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Objective: To determine the prevalence of preexisting antibodies against the pandemic 2009 Influenza A (H1N1) virus in pregnant women and to evaluate the seroprotection of the mothers and infants by a single injection of monovalent vaccine during the pandemic. Materials and Methods: Seropositivity rate of H1N1 among the nonvaccinated were compared with the vaccinated women. A single dose of vaccine, either nonadjuvanted AdimFlu-S or MF59-adjuvanted vaccine, was injected to the voluntarily vaccinated group. Maternal and cord blood sera were collected to evaluate the antibody response of the H1N1 virus. Seropositivity was defined as a hemagglutination inhibition titer to H1N1 (A/Taiwan/126/09) ≥1:40. Results: A total of 210 healthy, singleton, pregnant women were enrolled between January 2010 and May 2010. Seropositivity (≥1:40) of maternal hemagglutination inhibition was significantly higher in the vaccinated group (78%) than the nonvaccinated group (9.5%); 41.6% (20/48) of seropositive titers were >1:80. In nine vaccinated cases resulting in negative serum titers (75% could be achieved in the paired maternal and cord serum samples by a single injection of monovalent H1N1 vaccine.

PurposeTo define the clinical manifestations of rotavirus (RV) infection in neonates and young infants hospitalized in neonatal care units, which are rarely reported.Materials and MethodsFrom October 2008 to September 2010, a total of 153 stool specimens positive for RV were detected from 100 neonates and young infants hospitalized in neonatal care units of our hospital. Four infants had two episodes of RV infection. Demographics and clinical presentations of these infants were collected and analyzed. The infants were further classified as having hospital-acquired (HA) or community-acquired (CA) RV infection.ResultsOf the 104 episodes from 100 patients, 76 (73%) were classified as HA. Fifty-six infants were male. The mean age of onset was 2 days. The most common presentations were loose stool passages (52.9%), abdominal distension (51.9%), blood or mucus in stool (42.3%), and unstable vital signs (32.7%). Watery character in stool passage was identified in 13.5% of the infants and vomiting in 21.2%. A picture suggestive of necrotizing enterocolitis (NEC) was identified in 22 episodes (21.1%), and 12 of these were stage II or above. The average number of hospitalization days from the onset of HA-RV infection was 23 days. Compared with those in the CA group, the infants in the HA group had a significantly higher rate of blood or mucus in stools (52.6% vs. 14.3%, p

BackgroundDespite the high vaccination coverage in Taiwan, sporadic cases or small cluster of measles still occur every year. Nevertheless, few studies provided information about the serostatus for measles in recent years. This cross-sectional survey aimed to establish the seroepidemiologic data of measles among elementary school children in New Taipei City, Taiwan during 2012–2013.MethodsA multistage stratified sampling design using 14 variables was employed to obtain samples. All selected schoolchildren were bled for the serologic tests of measles by both chemiluminescence immunoassay (CLIA) and enzyme immunoassay (EIA).ResultsA total of 856 schoolchildren from 14 schools were recruited in this study. Among these individuals, the overall seropositive rates for measles were 82.24% and 92.17% by the Liaison and NovaLisa assays, respectively. For schoolchildren in each grade, the seropositive rates were > 90% for Grade 1, and then decreased gradually to 70–80% for Grade 6 (p 90% for Grade 1, the rate for Grade 6 was only in the range of 70–80%, which may be a challenge to prevent outbreaks of measles in the future and should be monitored meticulously.

Background Community-acquired pneumonia (CAP) is the leading cause of hospitalization of children. Mycoplasma pneumoniae is one of the most common pathogens. The disease severity is diverse, and the diagnosis remains a challenge to clinical pediatricians. The aims of this study are to provide a nationwide surveillance of the epidemiology and clinical manifestations of community-acquired mycoplasma pneumonia (CAMP) in children in Taiwan. Methods The medical records of children enrolled by the Taiwan Pediatric Infectious Disease Alliance (TPIDA) project during 2010–2011 were reviewed. Hospitalized children with segmental or lobar pneumonia were included. The demographic, clinical, laboratory and radiographic data were analyzed. Nasopharyngeal swabs, pleural effusion, and serum were collected for multiplex viral and bacterial polymerase chain reaction (PCR), mycoplasma immunoglobulin M (IgM), or paired immunoglobulin G (IgG) titer. Results There were overall 127 children with CAMP. Among them, 16 (12.6%) children had PCR and IgM positivity, 74 (58.3%) children had a positive serologic study, 34 (27.8%) children had positive PCR detection, and three (2.4%) children had paired IgG above a four-fold increase. Enrolled patients were divided into two groups before and after the age of 5 years. Children younger than 5 years or younger had a significantly longer hospitalization, higher intensive care unit (ICU) admission rates, and more complications. They were more frequent to receive oxygen supplementation and even surgical intervention. The white blood cell counts and C-reactive protein levels were higher in children 5 years old or younger. Conclusion Mycoplasma pneumoniae is an important etiology of CAP in children 5 years or younger. They had a longer length of hospitalization, higher inflammatory responses, and more complications, compared to children older than 5 years.

Summary Objective To assess the immunogenicity of a fully liquid diphtheria–tetanus–five component acellular pertussis–inactivated poliomyelitis– Haemophilus influenzae type b (DTaP–IPV–Hib) conjugate vaccine compared to DTaP–IPV and lyophilized Hib conjugate vaccines given simultaneously at separate sites as a three-dose primary vaccination in Taiwanese infants. Methods Two hundred infants were randomized to receive either DTaP–IPV–Hib or DTaP–IPV plus Hib vaccine at 2, 4, and 6 months of age. Both combined vaccines contained the same five pertussis antigens: pertussis toxoid (PT), filamentous hemagglutinin (FHA), pertactin (PRN), fimbriae 2 and 3 (FIM 2&3). Antibody concentrations were measured before the first and after the third dose. Reactogenicity was evaluated from parental reports. All subjects received hepatitis B vaccine at 0, 1, and 6 months of age following the national vaccination schedule of Taiwan. Results The immunogenicity after the third dose was high for each vaccine antigen in both groups, and the vaccines had low reactogenicity. Statistical analysis showed no differences in the immune responses to the fully liquid DTaP–IPV–Hib vaccine compared with those to the DTaP–IPV plus Hib control vaccines, notably the anti-PRP (polyribose ribitol phosphate capsular polysaccharide) response, with 97–99% of infants having concentrations ≥1.0μg/mL. Approximately 95% of all infants developed seroprotective levels of anti-hepatitis B surface antigen (HBs) antibodies (≥10mIU/mL). Conclusions Both combination vaccines had similar high immunogenicity for each antigen, and both were well tolerated. Thus, inclusion of a Haemophilus influenzae type b conjugate vaccine in the combination did not result in clinically significant decrease in the PRP response or increase reactogenicity. The fully liquid pentavalent vaccine has the advantages of not requiring reconstitution and of administration as a single injection.

Background/Purpose(s) In Taiwan, clinical and microbiological data on acute otitis media (AOM) with spontaneous otorrhea in children are limited. Methods We retrospectively collected data on children with AOM and spontaneous otorrhea between January 2011 and June 2012. Otorrhea samples were collected using sterile swabs and sent for cultures. Pathogens found were Streptococcus pneumoniae , Haemophilus influenzae , Moraxella catarrhalis , Streptococcus pyogenes , and Staphylococcus aureus . Pneumococcal isolates collected from October 2011 to June 2012 were serotyped. Results A total of 92 patients were enrolled in the study for demographic and microbiological analysis. Their median age was 2.5 years. After excluding those with lobar pneumonia, 84 patients were included for analysis of clinical manifestation. The mean febrile duration was 6 days. Leukocytosis and C-reactive protein (CRP) level >50 mg/L were noted in 29 (34.5%) patients and 38 (45.2%) patients, respectively. Patients with pneumococcal infection were older ( p = 0.007) and had more severe symptoms [fever ( p = 0.001), otalgia ( p = 0.055), respiratory symptoms ( p = 0.002–0.03), and higher CRP level ( p = 0.015)] than children with other bacterial infection. Otorrhea cultures were obtained from 69 (75%) patients, of whom 52 had definitive AOM pathogens. The most common causative pathogen was S. pneumoniae (61.5%), followed by S. aureus (36.5%). Serotype 19A accounted for two-thirds of pneumococcal isolates and had a high rate of nonsusceptibility to penicillin (66.7%) and ceftriaxone (83.3%). Conclusion S. pneumoniae was found to be the most important source of AOM with spontaneous otorrhea in children and caused more severe symptoms. Serotype 19A, which was usually nonsusceptible to antimicrobial agents, was the most prevalent serotype in these patients.

Natural human immunity to the mycobacteria group, including Mycobacterium tuberculosis, Bacille Calmette-Guerin (BCG) or nontuberculous mycobacteria (NTM), and/or Salmonella species, relies on the functional IL-12/23-IFN-γ integrity of macrophages (monocyte/dendritic cell) connecting to T lymphocyte/NK cells. Patients with severe forms of primary immunodeficiency diseases (PIDs) have more profound immune defects involving this impaired circuit in patients with severe combined immunodeficiencies (SCID) including complete DiGeorge syndrome, X-linked hyper IgM syndrome (HIGM) (CD40L mutation), CD40 deficiency, immunodeficiency with or without anhidrotic ectodermal dysplasia (NEMO and IKBA mutations), chronic granulomatous disease (CGD) and hyper IgE recurrent infection syndromes (HIES). The patients with severe PIDs have broader diverse infections rather than mycobacterial infections. In contrast, patients with an isolated inborn error of the IL-12/23-IFN-γ pathway are exclusively prone to low-virulence mycobacterial infections and nontyphoid salmonella infections, known as Mendelian susceptibility to the mycobacterial disease (MSMD) phenotype. Restricted defective molecules in the circuit, including IFN-γR1, IFN-γR2, IL-12p40, IL-12R-β1, STAT-1, NEMO, IKBA and the recently discovered CYBB responsible for autophagocytic vacuole and proteolysis, and interferon regulatory factor 8 (IRF8) for dendritic cell immunodeficiency, have been identified in around 60% of patients with the MSMD phenotype. Among all of the patients with PIDs referred for investigation since 1985, we have identified four cases with the specific defect (IFNRG1 for three and IL12RB for one), presenting as both BCG-induced diseases and NTM infections, in addition to some patients with SCID, HIGM, CGD and HIES. Furthermore, manifestations in patients with autoantibodies to IFN-γ (autoAbs-IFN-γ), which is categorized as an anticytokine autoantibody syndrome, can resemble the relatively persistent MSMD phenotype lacking BCG-induced diseases.

BackgroundIsolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children.MethodsFrom January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children’s hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses.ResultsThere were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42±0.14 years. The mean hospitalization duration was 4.21±0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78±1 days (range, 1–7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm3, and 63 (45%) patients had leukocytosis (>15,000/mm3). The mean serum C-reactive protein (CRP) level was 44.1±3.3mg/L (normal, 40mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand–foot–mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully.ConclusionsCox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand–foot–mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported recently and has become an emerging pathogen of infective endocarditis (IE) in adults, but still rarely reported in children. A previously healthy preschool child without any heart anomaly developed IE and pneumonia with pleural effusion. Blood cultures repeatedly yielded MRSA and did not become negative until 13 days after a teicoplanin-containing regimen was administered. In total, a 4-week intravenous antibiotic therapy and an additional 8-week oral antibiotic therapy were given. The patient recovered uneventfully. All five MRSA blood isolates were molecularly characterized and shared common characteristics, which were consistent with those of the endemic CA-MRSA clone in Taiwan. This case highlights that physicians should be aware of the growing role of CA-MRSA in childhood IE and should meticulously choose an appropriate empiric antibiotic regimen for such a severe disease.

Background The role of excessive adiposity or its metabolic consequences in persistent HPV infection among general adult women remains unknown. Methods Using data from the National Health and Nutrition Examination Survey (NHANES) in 2003–2010, we compared adult women’s likelihood for any- or high-risk (HR) type HPV infection by degrees of excessive adiposity and metabolic health status. Results Any-type (41.1 % vs. 44.9 %, P = 0.045) or HR-type HPV prevalence (21.9 % vs. 25.4 %, P = 0.055) was comparable in women aged 20–59 years with or without central obesity. After adjusting for age, socioeconomic indicators, and lifetime sexual risks, centrally-obese women barely showed a different likelihood for any-type (aPR [adjusted prevalence ratio] = 0.91, P = 0.03) or HR-HPV infection (aPR = 0.92, P = 0.279). However, obesity (aPR = 0.76, P = 0.017) or centrally-obesity (aPR = 0.72, P = 0.003) was negatively correlated with HR-HPV infection in women reporting an early sex debut (

Purpose: To compare the performance of a commercial interferon-gamma release assay, QuantiFERON TB Gold-in-Tube (QFG-IT) with the tuberculin skin test (TST) in Taiwanese children for the diagnosis of active tuberculosis (TB). Methods: A retrospective chart analysis of pediatric patients (

Background Staphylococcus aureus, particularly methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis. To evaluate nasal carriage, molecular characterization and effectiveness of decolonization of MRSA among patients receiving hemodialysis in Taiwan, we conducted this study. Methods From January to June 2011, two nasal samplings with a 3-month interval were obtained from patients undergoing hemodialysis in a medical center (CGMH), and in a local hospital (YMH) and sent for detection of MRSA. For MRSA carriers, decolonization procedures were administered. All patients in CGMH were observed if MRSA infections occurred during the study period. Results A total of 529 nasal specimens (265 from CGMH and 264 from YMH) were collected from 296 patients (161 from CGMH and 135 from YMH). 233 patients participated in both surveys. Average one-time point MRSA carriage rate was 3.8%, and the rate was up to 6.9% for those with two-time point surveys. No additional significant factor for MRSA carriage was identified. Seventy percent of the 20 colonizing MRSA isolates, though categorized as healthcare-associated strains epidemiologically, shared common molecular characteristics of the local community-associated strains. Only one of the 20 MRSA-colonized patients failed decolonization and had persistent colonization, while without any intervention, 17 (61%) of 28 patients with methicillin-sensitive S. aureus colonization in the first survey had persistent colonization of a genetically indistinguishable strain. Within the study period, two patients (1.24%) in CGMH, one with MRSA colonization (9.1%), developed MRSA infection. Conclusion A substantial proportion of patients receiving hemodialysis in Taiwan had MRSA colonization, mostly genetically community strains. Decolonization procedures may effectively eliminate MRSA colonization and might reduce subsequent MRSA infection in these patients.

We investigated the clinical and molecular characteristics of Candida albicans bloodstream infection (BSI) in children from a tertiary-level medical centre in Taiwan over a 9-year period from January 2003 to December 2011. We performed multilocus sequence typing (MLST) to investigate the genetic relatedness of these C. albicans BSI isolates. A total of 79 episodes of C. albicans BSI in 76 paediatric patients were identified, including 41 (51.9%) from the paediatric intensive care unit, 24 (30.4%) from the neonatal intensive care unit and 14 (17.7%) from general wards. More than half (59.5%) of these patients had underlying chronic co-morbidities, and the majority (94.9%) had a catheter or some other artificial device. All the isolates were susceptible to the antifungal agents tested. Only 32.9% (26/79) received effective antifungal agents within 24 h of onset of candidaemia. Twenty-five (31.6%) patients had persistent candidaemia (>3 days after the start of antifungal treatment) and candidaemia-attributable mortality rate was 22.8% (18/79). The 72 isolates available for MLST yielded 53 unique diploid sequence types (DSTs). Forty-five DSTs were singletons and eight DSTs were shared by 27 (37.5%) isolates. Seventy-one (98.6%) isolates were clustered within previously known clades. Based on the definition of two or more strains with shared DST occurring within a period of 90 days, 10.1% of the infections were categorized as nosocomial clusters, most commonly identified in the intensive care units. Although cluster-associated candidaemia was not associated with a higher mortality rate, none of the clusters were identified by the hospital infection control team.

a Primary Immunodeficiency Care And Research (PICAR) Institute, Chang Gung Medical Hospital and Children’s Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Chang Gung Medical Hospital and Children’s Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Pediatrics, Division of Hematology and Oncology, Chang Gung Medical Hospital and Children’s Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan Department of Pediatrics, Division of Infection, Chang Gung Medical Hospital and Children’s Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan Chinese Society of Immunology, Taiwan

International audience; The multidrug-resistant Staphylococcus capitis NRCS-A clone is responsible for sepsis in preterm infants in neonatal intensive care units (NICUs) worldwide. Here, to retrace the spread of this clone and to identify drivers of its specific success, we investigated a representative collection of 250 S. capitis isolates from adults and newborns. Bayesian analyses confirmed the spread of the NRCS-A clone and enabled us to date its emergence in the late 1960s and its expansion during the 1980s, coinciding with the establishment of NICUs and the increasing use of vancomycin in these units, respectively. This dynamic was accompanied by the acquisition of mutations in antimicrobial resistance- and bacteriocin-encoding genes. Furthermore, combined statistical tools and a genome-wide association study convergently point to vancomycin resistance as a major driver of NRCS-A success. We also identified another S. capitis subclade (alpha clade) that emerged independently, showing parallel evolution towards NICU specialization and non-susceptibility to vancomycin, indicating convergent evolution in NICU-associated pathogens. These findings illustrate how the broad use of antibiotics can repeatedly lead initially commensal drug-susceptible bacteria to evolve into multidrug-resistant clones that are able to successfully spread worldwide and become pathogenic for highly vulnerable patients.