The Epidemiology of Severe Infections in Children

  • Mary E. Hartman
  • R. Scott Watson
  • Joseph A. Carcillo
  • Derek C. Angus


Infectious diseases account for the majority of admissions to hospitals in the developing world (1,2). The Global Burden of Disease study, sponsored by the World Health Organization (WHO) and the World Bank, estimates that the majority of the nearly 11 million annual pediatric deaths in the world are due to infectious causes (2,3). Just over 1.6 million of these deaths are among neonates. The majority of cases occur in developing countries (2), and half of all infection-related deaths occur in just seven countries: India, China, Nigeria, Pakistan, Bangladesh, Ethiopia, and Zaire (3). Diarrheal and respiratory illnesses account for almost half of the deaths, while malaria, AIDS, and measles are responsible for another 17% (4).


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Accorsi S, Fabiani M, Lukwiya M, Onek PA, Mattei PD, Declich S. The increasing burden of infectious diseases on hospital services at St Mary's Hospital Lacor, Gulu, Uganda. Am J Trop Med Hyg 2001;64(3-4):154–158.PubMedCrossRefGoogle Scholar
  2. 2.
    Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349(9061):1269–1276.PubMedCrossRefGoogle Scholar
  3. 3.
    Hill K, Pande R, Mahy M, et al. Trends in Child Mortality in the Developing World: 1960 to 1996. New York: UNICEF, 2005:1.Google Scholar
  4. 4.
    Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003;361(9376):2226–2234.PubMedCrossRefGoogle Scholar
  5. 5.
    Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354(9194):1955–1961.PubMedCrossRefGoogle Scholar
  6. 6.
    Nhan NT, Phuong CXT, Kneen R, et al. Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis 2001;32(2):204–213.CrossRefGoogle Scholar
  7. 7.
    Osrin D, Vergnano S, Costello A. Serious bacterial infections in newborn infants in developing countries. Curr Opin Infect Dis 2004;17(3):217–224.PubMedCrossRefGoogle Scholar
  8. 8.
    Bacterial etiology of serious infections in young infants in developing countries: results of a multicenter study. The WHO Young Infants Study Group. Pediatr Infect Dis J 1999;18(10 suppl):S17–S22.Google Scholar
  9. 9.
    Cotton MF, Burger PJ, Bodenstein WJ. Bacteraemia in children in the south-western Cape. A hospital-based survey. S Afr Med J 1992;81(2):87–90.PubMedGoogle Scholar
  10. 10.
    Berkley JA, Lowe BS, Mwangi I, et al. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 2005;352(1):39–47.CrossRefGoogle Scholar
  11. 11.
    Mulholland EK, Ogunlesi OO, Adegbola RA, et al. Etiology of serious infections in young Gambian infants. Pediatr Infect Dis J 1999;18(10 suppl):S35–S41.PubMedCrossRefGoogle Scholar
  12. 12.
    Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Crit Care Med 1992;20(6):864–874.Google Scholar
  13. 13.
    Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288(7):862–871.PubMedCrossRefGoogle Scholar
  14. 14.
    Rivers E, Nguyen B, Havstad S, et al., for the Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368–1377.CrossRefGoogle Scholar
  15. 15.
    Briegel J, Forst H, Haller M, et al. Stress doses ofhydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study (see comments). Crit Care Med 1999;27(4):723–732.PubMedCrossRefGoogle Scholar
  16. 16.
    Reinhart K, Meier-Hellmann A, Beale R, et al. Open randomized phase II trial of an extracorporeal endotoxin adsorber in suspected Gram-negative sepsis. Crit Care Med 2004;32(8):1662–1668.PubMedCrossRefGoogle Scholar
  17. 17.
    Molnar Z, Mikor A, Leiner T, Szakmany T. Fluid resuscitation with colloids of different molecular weight in septic shock. Intensive Care Med 2004;30(7): 1356–1360.PubMedCrossRefGoogle Scholar
  18. 18.
    Bertolini G, Iapichino G, Radrizzani D, et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med 2003;29(5):834–840.PubMedCrossRefGoogle Scholar
  19. 19.
    Busund R, Koukline V, Utrobin U, Nedashkovsky E. Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Intensive Care Med 2002;28(10):1434–1439.PubMedCrossRefGoogle Scholar
  20. 20.
    Center for Disease Control. National Vital Statistics Report 2002;50 (16):1.Google Scholar
  21. 21.
    Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003;167(5):695–701.PubMedCrossRefGoogle Scholar
  22. 22.
    Watson RS, Linde-Zwirble WT, Lidicker J, et al. The increasing burden of severe sepsis in U.S. children. Crit Care Med 2001;29(suppl):(12)A8(abstr).Google Scholar
  23. 23.
    Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 1996;109(4): 1033–1037.PubMedCrossRefGoogle Scholar
  24. 24.
    Al Zwaini EJ. Neonatal septicaemia in the neonatal care unit, Al-Anbar governorate, Iraq. East Mediterr Health J 2002;8(4-5):509–514.PubMedGoogle Scholar
  25. 25.
    Ali Z. Neonatal bacterial septicaemia at the Mount Hope Women's Hospital, Trinidad. Ann Trop Paediatr 2004;24(1):41–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med 2003;4(3):333–337.PubMedCrossRefGoogle Scholar
  27. 27.
    Wisplinghoff H, Seifert H, Tallent SM, Bischoff T, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J 2003;22(8): 686–691.PubMedCrossRefGoogle Scholar
  28. 28.
    Gray JW. A 7-year study of bloodstream infections in an English children's hospital. Eur J Pediatr 2004;163(9):530–535.PubMedCrossRefGoogle Scholar
  29. 29.
    Perez LA, Gimenez M, Rodrigo C, Alonso A, Prat C, Ausina V. Seven-year review of paediatric bacteraemias diagnosed in a Spanish university hospital. Acta Paediatr 2003;92(7):854–856.CrossRefGoogle Scholar
  30. 30.
    Walsh AL, Phiri AJ, Graham SM, Molyneux EM, Molyneux ME. Bacteremia in febrile Malawian children: clinical and microbiologic features. Pediatr Infect Dis J 2000;19(4):312–318.PubMedCrossRefGoogle Scholar
  31. 31.
    Graham SM, Molyneux EM, Walsh AL, Cheesbrough JS, Molyneux ME, Hart CA. Nontyphoidal Salmonella infections of children in tropical Africa. Pediatr Infect Dis J 2000;19(12):1189–1196.PubMedCrossRefGoogle Scholar
  32. 32.
    Bacterial etiology of serious infections in young infants in developing countries: results of a multicenter study. The WHO Young Infants Study Group. Pediatr Infect Dis J 1999;18(10 suppl):S17-S22.Google Scholar
  33. 33.
    Galanakis E, Krallis N, Levidiotou S, Hotoura E, Andronikou S. Neonatal bacteraemia: a population-based study. Scand J Infect Dis 2002;34(8):598–601.PubMedCrossRefGoogle Scholar
  34. 34.
    Davidson G, Barnes G, Bass D, et al. Infectious diarrhea in children: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2002;35(suppl 2):S143–S150.PubMedCrossRefGoogle Scholar
  35. 35.
    Kosek M, Bern C, Guerrant RL. The global burden ofdiarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull WHO 2003;81(3): 197–204.PubMedGoogle Scholar
  36. 36.
    Thapar N, Sanderson IR. Diarrhoea in children: an interface between developing and developed countries. Lancet 2004;363(9409):641–653.CrossRefGoogle Scholar
  37. 37.
    Nascimento-Carvalho CM, Lopes AA, Gomes MD, et al. Community acquired pneumonia among pediatric outpatients in Salvador, Northeast Brazil, with emphasis on the role of pneumococcus. Braz J Infect Dis 2001;5(1):13–20.PubMedCrossRefGoogle Scholar
  38. 38.
    Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull WHO 2004;82(12):895–903.PubMedGoogle Scholar
  39. 39.
    Asturias EJ, Soto M, Menendez R, et al. Meningitis and pneumonia in Guatemalan children: the importance of Haemophilus influenzae type b and Streptococcus pneumoniae. Rev Panam Salud Publica 2003;14(6):377–384.PubMedCrossRefGoogle Scholar
  40. 40.
    Poehling KA, Lafleur BJ, Szilagyi PG, et al. Population-based impact of pneumococcal conjugate vaccine in young children. Pediatrics 2004;114(3):755–761.PubMedCrossRefGoogle Scholar
  41. 41.
    Ispahani P, Slack RC, Donald FE, Weston VC, Rutter N. Twenty year surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implications for immunisation. Arch Dis Child 2004;89(8):757–762.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Shann F. Haemophilus influenzae pneumonia: type b or non-type b? Lancet 1999;354(9189):1488–1490.PubMedCrossRefGoogle Scholar
  43. 43.
    World Health Organization. Communicable Disease Surveillance and Response. WHO Website, 2005.Google Scholar
  44. 44.
    Tam JS. Influenza A (HSNl) in Hong Kong: an overview. Vaccine 2002;20(suppl 2):S77–S81.PubMedCrossRefGoogle Scholar
  45. 45.
    Drummond P, Clark J, Wheeler J, Galloway A, Freeman R, Cant A. Community acquired pneumonia-a prospective UK study. Arch Dis Child 2000;83(5): 408–412.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Nichol KP, Cherry JD. Bacterial-viral interrelations in respiratory infections of children. N Engl J Med 1967;277(13):667–672.PubMedCrossRefGoogle Scholar
  47. 47.
    Shann F. Bacterial pneumonia: commoner than perceived. Lancet 2001;357(9274):2070–2072.PubMedCrossRefGoogle Scholar
  48. 48.
    Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113(4): 701–707.PubMedCrossRefGoogle Scholar
  49. 49.
    Tzeng YL, Stephens DS. Epidemiology and pathogenesis of Neisseria meningitidis. Microbes Infect 2000;2(6):687–700.PubMedCrossRefGoogle Scholar
  50. 50.
    Chonghaile CN. Meningitis in Africa-tackling W135. Lancet 2002;360(9350): 2054–2055.PubMedCrossRefGoogle Scholar
  51. 51.
    World Health Organization. Control of Epidemic Meningococcal Disease. WHO Practical Guidelines, 2nd ed. Geneva: World Health Organization, 1998:1.Google Scholar
  52. 52.
    Heyderman RS, Ben Shlomo Y, Brennan CA, Somerset M. The incidence and mortality for meningococcal disease associated with area deprivation: an ecological study of hospital episode statistics. Arch Dis Child 2004;89(11): 1064–1068.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Luca V, Gessner BD, Luca C, et al. Incidence and etiological agents of bacterial meningitis among children <5 years of age in two districts of Romania. Eur J Clin Microbial Infect Dis 2004;23(7):523–528.Google Scholar
  54. 54.
    Moura AS, Pablos-Mendez A, Layton M, Weiss D. Epidemiology of meningococcal disease, New York City, 1989–2000. Emerg Infect Dis 2003;9(3):355–361.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Hausdorff WP, Bryant J, Paradiso PR, Siber GR. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin Infect Dis 2000;30(1):100–121.PubMedCrossRefGoogle Scholar
  56. 56.
    Peltola H. Burden of meningitis and other severe bacterial infections of children in Africa: implications for prevention. Clin Infect Dis 2001;32(1):64–75.PubMedCrossRefGoogle Scholar
  57. 57.
    Dagan R, Engelhard D, Piccard E, Englehard D. Epidemiology of invasive childhood pneumococcal infections in Israel. The Israeli Pediatric Bacteremia and Meningitis Group. JAMA 1992;268(23):3328–3332.PubMedCrossRefGoogle Scholar
  58. 58.
    Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J 1999;18(9): 806–810.PubMedCrossRefGoogle Scholar
  59. 59.
    Baltimore RS. Neonatal sepsis: epidemiology and management. Paediatr Drugs 2003;5(11):723–740.PubMedCrossRefGoogle Scholar
  60. 60.
    Saha SK, Baqui AH, Darmstadt GL, et al. Invasive Haemophilus influenzae type B diseases in Bangladesh, with increased resistance to antibiotics. J Pediatr 2005;146(2):227–233.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Garpenholt O, Hugosson S, Fredlund H, Giesecke J, Oken P. Invasive disease due to Haemophilus influenzae type b during the first six years of general vaccination of Swedish children. Acta Paediatr 2000;89(4):471–474.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Starke JR. Childhood tuberculosis in the 1990s. Pediatr Ann 1993;22(9):550–560.PubMedCrossRefGoogle Scholar
  63. 63.
    Al Dossary FS, Ong LT, Correa AG, Starke JR. Treatment of childhood tuberculosis with a six month directly observed regimen of only two weeks of daily therapy. Pediatr Infect Dis J 2002;21(2):91–97.PubMedCrossRefGoogle Scholar
  64. 64.
    Walls T, Shingadia D. Global epidemiology of paediatric tuberculosis. J Infect 2004;48(1):13–22.PubMedCrossRefGoogle Scholar
  65. 65.
    Kochi A. The global tuberculosis situation and the new control strategy of the World Health Organization. Tubercle 1991;72(1):1–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Ussery XT, Valway SE, McKenna M, Cauthen GM, McCray E, Onorato IM. Epidemiology of tuberculosis among children in the United States: 1985 to 1994. Pediatr Infect Dis J 1996;15(8):697–704.PubMedCrossRefGoogle Scholar
  67. 67.
    Epidemiology of measles-United States, 2001-2003. MMWR Morb Mortal Wkly Rep 2004;53 (31):713–716.Google Scholar
  68. 68.
    Belamarich PR. Measles and malnutrition. Pediatr Rev 1998;19(2):70–71.PubMedCrossRefGoogle Scholar
  69. 69.
    O'Donovan C. Measles in Kenyan children. East Afr Med J 1971;48(10):526–532.PubMedGoogle Scholar
  70. 70.
    Muscat M, Glismann S, Bang H. Measles in Europe in 2001–2002. Eur Surveill 2003;8(6): 123–129.CrossRefGoogle Scholar
  71. 71.
    Measles outbreak-Romania, 1997. MMWR Morb Mortal Wkly Rep 1997;46 (49): 1159–1163.Google Scholar
  72. 72.
    Update: influenza activity-United States and worldwide, May-October 2004. MMWR Morb Mortal Wkly Rep 2004;53 (42):993–995.Google Scholar
  73. 73.
    Update: influenza activity-United States, 2003-04 season. MMWR Morb Mortal Wkly Rep 2003;52 (49):1197–1202.Google Scholar
  74. 74.
    Togashi T, Matsuzono Y, Narita M, Morishima T. Influenza-associated acute encephalopathy in Japanese children in 1994–2002. Virus Res 2004;103(1-2): 75–78.PubMedCrossRefGoogle Scholar
  75. 75.
    Glezen WP, Taber LH, Frank AL, Gruber WC, Piedra PA. Influenza virus infections in infants. Pediatr Infect Dis J 1997;16(11):1065–1068.PubMedCrossRefGoogle Scholar
  76. 76.
    Hull HF, Ward NA, Hull BP, Milstien JB, de Quadros C. Paralytic poliomyelitis: seasoned strategies, disappearing disease. Lancet 1994;343(8909):1331–1337.PubMedCrossRefGoogle Scholar
  77. 77.
    Global progress toward certifying polio eradication and laboratory containment of wild polioviruses-August 2002–August 2003. MMWR Morb Mortal Wkly Rep 2003;52(47):1158–1160.Google Scholar
  78. 78.
    One thousand days until the target date for global poliomyelitis eradication. MMWR Morb Mortal Wkly Rep 1998;47(12):234.Google Scholar
  79. 79.
    Gaspar M, Morais A, Brumana L, Stella AA. Outbreak of poliomyelitis in Angola. J Infect Dis 2000;181(5):1776–1779.PubMedCrossRefGoogle Scholar
  80. 80.
    Update: Outbreak of poliomyelitis-Dominican Republic and Haiti, 2000-2001. MMWR Morb Mortal Wkly Rep 2001;50(39):855–856.Google Scholar
  81. 81.
    The global HIV and AIDS epidemic, 2001. MMWR Morb Mortal Wkly Rep 2001;50(21):434–439.Google Scholar
  82. 82.
    Pancharoen C, Thisyakorn U. Pediatric acquired immunodeficiency syndrome in Asia: mother-to-child transmission. Clin Infect Dis 2002;34(suppl 2):S65–S69.PubMedCrossRefGoogle Scholar
  83. 83.
    Akinsete I. HIV infection in children. Niger Pop 1993;42–44.Google Scholar
  84. 84.
    Thorne C, Newell ML. Prevention of mother-to-child transmission of HIV infection. Curr Opin Infect Dis 2004;17(3):247–252.PubMedCrossRefGoogle Scholar
  85. 85.
    Thorne C, Newell ML. Mother-to-child transmission of HIV infection and its prevention. Curr HIV Res 2003;1(4):447–462.PubMedCrossRefGoogle Scholar
  86. 86.
    Breman JG. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg 2001;64(1–2 suppl):1–11.PubMedCrossRefGoogle Scholar
  87. 87.
    Singhal T. Management of severe malaria. Indian J Pediatr 2004;71(1):81–88.PubMedCrossRefGoogle Scholar
  88. 88.
    Planche T, Agbenyega T, Bedu-Addo G, et al. A prospective comparison of malaria with other severe diseases in African children: prognosis and optimization of management. Clin Infect Dis 2003;37(7):890–897.PubMedCrossRefGoogle Scholar
  89. 89.
    Snow RW, Craig M, Deichmann U, Marsh K. Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population. Bull WHO 1999;77(8):624–640.PubMedGoogle Scholar
  90. 90.
    de la HF, Higuera AB, Di Fabio JL, et al. Effectiveness of Haemophilus influenzae type b vaccination against bacterial pneumonia in Colombia. Vaccine 2004;23(1): 36–42.CrossRefGoogle Scholar
  91. 91.
    Baker JP, Katz SL. Childhood vaccine development: an overview. Pediatr Res 2004;55(2):347–356.PubMedCrossRefGoogle Scholar
  92. 92.
    Aaby P, Hedegaard K, Sodemann M, et al. Childhood mortality after oral polio immunisation campaign in Guinea-Bissau. Vaccine 2005;23(14):1746–1751.PubMedCrossRefGoogle Scholar
  93. 93.
    Veirum JE, Sodemann M, Biai S, et al. Routine vaccinations associated with divergent effects on female and male mortality at the paediatric ward in Bissau, Guinea- Bissau. Vaccine 2005;23(9):1197–1204.PubMedCrossRefGoogle Scholar
  94. 94.
    Aaby P, Bhuiya A, Nahar L, Knudsen K, de Francisco A, Strong M. The survival benefit of measles immunization may not be explained entirely by the prevention of measles disease: a community study from rural Bangladesh. Int J Epidemiol 2003;32(1):106–116.PubMedCrossRefGoogle Scholar
  95. 95.
    Stensballe LG, Nante E, Jensen IP, et al. Acute lower respiratory tract infections and respiratory syncytial virus in infants in Guinea-Bissau: a beneficial effect of BCG vaccination for girls communitybased case-control study. Vaccine 2005;23(10): 1251–1257.PubMedCrossRefGoogle Scholar
  96. 96.
    Measles deaths drop dramatically as vaccine reaches world's poorest children. J Adv Nurs 2004;48(3):312.Google Scholar
  97. 97.
    Makela PH. Conjugate vaccines-a breakthrough in vaccine development. Southeast Asian J Trop Med Public Health 2003;34(2):249–253.PubMedGoogle Scholar
  98. 98.
    Teitelbaum MA, Franklin PC. Vaccine-preventable illness in U.S. children 1980–1992. Stat Bull Metrop Insur Co 1994;75(4):2–9.PubMedGoogle Scholar
  99. 99.
    Hashimoto H, Kapiga SH, Murata Y. Mass treatment with nevirapine to prevent mother-to-child transmission of HIV/AIDS in sub-Saharan African countries. J Obstet Gynaecol Res 2002;28(6):313–319.PubMedCrossRefGoogle Scholar
  100. 100.
    Brown H. Disease and hunger in Sudan. Lancet 2004;364(9435):654.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    United Nations High Commission for Refugees. The State of the World's Refugees 2006; Oxford University Press, Oxford UK.Google Scholar
  102. 102.
    Thakur S, Gupta N, Kakkar P. Serum copper and zinc concentrations and their relation to superoxide dismutase in severe malnutrition. Eur J Pediatr 2004;163(12): 742–744.PubMedCrossRefGoogle Scholar
  103. 103.
    Schapiro JM, Libby SJ, Fang FC. Inhibition of bacterial DNA replication by zinc mobilization during nitrosative stress. Proc Natl Acad Sci U S A 2003;100(14): 8496–8501.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Benn CS, Bale C, Sommerfelt H, Friis H, Aaby P. Hypothesis: Vitamin A supplementation and childhood mortality: amplification of the non-specific effects of vaccines? Int J Epidemiol 2003;32(5):822–828.PubMedCrossRefGoogle Scholar
  105. 105.
    Ahmed J, Zaman MM, Ali SM. Immunological response to antioxidant vitamin supplementation in rural Bangladeshi school children with group A streptococcal infection. Asia Pac J Clin Nutr 2004;13(3):226–230.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2008

Authors and Affiliations

  • Mary E. Hartman
  • R. Scott Watson
  • Joseph A. Carcillo
  • Derek C. Angus

There are no affiliations available

Personalised recommendations