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H Peltola

Publications and source records attributed to H Peltola.

At least 19 recordsLinked to original sources
PubMed2006

Acute infections, infection pressure, and atopy.

BACKGROUND: During the recent years, a new theory postulating that lack of early childhood infections would increase the prevalence rate of allergies has rapidly gained momentum. This hygiene hypothesis has been widely disseminated to the general public and it has been suggested that vaccinations would accordingly indirectly increase rates of atopy. We thus investigated associations between acute infections, infection pressure (i.e. number of daily child contacts) and atopy in one of the largest population-based medical surveys ever published in the medical literature. METHODS: Almost all Finns born between 1976 and 1984 and a sample of older teenagers aged up to 19 years (n=5 47 190) were vaccinated and questioned to establish clinical history of mumps and rubella and manifestations of atopy (rhinoconjunctivitis, eczema, and asthma) in 1982-1986. A subsample (n=37 733) including all those subjects who were vaccinated during the first 2 months of the measles, mumps, and rubella (MMR) programme were also queried information about upper respiratory infections (URIs) and infection pressure. Crude and adjusted prevalence ratios of atopy among those with infectious disease history compared with those without it were calculated. RESULTS: The risk of URI and a history of mumps and rubella increased with the number of daily contacts. This association was apparent especially among the youngest subjects with regard to URIs whereas the proportion with histories of mumps and rubella increased with increasing infection pressure more clearly among the 6-year-olds. Atopy was not associated with daily child contacts among pre-schoolers. Children with histories of repeated URIs and MMR diseases had substantially more atopy than those with lower URI or MMR disease rates. CONCLUSIONS: Atopic subjects seem to be especially prone to clinically apparent acute respiratory tract infections, and might be in particular need of protection by immunizations. This study does not support the idea that the prevalence of atopy in affluent countries would be affected from disappearing respiratory tract infections.

Acute Disease↗
PubMed2004

Component carbon fluxes and their contribution to ecosystem carbon exchange in a pine forest: an assessment based on eddy covariance measurements and an integrated model.

We used a combination of eddy flux, canopy, soil and environmental measurements with an integrated biophysical model to analyze the seasonality of component carbon (C) fluxes and their contribution to ecosystem C exchange in a 50-year-old Scots pine forest (Pinus sylvestris L.) in eastern Finland (62 degrees 47' N, 30 degrees 58' E) over three climatically contrasting years (2000-2002). Eddy flux measurements showed that the growing Scots pine forest was a sink for CO2, with annual net C uptakes of 131, 210 and 258 g C m-2> year-1 in 2000, 2001 and 2002, respectively. The integrated process model reproduced the annual course of daily C flux above the forest canopy as measured by the eddy covariance method once the site-specific component parameters were estimated. The model explained 72, 66 and 68% of the variation in daily net C flux in 2000, 2001 and 2002, respectively. Modeled annual C loss by respiration was 565, 629 and 640 g C m-2 year-1, accounting for 77, 77 and 65% of annual gross C uptake, respectively. Carbon fluxes from the forest floor were the dominant contributors to forest ecosystem respiration, with the fractions of annual respiration from the forest floor, foliage and wood being 46-62, 27-44 and 9-10%, respectively. The wide range in daily net C uptake during the growing season was largely attributable to day-to-day fluctuations in incident quantum irradiance. During just a few days in early spring and late autumn, ecosystem net C exchange varied between source and sink as a result of large daily changes in temperature. The forest showed a greater reduction in gross C uptake by photosynthesis than in C loss by respiration during the dry summer of 2000, indicating that interannual variability in ecosystem net C uptake at this site was modified mostly by summer rainfall and vapor pressure deficit.

Carbon↗
PubMed2004

Epidemiology of rubella in Finland.

Before rubella vaccination programmes began, rubella infection was prevalent in Finnish children. The disease occurred as epidemics at intervals of a few years. Rubella infection was most often contracted between the ages of 2 and 12 years. Vaccinations specifically aimed at eradicating rubella were begun with monocomponent vaccine in the mid-1970s, and the measles, mumps and rubella (MMR) vaccination programme with two injections got underway in 1982. A clear reduction in rubella cases was evident a few years after the launch of the MMR programme. Owing to a sufficiently high vaccination coverage (>95% since 1987), circulation of the indigenous rubella virus in the Finnish population ceased in the late 1990s. Some rubella cases have been imported to Finland since elimination, but they have not caused any secondary cases. This shows unambiguously that protection against rubella continues to be effective, although our cohort studies imply that the vaccine induced antibody levels do decrease with time. The MMR programme has also eliminated congenital rubella syndrome (CRS) from the country. The last CRS case was recorded in 1986. As a result of the high coverage two dose MMR vaccination programme, rubella was successfully eliminated from Finland. How long the acquired protection will last remains to be seen.

Adolescent↗
PubMed2001

Reappraisal of lung tap: review of an old method for better etiologic diagnosis of childhood pneumonia.

Identification of the etiology of childhood pneumonia is difficult, even in the cases that most likely have bacterial origins. A positive blood culture result is diagnostic but rare (< 10% of cases), and other noninvasive microbiological methods are nonspecific or are at least shadowed by interpretation problems. However, lung tap (or aspiration), a method developed a century ago, warrants reappraisal, especially since the prevalence of pneumococcal resistance to penicillin is increasing. An analysis of 59 studies that were published in 6 languages led us to conclude that (1) bacterial etiology is disclosed in approximately 50% of cases (virological tests were rarely done); (2) lung tap is safer than is generally considered; (3) potential pneumothorax is mostly symptomless and resolves spontaneously without impairing recovery; and (4) in comparison with routine diagnostic tools, lung tap offers so many advantages that it warrants reconsideration at centers where personnel have experience in handling potential pneumothorax.

Adolescent↗
PubMed2001

Successful shortening from seven to four days of parenteral beta-lactam treatment for common childhood infections: a prospective and randomized study.

OBJECTIVES: To explore whether 4-day parenteral beta-lactam therapy is as effective as 7-day therapy for children hospitalized for parenteral antimicrobials. METHODS: A series of patients aged 3 months to 15 years who fulfilled strict criteria for bacterial pneumonia, other respiratory infections, sepsis-like infections, and other acute infections were prospectively randomized to receive parenteral penicillin or cefuroxime randomly for 4 or 7 days. Besides blood and throat cultures, the etiology was searched by serology for 23 different agents. RESULTS: Of 154 children analyzed, a probable etiology was established in 96. Of those, a bacterial infection, with or without concomitant viral infection, was disclosed in 80% and 94% in the 4-day and 7-day treatment groups, respectively; pneumococcus being the commonest agent. There was one possible treatment failure in the 4-day group, but with a questionable relation to the short course. Three patients in the 4-day and two in the 7-day group underwent treatment changes, or were rehospitalized within 30 days. All children recovered entirely. CONCLUSIONS: Shortening parenteral beta-lactam treatment to 4 days in infections for which most parenteral antimicrobials are instituted, is not only safe, but reduces costs, is ecologically sound, and minimizes the risks of nosocomial infections and other adverse effects of treatment.

Adolescent↗
PubMed2001

Risk of Guillain-Barré syndrome after measles-mumps-rubella vaccination.

OBJECTIVE: To assess the postulated causal association between measles-mumps-rubella (MMR) vaccination and Guillain-Barré syndrome (GBS). STUDY DESIGN: Active retrospective study based on linkage of the nationwide hospital discharge register with individual vaccination records. All patients hospitalized for treatment of GBS in Finland between November 1982 and December 1986 were included in the study. RESULTS: During the study period, 189 patients were hospitalized for treatment of GBS, and approximately 630,000 vaccine recipients received 900,000 doses of MMR vaccine; 24 of the 189 patients represented the prevailing target population for MMR vaccination, of whom 20 were vaccinated. MMR vaccination did not cause any increase over the background incidence of GBS, and no clustering of cases of GBS occurred at any time point after administration of MMR vaccine. The interval between vaccination and onset of symptoms of GBS exceeded the designated risk period of 6 weeks in all cases, varying from 80 days to years. MMR vaccination after recovery from GBS did not cause relapses of the illness. Respiratory or gastrointestinal tract infection predated the onset of GBS by 3 to 30 days in 20 (83%) of the 24 patients. CONCLUSIONS: No causal association seems to prevail between MMR vaccination and GBS.

Child↗
PubMed2001

Clinical "pneumococcal pneumonia" due to Moraxella osloensis: case report and a review.

A previously healthy 6-y-old girl presented with a disease very similar to pneumococcal pneumonia. However, Moraxella osloensis was isolated by lung tap. The patient responded well to a course of parenteral penicillin. This is probably the first documented case of community-acquired pneumonia associated with this agent. Clinical isolates of M. osloensis are rare and its pathogenesis has not been delineated; however, a literature review suggests that the organism is more common than is generally recognized.

Child↗
PubMed2001

Seroetiology of acute lower respiratory infections among hospitalized children in Beijing.

BACKGROUND: Little is known of the etiology of childhood acute lower respiratory infections in China, where the use of antimicrobials is indiscriminate. Trials to change such a policy require etiologic data, especially on the bacteria most relevant to these common diseases. METHODS: One hundred consecutive infants and children from 3 months to 14 years of age with symptoms and signs compatible with acute lower respiratory infections were studied prospectively in the largest pediatric hospital in Beijing from February to May, 1997. Blood culture, thorax radiography and paired sera for 20 microbiologic assays were taken, and the course of illness was monitored uniformly. Disease severity was graded. RESULTS: In 24 cases there was evidence only of bacterial etiology, and in 5 solely viral agents were found; 3 children probably had a mixed bacterial-viral infection. Surprisingly no pneumococcal infection was detected, Mycoplasma pneumoniae (n = 21), Haemophilus influenzae type b (n = 8) and Chlamydia pneumoniae (n = 7) being the dominant bacteria. All children recovered. CONCLUSIONS: Routine use of antimicrobials for these patients seems unjustified. Serologic evidence for the H. influenzae type b etiology is encouraging in terms of vaccination, but confirmatory studies are needed.

Adolescent↗
PubMed2001

Allergic reactions to measles-mumps-rubella vaccination.

OBJECTIVE: Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components. METHODS: Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed. RESULTS: Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity. CONCLUSIONS: Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.

Adolescent↗
PubMed2000

Burden of meningitis and other severe bacterial infections of children in africa: implications for prevention.

Apart from meningococcal disease in the sub-Saharan meningitis belt, the incidence and impact of life-threatening bacterial diseases in children across Africa have not been quantified. The clinical and epidemiological data on pneumococcal, Haemophilus influenzae type b (Hib), and other forms of bacterial meningitis, as well as data on other severe bacterial infections throughout the continent were scrutinized. Pneumococci were the leading causative agents of nonepidemic meningitis and other bacteremic diseases, followed by Hib. Meningococcal diseases were less common. Mortality rates associated with pneumococcal, Hib, and meningococcal meningitis were 549 (45%) of 1211 patients, 389 (29%) of 1352 patients, and 104 (8%) of 1236 patients, respectively; sequelae occurred in 50%, 40%, and 10% of cases. At 0-4 years of age, the estimated incidences of Hib meningitis and all classic Hib diseases were 70 and 100 cases per 100,000 population per year, accounting for approximately 90,000 and 120,000 cases per year, respectively. Including older age groups and, especially, nonbacteremic Hib pneumonia in the estimates of Hib disease in Africa increased the overall numbers manifold; the numbers of pneumococcal infections were even greater. The only realistic way to combat these severe infections efficaciously would be through widespread vaccination, starting with Hib conjugates.

Africa↗
PubMed2000

Duration of rubella immunity induced by two-dose measles, mumps and rubella (MMR) vaccination. A 15-year follow-up in Finland.

A national two-dose vaccination program with a combined measles, mumps and rubella (MMR-II) vaccine was introduced in Finland, in 1982, immunizing children at the ages of 14-18 months and 6 years. Antibody levels were determined from serial samples from a group of originally 350 children during 15 years. The latest samples were taken 15.5 years after the first vaccination and 70% of the children could still be reached. The aim of this study was to determine the kinetics of rubella antibodies induced by the MMR-II vaccine in these individuals. Rubella antibodies were analyzed from three different cohorts: Group I seronegative children (n=166) vaccinated at 14-18 months and 6 years, Group II seronegative children (n=139) and Group III seropositive children (n=16) vaccinated at 6 and 11-13 years. Samples collected 0-9 years after vaccination were analyzed by hemolysis-in-gel (HIG) and later samples by enzyme immunoassay (EIA) techniques. The primary vaccination induced 100% seropositivity in vaccinees with a mean zone diameter of 10 (+/-1.3), 10.2 (+/-1.1) and 11.5 (+/-0.9) mm, in Groups I, II and III, respectively. The seropositivity rate was still high at 15 years, 99%, 100% and 100% with the geometric mean titer 23, 46 and 105 IU/ml, respectively. At 15 years, antibody levels <15 IU/ml which is the suggested protective level, were found in 31, 9 and 0% of children in Groups I, II and III, respectively. Because almost a third of the individuals in Group I now, at the age of 17 years, had low levels of rubella antibodies, it is possible that rubella infections may re-emerge during pregnancy. A careful surveillance including serological follow-up is therefore very important.

Adolescent↗
PubMed2000

Measles history and atopic diseases: a population-based cross-sectional study.

CONTEXT: Many recent cross-sectional studies have suggested that lack of early exposure to communicable diseases, including measles, in affluent countries may have increased rates of atopic disease. OBJECTIVE: To study the association between natural measles infection and atopy. DESIGN AND SETTING: Cross-sectional nationwide study in Finland using data gathered between November 1, 1982, and June 30, 1986. SUBJECTS: A total of 547910 individuals aged 14 months to 19 years who at the time of measles-mumps-rubella (MMR) vaccination had relevant information collected on the occurrence of measles and allergic rhinitis, eczema, and asthma. MAIN OUTCOME MEASURES: Lifetime occurrence of atopic manifestations in subjects who had had measles compared with those who had not, expressed as age-specific and age-adjusted prevalence ratios. RESULTS: The age-adjusted prevalence ratio of atopic manifestations among those who had had measles (n = 20 690) compared with those who had not (n = 527 220) was 1.32 (95% confidence interval [CI], 1.27-1.36) for eczema, 1.41 (95% CI, 1.33-1.49) for rhinitis, and 1.67 (95% CI, 1.54-1.79) for asthma. The positive association between measles and atopy was evident at all ages, in both urban and rural dwellers, and among subjects with many or few contacts at home or in day care. CONCLUSIONS: Based on our data, measles and atopy occur more frequently together than expected, which does not support the hypothesis that experiencing natural measles infection offers protection against atopic disease.

Adolescent↗
PubMed2000

Narrow- versus broad-spectrum parenteral anatimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime.

UNLABELLED: Overuse of broad-spectrum antimicrobials has resulted in increasing bacterial resistance in many countries. We hypothesised that common childhood infections requiring parenteral medication are still curable with narrow-spectrum and inexpensive penicillin. A prospective and randomised study was performed in two referral hospitals in Helsinki. A total of 154 children aged 3 months to 15 years with pneumonia or other lower respiratory infections, sepsis-like infections, or other common acute infections warranting hospitalisation and parenteral antimicrobials were included. At random, 50% of children received procaine penicillin intramuscularly, the other 50% cefuroxime intravenously for 4-7 days. The course of illness was monitored with predetermined laboratory and radiological indices, by filling in a special form daily and a follow-up for 30 days after discharge. The infectious agent was searched for with a large laboratory set-up covering 23 bacterial, viral or protozoan species. The two groups were very similar at presentation. Probable aetiology was disclosed in 56% of the penicillin and in 68% of the cefuroxime recipients, the leading agent in both groups being Pneumococcus. In 8% only a viral aetiology was found. The children recovered with the same speed, regardless of which antimicrobial used, there being one possible failure in each group but no difference in the frequency of needing a physician again within 1 month of discharge. No adverse event was attributable to either drug. CONCLUSION: Procaine penicillin is as effective and safe as cefuroxime for common community-acquired infections in immunocompetent children.

Adolescent↗