New Zealand (NZ) has a large pertussis disease burden compared with other developed countries. Accurate ascertainment of disease burden is fundamental to controlling pertussis and informing immunisation policy. Disease burden estimates are primarily from passive surveillance, which underestimates disease incidence. The aim of this study is to use active surveillance to determine pertussis disease burden in infants hospitalised in NZ.Using the NZ Paediatric Surveillance Unit, active surveillance from 08/2004 to 07/2005 for infants <12 months old, hospitalised with pertussis.110 infants identified (196 per 100,000), including six with complications, eight intensive care admissions and one death. The hospitalisation rate (per 100,000) varied with ethnicity, being higher for Maori (296) and Pacific (358) compared with European/other (117). Twenty-four per cent were too young to be immunised. Of infants 6 weeks and older 46% had received no immunisations. Despite being more likely to be immunised Pacific infants had a higher hospitalisation rate owing to a larger proportion acquiring pertussis prior to age 6 weeks. Cyanosis and apnoea were frequent symptoms in young infants. Under-identification, estimated using capture-recapture analysis, was modest for both active surveillance (16%) and passive notification (19%).Infant pertussis hospitalisation rates are three to six times greater than rates in the USA, England and Australia. Underestimation of disease burden by passive notification in hospitalised infants is modest, suggesting a high degree of clinical awareness by paediatricians in NZ. New immunisation strategies are needed to protect infants from a younger age.
Aim: We aimed to develop policy in relation to three areas: (i) the diagnosis of iron deficiency; (ii) maternal–infant issues and the prevention of iron deficiency; and (iii) the treatment of iron deficiency. Methods: Within each of these topic areas we completed a literature review and developed recommendations to help direct activities of the Royal Australasian College of Physicians, update paediatricians and guide clinical practice. Results: Iron deficiency can be defined using cut‐off values for laboratory measures of iron status or, if an intercurrent infection is not present, by demonstrating a response to a therapeutic trial of iron. The appropriate measures of iron status vary depending upon the presence of intercurrent infection. Full‐term babies are born with iron stores sufficient to meet their needs to age 4–6 months but premature infants are not. After age 6 months infants are dependent upon dietary iron from complementary foods even with continued breastfeeding. Infants <33 weeks gestation or <1800 g birthweight should receive iron from 4 weeks of age. In most settings recommended treatment of iron deficiency is with oral ferrous sulphate as a single or twice daily dose of between 3 and 6 mg/kg/day. Conclusions: Iron deficiency is prevalent and an important determinant of child health. Precise and accurate diagnosis remains challenging. Iron supplementation is required for premature and low‐birthweight infants. Oral iron salts remain the recommended treatment of choice in most instances.
Abstract Objectives: First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility. Design: Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed. Results: A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG. Conclusions: This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.
Aim: To determine the epidemiology, management and outcome of Kawasaki disease (KD) in New Zealand. Design: Prospective audit using New Zealand Paediatric Surveillance Unit (NZPSU) Reports. Setting: Single country 2‐year epidemiological study. Patients: All patients diagnosed with KD in New Zealand reported to the NZPSU from January 2001 to December 2002. Main outcome measures: Incidence of KD; time to diagnosis; use of intravenous immunoglobulin; cardiac features and outcome. Results: Forty‐nine new cases were identified. The annual incidence was 8.0 cases/100 000 children aged less than 5 years. Age at onset was less than 5 years in 86% of cases. Incidence was 4.6/100 000 for children of European origin, 9.6 for Maori, 12.2 for Pacific Islanders and 32.2 for children of East Asian origin. KD was diagnosed at a median of 6 days from onset of illness. 89% had fever and four or more diagnostic features. All patients had at least one echocardiogram: There was one small (2%) coronary artery aneurysm only; 13 (26%) had mild coronary artery dilatation. Thirty‐five per cent did not have an echocardiogram performed four or more weeks from illness onset. 45 (92%) cases received intravenous immunoglobulin at median day six. There was one death due to occlusive coronary artery disease in a 3‐month‐old boy with atypical symptoms in whom KD was diagnosed at post‐mortem. Conclusions: The incidence of KD in New Zealand is defined with significantly variable risk according to ethnicity. Most patients received appropriate rapid diagnosis and treatment but there was considerable variation in practice in regard to number and timing of echocardiograms. There was a low coronary artery aneurysm rate (2%). Accelerated vaso‐occlusive disease was responsible for the single fatality in an atypical case.
Background. Rotavirus illness is associated with significant morbidity and mortality world-wide. We have examined trends in diarrheal disease in New Zealand children to determine the disease burden attributable to rotavirus and to estimate the proportion of hospitalizations preventable by vaccination. Methods. Hospital admissions data and laboratory records for 1994 to 1996, were obtained for children 0 to 4 years at four sites (serving ∼60% of the New Zealand population). Rotavirus disease burden was estimated using combined admissions and laboratory data. Severity of disease was estimated in a sample of 150 hospitalizations for rotavirus diarrhea, and the proportion of vaccine-preventable admissions was extrapolated. Mortality attributed to diarrheal causes was determined from national records for 1974 to 1993. Results. Between 1994 and 1996, 4436 children <5 years of age were hospitalized with diarrhea (1047/100 000 children per year). Admissions associated with rotavirus were estimated at 1522 to 1535 (315 to 362/100 000 annually). Infants between 6 and 17 months were most commonly affected (42% of all cases). More male children than female children were hospitalized (P < 0.001) and mean length of stay was calculated as 1.51 days (SD 2.35). Disease severity scoring revealed that 61.3 and 38.0% of admissions reviewed were severe and very severe, respectively. Deaths from diarrheal causes numbered 138 among children 0 to 4 years old for the 20-year period 1974 to 1993, with 18 deaths occurring between 1984 and 1993 (10 years). Conclusion. Current vaccines control severe disease, suggesting that 72% of cases reviewed would be eligible for prevention. A full cost effectiveness analysis is required to demonstrate anticipated benefits of vaccination.
To investigate the level of understanding parents/caregivers have regarding prescribed medicines for their sick children, and how they manage these medicines at home following hospital discharge.
To review recent cases of Kawasaki disease (KD) with significant cardiac sequelae in New Zealand. It is known that intravenous immunoglobulin (IVIG) reduces the risk of coronary artery aneurysm formation if given within 8-10 days of onset of KD.Retrospective review of medical course, criteria for KD, laboratory and cardiac findings for six children identified with KD and significant coronary artery sequelae.There was delay in diagnosis of KD in three of the six children. Three cases were atypical by extremes of age (2 months, 10 years, 14 years). By definition all six children had significant coronary artery involvement. One patient had a thrombus detected in a coronary aneurysm 3 weeks after KD. One patient underwent coronary artery bypass grafting for unstable angina 2 years after KD. One patient developed coronary artery aneurysms after an initial 'toxic shock' type illness evolving to KD. Three patients died, one due to rupture of a coronary artery aneurysm, two from rapid early coronary artery obstruction occurring at three and 4 months after initial KD.Kawasaki disease remains an important cause of mortality and morbidity for children. Diagnostic delay beyond 8 days reduces the chances of successful IVIG therapy in KD. Current studies supported by the Paediatric Surveillance Unit should establish the epidemiology of KD in New Zealand.
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