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ABSTRACT: Despite proven good efficacy of pneumococcal conjugated vaccine in preventing invasive pneumococcal disease, breakthrough infections remain a noticeable problem with significant morbidity and mortality, especially in selected high-risk groups. We present a 2-year-old girl with infantile spasm, who was treated with antiepileptic drugs and adrenocorticotropic hormone (ACTH). Vaccination with three doses 7-valent pneumococcal conjugate vaccine had been completed one month before ACTH therapy. Two months after ACTH therapy, she suffered from fever, cough, and decreased activity. Streptococcus pneumoniae, serotype 6B, was detected in blood culture. Vaccine failure could be possibly due to ACTH therapy.
Journal of the Formosan Medical Association 04/2013; 112(4):230-2. · 1.13 Impact Factor
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Chen-Yin Lai,
Chia-Jie Lee, Chun-Yi Lu,
Ping-Ing Lee,
Pei-Lan Shao,
En-Ting Wu,
Ching-Chia Wang,
Boon-Fatt Tan,
Hsin-Yu Chang,
Shao-Hsuan Hsia,
Jainn-Jim Lin,
Luan-Yin Chang,
Yhu-Chering Huang,
Li-Min Huang
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ABSTRACT: OBJECTIVE: Increased incidence of adenovirus infection in children was noticed since September 2010 in Taiwan and severe cases requiring intensive care were noted later. We did this study to find the clinical characteristics and risk factors associated with severe adenovirus infection. PATIENTS AND METHODS: We collected cases of severe adenovirus infection between November 2010 and June 2011 to analyze their clinical characteristics in two medical centers in northern Taiwan. Severe adenovirus infection was defined as laboratory-confirmed adenovirus cases with required intensive care. Hexon gene sequencing was performed for molecular genotyping. RESULTS: 45 patients were included, 22 cases (49%) were infected with serotype 7, 19 (42%) with serotype 3, and 4 with serotype 2. The median age (range) was 2.75 years (0.08-15.43 years); 87% were below 5 years. Male to female ratio was 1.65 (28 to 17). Of these patients, 56% had underlying neurological diseases, 50% experienced fever higher than 40°C and 69% suffered fever longer than one week. The clinical diagnosis included pneumonia in 40 (89%) patients, bronchopneumonia in 5 (11%), and encephalitis in 7 (16%). At least 22 patients had pleural effusion. They had complications of respiratory failure (53%), acute respiratory distress syndrome (24%), hypotension (40%), and 6 (13%) patients needed extracorporeal membranous oxygenation. Ten (22%) patients died, all with underlying major systemic diseases and 7 (70%) infected with serotype 7. CONCLUSIONS: Adenovirus serotype 7 and 3 can cause severe disease-even death-in children, especially those with underlying neurological diseases. Patients infected with adenovirus serotype 7 tended to have a higher case-fatality rate.
PLoS ONE 01/2013; 8(1):e53614. · 4.09 Impact Factor
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ABSTRACT: Accurate and timely diagnosis is vital for the clinical management of influenza. A 2009 pandemic influenza A (H1N1)-specific enzyme-linked immunosorbent assay (ELISA) was tested with selected clinical samples.
A selection of 90 throat swab samples with various viral loads of 2009 pandemic influenza A (H1N1) were tested.
Using the reverse transcriptase polymerase chain reaction as a gold standard, the overall sensitivity (0.57) was higher than that of the QuickVue Influenza A+B Test (0.43). The specificity of the ELISA was 1.0 using the selected sample set. The positive and negative predictive values were 1 and 0.4, respectively.
The ELISA is an easy to perform, highly specific, and fairly sensitive diagnostic tool for the 2009 pandemic influenza A (H1N1) virus infections. A strong correlation was found between viral load and specificity.
Journal of the Formosan Medical Association 12/2012; 111(12):693-7. · 1.13 Impact Factor
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Tsung-Pei Tsou,
Boon-Fatt Tan,
Hsin-Yu Chang,
Wan-Chin Chen,
Yuan-Pin Huang,
Chen-Yin Lai,
Yen-Nan Chao,
Sung-Hsi Wei,
Min-Nan Hung,
Li-Ching Hsu, Chun-Yi Lu,
Pei-Lan Shao,
Jung-Jung Mu,
Luan-Yin Chang,
Ming-Tsan Liu,
Li-Min Huang
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ABSTRACT: In 2011, a large community outbreak of human adenovirus (HAdV) in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of 2011 (March 14-October 16, 2011). Although HAdV-3 was the predominant strain detected (74%), an abrupt increase in the percentage of infections caused by HAdV-7 occurred, from 0.3% in 2008-2010 to 10% in 2011. Clinical information was collected for 202 inpatients infected with HAdV; 31 (15.2%) had severe infection that required intensive care, and 7 of those patients died. HAdV-7 accounted for 10%, 12%, and 41% of infections among outpatients, inpatients with nonsevere infection, and inpatients with severe infection, respectively (p<0.01). The HAdV-7 strain detected in this outbreak is identical to a strain recently reported in the People's Republic of China (HAdV7-HZ/SHX/CHN/2009). Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak.
Emerging Infectious Diseases 11/2012; 18(11):1825-1832. · 6.79 Impact Factor
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ABSTRACT: OBJECTIVE: To delineate whether serotype 19A invasive pneumococcal disease (IPD) comprised significantly more necrotizing pneumonia and empyema in children, we compared the clinical characteristics between serotype 19A and non-19A IPD. METHODS: Between January 2007 and December 2011, cases of children with IPD who were treated at the National Taiwan University Hospital were reviewed. Patients were assigned to the 19A group or the non-19A group based on the serotype. Their demographic data, clinical course, laboratory results, diagnosis, complications, and sequelae were collected and analyzed. RESULTS: Overall, 27 patients were included in the 19A group and 29 patients in the non-19A group. Compared with non-19A group, serotype 19A tended to cause IPD in patients without major underlying diseases (p = 0.015). Bacteremia without pneumonia or meningitis was found more frequently in the non-19A group (45% vs. 11%, p = 0.01), and pneumonia with or without empyema occurred significantly more frequently in the 19A group (89% vs. 52%, p = 0.006). Patients in the19A group had longer duration of fever (12 vs. 3 days, p = 0.01), and required more intensive care (78% vs. 41%, p = 0.01) and more video-assisted thoracoscopic surgery (74% vs. 28%, p = 0.001). CONCLUSION: In comparison with the other serotypes, serotype 19A IPD has significantly more empyema which required more video-assisted thoracoscopic surgery and more intensive care.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 10/2012; · 0.99 Impact Factor
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Tzou-Yien Lin, Chun-Yi Lu,
Luan-Yin Chang,
Cheng-Hsun Chiu,
Yhu-Chering Huang,
Hans L Bock,
Haiwen Tang,
Nancy François,
Marta Moreira,
Lode Schuerman,
Li-Min Huang
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ABSTRACT: The immunogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae (H. Influenzae) protein D conjugate vaccine (PHiD-CV), co-administered with routine childhood vaccines, were assessed in Taiwanese infants.
In this open study, 230 healthy infants were primed with three doses of PHiD-CV (Synflorix) and diphtheria, tetanus, acellular pertussis, hepatitis B (HBV), inactivated poliomyelitis and Haemophilus influenzae type b (Hib) conjugate vaccine (DTPa-HBV-IPV/Hib vaccine) at 1.5, 3 and 6 months of age and two doses of oral human rotavirus vaccine at 1.5 and 3 months. Pneumococcal immune responses were assessed 1 month post-dose three, by 22F-inhibition ELISA and opsonophagocytic activity (OPA) assay. Local and general solicited/unsolicited symptoms and serious adverse events (SAEs) were recorded.
At least 95.4% of participants had an antibody concentration ≥0.2 μg/mL against each vaccine serotype. At least 96.1% of participants had an OPA titer ≥8 against each vaccine serotype except 6B (87.3%). All infants, but one, were seropositive for antibodies against nontypeable H. influenzae protein D. Immune responses to the co-administered vaccines were good and in line with previous reports. PHiD-CV was well tolerated, with low (≤6.3%) incidences of grade 3 solicited local symptoms. The frequencies of general symptoms were in line with other pneumococcal conjugate vaccine studies. There were no systematic increases in incidences of solicited general or local symptoms with successive doses. There were no reports of grade 3 fever (rectal temperature > 40 °C) or SAEs considered to be causally related to vaccination.
PHiD-CV co-administered with routine childhood vaccines within the first 6 months of life, was highly immunogenic, and well tolerated in Taiwanese infants.
Journal of the Formosan Medical Association 09/2012; 111(9):495-503. · 1.13 Impact Factor
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ABSTRACT: Data on hospitalized novel influenza A (H1N1) infected children are limited and urgently in demand. We conducted a clinical study to identify clinical features and risk factors associated with severe novel H1N1 infections of children in Taiwan.
From July 24, 2009 to December 4, 2009, data from 61 hospitalized children infected with 2009 novel H1N1 were collected. Demographics, underlying medical conditions, clinical data, receipt of antiviral therapy, need for intensive care and outcome were analyzed to identify clinical features and risk factors of severe infections.
Of the 61 inpatients, the male to female ratio was 41 to 20 and the most common age group was between 6 and 12 years (36%). Almost all (98%) patients had fever, 53 (87%) patients received oseltamivir treatment and 51% of them received oseltamivir within 48 hours. Fourteen (23%) needed intensive care and 3 died. Obesity (a Body Mass Index ≥ 25 kg/m(2) in children ≥ 2 years of age, or a body weight ≥ the 95(th) percentile in children <2 years of age), dyspnea, C-reactive protein (CRP) > 3 mg/dL, pleural effusion, and delayed antiviral therapy were significantly associated with the need for intensive care and/or death.
Obesity, dyspnea, CRP > 3 mg/dL, pleural effusion, and delayed antiviral therapy are significantly associated with severe novel H1N1 infections in children.
Journal of the Formosan Medical Association 08/2012; 111(8):421-6. · 1.13 Impact Factor
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ABSTRACT: Rapid diagnosis of influenza was important in the global pandemic influenza A/H1N1 outbreak. The QuickVue Influenza A+B test is one of the most common tests for rapid diagnosis of influenza. We evaluated the sensitivity and specificity of the test in children.
We collected data from 970 patients with influenza-like illness who received rapid influenza antigen tests using the QuickVue Influenza A+B test as well as viral isolation. We compared the results with that of viral isolation and reverse-transcriptase polymerase chain reaction (RT-PCR) assays.
Based on viral culture, the QuickVue Influenza A+B test had an overall sensitivity of 0.82 (419/513) and specificity of 0.99 (70/71), with a positive predictive value (PPV) of 0.74 (419/563) and a negative predictive value (NPV) of 0.77 (313/407). The sensitivity of QuickVue was significantly higher in specimens with high viral loads. If the viral loads were less than 10(6), the sensitivity of QuickVue was 0.62, while the sensitivity of QuickVue was 0.88 if the viral loads were higher than 10(6) (p<0.001). Logistic regression analysis showed that higher viral loads correlated with positive QuickVue results (p<0.001). On the first day of fever, the sensitivity of QuickVue was only 0.67; on the second day, the sensitivity was 0.86; on the third day, the sensitivity was 0.98, and on the fourth day, the sensitivity was 0.90. The sensitivity is significantly higher on days 2-3 in comparison with the first day of fever (p<0.05). We calculated the correlation of viral load and fever days, and the result showed higher mean viral load on the second and third days of fever. Age did not affect the sensitivity.
In children, the sensitivity of QuickVue Influenza A+B test was 0.82. In addition, the sensitivity was significantly elevated in the higher viral load group and on the third day of fever.
Journal of the Formosan Medical Association 08/2012; 111(8):427-30. · 1.13 Impact Factor
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Pediatrics & Neonatology 08/2012; 53(4):217-8. · 0.75 Impact Factor
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Chun-Fu Tai,
Tsung-Pei Tsou,
Wu-Shiun Hsieh,
Chien-Yi Chen,
Hung-Chieh Chou,
Po-Nien Tsao,
Chien-Hui Hsu,
Yi-Jen Liau, Chun-Yi Lu,
Pei-Lan Shao,
Luan-Yin Chang,
Li-Min Huang
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ABSTRACT: Human papillomavirus (HPV) infection can cause laryngeal papillomas in children. Vertical transmission has been confirmed. This study aimed to establish a sensitive molecular diagnostic method and understand the incidence of the HPV-6 and HPV-11 in neonates with intubation.
We enrolled 108 newborns between October 2007 and January 2010. All neonates were intubated due to underlying disease. The specimens were collected via endotracheal aspiration. DNA of HPV types 6 and 11 was detected by real-time PCR and nested PCR.
HPV-DNA was detected in eight of the 108 newborns studied. Seven respiratory specimens tested positive for HPV-11 and one was positive for HPV-6. The HPV 6/11 detection rate in neonates was 7.4% (8/108).
A rapid, sensitive, specific, and reproducible RT-PCR method and nest PCR were developed for the detection and differentiation of HPV-6 and HPV-11 genomic variants in a single PCR reaction. The assays are of great value for clinical and epidemiologic studies of HPV-6 and HPV-11 infections. Neonatal HPV colonization may be related to juvenile-onset recurrent respiratory papillomatosis. The transmission route may be from mother to child. The clinical significance of neonatal carriage of HPV-6 or HPV-11 warrants further study.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2012; 45(3):185-92. · 0.99 Impact Factor
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ABSTRACT: To probe seroepidemiology of the 2009 pandemic influenza A (H1N1) among health care workers (HCWs) in a children's hospital.
From August 2009 to March 2010, serum samples were drawn from 150 HCWs in a children's hospital in Taipei before the 2009 influenza A (H1N1) pandemic, before H1N1 vaccination, and after the pandemic. HCWs who had come into direct contact with 2009 influenza A (H1N1) patients or their clinical respiratory samples during their daily work were designated as a high-risk group. Antibody levels were determined by hemagglutination inhibition (HAI) assay. A four-fold or greater increase in HAI titers between any successive paired sera was defined as seroconversion, and factors associated with seroconversion were analyzed.
Among the 150 HCWs, 18 (12.0%) showed either virological or serological evidence of 2009 pandemic influenza A (H1N1) infection. Of the 90 unvaccinated HCWs, baseline and post-pandemic seroprotective rates were 5.6% and 20.0%. Seroconversion rates among unvaccinated HCWs were 14.4% (13/90), 22.5% (9/40), and 8.0% (4/50) for total, high-risk group, and low-risk group, respectively. Multivariate analysis revealed being in the high-risk group is an independent risk factor associated with seroconversion.
The infection rate of 2009 pandemic influenza A (H1N1) in HCWs was moderate and not higher than that for the general population. The majority of unvaccinated HCWs remained susceptible. Direct contact of influenza patients and their respiratory samples increased the risk of infection.
BMC Infectious Diseases 04/2012; 12:89. · 3.12 Impact Factor
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ABSTRACT: In influenza B infection, viral load is believed to be related to the severity of clinical illness. The correlation between viral load and symptoms is not known. We conducted a study to assess the relationship between virus load and clinical features in children infected with influenza B, in the hope that clinical features could be used as surrogate markers of viral load to guide treatment.
Between December 2006 and February 2007, 228 patients with fever and respiratory symptoms were prospectively enrolled in our tertiary hospital-based study. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed to determine viral load.
Real-time RT-PCR was positive for influenza B in 76 patients. Using virus culture as the gold standard, the sensitivity and specificity were 95% and 87%, respectively. Influenza culture positive rate significantly correlated with viral load (p = 0.03). The median copy number of influenza B virus in the 76 RT-PCR positive patients was 9735 copies/ml (range 4.8×10¹-2.0×10⁶ copies/ml). Samples obtained later in the clinical course tended to have lower viral load (p = 0.7), while patient age (p = 0.72) and fever duration (p = 0.96) positively related to viral load. In patients >3 years of age, myalgia was related to statistically lower viral loads (14300 vs. 1180; p = 0.025). Patients with chills tended to have higher viral loads (72450 vs. 7640; p = 0.1). Patients with abdominal pain tended to have lower viral loads (1998 vs. 12550; p = 0.06).
Culture rate positively correlated with viral load. Patients with myalgia had a lower viral load.
Journal of the Formosan Medical Association 02/2012; 111(2):83-7. · 1.13 Impact Factor
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ABSTRACT: Systemic fungal infections have high morbidity and mortality rates in neonates, especially neonates with an extremely low birth weight (ELBW). Here, we describe a 21-day-old ELBW female infant with an amphotericin B-unresponsive congenital Candida albicans infection that was treated with caspofungin. Blood sterilization was performed during the first episode, but a second episode of candidemia occurred after the discontinuation of caspofungin. Blood sterilization was again performed during the second round of caspofungin treatment, but fungal endocarditis and renal fungal balls still developed during the second episode. Caspofungin can be considered for invasive candidiasis in premature infants, especially in life-threatening situations. As for the focal lesions, more aggressive treatments other than just parenteral antibiotics should be considered. The literature regarding caspofungin therapy for neonatal candidiasis is also reviewed.
Journal of the Formosan Medical Association 01/2012; 111(1):46-50. · 1.13 Impact Factor
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ABSTRACT: Enterovirus 71 (EV71) infection may cause severe neurological and cardiopulmonary complications, especially in preschool children. This study is to investigate the seroprevalence and seroconversion of EV71, and the crossprotection of EV71 antibody against other enteroviruses among kindergarteners.
Overall 228 children in a public kindergarten were enrolled during two academic years, 2006 and 2007, in Taipei, Taiwan and we measured their EV71 neutralizing antibody. When the participants had herpangina; hand, foot and mouth disease (HFMD); febrile illness or respiratory symptoms, throat swabs were sampled and processed for viral culture and enterovirus real-time reverse transcriptase polymerase chain reaction (RT-PCR). Questionnaires, completed by the participants' guardians, surveyed the history of allergy and annual incidence of symptoms related to enterovirus infection.
Seropositive rates of EV71 were 20% (32/163) in 2006 and 6% (4/65) in 2007. The rate of EV71 seropositivity increased with age (p < 0.01) in 2006 but it did not differ between genders (p = 0.14). No seroconversion was observed from 2006 to 2007. Herpangina occurred in 64% of children with EV71 seropositivity and 48% of those without EV71 antibodies (p = 0.12). Non-71 enterovirus infection, confirmed by viral study, occurred in 53% (19/36) of the EV71-seropositive children and in 53% (102/192) of EV71-seronegative children (p = 0.89). No participants had EV71 infection during the study period.
EV71 did not frequently circulate in Taipei City from September 2006 to June 2008. Presence of EV71 neutralizing antibody was not associated with lower incidence of enterovirus infection caused by non-71 serotypes.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2011; 45(2):96-101. · 0.99 Impact Factor
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ABSTRACT: Children in the Asia Pacific region are still suffering from certain vaccine-preventable diseases. The current study surveyed the national immunization programs and vaccine uptake of traditional and newly developed vaccines in 12 countries in this area. The results showed children in most countries were well protected from conventional vaccine-preventable diseases, while immunization programs for certain diseases such as poliovirus or measles should be strengthened in certain countries. Protection against pneumococcus, rotavirus, and human papillomavirus infections were obviously inadequate in most of the countries in the region. Promoting coverage of newly developed vaccines will benefit a great number of children in this area.
Vaccine 11/2011; 30(13):2250-5. · 3.77 Impact Factor
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ABSTRACT: During August-November 2009, to investigate disease transmission within households in Taiwan, we recruited 87 pandemic (H1N1) 2009 patients and their household members. Overall, pandemic (H1N1) 2009 virus was transmitted to 60 (27%) of 223 household contacts. Transmission was 4× higher to children than to adults (61% vs. 15%; p<0.001).
Emerging Infectious Diseases 10/2011; 17(10):1928-31. · 6.79 Impact Factor
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ABSTRACT: Immunogenicity and reactogenicity of the combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (Hib) conjugate vaccine (DTPa-IPV/Hib, Infanrix™-IPV + Hib) was assessed when co-administered with hepatitis B (HBV) vaccine. Seventy healthy infants received DTPa-IPV/Hib at 1.5, 3.5, 6 and 15-18 months, and HBV at birth, 1.5, 6 and 15-18 months of age. Serological responses were assessed. Diphtheria, tetanus, Hib and pertussis seroprotection/seropositivity rates were 100% after primary vaccination. Post-primary immune responses to poliovirus could not be evaluated for technical reasons. However, after the booster dose, seroprotection/seropositivity rates, including poliovirus, were 100%. Over 95% were seroprotected against HBV. Post-booster geometric mean antibody concentrations/titers (GMC/GMTs) rose from 14-fold to 45-fold, indicating effective priming against all antigens, including polioviruses. DTPa-IPV/Hib was well tolerated alone or co-administered with HBV. No serious adverse events were considered related to vaccination. Primary and booster vaccination with combined DTPa-IPV/Hib and HBV was immunogenic and well tolerated. Combination vaccines enable vaccine providers to conveniently provide routine pediatric immunizations, with minimal discomfort.
Journal of the Formosan Medical Association 06/2011; 110(6):415-22. · 1.13 Impact Factor
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ABSTRACT: Immunogenicity and reactogenicity of primary vaccination with combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus (DTPa-HBV-IPV) vaccine when co-administered with Haemophilus influenzae (Hib) conjugate vaccine were assessed in 60 healthy infants. Infants received HBV vaccine at birth, then DTPa-HBV-IPV and Hib vaccines at age 1.5 months, 3.5 months and 6 months. Blood samples were collected before the first DTPa-HBV-IPV and Hib vaccine doses and 1 month after dose 3. Reactogenicity was assessed using diary cards. One month after primary vaccination, all infants were seroprotected/seropositive against all vaccine antigens evaluated. The poliovirus antigen could not be evaluated. The vaccines were well tolerated. No case of fever > 39.0 °C was reported. No serious adverse events were considered related to vaccination. Primary vaccination with DTPa-HBV-IPV and Hib vaccines was immunogenic and well tolerated. Combined vaccines, such as this pentavalent vaccine, minimize the number of injections and vaccination visits required to complete primary vaccination, and provide choice and flexibility for physicians and vaccine providers.
Journal of the Formosan Medical Association 05/2011; 110(5):336-41. · 1.13 Impact Factor
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Journal of the Formosan Medical Association 02/2011; 110(2):67-9. · 1.13 Impact Factor
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ABSTRACT: Human bocavirus (HBoV), first described in September 2005, was considered a causative agent of previously unexplained respiratory tract diseases. However, only few reports provide the evidence for an association between HBoV and respiratory tract diseases. We conducted a prospective clinical and molecular study of HBoV in Taiwan.
We enrolled 705 children who visited our outpatient pediatric clinics in a medical center because of symptoms and signs of respiratory tract infections from November 2008 to October 2009. Throat swab was performed and HBoV polymerase chain reaction and viral culture were done simultaneously.
Positive viral results were confirmed in 159 (22.6%) of the 705 children. HBoV was found in 35 samples and it was supposed to be as a single virus in 32 samples because viral isolation of these 32 samples did not identify other virus. The other three patients had coinfection with another virus. One child got HBoV reinfection 6 months after the first infection. Seventy-one percentage of these HBoV infections occurred between November and March. Of the 34 children with positive HBoV, 26 (76%) patients were younger than 5 years; their common symptoms were cough, rhinorrhea, and fever; the most common diagnoses were bronchitis (34%, 12/35) and sinusitis (31%, 11/35) followed by pharyngitis (29%, 10/35) and asthma exacerbation (26%, 9/35). Three of the 34 patients needed hospitalization.
HBoV is an emerging human parvovirus that may cause respiratory tract infection in young children. Diseases associated with HBoV may range from pharyngitis, sinusitis, acute otitis media to bronchitis, asthma, and even pneumonia.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 01/2011; 44(5):323-7. · 0.99 Impact Factor
