1
|
Guerzoni ME, Marchesi S, Palazzi G, Lodi M, Pinelli M, Venturelli D, Bigi E, Quaglia N, Corti P, Serra R, Colombatti R, Sainati L, Masera N, Colombo F, Barone A, Iughetti L. Environmental Factors in Northern Italy and Sickle Cell Disease Acute Complications: A Multicentric Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1478. [PMID: 36291415 PMCID: PMC9600492 DOI: 10.3390/children9101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Environmental factors seem to influence clinical manifestations of sickle cell disease (SCD), but few studies have shown consistent findings. We conducted a retrospective multicentric observational study to investigate the influence of environmental parameters on hospitalization for vaso-occlusive crises (VOC) or acute chest syndrome (ACS) in children with SCD. METHODS Hospital admissions were correlated with daily meteorological and air-quality data obtained from Environmental Regional Agencies in the period 2011-2015. The effect of different parameters was assessed on the day preceding the crisis up to ten days before. Statistical analysis was performed using a quasi-likelihood Poisson regression in a generalized linear model. RESULTS The risk of hospitalization was increased for low maximum temperature, low minimum relative humidity, and low atmospheric pressure and weakly for mean wind speed. The diurnal temperature range and temperature difference between two consecutive days were determined to be important causes of hospitalization. For air quality parameters, we found a correlation only for high levels of ozone and for low values at the tail corresponding to the lowest concentration of this pollutant. CONCLUSIONS Temperature, atmospheric pressure, humidity and ozone levels influence acute complications of SCD. Patients' education and the knowledge of the modes of actions of these factors could reduce hospitalizations.
Collapse
Affiliation(s)
- Maria Elena Guerzoni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Stefano Marchesi
- Arpae-Agenzia Regionale per la Prevenzione, L’ambiente e L’energia dell’Emilia, Romagna, 41121 Modena, Italy
| | - Giovanni Palazzi
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Mariachiara Lodi
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Margherita Pinelli
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Donatella Venturelli
- Department of Transfusion Medicine, University Hospital of Modena, 41124 Modena, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Nadia Quaglia
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Paola Corti
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Roberta Serra
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Nicoletta Masera
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Francesca Colombo
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Angelica Barone
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| |
Collapse
|
2
|
Oliveira CDM, Soares VJ, Rechenmacher C, Daudt LE, Michalowski MB. From H1N1 to COVID-19: What we have seen in children with hemoglobinopathies. Clinics (Sao Paulo) 2022; 77:100004. [PMID: 35113785 PMCID: PMC8801343 DOI: 10.1016/j.clinsp.2021.100004] [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: 08/10/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022] Open
Abstract
This work aimed to better understand the impact of pandemics of respiratory viruses on children with hemoglobinopathies through a comprehensive review of the literature. MEDLINE, SCIELO, LILACS, and PUBMED were used as data sources to find articles without time period restrictions. Previous observations suggest that patients with hemoglobinopathies are a group especially susceptible to the complications of viral respiratory infections, with greater morbidity and mortality related to them. Within this context, this review found that, during the 2009 H1N1 pandemic, the risk of hospitalization in children and adults increased, especially in patients with a history of complications such as acute chest syndrome. In addition, the Coronavirus Disease 2019 (COVID-19) pandemic appears to have less repercussion among children with hemoglobinopathies compared to adults, similar to what is seen in the general population. In the H1N1 pandemic, patients with hemoglobinopathies behaved as a group more susceptible to complications, with increased morbidity and mortality. However, for COVID-19, the existing data to date on these patients do not show the same clinical impact. Thus, although these children deserve attention in case of infection due to their potential risks, they seem to have a favorable evolution.
Collapse
Affiliation(s)
- Claudia de Melo Oliveira
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | - Ciliana Rechenmacher
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Pediatria Translacional, Serviço de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Liane Esteves Daudt
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Pediatria Translacional, Serviço de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Unidade de Hematologia e Transplante de Medula Óssea Pediátrica, Serviço de Hematologia Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mariana Bohns Michalowski
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Pediatria Translacional, Serviço de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Serviço de Oncologia Pediátrica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
3
|
MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [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: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
Collapse
Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Wiyeh AB, Abdullahi LH, Wonkam A, Wiysonge CS, Kaba M. Effects of vaccines in patients with sickle cell disease: a systematic review protocol. BMJ Open 2018; 8:e021140. [PMID: 29581211 PMCID: PMC5875604 DOI: 10.1136/bmjopen-2017-021140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited haematological disorder caused by a single point mutation (Glub6Val) that promotes polymerisation of haemoglobin S and sickling of erythrocytes. Inflammation, haemolysis, microvascular obstruction and organ damage characterise the highly variable clinical expression of SCD. People with SCD are at increased risk of severe infections, hence the need for vaccination against common disease-causing organisms in this population. We aim to review the evidence on the efficacy and safety of vaccines in people with SCD. METHODS AND ANALYSIS The present systematic review will examine the current data as indexed in PubMed, CENTRAL, EMBASE and EBSCOHost. We will consult Strategic Advisory Group of Experts practice statements, conference abstracts, reference lists of relevant articles, WHO ICTRP trial registry and experts in the field. Two authors will independently screen search outputs, select studies, extract data and assess risk of bias; resolving discrepancies by discussion and consensus between the two authors or arbitration by a third author when necessary. We will perform a meta-analysis for clinically homogenous studies. Evidence from clinically diverse studies will be aggregated using narrative synthesis of the findings. In either case, we will use the GRADE approach to assess the strength of the available evidence. ETHICS AND DISSEMINATION The study draws on data that are readily available in the public domain, hence no formal ethical review and approval is required. The findings of this review will be disseminated through conference presentations and a publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018084051.
Collapse
Affiliation(s)
- Alison Beriliy Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Leila Hussein Abdullahi
- Save the Children International (SCI), Somalia/Somaliland Country Office, Nairobi, Kenya
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Mamadou Kaba
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Colombatti R, Palazzi G, Masera N, Notarangelo LD, Bonetti E, Samperi P, Barone A, Perrotta S, Facchini E, Miano M, Del Vecchio GC, Guerzoni ME, Corti P, Menzato F, Cesaro S, Casale M, Rigano P, Forni GL, Russo G, Sainati L. Hydroxyurea prescription, availability and use for children with sickle cell disease in Italy: Results of a National Multicenter survey. Pediatr Blood Cancer 2018; 65. [PMID: 28868627 DOI: 10.1002/pbc.26774] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The number of patients with sickle cell disease (SCD) has increased in Italy in the past decade due to immigration. In spite of the established efficacy of hydroxyurea (HU) in childhood, population-based data regarding its prescription and effectiveness come mainly from studies performed in adults or outside Europe. POPULATION AND METHODS The Hydroxyurea in SCD: A Large Nation-wide Cohort Study from Italy was a retrospective cohort study of adult and pediatric patients with SCD attending 32 centers. Pediatric data are analyzed separately. RESULTS Out of 504 children followed in 11 centers, 206 (40%) were on HU (194 SS/Sβ°, 12 SC/Sß+); 74% came from Sub-Saharian Africa and 18% from Europe. HU therapy indications for SS/Sβ° patients were as follows: 57% painful vaso-occlusive crisis, acute chest syndrome or both, 24% anemia, 8% anemia, and other reasons (the majority had Hb ≤ 8-8.5 g/dl, revealing scarce acceptance of low Hb values by pediatric hematologist). Mean starting dose was 15.5 mg/kg, and dose at full regimen was 17.1 mg/kg. Mean age at HU therapy was 7.68 years, although it was lower for SS/Sβ° patients. Only 10% started HU before 3 years. In 92%, 500 mg capsule was used; in 6%, the galenic was used; and in 2%, 100 mg tablet was used. Significant reduction of clinical events and inpatients admissions, with improvement in hematological parameters, was observed for SS/Sβ° patients and a trend toward improvement for SC/Sß+ patients was also observed. CONCLUSIONS HU effectiveness is demonstrated in a national cohort of children with SCD living in Italy, even at a lower dose than recommended, revealing good adherence to a treatment program by a socially vulnerable group of patients such as immigrants.
Collapse
Affiliation(s)
- Raffaella Colombatti
- Department of Child and Maternal Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Giovanni Palazzi
- Department of Child and Maternal Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università degli Studi di Modena, Modena, Italy
| | - Nicoletta Masera
- Department of Pediatric Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Elisa Bonetti
- Department of Pediatric Onco-Hematology, Azienda Ospedaliera Universitaria Integrata, Verona, Itlay
| | - Piera Samperi
- Department of Pediatric Hematology and Oncology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Silverio Perrotta
- Department of Woman, Child and General and Specialist Surgery, Università degli Studi della Campania "Luigi Vanvitelli,", Napoli, Italy
| | - Elena Facchini
- Clinic of Pediatric Hematology Oncology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maurizio Miano
- Haematology Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy
| | | | - Maria Elena Guerzoni
- Department of Child and Maternal Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università degli Studi di Modena, Modena, Italy
| | - Paola Corti
- Department of Pediatric Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Federica Menzato
- Department of Child and Maternal Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Simone Cesaro
- Department of Pediatric Onco-Hematology, Azienda Ospedaliera Universitaria Integrata, Verona, Itlay
| | - Maddalena Casale
- Department of Woman, Child and General and Specialist Surgery, Università degli Studi della Campania "Luigi Vanvitelli,", Napoli, Italy
| | - Paolo Rigano
- Campus of Haematology Franco e Piera Cutino-A.O.O.R. "Villa Sofia-Cervello,", Palermo, Italy
| | - Gian Luca Forni
- Hematology-Thalassemia and Congenital Anemia Center, Galliera Hospital, Genoa, Italy
| | - Giovanna Russo
- Department of Pediatric Hematology and Oncology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Sainati
- Department of Child and Maternal Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | | |
Collapse
|
6
|
Colombatti R, Perrotta S, Samperi P, Casale M, Masera N, Palazzi G, Sainati L, Russo G. Organizing national responses for rare blood disorders: the Italian experience with sickle cell disease in childhood. Orphanet J Rare Dis 2013; 8:169. [PMID: 24139596 PMCID: PMC4231397 DOI: 10.1186/1750-1172-8-169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/09/2013] [Indexed: 02/01/2023] Open
Abstract
Background Sickle cell disease (SCD) is the most frequent hemoglobinopathy worldwide but remains a rare blood disorder in most western countries. Recommendations for standard of care have been produced in the United States, the United Kingdom and France, where this disease is relatively frequent because of earlier immigration from Africa. These recommendations have changed the clinical course of SCD but can be difficult to apply in other contexts. The Italian Association of Pediatric Hematology Oncology (AIEOP) decided to develop a common national response to the rising number of SCD patients in Italy with the following objectives: 1) to create a national working group focused on pediatric SCD, and 2) to develop tailored guidelines for the management of SCD that could be accessed and practiced by those involved in the care of children with SCD in Italy. Methods Guidelines, adapted to the Italian social context and health system, were developed by 22 pediatric hematologists representing 54 AIEOP centers across Italy. The group met five times for a total of 128 hours in 22 months; documents and opinions were circulated via web. Results Recommendations regarding the prevention and treatment of the most relevant complications of SCD in childhood adapted to the Italian context and health system were produced. For each topic, a pathway of diagnosis and care is detailed, and a selection of health management issues crucial to Italy or different from other countries is described (i.e., use of alternatives for infection prophylaxis because of the lack of oral penicillin in Italy). Conclusions Creating a network of physicians involved in the day-to-day care of children with SCD is feasible in a country where it remains rare. Providing hematologists, primary and secondary care physicians, and caregivers across the country with web-based guidelines for the management of SCD tailored to the Italian context is the first step in building a sustainable response to a rare but emerging childhood blood disorder and in implementing the World Health Organization’s suggestion “to design (and) implement … comprehensive national integrated programs for the prevention and management of SCD".
Collapse
|
7
|
Purohit S, Alvarez O, O'Brien R, Andreansky S. Durable immune response to inactivated H1N1 vaccine is less likely in children with sickle cell anemia receiving chronic transfusions. Pediatr Blood Cancer 2012; 59:1280-3. [PMID: 22628221 DOI: 10.1002/pbc.24206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/02/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Defects in the immune system may affect vaccine responsiveness. Because of the splenic hypofunction and abnormal opsonic activity, it was unknown whether patients with sickle cell disease (SCD) would respond appropriately to H1N1 vaccination. The objective of this study was to assess seroprotective post-vaccine H1N1 antibody response in children with SCD. PROCEDURE Serum antibody titers were measured by hemagglutination inhibition and microneutralization (MN) assays. Correlations were established between clinical and treatment parameters and immune response. RESULTS Twenty-nine of 38 (76.3%) subjects (mean age 11 ± 5.4 years) had durable protective antibody titers 8 ± 1.6 months (range 5-12 months) post-vaccination. Lessened immune response was not associated with time interval from vaccination, splenectomy, or hydroxyurea treatment. Lack of antibody response was associated with age less than 3 years and treatment with chronic transfusions. Of the nine non-responders, seven were on chronic transfusions (39% unresponsiveness rate in the transfused group). The difference in the number of patients with seropositivity between the non-transfused and the transfused groups was statistically significant (P = 0.039). CONCLUSIONS Most subjects were able to mount an influenza-specific antibody response against the inactivated H1N1 vaccine. Similar to the general population, children less than 3 years were less likely to respond. In addition, patients on chronic transfusions were less likely to respond when compared to non-transfused children. Clinicians should be aware of the possibility of decreased vaccine response in patients with SCD on chronic transfusions. We postulate that transfusion-related immunomodulation (TRIM) may be related to decreased response.
Collapse
Affiliation(s)
- Saroj Purohit
- Division of Pediatric Hematology, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | | | | | | |
Collapse
|