Newborn infants, including premature infants, are high-risk patients susceptible to various microorganisms. Catheter-related bloodstream infections are the most common type of nosocomial infections in this population. Regular education and training of medical staffs are most important as a preventive strategy for central line-associated bloodstream infections (CLABSIs). Bundle approaches and the use of checklists during the insertion and maintenance of central catheters are effective measures to reduce the incidence of CLABSIs. Chlorhexidine, commonly used as a skin disinfectant before catheter insertion and dressing replacement, is not approved for infants <2 months of age, but is usually used in many neonatal intensive care units due to the lack of alternatives. Chlorhexidine-impregnated dressing and bathing, recommended for adults, cannot be applied to newborns. Appropriate replacement intervals for dressing and administration sets are similar to those recommended for adults. Umbilical catheters should not be used longer than 5 days for the umbilical arterial catheter and 14 days for the umbilical venous catheter. It is most important to regularly educate, train and give feedback to the medical staffs about the various preventive measures required at each stage from before insertion to removal of the catheter. Continuous efforts are needed to develop effective and safe infection control strategies for neonates and young infants.

Ha SG, et al. J Korean Med Sci. 2018 Aug;33(43):e268. https://doi.org/10.3346/jkms.2018.33.e268

While there is an urgent need for diagnosis and therapeutic intervention in patients with primary immunodeficiency diseases (PIDs), current genetic tests have drawbacks. We retrospectively reviewed the usefulness of flow cytometry (FCM) as a quick tool for immunophenotyping and functional assays in patients suspected to have PIDs at a single tertiary care institute. Between January 2001 and June 2018, patients suspected of having PIDs were subjected to FCM tests, including lymphocyte subset analysis, detection of surface- or intracellular-target proteins, and functional analysis of immune cells, at Samsung Medical Center, Seoul, Korea. The genetic diagnosis was performed using Sanger or diagnostic exome sequencing. Of 60 patients diagnosed with definite or probable PID according to the European Society of Immune Deficiencies criteria, 24 patients were provided with useful information about immunological dysfunction after initial FCM testing. In 10 patients, the PID diagnosis was based on abnormal findings in FCM testing without genetic tests. The FCM findings provided strong evidence for the diagnosis of severe combined immunodeficiency (n = 6), X-linked chronic granulomatous diseases (CGD) (n = 6), leukocyte adhesion deficiency type 1 (n = 3), X-linked agammaglobulinemia (n = 11), autoimmune lymphoproliferative syndrome-FASLG (n = 1), and familial hemophagocytic lymphohistiocytosis type 2 (n = 1), and probable evidence for autosomal recessive-CGD (n = 2), autosomal dominant-hyper-immunoglobulin E (IgE)-syndrome (n = 1), and STAT1 gain-of-function mutation (n = 1). In PIDs derived from PIK3CD (n = 2), LRBA (n = 2), and CTLA4 mutations (n = 3), the FCM test provided useful evidence of immune abnormalities and a tool for treatment monitoring. The initial application of FCM, particularly with known protein targets on immune cells, would facilitate the timely diagnosis of PIDs and thus would support clinical decisions and improve the clinical outcome.

Coronavirus disease 2019 (COVID-19) vaccines are currently authorized for emergency use in adolescents aged 12–17 years; however, there is concern and uncertainty regarding the safety and necessity of COVID-19 vaccination. A survey was carried out to assess the attitudes and acceptance towards vaccination in adolescents. A nationwide web-based survey was conducted among adolescents aged 12–17 years and their parents between June 29 and July 8, 2021 on a platform provided by the Ministry of Education. A total of 341,326 parents and 272,914 adolescents participated in this study. Intention for vaccination was 69.1% for adolescents, and 72.2% of parents reported they would recommend vaccination for their child. Among adolescents, perception of safety (odds ratio [OR] 4.09, 95% confidence interval [CI] 3.95–4.22), effectiveness (OR 2.24, 95% CI 2.17–2.32), and risk-benefit (OR 1.75, 95% CI 1.72–1.78) had the highest impact on intention for vaccination. Also, perceived risk (OR 1.14, 95% CI 1.12–1.17), severity (OR 1.12, 95% CI 1.10–1.13) for COVID-19 infection, self-health perception (OR 1.12, 95%, CI 1.10–1.14) and recent vaccination of childhood vaccines (OR 1.25, 95% CI 1.19–1.32) were related to intention for COVID-19 vaccination. On the other hand, self-perceived knowledge (OR 0.96, 95% 0.95–0.98) was related to vaccine hesitancy. Gender or school district did not influence intention for COVID-19 vaccination in adolescents. Decisions on COVID-19 vaccination for adolescents should be a shared process between adolescents, parents, and physicians based on updated information on safety and effectiveness.

Cho EY, et al. J Korean Med Sci. 2016 Jul;31(7):1082-1088. https://doi.org/10.3346/jkms.2016.31.7.1082