Asian-Oceanian Journal of Pediatrics and Child Health JAPANESE PEDIATRIC BOARD CERTIFICATION: HISTORY AND FUTURE PERSPECTIVES

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1 Asian-Oceanian Journal of Pediatrics and Child Health Volume One December 2002 Number Two JAPANESE PEDIATRIC BOARD CERTIFICATION: HISTORY AND FUTURE PERSPECTIVES Nobutake Matsuo, M.D. (1), John Ichiro Takayama, M.D., M.P.H. (1), Shigehiko Kamoshita, M.D. (2) (1) National Center for Child Health and Development (2) Saniku-kai Hospital Abstract Objectives: The pediatric workforce in the Asia-Oceania region remains unknown. We describe the Japanese Pediatric Board Certification system and recent trends in the Japanese pediatric workforce as defined by board certification. Method: To better define the Japanese pediatric workforce, pediatricians certified by the Japanese Pediatric Board were collectively identified. Characteristics of this workforce and trends between 1994 and 2002 were examined. A telephone survey of a subset of 842 pediatricians who started pediatric residency in 1987 and in 1990 was conducted to determine current work status. Results: 4226 pediatricians received Board Certification in During this period, the number of male pediatricians slightly decreased and that of female pediatricians steadily increased with the total number of pediatricians annually certified slightly increased. Among the subset of 842 pediatricians, 49 (all women) were no longer in practice. Conclusions: If the current trends continue, the cumulative number of Japanese pediatricians is likely to slowly increase in the next decade. Given the age and gender profiles of pediatricians in Japan, however, the current rate of board certification may not be sufficient to maintain a viable workforce. The premature retirement of women pediatricians requires further study. Keywords: Japan, Board Certification, pediatric workforce, women pediatrician.

2 Corresponding author: Nobutake Matsuo, M.D. Address: The National Center for Child Health and Development, Ohkura, Setagaya-ku, Tokyo, Japan Fax: Tel: MEASLES IN HONG KONG 1961 to 2000 Professor Yu-Lung Lau, MD ABSTRACT With the use of measles vaccine since 1967, Hong Kong has experienced a relatively lower incidence of measles until a major outbreak occurred in 1988 with an incidence of 56 per 100,000. Vaccine failures accounted for only 24% of the cases in 1988, therefore control strategies at that time were targeted at increasing the coverage rate rather than introducing a two-dose regimen. After the 1988 measles outbreak, the incidence of measles was only 1.6 per 100,000 for 1989 and A second dose of MMR vaccine was introduced in 1996 because the proportion of measles cases with a history of measles vaccination rose from 16% in 1991 to 43% in An outbreak, mainly because of failure of the first dose to produce immunity, seemed imminent in mid-1997, hence a mass vaccination campaign to vaccinate over one million children aged 1-19 was conducted. After the campaign, the incidence of measles fell to less than 1 per 100,000 between 1998 and A two-dose strategy and supplementary campaign will maintain measles susceptibility at low levels in Hong Kong, hence paving the way for the eradication of measles. Keywords: Measles, Epidemiology, Vaccine Correspondence to: Prof Y.L Lau, Department of Paediatrics & Adolescent Medicine Queen Mary Hospital, Pokfulam Road, Hong Kong PREVALENCE OF MALNUTRITION AMONG CHILDREN IN ASIA Geok Lin Khor Ph.D. * Professor of Community Nutrition, Department of Nutrition & Health Sciences, Faculty of

3 Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia Introduction Significant progress has been made over the last 30 years in the nutritional status of young children. Between 1970 and 2000 the proportion of malnourished children was reduced by 20% in developing countries1. The prevalence of underweight among preschool children (< 5 years old) in developing countries declined from 34.3% in 1985 to 29.3% in In absolute numbers, however the decline is not as impressive. In fact, the number of underweight children has changed little over this period, decreasing from million in 1985 to million in Asia with several highly populated countries bears a vast burden of malnutrition in children. The concentration of malnutrition amongst children is highest in Asia compared with other continents. Seventy percent of the world s malnourished children reside in the region1. About half of the preschool children in Asia are malnourished, ranging from 16% underweight in the People s Republic of China (PRC) to 64% in Bangladesh. Some 120 million children are malnourished, constituting three quarters of the global total. One in three preschool children are stunted, rising to one out of every two children in the countries of South Asia such as India, Bangladesh and Nepal. In terms of number of underweight children, India leads with an estimated 62 million followed by PRC (17 million)3. A high proportion of young children in developing countries suffer from a number of micronutrient deficiencies, besides the problem of protein-energy malnutrition as manifested by underweight and stunting. In the Asia and Pacific region, commonly reported micronutrient problems involving children are iron deficiency anemia, vitamin A deficiency, and iodine deficiency disorders (Table 1). The focus of this report is limited to these major nutritional problems from the perspective of their extent, determinants and consequences on health. Intervention strategies and activities for overcoming malnutrition and specific nutrients are not included as they cover a wide scope and warrant a separate report. LACTOSE INTOLERANCE IN SINGAPORE CHILDREN S.H. Quak, MBBS; M Med (Paediatrics); MD; FRCPCH; FAMS; FRCP (Glasg) ABSTRACT Lactose intolerance is common among Asian children. This paper studies the incidence of lactose intolerance among healthy children in Singapore using oral lactose breath hydrogen test and milk breath hydrogen test. It was found that 74.6% of the children had evidence of lactose intolerance and all the races were similarly affected. There was an increasing incidence with increasing age. Significantly fewer children were symptomatic when milk was used as a source of lactose.

4 Key words: breath test, diarrhoea, abdominal pain, flatulence. Correspondence to: Prof S.H. Quak, Associate Professor, The Children s Medical Institute, National University Hospital, Lower Kent Ridge Road, Singapore PAEDIATRIC AIDS IN ASIA Chitsanu Pancharoen, M.D. Usa Thisyakorn, M.D. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, Tel. (662) begin_of_the_skype_highlighting (662) end_of_the_skype_highlighting, Fax (662) Correspondence: Dr. Usa Thisyakorn, Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok Thailand. Abstract The incidence of HIV infection and AIDS amongst children in Asian countries has risen steadily and has become an increasing cause of morbidity and mortality during childhood. More than 90% of all children with HIV infection acquired their infection at birth from HIVinfected mothers. With increasing evidence of heterosexual HIV transmission, the number of infected women and consequently their children is increasing. Transmission rate of HIV from mother to infant varies from 20 to 40 percent in Asian countries, a higher transmission rate was observed when the HIV-infected mothers breast-fed their babies. HIV infection and pediatric AIDS is now threatening much of the progress that has been made in child survival in Asian countries during the past 20 years. Children can be affected directly through HIV infection and AIDS and indirectly by the effects of HIV on their parents which includes orphans, discrimination, infant abandonment and negative impacts on children s education. Another problem of concern is children who are most vulnerable to HIV infection and AIDS and this includes child prostitutes and children in difficult circumstances. Recommendations for action include prevention of parental HIV infection, prevention of motherto-child transmission of HIV, addressing child prostitution, prevention of child labour and

5 improving work conditions, assistance to street children, addressing discrimination, solving the problem of children orphaned by AIDS, reducing HIV-related child abandonment, new roles for schools in reducing impacts. What needs to be done cannot be accomplished by any one agency or group alone. It takes the shared commitment, decision making, resources and efforts of all sectors of society to achieve the goals of protecting children from HIV and its effects. The government, NGOs, businesses and communities including community opinion leaders and most importantly, people living with HIV and AIDS, all have key roles to play in mounting an effective multisectoral response to the problem. It will also require leadership; the cost of indecision and delay in acting will be high. Every additional HIV infection not prevented, every additional child allowed to enter prostitution, every additional child denied an education by discrimination will increase the ultimate economic and social cost to the country. Children are the country s future, the country s response to their problems will give an indication of how highly the country values its future. Keywords: Child HIV infection; child AIDS PREVENTION OF HEPATITIS B VIRUS INFECTION AND ITS RELATED DISEASES BY VACCINATION Mei-Hwei Chang, M.D. Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, TAIWAN Hepatitis B virus (HBV) infection is closely related to chronic liver diseases and hepatocellular carcinoma (HCC). Approximately two billion people in the world have been infected by HBV, and 350 million of them became chronic hepatitis B surface antigen (HBsAg) carriers. The peak age for HCC is between 40 to 60 years in most areas, while the peak age of HCC is younger in Africa. In hyperendemic areas for HBV, most of the complications of chronic HBV infection develop in adulthood,while primary HBV infection occurs mainly during infancy or early childhood [1].

6 HBV infection is prevalent in Asia, Africa, Southern Europe and Latin America, where the HBsAg seropositive rates range from 2 to 20%. In those hyperendemic areas, HBV infections occurs mainly during infancy and early childhood. HCC is an important health problem in those who have been infected early in their lives. Infection during early childhood is a very important event leading to chronicity of the condition and to complications. In Taiwan, the HBsAg carrier rate in the general population is approximately 10 to 20%. Before the implementation of universal HBV vaccination program, the HBsAg seropositive rate was 5% in infants, and increased to 10% at 2 years of age, remaining stationary thereafter[1]. However, the infection rate reflected by anti-hbc seropositivity, reaches 50% by the age of 15 years. This suggests that most chronic HBsAg carriers are infected before 2 years of age in this population [1]. In rural Senegal, by the age of 2 years, 25% of children are infected, while at age 15, the infection rate rises to 80% 2. In hyperendemic areas in Asia, perinatal transmission through HBsAg carrier mothers accounts for 40-50% of HBsAg carriers. Around 90% of the infants of hepatitis B e antigen (HBeAg) seropositive carrier mothers became HBsAg carriers 3, irrespective of a high or low HBsAg carrier rate in the population. Age of infection is an important factor determining the outcome of infection. The other transmission route is horizontal transmission, mainly through highly infectious family members, such as elder siblings, and improperly sterile needles or syringes. Current therapies for hepatitis B, liver cirrhosis and HCC are not satisfactory. Immunoprophylaxis is thus the best way to get rid of the threat of HBV infection and its related HCC. The optimal timing for immunoprophylaxis against HBV infection and its related HCC is during neonatal period or early infancy. Correspondence: Dr Mei-Hwang Chang, No. 7, Chung-Shan S. Road, Department of Pediatrics, National Taiwan University Hospital, Taipei, TAIWAN Telephone No. : (886-2) , ext Fax: (886-2) mhchang@ha.mc.ntu.edu.tw Epidemiology of Kawasaki Disease Hung-Chi Lue, MD, PhD 1, 2, Saji Philip MD1, Hsu Ming-Chia, MD1, Jou-Kou Wang, MD, PhD 2, Mei-Hwan Wu MD, PhD 2. Department of Pediatrics, Min-Sheng General Hospital 1 and National Taiwan University Hospital2, Taiwan Abstract:

7 Objective: To report the epidemiology of Kawasaki disease (KD) based on the Taiwan experiences and a review of the literature. Methods: We conducted four nationwide surveys on the number of patients encountered in hospitals of 100 or more beds with pediatric services in Taiwan. The first survey covered , the second survey , the third survey and the fourth survey The annual incidence of KD was expressed as the number of KD patients per 100,000 children less than 5 years of age. The literature on the incidence of KD was reviewed, compared and discussed. Results: In Taiwan, the first case of KD was encountered in 1976, and the number of patients increased thereafter, to 440 in 1986, 512 in 1993, 736 in 1996, 838 in 1998, and 792 in The incidence increased to 24.8 in 1986, 31.6 in 1993, 46.3 in 1996, then to a peak of 54.3 in Male to female ratio ranged 1.5 to1.7 with an average of 1.6. The percent frequency of patients aged below 2-years ranged 57.6%-65.2%, average 59.8%; 2 to 4-years 23.3%-26.5%, average 25.3% and above 4 years 13.1%-15.8%, average 14.9%. Early coronary artery lesions were present in 27.2% to 31.5%, average 25.9% of the patients. 112 The fatality rate decreased from 0.4% in the first survey to 0.06% in the fourth survey. The peak incidence observed in the past, was the highest, in Japan, second highest 54.3 in Taiwan, followed by 38.9 in Korea, and 32.0 in Hong Kong, China, in the South-East Asian region. In the other regions of the world, the highest was 47.7 in Hawaii, USA, then 20.6 in Ontario, Canada. Conclusions: KD affects mainly infants and children, most frequently in Japan, then in Taiwan, Hawaii, Korea, Hong Kong, Ontario and Beijing. The etiology of KD is still unknown. Key words: Kawasaki disease, coronary artery lesions, epidemiology, Taiwan, the world Corresponding author: Hung-Chi Lue, MD, PhD, FACC Emeritus Professor of Pediatrics, National Taiwan University President, Association of Pediatric Societies of South East Asia Region Director, Min-Sheng General Hospital 168, Ching-Kuo Rd, Tao-Yuan 330, Taiwan Fax: , Tel: begin_of_the_skype_highlighting end_of_the_skype_highlighting hclue@e-ms.com.tw

8 AGE SPECIFIC SEROPREVALENCE OF HEPATITIS A VIRUS INFECTION IN MALAYSIA A CHANGING PATTERN Khairullah N *, Merican I +, Padmanathan A *, Yusup R *, Ismail R # * Malaysian Liver Foundation, + Ministry of Health, # Aventis Pasteur (M) Kuala Lumpur, Malaysia ABSTRACT The change in prevalence of Hepatitis A virus (HAV) infection from hyperendemicity to lower endemicity resulting from improvements in socio-economic status and sanitation has public health implications. The objective of our study is to assess the exposure to HAV in our population in the year 2000 and to determine the epidemiological trend that would contribute to the implementation of preventive measures and control of this disease. We conducted a randomised, cross-sectional survey of 2,200 sera obtained from non-icteric subjects aged 1-70 years for the presence of hepatitis A antibodies. Sera obtained from subjects from Peninsular and East Malaysia were categorised into five regions according to geographical locations. Total antibodies against hepatitis A virus were detected by ELISA using a commercially available kit, ETI-AB-HAVK-3 (DiaSorin, Italy) following the manufacturing s instructions. All statistical tests were two-sided and were interpreted at a 5% level of significance; 95% confidence intervals for prevalence were based on Fleiss quadratic computation. Keywords: Hepatitis A, Seroprevalence, Endemicity, Epidemiological Trend Correspondence to: Raman ISMAIL, MD, MPH, Aventis Pasteur SA, 74, Jalan Universiti, Petaling Jaya, Selangor, Malaysia