaccines8030489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Internationally Adopted Children (IAC) often show suboptimal immunisation coverage, but available data are discordant. Data at the first evaluation of 2073 IAC (median age: 6 years) referred to the Meyer Children’s University Hospital (Florence, Italy) in 2009–2019 were analysed in order to evaluate their immunisation status against diphtheria, tetanus, and hepatitis B. Negative antibody titres were observed in 11.5% of the IAC for diphtheria, 18.6% for tetanus, and 39.0% for hepatitis B. At multivariate analysis, originating from Africa was an independent risk factor for seronegativity for the three diseases (p < 0.001), while age below four years was an independent factor associated with protective immunity, only considering hepatitis B (p < 0.001). Vaccine documentation was an additional factor independently associated with protective immunity. However, a discrepancy between documentation (indicating previous vaccinations) and serology (showing negative antibody titres) was evidenced in 3.8% of the children for diphtheria, 12.6% for tetanus, and 29.6% for hepatitis B. This finding suggests that although vaccine documentation may reflect the presence of protective antibody titres, it should not be accepted as absolute evidence of protective immunity, underlining the importance of a complete assessment of immunisation status in IAC, particularly in those originating from Africa and aged over four years.
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Nielsen AV, Kjærgaard J, Pedersen TM, Helmuth IG, Nygaard U, Nielsen HW, Christensen VB, Kurtzhals JAL, Poulsen A. Infectious diseases detected by screening after arrival to Denmark in internationally adopted children. Acta Paediatr 2020; 109:1004-1010. [PMID: 31580515 DOI: 10.1111/apa.15045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/05/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Abstract
AIM To show the prevalence of selected infectious diseases among internationally adopted children (IAC) in Denmark. BACKGROUND Each year approximately 200 IAC arrive in Denmark. These are at increased risk of infectious diseases rarely seen in Danish children. Studies from the 1990s showed that 60% of IAC had infectious diseases and that the majority of these were undetected without screening. METHODS The study is a prospective study of medical records from children seen in the adoption clinic at Copenhagen University Hospital in the period 2009-2013. Screening was done for hepatitis A (HAV), B (HBV) and C (HCV), syphilis, HIV, tuberculosis (TB) and intestinal parasites. RESULTS In 245 IAC tested, 2% had evidence of recent HAV infection, 3% with HBV and one child with HCV, and no cases of HIV were found. One child had antibodies against syphilis (anti-Trpa AB positivity), and 2% were latently infected with tuberculosis. We found 30% infected with pathogenic intestinal parasites. Only 46% had serologic evidence of immunisation against HBV. CONCLUSION The prevalence of infections in IAC was lower than previously reported but compared to the general population, a higher prevalence of intestinal parasites, hepatitis and tuberculosis was found. We recommend that IAC are offered screening shortly after arrival.
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Affiliation(s)
- Agnethe Vale Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jesper Kjærgaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tine Marie Pedersen
- Copenhagen Prospective Studies on Asthma in Childhood Health Sciences University of Copenhagen Naestved Denmark
- Department of Pediatrics Naestved Hospital Naestved Denmark
| | - Ida Glode Helmuth
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ulrikka Nygaard
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Helle Winter Nielsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Vibeke Brix Christensen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jørgen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology at Department of Clinical Microbiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - Anja Poulsen
- The Department of Pediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Immunization Status against Measles, Mumps, Rubella and Varicella in a Large Population of Internationally Adopted Children Referred to Meyer Children's University Hospital from 2009 to 2018. Vaccines (Basel) 2020; 8:vaccines8010051. [PMID: 32013010 PMCID: PMC7158658 DOI: 10.3390/vaccines8010051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023] Open
Abstract
Control of vaccine preventable diseases (VPDs) is a challenge for healthcare systems. Different studies highlighted the suboptimal immunization of internationally adopted children (IAC). To evaluate the immunization status against measles, mumps, rubella (MMR), and varicella (V) in a large cohort of IAC, data at first screening visit of all IAC (<18 years) consecutively referred to Meyer Children's University Hospital (Florence, Italy) from 2009 to 2018 were collected and analyzed. In total, 1927 children (median age: 5.99 years, interquartile range: 3.33-8.21) were enrolled. More than half of IAC were unprotected against MMR-V. The reliability of the vaccination documentation of the country of origin was poor, since more than a quarter of the IAC serologically tested were not protected against MMR-V, despite the vaccination documentation attesting previous vaccination. This was significantly more pronounced in children aged 15-18 years and in those originating from Africa. High rate of discordant serological results/documentation brings up questions regarding the optimal management of IACs, and suggests a rapid, careful, and complete assessment of immunization status timely after IAC's arrival. Serological testing of IAC of all ages followed by vaccination of seronegative children should be provided.
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Rosenthal P, Ling SC, Belle SH, Murray KF, Rodriguez-Baez N, Schwarzenberg SJ, Teckman J, Lin HHS, Schwarz KB. Combination of Entecavir/Peginterferon Alfa-2a in Children With Hepatitis B e Antigen-Positive Immune Tolerant Chronic Hepatitis B Virus Infection. Hepatology 2019; 69:2326-2337. [PMID: 30318613 PMCID: PMC6465180 DOI: 10.1002/hep.30312] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
The optimal management strategy for children with immune-tolerant chronic hepatitis B virus (HBV) infection remains unknown. The purpose of this clinical trial was to determine the safety and efficacy of therapy with entecavir and peginterferon in a group of children in the immune-tolerant phase of HBV infection. Children with immune-tolerant features of chronic hepatitis B (CHB) received entecavir once-daily in a dose of 0.015 mg/kg (0.5 mg maximum) for 48 weeks; peginterferon alfa-2a (180 µg/1.73m2 subcutaneously) once-weekly was added at the end of week 8 and continued until week 48. The primary endpoint was lack of detectable hepatitis B e antigen (HBeAg) with HBV DNA levels ≤1,000 IU/mL 48 weeks after stopping therapy. Sixty children (75% female), median age 10.9 (range, 3.4-17.9) years, were enrolled. All were positive for hepatitis B surface antigen (HBsAg) and HBeAg and had high levels of HBV DNA with normal or minimally elevated levels of alanine aminotransferase (ALT). Fifty-five children completed the entire 48-week course of therapy. At 48 weeks after treatment ended (week 96), 2 children (3%) achieved the primary endpoint and were also HBsAg negative and anti-hepatitis B surface antigen antibody (anti-HBs) positive. One child was HBeAg positive but HBsAg negative at week 60; another was HBeAg negative but HBsAg positive at week 72, which were their last clinic visits. In the remaining children, serum ALT and HBV DNA levels at week 96 were similar to baseline. Thirty-seven children experienced adverse events (AEs), and 1 had a serious AE (SAE). Conclusion: The combination of entecavir and peginterferon for up to 48 weeks rarely led to loss of HBeAg with sustained suppression of HBV DNA levels in children in the immune-tolerant phase of HBV infection, and treatment was associated with frequent AEs.
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Affiliation(s)
- Philip Rosenthal
- Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Simon C. Ling
- The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Steven H. Belle
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karen F. Murray
- Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, United States
| | - Norberto Rodriguez-Baez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah J. Schwarzenberg
- Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, United States
| | - Jeffrey Teckman
- Pediatrics, Saint Louis University, Saint Louis, MO, United States
| | - Hsing-Hua S. Lin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kathleen B. Schwarz
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Venturini E, Piccini P, Tersigni C, Chiappini E, Galli L. Systematic review shows that immunising internationally adopted children is a major challenge for primary health care. Acta Paediatr 2019; 108:411-418. [PMID: 30368909 DOI: 10.1111/apa.14625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
AIM This systematic review aimed to provide an overview of the immunisation of internationally adopted children and to discuss possible vaccination strategies. METHODS A literature search was performed covering papers published in English from 1988 to 15 June 2018 using the Ovid MEDLINE, EMBASE and Cochrane Library databases. This identified 749 studies and 41 full texts were evaluated. RESULTS Overall, 19 studies conducted between 1988 and 2016 fulfilled our inclusion criteria. These covered 7663 children aged 1.1-5.7 years adopted from Asia, Eastern Europe, Africa and South and Central America. Tetanus protective antibody levels ranged from 35 to 95%, and similar data were reported for diphtheria. A higher percentage of adoptees had protective antibody levels for polio (50-93%) and measles (62-95%). More than a third (35%) did not have protective antibody titres for hepatitis B. Only one study investigated adoptees with protective antibodies against haemophilus influenza, and it reported that this was around 66%. CONCLUSION The appropriate immunisation of internationally adopted children is a major challenge for primary health care and a number of different approaches have been suggested, with no clear conclusions. Further studies on the cost-effectiveness of different approaches should be performed to optimise screening strategies and develop recommendations.
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Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Paola Piccini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Chiara Tersigni
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Elena Chiappini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
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Chiappini E, Bortone B, Borgi S, Sollai S, Matucci T, Galli L, de Martino M. Infectious Diseases in Internationally Adopted Children and Intercountry Discrepancies Among Screening Protocols, A Narrative Review. Front Pediatr 2019; 7:448. [PMID: 31788456 PMCID: PMC6853896 DOI: 10.3389/fped.2019.00448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Internationally adopted children (IAC) require thorough health assessments at time of arrival in the host country. As these children are at higher risk for infectious diseases, such as gastrointestinal parasites, tuberculosis, hepatitis, syphilis, and human immunodeficiency virus, early diagnosis of infectious diseases is fundamental for the optimal management of the child and, also, to reduce the risk of transmission to the adopting community. Comparative analysis of the screening protocols adopted in Europe, the United States, and Canada revealed different approaches to the adopted children. A homogeneous and internationally shared standard of care in the management of IAC should be provided.
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Affiliation(s)
- Elena Chiappini
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Barbara Bortone
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Borgi
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Sollai
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Tommaso Matucci
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Chiappini E, Zaffaroni M, Bianconi M, Veneruso G, Grasso N, Garazzino S, Arancio R, Valentini P, Ficcadenti A, Da Riol MR, La Placa S, Galli L, de Martino M, Bona G. Italian multicentre study found infectious and vaccine-preventable diseases in children adopted from Africa and recommends prompt medical screening. Acta Paediatr 2018; 107:1581-1586. [PMID: 29364534 DOI: 10.1111/apa.14237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/07/2017] [Accepted: 01/19/2018] [Indexed: 11/26/2022]
Abstract
AIM This study evaluated the prevalence of infectious diseases and immunisation status of children adopted from Africa. METHODS We studied 762 African children referred to 11 Italian paediatric centres in 2009-2015. Clinical and laboratory data were retrospectively collected and analysed. RESULTS The median age of the children (60.3% males) was 3 years and 6 months, 52.6% came from Ethiopia and 50.1% had at least one infectious disease. Parasitic infections accounted for the majority of the infectious diseases (409 of 715), and the most common were Giardia lamblia (n = 239), Toxocara canis (n = 65) and skin infections (n = 205), notably Tinea capitis/corporis (n = 134) and Molluscum contagiosum (n = 56) Active tuberculosis (TB) was diagnosed in nine children (1.2%). Latent TB infections were diagnosed in 52 (6.8%) children, and only 23 had concordant positive tuberculin skin tests and Quantiferon Gold In-Tube results. Discordant results were associated with Bacille de Calmette-Guérin vaccinations (odd ratio 6.30 and 95% confidence interval of 1.01-39.20, p = 0.011). Nonprotective antitetanus or antihepatitis B antibody titres were documented in 266 (34.9%) and 396 (51.9%) of the 762 children. CONCLUSION The prevalence of infectious conditions and not-protective titres for vaccine-preventable diseases observed in our population underlines the need for prompt and complete medical screening of children adopted from Africa.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Mauro Zaffaroni
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Martina Bianconi
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Giuseppina Veneruso
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Nicolino Grasso
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Piero Valentini
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gemelli Hospital, Catholic University A, Rome, Italy
| | - Anna Ficcadenti
- Pediatric Division, Department of Clinical Sciences, Polytechnic University of Marche, Ospedali Riuniti, Presidio Salesi, Ancona, Italy
| | | | - Simona La Placa
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
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Van Kesteren L, Wojciechowski M. International adoption from Ethiopia: An overview of the health status at arrival in Belgium. Acta Clin Belg 2017; 72:300-305. [PMID: 27892847 DOI: 10.1080/17843286.2016.1258178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ethiopia is a densely populated country with a fast growing economy. Still socioeconomic and health issues render many children parentless. One thousand and twenty eight Ethiopian children have been adopted in Belgium from September 2005 to September 2015. Little has been published about their health status at arrival. METHODS Three hundred and fifteen children adopted from Ethiopia were clinically evaluated at the Institute of Tropical Medicine in Antwerp from 1 January 2008 until 31 December 2014. Epidemiological and medical data were collected and analysed retrospectively. RESULTS Data about 164 boys and 151 girls with a mean age of three years were analysed. Twenty per cent was adequately vaccinated, for 66.7% of children these data were absent. About 8.6% of the children were wasted/thin, 28.9% stunted. Skin abnormalities were seen in 40.3%, especially Tinea capitis. No children tested positive for HIV, syphilis or hepatitis C. Four children had an acute or chronic hepatitis B (HBV) infection, eight children had a cured HBV infection. Two children tested positive for malaria. Active pulmonary tuberculosis was found in six children. Sixty-two per cent had one or more intestinal parasite. Giardia lamblia (41.9%) and Blastocystis hominis (27.0%) were most frequently isolated. There is a statistically relevant association between the number of intestinal parasites and age at presentation. In this group eosinophilia had a sensitivity of 30.2%, a specificity of 79.1% for intestinal parasites and a positive likelihood ratio of 1.44 with a negative likelihood ratio of 0.88. CONCLUSION Apart from the high prevalence of stunting and intestinal parasites important medical problems were infrequent. A systematic clinical examination and screening for infectious diseases remain important to ensure a healthy start of a new life in Belgium.
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Affiliation(s)
- Lydia Van Kesteren
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marek Wojciechowski
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- Department of Travel Medicine/Tropical and Import Pathology, Institute of Tropical Medicine, Antwerp, Belgium
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Health-related Quality of Life in Pediatric Patients With Chronic Hepatitis B Living in the United States and Canada. J Pediatr Gastroenterol Nutr 2017; 64:760-769. [PMID: 28169971 PMCID: PMC5403561 DOI: 10.1097/mpg.0000000000001525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the study was to determine whether selected sociodemographic and hepatitis B virus (HBV)-specific clinical factors are associated with health-related quality of life (HRQoL) among pediatric patients chronically infected with HBV. METHODS Children with chronic HBV enrolled in the Hepatitis B Research Network completed the Child Health Questionnaire at study entry. Caregivers of children 5 to <10 years completed the parent-reported form (CHQ-Parent Report Form); youth 10 to <18 years completed the child-reported CHQ-Child Report Form. We examined univariable associations of the Child Health Questionnaire scores with selected independent variables: sex, adoption status, maternal education, alanine aminotransferase (U/L), aspartate aminotransferase-to-platelet ratio index, and HBV-specific symptom count. RESULTS A total of 244 participants (83 young children 5-<10 years, 161 youth 10-<18 years) were included, all HBV treatment-naïve. Among young children, increased alanine aminotransferase level was negatively associated with CHQ-Parent Report Form psychosocial summary t score (r = -0.28, P = 0.01). No other subscale comparisons for young children were statistically significant. Among youth, adoption was associated with better physical functioning and general health (P < 0.01). Higher maternal education was associated with better role/functioning-physical and -emotional scores (P < 0.05). Maternal education and adoption status were linked with adoption associated with higher maternal education. Increased symptom count in youth was associated with worse HRQoL in subscales measuring bodily pain, behavior, mental health, and self-esteem (P < 0.01). CONCLUSIONS Although overall HRQoL is preserved in children with chronic HBV, some sociodemographic and HBV-related clinical factors were associated with impaired HRQoL in our pediatric patients at baseline. Measurement of HRQoL can focus resources on education and psychosocial support in children and families most in need.
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Sollai S, Ghetti F, Bianchi L, de Martino M, Galli L, Chiappini E. Infectious diseases prevalence, vaccination coverage, and diagnostic challenges in a population of internationally adopted children referred to a Tertiary Care Children's Hospital from 2009 to 2015. Medicine (Baltimore) 2017; 96:e6300. [PMID: 28328809 PMCID: PMC5371446 DOI: 10.1097/md.0000000000006300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious diseases are common in internationally adopted children (IAC).With the objective to evaluate infectious diseases prevalence in a large cohort of IAC and to explore possible risk factors for tuberculosis (TB) and parasitic infections, clinical and laboratory data at first screening visit of all IAC (<18 years) consecutively referred to our Center in 2009 to 2015 were collected and analyzed.In total, 1612 children (median age: 5.40 years; interquartile range: 3.00-7.90) were enrolled, 123/1612 (7.60%) having medical conditions included in the special needs definition. The most frequent cutaneous infections were Molluscum contagiosum (42/1612; 2.60%) and Tinea capitis (37/1612; 2.30%). Viral hepatitis prevalence was <1% (hepatitis B virus [HBV]: 13 children, 0.80%; hepatitis C virus: 1 child, 0.10%; hepatitis A virus: 6 children, 0.40%). A parasitic infection was diagnosed in 372/1612 (23.10%) children. No risk factors for parasitosis were evidenced. Active TB was diagnosed in 4/1355 (0.3%) children, latent TB in 222/1355 (16.40%). Only 3.7% (51/1355) children had concordant positive tuberculin skin test (TST) and QuantiFERON-TB-Gold In-Tube (QFT-G-IT) results. Risk factors for TST+/QFT-G-IT- results were previous Bacille de Calmette-Guérin vaccination (adjusted odds ratio [aOR]: 2.18; 96% confidence interval [CI]: 1.26-3.79; P = 0.006), and age ≥5 years (aOR: 1.49; 95% CI: 1.06-2.11; P = 0.02). The proportion of children with nonprotective titers for vaccine-preventable diseases (VPD) ranged from 15.70% (208/1323) for tetanus to 35.10% (469/1337) for HBV.Infectious diseases were commonly observed in our cohort. The high rate of discordant TST/QFT-G results brings up questions regarding the optimal management of these children, and suggests that, at least in children older than 5 years, only QFT-G-IT results may be reliable. The low proportion of children protected for VPD, confirms importance of a timely screening.
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Kunoee A, Nielsen J, Cowan S. Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010. ACTA ACUST UNITED AC 2016; 21:pii=30136. [PMID: 26923681 DOI: 10.2807/1560-7917.es.2016.21.7.30136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
In Denmark, universal screening of pregnant women for hepatitis B has been in place since November 2005, with the first two years as a trial period with enhanced surveillance. It is unknown what the change to universal screening without enhanced surveillance has meant for vaccination coverage among children born to hepatitis B surface antigen (HBsAg)-positive mothers and what risk factors exist for incomplete vaccination. This retrospective cohort study included 699 children of mothers positive for HBsAg. Information on vaccination and risk factors was collected from central registers. In total, 93% (651/699) of the children were vaccinated within 48 hours of birth, with considerable variation between birthplaces. Only 64% (306/475) of the children had received all four vaccinations through their general practitioner (GP) at the age of two years, and 10% (47/475) of the children had received no hepatitis B vaccinations at all. Enhanced surveillance was correlated positively with coverage of birth vaccination but not with coverage at the GP. No or few prenatal examinations were a risk factor for incomplete vaccination at the GP. Maternity wards and GPs are encouraged to revise their vaccination procedures and routines for pregnant women, mothers with chronic HBV infection and their children.
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Affiliation(s)
- Asja Kunoee
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
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12
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Soriano-Arandes A, Sulleiro E, Zarzuela F, Ruiz E, Clavería I, Espasa M. Discordances Between Serology and Culture for Strongyloides in an Ethiopian Adopted Child With Multiple Parasitic Infections: A Case Report. Medicine (Baltimore) 2016; 95:e3040. [PMID: 26962825 PMCID: PMC4998906 DOI: 10.1097/md.0000000000003040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 11/25/2022] Open
Abstract
RATIONALE infectious diseases screening of international adoptees is complex because of the concurrence of different pathogens in a child at same time. We describe an international adopted child born at Ethiopia infected by 5 different pathogens (Hymenolepis nana, Giardia intestinalis, Entamoeba histolytica, Strongyloides stercoralis, and Trichuris trichiura), 2 of them S. stercoralis and E. histolytica with a capacity to develop severe clinical complications if not detected promptly with appropriate diagnosis tests.Concerns of the patient: according to the screening protocol a stool sample is always processed for culture addressed to find out protozoan and helminthic pathogens but not specifically for S. stercoralis. Only, when eosinophilia is detected 3 serial stool samples are collected to rule out intestinal parasitic infection including S. stercoralis. INTERVENTIONS in our case, S. stercoralis would not have been detected if we had followed the protocol because eosinophilia was absent and its specific serology was negative. Fortunately, the initial inclusion of the feces charcoal culture for S. stercoralis allowed us to detect this infection. OUTCOMES discordances between direct methods such as culture and indirect as serology or antigen test forces us to be very cautious before ruling out S. stercoralis or E. histolytica infection, respectively. Also, if a child from tropical areas has persistent symptoms (such as diarrhea or fever) that have not been treated we have to rule out other infections that have not been detected yet.Main lessons: The introduction of different sequencing tests and the insistence to find out pathogens such as S. stercoralis or E. histolytica was determinant to be able to cure this symptomatic child and to prevent potential severe clinical forms in case of immunosuppression.
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Affiliation(s)
- Antoni Soriano-Arandes
- From the Pediatric Infectious Diseases and Immunodeficiencies Unit, Unit of International Health-Tuberculosis Drassanes-Vall Hebron, Hospital Universitari Vall d'Hebron (AS-A); Unit of International Health Drassanes-Vall Hebron, Programa Especial de Malalties Infeccioses (PROSICS), Hospital Universitari Vall d'Hebron (FZ, ER, IC); and Department of Microbiology, Hospital Universitari Vall Hebron, Barcelona, Spain (ES, ME)
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Komatsu H, Inui A. Chronic hepatitis B in children in the United States and Canada: international origins place the disease burden on children even in the era of universal vaccination. Transl Pediatr 2016; 5:1-4. [PMID: 26835398 PMCID: PMC4729037 DOI: 10.3978/j.issn.2224-4336.2015.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Haruki Komatsu
- 1 Department of Pediatrics, Toho University Sakura Medical Center, Chiba, Japan ; 2 Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan
| | - Ayano Inui
- 1 Department of Pediatrics, Toho University Sakura Medical Center, Chiba, Japan ; 2 Department of Pediatric Hepatology and Gastroenterology, Eastern Yokohama Hospital, Kanagawa, Japan
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Hénaff F, Hazart I, Picherot G, Baqué F, Gras-Le Guen C, Launay E. Frequency and characteristics of infectious diseases in internationally adopted children: a retrospective study in Nantes from 2010 to 2012. J Travel Med 2015; 22:179-85. [PMID: 25787709 DOI: 10.1111/jtm.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/08/2015] [Accepted: 01/19/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Internationally adopted children are more susceptible to developing and carrying acute or chronic infectious diseases. Specialized consultations exist in the main French cities; however, specialized consultation with a pediatrician is not mandatory. The main objective of this study was to determine the frequency and characteristics of infections (bacterial, viral, and parasitic) among a group of international adoptees in Nantes over a 3-year period. METHODS A retrospective chart review was conducted of internationally adopted children who went through the Medical Guidance for Adopted Children Consultation between 2010 and 2012. RESULTS A total of 133 children were included in the study. Of these, 55% had an infectious disease; 8% were severe infections. We found a frequency of 38% [confidence interval (CI) 95% 30-46] for parasitic intestinal and 35% (CI 95% 27-43) for dermatologic infections. African children were more likely to have infections that required hospitalization [odds ratio (OR) = 12, p = 0.004, CI 95% 1.3-113.7] and more likely to carry extended-spectrum β-lactamase-producing bacteria. CONCLUSION The frequency of infectious diseases, and sometimes severe diseases, found among our cohort of internationally adopted children highlights the need for systematic, specialized medical care.
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Martínez Ortiz A, Domínguez Pinilla N, Wudineh M, González-Granado L. International adoption from Ethiopia in a 5-year period. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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[International adoption from Ethiopia in a 5-year period]. An Pediatr (Barc) 2014; 82:302-7. [PMID: 25047307 DOI: 10.1016/j.anpedi.2014.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION An increase in the number of internationally adopted children has been observed in the last few years. The country of origin that has experienced a greater increase is Ethiopia. The health of internationally adopted children from Ethiopia has not been extensively assessed to date. The main objective of the study is to determine the prevalence of infectious diseases in children adopted from Ethiopia, and to assess their nutritional status. METHOD A prospective, observational cohort study was conducted using the medical records of 251 children adopted from Ethiopia to Spain in the period from Jan 1, 2006 and December 31, 2010. RESULTS The mean age of the children was 7 months (range 1-120). Abnormalities were detected on physical examination in 56.6%. In 90% of cases the child was less than 5 years-old. Half of the sample had a weight below the third percentile, with some degree of malnutrition in 65% of the children. HIV exposure was not uncommon (4.8%). CONCLUSIONS Low weight and acute gastroenteritis were the main findings in this cohort. Infectious diseases should be systematically assessed.
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Abstract
Hepatitis B virus (HBV) infection is a worldwide health problem, which can cause acute liver failure, acute hepatitis, chronic hepatitis, liver cirrhosis, and liver cancer. It is most prevalent in Asia, Africa, Southern Europe, and Latin America. Approximately 2 billion people in the world have been infected by HBV, with more than 350 million as chronic carriers. Implementation of the HBV vaccine led to a significant reduction in viral transmission in many areas of the world; however, it remains highly endemic in many developing countries. The main source of infection in childhood is via perinatal transmission or horizontal transmission during preschool years. The majority of children with chronic hepatitis B (CHB) infection are asymptomatic; however, they may develop progressive disease and are at increased risk of advanced liver disease or liver cancer before their third decade. All children with chronic HBV infection should be regularly monitored for disease progression. The goal of therapy for children with CHB is to arrest disease progression and reduce the risk of developing cirrhosis and cancer. The available medications have a low success rate because of immunotolerance in the child and the development of viral resistance to standard therapy. Therefore, case selection and determination of the best time to commence treatment are essential to increase treatment efficacy and reduce the risk of viral resistance.
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Affiliation(s)
- Mona Abdel-Hady
- Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Affiliation(s)
- Kristina N Feja
- Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ 08901, USA
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Paganelli M, Stephenne X, Sokal EM. Chronic hepatitis B in children and adolescents. J Hepatol 2012; 57:885-96. [PMID: 22634122 DOI: 10.1016/j.jhep.2012.03.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Massimiliano Paganelli
- Pediatric Gastroenterology and Liver Unit, Cliniques St Luc, Université Catholique de Louvain, Brussels, Belgium
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Abstract
HBV and HCV are the predominant causes of chronic viral hepatitis in children and adults. The main purposes of the present review are to provide the reader with a comprehensive overview of the currently available therapies for chronic hepatitis B and C in children and to critically review the current guidelines and indications for treatment provided by the major international societies and by the consensus of expert panels. Overall, a conservative approach is generally warranted in children with chronic hepatitis B. For HCV, the high effectiveness of pegylated interferon and ribavirin in children with genotype 2 or 3 chronic infection supports the decision to treat. For genotype 1 infection the encouraging results of the use of direct antiviral agents in adults suggest a more conservative approach.
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Affiliation(s)
- Giuseppe Indolfi
- Pediatric & Liver Unit, Meyer Children’s University Hospital of Florence, Viale Pieraccini 34, Firenze, Italy, I-50134
| | - Alessandro Nesi
- Pediatric & Liver Unit, Meyer Children’s University Hospital of Florence, Viale Pieraccini 34, Firenze, Italy, I-50134
| | - Massimo Resti
- Pediatric & Liver Unit, Meyer Children’s University Hospital of Florence, Viale Pieraccini 34, Firenze, Italy, I-50134
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Hepatitis B virus infections among children and adolescents in Germany: migration background as a risk factor in a low seroprevalence population. Pediatr Infect Dis J 2011; 30:19-24. [PMID: 20683220 DOI: 10.1097/inf.0b013e3181ef22d5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on hepatitis B (HB) infection prevalence among children and adolescents in Germany are scarce. We estimated seroprevalence of HB infection and assessed determinants for HB infection among children and adolescents in Germany from a representative population sample. METHODS From 2003 to 2006, the Robert Koch Institute conducted a nationwide cross-sectional Health Interview and Examination Survey for Children and Adolescents in Germany. Data on age, gender, migration background, and socioeconomic status were collected through questionnaires. A child was defined as having a 2-sided migration background if both parents, or the child and 1 parent, immigrated, and a 1-sided migration background if only 1 parent immigrated. Among children with migration background, a first-generation migrant was defined as born outside Germany; a second-generation migrant was born in Germany. Information on HB vaccination status was obtained from vaccination cards. Serologic samples from participants were tested for anti-hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen. We performed weighted univariable and multivariable logistic regression analyses to assess determinants for HB infection. RESULTS Of 13,065 participants (3-17 years), 0.5% (95% confidence interval [CI], 0.4-0.7) were anti-HBc positive, among whom 38.7% (95% CI, 20.0-57.5) were hepatitis B surface antigen positive. Two-sided migration background and being a first- or second-generation migrant were significantly associated with anti-HBc positivity (odds ratio [OR]: 8.3, 95% CI: 4.0 –17.4; OR: 11.0, 95% CI: 3.5-35.0; OR: 3.0, 95% CI: 1.2-7.3). No further determinants were found. CONCLUSIONS HB infection is rare among children and adolescents in Germany. First- and second-generation migrant children can be considered to be at risk for HB infection, 2-sided migration background or being a first-generation migrant carried the greatest risk. Targeted testing for HB infection and early HB vaccination should be provided to immigrants' children.
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Affiliation(s)
- Kevin B Spicer
- The Ohio State University College of Medicine, Columbus, OH, USA
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