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In a prospective study of 148 children from urbanized southern Finland 3 were found to be congenitally and 48 perinatally infected with cytomegalovirus (CMV), while 6 developed "late" infection during the first year of life. During pregnancy and the first year after delivery 23 of the mothers had no CMV antibodies; none of the children of these seronegative mothers developed any type of CMV infection. Fresh blood exchange transfusions did not increase the risk of CMV infection. The data support the hypothesis that the mother is the source of perinatal CMV infection. Children with a low birthweight not due to prematurity, and first children seem to run a greater risk of acquiring perinatal CMV infection. If the child is breast fed up to the age of 2 months the risk seems to be increased. Perinatal CMV infection gave rise to no symptoms or signs and had no effect on growth or on motor and psychosocial development during the first year of life. [ABSTRACT FROM AUTHOR]

A total of 410 proved cases of neonatal septicaemia from seven Finnish hospitals seen between 1976 and 1980 were reviewed. The annual incidence of neonatal septicaemia was 3 per 1000 births, and overall mortality was 23%. Onset was early in most patients. Symptoms of septicaemia occurred within the first 24 hours of life in 44% and within the first week of life in 90%. In the very early onset disease (within 24 hours) mortality was 30%, compared with 17% in all other cases. Group B streptococcus was the leading cause in very early onset disease (52%) but mortality from infection with this organism was similar to that in other very early onset cases. It is concluded that very early onset neonatal septicaemia, probably of intrauterine origin and caused by group B streptococcus in one half of the cases, constitutes the major form of neonatal septicaemia in Finland and should receive the highest priority in preventive measures. [ABSTRACT FROM AUTHOR]

Meningococcal group A polysaccharide vaccine was used in children 3 months to 5 years of age in the winter 1974-75 during an epidemic caused by sulphanamide-resistant group A meningococci. In 3 provinces, the vaccine was offered on a double-blind basis, using Haemophilus influenzae type b polysaccaride vaccine as control. Approximately 100 000 children were vaccinated with either one of the vaccines. In the Kymi province, approximately 22 000 children representing 90% of the child population of this age received the meningococcus vacine. Infants below 18 months received a booster dose of vaccine 3 months after the first dose. The meningococcus vaccine caused local symptoms in 71%, mild systemic reactions in 37%, and high fever (38.5 degrees C or more) in 1.8% The haemophilus vaccine produced fewer side effects. No clinical infections caused by group A meningococci were reported in the first 6 months after vaccination among those who had received the meningococcal vaccine. At the same time, group A cases continued to appear in other age groups and other areas of the country.

In the lifespan of a human being the two extremes, the early childhood and old age are prone to septicaemia because of poorly functioning anti-infectious defensive mechanisms. In a newborn full term baby these mechanisms are all present but still unexperienced. The importance of both specific and nonspecific factors will be discussed. The etiologic agents, causing septicaemia in nurseries undergo continuous change. In Helsinki we have during the last 20 years experienced staphylococci to start with, changing then to Gram-negative rods, to streptococci group B and now we have increasing difficulties with hospital infections. In the treatment of these children antibiotics alone are not sufficient but repeated exchange transfusions and granulocyte transfusions are needed. In infants after the first month of life, septicaemias produce a clinical picture different from that in newborns but still different also from that in adults. Also in this age group a shift in etiology has been observed. Increasing resistance to antimicrobial agents in the bacteria encountered makes a reconsideration of therapeutic schemes necessary.

An epidemic due to sulphonamide-resistant group A meningococci started in Finland in January 1973. By the end of 1974 the number of cases exceeded 1300. This report describes epidemiological and clinical observations in 370 patients treated in Helsinki 1973-1974. The incidence was about 65 per 100 000 per year in children under 7 years of age and about 10 per 100 000 in adults. More than one case occurred in 3.8% of the families and in 36% of the lodging-houses of the lowest social group. The fatality rate of patients treated in hospital was 4.1%. Persistent neurological damage was noticed in 4.6%.

We performed field trials in the course of an epidemic in Finland to learn whether Group A memingococcal capsular polysaccharide vaccine protects infants and young children from meningitis. The first trial involved 130,178 children between the ages of three months and five years; 49,295 children received the vaccine, 48,977 received a control Haemophilus influenzae Type b polysaccharide vaccine, and 31.906 remained unvaccinated. No cases of meningitis or sepsis caused by Group A meningococci were seen in the first year of observation among the children vaccinated with meningococcal vaccine whereas six occurred among those vaccinated with the H. influenzae vaccine and 13 among those not vaccinated. In the second trial 21,007 children of the same ages received the meningococcal vaccine. No cases caused by Group A occurred among those vaccinated, although five to seven would have been expected within the year. Meningococcal Group A vaccine appears efficacious in young infants and children.

The occurrence and possible consequences of cytomegalovirus (CMV) infections were studied in 200 mothers and their children by means of immunofluorescent antibody assays in serum, virus isolation from urine and regular clinical and neurological examinations. The prospective study covered the time from early pregnancy to 1 year post partum. The frequency of intrauterine infections was 2%, while 30% of the children became perinatally infected as indicated by the onset of virus excretion and an antibody response at the age of 2--4 months. Later on the occurrence of CMV infections declined sharply. 23 mothers had no CMV antibodies and none of their children contracted CMV during the first year of life. Maternal antibodies seemed unable to protect the child from CMV infections or to delay the onset of virus excretion in perinatally infected children. Intrauterine infections did not correlate with significant increases in the antibodiy titres of the mothers or the presence of IgM antibodies either in the mother's sera or in the cord sera. Perinatal infections were often associated with the presence of IgM antibodies both in the child and in the mother and in these mothers significant increases in CMV antibody titres were frequently seen, probably indicating an activated latent infection. Immunofluorescent antibody assay correlated well with virus isolations and was more sensitive than complement-fixing antibody assay.

We present a series of 43 infants with neonatal herpes simplex virus infection treated at the Children's Hospital, University of Helsinki, during a 16-year period from 1970 to 1985. Twelve mothers (28%) had a history of genital herpes during pregnancy, and two had had labial herpes infection. Eight infants (19%) were delivered by cesarean section. In 14 (33%) infants symptoms appeared within 24 hours and in 26 (61%) they appeared within 7 days. The presenting symptoms were neurologic in 79%, cutaneous in 30%, respiratory in 19%, cyanosis/pallor/grayish skin in 16%, irritability in 12% and fever in 7%. Herpes simplex virus was detected most early and frequently in pharyngeal swabs, in one-third on Postnatal Days 2 to 5. Cerebrospinal fluid contained an increased amount of protein and/or pleocytosis in 72%. Abnormal electroencephalographic background activity appeared in 56% and electrical paroxysms in 41%. Six infants (14%) died, 9 (21%) were damaged severely and 6 (14%) were moderately or mildly damaged. Poor prognosis was associated with acute maternal illness at delivery, prematurity, visceral involvement and/or electrical paroxysms in the electroencephalograms. This study underlines the occurrence of intrauterine transmission of herpes virus, infections with neurologic manifestations, early symptomatology and the need for prompt diagnosis, brain biopsy in selected patients and antiviral therapy in neonates with herpes virus infection.