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Background: Limited data are available on disease characteristics and outcomes of children with 2009 pandemic influenza A(H1N1) virus infection (pandemic H1N1 influenza) who have required hospital admission. Methods: We reviewed the charts of 58 children with pandemic H1N1 influenza admitted to a large pediatric hospital in Ontario, Canada, between May 8 and July 22, 2009. We compared risk factors, severity indicators and outcomes of these children with those of 200 children admitted with seasonal influenza A during the previous 5 years (2004/05 to 2008/09). Results: Children with pandemic H1N1 influenza were significantly older than those with seasonal influenza (median age 6.4 years v. 3.3 years). Forty-six (79%) of the children with pandemic H1N1 influenza had underlying medical conditions; of the other 12 who were previously healthy, 42% were under 2 years of age. Children admitted with pandemic H1N1 influenza were significantly more likely to have asthma than those with seasonal influenza (22% v. 6%). Two children had poorly controlled asthma, and 6 used inhaled medications only intermittently. The median length of stay in hospital was 4 days in both groups of children. Similar proportions of children required admission to the intensive care unit (21% of those with pandemic H1N1 influenza and 14% of those with seasonal influenza) and mechanical ventilation (12% and 10% respectively). None of the children admitted with pandemic H1N1 influenza died, as compared with 1 (0.4%) of those admitted with seasonal influenza. Interpretation: Pandemic H1N1 influenza did not appear to cause more severe disease than seasonal influenza A. Asthma appears to be a significant risk factor for severe disease, with no clear relation to severity of asthma. This finding should influence strategies for vaccination and pre-emptive anti viral therapy., Influenza causes significant morbidity and mortality in childhood. (1) Infants, young children and people 65 years of age and older account for the highest rates of influenza-related hospital admission. (2) [...]

Objectives: To identify immunosuppressed children who are at risk of cytomegalovirus (CMV) retinitis developing and to evaluate the use of laboratory results for identifying this risk. Design: Prospective cohort and retrospective case-control series. Setting: University hospital pediatric referral center. Patients: Fifty-six consecutive immunocompromised children (de, the prospective group) with laboratory evidence consistent with acute or recently acquired CMV infection, which was defined as CMV cultured from the blood, urine, nasopharynx, or biopsy specimen, recent seroconversion, a 4-fold increase in the CMV antibody titer, or an antibody titer of 1:512 or greater. Ninety-three immunocompromised children (de, the retrospective group) with acute CMV or previous CMV exposure, which was defined as a CMV titer of 1:4 or greater and less than 1:512. Main Outcome Measure: Occurrence of CMV retinitis. Results: Cytomegalovirus retinitis developed in 3 children in the prospective group and in 4 children in the retrospective group. The causes of immunosuppression were severe combined immunodeficiency syndrome (n=2), severe combined immunodeficiency syndrome status post bone marrow transplantation (n=1), acquired immunodeficiency syndrome (n=1), and acquired immunodeficiency syndrome status post bone marrow transplantation for leukemia (n=1), renal transplantation (n=1), and chemotherapy for leukemia (n=1). Cytomegalovirus retinitis was associated with a positive CMV culture result from the urine (P=.03) or nasopharynx (P< 001) in the retrospective group. In the retrospective group, one child with congenital CMV infection and CMV retinitis was excluded from analysis because laboratory tests for CMV were not obtained prior to ganciclovir therapy. Conclusions: Cytomegalovirus retinitis is uncommon in children compared with adults; it occurred in 5% of the children in our series. A screening ophthalmologic examination should be considered in immunocompromised children with positive CMV laboratory results, particularly positive results of urine or nasopharynx cultures., Cytomegalovirus (CMV) retinitis may be infrequent among children with weakened immune systems. CMV is a congenital infection and may readily infect immunocompromised people. CMV retinitis is a form of the disease that destroys the retina of the eye. Researchers prospectively studied 56 and retrospectively studied 93 immunocompromised children for the presence of CMV infection and CMV retinitis. Only 5% of the children studied developed CMV retinitis, three in the prospective group and four in the retrospective group. Children with AIDS or other immunodeficiency diseases may have a greater risk of CMV retinitis.

The rate of HIV infection in the Bahamas may be the highest in the Caribbean. Of 3,914 women attending prenatal care clinics in New Providence island between Sep 1990 and Aug 1991, 2.9% tested positive for HIV. Among the women born in the Bahamas, the prevalence of HIV infection was 2.5%, compared to 4.5% among women born in Haiti. Older age and number of children were associated with HIV infection, as was syphilis. This indicates that most women acquire the disease from sexual intercourse. Women with little education were more likely to be HIV-positive as were those who freebased cocaine.

Cellular immunity was studied in 73 patients with recurrent vaginal moniliasis and 37 healthy controls, by skin testing with the multitest CMI kit and Candida antigen, with measurement of lymphoblastic transformation to phytohemagglutinin, antigens of Candida albicans, mumps, and streptokinase. Eighteen patients (24.7%) had a hypoergic or anergic response to Candida antigen on skin testing versus two controls (5.4%), p = 0.01. Overall, the patient's lymphoblastic proliferation to mitogen and various antigens was not significantly different from that of the controls. However, a subgroup of younger women (19 to 29 years old) had impaired responses to Candida antigen when compared with age-matched controls, 58% versus 17%, p < 0.005. Most women with recurrent vaginal moniliasis had normal cellular immunity. (Am J Obstet Gynecol 1992;166:887-90.)

Health care workers have a small but possible risk of acquiring the human immunodeficiency virus (HIV), the agent that causes AIDS, as a result of job-related exposure to HIV-infected blood. The most common means of such exposure is through needlesticks, and one survey of senior residents in internal medicine showed a 72 percent rate of needlestick injuries during the years of training. Generally, patient's HIV status is unknown. The drug zidovudine is one of the few agents that has any effect against this virus, and some researchers have suggested that this drug be offered to all health care workers who sustain needlestick injuries involving patients with known HIV infection. Zidovudine has some serious side effects, making such a recommendation at least somewhat controversial. A theoretical model was devised to determine what course of action seems most reasonable in the case of needlestick injuries. Two possible options are to refrain from treating any one who has suffered a needlestick injury with zidovudine, and to treat all needlestick-injured health care workers with zidovudine. The risk of HIV infection in a health care worker following a needlestick injury involving an HIV-infected patient ranges from 0 to 1.82 percent. A presentation of the various treatment options was presented to some health care workers who might be at risk for needlestick injuries; their responses were evaluated. The most sensible course of action, according to the health care workers, would be to test the blood of the patient for HIV. This was seen as important for preserving the emotional state of the health care worker who had sustained the injury. Some of the health care workers would also prefer to be treated with zidovudine, despite the absence of proof that it is of significant value in preventing HIV transmission in needlestick injuries, and despite its side effect profile. The survey concluded that health care workers who sustain needlestick injuries should be offered the option of zidovudine therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children who have hemophilia, a bleeding disorder, need treatment with blood products and thereby tend to become infected with hepatitis B. Immunization against hepatitis B is variably successful, depending on age, site of vaccination, and immune status. Children who become infected with human immunodeficiency virus type 1 (HIV), the agent that causes AIDS, may be less successfully immunized against hepatitis B. This was studied in 23 children with hemophilia; 12 of these children tested positive for HIV. Generally, antibody levels rose quickly after immunization, but tended to drop over the following five years. The levels of antibodies against hepatitis B, a measure of immunization, were significantly greater in the 11 children who were not HIV-infected. Antibodies declined below protective levels in 3 of 12 children with HIV when measured at three, four, or five years after immunization, while this decline occurred in only 1 of the 11 children without HIV. The study suggests that children with hemophilia who are immunized against hepatitis B should be monitored after immunization and yearly thereafter to determine antibody levels. Booster doses of vaccine should then be given as needed. Further studies are required to assess the effects of different immunization strategies for hemophilic children. (Consumer Summary produced by Reliance Medical Information, Inc.)