[Show abstract][Hide abstract]ABSTRACT: Objective:
Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children.
Patients and methods:
A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed.
Results and conclusion:
During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.
Full-text Article · Apr 2014 · BioMed Research International
[Show abstract][Hide abstract]ABSTRACT: Rubella: Salient Points
Congenital rubella (CR) infection leads to damage in over 80% of fetuses during the first trimester of pregnancy, in 25–34% of cases in the second trimester, while no malformations occur in the third trimester.
CR syndrome (CRS) is characterized by the combination of cardiac, ocular, and hearing defects, although any organ may be affected leading to long-term disabilities.
To prevent CRS it is essential to verify before or during pregnancy, that all women have natural or vaccine-induced immunity to the rubella virus.
[Show abstract][Hide abstract]ABSTRACT: Influenza A (H1N1) pandemic reached its peak in Europe in autumn 2009. H1N1 infection can be a serious complication in patients with comorbidity or immunodepression. Here, we report of a boy with newly diagnosed acute promyelocytic leukemia with a very severe respiratory distress caused by influenza A (H1N1) infection in pulmonary aspergillosis, successfully treated with antifungal therapy, oseltamivir, and extracorporeal membrane oxygenation.
Article · Oct 2011 · Journal of Pediatric Hematology/Oncology
[Show abstract][Hide abstract]ABSTRACT: Invasive fungal infections (IFI) are an important complication in pediatric haematological and oncological patients who undergo intensive chemotherapy for leukemia, solid tumour at advanced stage or relapsed, and hematopoietic stem cell transplantation. The incidence of IFI is lower than bacterial infection but mortality rate remains high. This review is designed to help paediatric oncologists in choosing the appropriate anti-fungal strategy and agents for prophylaxis, empirical, pre-emptive and specific therapy on the basis of published evidence.
[Show abstract][Hide abstract]ABSTRACT: Aim - Defining the guidelines on vaccinations in paediatric cancer patients. Method - We reviewed the literature published from 1980 to 2009 according to the methodology suggested by the American Society of Infectious Disease. The intention was to define recommendations on vaccinations in patients both during and after chemotherapy as well as recommendation on vaccinations in family members. The conclusions achieved were presented in 2 plenary discussion sessions before final approval. In case of disagreement the issue was settled by discussion with an external expert. Results - While on chemotherapy, the patient benefits HBV and influenza vaccinations. During this phase, family members are advised to continue vaccinations as scheduled by health plan or, if seronegative, vaccinations against varicella, measles, mumps, rubeola are recommended. Although a reduction of serum antibody levels for vaccine-preventable disease is reported following suspension of chemotherapy, the immunological memory seems preserved. The response to booster is generally good, gives the patients good protection and contributes to herd immunity.
[Show abstract][Hide abstract]ABSTRACT: This prospective observational study was designed to assess the incidence of, risk factors for, and outcome of catheter-related bloodstream infection in children undergoing cardiac surgery. A staff specifically trained to handle the central venous catheters with proper aseptic techniques and an appropriate patient to medical staff ratio remain the most effective measures to prevent this infection.
Full-text Article · Aug 2009 · Infection Control and Hospital Epidemiology
[Show abstract][Hide abstract]ABSTRACT: The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age <or=3 years for dislocations; nonmalignant disease for ruptures; ALL for thrombosis; double-lumen and partially implanted CVCs for bloodstream infections; age <or=3 years for tunnel infections. In conclusion, the rate of CVC-related complications in children was lower than that usually reported.
Article · Mar 2009 · European Journal of Pediatrics
[Show abstract][Hide abstract]ABSTRACT: This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2-3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2-3 weeks leads to a rapid clinical response and a definitive clearance of infection.
Article · May 2008 · European Journal of Pediatrics
[Show abstract][Hide abstract]ABSTRACT: Tunnel infection is an uncommon but serious complication observed in patients with partially implanted central venous catheters. International guidelines suggest that should include antibiotics and catheter removal. A success rate of only 5-20% was reported without catheter removal. We treated 13 episodes of tunnel Gram-positive bacterial infection occurring in pediatric patients with cancer or serious blood disorders with 24-hr intra-catheter antibiotic continuous infusion. This approach led to a 69% success rate. Continuous infusion might be an attractive option to treat tunnel Gram-positive bacterial infections when catheter removal might not be feasible or advisable.
[Show abstract][Hide abstract]ABSTRACT: Candida species is the third most common organism responsible for bloodstream infections in neonatal intensive care units; we report the case of a newborn with a positive blood culture for Candida parapsilosis infection from a central venous catheter. After failure of fluconazole therapy, she was treated with caspofungin, which proved to be safe and effective.
[Show abstract][Hide abstract]ABSTRACT: We report three cases of invasive Geotrichum capitatum infection in patients with acute leukemia for which an enzyme-linked immunosorbent assay (ELISA) for Aspergillus galactomannan was positive, with no evidence of aspergillosis. Supernatants obtained from suspensions of 17 G. capitatum strains gave positive reactions with the Aspergillus galactomannan ELISA. These clinical and laboratory data seem to suggest that G. capitatum produces a soluble antigen that is cross-reactive with Aspergillus galactomannan.
Full-text Article · Oct 2006 · Journal of Clinical Microbiology