title: Vaccine preventable infections and multiple organ dysfunction syndrome in critically ill children in China.
abstract: BACKGROUND
  Multiple organ dysfunction syndrome (MODS) is a major cause of mortality in PICUs in industrialized countries. As developing countries become more advanced, PICU care comes into reach. The aim of this study was to examine MODS in a PICU in China in comparison with other countries.
  
  
  METHODS
  A retrospective 5-year audit (2001-2006) of MODS cases in a 6-bed PICU in the Second Hospital of Lanzhou University, China.
  
  
  RESULTS
  Of the 332 PICU patients, 176 (53%) had MODS; the mean age was 35 months, and 60% were <1 year of age. Infectious diseases were the predominant factor underlying MODS (128/176; 73%) with 24% attributable to potentially vaccine preventable infections (14 to Haemophilus influenzae b, 13 to Streptococcus pneumoniae, and 4 to Neisseria meningitidis). The case fatality rate for MODS was 49% with no difference between infectious or noninfectious causes (48% vs. 52%; P > 0.05). The frequency of organ dysfunction in MODS was in decreasing order: respiratory (95%), cardiovascular (89%), gastrointestinal (39%), neurologic (35%), hematologic (16%), renal (14%), and hepatic (4%) systems. Mortality rose with increasing number of organs involved. Gastrointestinal system failure was more common in MODS caused by infection than noninfection (45% vs. 23%; P <0.01) and had a higher mortality (72% vs. 34%; P < 0.001). The case fatality rate for MODS in this study was comparable to rates in other developing countries but higher than in industrialized countries.
  
  
  CONCLUSIONS
  MODS is a major cause of mortality in PICU patients in China. In China, infection-related MODS PICU cases could potentially be reduced to rates closer to those in industrialized countries, if conjugated H. influenzae b and conjugated pneumococcal vaccines were introduced into routine practice.
authors.affiliation: Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China.
authors.forename: Qing Li
authors.initials: QL
authors.lastname: Zhang
authors.forename: Chao Min
authors.initials: CM
authors.lastname: Wan
authors.forename: Noni E
authors.initials: NE
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D006192:Haemophilus Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D019741:Haemophilus influenzae type b; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011008:Pneumococcal Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D013296:Streptococcus pneumoniae
chemical_list: D018073:Haemophilus Vaccines; D022242:Pneumococcal Vaccines