Tularemia: A Changing Presentation in Children

Abstract

A high incidence of rickets among infants in t h e people; Republic of Cadham P r o v i n c i a l Laboratory, Winnipeg, Canada.China has been reoorted. etioloev unclear. The vit. D status of infants in An outbreak of Echovirus 11 i l l n e s s occurred among i n f a n t s ~ China has not bekn invkstigateY;I. The specific effect of sunshine (UV) exposure on D status in any infant is unstudied. We hypothesized that breast-fed infants in China have low vit. D status and UV exposure increases serum 250H vit. D into the normal range. 54 breast-fed term infants 1 t o 8 mos. without D supplements were randomly assigned into 2 grps. in a 2 mo. study, Sept. and Oct. (mos. of high UV exposure): controls with "usual" sun exposure; and experimental with 2 hr. sunld. Infants received only human milk, rice soup, fruit juice and mashed vegetables and exposed mostly face and forearms. A 20 nurse team monitored UV exposure with diaries and a unique infant UV dosimeter.Only 100 u1 blood samples were permissible in infants. Serum 250HD was measured by protein binding assay after chromatography. (N I1 t o 68 nglrnl). Mean maternal 250HD was 22 nglml. Infant 250HD correlated with mother's k0.48). Infant 250HD ranged 3 t o 61 nglml a t entry with 20% <I 1 nglml. Mean + SE 250HD did not change for controls (21 + 3 vs 18 + 3 nglml, pre-vs. post-2 mo.sun exposure 8 3 min./d) but increased significantly for experimental (28 2 4 vs 40 2 5 nglml, p<0.01, sun I44 min./d). Thus, infant 250HD correlated with maternal 250HD; although infants in Beijing may receive moderate sun exposure in fall, 20% of 250HD a r e low and additional sun exposure for 2 mos. increases serum 250HD towards normal. EPIDEMIOLOGY OF CYTOMEGALOVIRUS (CMV) INFECTIONS: 529 GROUP DAY CARE (DC) AND SOCIOECONOMIC FACTORS.Hutto and Robert F. Pass, University of Alabama i n Birmingham, Department of P e d i a t r i c s , Birmingham, Alabama.A r e c e n t study found a high r a t e of CMV e x c r e t i o n among c h i ldren i n a group day c a r e c e n t e r (DCC) e n r o l l i n g p r i m a r i l y c h i ldren from middle income f a m i l i e s , suggesting t h a t t h e i n c r e a s i n g use of group D C i n t h i s country could change t h e epidemiology of CMV.We s t u d i e d 5 DCCs s e r v i n g c h i l d r e n of d i v e r s e backgrounds and examined CMV i n f e c t i o n r a t e s (IR) ( v i r a l e x c r e t i o n + sero-