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Effective strategies to prevent infant death rely on knowledge of prevalent pathogens. Recent publications have drawn attention to limited data on the contribution of group B streptococcal infection to neonatal and infant mortality in resource-restricted settings. The aim was to describe all cases of group B streptococcal infection isolated from the blood culture of infants up to 90 days of age in two South African hospitals over a two-year period. A retrospective record review took place of infants in whom group B streptococcus was isolated from blood culture or cerebrospinal fluid from January 2010 and December 2011. The maternal records of infants were also reviewed. Data were analysed using Stata® version 1.1. Forty-one cases of group B streptococcal infection were identified, for which 33 records were available for analysis. There was early-onset disease in 14 (42.4%) and late-onset disease in 19 (57.6%) of the infants. Eight (24%) infants were human immunodeficiency virus (HIV)- exposed. There was a confirmed positive HIV PCR test for one infant only. Six infants had pneumonia, 11 meningitis and two died. Serotyping was not performed. All isolates were sensitive to penicillin. The crude incidence rate was calculated as 0.67/1 000 live births. The incidence rate of group B streptococcal disease was less than that in other African studies. Further data are needed for relevant prevention strategies to be established. [ABSTRACT FROM AUTHOR]

This paper describes our experience of the novel H1N1 pandemic at Tygerberg Children’s Hospital. Twenty-six children with polymerase chain reaction (PCR)-confirmed H1N1 infection were hospitalised between 1 July 2009 and 30 September 2009. Seventy-three per cent (19/26) had underlying co-morbidities. Cough and/or dyspnoea (92%) and fever (54%) were the main presenting features. Seven children (27%) required intensive care management, with one death. Nosocomial transmission was suspected in 6/26 (23%) children. The H1N1 pandemic caused morbidity especially among low birthweight, premature infants. There is a need for continued vigilance, improved isolation facilities and appropriate immunisation. [ABSTRACT FROM AUTHOR]

Perinatal infection significantly contributes to neonatal morbidity and mortality. There are no reliable rapid diagnostic tests. Drug resistance is increasing in organisms acquired in hospital. There are little data on the indications for antibiotic use and the prevalent organisms in lower resource settings, and none in regional hospitals in South Africa. We conducted a retrospective cohort study of risk factors, indications for and drugs used at Worcester Provincial Hospital Neonatal Unit. A systematic sample of every alternate neonate listed in the admissions register from 1 July 2005 to 30 June 2006 was taken. Charts for all cases were reviewed. Early antibiotic use was defined as therapy within 72 hours of life. One hundred and ninetyfive infants where included; 144 (74%) had 194 antibiotic events. Antibiotic events occurred at a rate of 99 events per 100 neonates. Prematurity was common (83% of admissions) and, in conjunction with prolonged rupture of membranes, was the major driver of early antibiotic use. Ceftriaxone use within 72 hours of birth was significantly associated with subsequent antibiotic events, compared with penicillin alone or in combination with an aminoglycoside (p<0.04). Longer duration of treatment for early events was associated with subsequent empiric need for antibiotics (p<0.02). Prematurity is the major driver for antibiotic use at this unit. Antibiotics are prescribed appropriately but earlier discontinuation, which may be complicated by the inability to confirm/refute infection, should be practised. Alternatives to third generation cephalosporins should be available to treat hospital infection at secondary level. [ABSTRACT FROM AUTHOR]

We report a case of rapidly progressive miliary tuberculosis in a 21-month-old HIV-infected girl exposed to tuberculosis, despite early access to highly active antiretroviral therapy and proven adherence to isoniazid chemoprophylaxis. Post mortem revealed multidrug-resistant tuberculosis. This case report illustrates three important points: a) the consequences of inadequate programmatic management of children exposed to an adult case of sputum smear-positive multidrug-resistant tuberculosis, b) multiple exposures to source cases over time and c) the difficulty in diagnosing childhood tuberculosis in the setting of close supervision. Drug susceptibility testing of the adult source case should become standard of care for all children who have been in close contact with a case of sputum smear-positive tuberculosis, and the choice of chemoprophylactic agents should be based on the sensitivities of the source case organism. Regular inquiry for new exposure to source cases should also be made. New tests are urgently needed for childhood tuberculosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the management of HIV-infected neonate and prevention of vertical HIV transmissions or mother-to-child transmissions (PMTCT) of HIV.

Background. Although subSaharan Africa faces the world's largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resourcelimited settings encounter many challenges to community-initiated paediatric ART implementation. Methods. A retrospective cohort analysis of 613 children receiving ART between 2004 and 2009 was performed in seven physician-run primary healthcare (PHC) clinics in Cape Town. Baseline characteristics, serial CD4+, viral load (VL) levels and status at study closure were collected. Results. Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4+ counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression >80%, high rates of immune reconstitution and low mortality. Conclusions. Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications. [ABSTRACT FROM AUTHOR]

The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-to-child transmission. [ABSTRACT FROM AUTHOR]