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Malorey D, Lorton F, Chalumeau M, Bourgoin P, Boussicault G, Chantreuil J, Gaillot T, Roué JM, Martinot A, Assathiany R, Saulnier JP, Caillon J, Grain A, Gras-Le Guen C, Launay E. Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study. Pediatr Crit Care Med 2023; 24:e441-e451. [PMID: 37260312 DOI: 10.1097/pcc.0000000000003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs). DESIGN Secondary analysis of the available data from a prospective population-based study from 2009 to 2014. SETTING An administrative area in western France accounting for 13% of the national pediatric population. PATIENTS All children from 1 month to 16 years old admitted to a PICU or who died before admission and had a COSBI. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The time to antibiotics was divided into patient interval (from first signs of COSBI to the first medical consultation) and medical interval (from the first consultation to appropriate antibiotics administration). The association between the medical interval and child outcome was studied by a multinomial logistic regression model and the potential determinants of the patient and medical intervals were by a Cox proportional-hazards model. Of the 227 children included (median age 2.1 yr), 22 died (9.7%), and 21 (9.3%) had severe sequelae at PICU discharge. Median patient and medical intervals were 7.0 hours (interquartile range [IQR], 2.0-16.5 hr) and 3.3 hours (IQR, 1.1-12.2 hr), respectively. The last quartile of medical interval was not associated with death (adjusted odds ratio [aOR], 3.7; 95% CI, 0.8-17.5) or survival with severe sequelae (aOR, 1.3; 95% CI, 0.4-4.0) versus survival without severe sequelae. Patient interval was shorter in younger children (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.92-0.99), and medical interval was reduced when the first consultation was conducted in a hospital (aHR, 1.5; 95% CI, 1.1-2.0) versus outpatient medicine. CONCLUSIONS For children with COSBI, we found no significant association between medical interval and mortality or severe sequelae. An initial hospital referral could help reduce the time to antibiotics in COSBIs.
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Affiliation(s)
- David Malorey
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
| | - Fleur Lorton
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pierre Bourgoin
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | | | - Julie Chantreuil
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
| | - Théophile Gaillot
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Jean-Michel Roué
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
| | - Alain Martinot
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
| | - Rémy Assathiany
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
| | - Jean-Pascal Saulnier
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
| | - Jocelyne Caillon
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
| | - Audrey Grain
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Christèle Gras-Le Guen
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Elise Launay
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France
- Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
- Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France
- Department of Pediatric Critical Care, CHU d'Angers, Angers, France
- Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
- Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France
- University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
- Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
- Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
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Jacques M, Lorton F, Dufourg MN, Bois C, Launay E, Siméon T, Raude J, Guen CGL, Lévy-Brühl D, Charles MA, Chalumeau M, Scherdel P. Determinants of incomplete vaccination in children at age two in France: results from the nationwide ELFE birth cohort. Eur J Pediatr 2023; 182:1019-1028. [PMID: 36542162 PMCID: PMC9768772 DOI: 10.1007/s00431-022-04733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Incomplete vaccination in the pediatric population is a growing public health issue in high-income countries, but its determinants are poorly understood. Their identification is necessary to design target actions that can improve vaccination uptake. Our aim was to assess the determinants of incomplete vaccination in two-year-old children in France. Among the 18,329 children included in the 2011 ELFE French nationwide population-based birth cohort, we selected those for whom vaccination status was available at age two years. Incomplete vaccination was defined as ≥ 1 missing dose of recommended vaccines. Potential determinants of incomplete vaccination were identified by using logistic regression, taking into account attrition and missing data. Of the 5,740 (31.3%) children analyzed, 46.5% (95% confidence interval [CI] 44.7-48.0) were incompletely vaccinated. Factors independently associated with incomplete vaccination were having older siblings (adjusted odds ratio 1.18, 95% CI [1.03-1.34] and 1.28 [1.06-1.54] for one and ≥ 2 siblings, respectively, vs. 0), residing in an isolated area (1.92 [1.36-2.75] vs. an urban area), parents not following health recommendations or using alternative medicines (1.81 [1.41-2.34] and 1.23 [1.04-1.46], respectively, vs. parents confident in institutions and following heath recommendations), not being visited by a maternal and child protection service nurse during the child's first two months (1.19 [1.03-1.38] vs. ≥ 1 visit), and being followed by a general practitioner (2.87 [2.52-3.26] vs. a pediatrician). CONCLUSIONS Incomplete vaccination was highly prevalent in the studied pediatric population and was associated with several socio-demographic, parental, and healthcare service characteristics. These findings may help in designing targeted corrective actions. WHAT IS KNOWN • Incomplete vaccination in the pediatric population is a growing public health issue in high-income countries. • The partial understanding of the determinants of incomplete vaccination precludes the design of effective targeted corrective actions. WHAT IS NEW • High prevalence of incomplete vaccination at age two years in France. • Incomplete vaccination was independently associated with several socio-demographic, parental, and healthcare service characteristics.
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Affiliation(s)
- Marianne Jacques
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.277151.70000 0004 0472 0371Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
| | - Fleur Lorton
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.277151.70000 0004 0472 0371Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- grid.277151.70000 0004 0472 0371Department of Pediatric Emergency Care, Nantes University Hospital, Nantes, France
| | - Marie-Noëlle Dufourg
- grid.7429.80000000121866389French Institute for Demographic Studies (Ined), Inserm, French Blood Agency, ELFE Joint Unit, Aubervilliers, France
| | - Corinne Bois
- grid.7429.80000000121866389French Institute for Demographic Studies (Ined), Inserm, French Blood Agency, ELFE Joint Unit, Aubervilliers, France
| | - Elise Launay
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.277151.70000 0004 0472 0371Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- grid.277151.70000 0004 0472 0371Department of Pediatric Emergency Care, Nantes University Hospital, Nantes, France
| | - Thierry Siméon
- grid.7429.80000000121866389French Institute for Demographic Studies (Ined), Inserm, French Blood Agency, ELFE Joint Unit, Aubervilliers, France
| | - Jocelyn Raude
- grid.414412.60000 0001 1943 5037EHESP-School of Public Health, Rennes, France
| | - Christèle Gras-Le Guen
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.277151.70000 0004 0472 0371Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
- grid.277151.70000 0004 0472 0371Department of Pediatric Emergency Care, Nantes University Hospital, Nantes, France
| | - Daniel Lévy-Brühl
- grid.493975.50000 0004 5948 8741Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Marie-Aline Charles
- grid.7429.80000000121866389French Institute for Demographic Studies (Ined), Inserm, French Blood Agency, ELFE Joint Unit, Aubervilliers, France
| | - Martin Chalumeau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.508487.60000 0004 7885 7602Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants malades hospital, Université Paris Cité, Paris, France
| | - Pauline Scherdel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France
- grid.277151.70000 0004 0472 0371Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France
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Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review. J Clin Med 2023; 12:jcm12030849. [PMID: 36769498 PMCID: PMC9917955 DOI: 10.3390/jcm12030849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Invasive meningococcal disease (IMD) remains a significant health concern due to its unpredictable nature and its rapid progression. Even if occurrence of IMD is strictly monitored by a national surveillance network, no information on long-term sequelae is reported, making it difficult to assess the entire clinical burden of IMD in France. The aim of this scoping review was to analyze the epidemiology and the clinical burden of IMD in France by reporting the main epidemiological parameters, and by describing the clinical consequences and the care pathway of patients. The process of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to the Scoping Reviews guidelines. In France, the incidence of IMD cases has been fluctuating over time, characterized by an overall downward trend linked to a decrease in Sg B cases and the introduction of mandatory vaccination against Sg C. Sg W cases increased in recent years (from 5% to 21% in 2019). The case fatality rate remained constant (6-12.9%). The most frequently reported sequelae were severe neurological disorder, epilepsy, and anxiety. However, data on sequelae and care pathways were scarce. Further research should concentrate on providing robust identification of sequelae and the subsequent impact on quality of life, as well as on the organization of optimal care and support for patients and their families.
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Chen KZ, Liu SX, Li YW, He T, Zhao J, Wang T, Qiu XX, Wu HF. Vimentin as a potential target for diverse nervous system diseases. Neural Regen Res 2022; 18:969-975. [PMID: 36254976 PMCID: PMC9827761 DOI: 10.4103/1673-5374.355744] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vimentin is a major type III intermediate filament protein that plays important roles in several basic cellular functions including cell migration, proliferation, and division. Although vimentin is a cytoplasmic protein, it also exists in the extracellular matrix and at the cell surface. Previous studies have shown that vimentin may exert multiple physiological effects in different nervous system injuries and diseases. For example, the studies of vimentin in spinal cord injury and stroke mainly focus on the formation of reactive astrocytes. Reduced glial scar, increased axonal regeneration, and improved motor function have been noted after spinal cord injury in vimentin and glial fibrillary acidic protein knockout (GFAP-/-VIM-/-) mice. However, attenuated glial scar formation in post-stroke in GFAP-/- VIM-/- mice resulted in abnormal neuronal network restoration and worse neurological recovery. These opposite results have been attributed to the multiple roles of glial scar in different temporal and spatial conditions. In addition, extracellular vimentin may be a neurotrophic factor that promotes axonal extension by interaction with the insulin-like growth factor 1 receptor. In the pathogenesis of bacterial meningitis, cell surface vimentin is a meningitis facilitator, acting as a receptor of multiple pathogenic bacteria, including E. coli K1, Listeria monocytogenes, and group B streptococcus. Compared with wild type mice, VIM-/- mice are less susceptible to bacterial infection and exhibit a reduced inflammatory response, suggesting that vimentin is necessary to induce the pathogenesis of meningitis. Recently published literature showed that vimentin serves as a double-edged sword in the nervous system, regulating axonal regrowth, myelination, apoptosis, and neuroinflammation. This review aims to provide an overview of vimentin in spinal cord injury, stroke, bacterial meningitis, gliomas, and peripheral nerve injury and to discuss the potential therapeutic methods involving vimentin manipulation in improving axonal regeneration, alleviating infection, inhibiting brain tumor progression, and enhancing nerve myelination.
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Affiliation(s)
- Kang-Zhen Chen
- Department of Anesthesiology, Guangzhou Huadu Hospital Affiliated to Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, Guangdong Province, China,Dongguan City Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, Guangdong Province, China
| | - Shu-Xian Liu
- Department of Anesthesiology, Guangzhou Huadu Hospital Affiliated to Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, Guangdong Province, China
| | - Yan-Wei Li
- Department of Anesthesiology, Guangzhou Huadu Hospital Affiliated to Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, Guangdong Province, China
| | - Tao He
- Dongguan City Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, Guangdong Province, China
| | - Jie Zhao
- Dongguan City Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, Guangdong Province, China
| | - Tao Wang
- Department of Surgery, the Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District), Foshan, Guangdong Province, China,Correspondence to: Hong-Fu Wu, ; Xian-Xiu Qiu, ; Tao Wang, .
| | - Xian-Xiu Qiu
- Dongguan City Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, Guangdong Province, China,Correspondence to: Hong-Fu Wu, ; Xian-Xiu Qiu, ; Tao Wang, .
| | - Hong-Fu Wu
- Department of Anesthesiology, Guangzhou Huadu Hospital Affiliated to Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, Guangdong Province, China,Dongguan City Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, Guangdong Province, China,Correspondence to: Hong-Fu Wu, ; Xian-Xiu Qiu, ; Tao Wang, .
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Lorton F, Chalumeau M, Martinot A, Assathiany R, Roué JM, Bourgoin P, Chantreuil J, Boussicault G, Gaillot T, Saulnier JP, Caillon J, Gras-Le Guen C, Launay E. Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children. JAMA Netw Open 2022; 5:e2216778. [PMID: 35696162 PMCID: PMC9194668 DOI: 10.1001/jamanetworkopen.2022.16778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/17/2022] [Indexed: 12/19/2022] Open
Abstract
Importance Assessment of the quality of initial care is necessary to target priority actions that can reduce the still high morbidity and mortality due to community-onset severe bacterial infections (COSBIs) among children. Objective To study the prevalence, characteristics, and determinants of suboptimal care in the initial management of COSBIs. Design, Setting, and Participants This prospective, population-based, cohort study and confidential enquiry was conducted between August 2009 and January 2014 in western France, a region accounting for 15% of the French pediatric population (1 968 474 children aged 1 month to 16 years) and including 6 pediatric intensive care units (PICUs) and 35 emergency departments. Participants included all children aged 1 month to 16 years who died before PICU admission or were admitted to a PICU with a COSBI (ie, bacterial sepsis, including meningitis, purpura fulminans, and pulmonary, osteoarticular, intra-abdominal, cardiac, and soft-tissue severe infections). Data were analyzed from March to June 2020. Exposures Suboptimal care determined according to evaluation of 8 types of care: (1) the delay in seeking care by family, (2) the physician's evaluation of severity, (3) the patient's referral at the first consultation with signs of severity, (4) the timing and (5) dosage of antibiotic treatment, (6) the timing and (7) volume of fluid bolus administration, and (8) the clinical reassessment after fluid bolus. Main Outcomes and Measures Two experts assessed the quality of care before death or PICU admission as optimal, possibly suboptimal, or certainly suboptimal. The consequences and determinants of certainly suboptimal care were identified with multinomial logistic regression and generalized linear mixed models. Results Of the 259 children included (median [IQR] age, 24 [6-66] months; 143 boys [55.2%]), 27 (10.4%) died, and 25 (9.6%) had severe sequelae at PICU discharge. The quality of care was certainly suboptimal in 89 cases (34.4%). Suboptimal care was more frequent in children with sequelae (adjusted odds ratio [aOR], 5.61; 95% CI, 1.19-26.36) and less frequent in children who died (aOR, 0.16; 95% CI, 0.04-0.65) vs those surviving without sequelae. Factors independently associated with suboptimal care were age younger than 5 years (aOR, 3.15; 95% CI, 1.25-7.90), diagnosis of sepsis with no source (aOR, 5.77; 95% CI, 1.64-20.30) or meningitis (aOR, 3.39; 95% CI, 1.15-9.96) vs other severe infections, and care by a primary care physician (aOR, 3.22; 95% CI, 1.17-8.88) vs a pediatric hospital service. Conclusions and Relevance This study found that suboptimal care is frequent in the initial management of COSBI and is associated with severe sequelae. The paradoxical association with reduced risk of death may be explained by an insufficient adjustment on bacterial or host intrinsic factors. Management could be optimized by improving the quality of primary care, especially for young children.
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Affiliation(s)
- Fleur Lorton
- Centre of Clinical Research Femme Enfant Adolescent, Hôpital Femme Enfant Adolescent, Inserm 1413, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alain Martinot
- Univ Lille, ULR 2694-METRICS, Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France
| | - Rémy Assathiany
- Association pour la Recherche et l’Enseignement en Pédiatrie Générale, Association Française de Pédiatrie Ambulatoire, Cabinet de Pédiatrie, Issy-les-Moulineaux, France
| | - Jean-Michel Roué
- Department of Pediatric and Neonatal Critical Care, Brest University Hospital, Brest, France
| | - Pierre Bourgoin
- Department of Pediatric and Neonatal Critical Care, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | - Julie Chantreuil
- Department of Pediatric and Neonatal Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France
| | | | - Théophile Gaillot
- Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Jean-Pascal Saulnier
- Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
| | - Jocelyne Caillon
- Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France
| | - Christèle Gras-Le Guen
- Centre of Clinical Research Femme Enfant Adolescent, Hôpital Femme Enfant Adolescent, Inserm 1413, CHU de Nantes, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | - Elise Launay
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre of Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
- Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
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Therapist disclosure to combat COVID-19 vaccine hesitancy: a narrative review. J Behav Med 2022; 46:346-355. [PMID: 35355152 PMCID: PMC8967560 DOI: 10.1007/s10865-022-00305-6] [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: 09/13/2021] [Accepted: 02/22/2022] [Indexed: 11/05/2022]
Abstract
With the onset of the COVID-19 pandemic in 2019–2020 and the rapid development of vaccines to prevent this disease came a rise in interest around vaccine hesitancy. Naturally, methods of combatting vaccine hesitancy and increasing vaccination rates are of paramount importance. One such method is building upon the trust and openness of one’s relationship with their healthcare provider. Specifically, this paper examines how psychotherapist self-disclosure could facilitate effective health behaviors in patients, focusing on vaccines. Traditionally, mental health therapists have been encouraged to avoid self-disclosure of personal information due to the possibility of unbalancing or damaging the therapeutic relationship. However, research from medicine and other disciplines suggests that personal recommendation, self-disclosure of vaccination status, and expert encouragement may be effective methods of addressing vaccine hesitancy. In addition, recommendations for therapists in discussing vaccination and in working with vaccine-hesitant patients are provided.
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de Souza DC, Gonçalves Martin J, Soares Lanziotti V, de Oliveira CF, Tonial C, de Carvalho WB, Roberto Fioretto J, Pedro Piva J, Juan Troster E, Siqueira Bossa A, Gregorini F, Ferreira J, Lubarino J, Biasi Cavalcanti A, Ribeiro Machado F. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:873-881. [PMID: 34756191 DOI: 10.1016/s2352-4642(21)00286-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. METHODS We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. FINDINGS Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p<0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). INTERPRETATION In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniela Carla de Souza
- Instituto Latino Americano de Sepsis, São Paulo, Brazil; Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
| | - Joelma Gonçalves Martin
- Department of Pediatrics, Medical School of Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janiero, Brazil
| | | | - Cristian Tonial
- Pediatric Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Werther Brunow de Carvalho
- Pediatric Intensive Care/Neonatology of the Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Fioretto
- Department of Pediatrics, Medical School of Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | - Jefferson Pedro Piva
- Pediatric Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Juan Troster
- Medical School of Faculdade Israelita Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Flávia Ribeiro Machado
- Instituto Latino Americano de Sepsis, São Paulo, Brazil; Anesthesiology, Pain and Intensive Care Department, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
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Gras-Le Guen C, Vignier N, Kochert F, Javouhey E, Launay E, Dufour V, Gaudelus J, Launay O, Stahl JP, Tattevin P, Cohen R. Why should the meningococcal B vaccine be recommended, and therefore reimbursed, for infants in France? Infect Dis Now 2021; 51:407-409. [PMID: 33984551 DOI: 10.1016/j.idnow.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Nicolas Vignier
- Inserm UMR 1136, CIC Inserm 1424, IPLESP, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, centre d'investigation clinique Antilles Guyane, centre hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Etienne Javouhey
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Université Lyon 1, Lyon, France; GFRUP (Groupe francophone de réanimation et urgences pédiatriques), Paris, France
| | - Elise Launay
- Service de pédiatrie générale et urgences pédiatriques, CHU de Nantes, Nantes, France
| | | | - Joël Gaudelus
- Groupe de pathologie infectieuse pédiatrique (GPIP), Créteil, France
| | - Odile Launay
- Inserm CIC1417, SPILF, Université de Paris, Hôpital Cochin, AP-HP, Paris, France
| | - Jean Paul Stahl
- SPILF, Université Grenoble-Alpes, CHU de Grenoble-Alpes, infectiologie, Grenoble, France
| | | | - Robert Cohen
- Conseil national professionnel de pédiatrie, centre hospitalier intercommunal de Créteil, Créteil, France.
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Flatrès C, Roué JM, Picard C, Carausu L, Thomas C, Pellier I, Millot F, Gandemer V, Chantreuil J, Lorton F, Gras Le Guen C, Launay E. Investigation of primary immune deficiency after severe bacterial infection in children: A population-based study in western France. Arch Pediatr 2021; 28:398-404. [PMID: 33903000 DOI: 10.1016/j.arcped.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/30/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitted to a pediatric intensive care unit. We also assessed the frequency and described the typology of diagnosed primary immune deficiency (PID). METHODS We conducted a retrospective observational epidemiological study in six university hospitals in western France. All children from 1 month to 16 years of age admitted to hospital for bacterial meningitis, purpura fulminans, or meningococcal disease between August 2009 and January 2014 were included. We analyzed the frequency, type, and results of the immunological tests performed on children with meningitis, purpura fulminans, or a meningococcemia episode. RESULTS Among the 143 children included (144 episodes), 84 (59%) and 60 (41%) had bacterial meningitis and purpura fulminans or meningococcemia, respectively: 72 (50%) had immunological tests and 8% had a complete immunological investigation as recommended. Among the 72 children examined for PID, 11 (15%) had at least one anomaly in the immunological test results. Two children had a diagnosis of PID (one with C2 deficit and the other with C8 deficit) and seven other children had possible PID. Thus, the prevalence of a definite or possible diagnosis of PID was 12% among the children examined. CONCLUSION PID is rarely investigated after COSBI. We raise awareness of the need for immunological investigations after a severe infection requiring PICU admission.
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Affiliation(s)
- C Flatrès
- Brest University Hospital, Pediatrics Department, Brest, France.
| | - J M Roué
- Brest University Hospital, neonatal Intensive Care Unit, Brest, France
| | - C Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, Inserm UMR 1163, Paris, University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - L Carausu
- Brest University Hospital, Pediatrics Department, Brest, France
| | - C Thomas
- CHU de Nantes, Pediatric Hematology-Oncology Unit, Nantes, France
| | - I Pellier
- University Hospital of Angers, Department of Pediatric Onco-hematology, Angers, France
| | - F Millot
- Department of Pediatric Onco-Hematology, Poitiers University Hospital, Poitiers, France
| | - V Gandemer
- Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes, France
| | - J Chantreuil
- Centre Hospitalo-universitaire de Tours, Service de réanimation pédiatrique, Tours, France
| | - F Lorton
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France
| | - C Gras Le Guen
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France; CHU de Nantes, Department of Pediatrics, Nantes, France
| | - E Launay
- CHU de Nantes, Department of Pediatrics, Nantes, France
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Abstract
Purpose of review Community-acquired bacterial meningitis is a continually changing disease. This review summarises both dynamic epidemiology and emerging data on pathogenesis. Updated clinical guidelines are discussed, new agents undergoing clinical trials intended to reduce secondary brain damage are presented. Recent findings Conjugate vaccines are effective against serotype/serogroup-specific meningitis but vaccine escape variants are rising in prevalence. Meningitis occurs when bacteria evade mucosal and circulating immune responses and invade the brain: directly, or across the blood–brain barrier. Tissue damage is caused when host genetic susceptibility is exploited by bacterial virulence. The classical clinical triad of fever, neck stiffness and headache has poor diagnostic sensitivity, all guidelines reflect the necessity for a low index of suspicion and early Lumbar puncture. Unnecessary cranial imaging causes diagnostic delays. cerebrospinal fluid (CSF) culture and PCR are diagnostic, direct next-generation sequencing of CSF may revolutionise diagnostics. Administration of early antibiotics is essential to improve survival. Dexamethasone partially mitigates central nervous system inflammation in high-income settings. New agents in clinical trials include C5 inhibitors and daptomycin, data are expected in 2025. Summary Clinicians must remain vigilant for bacterial meningitis. Constantly changing epidemiology and emerging pathogenesis data are increasing the understanding of meningitis. Prospects for better treatments are forthcoming.
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Taine M, Offredo L, Drouin J, Toubiana J, Weill A, Zureik M, Dray-Spira R. Mandatory Infant Vaccinations in France During the COVID-19 Pandemic in 2020. Front Pediatr 2021; 9:666848. [PMID: 34123969 PMCID: PMC8192803 DOI: 10.3389/fped.2021.666848] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/01/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: To describe changes in the dispensation of 11 mandatory vaccines to infants in France during the COVID-19 pandemic in 2020, considering the priming doses and boosters separately. Methods: With data from the French national health database, all dispensations of priming doses and boosters of 11 mandatory vaccines [penta/hexavalent, measles mumps rubella (MMR), meningococcal conjugate type-C (Men-C-C), 13-valent pneumococcal conjugate (PCV13)] for infants ≤24 months old were aggregated by 4-week periods in 2020. Expected counts in 2020 were estimated according to counts in 2019 weighted by a ratio considering the level of vaccine dispensation before the pandemic onset in 2020. Relative differences (RDs) and their 95% confidence intervals (CIs) were computed to compare the observed and expected counts during the first and second lockdown and the period in between. Results: During the first 4 weeks of the first lockdown, as compared with the expected numbers, the observed priming dose counts substantially decreased [RD: from -5.7% (95% CI -6.1; -5.2) for penta/hexavalent to -25.2% (95% CI -25.6; -24.8) for MMR], as did the booster counts [RD: from -15.3% (95% CI -15.9; -14.7) for penta/hexavalent to -20.7% (95% CI -21.3; -20.2) for Men-C-C]. Counts for priming doses and boosters remained slightly below the expected numbers after the lockdown. During 2020, MMR priming doses and the Men-C-C booster had the greatest shortfalls (N = 84,893 and 72,500, respectively). Conclusions: This study provides evidence of a lack of vaccination catch-up after the first lockdown and a persistent shortfall in infant vaccination after the first 10 months of the COVID-19 pandemic in France, especially for the MMR priming doses and Men-C-C booster.
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Affiliation(s)
- Marion Taine
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
| | - Lucile Offredo
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
| | - Julie Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades Hospital, AP-HP, Université de Paris, Paris, France
| | - Alain Weill
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis, France
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Updating the Epidemiology of Severe Bacterial Infections Reveals Old Truths: Vaccination Saves Life and Limb. Pediatr Crit Care Med 2020; 21:595-596. [PMID: 32483027 DOI: 10.1097/pcc.0000000000002304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Epidemiology of Community-Onset Severe Bacterial Infections in Children and Its Evolution: A Population-Based Study in France. Pediatr Crit Care Med 2020; 21:e325-e332. [PMID: 32224829 DOI: 10.1097/pcc.0000000000002300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the epidemiology of community-onset severe bacterial infections in children and its recent evolution. DESIGN Prospective, observational, population-based study from 2009 to 2014. SETTING An administrative area accounting for 13% of the French pediatric population. PATIENTS All children 1 month to 16 years old who died before admission or were admitted to a PICU for a community-onset severe bacterial infection. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The incidence and mortality rate of community-onset severe bacterial infections were compared with data from a reference population-based study conducted between 2000 and 2006, that is, before national recommendations for antimeningococcal C and antipneumococcal generalized vaccinations. Among the 261 children included (median age 25 mo), 28 (10.7%) died. The main diagnoses were meningitis (n = 85; 32%) and purpura fulminans (n = 59; 22%). The most common isolated bacteria were Neisseria meningitidis (n = 75; 29%), including 47 (63%) cases of serogroup B and 15 (20%) serogroup C, Streptococcus pneumoniae (n = 49, 19%), and Staphylococcus aureus (n = 15; 6%). The incidence of community-onset severe bacterial infections was three per 100,000 person-years (95% CI, 2.6-3.3) and had decreased by 53% from the reference period. Mortality rate was 0.3 per 100,000 person-years (95% CI, 0.2-0.4) and had decreased by 73% from the reference period. The incidence of community-onset severe bacterial infections caused by N. meningitidis and S. pneumoniae was 0.8 and 0.5 per 100,000 person-years and had decreased by 70% and 67% from the reference period. The incidence of community-onset severe bacterial infections-related to Staphylococcus aureus was 0.16 per 100,000 person-years and had increased by 220% from the reference period. CONCLUSIONS The incidence and mortality rate of community-onset severe bacterial infections, except for S. aureus infection, have decreased in France. N. meningitidis and S. pneumoniae continue to account for many infections, which indicates the need for better vaccination coverage and spectrum.
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Mortality of children aged 5-15 years in a tertiary care center in Yaoundé, Cameroon. Arch Pediatr 2020; 27:257-260. [PMID: 32409247 DOI: 10.1016/j.arcped.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/08/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although sub-Saharan Africa accounts for only 21% of the global population of children and adolescents aged 5-15 years, 55% of deaths among children in this age group occur in this region. This seems to be related to infectious diseases. We hypothesized that besides infectious diseases, in our context, a chronic underlying condition increases mortality. Our goal was to describe the leading causes of mortality among this age group. PATIENTS AND METHODS We conducted a retrospective study in a tertiary care center in Yaoundé. We included the medical files of children who died between January 2013 and December 2017. RESULTS The in-hospital mortality rate was 10.3 per 1000. Coma and/or convulsion was the main cause of death (70.6%), followed by severe anemia (64.7%) and respiratory distress (56.8%). We identified a chronic illness in 62.2% of cases: HIV infection (39.2%) and sickle cell disease (24.5%) were the most prevalent. The main diagnoses were severe malaria, severe sepsis, and meningitis (Cryptococcus sp. included) in 25 (n=35), 16.4 (n=27), and 10.3% (n=17) of cases, respectively. CONCLUSION HIV infection and sickle cell disease are the most prevalent chronic diseases related to the patients' death in the age group studied. Specific interventions focusing on this age group are recommended including intensification of impregnated bednet usage as well as HIV and sickle cell disease management.
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