BackgroundAlthough acute otitis media (AOM) remains a major public health problem worldwide and brings economic burden on health care system and caregivers, little information is available about its epidemiology in Eastern Europe.MethodsWe conducted an epidemiological, prospective, observational, multi-centre cohort study (NCT01365390) in five East European countries (Estonia, Lithuania, Poland, Romania and Slovenia) between June 2011 and January 2013 to determine the incidence and clinical characteristics of AOM among children aged < 6 years during 1 year.ResultsAOM incidence was 160.7 cases (95 % confidence interval [CI]: 144.7–177.9) per 1000 person-years (PY) being the lowest in the < 1 year age group (92.3 cases [95 % CI: 59.7–136.2] per 1000 PY) and the highest in the 3– < 4 years age group (208.9 cases [95 % CI: 165.1–260.7] per 1000 PY). AOM incidence was similar across the countries, with the exception of Slovenia (340.3 cases [95 % CI: 278.3–412.0] per 1000 PY). There was a lower risk in breastfed children and a higher risk in those attending school/childcare or with allergies. AOM required 521 visits to the doctor. Antibiotics were prescribed for 276 (74.8 %) episodes with the lowest prescription rate in Estonia (51.4 %) and the highest in Romania (83.7 %). Complications were rare and hospitalisations occurred in 2 % of the cases.ConclusionsThe disease burden of AOM in Eastern Europe is relevant and public health initiatives to reduce it should be considered.Trial registrationClinicalTrial.gov NCT01365390.

BackgroundStreptococcus pneumoniae (SPn) is an important pathogen causing a variety of clinical manifestations. The effects of SPn nasopharyngeal colonization on respiratory tract infections are poorly studied. We evaluated the association of SPn colonization with features of respiratory tract infections.MethodsChildren under the age of 6 years who visited a primary care physician because of respiratory tract infections were enrolled in the study. History was taken, children were clinically assessed by the physician, and nasopharyngeal swabs were obtained and cultured for SPn. Positive samples were serotyped. Associations of SPn colonization with clinical signs and symptoms, recovery duration, absence from day care centre, frequencies of specific diagnoses, and treatment with antimicrobials were evaluated.ResultsIn total 900 children were enrolled. The prevalence of SPn colonization was 40.8 % (n = 367). There were minor differences between male and female subjects (199 of 492, 40.4 % vs 168 of 408, 41.2 %, p = 0.825). Children with and without siblings had similar colonization rates (145 of 334, 43.4 % vs 219 of 562, 39.0 %, p = 0.187). Clinical signs and symptoms were not associated with SPn colonization. Children colonized with SPn had longer recovery duration compared to non-colonized children (114 of 367, 31.1 % vs 98 of 533, 18.4 %, p < 0.001) and were longer absent from day care (270 of 608, 44.4 % vs 94 of 284, 33.1 %, p = 0.001). Pneumonia, sinusitis, and acute otitis media were more frequently diagnosed in children colonized with SPn. Children attending day care centres had significantly higher prevalence of SPn colonization (270 of 367, 44.4 % vs 338 of 533, 33.1 %, p = 0.001). Children with pneumonia, sinusitis and acute otitis media were more frequently treated with antimicrobials than children with other diagnoses.ConclusionsSPn nasopharyngeal colonization has a negative impact on the course of respiratory tract infection, likely because of SPn being the cause of the disease or a complicating factor. It is also associated with and may be responsible for higher frequencies of bronchitis, pneumonia, acute otitis media, sinusitis and the need of antimicrobial treatment.

BackgroundIncreasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination.MethodsA prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated.ResultsAbout a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim–sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %–82.4 % were present in currently available pneumococcal conjugate vaccines.ConclusionsThe rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country.

Data on distribution of Streptococcus pneumoniae (SPn) serotypes among children in Lithuania are limited. A prospective study was carried out from February 2012 to March 2013 to evaluate the circulation of SPn serotypes among young children in five cities of Lithuania before the introduction of universal vaccination with pneumococcal conjugate vaccine (PCV). A total of 900 children under six years of age who presented to primary care centres or a hospital emergency department with acute respiratory tract infection (RTI) were enrolled in the study. The SPn colonisation rate was 40.8% (367/900), with a peak at two and three yearsold (48.8% and 45.4%, respectively). Of the 367 SPn isolates, the most common serotypes were 6B (15.8%, n = 58), 19F (13.9%, n = 51), 23F (13.9%, n = 51), 15 (10.1%, n = 37), 14 (9.5%, n = 35), 6A (9.3%, n= 34), 11 (4.6%, n = 17), 3 (3.0%, n = 11) and 18C (3.0%, n = 11); less frequent were 23 (non-23F) (2.7%, n = 10), 19A (2.2%, n = 8) and 9V (1.6%, n = 6). Serotypes 6A and 11 were more common in children under two years-old; 18C was found only in children aged two to five years. The serotypes found might be an important predictor of the likely effectiveness of the PCVs currently available in Lithuania

Background The application of preparations containing food allergens can cause percutaneous sensitization and provocation. The prevalence of food allergens in children's cosmetics is unknown. Objectives To analyse the prevalence of food allergens in skincare products marketed for children and their association with marketing claims and product price. Methods We reviewed 276 skincare product ingredient labels for the presence of milk, eggs, wheat, soy, oats, tree nuts, peanuts, and sesame. Results More than one‐third (108; 39.1%) of the products listed at least one allergen. A total of 156 allergens were recorded, of which 65 (41.7%) were almonds, 35 (22.4%) wheat, 24 (15.4%) soy, 16 (10.3%) oats, 13 (8.3%) sesame, 2 (1.3%) milk, and 1 (0.6%) peanuts. Products that claimed to be "natural" or "ecological" were more likely to contain food allergens than those not labelled so (P < .001). The prices were higher for products containing food allergens compared with allergen‐free products (P = .028). Conclusions Food allergens are prevalent in children's cosmetics, especially those that claim to be natural or ecological. The most incorporated food allergens are almonds, wheat, and soy. Products containing food allergens cost more than allergen‐free ones.

Background. Streptococcus pneumoniae (pneumococcus) is a potential respiratory pathogen causing high-risk diseases, particularly in young children. Otherwise, carriage of pneumococcus may be asymptomatic depending on the serotype and the immune system of the individual. The aim of this study was to determine nasopharyngeal carriage rates, serotype distribution and to evaluate the mucosal immune response to S. pneumoniae infection in healthy 2-7-year-old children attending day care centres in Vilnius, Lithuania.Materials and methods. Nasopharyngeal (n = 601) and saliva samples were collected randomly. A pneumotest kit (Statens Serum Institute, Denmark) was used for serogrouping / serotyping; the sandwich ELISA with a double monoclonal system was used for immunoglobulin concentration measurement.Results. Carriage rate in the children's population was 43%; from 33 serotypes found, the following six prevailed: 19F, 23F, 6B, 6A, 3 and 18C, which accounted for 58% of isolates. The carriage rates in children over four were found to be decreased. The concentrations of total and specific salivary antibodies of three isotypes (IgA, IgM and IgG) in carriers of six pneumococcal serotypes (3, 6B, 14, 18C, 19F and 23F) were measured.Conclusions. The carriage rates and prevalent serotypes of S. pneumoniae in healthy preschool Lithuanian children were similar as in the neighbouring states. The response of total and specific salivary antibodies was found to be serotypespecific. The pneumococcal carriage stimulated the production of not only specific antibodies, but also of total immunoglobulins of S-IgA, IgM and IgG isotypes.

Human bocavirus 1 (HBoV1) is a parvovirus recently found to be a possible aetiologic agent of acute respiratory disease in children. We conducted the first clinical and molecular study on this virus in Latvia (LV) and Lithuania (LT). The aim of the study was to determine the occurrence of HBoV1 in respiratory tract samples taken from hospitalised children with acute respiratory tract infections in LV and LT. In total 186 children with age one to 50 months, and who fulfilled criteria of acute respiratory tract infection, including lower respiratory tract infections, with or without fever, were included in this study. A nasopharyngeal aspirate was obtained from each patient on admission. DNA was isolated and polimerase chain reaction (PCR) performed targeting the HBoV1 NS1sequence. HBoV1 positive samples were sequenced and phylogenetic analysis was performed. HBoV1 sequence was detected in 42 (32%) of 130 LV and in 8 (14%) of 56 LT samples. In LV the majority of patients with HBoV1 infection were observed in February while in LT in October. The phylogenetic tree for HBoV1 indicated that isolates of HBoV1 cluster closely and include almost all of the isolates in this study. HBoV1 is common in Latvia and Lithuania and might be a significant pathogen that contributes to acute respiratory tract infections in children.

Background. This study assessed the utility of a prick-by-prick test with pasteurised cow’s milk in predicting a pasteurised cow’s milk allergy (CMA) diagnosis. Methods. This was a retrospective study of 86 paediatric patients who had undergone open pasteurised cow’s milk oral food challenges (OFCs). We evaluated the diagnostic performance of a prick-by-prick test with pasteurised cow’s milk in predicting a positive OFC result. We calculated the threshold values representing high test specificity and predictive probability in children aged ≤24 and >24 months. Results. A prick-by-prick test with pasteurised cow’s milk was a good classifier of a positive cow’s milk OFC outcome. The mean   prick − by − prick   test   wheal   diameter ≥ 3  mm yielded 100% sensitivity in both groups of children. Thresholds representing high test specificity and 95% predicted probability were 7 and 11 mm in children ≤ 24 months and 11 and 17 mm in children > 24 months of age, respectively. Conclusion. A prick-by-prick test with pasteurised cow’s milk is valuable in paediatric practice when diagnostic thresholds are implemented.