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AAP News Vol. 18 No. 4
April 2001, p. 144
Effectiveness of mass immunization
An increased number of cases of serogroup C serotype 2a Neisseria meningitidis was reported to the public health authorities in the late 1980s. The outbreak was associated with an increased proportion of cases in teen-agers and young adults, a high case fatality rate and a high sequelae rate. In response, a mass immunization campaign targeting school-aged children and adolescents was initiated in late 1991 and 1992. The campaign was extended from December 1992 through March 1993 to include all residents of Quebec between the ages of 6 months and 20 years. A vaccination rate of 84% was achieved. A quarter of those immunized received the tetravalent (A, C, Y, W135) vaccine and the remainder, the bivalent (A, C) vaccine. The incidence of serogroup C N. meningitidis dropped markedly from 1.4 cases per 100,000 in 1990-1992 to 0.3 cases per 100,000 in 1993-1998. Except for a small increase in serogroup Y cases, the incidence of other serogroups did not change. The risk of infection was greatest in the first two years of the study and higher in unvaccinated than in vaccinated persons. In years three through five, the risk fell for both vaccinated and unvaccinated persons. Vaccine effectiveness also increased with age. It was ineffective for children under 2 years, 41% effective for children 2 to 9 years, 75% effective for those 10 to 14, and 83% effective for those 15 to 20 years. Treating partial-thickness burns
Use of beta glucan collagen matrix (BGC) as a primary wound dressing on partial-thickness burns showed several advantages over standard techniques, including a decrease in fluid loss and reduction in pain, according to a retrospective study of pediatric burn patients.
Investigators at the Medical University of South Carolina compared 43 children treated with BGC to 130 patients treated with daily dressing changes and either topical silver sulfadiazene or bacitracin. In both groups, the average age of patients was 5 BGC was applied to a clean, debrided wound, secured with Steri-strips, covered with fluffed gauze wrap and held in place with an elastic bandage. The following day, the outer wrap and gauze dressing were removed, and the wound with the adherent BGC was left open to air. Burns that were several days old or on the face, hands, feet, joints or genitalia were considered unsuitable for BGC. BGC combines beta glucan, a complex carbohydrate known to stimulate macrophages, with collagen in a meshed reinforced wound dressing. Treatment with BGC results in decreased evaporative water and heat loss from the wound, since BGC provides a semi-occlusive wound covering and an effective barrier to bacterial contamination. Among the patients treated with BGC, 10 (23%) did not require hospitalization and 12 were hospitalized for less than 24 hours. The results were excellent in 79% of the patients. Nine patients, however, had the BGC removed before complete healing: six due to progression to full thickness, two because of nonadherence over a joint and one for unexplained nonadherence. Five of these patients required skin grafting. Wound healing with standard treatment or BGC was similar. However, those treated with BGC experienced less pain and had less need for narcotics than those treated traditionally, since sensory nerve terminals were covered and daily dressing changes were not needed. Developmental screening referrals
Children who have false-positive results on developmental screening tests still benefit from referral for diagnostic testing, according to a study of 511 children ages 7 months to 8 years. The value of screening tests has been questioned because they produce failing scores for 15% to 30% of children who are not found to have disabilities (false-positives). The author sought to determine whether children overreferred by screening tests differ from children who pass the tests (true-negatives). She compared the results of diagnostic testing in the 42% of children who had false-positive results with the 43% who had true-negative results. Among children with false-positive results, 70% scored below the 25th percentile (the cutoff for placement in remedial reading and math programs) on at least one diagnostic measure compared to 29% of children with true-negative scores. Those with false-positive scores were 2.6 times more likely to score below the 25th percentile in adaptive behavior, 3.1 times in language skills, 6.7 on intelligence tests and 4.9 times on academic measures. Children with false-positive results also were more likely to be members of a racial minority and to have parents who had not graduated from high school. Their scores, however, remained significantly lower after controlling for sociodemographic differences. The author recommended pediatricians use diagnostic test results to promote optimal development, monitor progress and make appropriate referrals. Although these children do not qualify for special education placement, they would benefit from individualized instruction and programs known to improve language, cognitive and academic skills, such as Head Start, Title I services, tutoring, private speech and language therapy, and quality day care. Multicystic dysplastic kidneys
While children with simple multicystic dysplastic kidney (MCDK) disease had excellent outcomes, those with complex MCDK did not fare as well, according to a retrospective study of 35 patients at Yale University School of Medicine. A diagnosis of MCDK often is made by prenatal sonography. In some patients, the abnormality has involuted by the time of birth, but in others the disease is complicated by urinary tract infection (UTI), hypertension or malignancy postnatally. Because the nature of these complications is poorly understood, management of this disorder has ranged from simple observation to nephrectomy. The authors conducted a review of all patients diagnosed with MCDK between August 1995 and March 1999 to determine the clinical course and to predict which patients are at significant risk for developing UTI and renal insufficiency. Patients with unilateral multicystic kidney and no associated genitourinary tract abnormalities on physical examination and ultrasonography were classified as having simple MCDK. All 21 patients had compensatory growth of the contralateral kidney, normal renal function and normal blood pressure. A voiding cystourethrogram (VCUG) was performed in five patients at diagnosis and demonstrated reflux in four. However, only one patient developed a UTI. In contrast, 14 patients had complex MCDK with bilateral disease or associated abnormalities on physical examination or ultrasonography. Three patients had a VCUG performed at diagnosis; reflux was present in two. Four patients had documented UTI. Half the patients with complex MCDK developed renal insufficiency or end-stage renal disease. The authors concluded that the clinical course and outcome of patients with MCDK can be predicted without an initial VCUG and independent of the presence or absence of reflux.
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years, the primary cause of the burn was a scald injury and the number of days to complete healing was 15. 
