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Xylitol is a sugar alcohol that inhibits the growth and adherence of Streptococcus pneumoniae. In clinical trials, xylitol has been shown to decrease the occurrence of acute otitis media in day-care children but did not decrease nasopharyngeal carriage of the pneumococci. It has also been shown that xylitol affects the ultrastructure of the pneumococcal capsule. Here, it was hypothesized that xylitol might affect the expression of pneumococcal capsular genes. Capsule gene expression levels were studied in 24 clinical pneumococcal isolates and one ATCC strain (49619) by using a real-time RT-PCR method targeting the mRNA of the second gene of the pneumococcal capsular locus, the cpsB gene. The isolates were exposed to 5 % glucose, 5 % xylitol and control medium (brain heart infusion medium containing 10 % fetal bovine serum) for 2 h. cpsB gene expression levels were measured by using a relative quantification method with calibrator normalization where the 16S rRNA gene of pneumococcus was used as a reference. Exposure to xylitol lowered cpsB gene expression levels significantly compared with those in the control (P=0.035) and glucose (P=0.011) media. This finding supports previous results where exposure to xylitol changed the ultrastructure of the pneumococcal capsule and could explain further the high clinical efficacy of xylitol in preventing otitis media.

Alcohol hand gels (AHG) have been used by children in child day care centers (CDCCs) to prevent the transmission of microbes. Because parents and personnel have been concerned about the safety of AHGs, we conducted a trial to assess this.A total of 82 children age 3.5 to 7.2 years (mean, 5.7 years) at 2 CDCCs rubbed their hands with AHG. Alcohol concentrations in expiratory air were measured using an official police alcometer after 15 and 60 minutes. We also conducted a questionnaire survey asking how commonly AHGs were used in CDCCs, obtaining 128 answers from 68 CDCCs (with more than 1 person responding in 6 CDCCs).All of the alcometer readings were0.01 per thousand, although up to 30 contacts with the mucous membranes (mean, 2.4) occurred during the first 15 minutes. An AHG was used in all 68 CDCCs, but only by adults at 11 of them. The most common occasions for using an AHG were before serving food and after cleaning secretions. One case of fire occurred when a worker lit a fire while his hands were covered with AHG. Personnel were most concerned about situations in which children put their fingers into their mouth or eyes after using an AHG.The use of an AHG in CDCCs is safe. Even though children tend to put their hands into their mouth after disinfection, no significant amount of alcohol is absorbed.

Background Xylitol has antiadhesive effects on Streptococcus pneumoniae and inhibits its growth, and has also been found to be effective in preventing acute otitis media and has been used in intensive care as a valuable source of energy. Results We evaluated the oxidative burst of neutrophils in rats fed with and without xylitol. The mean increase in the percentage of activated neutrophils from the baseline was higher in the xylitol-exposed group than in the control group (58.1% vs 51.4%, P = 0.03 for the difference) and the mean induced increase in the median strength of the burst per neutrophil was similarly higher in the xylitol group (159.6 vs 140.3, P = 0.04). In two pneumococcal sepsis experiments rats were fed either a basal powder diet (control group) or the same diet supplemented with 10% or 20% xylitol and infected with an intraperitoneal inoculation of S. pneumoniae after two weeks. The mean survival time was 48 hours in the xylitol groups and 34 hours in the control groups (P < 0.001 in log rank test). Conclusion Xylitol has beneficial effects on both the oxidative killing of bacteria in neutrophilic leucocytes and on the survival of rats with experimental pneumococcal sepsis.

Viruses are important causes of paediatric hospital-associated infections (HAIs). We evaluated the frequency of viral HAIs during hospitalisation and after discharge in a paediatric infection ward. Data were collected prospectively for two years with follow-up questionnaires in which parents reported symptoms of new infections. Infections occurring >72 h after admission to hospital or

Background: Xylitol administered regularly 5 times a day after each meal is successful in preventing acute otitis media (AOM) in children, but if given only during respiratory infections it is ineffective against AOM. To find a more convenient dosing regimen, we tested whether xylitol administered 3 times a day reduces the occurrence of AOM. Methods: In this 3-month randomized, double-blind trial, 663 healthy day care children were randomized to receive either a control product (n = 331) or xylitol (n = 332). Xylitol was given in chewing gum or in a mixture 3 times a day, the daily dose being 0.5 g in the control group and 9.6 g in the xylitol group. The occurrence of the first AOM diagnosed during any period of respiratory symptoms during the follow-up was the main outcome measure. Results: At least one AOM episode was diagnosed in 98 of the 331 children who received control products (30%) and in 94 of the 332 who received xylitol products (28%). A total of 142 episodes of AOM were diagnosed in the control group compared with 156 in the xylitol group. The differences were not statistically significant. Conclusions: Xylitol given regularly 3 times a day for 3 months during the respiratory infection season failed to prevent AOM.

Background: We have previously found by lateral cephalometry an association between nasopharyngeal anatomy and the risk of acute otitis media (AOM). We evaluate here the association of nasopharyngeal dimensions in magnetic resonance imaging (MRI) with the occurrence of AOM in otherwise healthy children. Methods: Sixty-one healthy children (mean age 5.7 years, range 3.9-6.9) were recruited from child care centres. The parents filled in a questionnaire on the child's history of ear infections and adenoidectomy. MRI was performed with a 4 mm slice thickness during an upper respiratory infection. Five dimensions and two angles expressing the structure of the bony nasopharynx were measured in sagittal images. Results: The dimension from the caudal edge of the septum to the midpoint of the sella, reflecting the height of the nasopharynx, was on average 2.2 mm smaller in the children who had had AOM attacks during the last 12 months than those without attacks (95% confidence interval (CI) 0.9 to 3.4, p = 0.001) and the nasal base angle was on average 2.1 degrees smaller (95% CI 0.7 to 3.5, p = 0.004). These differences remained significant after adjustment for age, sex and previous adenoidectomy in the logistic modelling. A history of adenoidectomy did not have any effect on the dimensions. Conclusions: The nasopharynx was smaller in the children with AOM attacks during the last year. The value of this finding for predicting susceptibility to recurrent AOM and directing preventive procedures should be evaluated.

The aim of the study was to evaluate the dynamics of gut colonization and the main source of intestinal bacterial flora in infancy in a quantitative manner using computerized analysis of bacterial cellular fatty acid (CFA) profiles. Each stool was collected from 10 healthy newborn infants during their first 2-7 days of life and a follow-up sample at 6 months of age. Stool samples were collected from mothers and nurses for comparison. Gas-liquid chromatography of the 159 stool samples was used to produce bacterial cellular fatty acid (CFA) profiles by means of a previously developed computerized program. The CFA profiles for the infants fluctuated from hour to hour during the first days of life and resembled those for both the mothers and the nurses, doing so all the more in the case of the five infants examined 6 months after birth. Gut colonization fluctuated markedly from hour to hour in the perinatal period. The effect of the maternal flora on the initial gut colonization may be less than expected as the fecal flora of infants started to resemble both the fecal flora of the mother as well as that of the first nurse.

The effect of injection site on reactogenicity and specific immunogenicity was assessed in participants in a pertussis vaccine efficacy trial. The percent of DTwP and DTaP recipients with any reaction was slightly lower in subjects injected in the buttock compared with those injected in the thigh. This finding was most common in DTwP recipients. Geometric mean antibody values to pertactin, filamentous hemagglutinin and fimbriae (Bordetella pertussis antigens) were lower in DTaP vaccinees when buttock was utilized as the injection site. Our findings present evidence against the use of the buttock as the site of immunization for DTaP vaccines since the benefit with regards to reactogenicity is minimal and the immunologic response to an important antigen of B. pertussis, pertactin, is decreased.

Objectives:To evaluate the attitudes of pediatric healthcare workers (HCWs) toward influenza vaccination and to increase their rate of immunization.Methods:A survey was conducted among pediatric HCWs using an anonymous questionnaire. Survey results were used to design an intervention to increase the immunization rate of staff. Immunization rates before (2003-2004) and after (2004-2005) intervention were assessed using immunization clinic records.Setting:A university children's hospital in Switzerland.Interventions:(1) An informational letter based on misconceptions noted in the survey, (2) educational conversations with head nurses, (3) more “walk-in” immunization clinics, and (4) a direct offer of influenza immunization on the wards.Results:Among vaccine nonrecipients, doubts about the efficacy and necessity of influenza immunization were prevalent and more often reported by nurses than physicians (75% vs 41%, P = .002; and 55% vs 23%, P = .001, respectively). Physicians more often than nurses reported lack of time as a reason for not receiving influenza vaccination (23% vs 5%, P = .01). After intervention, the immunization rate of HCWs increased from 19% to 24% (P = .03). The immunization rate of physicians increased from 43% to 64% (P = .004). No change was noted among nurses (13% vs 14%) and other HCWs (16% vs 16%).Conclusions:Misconceptions about influenza vaccination were prevalent among pediatric staff, particularly nurses. Active promotion and educational efforts were successful in increasing the immunization rate of physicians but not nurses and other HCWs.

We report the case of a 10-year-old boy with prolonged fever who was found to have tularemia of the middle ear. Otolaryngologic cases including oropharyngeal and glandular or ulceroglandular forms of the head and neck region are estimated to account for 12% of all tularemia cases, but to date we have not seen a report of tularemia in the middle ear. The possibility of tularemia may not occur to a physician because of the wide variation of clinical manifestations.

Objective To evaluate the effect of successful prevention of common infections in child day care centers on the later development of allergic diseases. Design Prospective follow-up survey with a questionnaire administered 12 years after a controlled randomized hygiene intervention. Setting Twenty municipal child day care centers in Oulu, Finland. Participants A questionnaire was sent to 1354 prior participants (98%) in the intervention trial. The response rate was 68% (928 of 1354 participants). Main Intervention Hygiene intervention from March 1, 1991, to May 31, 1992. Main Outcome Measures The number of respondents who had a diagnosis of asthma, allergic rhinitis, and/or atopic dermatitis made by a physician, and the number of those who reported symptoms of atopic diseases. Results Asthma was diagnosed by a physician in 48 of the 481 respondents (10%) from the intervention child day care centers, with markedly fewer infections, and in 46 of the 447 controls (10%) (relative risk, 1.0; 95% confidence interval, 0.7-1.4). Similarly, no differences were found in the numbers of children who had a diagnosis of other atopic diseases or who had reported such symptoms. Conclusion The prevention of common respiratory tract and enteric infections during early childhood does not change later allergic morbidity.