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Vaccine Preventable Infections and Multiple Organ Dysfunction Syndrome in Critically Ill Children in China

Zhang, Qing Li MD*†‡; Wan, Chao Min MD*; MacDonald, Noni E. MD, FRCPC‡

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31818a65d2
Original Studies

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.

Author Information

From the *Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China; †Department of Pediatrics, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China; and ‡Canadian Center for Vaccinology, IWK Health Centre and the Department of Pediatrics, Dalhousie University, Halifax, Canada.

Accepted for publication August 13, 2008.

Address for correspondence: Noni E. MacDonald, MD, FRCPC, Department of Pediatrics, IWK Health Centre, 5850/5980 University Ave, P O Box 9700, Halifax, Nova Scotia, Canada B3J 0A3. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.