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Sitthikarnkha P, Phunyaissaraporn R, Niamsanit S, Techasatian L, Saengnipanthkul S, Uppala R. Clinical Characteristics and Outcomes of Pediatric COVID-19 Pneumonia Treated with Favipiravir in a Tertiary Care Center. Viruses 2024; 16:946. [PMID: 38932238 PMCID: PMC11209591 DOI: 10.3390/v16060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, has posed significant health challenges worldwide. While children generally experience less severe illness compared to adults, pneumonia remains a substantial risk, particularly for those under five years old. This study examines the clinical characteristics and treatment outcomes of pediatric COVID-19 pneumonia patients treated with favipiravir in Thailand, aiming to identify associated factors for pneumonia. A retrospective review was performed on pediatric patients aged 1 month to 18 years hospitalized with COVID-19 at Srinagarind Hospital, Khon Kaen University, from 13 January 2020 to 15 November 2021. Data on demographics, clinical symptoms, treatment, and outcomes were collected, and logistic regression analysis was used to identify factors associated with pneumonia. Among 349 hospitalized children, the median age was 8 years, with 51.9% being male. Symptoms included a fever (100%), a cough (74.2%), and a rash (24.9%). COVID-19 pneumonia was diagnosed in 54.7% of the children. Favipiravir was administered as the standard treatment, showing mild adverse effects, including a rash (4.3%) and nausea (2.8%). Monocytosis was significantly associated with COVID-19 pneumonia (aOR 30.85, 95% CI: 9.03-105.41, p < 0.001), with an ROC curve area of 0.77 (95% CI: 0.71-0.83). Pediatric COVID-19 patients typically exhibit mild-to-moderate symptoms, with pneumonia being common in the early pandemic phase. Monocytosis is a significant factor associated with COVID-19 pneumonia. Favipiravir demonstrated mild adverse effects. Further studies are needed to validate these findings across different settings and phases of the pandemic.
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Affiliation(s)
| | | | | | | | | | - Rattapon Uppala
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Muang, Khon Kaen 40002, Thailand; (P.S.); (R.P.); (S.N.); (L.T.); (S.S.)
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Chang E, Jeon K, Lee N, Park MJ, Song W, Kim HS, Kim HS, Kim JS, Kim J, Jeong S. Clinical performance of the Roche Cobas Liat SARS-CoV-2 & influenza A/B assay: A systematic review and meta-analysis. J Clin Virol 2024; 174:105706. [PMID: 38908267 DOI: 10.1016/j.jcv.2024.105706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 06/24/2024]
Abstract
Respiratory tract infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses are persistent and critical. The Cobas Liat SARS-CoV-2 & influenza A/B assay (Multiplex Liat), the FDA-authorized point-of-care reverse transcriptase polymerase chain reaction (RT-PCR) assay, has a turnaround time of 20 min and high accuracy. This study evaluates the pooled performance of this assay to provide practical information. This meta-analysis was registered in PROSPERO (registration number: CRD42023467579). A systematic literature search was conducted within PubMed, Ovid-EMBASE, and the Cochrane Library for articles evaluating the accuracy of the Multiplex Liat assay through September 2023. A random-effects model was used to calculate the pooled diagnostic values with real-time RT-PCR (rRT-PCR) as a reference test. A total of 4,705 samples from eight studies were included in the primary meta-analysis. The overall pooled sensitivity and specificity of Multiplex Liat were 100.0 % (95 % confidence interval [CI] = 96.7 %-100.0 %) and 99.7 % (95 % CI = 98.7 %-99.9 %), respectively. The presence of variants of concern or in-house rRT-PCR assays as reference standards did not significantly affect the pooled diagnostic performance of the Multiplex Liat. When 5,333 samples from nine studies were assessed for sensitivity, the pooled sensitivity was 100.0 % (95 % CI = 85.8 %-100.0 %) without a significant difference. This meta-analysis demonstrates the usefulness of Multiplex Liat for the detection of SARS-CoV-2 based on pooled diagnostic values. These practical findings may facilitate appropriate settings for the diagnosis and management of patients with respiratory tract infections.
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Affiliation(s)
- Eunjin Chang
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kibum Jeon
- Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Nuri Lee
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jimin Kim
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
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Reyes-Pagcatipunan MG, Isada PMD, Delos Reyes CA. Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital. ACTA MEDICA PHILIPPINA 2024; 58:14-26. [PMID: 38882922 PMCID: PMC11168954 DOI: 10.47895/amp.v58i7.7717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deaths during the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designated COVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases.Antibiotics were given to 71.7% of patients at the outset. As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at 2.2%. Conclusion Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illness or comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.
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Affiliation(s)
- Marimel G Reyes-Pagcatipunan
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- National Clinical Trials and Translation Center, University of the Philippines Manila
| | | | - Carmina A Delos Reyes
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
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Duan C, Liu L, Wang T, Wang G, Jiang Z, Li H, Zhang G, Ye L, Li C, Cao Y. Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review. BMC Med 2024; 22:116. [PMID: 38481207 PMCID: PMC10938697 DOI: 10.1186/s12916-024-03334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus. METHODS In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures. RESULTS We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression. CONCLUSIONS The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Guanru Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Honglin Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China.
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Zhang H, Lin J, Wu J, Zhang J, Zhang L, Yuan S, Chen J, Tang Q, Zhang A, Cui Y, Xu X, Dai H, Shi H, Hu X, Xie D, Chen J, He F, Yin Y. Allergic diseases aggravate the symptoms of SARS-CoV-2 infection in China. Front Immunol 2023; 14:1284047. [PMID: 38204754 PMCID: PMC10777727 DOI: 10.3389/fimmu.2023.1284047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Background The relationship between allergic diseases and the adverse outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a subject of controversy. This study aimed to investigate the association between allergic diseases and the incidence and severity of symptoms in SARS-CoV-2 infection. Methods Clinical data of individuals, including children and their parents, infected with SARS-CoV-2 from December 2022 to January 2023 in China were retrospectively analyzed. The data were collected through questionnaires. Statistical analysis, including chi-squared tests, nonparametric analysis, one-way ANOVA, and logistic regression analysis, was used to examine the relationship between allergic diseases, prior medication, and the symptoms of SARS-CoV-2 infection. Results There were 3,517 adults and 3,372 children with SARS-CoV-2 infection included in the study. Fever was found to occur at similar rates in children (86.5%) and adults (86.8%). However, other symptoms related to respiratory issues (such as cough and sore throat), neurological symptoms (headache, loss of smell, and loss of taste), and systemic symptoms (muscle soreness and weakness) were observed more frequently in adults (P < 0.001). Additionally, adults exhibited higher overall symptom scores, indicating greater severity. Allergic diseases were found to be associated with the incidence of certain SARS-CoV-2 infection symptoms in both children and adults. Specifically, children with allergic rhinitis (AR) were observed to be more susceptible to upper respiratory symptoms (OR: 1.320, 95% CI: 1.081-1.611, P = 0.006), while asthma patients were found to be more susceptible to severe respiratory symptoms (OR: 1.736, 95% CI: 1.250-2.411, P = 0.001). Similar patterns were identified in adults. Furthermore, AR was also suggested to be a risk factor for symptom severity in both children (OR: 1.704, 95% CI: 1.314-2.209, P < 0.001) and adults (OR: 1.736, 95% CI: 1.250-2.411, P = 0.001). However, prior medication for allergic diseases did not exhibit a preventive effect on SARS-CoV-2 infection symptoms. Conclusions Both children and adults with allergic diseases were found to be more prone to experiencing symptoms of SARS-CoV-2 infection, and these symptoms tended to be more severe.
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Affiliation(s)
- Huishan Zhang
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jilei Lin
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinhong Wu
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiande Chen
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiuyu Tang
- Department of Respiratory Medicine, Shanghai Children’s Medical Centre Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children’s Hospital, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology And Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Ailian Zhang
- Department of Respiratory Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yuxia Cui
- Department of Respiratory Medicine, Guizhou Provincial People’s Hospital, Shanghai Children’s Medical Center, Shanghai JiaoTong University School of Medicine, Guiyang, Guizhou, China
| | - Xiaojuan Xu
- Department of Respiratory Medicine, Shaoxing Central Hospital, Shaoxing, Zhejiang, China
| | - Hongxie Dai
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Hongbo Shi
- Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Xiaowei Hu
- Department of Respiratory Medicine, Shanghai Children’s Medical Centre Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children’s Hospital, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology And Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Dan Xie
- Department of Respiratory Medicine, Sanya Women and Children’s Hospital Affiliated to Hainan Medical College, Shanghai Children’s Medical Center, Sanya, Hainan, China
| | - Jing Chen
- Department of Respiratory Medicine, Linyi Maternal and Child Healthcare Hospital, Linyi, Shandong, China
| | - Fengquan He
- HongHe MCH (HongHe Hani and Yi Autonomous Prefecture Maternal and Child Health Hospital), Honghe, Yunnan, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory Medicine, Sanya Women and Children’s Hospital Affiliated to Hainan Medical College, Shanghai Children’s Medical Center, Sanya, Hainan, China
- Department of Respiratory Medicine, Linyi Maternal and Child Healthcare Hospital, Linyi, Shandong, China
- Department of Respiratory Medicine, Shanghai Children’s Medical Center Pediatric Medical Complex (Pudong), Shanghai, China
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai Children’s Medical Center, Shanghai, China
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Singh S, Singh US. Acute haemorrhagic necrotizing encephalopathy associated with COVID-19 in a patient with liver cirrhosis. J Family Med Prim Care 2023; 12:3429-3433. [PMID: 38361838 PMCID: PMC10866223 DOI: 10.4103/jfmpc.jfmpc_1145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 02/17/2024] Open
Abstract
COVID-19 is emerging as a global pandemic and is a complex disease presenting with multi-organ involvement. Acute haemorrhagic necrotizing encephalopathy (AHNE) is a rarely reported phenomenon post-COVID-19 but is a rapidly progressing, fatal, haemorrhagic necrosis of the CNS parenchyma. Here, we present a very interesting case of a cirrhotic male patient with AHNE with COVID-19. Diagnosis of AHNE requires a multimodality approach and high index of suspicion in a patient suffering from SARS-CoV-2. Timely intervention and diagnosis may lead to a favourable outcome in the diagnosed cases. Future detailed studies in this direction may give an insight into this rare but important disease entity.
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Affiliation(s)
- Sweta Singh
- Department of Microbiology, AIIMS, Raebareli, Uttar Pradesh, India
| | - Uday S. Singh
- Department of Radiodiagnosis, Advance Diagnostic Centre, Lucknow, Uttar Pradesh, India
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McMann T, Wenzel C, Le N, Li Z, Xu Q, Cuomo RE, Mackey T. Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data. JMIR Pediatr Parent 2023; 6:e48004. [PMID: 38038663 DOI: 10.2196/48004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19-related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective This study aimed to characterize COVID-19 vaccine-related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine-related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71% vs 2090/3106, 67.29%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7%). Conclusions Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations.
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Affiliation(s)
- Tiana McMann
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | | | - Nicolette Le
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Zhuoran Li
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Tim Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
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Mastrolia MV, De Cillia C, Orlandi M, Abu-Rumeileh S, Maccora I, Maniscalco V, Marrani E, Pagnini I, Simonini G. Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2027. [PMID: 38004076 PMCID: PMC10673592 DOI: 10.3390/medicina59112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This narrative review aims to report the main clinical manifestations, therapeutic strategies, outcomes, and complications of acute SARS-CoV-2 infection in childhood and to summarize the data relating the SARS-CoV-2 vaccination efficacy and safety in pediatric age. SARS-CoV-2 infection mostly occurs asymptomatically in the pediatric population, while multisystem inflammatory syndrome in children (MIS-C) represents the most severe coronavirus disease 2019 (COVID-19)-related illness, a life-threatening event with a high morbidity rate. After the development of SARS-CoV-2 vaccines and their subsequent approval in children, the rate of infection as well as the number of its related complications have shown a drastic decrease. Fully vaccinated children are protected from the risk of developing a severe disease and a similar protective role has been observed in the reduction of complications, in particular MIS-C. However, long-lasting immunity has not been demonstrated, booster doses have been required, and reinfection has been observed. With regards to vaccine safety, adverse events were generally mild to moderate in all age groups: local adverse events were the most commonly reported. Nevertheless, a potential association between SARS-CoV-2 vaccine and the subsequent development of inflammatory manifestations has been suggested. Myocarditis has rarely been observed following vaccination; it appeared to be more frequent among adolescent males with a mild clinical course leading to a complete recovery. SARS-CoV-2 vaccine-related MIS-C cases have been described, although a univocal definition and an exact time interval with respect to vaccination has not been reported, thus not establishing a direct causal link. Current evidence about COVID-19 vaccination in children and adolescents suggest that benefits outweigh potential risks. Long-term data collection of the post-authorization safety surveillance programs will better define the real incidence of SARS-CoV-2 vaccine-related complications in the pediatric population.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Camilla De Cillia
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Michela Orlandi
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
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Schmidt CJ, Casassola GM, Affeldt GH, Morais DS, Alvarenga LKB, Miller C, Ziegler B. One-year follow-up of children hospitalized with COVID-19: a prospective cohort study. J Bras Pneumol 2023; 49:e20230151. [PMID: 37991071 PMCID: PMC10760420 DOI: 10.36416/1806-3756/e20230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/12/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Currently, little is known about the long-term outcomes of COVID-19 in the pediatric population. The aim of this study was to investigate the long-term clinical outcomes of pediatric patients hospitalized with COVID-19. METHODS This was a prospective cohort study involving unvaccinated children and adolescents admitted to a tertiary hospital in southern Brazil with a COVID-19 diagnosis. Data were collected from electronic medical records for one year after the diagnosis. RESULTS A total of 66 children were included: the median age was 2.9 years; 63.6% were male; and 48.5% were under 2 years of age. Over 70% had at least one comorbidity prior to the COVID-19 diagnosis. During the one-year follow-up period, 59.1% of the children revisited the emergency department, 50% required readmission, and 15.2% died. Younger children with longer hospital stays were found to be at greater risk of readmission. Having cancer and impaired functionality were found to increase the risk of death within one year. CONCLUSIONS Our findings indicate that most children hospitalized with COVID-19 have comorbidities. Younger age at admission and a longer hospital stay seem to be risk factors for readmission. In addition, the presence of cancer and impaired functionality are apparently associated with the poor outcome of death within the first year after the diagnosis of COVID-19.
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Affiliation(s)
- Caroline Jacoby Schmidt
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Giovana Morin Casassola
- . Residente Multiprofissional em Saúde da Criança, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Guilherme Hoff Affeldt
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Debora Sana Morais
- . Programa de Pós-Graduação em Pesquisa Clínica, Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Letícia Krás Borges Alvarenga
- . Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Cristina Miller
- . Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Bruna Ziegler
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
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de Mello LB, da Silva JA, Clemente HA, Neto JAB, Mello CS. Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort. J Pediatr (Rio J) 2023; 99:641-647. [PMID: 37478896 PMCID: PMC10594002 DOI: 10.1016/j.jped.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To verify the association between nutritional risk on admission and clinical outcomes of COVID-19 in hospitalized children and adolescents. METHODS Multicenter cohort study was conducted in two cities in the northeastern region of Brazil, with children under 18 years of age laboratory diagnosed with COVID-19. Sociodemographic data and nutritional risk screening by STRONGKids (low, medium and high risk) were collected remotely and in hospital records, respectively. The outcomes assessed were the need for ICU admission, length of stay (< 10 days or ≥ 10 days), critical cases, and death. Multivariable logistic regression models were used to evaluate the effects of high nutritional risk on COVID-19 clinical outcomes. RESULTS 103 individuals were evaluated, of these 35 (34.0%) had low risk, 44 (42.7%) medium risk, and 24 (23.3%) had high risk of malnutrition. In multivariate analysis, ICU bed admission (OR: 4.57; 95%CI, 1.39-4.97; p = 0.01), hospitalization longer than or equal to ten days (OR: 3.96; 95%CI, 1.22-2.83; p = 0.02) and critical cases (OR: 4.35; 95%CI, 1.08-7.55; p = 0.04) were associated with high nutritional risk. Death was not associated with high nutritional risk. CONCLUSIONS Children and adolescents with high nutritional risk by STRONGkids at hospital admission were more likely to be admitted to the ICU, have hospitalization longer than or equal to ten days, and have critical cases when infected with SARS-CoV-2.
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Affiliation(s)
- Leilah B de Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Nutrição Clínica, Salvador, BA, Brazil
| | - José Adailton da Silva
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - Heleni A Clemente
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Saúde Coletiva, Natal, RN, Brazil
| | - João A Barros Neto
- Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Processos Interativos dos Órgãos e Sistemas, Maceió, AL, Brazil
| | - Carolina S Mello
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Pediatria e Ciências Aplicadas à Pediatria, Salvador, BA, Brazil.
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Paduano S, Facchini MC, Borsari L, D’Alterio A, Iacuzio L, Greco A, Fioretti E, Creola G, Kahfian Z, Zona S, Bargellini A, Filippini T. Health surveillance for SARS-CoV-2: infection spread and vaccination coverage in the schools of Modena province, Italy. Front Public Health 2023; 11:1240315. [PMID: 37965518 PMCID: PMC10641794 DOI: 10.3389/fpubh.2023.1240315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In Italy, over 4.8 million individuals aged 0-19 years have been infected with SARS-CoV-2. This study aims to evaluate the spread of SARS-CoV-2 within schools in Modena province and the influence of anti-SARS-CoV-2 vaccination coverage. Methods We performed a survey in the period 1 September-15 December 2021, involving student population aged 0-19 years and related teachers screened for SARS-CoV-2 infection using nasopharyngeal swab after the detection of an index case within their class. During the study period, vaccination against SARS-CoV-2 was actively offered to all subjects aged ≥12 years. Results A total of 13,934 subjects were tested, 12,534 students and 1,400 teachers (594 classes). We identified a total of 594 and 779 index and secondary cases, respectively. We found that 9.8% of students and 10.6% of teachers were positive for SARS-CoV-2. Overall at the test time, 32.5% were vaccinated with at least one dose of anti-SARS-CoV-2 vaccine. Among secondary cases, 7.8% were vaccinated compared to 34.9% among negative tested subjects. A higher secondary attack rate was for non-vaccinated subjects rather than vaccinated ones (8.1% vs. 1.4%). Higher secondary attack rates were reported for subjects attending infant and primary school (5.9 and 9.6%, respectively). Lower secondary attack rates were for those who attended middle school (4.9%) and especially high school (1.7%). Conclusion Our results highlight the differential spread of the infection within various educational settings and that the vaccination, available in the study period for the population aged ≥12, have mitigated SARS-CoV-2 spread in high and middle schools.
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Affiliation(s)
- Stefania Paduano
- Department of Biomedical, Metabolic and Neural Sciences – Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Facchini
- Department of Biomedical, Metabolic and Neural Sciences – Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Borsari
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Alessandra D’Alterio
- Department of Biomedical, Metabolic and Neural Sciences – Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Iacuzio
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Antonella Greco
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Elisabetta Fioretti
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Giacomo Creola
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Zaynalabedin Kahfian
- Department of Public Health – Public Hygiene Service, Local Health Authority of Modena, Modena, Italy
| | - Stefano Zona
- Infection Control Strategic Group, Local Health Authority of Modena, Modena, Italy
| | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences – Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences – Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
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Liu S, Chen M, Tang L, Li X, Zhou S. Association between Serum Ferritin and Prognosis in Patients with Ischemic Heart Disease in Intensive Care Units. J Clin Med 2023; 12:6547. [PMID: 37892684 PMCID: PMC10607098 DOI: 10.3390/jcm12206547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Recent years have seen a clear link established between elevated ferritin levels and COVID-19 prognosis. However, the impact of heightened ferritin levels on the prognosis of individuals with severe ischemic heart disease remains uncertain. METHODS We utilized the MIMIC IV database to identify a cohort of ischemic heart disease patients who underwent serum ferritin testing. We conducted regression analyses, employed the overlap propensity score weighting model, and utilized the restricted cubic splines model to comprehensively investigate the associations between serum ferritin levels and clinical outcomes. RESULTS Our cohort included 1173 patients with diagnosed ischemic heart disease, categorized into high and low serum ferritin groups. After meticulous adjustment for confounding factors in a fully adjusted model, the hazard ratios (HRs) for 90-day and 1-year mortality were 1.63 (95% CI: 1.27-2.09) and 1.49 (95% CI: 1.19-1.86), respectively, in the high-ferritin group compared to the low-ferritin group. Subsequent analyses with propensity score weighting confirmed these results. Remarkably, restricted cubic spline analysis revealed an almost linear relationship between log-transformed serum ferritin levels and the risk of both 90-day and 1-year all-cause mortality. Moreover, incorporating ferritin into conventional severity of illness scores significantly improved the area under the curve for both 90-day and 1-year mortality. CONCLUSIONS This study provides compelling evidence regarding the prognostic significance of serum ferritin in predicting 90-day and one-year mortality rates among patients diagnosed with ischemic heart disease.
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Affiliation(s)
| | | | | | | | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China; (S.L.)
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Rosazza C, Alagna L, Bandera A, Biffi A, Ciciriello F, Gramegna A, Lucidi V, Marchisio PG, Medino P, Muscatiello A, Uceda Renteria S, Colombo C. Severity of SARS-CoV-2 infection in a hospital population: a clinical comparison across age groups. Ital J Pediatr 2023; 49:135. [PMID: 37807040 PMCID: PMC10561461 DOI: 10.1186/s13052-023-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/22/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Children tend to have milder forms of COVID-19 than adults, however post-acute complications have been observed also in the paediatric population. In this study, we compared COVID-19-related outcomes and long-term complications between paediatric and adult patients infected by SARS-CoV-2. METHODS The study is based on individuals enrolled from October 2020 to June 2021 in the DECO COVID-19 multicentre prospective study supported by the Italian Ministry of Health (COVID-2020-12371781). We included individuals with RT-PCR -confirmed SARS-CoV-2 infection, who were evaluated in the emergency department and/or admitted to COVID-dedicated wards. The severity of SARS-CoV-2 infection was compared across age groups (children/adolescents aged < 18 years, young/middle-aged adults aged 18-64 years and older individuals) through the relative risk (RR) of severe COVID-19. Severity was defined by: 1) hospitalization due to COVID-19 and/or 2) need or supplemental oxygen therapy. RR and corresponding 95% confidence intervals were estimated using log-binomial models. RESULTS The study included 154 individuals, 84 (54.5%) children/adolescents, 50 (32.5%) young/middle-aged adults and 20 (13%) older adults. Compared to young/middle-aged adults the risk of hospitalization was lower among paediatric patients (RR: 0.49, 95% CI: 0.32-0.75) and higher among older adults (RR: 1.52, 95% CI: 1.12-2.06). The RR of supplemental oxygen was 0.12 (95% CI: 0.05-0.30) among children/adolescents and 1.46 (95% CI: 0.97-2.19) among older adults. Three children developed multisystem inflammatory syndrome (MIS-C), none was admitted to intensive care unit or reported post-acute Covid-19 complications. CONCLUSIONS Our study confirms that COVID-19 is less severe in children. MIS-C is a rare yet severe complication of SARS-CoV-2 infection in children and its risk factors are presently unknown.
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Affiliation(s)
- Chiara Rosazza
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Alagna
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
| | - Arianna Biffi
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ciciriello
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Paola Giovanna Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Medino
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatiello
- Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Paediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Via Commenda 9, 20122, Milan, Italy.
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Ahmed IS, Tapponi SL, Widatallah ME, Alakkad YM, Haider M. Unmasking the enigma: An in-depth analysis of COVID-19 impact on the pediatric population. J Infect Public Health 2023; 16:1346-1360. [PMID: 37433256 PMCID: PMC10299956 DOI: 10.1016/j.jiph.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES COVID-19, caused by the novel coronavirus, has had a profound and wide-reaching impact on individuals of all age groups across the globe, including children. This review article aims to provide a comprehensive analysis of COVID-19 in children, covering essential topics such as epidemiology, transmission, pathogenesis, clinical features, risk factors, diagnosis, treatment, vaccination, and others. By delving into the current understanding of the disease and addressing the challenges that lie ahead, this article seeks to shed light on the unique considerations surrounding COVID-19 in children and contribute to a deeper comprehension of this global health crisis affecting our youngest population. METHODS A comprehensive literature search was conducted to gather the most recent and relevant information regarding COVID-19 in children. Multiple renowned databases, including MEDLINE, PubMed, Scopus, as well as authoritative sources such as the World Health Organization (WHO), the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the National Institutes of Health (NIH) websites and others were thoroughly searched. The search included articles, guidelines, reports, clinical trials results and expert opinions published within the past three years, ensuring the inclusion of the latest research findings on COVID-19 in children. Several relevant keywords, including "COVID-19," "SARS-CoV-2," "children," "pediatrics," and related terms were used to maximize the scope of the search and retrieve a comprehensive set of articles. RESULTS AND CONCLUSION Three years since the onset of the COVID-19 pandemic, our understanding of its impact on children has evolved, but many questions remain unanswered. While SAR-CoV-2 generally leads to mild illness in children, the occurrence of severe cases and the potential for long-term effects cannot be overlooked. Efforts to comprehensively study COVID-19 in children must continue to improve preventive strategies, identify high-risk populations, and ensure optimal management. By unraveling the enigma surrounding COVID-19 in children, we can strive towards safeguarding their health and well-being in the face of future global health challenges.
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Affiliation(s)
- Iman Saad Ahmed
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Sara Luay Tapponi
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Marwa Eltahir Widatallah
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Yumna Mohamed Alakkad
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mohamed Haider
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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Khorasani Esmaili P, Dabiri S, Movahedinia S, Shojaeepour S, Bagheri F, Ranjbar H, Shamsi Meymandi M, Mohebbi E, Farrokhnia M. Evaluation of Laboratory Findings of Patients with Coronavirus Disease 2019 in Kerman, Iran. IRANIAN JOURNAL OF PATHOLOGY 2023; 18:347-355. [PMID: 37942197 PMCID: PMC10628381 DOI: 10.30699/ijp.2023.1971332.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/30/2023] [Indexed: 11/10/2023]
Abstract
Background & Objective Since December 2019 in Wuhan, China there is a new form of pneumonia and after expansion in other countries, World Health Organization (WHO) called it Coronavirus Disease 2019 (COVID-19). Since the clinical laboratory findings have played an important role in the progression of the disease, this study aimed to evaluate the laboratory findings in COVID-19 patients (before vaccination). Methods In this case-control study that was conducted from February to August 2020; the laboratory test status in 101 positive COVID-19 patients was evaluated and compared with 101 healthy individuals. Results The results of our study showed that 21% of patients had low WBC, 24.75% low RBC, 37.62%, low Hb, 18.81% with low HCT, 29.7%, low Plt, 41.58% had High PT, 71.29% high CRP, 17.82% high urea, 11.88% high CR, 15.84% high LDH, 10.89% low sodium, 14.75% low potassium (K). The quantitative examination of blood factors showed that lymph%, mixed%, PLT, HCT, Hb, and RBC were higher in the control group than in the case group. While Neu%, WBC, PTT, CRP, UREA, LDH, K in the patient group were higher than in the control group. Conclusion According to the results of the study, it can be concluded that in the clinical treatment of COVID-19 patients, much attention should be paid to the laboratory indicators to identify and intervene early in critically ill patients.
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Affiliation(s)
- Parisa Khorasani Esmaili
- Department of Pathology, Pathology and Stem Cells Research Center, Afzali Pour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahriar Dabiri
- Department of Pathology, Pathology and Stem Cells Research Center, Afzali Pour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Sajjadeh Movahedinia
- Department of Pathology, Pathology and Stem Cells Research Center, Afzali Pour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeedeh Shojaeepour
- Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Fatemeh Bagheri
- Legal Medicine Research Center, Legal Medicine Organization, Kerman, Iran
| | - Hanieh Ranjbar
- Department of Pathology, Pathology and Stem Cells Research Center, Afzali Pour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Manzumeh Shamsi Meymandi
- Department of Pathology, Pathology and Stem Cells Research Center, Afzali Pour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Mohebbi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Farrokhnia
- Infectious and Internal Medicine Department, Afzalipour Hospital, Kerman University of Medical Science, Kerman, Iran
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Wang B, Yuan S, Ruan S, Ning X, Li H, Liu Y, Li X. Associations between underlying diseases with COVID-19 and its symptoms among adults: a cross-sectional study. Front Public Health 2023; 11:1210800. [PMID: 37383271 PMCID: PMC10298173 DOI: 10.3389/fpubh.2023.1210800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Background Specific underlying diseases were reported to be associated with severe COVID-19 outcomes, but little is known about their combined associations. The study was aimed to assess the relations of number of and specific underlying diseases to COVID-19, severe symptoms, loss of smell, and loss of taste. Methods A total of 28,204 adult participants in the National Health Interview Survey 2021 were included. Underlying diseases (including cardiovascular diseases, cancer, endocrine diseases, respiratory diseases, neuropsychiatric diseases, liver and kidney diseases, fatigue syndrome, and sensory impairments), the history of COVID-19, and its symptoms were self-reported by structured questionnaires. Multivariable logistic regression models were used to assess the combined relation of total number of underlying diseases to COVID-19 and its symptoms, while mutually adjusted logistic models were used to examine their independent associations. Results Among the 28,204 participants (mean ± standard deviation: 48.2 ± 18.5 years), each additional underlying disease was related to 33, 20, 37, and 39% higher odds of COVID-19 (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.29-1.37), severe symptoms (OR: 1.20, 95% CI: 1.12-1.29), loss of smell (OR: 1.37, 95% CI: 1.29-1.46), and loss of taste (OR: 1.39, 95% CI: 1.31-1.49). In addition, independent associations of sensory impairments with COVID-19 (OR: 3.73, 95% CI: 3.44-4.05), severe symptoms (OR: 1.37, 95% CI: 1.13-1.67), loss of smell (OR: 8.17, 95% CI: 6.86-9.76), and loss of taste (OR: 6.13, 95% CI: 5.19-7.25), cardiovascular diseases with COVID-19 (OR: 1.13, 95% CI: 1.03-1.24), neuropsychiatric diseases with severe symptoms (OR: 1.41, 95% CI: 1.15-1.74), and endocrine diseases with loss of taste (OR: 1.28, 95% CI: 1.05-1.56) were observed. Conclusion A larger number of underlying diseases were related to higher odds of COVID-19, severe symptoms, loss of smell, and loss of taste in a dose-response manner. Specific underlying diseases might be individually associated with COVID-19 and its symptoms.
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Affiliation(s)
- Binghan Wang
- Department of Big Data in Health Science, and Center for Clinical Big Data and Statistics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuyan Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuke Ruan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiuyuan Ning
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hanrui Li
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanhao Liu
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiuyang Li
- Department of Big Data in Health Science, and Center for Clinical Big Data and Statistics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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17
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Shishido Y, Nakamura H, Nakagawa T, Kanou S, Ito T, Kuwana S, Ota C. Incidental Hyperferritinemia in Very Young Infants with Mild Symptoms of COVID-19 Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050874. [PMID: 37238422 DOI: 10.3390/children10050874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The number of children infected with novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increased during the outbreak of the Omicron strain. Hyperferritinemia has been reported in severe cases of COVID-19, and in children or neonates with multisystem inflammatory syndrome (MIS). Hyperferritinemia is considered to be one of the signs of MIS, but thus far, there have been few summarized reports on it. We retrospectively analyzed four infants less than 3 months of age with SARS-CoV-2 infections treated in our institution during the outbreak of the Omicron strain. RESULTS most patients were in good condition, but hyperferritinemia was observed in all of four cases. CONCLUSIONS Hyperferritinemia can be observed in infantile COVID-19 patients even with mild symptoms. It is necessary to carefully monitor their clinical course and monitor the patients.
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Affiliation(s)
- Yuka Shishido
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Haruhiko Nakamura
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
- Department of Neurology, Miyagi Children's Hospital, Sendai 9893126, Japan
| | - Tomohiro Nakagawa
- Department of Pediatrics, Tohoku University Hospital, Sendai 9808574, Japan
| | - Shinsuke Kanou
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Takeshi Ito
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Shota Kuwana
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Sendai 9808574, Japan
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan
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18
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Schmidt KLJ, Dautzenberg NMM, Hoogerbrugge PM, Lindemans CA, Nierkens S, Smits G, Van Binnendijk RS, Bont LJ, Tissing WJE. Immune Response following BNT162b2 mRNA COVID-19 Vaccination in Pediatric Cancer Patients. Cancers (Basel) 2023; 15:cancers15092562. [PMID: 37174028 PMCID: PMC10177402 DOI: 10.3390/cancers15092562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
COVID-19 vaccinations are recommended for children with cancer but data on their vaccination response is scarce. This study assesses the antibody and T-cell response following a 2- or 3-dose vaccination with BNT162b2 mRNA COVID-19 vaccine in children (5-17 years) with cancer. For the antibody response, participants with a serum concentration of anti-SARS-CoV-2 spike 1 antibodies of >300 binding antibody units per milliliter were classified as good responders. For the T-cell response, categorization was based on spike S1 specific interferon-gamma release with good responders having >200 milli-international units per milliliter. The patients were categorized as being treated with chemo/immunotherapy for less than 6 weeks (Tx < 6 weeks) or more than 6 weeks (Tx > 6 weeks) before the first immunization event. In 46 patients given a 2-dose vaccination series, the percentage of good antibody and good T-cell responders was 39.3% and 73.7% in patients with Tx < 6 weeks and 94.4% and 100% in patients with Tx > 6 weeks, respectively. An additional 3rd vaccination in 16 patients with Tx < 6 weeks, increased the percentage of good antibody responders to 70% with no change in T-cell response. A 3-dose vaccination series effectively boosted antibody levels and is of value for patients undergoing active cancer treatment.
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Affiliation(s)
- K L Juliëtte Schmidt
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Noël M M Dautzenberg
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Peter M Hoogerbrugge
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Caroline A Lindemans
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Stefan Nierkens
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Rob S Van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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19
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De Rose DU, Pace PG, Ceccherini-Silberstein F, Dotta A, Andreoni M, Sarmati L, Iannetta M. T Lymphocyte Subset Counts and Interferon-Gamma Production in Adults and Children with COVID-19: A Narrative Review. J Pers Med 2023; 13:jpm13050755. [PMID: 37240926 DOI: 10.3390/jpm13050755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Adults and children exhibit a broad range of clinical outcomes from SARS-CoV-2 infection, with minimal to mild symptoms, especially in the pediatric age. However, some children present with a severe hyperinflammatory post-infectious complication named multisystem inflammatory syndrome in children (MIS-C), mainly affecting previously healthy subjects. Understanding these differences is still an ongoing challenge, that can lead to new therapeutic strategies and avoid unfavorable outcomes. In this review, we discuss the different roles of T lymphocyte subsets and interferon-γ (IFN-γ) in the immune responses of adults and children. Lymphopenia can influence these responses and represent a good predictor for the outcome, as reported by most authors. The increased IFN-γ response exhibited by children could be the starting point for the activation of a broad response that leads to MIS-C, with a significantly higher risk than in adults, although a single IFN signature has not been identified. Multicenter studies with large cohorts in both age groups are still needed to study SARS-CoV-2 pathogenesis with new tools and to understand how is possible to better modulate immune responses.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Pier Giorgio Pace
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | | | - Andrea Dotta
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
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20
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Zamani R, Zare A, Davoodi SZ, Shati M, Eshaghi H, Faramarzinia A, Mirjamali N, Barekati SH, Lornejad H. Early Childhood COVID-19: A Comparative Report of 20,506 Cases. Pediatr Infect Dis J 2023:00006454-990000000-00439. [PMID: 37171970 DOI: 10.1097/inf.0000000000003955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This report includes a retrospective analysis of 20506 children aged under 6 years old admitted with Coronavirus Disease of 2019 in Iranian hospitals. The total mortality rate was 2.9%, and 5.7% required mechanical ventilation. We demonstrate a higher mortality rate in comparison with existing studies as well as identifying clinical predictors of survival.
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Affiliation(s)
- Raha Zamani
- From the Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Zare
- From the Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zahra Davoodi
- Student Research Committee, Faculty of Medicine, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Eshaghi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; and
| | - Arian Faramarzinia
- From the Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Mirjamali
- Student Research Committee, Faculty of Medicine, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hamed Barekati
- Family, Population and School Health Office, Health Deputy, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamidreza Lornejad
- Family, Population and School Health Office, Health Deputy, Ministry of Health and Medical Education, Tehran, Iran
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21
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Sokolovskaya VV, Litvinova AA, Balukhto DA, Kuzmina IN, Krikova AV, Kozlov RS. New coronavirus infection in pediatric practice: clinical and epidemiological features of COVID-19 in the city of Smolensk. CHILDREN INFECTIONS 2023. [DOI: 10.22627/2072-8107-2023-22-1-5-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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22
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Pillai A, Nayak A, Tiwari D, Pillai PK, Pandita A, Sakharkar S, Balasubramanian H, Kabra N. COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination. Vaccines (Basel) 2023; 11:693. [PMID: 36992278 PMCID: PMC10058749 DOI: 10.3390/vaccines11030693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk-benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.
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Affiliation(s)
- Anish Pillai
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
- British Columbia Children’s Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Anuja Nayak
- Bai Jerabai Wadia Hospital for Children, Acharya Donde Marg, Parel East, Parel, Mumbai 400012, Maharashtra, India
| | - Deepika Tiwari
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | - Pratichi Kadam Pillai
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | - Aakash Pandita
- Medanta Super Specialty Hospital, Sector-A, Pocket-1, Amar Shaheed Path, Golf City, Lucknow 226030, Uttar Pradesh, India
| | - Sachin Sakharkar
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
| | | | - Nandkishor Kabra
- Surya Hospitals, Mangal Ashirwad Building, Swami Vivekananda Road, Santacruz West, Mumbai 400054, Maharashtra, India
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23
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Garkaby J, Willett Pachul J, Scott O, Abrego Fuentes L, Vong L, Upton JEM, Kim VHD, Roifman CM. Favorable outcome of COVID-19 in pediatric patients with primary immunodeficiency. Pediatr Allergy Immunol 2023; 34:e13928. [PMID: 36974644 DOI: 10.1111/pai.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Jenny Garkaby
- Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Jessica Willett Pachul
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Ori Scott
- Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Laura Abrego Fuentes
- Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Linda Vong
- Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Julia E M Upton
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Vy H D Kim
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Chaim M Roifman
- Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
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24
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Anindya R, Rutter GA, Meur G. New-onset type 1 diabetes and severe acute respiratory syndrome coronavirus 2 infection. Immunol Cell Biol 2023; 101:191-203. [PMID: 36529987 PMCID: PMC9877852 DOI: 10.1111/imcb.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Type 1 diabetes (T1D) is a condition characterized by an absolute deficiency of insulin. Loss of insulin-producing pancreatic islet β cells is one of the many causes of T1D. Viral infections have long been associated with new-onset T1D and the balance between virulence and host immunity determines whether the viral infection would lead to T1D. Herein, we detail the dynamic interaction of pancreatic β cells with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the host immune system with respect to new-onset T1D. Importantly, β cells express the crucial entry receptors and multiple studies confirmed that β cells are infected by SARS-CoV-2. Innate immune system effectors, such as natural killer cells, can eliminate such infected β cells. Although CD4+ CD25+ FoxP3+ regulatory T (TREG ) cells provide immune tolerance to prevent the destruction of the islet β-cell population by autoantigen-specific CD8+ T cells, it can be speculated that SARS-CoV-2 infection may compromise self-tolerance by depleting TREG -cell numbers or diminishing TREG -cell functions by repressing Forkhead box P3 (FoxP3) expression. However, the expansion of β cells by self-duplication, and regeneration from progenitor cells, could effectively replace lost β cells. Appearance of islet autoantibodies following SARS-CoV-2 infection was reported in a few cases, which could imply a breakdown of immune tolerance in the pancreatic islets. However, many of the cases with newly diagnosed autoimmune response following SARS-CoV-2 infection also presented with significantly high HbA1c (glycated hemoglobin) levels that indicated progression of an already set diabetes, rather than new-onset T1D. Here we review the potential underlying mechanisms behind loss of functional β-cell mass as a result of SARS-CoV-2 infection that can trigger new-onset T1D.
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Affiliation(s)
- Roy Anindya
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Guy A Rutter
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.,Centre of Research of Centre Hospitalier de l'Université de Montréal (CRCHUM), Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Gargi Meur
- ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
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25
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Varnell C, Harshman LA, Liu C, Smith L, Al-Akash S, Barletta GM, Brakeman P, Chaudhuri A, Fadakar P, Galea L, Garro R, Gluck C, Kershaw DB, Matossian D, Patel HP, Peterson C, Pruette C, Ranabothu S, Rodig N, Singer P, Sebestyen VanSickle J, Weng PL, Danziger-Isakov L, Seifert ME, Hooper DK. COVID-19 in pediatric kidney transplantation: a follow-up report of the Improving Renal Outcomes Collaborative. Pediatr Nephrol 2023; 38:537-547. [PMID: 35538239 PMCID: PMC9090538 DOI: 10.1007/s00467-022-05570-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND We report follow-up data from an ongoing prospective cohort study of COVID-19 in pediatric kidney transplantation through the Improving Renal Outcomes Collaborative (IROC). METHODS Patient-level data from the IROC registry were combined with testing, indication, and outcomes data collected to describe the epidemiology of COVID testing, treatment, and clinical outcomes; determine the incidence of a positive COVID-19 test; describe rates of COVID-19 testing; and assess for clinical predictors of a positive COVID-19 test. RESULTS From September 2020 to February 2021, 21 centers that care for 2690 patients submitted data from 648 COVID-19 tests on 465 patients. Most patients required supportive care only and were treated as outpatients, 16% experienced inpatient care, and 5% experienced intensive care. Allograft complications were rare, with acute kidney injury most common (7%). There was 1 case of respiratory failure and 1 death attributed to COVID-19. Twelve centers that care for 1730 patients submitted complete testing data on 351 patients. The incidence of COVID-19 among patients at these centers was 4%, whereas the incidence among tested patients was 19%. Risk factors to predict a positive COVID-19 test included age > 12 years, symptoms consistent with COVID-19, and close contact with a confirmed case of COVID-19. CONCLUSIONS Despite the increase in testing and positive tests over this study period, the incidence of allograft loss or death related to COVID-19 remained extremely low, with allograft loss or death each occurring in < 1% of COVID-19-positive patients and in less than < 0.1% of all transplant patients within the IROC cohort. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Charles Varnell
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | - Chunyan Liu
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA
| | - Laurie Smith
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA
| | | | | | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Abanti Chaudhuri
- Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Paul Fadakar
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Galea
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rouba Garro
- Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA, USA
| | - Caroline Gluck
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Debora Matossian
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Caitlin Peterson
- Primary Children's Hospital, The University of Utah, Salt Lake City, UT, USA
| | - Cozumel Pruette
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Nancy Rodig
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pamela Singer
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Brooklyn, NY, USA
| | | | | | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael E Seifert
- University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
| | - David K Hooper
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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26
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Ali FEM, Abd El-Aziz MK, Ali MM, Ghogar OM, Bakr AG. COVID-19 and hepatic injury: cellular and molecular mechanisms in diverse liver cells. World J Gastroenterol 2023; 29:425-449. [PMID: 36688024 PMCID: PMC9850933 DOI: 10.3748/wjg.v29.i3.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) represents a global health and economic challenge. Hepatic injuries have been approved to be associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The viral tropism pattern of SARS-CoV-2 can induce hepatic injuries either by itself or by worsening the conditions of patients with hepatic diseases. Besides, other factors have been reported to play a crucial role in the pathological forms of hepatic injuries induced by SARS-CoV-2, including cytokine storm, hypoxia, endothelial cells, and even some treatments for COVID-19. On the other hand, several groups of people could be at risk of hepatic COVID-19 complications, such as pregnant women and neonates. The present review outlines and discusses the interplay between SARS-CoV-2 infection and hepatic injury, hepatic illness comorbidity, and risk factors. Besides, it is focused on the vaccination process and the role of developed vaccines in preventing hepatic injuries due to SARS-CoV-2 infection.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | | | - Mahmoud M Ali
- Department of Pharmacology, Al-Azhar University, Assiut 71524, Egypt
| | - Osama M Ghogar
- Department of Biochemistry Faculty of Pharmacy, Badr University in Assiut, Egypt
| | - Adel G Bakr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
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27
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Casassola GM, Schmidt CJ, Affeldt GH, Morais DS, Alvarenga LKB, Miller C, Ziegler B. Functional status of hospitalized pediatric patients with COVID-19 in southern Brazil: a prospective cohort study. J Bras Pneumol 2023; 48:e20220153. [PMID: 36651435 PMCID: PMC9747171 DOI: 10.36416/1806-3756/e20220153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the functional status of children diagnosed with COVID-19 at the time of hospitalization and the associations with clinical features. METHODS This prospective cohort study was carried out with children diagnosed with COVID-19 admitted to a tertiary hospital. The patients' functioning was assessed using the pediatric Functional Status Scale (FSS). RESULTS A total of 62 children with a median age of 3 years old were included in the study, and 70% had some comorbidity prior to the diagnosis of COVID-19. The median length of stay was nine days, during which period five patients died. The FSS assessment of the sample showed that approximately 55% had some functional alteration. The group of patients with the highest FSS scores presented a lengthier hospital stay (p = 0.016), required more oxygen therapy (p < 0.001), mechanical ventilation (p = 0.001), and intensive care unit admissions (p = 0.019), and had more cardiac (p = 0.007), neurological (p = 0.003), and respiratory (p = 0.013) comorbidities. In the multivariate analysis, there was an association between the dependent variable length of stay and the total FSS score (b = 0.349, p = 0.004) and the presence of comorbidities (b = 0.357, p = 0.004). CONCLUSIONS We observed that more than half of the children hospitalized due to COVID-19 had some level of functional change. Greater alterations in functional status were associated with the presence of previous comorbidities, a greater need for ventilatory support, and longer hospital stays.
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Affiliation(s)
| | | | - Guilherme Hoff Affeldt
- . Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brasil
| | | | | | - Cristina Miller
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
| | - Bruna Ziegler
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
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Sikkema RS, de Bruin E, Ramakers C, Bentvelsen R, Li W, Bosch BJ, Westerhuis B, Haagmans B, Koopmans MPG, Fraaij PLA. Reduced Seasonal Coronavirus Antibody Responses in Children Following COVID-19 Mitigation Measures, The Netherlands. Viruses 2023; 15:212. [PMID: 36680252 PMCID: PMC9862716 DOI: 10.3390/v15010212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
SARS-CoV-2 prevention and control measures did not only impact SARS-CoV-2 circulation, but also the timing and prevalence of other seasonal respiratory viruses. Especially in children, information on exposure and infections to seasonal coronaviruses as well as SARS-CoV-2 in the first year of the pandemic is largely lacking. Therefore, we set up a one-year serological survey in a large tertiary hospital in the Netherlands. We show that seasonal coronavirus seroprevalence significantly decreased in 2021 in children less than one year, most likely due to COVID-19 control measures. The SARS-CoV-2 seroprevalence in children and adolescents increased from 0.4% to 11.3%, the highest in adolescents. This implies higher exposure rates in adolescents as compared to the general population (>18 years old). It is clear that there have been significant changes in the circulation and subsequent immunity against most respiratory pathogens as a result of the mitigation measures. The implications on shorter as well as longer term are still largely unknown, but the impact of the SARS-CoV-2 pandemic and subsequent control measures will continue to affect the dynamics of other pathogens.
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Affiliation(s)
| | - Erwin de Bruin
- Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | | | - Robbert Bentvelsen
- Microvida Laboratory for Microbiology, Amphia Hospital, 4818 Breda, The Netherlands
- Department of Medical Microbiology, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Wentao Li
- Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht University, 3584 Utrecht, The Netherlands
| | - Berend-Jan Bosch
- Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht University, 3584 Utrecht, The Netherlands
| | | | - Bart Haagmans
- Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
| | | | - Pieter L. A. Fraaij
- Viroscience, Erasmus MC, 3015 Rotterdam, The Netherlands
- Pediatrics, Erasmus MC-Sophia Children’s Hospital, 3015 Rotterdam, The Netherlands
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ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System. Int J Pediatr 2023; 2023:1698407. [PMID: 36873820 PMCID: PMC9981283 DOI: 10.1155/2023/1698407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Aim The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. Methods We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. Results We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. Conclusions In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.
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Solórzano-Santos F, Miranda-Lora AL, Márquez-González H, Klünder-Klünder M. Survival analysis and mortality predictors of COVID-19 in a pediatric cohort in Mexico. Front Public Health 2022; 10:969251. [PMID: 36589967 PMCID: PMC9801985 DOI: 10.3389/fpubh.2022.969251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background The new coronavirus SARS-CoV-2 pandemic has been relatively less lethal in children; however, poor prognosis and mortality has been associated with factors such as access to health services. Mexico remained on the list of the ten countries with the highest case fatality rate (CFR) in adults. It is of interest to know the behavior of COVID-19 in the pediatric population. The aim of this study was to identify clinical and sociodemographic variables associated with mortality due to COVID-19 in pediatric patients. Objective Using National open data and information from the Ministry of Health, Mexico, this cohort study aimed to identify clinical and sociodemographic variables associated with COVID-19 mortality in pediatric patients. Method A cohort study was designed based on National open data from the Ministry of Health, Mexico, for the period April 2020 to January 2022, and included patients under 18 years of age with confirmed SARS-CoV-2 infection. Variables analyzed were age, health services used, and comorbidities (obesity, diabetes, asthma, cardiovascular disease, immunosuppression, high blood pressure, and chronic kidney disease). Follow-up duration was 60 days, and primary outcomes were death, hospitalization, and requirement of intensive care. Statistical analysis included survival analysis, prediction models created using the Cox proportional hazards model, and Kaplan-Meier estimation curves. Results The cohort included 261,099 cases with a mean age of 11.2 ± 4 years, and of these, 11,569 (4.43%) were hospitalized and 1,028 (0.39%) died. Variables associated with risk of mortality were age under 12 months, the presence of comorbidities, health sector where they were treated, and first wave of infection. Conclusion Based on data in the National database, we show that the pediatric fatality rate due to SARS-CoV-2 is similar to that seen in other countries. Access to health services and distribution of mortality were heterogeneous. Vulnerable groups were patients younger than 12 months and those with comorbidities.
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Affiliation(s)
- Fortino Solórzano-Santos
- Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico
| | - América Liliana Miranda-Lora
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico
| | - Horacio Márquez-González
- Departamento de Investigación Clínica, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico,*Correspondence: Horacio Márquez-González
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico,Miguel Klünder-Klünder
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The Age-Related Course of COVID-19 in Pediatric Patients-1405 Cases in a Single Center. J Clin Med 2022; 11:jcm11247347. [PMID: 36555963 PMCID: PMC9782360 DOI: 10.3390/jcm11247347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Since the beginning of the pandemic, many reports have pointed to age as the most important risk factor for severe COVID-19 in adults, but this relationship is less clear in children. Between March 2020 and April 2022, 1405 pediatric COVID-19 patients were included in our prospective study, which aimed to analyze the disease's characteristics in three age groups: infants, toddlers (1-5 years), and children (5-18 years). We observed male prevalence of the disease in infants and toddlers compared to female prevalence in children. Comorbidities appeared most often in children. In the first pandemic wave, the vast majority of pediatric patients were children, but later, the percentage of infant and toddler patients increased significantly. A total of 74% of hospitalized children were younger than five years. Upper respiratory tract symptoms were most common in infants and toddlers, and lower respiratory tract symptoms and gastroenterocolitis were more common in children. Neurological symptoms appeared similarly in all age groups. The activities of ALT, CK, and LDH were the most elevated in infants, along with D-dimers. The median length of hospitalization fluctuated between three and four days and was highest in infants. Severe courses were more common in adolescents.
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Shingleton J, Burton L, Williams HE, Finnie TJR, Bennett E, Birrell P, Kenny S, Watson-Koszel T, Viner R, Arditi M, DeAngelis D, Gent N, Ladhani SN. Risk of paediatric multisystem inflammatory syndrome (PIMS-TS) during the SARS-CoV-2 alpha and delta variant waves: National observational and modelling study, 2020-21, England. Front Pediatr 2022; 10:1034280. [PMID: 36545670 PMCID: PMC9762156 DOI: 10.3389/fped.2022.1034280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) is a rare life-threatening complication that typically occurs several weeks after SARS-CoV-2 infection in children and young people (CYP). We used national and regional-level data from the COVID-19 pandemic waves in England to develop a model to predict PIMS-TS cases. Methods SARS-CoV-2 infections in CYP aged 0-15 years in England were estimated using the PHE-Cambridge real-time model. PIMS-TS cases were identified through the British Paediatric Surveillance Unit during (March-June 2020) and through Secondary Uses Services (SUS) from November 2020. A predictive model was developed to estimate PIMS-TS risk and lag times after SARS-CoV-2 infections. Results During the Alpha wave, the model accurately predicted PIMS-TS cases (506 vs. 502 observed cases), with a median estimated risk of 0.038% (IQR, 0.037-0.041%) of paediatric SARS-CoV-2 infections. For the Delta wave, the median risk of PIMS-TS was significantly lower at 0.026% (IQR, 0.025-0.029%), with 212 observed PIMS-TS cases compared to 450 predicted by the model. Conclusions The model accurately predicted national and regional PIMS-TS cases in CYP during the Alpha wave. PIMS-TS cases were 53% lower than predicted during the Delta wave. Further studies are needed to understand the mechanisms of the observed lower risk with the Delta variant.
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Affiliation(s)
- Joseph Shingleton
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Lucy Burton
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Hannah E. Williams
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Thomas J. R. Finnie
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Emma Bennett
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Paul Birrell
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, United Kingdom
- Statistical Modelling and Economics, UK Health Security Agency, Colindale, United Kingdom
| | - Simon Kenny
- CYP Transformation Programme Team, Nursing Directorate, NHS England and NHS Improvement, Leeds, England
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
| | - Tiffany Watson-Koszel
- CYP Transformation Programme Team, Nursing Directorate, NHS England and NHS Improvement, Leeds, England
| | - Russell Viner
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniela DeAngelis
- Statistical Modelling and Economics, UK Health Security Agency, Colindale, United Kingdom
| | - Nick Gent
- Emergency Preparedness Response and Resilience Directorate, UK Health Security Agency, Porton Down, London, United Kingdom
- Joint Modelling Team, UK Health Security Agency, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
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KALAYCIK SENGUL O, BEKEN B, OZTURK Z, OZPINAR S, OZKAN G, GUNGOR G. Gastrointestinal System Involvement in Pediatric Patients with Acute SARS-CoV-2 Infection. Medeni Med J 2022; 37:332-338. [PMID: 36578161 PMCID: PMC9808857 DOI: 10.4274/mmj.galenos.2022.79674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective The prevalence of gastrointestinal symptoms in coronavirus disease-2019 (COVID-19) has been reported widely. In this study, the prevalence of gastrointestinal system (GIS) involvement in pediatric COVID-19 and its effect on prognosis were investigated. Methods Children (aged 0-18 years) with acute COVID-19 were included in the study. The patients were grouped according to system involvement: isolated respiratory system (RS), isolated GIS, and combination of both (RS+GIS). These groups were compared in terms of demographic data, clinical characteristics, laboratory and imaging findings, and hospitalization. Results A total of 223 pediatric patients were included in the study. Of these patients, 19 were asymptomatic, 12 were diagnosed with a multisystem inflammatory syndrome in children, 21 had chronic disorders that may affect disease severity, and 27 had symptoms not related to RS or GIS. The remaining 144 patients were classified according to system involvement: 79 (35.4%), 14 (6.3%), and 51 (22.9%) had isolated RS, isolated GIS, and RS+GIS involvement, respectively. The GIS group was much younger than the RS group (median, 30 and 150 months, respectively, p=0.006). Three patients from the RS group were followed in the intensive care unit (ICU). Moreover, 17 (21.5%) and 4 (7.8%) patients from the RS group had severe-critical respiratory symptoms, in the RS+GIS group had severe-critical respiratory symptoms (p=0.039). Conclusions Our study showed that GIS involvement in children with COVID-19 is more prevalent than RS involvement in the younger age group. Respiratory symptom severity and ICU admission also decreased with accompanying GIS involvement. GIS involvement was still associated with a milder disease course after adjustment for age.
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Affiliation(s)
- Ozlem KALAYCIK SENGUL
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey
| | - Burcin BEKEN
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatric Allergy and Immunology, Istanbul, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatric Allergy and Immunology, Istanbul, Turkey E-mail:
| | - Zehra OZTURK
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatrics, Istanbul, Turkey
| | - Seyma OZPINAR
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatrics, Istanbul, Turkey
| | - Gizem OZKAN
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatrics, Istanbul, Turkey
| | - Gizem GUNGOR
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Pediatrics, Istanbul, Turkey
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Timur D, Demirpek U, Demirbaş BC, Türe E, Korkmaz MF, Timur A. Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1758743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection.
Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied.
Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower.
Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered.
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Affiliation(s)
- Demet Timur
- Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Turkey
| | - Ugur Demirpek
- Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Turkey
| | | | - Esra Türe
- Division of Pediatric Emergency Diseases, Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
| | | | - Ahmet Timur
- Bursa City Department of Health, Bursa, Turkey
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Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is common in children, and clinical manifestations can vary depending on age, underlying disease, and vaccination status. Most children will have asymptomatic or mild infection, but certain baseline characteristics can increase the risk of moderate to severe disease. The following article will provide an overview of the clinical manifestations of coronavirus disease 2019 in children, including the post-infectious phenomenon called multisystem inflammatory syndrome in children. Currently available treatment and prophylaxis strategies will be outlined, with the caveat that new therapeutics and clinical efficacy data are constantly on the horizon.
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Stopyra L, Kowalik A, Stala J, Majchrzak I, Szebla J, Jakosz M, Grzywaczewska K, Kwinta P. Characteristics of Hospitalized Pediatric Patients in the First Five Waves of the COVID-19 Pandemic in a Single Center in Poland-1407 Cases. J Clin Med 2022; 11:jcm11226806. [PMID: 36431283 PMCID: PMC9697870 DOI: 10.3390/jcm11226806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/30/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
This is a single-center, prospective study that compared the clinical presentation and laboratory findings of hospitalized children during the first five waves of the COVID-19 pandemic. Data were collected, according to a standardized questionnaire, from 1407 children from 23 March 2020 to 30 April 2022. Significant differences in clinical courses were found among the five waves probably due to different SARS-CoV-2 variants. The median age was 95.8 months in the first wave versus 14.6-23 months in the others. The number of patients with upper respiratory infection was the highest in the fifth wave (74.4% versus 43.8-56.9% in the others) and for lower respiratory infection in the first wave (50.0% versus 16.4-32.5%). Gastroenterocolitis was more common in the fifth wave (24.4% versus 8.9-16.5%); neurological diagnoses appeared more frequently in the fourth wave (16.6% versus 0.6-9.9%), while anosmia and ageusia were higher in the fifth wave (13% versus 1.5-4%). Life-threatening courses were relatively rare. However, children with pneumonia, dehydration from high fever, gastrointestinal symptoms, loss of smell and taste, and neurological symptoms required hospitalization.
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Affiliation(s)
- Lidia Stopyra
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
- Correspondence: ; Tel.: +48-126-229-513
| | - Aleksandra Kowalik
- Department of Pediatrics, Jagiellonian University Medical College, 30-663 Kraków, Poland
| | - Justyna Stala
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
| | - Ida Majchrzak
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
| | - Justyna Szebla
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
| | - Mateusz Jakosz
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
| | - Karolina Grzywaczewska
- Department of Infectious Diseases and Pediatrics, Zeromski Specialist Hospital in Krakow, 30-931 Kraków, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, 30-663 Kraków, Poland
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Yu Z, Li X, Zhao J, Sun S. Identification of hospitalized mortality of patients with COVID-19 by machine learning models based on blood inflammatory cytokines. Front Public Health 2022; 10:1001340. [PMID: 36466533 PMCID: PMC9715399 DOI: 10.3389/fpubh.2022.1001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) spread worldwide and presented a significant threat to people's health. Inappropriate disease assessment and treatment strategies bring a heavy burden on healthcare systems. Our study aimed to construct predictive models to assess patients with COVID-19 who may have poor prognoses early and accurately. This research performed a retrospective analysis on two cohorts of patients with COVID-19. Data from the Barcelona cohort were used as the training set, and data from the Rotterdam cohort were used as the validation set. Cox regression, logistic regression, and different machine learning methods including random forest (RF), support vector machine (SVM), and decision tree (DT) were performed to construct COVID-19 death prognostic models. Based on multiple clinical characteristics and blood inflammatory cytokines during the first day of hospitalization for the 138 patients with COVID-19, we constructed various models to predict the in-hospital mortality of patients with COVID-19. All the models showed outstanding performance in identifying high-risk patients with COVID-19. The accuracy of the logistic regression, RF, and DT models is 86.96, 80.43, and 85.51%, respectively. Advanced age and the abnormal expression of some inflammatory cytokines including IFN-α, IL-8, and IL-6 have been proven to be closely associated with the prognosis of patients with COVID-19. The models we developed can assist doctors in developing appropriate COVID-19 treatment strategies, including allocating limited medical resources more rationally and early intervention in high-risk groups.
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Affiliation(s)
- Zhixiang Yu
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiayin Li
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China,First Unit, Third Branch of Fangcang Shelter Hospital of National Exhibition and Convention Center, Shanghai, China,*Correspondence: Shiren Sun
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Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in children: update and new insights from the second report of an Iranian referral hospital. Epidemiol Infect 2022; 150:e179. [PMID: 36254726 PMCID: PMC9671882 DOI: 10.1017/s0950268822001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Here, we are sharing our second report about children affected by Multisystem Inflammatory Syndrome in Children (MIS-C). The aim of the present study was to update our knowledge about children with MIS-C. Furthermore, we tried to compare clinical manifestations, laboratory features and final outcome of patients based on disease severity, in order to better understanding of the nature of this novel syndrome. METHODS This retrospective study was conducted at Children's Medical Center Hospital, the hub of excellence in paediatrics in Iran, located in Tehran, Iran. We reviewed medical records of children admitted to the hospital with the diagnosis of MIS-C from July 2020 to October 2021. RESULTS One hundred and twenty-two patients enrolled the study. Ninety-seven (79.5%) patients had mild to moderate MIS-C (MIS-C without overlap with KD (n = 80); MIS-C overlapping with KD (n = 17)) and 25 (20.5%) patients showed severe MIS-C. The mean age of all patients was 6.4 ± 4.0 years. Nausea and vomiting (53.3%), skin rash (49.6%), abdominal pain (46.7%) and conjunctivitis (41.8%) were also frequently seen Headache, chest pain, tachypnea and respiratory distress were significantly more common in patients with severe MIS-C (P < 0.0001, P = 0.021, P < 0.0001 and P < 0.0001, respectively). Positive anti-N severe acute respiratory syndrome coronavirus 2 IgM and IgG were detected in 14 (33.3%) and 23 (46.9%) tested patients, respectively. Albumin, and vitamin D levels in children with severe MISC were significantly lower than children with mild to moderate MIS-C (P < 0.0001, P = 0.05). Unfortunately, 2 (1.6%) of 122 patients died and both had severe MIS-C. CONCLUSION Patients with MIS-C in our region suffer from wide range of signs and symptoms. Among laboratory parameters, hypoalbuminemia and low vitamin D levels may predict a more severe course of the disease. Coronary artery dilation is frequently seen among all patients, regardless of disease severity.
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Van de Casteele M, Waterschoot J, Anthierens S, DeSmet A, Galand B, Goossens H, Morbée S, Vansteenkiste M. Saliva testing among teachers during the COVID-19 pandemic: Effects on health concerns, well-being, and precautionary behavior. Soc Sci Med 2022; 311:115295. [PMID: 36067619 PMCID: PMC9394098 DOI: 10.1016/j.socscimed.2022.115295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
RATIONALE At the start of 2021, several SARS-CoV-2 cluster outbreaks in schools threatened in-person education and created a fairly chaotic and frightening environment for school personnel. To keep the schools open while preventing COVID-19 outbreaks, intensive diagnostic testing in teachers and school personnel was strongly recommended but missing at the time. OBJECTIVES A project was launched in Belgian schools to weekly analyze the morning saliva of school personnel using PCR-testing to detect and prevent COVID-19 positive cases. In this quasi-experimental study, we aimed to examine whether the implementation of this saliva testing project impacted school personnel's pandemic-related health concerns, well-being, and adherence to the health-protective measures, contrasting experimental with control schools. METHODS The data were collected during the third wave (Alpha-wave, February-March 2021) of the pandemic. The sample consisted of 435 participants from 34 different schools across Flanders (Belgium) (78.8% female; M age = 43.87 years, range = 21-67) of which 82% participated in the weekly saliva tests (i.e., experimental group) and 18% took part in the control group. RESULTS Results from a series of linear mixed regression models showed that saliva testing buffered against an increase in health concerns among tested school personnel but did not affect participants' general well-being. Slight declines in adherence to the health-protective behaviors were observed, yet this was only the case for participants who felt less supported by their school principal. High degrees of principals' support also fostered the sharpest decreases in school staff's pandemic-related health concerns. CONCLUSIONS When keeping the schools open in unstable pandemic times, weekly saliva testing is a promising strategy to prevent cluster outbreaks while simultaneously safeguarding health concerns among school personnel. School principals appear to play a critical role in the implementation of saliva testing to secure positive effects.
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Affiliation(s)
| | | | | | - Ann DeSmet
- Université Libre de Bruxelles, Belgium; University of Antwerp, Belgium
| | | | | | - Sofie Morbée
- Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Abstract
INTRODUCTION Children are less likely to acquire SARS-CoV-2 infections than adults and when infected, usually have milder disease. True infection and complication rates are, however, difficult to ascertain. In Iceland, a strict test, trace and isolate policy was maintained from the start of the pandemic and offers more accurate information of the number of truly infected children in a nationwide study. MATERIAL AND METHODS All children with positive PCR for SARS-CoV-2 infections from February 28, 2020 to August 31, 2021 were followed up through telephone consultations for at least 14 days and their symptoms were registered. Symptom severity and duration were categorized based on age groups and the source of infection was registered. RESULTS A total of 1749 children were infected with SARS-CoV-2 in 3 waves of infections. All waves had similar disease severity whereas the incidence was 5-fold higher in the third wave (3.5 vs. 0.73/1000 children/month). No children had severe symptoms, 81 (4.6%) had moderate symptoms, 1287 (73.9%) had mild and 374 (21.5%) were asymptomatic. Symptoms from upper (n = 839, 48%) and lower respiratory tract (n = 744, 43%) were most common. Median duration of symptoms was 5 days and adolescents had a higher risk of prolonged duration [OR:1.84 (1.39-2.43)]. Nineteen (1.1%) children needed medical attention, but no child was hospitalized. The source of infection was a household member in 65% of cases. DISCUSSION During the first 3 waves of the pandemic, SARS-CoV-2 infections in Icelandic children were mild and none were hospitalized. The most common symptoms were respiratory symptoms followed by fever, headache and tiredness. This study helps shed light on true complication rates of children with confirmed SARS-CoV-2 infection.
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Krishnamurthy S, Kar SS, Dhodapkar R, Parameswaran N. Comparison of COVID-19 Infection in Children During the First and Second Wave. Indian J Pediatr 2022; 89:1016-1018. [PMID: 35182382 PMCID: PMC8857888 DOI: 10.1007/s12098-022-04127-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/24/2021] [Indexed: 01/20/2023]
Abstract
Concerns have been raised in the media that 'the third wave' will severely affect children. Here, an experience of SARS-CoV-2 infection in children is reported. Of the 8,626 SARS-CoV-2 RT-PCR tests performed in children (0-17 y) from March 2020 to July 2021 at the authors' institute, 1470 (17%) were positive, [711/4821 (14.7%) during the first wave (July 2020 to January 2021), and 759/3583 (21.2%) during the second wave (February 2021 to July 2021)]. The children in both waves were similar in presentation (74.1% mildly symptomatic versus 80.2% mildly symptomatic; rest asymptomatic). None of them had COVID pneumonia. Five children died (0.3%), all of a serious primary non-COVID disease. Seventy-three cases of MIS-C during August 2020 to July 2021, with low mortality (2.7%) were also identified. The similarity in COVID-19 infection in children between the first and the second waves seems to suggest that the likelihood of the 'third wave' hitting children hard is low.
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Affiliation(s)
- Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Narayanan Parameswaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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Krom H, van Mameren J, Remijn L, de Nennie K, Dumont E, van der Gaag E, van Leeuwen MCC, Mulkens S, Schakelaar C, Kindermann A. Impact of COVID-19 Pandemic on Young Children With Feeding and Eating Problems and Disorders and Their Families. J Pediatr Gastroenterol Nutr 2022; 75:529-534. [PMID: 35836323 PMCID: PMC9470045 DOI: 10.1097/mpg.0000000000003563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The incidence of feeding and eating problems and disorders (FEPD) in children increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on young children with FEPD and their parents. METHODS Cross-sectional survey: parents of children with FEPD (0-11 years) in the Netherlands completed an online questionnaire (January-April 2021). This questionnaire included 4 demographic questions (including criteria of pediatric feeding disorder [PFD] and/or avoidant/restrictive food intake disorder [ARFID]) and 11 questions related to experienced impact of the COVID-19 pandemic. Parental responses regarding children with FEPD (including PFD and ARFID) were compared with those of healthy controls (HCs). RESULTS In total, 240 children (median age, 5.5 years; interquartile range [IQR], 3.5-7.9 years; 53.3% female) were included; 129 children with FEPD and 111 HC. Most children with FEPD fulfilled criteria for PFD (n = 119; 92.2%) and/or ARFID (n = 117; 90.7%). Parents of children with FEPD reported more stress (of their child [ P = 0.014] and parental stress [ P = 0.014]), worse eating by the child ( P < 0.001), more negative relations within the family ( P = 0.006), and less support from the environment ( P = 0.001) compared with parents of HC during the COVID-19 pandemic than before. CONCLUSIONS It seems that the COVID-19 pandemic had great impact on young children with FEPD and their parents because parents of children with FEPD reported significantly more perceived stress within both the child and parents, more difficult eating behavior of the child, more negative behavior between family members, and less support from the environment as compared with HC.
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Affiliation(s)
- Hilde Krom
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- the SeysCentra, Malden, The Netherlands
| | - Joost van Mameren
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Institute of Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Lianne Remijn
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the HAN University of Applied Sciences, Academy of Health Studies, Nijmegen, The Netherlands
| | - Katinka de Nennie
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Pediatric Dietetic Practice Katinka de Nennie, Gouda/Zoetermeer, The Netherlands
| | - Eric Dumont
- the SeysCentra, Malden, The Netherlands
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
- the Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ellen van der Gaag
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Pediatric Department Hospital Group Twente, Almelo-Hengelo, The Netherlands
| | | | - Sandra Mulkens
- the SeysCentra, Malden, The Netherlands
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
- the Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Chantal Schakelaar
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
- the Isa Power, Udenhout, The Netherlands
| | - Angelika Kindermann
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- the Multidisciplinary Advisory Board, Patient organization "Nee-eten," Haarlem, The Netherlands
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Bai GH, Shih PY, Chen SY, Hsieh KS, Chou CC, Feng PH, Kong SS, Lin WC, Lu MC. Clinical features and characteristics of pediatric patients with COVID-19 infection: Experiences in a Tertiary Taiwan Hospital. Medicine (Baltimore) 2022; 101:e30157. [PMID: 36107524 PMCID: PMC9439632 DOI: 10.1097/md.0000000000030157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) patients have distinct clinical features in the pediatric groups. However, there is a paucity of research focused on clinical manifestation within pediatric group in Taiwan. This study is to conduct a retrospective study of the clinical features of COVID-19 in Taiwan pediatric patients. A retrospective study was conducted on pediatric patients (Aged ≤ 18 years) in a Northern Taiwan hospital from May 1st, 2021 to June 30th, 2021. Thirty-eight patients were included from emergency room. They were laboratory confirmed COVID-19 through specimens from nasopharyngeal swab by real-time reverse-transcription polymerase chain reaction (RT-PCR). Data including RT-PCR cycle threshold (Ct) values, clinical and epidemiological features were collected and analyzed. Thirty-eight patients aged from 7-month to 18-year-old were included. The median age of patients was 15-year-old. The patients had sex ratio of 23 males to 15 females. More than half patients were infected from family members. Asymptomatic patients were 47.37%. In the symptomatic patients, fever (34.21%) was the most predominant symptom. Cough, nasal obstruction and sore throat were also common. Asymptomatic children had significantly higher Ct-values than symptomatic children, and diagnosed patients with Ct-values more than 19 were associated with asymptomatic infection (P = .0084). Ct-values higher than 19 were associated with asymptomatic infection, which may be a predictor of pediatric disease severity. Our results highlight the distinct clinical manifestations and outcomes in pediatric COVID-19 patients. Compared to the adults, pediatric patients aged ≤ 18 years with COVID-19 in Taiwan mainly had mild disease.
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Affiliation(s)
- Geng-Hao Bai
- Department of Education, National Taiwan University Hospital, Taipei city, Taiwan
| | - Ping-Yi Shih
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Yen Chen
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei city, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Che Chou
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei city, Taiwan
| | - Shu-Sing Kong
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Chuan Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pediatric Infectious Disease, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Meng-Che Lu
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Allergy, Asthma and Immunology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Lin DC, Parakati I, Haymond S. The Impact of COVID-19 on Laboratory Test Utilization at a Pediatric Medical Center. J Appl Lab Med 2022; 7:1076-1087. [PMID: 35723285 PMCID: PMC9384293 DOI: 10.1093/jalm/jfac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The epidemiology and clinical manifestation of coronavirus disease 2019 (COVID-19) in the pediatric population is different from the adult population. The purpose of this study is to identify effects of the COVID-19 pandemic on laboratory test utilization in a pediatric hospital.
Methods
We performed retrospective analysis on test utilization data from Ann & Robert H. Lurie Children’s Hospital of Chicago, an academic pediatric medical center. Data between two 100-day periods prior to (prepandemic) and during the pandemic (mid-pandemic) were analyzed to evaluate changes in test volume, lab utilization, and test positivity rate. We also evaluated these metrics based on in- vs outpatient testing and performed modeling to determine what variables significantly impact the test positivity rate.
Results
During the pandemic period, there was an expected surge in COVID-19 testing, while over 84% of lab tests studied decreased in ordering volume. The average number of tests ordered per patient was not significantly different during the pandemic for any of the laboratories (adjusted P value > 0.05). Thirty-three studied tests showed significant change in positivity rate during the pandemic. Linear modeling revealed test volume and inpatient status as the key variables associated with change in test positivity rate.
Conclusions
Excluding severe acute respiratory syndrome coronavirus 2 tests, the COVID-19 pandemic has generally led to decreased test ordering volume and laboratory utilization. However, at this pediatric hospital, the average number of tests performed per patient and test positivity rates were comparable between pre- and mid-pandemic periods. These results suggest that, overall, clinical test utilization at this site remained consistent during the pandemic.
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Affiliation(s)
- David C Lin
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
- Northwestern University, Feinberg School of Medicine, Department of Pathology , Chicago, IL , USA
| | - Isaac Parakati
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
| | - Shannon Haymond
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
- Northwestern University, Feinberg School of Medicine, Department of Pathology , Chicago, IL , USA
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Sebastian T, Carlson JJ, Gaensbauer J, Podewils LJ. Epidemiology and Transmission Dynamics of COVID-19 in an Urban Pediatric US Population. Public Health Rep 2022; 137:1013-1022. [PMID: 35786113 PMCID: PMC9357825 DOI: 10.1177/00333549221105232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This analysis summarizes observational epidemiologic data and transmission dynamics of SARS-CoV-2 among people aged <18 years to better characterize the pediatric COVID-19 pandemic. METHODS We conducted a retrospective study of public health surveillance data among children in Denver, Colorado, who were reported to have COVID-19 from March 1, 2020, through September 30, 2021. We used descriptive statistics and bivariate rate ratios (RRs) to describe demographic and clinical characteristics, transmission dynamics, case trends, and ecological associations. RESULTS A total of 9815 children and adolescents who had COVID-19 were reported during the study period. Adolescents aged 14-17 years had the highest incidence rate (IR) per 1000 people (IR = 107.5; 3021 of 28 108). Hispanic/Latino children had a 1.6 times higher rate of infection than non-Hispanic White children (RR = 1.57; 95% CI, 1.50-1.65; P < .001). Few hospitalizations (n = 138, 1.4%) and deaths (n = 3, 0%) occurred. Most children were symptomatic (4487 of 5499, 81.6%). Within household clusters, a large proportion of pediatric cases (n = 6136) were a secondary case (n = 3959, 64.5%), followed by index case (n = 1170, 19.1%) and co-index case (n = 1007, 16.4%). Non-Hispanic White children had an increased risk of being an index or co-index case (RR = 1.14; 95% CI, 1.06-1.23; P < .001), while Hispanic/Latino children had an increased risk of being a secondary case (RR = 1.07; 95% CI, 1.03-1.11; P < .001). From 2020 to 2021, the association between pediatric case rates and neighborhoods with higher poverty and households with ≥3 people decreased. CONCLUSIONS Older children and those identifying as Hispanic/Latino had a disproportionate incidence of disease. A sizable proportion of children were considered index cases or co-index cases. Pediatric prevention strategies, especially vaccinations, are vital for pandemic control.
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Affiliation(s)
- Thresia Sebastian
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
| | - Jesse J. Carlson
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - James Gaensbauer
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Department of Pediatrics and Adolescent
Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Laura Jean Podewils
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Office of Research, Denver Health and
Hospital Authority, Denver, CO, USA
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Santos VS, Siqueira TS, Atienzar AIC, Santos MARDR, Vieira SCF, Lopes ADSA, Silva JRS, Martins-Filho PR, Cuevas LE, Gurgel RQ. Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: A nationwide population-based ecological study. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100311. [PMID: 35789692 PMCID: PMC9242540 DOI: 10.1016/j.lana.2022.100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Data regarding the geographical distribution of cases and risk factors for COVID-19 death in children and adolescents are scarce. We describe the spatial distribution of COVID-19 cases and deaths in paediatric population and their association with social determinants of health in Brazil. Methods This is a population-based ecological study with a spatial analysis of all cases and deaths due to COVID-19 in Brazil among children and adolescents aged 0-19 years from March 2020 to October 2021. The units of analysis were the 5570 municipalities. Data on COVID-19 cases and deaths, social vulnerability, health inequities, and health system capacity were obtained from publicly available databases. Municipalities were stratified from low to very high COVID-19 incidence and mortality using K-means clustering procedures, and spatial clusters and relative risks were estimated using spatial statistics with Poisson probability models. The relationship between COVID-19 estimates and social determinants of health was explored by using multivariate Beta regression techniques. Findings A total of 33,991 COVID-19 cases and 2424 deaths among children and adolescents aged 0-19 years were recorded from March 2020 to October 2021. There was a spatial dependence for the crude mortality coefficient per 100,000 population in the paediatric population aged 0-19 years (I Moran 0·10; P < 0·001). Forty municipalities had higher mortality rates, of which 20 were in states from the Northeast region. Seven spatial clusters were identified for COVID-19 mortality, with four clusters in the Northeast region and three in the North region. Municipalities with higher social inequality and vulnerability had higher COVID-19 mortality in the paediatric population. Interpretation The main clusters of risk for mortality among children and adolescents were identified in municipalities in the North and Northeast regions, which are the regions with the worst socioeconomic indicators and greatest health disparities in the country. Our findings confirmed the higher burden of COVID-19 for Brazilian paediatric population in municipalities with higher social inequality and vulnerability and worse socioeconomic indicators. To reduce the burden of COVID-19 on children, mass immunisation is necessary. Funding None.
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Affiliation(s)
- Victor Santana Santos
- Department of Medicine, Federal University of Sergipe, Lagarto, Brazil
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | | | - Ana I. Cubas Atienzar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Sarah Cristina Fontes Vieira
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Division of Paediatric, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | - Aline de Siqueira Alves Lopes
- Department of Medicine, Federal University of Sergipe, Lagarto, Brazil
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | | | - Paulo Ricardo Martins-Filho
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - Luis Eduardo Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ricardo Queiroz Gurgel
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Division of Paediatric, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
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Dandachi I, Aljabr W. Prognosis of COVID-19 in the middle eastern population, knowns and unknowns. Front Microbiol 2022; 13:974205. [PMID: 36118201 PMCID: PMC9471247 DOI: 10.3389/fmicb.2022.974205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.
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Satdhabudha A, Chaiyakulsil C, Uppala R, Niyomkarn W, Tovichien P, Norasettekul V, Ruangnapa K, Smathakanee C, Choursamran B, Kulbun A, Jaroenying R, Kamalaporn H, Sriboonyong T, Roekworachai K, Sunkonkit K, Tangsathapornpong A, Bunjoungmanee P, Pao-in W, Thaweekul P, Tantiyavarong P, Ratanavongkosol T, Thongnual C, Sritipsukho P, Deerojanawong J. Development and validation of the predictive score for pediatric COVID-19 pneumonia: A nationwide, multicenter study. PLoS One 2022; 17:e0273842. [PMID: 36037228 PMCID: PMC9423652 DOI: 10.1371/journal.pone.0273842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation. Methods This was a retrospective cohort study done by chart review of all children aged 0–15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort. Results The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491–0.602) in the low-risk category, 1.563 (95% CI: 1.454–1.679) in the moderate, and 4.339 (95% CI: 2.527–7.449) in the high-risk. Conclusion This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.
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Affiliation(s)
- Araya Satdhabudha
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Chanapai Chaiyakulsil
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
- * E-mail:
| | - Rattapon Uppala
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Watit Niyomkarn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Prakarn Tovichien
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kanokpan Ruangnapa
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | | | - Aunya Kulbun
- Department of Pediatrics, Her Royal Highness Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Rasintra Jaroenying
- Department of Pediatrics, Faculty of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
- Phramongkutklao Hospital Sleep Disorder Center, Faculty of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Harutai Kamalaporn
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tidarat Sriboonyong
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kanokkarn Sunkonkit
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Auchara Tangsathapornpong
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Pornumpa Bunjoungmanee
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Wanida Pao-in
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Patcharapa Thaweekul
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Paskorn Sritipsukho
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
| | - Jitladda Deerojanawong
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Jugulete G, Pacurar D, Pavelescu ML, Safta M, Gheorghe E, Borcoș B, Pavelescu C, Oros M, Merișescu M. Clinical and Evolutionary Features of SARS-CoV-2 Infection (COVID-19) in Children, a Romanian Perspective. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1282. [PMID: 36138590 PMCID: PMC9497796 DOI: 10.3390/children9091282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 01/08/2023]
Abstract
Background: Given the potential for additional development to clarify a better knowledge of generally influence of COVID-19 upon the pediatric population, the clinical symptoms of SARS-CoV-2 infection in children and adolescents are still being explored. Morbidity in children is characterized by a variable clinical course. Our study’s goal was to compare clinical aspects of 230 pediatric patients who analyzed positive for SARS-CoV-2 and were hospitalized between April 2020 and March 2022. Methods: This retrospective study aimed to compare the clinical characteristics of coronavirus disease 2019, (COVID-19) in two groups of pediatric patients hospitalized in the infectious disease clinical ward IX at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals,” Bucharest, Romania. Clinical characteristics of 88 patients (first group), admitted between April−December 2020 were compared with the second group of 142 children admitted between July 2021 and March 2022. Results: Of 230 children, the median age was 4.5 years, and 53.9% were male. Fever (82.17%) and sore throat (66%) were the most common initial symptoms. Rhinorrhea (42%), cough (34%) and diarrhea (41.74%), with abdominal pain (26%) were also reported in a considerable number of cases. 88 (36.21%) patients (first group) were admitted during the second wave in Romania, mostly aged <5 years old, and experienced digestive manifestations like fever (p = 0.001), and diarrhea (p = 0.004). The second group experienced different clinical signs when compared with the first group, with higher temperature and increased respiratory symptoms analogous to persons who suffer acute respiratory viral infections. The proportion in the second group increased by 23.48% from the first group, and the 0−4 age group for both groups had symptoms for a median interval of 5 days; age (0−4-years old) and length of stay were both proportionally inversely and required longer hospitalization (5 days), for the first group. During study time, the fully vaccinated children for 5−12 years old were 10%, and for 13−18 years old, 14.35% respective. We report two Pediatric Inflammatory Multisystem Syndrome (PIMS) in the second group, with favorable evolution under treatment. Comorbidities (obesity and oncological diseases) were reported in both groups and are risk factors for complications appearing (p < 0.001). All pediatric cases admitted to our clinic evolved favorably and no death was recorded. Conclusions: Clinical characteristics of pediatric patients with COVID-19 are age-related. In the first group, 85.29% of 0−4 years old children experienced digestive symptoms, whereas in the second group 83.78% underwent mild and moderate respiratory symptoms for the 5−12 age range. The potential effects of COVID-19 infection in children older than 5 years should encourage caregivers to vaccinate and improve the prognosis among pediatric patients at risk.
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Affiliation(s)
- Gheorghiță Jugulete
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Daniela Pacurar
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, No. 30-32, Iancu de Hunedoara Blvd., 011743 Bucharest, Romania
| | - Mirela Luminița Pavelescu
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, No. 30-32, Iancu de Hunedoara Blvd., 011743 Bucharest, Romania
| | - Mihaela Safta
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Elena Gheorghe
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Bianca Borcoș
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Carmen Pavelescu
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
| | - Mihaela Oros
- Ponderas Academic Hospital, No. 85A, Nicolae G. Caramfil Street, 014142 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, No. 67A, Gheorghe Petraşcu Street, 3rd District, 031593 Bucharest, Romania
| | - Mădălina Merișescu
- Faculty of Medicine, University of Medicine and Pharmacy, “Carol Davila”, No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- “Matei Balş” National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
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50
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Fan C, Wu Y, Rui X, Yang Y, Ling C, Liu S, Liu S, Wang Y. Animal models for COVID-19: advances, gaps and perspectives. Signal Transduct Target Ther 2022; 7:220. [PMID: 35798699 PMCID: PMC9261903 DOI: 10.1038/s41392-022-01087-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, is the most consequential pandemic of this century. Since the outbreak in late 2019, animal models have been playing crucial roles in aiding the rapid development of vaccines/drugs for prevention and therapy, as well as understanding the pathogenesis of SARS-CoV-2 infection and immune responses of hosts. However, the current animal models have some deficits and there is an urgent need for novel models to evaluate the virulence of variants of concerns (VOC), antibody-dependent enhancement (ADE), and various comorbidities of COVID-19. This review summarizes the clinical features of COVID-19 in different populations, and the characteristics of the major animal models of SARS-CoV-2, including those naturally susceptible animals, such as non-human primates, Syrian hamster, ferret, minks, poultry, livestock, and mouse models sensitized by genetically modified, AAV/adenoviral transduced, mouse-adapted strain of SARS-CoV-2, and by engraftment of human tissues or cells. Since understanding the host receptors and proteases is essential for designing advanced genetically modified animal models, successful studies on receptors and proteases are also reviewed. Several improved alternatives for future mouse models are proposed, including the reselection of alternative receptor genes or multiple gene combinations, the use of transgenic or knock-in method, and different strains for establishing the next generation of genetically modified mice.
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Affiliation(s)
- Changfa Fan
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
| | - Yong Wu
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
| | - Xiong Rui
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100083, China
| | - Yuansong Yang
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
| | - Chen Ling
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
- College of Life Sciences, Northwest University; Provincial Key Laboratory of Biotechnology of Shaanxi Province, Northwest University, Xi'an, 710069, China
| | - Susu Liu
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
| | - Shunan Liu
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control (NIFDC), National Rodent Laboratory Animal Resources Center, Beijing, 102629, China
| | - Youchun Wang
- Division of HIV/AIDS and Sexually Transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, China.
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