CPSP Highlights

Canadian Paediatric Surveillance Program 2004 quiz

1. One of the greatest strengths of the Canadian Paediatric Surveillance Program is that it is an active surveillance system. Identify one advantage of active surveillance over passive surveillance.

2. What is the most common cause of acute flaccid paralysis?

3. Globally, which countries are still polio-endemic?

4. In children with early-onset eating disorders, what are the female-to-male ratio, the average weight loss and the most affected subgroup?

5. How could ‘lap-belt syndrome’ be prevented?

6. Surveillance of neonatal herpes simplex virus infection confirmed an overall fatality rate of 15.5%, occurring mainly in disseminated cases. Name two public health issues identified through this study.

7. How can nutritional rickets be prevented in exclusively breastfed infants and children?

8. Surveillance for necrotizing fasciitis or ‘flesh-eating’ disease showed that 16 of 26 (61.5%) group A streptococcus-related necrotizing fasciitis cases were preceded by an infection. What is the Canadian immunization recommendation to prevent this infection, and which Canadian provinces/territories have implemented it?

9. What is the most significant finding of the neonatal hyperbilirubinemia study?

10. What device responsible for serious injuries in children did Health Canada ban in 2004?

Canadian Paediatric Surveillance Program 2004 quiz – Answers

1. Active surveillance reaches out to participants by regularly asking them to report. Passive surveillance relies on participants remembering to report on their own, which often results in under-reporting. Canadian Paediatric Surveillance Program (CPSP) national timely research data collected on the health of Canadian children and youth impacts medical and/or public health decisions.

2. Guillain-Barré syndrome, a postinfectious polyneuropathy that causes mostly motor, but also sensory, nerve demyelination is the most common cause of acute flaccid paralysis (AFP) accounting for 74% of all confirmed AFP cases. Because poliomyelitis should be considered in all AFP cases, throat and stool specimens for enterovirus isolation should be obtained as early as possible in the course of the illness, ideally within two weeks.

3. Only six countries remain polio-endemic (Nigeria, Niger, Egypt, India, Pakistan and Afghanistan), which is down from over 125 countries when the Global Polio Initiative was launched in 1988. However, recent World Health Organization data suggest that re-established transmission has occurred in four countries in Africa, ie, Burkina Faso, Chad, Cote d’Ivoire and the Sudan.

4. The female-to-male ratio of early-onset eating disorders in five- to 12-year-old children is 5:1, compared with 10:1 in the older adolescent and adult population. Early results indicate that boys are more likely than girls to be affected in the preadolescent group. Average weight loss (6.8±4.7 kg) for both sexes was substantial during the important growing years, with older children aged 11 to 12 years being most affected:

   • Girls: average loss of 8.15 kg (±4.9) or 18% of body weight
   • Boys: average loss of 7.57 kg (±4.6) or 17.5% of body weight

5. ‘Lap-belt syndrome’, first described by Garrett and Braunstein in 1962, refers to intestinal viscera and lumbar spine injuries associated with the improper use of the lap-belt restraint. Preliminary results indicate that the majority of affected children are between six and 12 years of age, reinforcing the importance of prolonged use of booster seats and the need to review the use of child restraints in motor vehicles.

6. The neonatal herpes simplex virus (HSV) infection study identified two important public health issues:

   • Herpes vaccine should be effective against both HSV-1 and HSV-2 because a majority of typed cases were HSV-1 (62.5%).
   • The challenge of preventing HSV infection and the implications for prenatal screening are illustrated by the result that eight of 20 (40%) mothers (with available data) were unaware of their herpes infection before delivery and only one of 58 (1.7%) mothers had obvious genital lesions at delivery.

7. Vitamin D supplementation (400 IU/day; 800 IU/day if living north of the 55th latitude), given to all exclusively breastfed infants and children, remains the most effective measure for preventing nutritional rickets and associated complications such as seizures, fractures and delayed milestones.

8. Varicella is a vaccine-preventable disease, yet 61.5% of group A streptococcus-related necrotizing fasciitis cases identified in the CPSP study were preceded within one month by varicella. Both the National Advisory Committee on Immunization and the Canadian Paediatric Society recommend universal vaccination of varicella-susceptible children and adolescents:

   • Children aged 12 months to 13 years: one dose
   • Adolescents older than 13 years: two doses, at least four weeks apart

   Presently, three provinces (Alberta, Nova Scotia and Prince Edward Island) and two territories (Nunavut and Northwest Territories) provide varicella immunization at 12 months of age; two provinces (Manitoba and Ontario) will start a similar program within the next year; and a few provinces target high-risk populations. In the other provinces, varicella vaccine is available but must be purchased. Continued advocacy is needed to assure universal access to this vaccine.

9. In the first 18 months of surveillance for severe neonatal hyperbilirubinemia, a significant number of cases (n=203) were confirmed, with an average peak bilirubin of 477 μmol/L. More importantly, etiologies were identified in only 30% of cases, indicating the need for a more complete workup before discharge.

10. Canada was the first country to impose a total ban on the sale, advertisement and importation of baby walkers. The CPSP baby walker survey in 2002 documented serious injuries, including burns, head and spinal injuries, and fractured arms and legs. As baby walkers continue to be handed down in families, health care providers still need to provide anticipatory guidance to prevent further baby-walker injuries.