Vaccine preventable infections and multiple organ dysfunction syndrome in critically ill children in China

Admissions due to vaccine preventable diseases in a large paediatric intensive care unit in Greece over a 10-year period

AIM

Childhood immunisation is an important preventive measure. However, care givers may delay routine immunisations or seek exemptions from state vaccine mandates. Vaccine refusal creates barriers on vaccine coverage and leads to morbidity and mortality.

METHODS

Our study reviews morbidity and mortality from vaccine preventable diseases (VPDs) in a large paediatric intensive care unit in Greece over a 10-year period.

RESULTS

During the study period, 73 cases of VPDs were recorded, corresponding to 3.5% of total paediatric intensive care unit admissions. Influenza was the most prevalent VPD, followed by pneumococcal disease, measles, pertussis and meningococcal disease. Most patients (83.3%) were unvaccinated for the admission's VPD. Outcome was unfavourable for 31.9% of the patients (17 children died, 6 developed chronic impairment).

CONCLUSION

Absent or incomplete vaccination may result in serious morbidity and mortality from preventable diseases. Strengthening vaccination strategies are needed to improve individual protection as well as herd immunity.

Missed vaccinations and critical care admission: all you may wish to know or rediscover-a narrative review

Most vaccines are so effective that they could lead to the control/elimination of the diseases they target and directly impact on intensive care admissions or complications. This is best illustrated by the use of vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, zoster, yellow fever, Ebola virus, influenza or measles-but also by third party strategies such as maternal, toddler and care-giver immunization. However, each of these vaccine-induced protection is threatened by insufficient vaccine uptake. Here, we briefly discuss how vaccine hesitancy has led to the resurgence of diseases that were considered as controlled and explore the effect of vaccine-hesitant healthcare workers on nosocomial infections. As intensive care physicians are in charge of polymorbid patients, we briefly summarize the current recommendations for vaccinations in high-risk patients. We finally give some perspective on ongoing research, and discuss how institutional policies and intensive care physicians could play a role in increasing the impact of vaccination, overall and in intensive care units.

Global advocacy needed for sepsis in children

Sepsis in children is a complex syndrome that develops from various infections and results in 15-30% mortality in high-income countries and up to 50% or higher in low-income countries. Worldwide, this represents an annual burden of 30 million cases resulting in 8 million deaths. Not surprisingly, there is a significantly higher burden in low-income countries with children there being 18 times more likely to die before the age of 5 years compared to high-income countries. Factors such as commercial air travel, climate change, and unchecked population growth have contributed to the growing burden of infectious diseases and ensuing sepsis. In this article, we review the important role of global advocacy to improve public awareness of sepsis; increase access to essential medicines and vaccines; improve use of evidence-based treatment guidelines; raise awareness of antimicrobial resistance and encourage antibiotic stewardship; and, develop resilient health systems that can cope with health crises. Advocacy in these areas can assist nations in reaching the United Nations sustainable development goals (UN SDGs) of low rates of neonatal and under-5 mortality.

Risk factors and outcomes for pandemic H1N1 influenza compared with seasonal influenza in hospitalized children in China

OBJECTIVE

To compare clinical features and outcomes of children hospitalized in China with pandemic (p)H1N1 between 2009 and 2010 versus seasonal influenza A between 2008 and 2009.

METHODS

Systematic review of laboratory-confirmed admissions to the Children's Hospital, Soochow University (Suzhou, China).

RESULTS

Seventy-five children younger than 14 years of age were admitted with pH1N1, 70 with H3N2 and three with seasonal H1N1. With pH1N1, the mean age was older (36 months versus seven months), the length of stay was longer (nine days versus seven days), underlying conditions were more common (29% versus 15%), anemia was more common (11% versus 0%) (P<0.05), with trends toward more secondary bacterial pneumonia and intensive care unit care, compared with seasonal influenza. Two of the 75 children with pH1N1 died versus no deaths in children with seasonal influenza. None of the children had received pH1N1, seasonal influenza, conjugated pneumococal or Haemophilus influenzae b vaccines.

CONCLUSION

In China, children hospitalized with pH1N1 influenza differed from case series in Canada, Argentina and the United States, suggesting that locale, background and health care system influenced the presentation and outcomes of pandemic and seasonal influenza.

Vaccine preventable community-acquired pneumonia in hospitalized children in Northwest China

BACKGROUND

Community-acquired pneumonia (CAP) is a major cause of morbidity in industrialized countries and morbidity/mortality in developing countries. In China, comprehensive studies of the etiology of CAP in children aged between 2 months and 14 years who are serious enough to require hospitalization are lacking. Previous studies have been limited in child age range, focused on fatal cases, and/or limited in etiologies sought. An understanding of the etiologies is needed for development of best prevention and management practices.

OBJECTIVE

The aim of this study was to prospectively determine during a 12-month period the etiology of CAP in hospitalized children in a center in Northwest China.

DESIGN/METHODS

A prospective 12-month study (2004-2005) of CAP cases in children who were 2 months to 14 years of age admitted to the Second Hospital of Lanzhou University, China. Testing included admission and 1-month postdischarge serum for viral and bacterial serologic analyses (respiratory syncytial virus, influenza A and B, paraflu 1-3, adenovirus; Streptococcus pneumoniae, Haemophilus influenza B, Mycoplasma, and Moraxella. catarrhalis), blood culture, a nasopharyngeal aspirate for viral antigen testing, and a chest radiograph on admission and 1 month postdischarge. The study was funded by Lanzhou University. The study was performed in compliance with the guidelines of the institutional review board of the Second Hospital of Lanzhou University.

RESULTS

CAP was the admitting diagnosis for 29% of all admissions during the 12-month study. Of the 884 CAP cases, 821 (93%) were enrolled and completed the study. The age range was 2 months to 14 years; mean age was 2.3 years; 40% were <1 year. The average length of stay was 9.2 days (range, 6-20) but varied by age and etiology. Fourteen percent had received antibiotics before admission and 14% had underlying illnesses; 12% required intensive care unit treatment and 5 died. A microbial etiology for CAP was identified in 547 (67%); viral 535 (43%), bacterial 228 (27%), mixed viral bacterial 107 (13%), mixed viral in 1%, and mixed bacterial in 1%. The etiology varied by age; respiratory syncytial virus was most common in <1 year, S. pneumoniae and Hib 1-3 years, and Mycoplasma 5 years. Three potentially vaccine preventable etiologies accounted for 35% of the cases: influenza 9%, Hib 12%, and S. pneumonia 14%.

CONCLUSIONS

CAP is a major cause of childhood admission in China. Given the etiologic findings in this study, potentially 25% to 35% of cases could be prevented if seasonal influenza vaccine and conjugated H. influenza b and conjugated pneumococcal vaccines were introduced into routine practice.