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Turner EM, Cassidy AR, Rea KE, Smith-Paine JM, Wolfe KR. [Formula: see text] The multifaceted role of neuropsychology in pediatric solid organ transplant: preliminary guidelines and strategies for clinical practice. Child Neuropsychol 2024; 30:503-537. [PMID: 37291962 DOI: 10.1080/09297049.2023.2221759] [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: 11/23/2022] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
The incidence of pediatric solid organ transplantation (SOT) has increased in recent decades due to medical and surgical advances as well as improvements in organ procurement. Survival rates for pediatric kidney, liver, and heart transplantation are above 85% but patients continue to experience complex healthcare needs over their lifetime. Long-term developmental and neuropsychological sequelae are becoming increasingly recognized in this population, although preliminary work is limited and deserves further attention. Neuropsychological weaknesses are often present prior to transplantation and may be related to underlying congenital conditions as well as downstream impact of the indicating organ dysfunction on the central nervous system. Neuropsychological difficulties pose risk for functional complications, including disruption to adaptive skill development, social-emotional functioning, quality of life, and transition to adulthood. The impact of cognitive dysfunction on health management activities (e.g., medication adherence, medical decision-making) is also an important consideration given these patients' lifelong medical needs. The primary aim of this paper is to provide preliminary guidelines and clinical strategies for assessment of neuropsychological outcomes across SOT populations for pediatric neuropsychologists and the multidisciplinary medical team, including detailing unique and shared etiologies and risk factors for impairment across organ types, and functional implications. Recommendations for clinical neuropsychological monitoring as well as multidisciplinary collaboration within pediatric SOT teams are also provided.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly E Rea
- Division of Pediatric Psychology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Julia M Smith-Paine
- Division of Developmental-Behavioral Pediatrics & Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
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Ryan RE, Silke C, Parkhill A, Virgona A, Merner B, Hurley S, Walsh L, de Moel-Mandel C, Schonfeld L, Edwards AG, Kaufman J, Cooper A, Chung RKY, Solo K, Hellard M, Di Tanna GL, Pedrana A, Saich F, Hill S. Communication to promote and support physical distancing for COVID-19 prevention and control. Cochrane Database Syst Rev 2023; 10:CD015144. [PMID: 37811673 PMCID: PMC10561351 DOI: 10.1002/14651858.cd015144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response. OBJECTIVES To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing. SECONDARY OBJECTIVE to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups. SEARCH METHODS We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021). SELECTION CRITERIA Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review. DATA COLLECTION AND ANALYSIS Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework. MAIN RESULTS This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures. AUTHORS' CONCLUSIONS Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.
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Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Charlotte Silke
- UNESCO Child & Family Research Centre, School of Political Science & Sociology, University of Galway, Galway, Ireland
| | - Anne Parkhill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Shauna Hurley
- Cochrane Australia, School of Public Health & Preventive Medicine, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Australia
- Burnet Institute, Melbourne, Australia
| | | | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Adrian Gk Edwards
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Vaccine Uptake Group, Murdoch Children's Research Institute , The Royal Children's Hospital, Parkville, Australia
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | | | - Karla Solo
- GRADE McMaster & Cochrane Canada, Health Research Methods, Evidence & Impact, McMaster University , Hamilton, Ontario , Canada
| | | | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Zhan Z, Li Y, Yuan X, Chen Q. To Be or Not to Be: Parents’ Willingness to Send Their Children Back to School After the COVID-19 Outbreak. THE ASIA-PACIFIC EDUCATION RESEARCHER 2022. [PMCID: PMC8340808 DOI: 10.1007/s40299-021-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the factors that parents considered when sending their children back to school after the COVID-19 outbreak and analyzed the dilemma that parents were facing. A total of 1067 questionnaires were collected through snowball sampling. After three levels of coding based on Grounded Theory and Field Theory, parents’ key concerns were categorized as four personal factors (i.e., intuitive expectation, health issue, learning effectiveness, perceived epidemic safety) and three environmental factors (i.e., school environment, family environment, social environment). By factor weight analysis using the Kruskal–Wallis H test, a field model of factors that affect parents’ willingness was set up. Results indicated that learning effectiveness is the most critical factor affecting parents’ willingness. By considering both personal and environmental factors, most parents were not satisfied with the effect of home-based online education and expressed their willingness to send their children back to school and resume classes; however, they also worried about students’ epidemic awareness and self-protection abilities. Students’ development highly depends on the social atmosphere, a regular schedule, and environmental support from schools, which can hardly be achieved by home-based online learning. The findings suggest that the joint efforts of society, schools, and families are needed on the issue of students returning to school after the COVID-19 outbreak.
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Downes KJ, Statler VA, Orscheln RC, Cousino MK, Green M, Michaels MG, Muller WJ, Sharma TS, Danziger-Isakov LA, Ardura MI. Return to School and COVID-19 Vaccination for Pediatric Solid Organ Transplant Recipients in the United States: Expert Opinion for 2021-2022. J Pediatric Infect Dis Soc 2022; 11:43-54. [PMID: 34734268 PMCID: PMC8689907 DOI: 10.1093/jpids/piab098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic continues to generate challenges for pediatric solid organ transplant (SOT) recipients and their families. As rates of COVID-19 fluctuate, new SARS-CoV-2 variants emerge, and adherence to and implementation of mitigation strategies vary from community to community, questions remain about the best and safest practices to prevent COVID-19 in vulnerable patients. Notably, decisions about returning to school remain difficult. We assembled a team of specialists in pediatric infectious diseases, transplant infectious diseases, public health, transplant psychology, and infection prevention and control to re-address concerns about school re-entry, as well as COVID-19 vaccines, for pediatric SOT recipients in the United States in 2021. Based on available literature and guidance from national organizations, we generated expert statements specific to pediatric SOT recipients focused on school attendance in 2021.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria A Statler
- Division of Infectious Diseases, Norton Children’s Hospital, Louisville, Kentucky, USA
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Rachel C Orscheln
- Division of Pediatric Infectious Diseases, St. Louis Children’s Hospital, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University, St. Louis, Missouri, USA
| | - Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Ann Arbor, Michigan, USA
| | - Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William J Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanvi S Sharma
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lara A Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Monica I Ardura
- Division of Infectious Diseases and Host Defense, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Abdellatif AA, Mogawer MS, El- Shazli M, El-Karaksy H, Salah A, Abdel-Maqsod A, El-Amir M, Said M, Zayed N, Hosny K, Eldeen HG, Osman AMA, Mansour DA, Nabil A, Abdel-Ghani A, Mogahed EA, Yasin NA. Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience. EGYPTIAN LIVER JOURNAL 2021; 11:92. [PMID: 34956680 PMCID: PMC8686346 DOI: 10.1186/s43066-021-00153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities. OBJECTIVES To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced. MATERIAL AND METHODS This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs). RESULTS In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation. CONCLUSION Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.
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Affiliation(s)
- Abeer Awad Abdellatif
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mohamad Sherif Mogawer
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mostafa El- Shazli
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa El-Karaksy
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Ayman Salah
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amany Abdel-Maqsod
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mona El-Amir
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Mohamed Said
- Endemic Medicine, Hepatogastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Naglaa Zayed
- Endemic Medicine Department, Liver Transplantation unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim Hosny
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Hadeel Gamal Eldeen
- Endemic Hepatology and Gastroenterology, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M. A. Osman
- General & HPB Surgery, Department of General Surgery, Unit of Hepatobiliary Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa A. Mansour
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Nabil
- Department of General Surgery, Liver Transplantation Unit, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdel-Ghani
- Hepatogastroenterology, Liver Transplantation Unit, Internal Medicine Department, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Street, Cairo, PO: 11451 Egypt
| | - Engy A. Mogahed
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
| | - Noha A. Yasin
- Pediatrics Department, Liver Transplantation Unit, Cairo University, Cairo, Egypt
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Talgam-Horshi E, Mozer-Glassberg Y, Waisbourd-Zinman O, Ashkenazi-Hoffnung L, Haskin O, Levi S, Hamdani G, Landau D, Alfandary H. Clinical Outcomes and Antibody Response in COVID-19-Positive Pediatric Solid Organ Transplant Recipients. Pediatr Infect Dis J 2021; 40:e514-e516. [PMID: 34382612 PMCID: PMC8575083 DOI: 10.1097/inf.0000000000003293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
We describe the clinical and laboratory manifestations and outcomes of 25 pediatric solid organ transplant recipients who tested positive for severe acute respiratory coronavirus-2. Twenty-one (84%) developed a mild disease; 22 of 23 (96%) had a positive serologic response. Two patients (8%), both kidney transplant recipients with additional comorbidities, developed a severe disease. The findings emphasize the need for close monitoring of this population.
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Affiliation(s)
- Efrat Talgam-Horshi
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Yael Mozer-Glassberg
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
- Institute of Gastroenterology, Nutrition, and Liver Disease
| | - Orit Waisbourd-Zinman
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
- Institute of Gastroenterology, Nutrition, and Liver Disease
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Day Hospitalization Department
- Pediatric Infectious Diseases Unit
| | - Orly Haskin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Shelly Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Gilad Hamdani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Daniel Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Hadas Alfandary
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
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Forner-Puntonet M, Castell-Panisello E, Quintero J, Ariceta G, Gran F, Iglesias-Serrano I, Gisbert-Gustemps L, Daigre C, Ibañez-Jimenez P, Delgado M, Español-Martín G, Parramon G, Pont T, Ramos-Quiroga JA. Impact of COVID-19 on Families of Pediatric Solid Organ Transplant Recipients. J Pediatr Psychol 2021; 46:927-938. [PMID: 34313783 PMCID: PMC8344614 DOI: 10.1093/jpepsy/jsab058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic and lockdown measures have had a clear psychological impact on families, and specifically those with children with chronic illnesses have reported greater overloads and exhaustion. The objective of this study was to evaluate the exposure, impact and experience of the pandemic on families of pediatric solid organ transplant (SOT) recipients compared to families of healthy children and adolescents. METHODS We recruited 96 families, 48 with a pediatric SOT recipient and 48 healthy controls, matched by child age and gender. A primary caregiver from each family responded to an online sociodemographic questionnaire and the COVID-19 Exposure and Family Impact Survey (CEFIS), which explores the exposure, impact and experience of the pandemic and lockdown on families. RESULTS Exposure to the pandemic was greater in families of healthy children and adolescents. The impact was mostly negative in both groups: caregivers reported increased anxiety (76%) and mood disturbances (71.9%) and hindered quality of sleep (64.6%) and health habits (58.3%). On the positive side, family relationships improved. Qualitatively, the SOT group positively perceived isolation and established hygienic measures as protective and destigmatizing, although they reported fear of virus transmission to their child. CONCLUSIONS The psychological impact of the pandemic has been similar in both groups, although families of transplant recipients have protected themselves more, probably because they are used to prevention measures and they see contagion as a graver risk. Additionally, SOT recipients' families presented some idiosyncratic elements, especially a decrease in their perception of stigma associated with the medical condition.
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Affiliation(s)
- Mireia Forner-Puntonet
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
| | | | - Jesús Quintero
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - Gema Ariceta
- Pediatric Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona
| | - Ferran Gran
- Pediatric Cardiology Department, Hospital Universitari Vall d’Hebron
| | | | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Pol Ibañez-Jimenez
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
| | | | - Gemma Español-Martín
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
| | - Gemma Parramon
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
| | - Teresa Pont
- Department of Donor and Transplant Coordination, Hospital Universitari Vall d'Hebron
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona
- Biomedical Network Research Centre on Mental Health (CIBERSAM)
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Varnell C, Harshman LA, Smith L, Liu C, Chen S, Al‐Akash S, Barletta G, Belsha C, Brakeman P, Chaudhuri A, Fadakar P, Garro R, Gluck C, Goebel J, Kershaw D, Matossian D, Nailescu C, Patel HP, Pruette C, Ranabothu S, Rodig N, Smith J, Sebestyen VanSickle J, Weng P, Danziger‐Isakov L, Hooper DK, Seifert M. COVID‐19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative. Am J Transplant 2021. [DOI: 10.1111/ajt.16501 10.1111/ajt.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Varnell
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | | | - Laurie Smith
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | - Chunyan Liu
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | - Shiran Chen
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | | | | | - Craig Belsha
- SSM Health Cardinal Glennon Children's Hospital Saint Louis Missouri
| | - Paul Brakeman
- Department of Pediatrics University of California San Francisco California
| | - Abanti Chaudhuri
- Lucile Packard Children’s HospitalStanford University Stanford California
| | - Paul Fadakar
- UPMC Children’s Hospital of Pittsburgh Pittsburgh Pennsylvania
| | - Rouba Garro
- Children’s Healthcare of AtlantaEmory School of Medicine Atlanta Georgia
| | - Caroline Gluck
- Nemours/Alfred I. duPont Hospital for Children Wilmington Delaware
| | - Jens Goebel
- Children’s Hospital Colorado Aurora Colorado
| | | | - Debora Matossian
- Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois
| | - Corina Nailescu
- Riley Hospital for Children at Indiana University Health Indianapolis Indiana
| | | | - Cozumel Pruette
- Johns Hopkins University School of Medicine Baltimore Maryland
| | | | - Nancy Rodig
- Boston Children’s HospitalHarvard Medical School Boston Massachusetts
| | - Jodi Smith
- Seattle Children’s Hospital Seattle Washington
| | | | - Patricia Weng
- UCLA Mattel Children’s Hospital Los Angeles California
| | - Lara Danziger‐Isakov
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | - David K. Hooper
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | - Michael Seifert
- University of Alabama at BirminghamChildren’s of Alabama Birmingham Alabama
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9
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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10
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Varnell Jr C, Harshman LA, Smith L, Liu C, Chen S, Al-Akash S, Barletta GM, Belsha C, Brakeman P, Chaudhuri A, Fadakar P, Garro R, Gluck C, Goebel J, Kershaw D, Matossian D, Nailescu C, Patel HP, Pruette C, Ranabothu S, Rodig N, Smith J, Sebestyen VanSickle J, Weng P, Danziger-Isakov L, Hooper DK, Seifert M. COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative. Am J Transplant 2021; 21:2740-2748. [PMID: 33452854 PMCID: PMC8013281 DOI: 10.1111/ajt.16501] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 01/25/2023]
Abstract
There are limited data on the impact of COVID-19 in children with a kidney transplant (KT). We conducted a prospective cohort study through the Improving Renal Outcomes Collaborative (IROC) to collect clinical outcome data about COVID-19 in pediatric KT patients. Twenty-two IROC centers that care for 2732 patients submitted testing and outcomes data for 281 patients tested for SARS-CoV-2 by PCR. Testing indications included symptoms and/or potential exposures to COVID-19 (N = 134, 47.7%) and/or testing per hospital policy (N = 154, 54.8%). Overall, 24 (8.5%) patients tested positive, of which 15 (63%) were symptomatic. Of the COVID-19-positive patients, 16 were managed as outpatients, six received non-ICU inpatient care and two were admitted to the ICU. There were no episodes of respiratory failure, allograft loss, or death associated with COVID-19. To estimate incidence, subanalysis was performed for 13 centers that care for 1686 patients that submitted all negative and positive COVID-19 results. Of the 229 tested patients at these 13 centers, 10 (5 asymptomatic) patients tested positive, yielding an overall incidence of 0.6% and an incidence among tested patients of 4.4%. Pediatric KT patients in the United States had a low estimated incidence of COVID-19 disease and excellent short-term outcomes.
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Affiliation(s)
- Charles Varnell Jr
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laurie Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Chunyan Liu
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Shiran Chen
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Craig Belsha
- SSM Health Cardinal Glennon Children’s Hospital, Saint Louis, Missouri
| | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, California
| | - Abanti Chaudhuri
- Lucile Packard Children’s Hospital, Stanford University, Stanford, California
| | - Paul Fadakar
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rouba Garro
- Children’s Healthcare of Atlanta, Emory School of Medicine, Atlanta, Georgia
| | - Caroline Gluck
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jens Goebel
- Children’s Hospital Colorado, Aurora, Colorado
- Present address Jens Goebel, Helen DeVos Children’s Hospital, Grand Rapids, MichiganMichigan, USA
| | | | - Debora Matossian
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Corina Nailescu
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | | | - Cozumel Pruette
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nancy Rodig
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jodi Smith
- Seattle Children’s Hospital, Seattle, Washington
| | | | - Patricia Weng
- UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Lara Danziger-Isakov
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David K. Hooper
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael Seifert
- University of Alabama at Birmingham, Children’s of Alabama, Birmingham, Alabama
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11
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Marlais M, Wlodkowski T, Al-Akash S, Ananin P, Bandi VK, Baudouin V, Boyer O, Vásquez L, Govindan S, Hooman N, Ijaz I, Loza R, Melgosa M, Pande N, Pape L, Saha A, Samsonov D, Schreuder MF, Sharma J, Siddiqui S, Sinha R, Stewart H, Tasic V, Tönshoff B, Twombley K, Upadhyay K, Vivarelli M, Weaver DJ, Woroniecki R, Schaefer F, Tullus K. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Arch Dis Child 2021; 106:798-801. [PMID: 33355203 PMCID: PMC7754669 DOI: 10.1136/archdischild-2020-320616] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity. METHODS Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19. RESULTS 113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications. CONCLUSIONS This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.
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Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Samhar Al-Akash
- Driscoll Children's Kidney Center, Driscoll Children's Hospital, Corpus Christi, Texas, USA
| | - Petr Ananin
- Pediatric Nephrology, National Medical Research Center for Children's Health, Moscow, Russian Federation
| | - Varun Kumar Bandi
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and RF, Vijayawada, India
| | | | - Olivia Boyer
- Service de Néphrologie pédiatrique, Centres de référence MARHEA et SNI, Université de Paris, Inserm U1163, Hôpital Necker-Enfants malades, AP-HP, Paris, France
| | - Luciola Vásquez
- Pediatric Nephrology Transplant Department, G.Almenara Hospital, Lima, Peru
| | - Sukanya Govindan
- Department of Paediatric Nephrology, Mehta Multispecialty Hospitals, Chennai, India
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Aliasghar Children hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran (the Islamic Republic of)
| | - Iftikhar Ijaz
- Children's Kidney Centre, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Reyner Loza
- Nephrology Paediatric Unit, Department of Pediatrícs, Cayetano Heredia National Hospital, Lima, Peru
| | - Marta Melgosa
- Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
| | - Nivedita Pande
- Department of Pediatrics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India
| | - Lars Pape
- Department of Paediatrics II, University Hospital Essen, Essen, Germany
| | - Anshuman Saha
- Pediatric Nephrology, Institute Of Kidney Diseases And Research Center And Institute Of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | | | | | | | - Sahar Siddiqui
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Rajiv Sinha
- ICH, Institute of Child Health, Kolkata, India
| | - Heather Stewart
- Dwaine & Cynthia Willet Children's Hospital, Savannah, Georgia, USA
| | - Velibor Tasic
- Paediatric Nephrology, University Children's Hospital, Skopje, North Macedonia
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | | | - Kiran Upadhyay
- Division of Pediatric Nephrology, University of Florida, Gainesville, Florida, USA
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Donald J Weaver
- Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children's, Charlotte, North Carolina, USA
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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12
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Milani GP, Casazza G, Corsello A, Marchisio P, Rocchi A, Colombo G, Agostoni C, Costantino G. Early evidence of SARS-CoV-2 in Milan, Jan-Feb 2020. Ital J Pediatr 2021; 47:145. [PMID: 34193222 PMCID: PMC8243623 DOI: 10.1186/s13052-021-01095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A few studies have suggested that the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was present in Northern Italy several weeks before its official detection on February 21, 2020. On the other hand, no clinical data have been provided so far to support such hypothesis. We investigated clinical-epidemiological evidence of SARS-CoV-2 infection among children and adults referring to emergency department (ED) in the main hospital of the center of Milan (Italy) before February 21, 2020. METHODS A retrospective analysis of medical records of ED visits at the Fondazione Ca' Granda Policlinico, Milan between January 11 and February 15 in 2017, 2018, 2019 and in 2020 was performed. The number of subjects referring with fever, cough or dyspnea was compared between the studied period of 2020 and the previous 3 years, by calculating a standardized referral ratio (SRR, number of observed cases in 2020 divided by the number of expected cases according to 2017-2019) and the corresponding 95% confidence interval (CI). RESULTS In the pediatric ED, 7709 (average 2570/year) and 2736 patients were visited during the period 2017-2019 and in the 2020, respectively. Among adults, 13,465 (average 4488/year) and 4787 were visited during the period 2017-2019 and in the 2020, respectively. The SRR was 1.16 (95% CI 1.10-1.23) in children and 1.25 (95% CI 1.16-1.35) in adults. The ratio for the two (children and adults) SRRs was 0.93 (0.84-1.02), suggesting a trend towards a higher frequency in adults compared to children. CONCLUSIONS This study suggests that SARS-CoV-2 might have spread in Milan before February 21, 2020 with a minor trend among children.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Colombo
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy. .,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.
| | - Giorgio Costantino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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13
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Kehar M, Ebel NH, Ng VL, Baquero JER, Leung DH, Slowik V, Ovchinsky N, Shah AA, Arnon R, Miloh T, Gupta N, Mohammad S, Kogan-Liberman D, Squires JE, Sanchez MC, Hildreth A, Book L, Chu C, Alrabadi L, Azzam R, Chepuri B, Elisofon S, Falik R, Gallagher L, Kader H, Mogul D, Mujawar Q, Namjoshi SS, Valentino PL, Vitola B, Waheed N, Zheng MH, Lobritto S, Martinez M. Severe Acute Respiratory Syndrome Coronavirus-2 Infection in Children With Liver Transplant and Native Liver Disease: An International Observational Registry Study. J Pediatr Gastroenterol Nutr 2021; 72:807-814. [PMID: 33605666 PMCID: PMC8183254 DOI: 10.1097/mpg.0000000000003077] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/06/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry. METHODS In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020. RESULTS Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death). CONCLUSIONS Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.
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Affiliation(s)
- Mohit Kehar
- Queen's University, Kingston
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Stanford University, Stanford, CA
| | | | - Vicky L. Ng
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Amit A. Shah
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Nitika Gupta
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | - Linda Book
- Primary Children's Hospital, Salt Lake City, UT
| | | | | | | | | | | | - Rachel Falik
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Lisa Gallagher
- University of California, San Francisco, San Francisco, CA
| | - Howard Kader
- University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Nadia Waheed
- Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Ming-Hua Zheng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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14
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Milani GP, Marchisio P, Rocchi A, Bertolozzi G, Furlan L, La Vecchia A, Agostoni C, Costantino G. Frequency of asymptomatic carriers of SARS-CoV-2 among children and adults after school reopening. Ital J Pediatr 2021; 47:65. [PMID: 33712061 PMCID: PMC7953180 DOI: 10.1186/s13052-021-01016-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Children often develop an asymptomatic form of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but it is debated if children are at higher risk than adults to be asymptomatic carriers of SARS-CoV-2, especially during the school reopening. The main aim of this study was to investigate the frequency of SARS-CoV-2 asymptomatic carriers in children and adults during the reopening of the schools in Milan, Italy. Methods We conducted a cross-sectional study at the pediatric and adult Emergency Department (ED) of the Ca' Granda Ospedale Maggiore Policlinico (Milan) between October 1 and 31, 2020, i.e. 3 weeks after the reopening of schools. Patients admitted to the ED short stay observation and without any sign or symptom consistent with a SARS-CoV-2 were eligible. These patients underwent a nasopharyngeal swab specimen for the detection of SARS-CoV-2. The odds ratio and its 95% confidence interval (CI) was calculated to assess the risk of asymptomatically carrying the SARS-CoV-2 infection in children and adults. Results A total of 69 (27 females, median age 8.7 years) children and 251 (107 females, median age 71 years) adults were enrolled. Pediatric and adult subjects tested positive for SARS-CoV-2 with a similar frequency (1/69 [1.4%] vs 4/251 [1.6%]). Children had an odds ratio to be a carrier of 0.91 (CI 0.02– 9.38) compared to adults. Conclusions The frequency of asymptomatic SARS-CoV-2 carriers was similar among children and adults. Considering the emerging diffusion of new SARS-CoV-2 variants, the asymptomatic spread of SARS-CoV-2 infection among children and adults should be monitored.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessia Rocchi
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Bertolozzi
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ludovico Furlan
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Adriano La Vecchia
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. .,Department of Clinical Science and Community Health, University of Milan, Milan, Italy. .,Dipartimento di Emergenza e Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giorgio Costantino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Dipartimento di Emergenza e Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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Lo Moro G, Sinigaglia T, Bert F, Savatteri A, Gualano MR, Siliquini R. Reopening Schools during the COVID-19 Pandemic: Overview and Rapid Systematic Review of Guidelines and Recommendations on Preventive Measures and the Management of Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8839. [PMID: 33261208 PMCID: PMC7731329 DOI: 10.3390/ijerph17238839] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
Given the limited evidence of school closure effectiveness in containing the pandemic and the consequences for young people, reopening schools with appropriate measures is essential. This overview aimed to describe the main measures planned for the 2020-2021 academic year within the WHO European Region. A rapid systematic review of scientific databases was also performed. The websites of the government, Ministry of Health, and Ministry of Education of European Region countries were searched through 1 October for official documents about the prevention and management of suspected cases/confirmed cases in primary and secondary schools. To find further suggestions, a rapid systematic review was conducted through 20 October searching Pubmed, Scopus, and Embase. There were 23 official documents. France, Luxembourg, Malta, Ireland, Italy, Portugal, the UK, Spain, and San Marino were considered. Performing the rapid review, 855 records were identified and 7 papers were finally selected. The recommendations mostly agreed. However, there was no consensus on the criteria for the return to school of students that tested positive, and the flexibility between attendance at school and remote education for high-risk children often varied. School closure was commonly considered as the very last resort for COVID-19 control. Studies are required to evaluate the impact of different recommendations during this autumn term.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
| | - Tiziana Sinigaglia
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
| | - Fabrizio Bert
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
- AOU City of Health and Science of Turin, 10126 Torino, Italy
| | - Armando Savatteri
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
| | - Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
| | - Roberta Siliquini
- Department of Public Health Sciences and Paediatrics, University of Torino, 10126 Torino, Italy; (G.L.M.); (T.S.); (A.S.); (M.R.G.); (R.S.)
- AOU City of Health and Science of Turin, 10126 Torino, Italy
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16
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Teoh CW, Gaudreault-Tremblay MM, Blydt-Hansen TD, Goldberg A, Arora S, Feber J, Langlois V, Ruhl M, Phan V, Morgan C, Acott P, Hamiwka L. Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group. Can J Kidney Health Dis 2020; 7:2054358120967845. [PMID: 33240516 PMCID: PMC7672730 DOI: 10.1177/2054358120967845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM To provide guidance on the management of pediatric kidney transplant patients during the COVID-19 pandemic. SOURCES OF INFORMATION Program-specific documents, preexisting, and related to COVID-19; documents from provincial, national, and international kidney transplant societies/agencies and organ procurement agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. METHODS Challenges in the care of pediatric kidney transplant patients during the COVID-19 pandemic were highlighted within the Canadian Society of Transplantation (CST) Pediatric Group. It identified pediatric kidney transplant nephrologists (including a pediatric nephrologist ethicist) across the country and formed a workgroup. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via e-mail and virtual meetings. Disagreements were resolved by consensus. The document was reviewed by the CST Kidney Transplant Working Group, by the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team (RRT), and an infectious disease expert. The suggestions were presented at an interactive webinar sponsored by CSN in collaboration with the CST and Canadian Association of Pediatric Nephrologists (CAPN), and attended by pediatric kidney health care professionals for further peer input. Final revisions were made based on feedback received. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. KEY FINDINGS We identified 8 key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic: (1) transplant activity, (2) outpatient clinic activity, (3) monitoring, (4) multidisciplinary care, (5) medications (immunosuppression and others), (6) patient/family education/support, (7) school and employment, and (8) management of pediatric kidney transplant patients who are COVID-19 positive. We make specific suggestions for each of these areas. LIMITATIONS A full systematic review of available literature was not undertaken for the sake of expediency in development of this guideline. There is a paucity of literature to support evidence-based recommendations at this time. Instead, these guidelines were formulated based on expert opinion derived from available knowledge/experience and are subject to the biases associated with this level of evidence. The parallel review process that was created to expedite the publication of this work may not be as robust as standard arms' length peer review processes. IMPLICATIONS These recommendations are meant to serve as a guide to pediatric kidney transplant directors, clinicians, and administrators for providing the best patient care in the context of limited resources while protecting patients and health care providers wherever possible by limiting exposure to COVID-19. We recognize that recommendations may not be applicable to all provincial/local health authority practices and that they may not be delivered to all patients given the time and resource constraints affecting the individual provincial/local health jurisdiction.
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Affiliation(s)
- Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | | | - Tom D. Blydt-Hansen
- Division of Nephrology, BC Children’s Hospital, Vancouver, Canada
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Aviva Goldberg
- Division of Nephrology, The Children’s Hospital of Winnipeg, MB, Canada
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Steven Arora
- Division of Nephrology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Janusz Feber
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- Department of Paediatrics, University of Ottawa, ON, Canada
| | - Valerie Langlois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | - Michelle Ruhl
- Division of Nephrology, Jim Pattison Children’s Hospital, Saskatoon, SK, Canada
- Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Veronique Phan
- Division of Nephrology, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Paediatrics, University de Montreal, QC, Canada
| | - Catherine Morgan
- Division of Nephrology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, Canada
| | - Philip Acott
- Division of Nephrology, IWK Health Centre, Halifax, NS, Canada
- Department of Paediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lorraine Hamiwka
- Division of Nephrology, Alberta Children’s Hospital, Calgary, Canada
- Department of Paediatrics, University of Calgary, AB, Canada
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Lobritto S, Danziger-Isakov L, Michaels MG, Mazariegos GV. Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs. Front Pediatr 2020; 8:612627. [PMID: 33363069 PMCID: PMC7758251 DOI: 10.3389/fped.2020.612627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has dramatically altered the health care landscape and disrupted global health and world economics in ways that are still being measured. Its impact on children with chronic conditions or those undergoing transplantation is evolving. The organ specific manifestations in children will be reviewed and treatment strategies outlined. The impact on pediatric transplantation in the United States over the initial 6 months of the pandemic has shown significant regional variation and lags persist in resumption of normal transplant activity, particularly for living related transplantation. Finally, guidelines regarding return to school will be discussed.
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Affiliation(s)
- Steven Lobritto
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Lara Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | - Marian G Michaels
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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18
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Nailescu C, Khalid M, Wilson AC, Amanat F, Arregui S, Canas J, Hooks J, Krammer F, Schwaderer AL, Hains DS. Assessment of Seroconversion to SARS-CoV-2 in a Cohort of Pediatric Kidney Transplant Recipients. Front Pediatr 2020; 8:601327. [PMID: 33194930 PMCID: PMC7661782 DOI: 10.3389/fped.2020.601327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The occurrence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated coronavirus disease 2019 (COVID-19) have profoundly affected adult kidney disease patients. In contrast, pediatric solid organ transplant recipients, including pediatric kidney transplant (KT) recipients, do not seem to be at particularly higher risk for SARS-CoV-2 infection or for severe COVID-19 disease. This patient population might be protected by certain mechanisms, such as the immunosuppressive medications with their anti-inflammatory properties or simply being well-versed in self-protection techniques. Assessing SARS-CoV-2 antibody serologies could potentially help understand why this patient population is apparently spared from severe SARS-CoV-2 clinical courses. Objective: To examine SARS-CoV-2 serologic status in a cohort of pediatric KT recipients. Methods: SARS-CoV-2 anti-spike IgG and IgM antibodies were measured by three different methods in pediatric KT recipients coming for routine clinic visits immediately post-confinement in May-June of 2020. The patients were considered seroconverted if SARS-CoV-2 antibodies were positive by 2/3 methods and weak positive/indeterminate if positive by 1/3. Results: Thirty-one patients were evaluated (about 1/3 of our institution's pediatric KT population). One patient seroconverted, while three were considered weak positive/indeterminate. None were symptomatic and none had nasopharyngeal PCR confirmed SARS-CoV-2 disease. Conclusions: Seroconversion to SARS-CoV-2 was rare in this population and likely reflects the social distancing practiced by these patients. The results will serve as a foundation for a future longitudinal study to evaluate the long-term emergence and persistence of antibodies in this population and may inform studies of response to a future vaccine.
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Affiliation(s)
- Corina Nailescu
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Myda Khalid
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Amy C Wilson
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, United States
| | - Samuel Arregui
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jorge Canas
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jenaya Hooks
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, United States
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - David S Hains
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
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