1
|
van Gameren-Oosterom HBM, Weijerman ME, van Wieringen H, de Winter JP, van Wermeskerken AM. Clinical practice - latest insights in optimizing the care of children with Down syndrome. Eur J Pediatr 2023; 182:2027-2039. [PMID: 36897403 DOI: 10.1007/s00431-023-04890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
An essential part of the care of children with Down syndrome is secondary screening for comorbidity. It is well known that comorbidity frequently occurs in these children. A new update of the Dutch Down syndrome medical guideline was developed to create a sound evidence base for several of these conditions. We present the latest insights and recommendations from this Dutch medical guideline which are based on the most relevant literature currently available and developed with rigorous methodology. The main focus of this revision of the guideline was on obstructive sleep apnea and other airway problems and hematologic disorders, such as transient abnormal myelopoiesis, leukemia, and thyroid disorders. Conclusion: This is a short summary of the latest insights and recommendations from the updated Dutch medical guideline for children with Down syndrome.
Collapse
Affiliation(s)
| | | | | | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | |
Collapse
|
2
|
De Lausnay M, Ides K, Wojciechowski M, Boudewyns A, Verhulst S, Van Hoorenbeeck K. Pulmonary complications in children with Down syndrome: A scoping review. Paediatr Respir Rev 2021; 40:65-72. [PMID: 34148805 DOI: 10.1016/j.prrv.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Down syndrome (DS) is a prevalent chromosomal disorder associated with a wide range of congenital anomalies and other health problems. OBJECTIVES To give a scoping overview of encountered lower airway problems (both infectious and non-infectious) in DS children. DATA SOURCES We systematically searched the MEDLINE and PubMed databases for relevant publications. STUDY SELECTION Studies were eligible if they were original studies about pediatric airway problems in DS and were evaluated by the PRISMA guidelines. DATA EXTRACTION Data concerning patient characteristics, study methods and outcomes were critically reviewed. RESULTS Sixty papers were included. These were reviewed and summarized by topic, i.e. airway anomalies, dysphagia and aspiration, lower respiratory tract infections (and bronchiolitis in particular), pulmonary hypertension and other. Respiratory problems are proven to be a frequent and a major health burden in DS children. Airway anomalies (both single and multiple) are more prevalent and require a specific approach. A large proportion of DS children have (often silent) aspiration, resulting in protracted and difficult-to-treat symptoms. Respiratory tract infections are usually more severe and associated with an increased need for (prolonged) hospitalization. Pulmonary hypertension, wheeze and some other rare conditions are more commonly encountered in DS. LIMITATIONS Large number of studies and high levels of study heterogeneity. CONCLUSIONS Several lower airway problems are more frequent and more complex in children with DS. These findings emphasize the need for a multidisciplinary approach by an experienced team allowing for a prompt diagnosis, proper management and improved long term outcome.
Collapse
Affiliation(s)
- Mariska De Lausnay
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Belgium.
| | - Kris Ides
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Belgium; Cosys Lab, Flanders Make, Antwerp University, Belgium
| | - Mark Wojciechowski
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - An Boudewyns
- Department of Otorhinolaryngology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Belgium
| | - Kim Van Hoorenbeeck
- Department of Pediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Belgium
| |
Collapse
|
3
|
Okamoto K, Morio T, Nakamura Y, Hataya H, Mizuta K, Mori M. Hospitalisations due to respiratory syncytial virus infection in children with Down syndrome before and after palivizumab recommendation in Japan. Acta Paediatr 2021; 110:1299-1306. [PMID: 33119906 DOI: 10.1111/apa.15641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
AIM Down syndrome has been considered an independent risk factor for respiratory syncytial virus (RSV) infection. Palivizumab, an anti-RSV humanised monoclonal antibody, was currently approved for all children with Down syndrome in Japan. To investigate the change in RSV-associated hospitalisation (RSVH) rates before and after the universal approval of palivizumab in Japan in 2013, we conducted a nationwide retrospective survey. METHODS We conducted a nationwide, retrospective, questionnaire survey across paediatric institutions in Japan. The recruited children with Down syndrome were divided into two groups: those born April 2010 to March 2013 (2010-2012 cohort) and those born April 2013 to March 2016 (2013-2015 cohort). RESULTS Of the 664 institutions, 321 (48.3%) replied, and a total of 3929 children with Down syndrome were registered. The percentage of children who received palivizumab increased from 49.2% to 82.2%. The cumulative RSVH rate showed a decreased trend in the 2013-2015 cohort (OR, 0.83; 95%CI, 0.63-1.10), while the rate of these children (without CHD and born at a gestational age ≥ 36 weeks) was significantly decreased in the 2013-2015 cohort (OR, 0.56; 95%CI, 0.34-0.92). CONCLUSION The cumulative RSVH rate tended to be decreased after approval for all children with Down syndrome although the result was not significant.
Collapse
Affiliation(s)
- Keisuke Okamoto
- Department of Pediatrics and Developmental Biology Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | | | - Hiroshi Hataya
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Tokyo Japan
| | - Koichi Mizuta
- Department of Transplant Surgery Jichi Medical University Shimotsuke Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| |
Collapse
|
4
|
Carbonell-Estrany X, Rodgers-Gray BS, Paes B. Challenges in the prevention or treatment of RSV with emerging new agents in children from low- and middle-income countries. Expert Rev Anti Infect Ther 2020; 19:419-441. [PMID: 32972198 DOI: 10.1080/14787210.2021.1828866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes approximately 120,000 deaths annually in children <5 years, with 99% of fatalities occurring in low- and middle-income countries (LMICs). AREAS COVERED There are numerous RSV interventions in development, including long-acting monoclonal antibodies, vaccines (maternal and child) and treatments which are expected to become available soon. We reviewed the key challenges and issues that need to be addressed to maximize the impact of these interventions in LMICs. The epidemiology of RSV in LMICs was reviewed (PubMed search to 30 June 2020 inclusive) and the need for more and better-quality data, encompassing hospital admissions, community contacts, and longer-term respiratory morbidity, emphasized. The requirement for an agreed clinical definition of RSV lower respiratory tract infection was proposed. The pros and cons of the new RSV interventions are reviewed from the perspective of LMICs. EXPERT OPINION We believe that a vaccine (or combination of vaccines, if practicable) is the only viable solution to the burden of RSV in LMICs. A coordinated program, analogous to that with polio, involving governments, non-governmental organizations, the World Health Organization, the manufacturers and the healthcare community is required to realize the full potential of vaccine(s) and end the devastation of RSV in LMICs.
Collapse
Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
| | | | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Okada K, Mizuno M, Moriuchi H, Kusuda S, Morioka I, Mori M, Okamoto K, Okada K, Yoshihara S, Yamagishi H, Yokoyama U, Kubota T, Kudo K, Takagi M, Ito S, Kanamori Y, Sasahara Y. The Working Group for Revision of "Guidelines for the Use of Palivizumab in Japan": A Committee Report. Pediatr Int 2020; 62:1223-1229. [PMID: 33078556 DOI: 10.1111/ped.14410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Satoshi Kusuda
- Japan Society for Neonatal Health and Development, Osaka, Japan
| | - Ichiro Morioka
- Japan Society for Neonatal Health and Development, Osaka, Japan
| | - Masaaki Mori
- Japanese Society for Pediatric Infectious Diseases, Tokyo, Japan.,Pediatric Rheumatology Association of Japan, Tokyo, Japan
| | - Keisuke Okamoto
- Japanese Society for Pediatric Infectious Diseases, Tokyo, Japan
| | | | | | - Hiroyuki Yamagishi
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Utako Yokoyama
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | | | - Kazuko Kudo
- The Japanese Society of Pediatric Hematology/Oncology, Tokyo, Japan
| | - Masatoshi Takagi
- The Japanese Society of Pediatric Hematology/Oncology, Tokyo, Japan
| | - Shuichi Ito
- Japanese Society for Pediatric Nephrology, Tokyo, Japan
| | | | - Yoji Sasahara
- Japanese Society for Immunodeficiency and Autoinflammatory Diseases, Tokyo, Japan
| |
Collapse
|
6
|
Takeuchi M, Kawakami K. Universal palivizumab prophylaxis for children with Down syndrome in Japan: analysis with interrupted time-series. Hum Vaccin Immunother 2020; 17:1235-1238. [PMID: 32961094 DOI: 10.1080/21645515.2020.1809265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Down syndrome (DS) is an independent risk factor for severe respiratory syncytial virus (RSV) infection. Palivizumab - passive immunization for RSV - is the only pharmacological measure for preventing severe disease. In most countries, palivizumab is indicated in young children with congenital heart disease, premature birth, and chronic lung disease. In Japan, since 2013, children with DS, but without such "standard" risk factors, have been able to receive insurance-covered palivizumab prophylaxis, but its effectiveness of policy is unknown. From a nationwide database, we extracted data of children with DS who hospitalized for RSV-related lower respiratory infections (LRTIs), from April 2010 to January 2019. Using an interrupted time-series design, we analyzed data from before and after the introduction of the universal palivizumab prophylaxis program for DS children in Japan. As a result, we identified a total of 152 RSV-related LRTIs in 147 children hospitalized with DS. With time-series analysis, we did not observe a significant change in both level (-1.07, P = .11) and slope (0.26 per 12 months, P = .30), before and after 2013. In summary, the expansion of the palivizumab prophylaxis program to all children with DS in Japan was not associated with a reduction in RSV-related hospitalization in these children.
Collapse
Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| |
Collapse
|
7
|
Bloomfield A, DeVincenzo JP, Ambrose CS, Krilov LR. RSV and non-RSV illness hospitalization in RSV immunoprophylaxis recipients: A systematic literature review. J Clin Virol 2020; 129:104339. [PMID: 32512375 DOI: 10.1016/j.jcv.2020.104339] [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: 11/12/2019] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
Respiratory syncytial virus (RSV) immunoprophylaxis (IP) has been shown to reduce RSV hospitalization rates in high-risk infants; however, it is unclear whether RSV IP is associated with increased risk of non-RSV disease, particularly non-RSV hospitalizations. We conducted a systematic literature review to understand the occurrences of non-RSV disease and/or non-RSV hospitalizations in published studies of RSV IP. Cochrane, Embase, and PubMed databases were searched and reviewed to summarize data regarding the incidence of RSV and non-RSV respiratory disease among RSV IP recipients and controls in randomized and non-randomized studies. Independent investigators screened and selected studies for inclusion. Risk-of-bias assessment was conducted to assess strength/validity of the data using the Jadad scoring system and Downs and Black quality assessment tool, where appropriate. Twenty studies were included for review (5 randomized controlled trials [RCTs]; 15 non-randomized studies). RCTs of RSV IP demonstrated reductions in RSV hospitalizations and all-cause hospitalizations, with no increase in hospitalizations for non-RSV disease. Non-randomized studies also demonstrated reduced RSV hospitalizations in RSV IP recipients but had mixed results in assessments of hospitalizations for non-RSV disease. When RSV IP recipients and controls were more similar in disease severity risk, results of non-randomized studies aligned more closely with RCTs. Observations of increased non-RSV hospitalization rates among RSV IP recipients in some non-randomized studies could be primarily explained by differences in the clinical characteristics between RSV IP recipients and controls.
Collapse
Affiliation(s)
| | - John P DeVincenzo
- Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Leonard R Krilov
- Children's Medical Center, NYU Winthrop Hospital and NYU Long Island School of Medicine, Mineola, NY, USA.
| |
Collapse
|
8
|
Kimura T, Takeuchi M, Kawakami K. Utilization and efficacy of palivizumab for children with Down syndrome. Pediatr Int 2020; 62:677-682. [PMID: 31961027 DOI: 10.1111/ped.14157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palivizumab is a prophylactic drug used for severe respiratory syncytial virus (RSV) infection in young children with high-risk factors, such as prematurity and congenital heart diseases. Although Japan expanded the use of palivizumab for Down syndrome (DS) in 2013 regardless of additional high-risk factors, there is not enough evidence to support its use. We analyzed health insurance claim data from the JMDC (Tokyo, Japan) to investigate the prescription pattern and efficacy of palivizumab in children with DS. METHODS We enrolled children of ≤24 months of age with DS at the start of the RSV epidemic season (2007-2015). We compared the risk of RSV-related admission with and without palivizumab prophylaxis using mixed effects logistic regression models accounting for patient-level clustering. RESULTS Of 632 children, 30% (81/268) and 83% (303/364) received palivizumab before and after the expanded program (2007-2012 and 2013-2015), respectively. Among children with DS but without additional high-risk factors (n = 135), palivizumab use surged from 0% (0/62) to 73% (53/73). In the whole study population, RSV-related hospitalization occurred in 4.2% (16/384) patients with prophylaxis and 6.0% (15/248) patients without prophylaxis. The multivariate analysis revealed that palivizumab was associated with reduced RSV-related hospitalization (odds ratio: 0.41, 95% confidence interval: 0.18-0.92, P = 0.03). CONCLUSIONS Virtually all children with DS in Japan have now received palivizumab, the use of which was associated with a reduction in RSV-related hospitalization in DS. Further evidence is required to clarify whether palivizumab prophylaxis should be risk-tailored or universal for DS.
Collapse
Affiliation(s)
- Takeshi Kimura
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| |
Collapse
|
9
|
Expert consensus on palivizumab use for respiratory syncytial virus in developed countries. Paediatr Respir Rev 2020; 33:35-44. [PMID: 31060948 DOI: 10.1016/j.prrv.2018.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022]
Abstract
Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention. Palivizumab guidelines should reflect the latest evidence, in addition to cost-effectiveness and healthcare budgetary considerations. RSV experts from Europe, Canada and Israel undertook a systematic review of the evidence over the last 5 years and developed recommendations regarding prophylaxis in industrialised countries. Almost 400 publications were reviewed. This group recommended palivizumab for: preterm infants (<29 and ≤31 weeks gestational age [wGA] and ≤9 and ≤6 months of age, respectively; high-risk 32-35wGA), former preterm children ≤24 months with chronic lung disease/bronchopulmonary dysplasia, children ≤24 months with significant congenital heart disease; and other high-risk populations, such as children ≤24 months with Down syndrome, pulmonary/neuromuscular disorders, immunocompromised, and cystic fibrosis. Up to 5 monthly doses should be administered over the RSV season. It is our impression that the adoption of these guidelines would help reduce the burden of RSV.
Collapse
|
10
|
Verstegen RHJ, Chang KJJ, Kusters MAA. Clinical implications of immune-mediated diseases in children with Down syndrome. Pediatr Allergy Immunol 2020; 31:117-123. [PMID: 31599041 DOI: 10.1111/pai.13133] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/18/2022]
Abstract
Children with Down syndrome have changes in their innate and adaptive immunity, which contribute to increased rates of infections, autoimmune diseases, and haematological malignancies. While improved care for congenital heart disease has decreased mortality and morbidity, complications related to immune-mediated diseases continue to limit the life expectancy in Down syndrome. Infectious diseases are common and have a significant effect on development, behaviour and quality of life. Infection frequency and severity are influenced by various anatomical and physiological alterations in addition to immunological changes in Down syndrome. Thus, prevention of respiratory tract infections requires a multifactorial approach. This could include additional active and/or passive immunizations, prophylactic antibiotics, immunoglobulin replacement and ear, nose and throat surgical interventions. Autoimmune conditions like coeliac disease, type I diabetes mellitus and thyroid disease are classically mentioned in the context of Down syndrome. However, autoinflammatory conditions are more prevalent as well. Screening for autoimmune diseases is required and immunosuppression has to be used with caution. Future studies should address optimal screening programmes for immune-mediated diseases in individuals with Down syndrome, as well as the effect of immune modulation, to further decrease morbidity and mortality, and improve the quality of life of individuals with Down syndrome.
Collapse
Affiliation(s)
- Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Krystal J J Chang
- Faculty of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Maaike A A Kusters
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
11
|
Karampatsas K, Kong J, Cohen J. Bronchiolitis: an update on management and prophylaxis. Br J Hosp Med (Lond) 2019; 80:278-284. [PMID: 31059347 DOI: 10.12968/hmed.2019.80.5.278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children less than 2 years of age in the UK. Respiratory syncytial virus is the most common virus associated with bronchiolitis and has the highest disease severity, mortality and cost. Bronchiolitis is generally a self-limiting condition, but can have serious consequences in infants who are very young, premature, or have underlying comorbidities. Management of bronchiolitis in the UK is guided by the National Institute for Health and Care Excellence (2015) guidance. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Pharmacological interventions including nebulized bronchodilators, steroids and antibiotics generally have limited or no evidence of efficacy and are not advised by National Institute of Health and Care Excellence. Antiviral therapeutics remain in development. As treatments are limited, there have been extensive efforts to develop vaccines, mainly targeting respiratory syncytial virus. At present, the only licensed product is a monoclonal antibody for passive immunisation. Its cost restricts its use to those at highest risk. Vaccines for active immunisation of pregnant women and young infants are also being developed.
Collapse
Affiliation(s)
- Konstantinos Karampatsas
- Specialist Registrar in Paediatrics, Paediatric and Adolescent Division, University College Hospitals NHS Foundation Trust, London NW1 2BU
| | - Jonathan Kong
- Specialty Trainee in Paediatrics, Paediatric and Adolescent Division, University College Hospitals NHS Foundation Trust, London
| | - Jonathan Cohen
- Consultant in General Paediatrics and Paediatric Infectious Diseases, Paediatric and Adolescent Division, University College Hospitals NHS Foundation Trust, London
| |
Collapse
|
12
|
Paes B, Mitra S. Palivizumab for children with Down syndrome: is the time right for a universal recommendation? Arch Dis Child 2019; 104:719-721. [PMID: 30591428 DOI: 10.1136/archdischild-2018-316408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Souvik Mitra
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, Nova Scotia, Canada
| |
Collapse
|
13
|
Respiratory Syncytial Virus Prophylaxis in Neurologic and Muscular Disorders in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab. Pediatr Infect Dis J 2019; 38:775-780. [PMID: 30985509 DOI: 10.1097/inf.0000000000002297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to examine the risk of respiratory-related hospitalization in children with neurologic and muscular disorders (NMDs) who received respiratory syncytial virus (RSV) prophylaxis in the Canadian RSV Evaluation Study of Palivizumab. METHODS Canadian RSV Evaluation Study of Palivizumab is a prospective registry of children who received ≥1 palivizumab injection among 32 Canadian sites. Demographic data were collected at enrollment, and respiratory events were documented monthly. Cox proportional hazard analyses were conducted to compare respiratory illness-related hospitalization (RIH) and RSV-related hospitalization (RSVH) among children with NMD and those prophylaxed for standard indications (SI) and complex medical disorders. RESULTS Group differences were found in enrollment age and weight, birth weight, household crowding, neonatal stay and supplemental oxygen requirement (all P < 0.05). RIH and RSVH incidences were 19.2%, 3.3% (NMD, n = 605); 6.0%, 1.5% (SI, n = 20,335), 9.4%, 1.6% (complex medical disorders, n = 4063), respectively. Children with NMD had a higher risk of RIH (hazard ratio [HR]: 1.90; 95% confidence interval (CI): 1.41-2.56; P < 0.0005) than those with SI. RSVH risk was greater in children with NMD compared with both the SI (HR: 2.26; 95% CI: 1.38-3.72; P = 0.001) and complex medical disorders groups (HR: 2.74; 95% CI: 1.55-4.84; P = 0.001). Children with more severe infantile onset NMD had a higher risk of RIH than those with general hypotonic disorders (HR: 1.69; 95% CI: 1.06-2.68; P = 0.027) but not RSVH. CONCLUSIONS Children with NMD who received palivizumab had a higher risk of both RIH and RSVH. Our results imply that all children with NMD, regardless of disease severity, are at risk for respiratory-related illness and RSV infection.
Collapse
|
14
|
Kang JM, Lee J, Kim YK, Cho HK, Park SE, Kim KH, Kim MJ, Kim S, Kim YJ. Pediatric intensive care unit admission due to respiratory syncytial virus: Retrospective multicenter study. Pediatr Int 2019; 61:688-696. [PMID: 31107995 PMCID: PMC7168019 DOI: 10.1111/ped.13893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 04/12/2019] [Accepted: 05/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA. METHODS In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed. RESULTS A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%. CONCLUSIONS Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.
Collapse
Affiliation(s)
- Ji-Man Kang
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, , Korea.,Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Hye Kyung Cho
- Department of Pediatrics, Gachon University School of Medicine, Incheon, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, Ewha Women's University School of Medicine, Seoul, Korea
| | - Min-Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, , Korea
| |
Collapse
|
15
|
Huggard D, Molloy EJ. Question 1: Palivizumab for all children with Down syndrome? Arch Dis Child 2019; 104:94-97. [PMID: 30279156 DOI: 10.1136/archdischild-2018-316140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Dean Huggard
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Neonatology, Our Lady's Children's Hospital, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland.,Neonatology, Coombe Women & Infants University Hospital, Dublin, Ireland
| |
Collapse
|
16
|
Mitra S, El Azrak M, McCord H, Paes BA. Hospitalization for Respiratory Syncytial Virus in Children with Down Syndrome Less than 2 Years of Age: A Systematic Review and Meta-Analysis. J Pediatr 2018; 203:92-100.e3. [PMID: 30266507 DOI: 10.1016/j.jpeds.2018.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To compare the respiratory syncytial virus (RSV)-related hospitalization rate, hospital length of stay (LOS), and need for assisted ventilation in children aged <2 years with Down syndrome and those without Down syndrome. STUDY DESIGN MEDLINE, Embase, and CINAHL databases were searched from inception up to December 2017. Studies that provided data on RSV-related hospitalization in children aged <2 years with Down syndrome and those without Down syndrome were included. Data were independently extracted in pairs by 2 reviewers and synthesized with random-effects meta-analysis. RESULTS In 10 studies including a total of 1 748 209 children, 12.6% of the children with Down syndrome (491 of 3882) were hospitalized with RSV infection. The presence of Down syndrome was associated with a significantly higher risk of RSV-related hospitalization (relative risk [RR], 6.06; 95% CI, 4.93-7.45; I2 = 65%; Grading of Recommendations, Assessment, Development and Evaluation [GRADE], moderate). RSV-related LOS (mean difference, 2.11 days; 95% CI, 1.47-2.75 days; I2 = 0%; GRADE, low), and the need for assisted ventilation (RR, 5.82; 95% CI, 1.81-18.69; I2 = 84%; GRADE, low). Children with Down syndrome without congenital heart disease (RR, 6.31; 95% CI, 4.83-8.23; GRADE, moderate) also had a significantly higher risk of RSV-related hospitalization. The risk of RSV-related hospitalization remained significant in the subgroup of children aged <1 year (RR, 6.25; 95% CI, 4.71-8.28; GRADE, high). CONCLUSION RSV-related hospitalization, hospital LOS, and the need for assisted ventilation are significantly higher in children with Down syndrome aged <2 years compared with those without Down syndrome. The results should prompt reconsideration of the need for routine RSV prophylaxis in children with Down syndrome up to 2 years of age.
Collapse
Affiliation(s)
- Souvik Mitra
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, NS, Canada.
| | - Mohamed El Azrak
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Helen McCord
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, NS, Canada
| | - Bosco A Paes
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
17
|
Underlying factors of recurrent infections in patients with down syndrome. North Clin Istanb 2018; 5:163-168. [PMID: 30374487 PMCID: PMC6191560 DOI: 10.14744/nci.2017.69379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/30/2017] [Indexed: 11/20/2022] Open
Abstract
Down syndrome is the most common chromosomal aberration. Patientswith Down syndrome suffer more infections than those without the disease. Underlying immunological disorders are consideredto be the reason for the increasing frequency of infections in patients with Down syndrome. In addition, some anatomical abnormalities in the respiratory tractaccompanying Down syndrome can disturb the innate immunity and contribute to the increase in infection rate. Respiratory tract infections are one of the most common causes of mortality in patients with Down syndrome. Awareness of the underlying reason for frequent respiratory tract infections should result in a decrease in mortality among these patients and contribute to an improvementin their quality of life.
Collapse
|
18
|
Beckhaus AA, Castro-Rodriguez JA. Down Syndrome and the Risk of Severe RSV Infection: A Meta-analysis. Pediatrics 2018; 142:peds.2018-0225. [PMID: 30093540 DOI: 10.1542/peds.2018-0225] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Down syndrome (DS) is the most common chromosomal condition in live-born infants worldwide, and lower respiratory infection caused by respiratory syncytial virus (RSV) is a leading cause of hospital admissions. OBJECTIVE To evaluate RSV-associated morbidity among children with DS compared with a population without DS. DATA SOURCES Four electronic databases were searched. STUDY SELECTION All cohorts or case-control studies of DS with an assessment of RSV infection and the associated morbidity or mortality were included without language restriction. DATA EXTRACTION Two reviewers independently reviewed all studies. The primary outcomes were hospital admission and mortality. Secondary outcomes included length of hospital stay, oxygen requirement, ICU admission, need for respiratory support, and additional medication use. RESULTS Twelve studies (n = 1 149 171) from 10 different countries met the inclusion criteria; 10 studies were cohort studies, 1 study was retrospective, and 1 study had both designs. DS was associated with a higher risk of hospitalization (odds ratio [OR]: 8.69; 95% confidence interval [CI]: 7.33-10.30; I2 = 11%) and mortality (OR: 9.4; 95% CI: 2.26-39.15; I2 = 38%) compared with what was seen in controls. Children with DS had an increased length of hospital stay (mean difference: 4.73 days; 95% CI: 2.12-7.33; I2 = 0%), oxygen requirement (OR: 6.53; 95% CI: 2.22-19.19; I2 = 0%), ICU admission (OR: 2.56; 95% CI: 1.17-5.59; I2 = 0%), need for mechanical ventilation (OR: 2.56; 95% CI: 1.17-5.59; I2 = 0%), and additional medication use (OR: 2.65 [95% CI: 1.38-5.08; I2 = 0%] for systemic corticosteroids and OR: 5.82 [95% CI: 2.66-12.69; I2 = 0%] for antibiotics) than controls. LIMITATIONS DS subgroups with and without other additional risk factors were not reported in all of the included studies. CONCLUSIONS Children with DS had a significantly higher risk of severe RSV infection than children without DS.
Collapse
Affiliation(s)
- Andrea A Beckhaus
- Division of Pediatrics, Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Division of Pediatrics, Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
19
|
Palivizumab use in infants with Down syndrome-report from the German Synagis™ Registry 2009-2016. Eur J Pediatr 2018; 177:903-911. [PMID: 29651734 DOI: 10.1007/s00431-018-3142-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/14/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Infants with Down syndrome (DS) face an increased risk of respiratory tract infections. Recent studies describe DS as independent risk factor for a complicated clinical course in infants with respiratory syncytial virus (RSV) infection. The prospective observational German Synagis™ Registry comprises data from 249 children below 25 months of age with DS and palivizumab prophylaxis 2009-2016 (1191 administrations; mean 4.8 per patient and season). The median gestational age and the birth weight in patients without and with DS were 31 versus 37 weeks (P < 0.001) and 1590 versus 2750 g, respectively (P < 0.001). Patients with DS significantly more often had congenital heart disease (CHD), siblings in kindergarten or school, treatment with oxygen at home, immunodeficiency, and neuromuscular impairment. The RSV-related hospitalization rate in patients with DS was 1.20%; the hospitalization rate in patients without DS was 0.71%. CONCLUSION Data from 249 children with DS receiving palivizumab prophylaxis in seven consecutive RSV seasons (2009-2016) in Germany reveal important differences between patients with and without DS concerning the main indication for palivizumab use and additional risk factors. Bearing in mind the limitations of an uncontrolled postmarketing observational study, the results confirm the field effectiveness of palivizumab prophylaxis in this special population. What is Known: • Recent studies describe the Down syndrome as independent risk factor for a complicated clinical course in infants with RSV infection. What is New: • Compared with other infants receiving palivizumab prophylaxis, patients with Down syndrome significantly more often had congenital heart disease, siblings in kindergarten or school, treatment with oxygen at home, immunodeficiency, and neuromuscular impairment. • In infants with palivizumab prophylaxis breakthrough, RSV-related hospitalization rates were not significantly higher in those with Down syndrome.
Collapse
|
20
|
Chan M, Park JJ, Shi T, Martinón-Torres F, Bont L, Nair H. The burden of respiratory syncytial virus (RSV) associated acute lower respiratory infections in children with Down syndrome: A systematic review and meta-analysis. J Glob Health 2018; 7:020413. [PMID: 29302319 PMCID: PMC5735780 DOI: 10.7189/jogh.07.020413] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Acute lower respiratory tract infections (ALRIs) caused by respiratory syncytial virus (RSV) are a leading cause of hospitalization in infants. Numerous risk factors have been identified in the aetiology of severe RSV–associated ALRI necessitating hospitalisation, including prematurity and congenital heart disease. Down syndrome (DS), a common genetic disorder associated with congenital and dysmorphic features, has recently been identified as an independent risk factor for RSV–associated ALRI requiring hospitalisation; however, the disease burden of RSV–associated ALRI in this population has not yet been established. Similarly, the impact of DS as an independent risk factor has not yet been quantified. We aimed therefore to estimate the incidence of admissions in children with DS, and by comparing this with unaffected children, to quantify the risk of DS independent of other risk factors. Methods A systematic review of the existing literature published between 1995 and March 1, 2017 was performed to quantify the incidence of hospitalisation due to RSV–associated ALRI in children with DS. Meta–analyses were performed on extracted data using STATA statistical software, and hospitalisation rates for children with and without DS under the age of 2 were calculated. Findings 5 articles were ultimately deemed eligible for analyses. Analyses were limited to children under the age of 2 years. We calculated the hospitalisation rate for children with DS in this age group to be 117.6 per 1000 child–years (95% CI 67.4–205.2), vs a rate of 15.2 per 1000 child–years (95% CI 8.3–27.6) in unaffected children. This indicates DS contributes to a 6.8 (95% CI 5.5–8.4) fold increase in the relative risk of hospitalisation for RSV–associated ALRI. Interpretation Though limited by a small number of articles, this review found sufficient evidence to conclude DS was a significant independent risk factor for the development of severe RSV–associated ALRI requiring hospitalisation. Further studies are needed to define the impact of DS in conjunction with other comorbidities on the risk of severe RSV infection. Determining benefits of immunoprophylaxis or future vaccines against RSV in this at–risk population is warranted.
Collapse
Affiliation(s)
- Markus Chan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK.,Joint first authroship
| | - John J Park
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Joint first authroship
| | - Ting Shi
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Louis Bont
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | | |
Collapse
|
21
|
Simões EAF, Bont L, Manzoni P, Fauroux B, Paes B, Figueras-Aloy J, Checchia PA, Carbonell-Estrany X. Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children. Infect Dis Ther 2018; 7:87-120. [PMID: 29470837 PMCID: PMC5840107 DOI: 10.1007/s40121-018-0188-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence - A Geographical Archive of the Literature) series has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This seventh and final publication covers the past, present and future approaches to the prevention and treatment of RSV infection among infants and children. METHODS A systematic review was undertaken of publications between January 1, 1995 and December 31, 2017 across PubMed, Embase and The Cochrane Library. Studies reporting data on the effectiveness and tolerability of prophylactic and therapeutic agents for RSV infection were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. A further nonsystematic search of the published literature and Clinicaltrials.gov on antiviral therapies and RSV vaccines currently in development was also undertaken. RESULTS The systematic review identified 1441 studies of which 161 were included. Management of RSV remains centered around prophylaxis with the monoclonal antibody palivizumab, which has proven effective in reducing RSV hospitalization (RSVH) in preterm infants < 36 weeks' gestational age (72% reduction), children with bronchopulmonary dysplasia (65% reduction), and infants with hemodynamically significant congenital heart disease (53% reduction) (high SOE). Palivizumab has also shown to be effective in reducing recurrent wheezing following RSVH (high SOE). Treatment of RSV with ribavirin has conflicting success (moderate SOE). Antibodies with increased potency and extended half-life are currently entering phase 3 trials. There are approximately 15 RSV vaccines in clinical development targeting the infant directly or indirectly via the mother. CONCLUSION Palivizumab remains the only product licensed for RSV prophylaxis, and only available for high-risk infants. For the general population, there are several promising vaccines and monoclonal antibodies in various stages of clinical development, with the aim to significantly reduce the global healthcare impact of this common viral infection. FUNDING AbbVie.
Collapse
Affiliation(s)
- Eric A F Simões
- Center for Global Health, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
- ReSViNET (Respiratory Syncytial Virus Network), Utrecht, The Netherlands
| | - Paolo Manzoni
- ReSViNET (Respiratory Syncytial Virus Network), Utrecht, The Netherlands
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
| |
Collapse
|
22
|
Kashiwagi T, Okada Y, Nomoto K. Palivizumab Prophylaxis Against Respiratory Syncytial Virus Infection in Children with Immunocompromised Conditions or Down Syndrome: A Multicenter, Post-Marketing Surveillance in Japan. Paediatr Drugs 2018; 20:97-104. [PMID: 28895096 PMCID: PMC5775975 DOI: 10.1007/s40272-017-0264-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to assess the safety and effectiveness of palivizumab for the prevention of lower respiratory tract infection (LRI) caused by respiratory syncytial virus (RSV) in children with immunocompromised conditions or Down syndrome. METHODS In this multicenter, post-marketing surveillance study (December 2013 to December 2015), children aged ≤24 months with immunocompromised conditions or Down syndrome (without hemodynamically significant congenital heart disease) receiving palivizumab immunoprophylaxis during two RSV seasons were observed until 30 days after the final palivizumab injection. Safety [adverse events (AEs), serious AEs (SAEs), adverse drug reactions (ADRs), serious ADRs (SADRs)] and effectiveness (frequency, incidence, and duration of hospitalization due to RSV infections) were assessed. RESULTS Of 304 patients receiving palivizumab, 167 (54.9%) had immunocompromised conditions, and 138 (45.4%) had Down syndrome; 260 (85.5%) completed palivizumab immunoprophylaxis. The annual mean (±standard deviation) number of doses was 5.3 (±2.4) per season. Overall, 220 AEs occurred in 99 patients (32.6%), including 89 SAEs in 53 patients (17.4%). Of these, 33 AEs in 25 patients (8.22%) were considered ADRs, and 13 ADRs in 11 patients (3.62%) were considered SADRs. In four patients, five SADRs (nephroblastoma and asthma in the same patient, septic shock, device-related infection, and drug-induced liver injury) were previously unreported; however, none were considered drug-related. During the observation period, five RSV infections occurred and two patients required hospitalization. CONCLUSION Palivizumab was generally safe and effective for the prevention of LRI caused by RSV in newborns, infants, and children with immunocompromised conditions or Down syndrome up to the age of 24 months.
Collapse
Affiliation(s)
| | - Yukiko Okada
- AbbVie GK, Mita 3-5-27, Minato-ku, Tokyo, 108-6302, Japan
| | - Ken Nomoto
- AbbVie GK, Mita 3-5-27, Minato-ku, Tokyo, 108-6302, Japan.
| |
Collapse
|
23
|
Grut V, Söderström L, Naumburg E. National cohort study showed that infants with Down's syndrome faced a high risk of hospitalisation for the respiratory syncytial virus. Acta Paediatr 2017; 106:1519-1524. [PMID: 28556255 DOI: 10.1111/apa.13937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
AIM The respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants. We investigated this risk in children with Down's syndrome under two years of age, adjusted for other known risk factors. METHODS This national, retrospective 1:2 matched cohort study comprised all Swedish children born with Down's from 2006 to 2011, who were each randomly matched to two controls without Down's. Data on RSV hospitalisation and risk factors for RSV were obtained from national registers. The risk of RSV hospitalisation was assessed using multivariable Cox regression with pairwise stratification. RESULTS The study comprised 814 children with Down's and 1628 controls. We found that 82 children with Down's (10.1%) and 22 controls (1.4%) were hospitalised for RSV. The hazard ratio for children with Down's was 4.00 (95% confidence interval 1.58-10.13) for up to one year of age and 6.60 (95% CI: 2.83-15.38) for up to two years of age, adjusted for other risk factors. During the second year of life, RSV hospitalisation continued for children with Down's, while it was minimal for the controls. CONCLUSION Children with Down's faced a high risk of RSV hospitalisation, which continued beyond the first year of age.
Collapse
Affiliation(s)
- Viktor Grut
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | - Lars Söderström
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | - Estelle Naumburg
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
- Department of Clinical Science, Pediatrics; Umeå University; Umeå Sweden
| |
Collapse
|
24
|
Resch B. Product review on the monoclonal antibody palivizumab for prevention of respiratory syncytial virus infection. Hum Vaccin Immunother 2017; 13:2138-2149. [PMID: 28605249 PMCID: PMC5612471 DOI: 10.1080/21645515.2017.1337614] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Respiratory syncytial virus (RSV) accounts for about 20% of all respiratory infections in children below the age of 5 y. It is associated with up to 63% of all acute respiratory infections and up to 81% of all viral lower respiratory tract infections causing hospitalization in infants and young children. RSV leads to seasonal epidemics between November and April in the northern hemisphere. Most severe infections (RSV accounts for 50 to 80% of all cause bronchiolitis) affect infants younger than 6 months of age and high-risk infants including those born preterm with or without bronchopulmonary dysplasia and those with hemodynamically significant congenital heart disease up to an age of 24 months. Palivizumab, a highly potent RSV-neutralizing monoclonal antibody (Mab), has been licensed in 1998 for prophylactic use to prevent RSV associated hospitalizations in high-risk infants. This Mab is given by monthly intramuscular injection at a dose of 15 mg/kg over the RSV season (up to 5 times). Palivizumab proved to be safe and well-tolerated in this population. Concerns have been raised regarding cost-effectiveness of palivizumab and thus, palivizumab prophylaxis is mainly limited to selected high-risk infants for the first RSV season. Long-lasting Mabs will be the next future approach in the prophylaxis of RSV hospitalization until a vaccine is developed.
Collapse
Affiliation(s)
- Bernhard Resch
- a Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Pediatric Department , Medical University Graz , Graz , Austria
| |
Collapse
|
25
|
Outcomes of Infants Receiving Palivizumab Prophylaxis for Respiratory Syncytial Virus in Canada and Italy: An International, Prospective Cohort Study. Pediatr Infect Dis J 2017; 36:2-8. [PMID: 27649365 DOI: 10.1097/inf.0000000000001340] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection frequently results in RSV-related hospitalization (RSVH) in young infants. We examined the outcomes of palivizumab recipients within the Canadian Registry (CARESS) and the Torino-Verona Italian Registry over the 2002-2014 RSV seasons. METHODS RSVHs were captured during the study seasons. Premature infants who received palivizumab (≤35 completed weeks' gestational age; group1) were compared with infants given palivizumab for underlying disorders regardless of gestational age (group 2). Variables and between-group incidences were analyzed. Risk factors associated with RSVH were assessed by logistic regression. RESULTS A total of 14,468 palivizumab-exposed infants were enrolled (group 1, n = 9093; group 2, n = 4856; miscellaneous, n = 519). RSVH was significantly more frequent in group 2 (211/4856, 4.34%) versus group 1 infants (216/9093, 2.37% [relative risk 1.93; 95% confidence interval (CI): 1.60-2.33; P < 0.0001]). Infants with neuromuscular disorders (7.88%), airway anomalies (5.95%), bronchopulmonary dysplasia (4.75%) and hemodynamically significant congenital heart disease (4.10%) had the highest RSVH incidences. After multivariable logistic regression, only neuromuscular disease [odds ratio [OR] 4.29; 95% CI: 2.30-8.00; P < 0.01], airway anomalies (OR 3.23; 95% CI: 1.92-5.43; P < 0.01), Down syndrome (OR 2.25; 95% CI: 1.31-3.89; P < 0.01), hemodynamically significant congenital heart disease (OR 2.24; 95% CI: 1.52-3.31; P < 0.001), prematurity ≤28 completed weeks' gestational age (OR 1.82; 95% CI: 1.29-2.58; P < 0.001) and bronchopulmonary dysplasia (OR 1.81; 95% CI: 1.31-2.50; P < 0.001) significantly predicted RSVH. No significant association was detected with the number of doses administered or the time elapsed after the previous dose. CONCLUSIONS RSVH rates are higher in infants given palivizumab for reasons other than prematurity. It is uncertain whether these findings relate to inadequate current palivizumab dosing protocols or to a specific increased RSVH risk inherent in infants with severe underlying comorbidities.
Collapse
|
26
|
Galleguillos C, Galleguillos B, Larios G, Menchaca G, Bont L, Castro-Rodriguez JA. Down's syndrome is a risk factor for severe lower respiratory tract infection due to respiratory syncytial virus. Acta Paediatr 2016; 105:e531-e535. [PMID: 27537430 DOI: 10.1111/apa.13552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/29/2016] [Accepted: 08/15/2016] [Indexed: 11/28/2022]
Abstract
AIM Previous studies have suggested that Down's syndrome is an independent risk factor for severe respiratory infection due to respiratory syncytial virus (RSV). We compared the clinical characteristics of children with and without Down's syndrome hospitalised due to RSV. METHODS This retrospective cohort study compared data from hospitalisations due to RSV lower respiratory tract infections (LRTI) in children under 14 years of age with (n = 58) and without (n = 58) Down's syndrome. RESULTS The Down's group had longer hospital stays than the controls of six versus four days (p < 0.0001), even after adjusting for age, weeks of gestation at birth, presence of asthma, bronchopulmonary dysplasia, haemodynamically significant and nonsignificant congenital heart disease. This difference increased when only children under one year of age were analysed to 11 versus five days (p < 0.0001). Children with Down's syndrome were more likely to be admitted to intensive care unit (43.1% versus 22.4%, p = 0.017), need noninvasive mechanical ventilation (36.2% versus 13.7%, p = 0.005) and be prescribed antibiotics and steroids. CONCLUSION Children with Down's syndrome hospitalised due to RSV LRTI had longer hospital stays and worse clinical courses than controls, highlighting the need for RSV prophylaxis for children with Down's syndrome, especially under one year of age.
Collapse
Affiliation(s)
- Constanza Galleguillos
- Division of Paediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Bárbara Galleguillos
- Department of Traumatology; School of Medicine; Universidad de Chile; Santiago Chile
| | - Guillermo Larios
- Division of Paediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Gonzalo Menchaca
- Division of Paediatrics; Hospital Dr. Sótero del Río; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Louis Bont
- University Medical Center-Utrecht; Utrecht The Netherlands
| | - Jose A. Castro-Rodriguez
- Division of Paediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| |
Collapse
|
27
|
Abstract
BACKGROUND Aboriginal infants are at risk for serious respiratory infection. OBJECTIVE To determine the hazard rate (HR) for respiratory-related illness (RIH) and respiratory syncytial virus (RSV) specific infection hospitalization (RSVH) in Aboriginal versus non-Aboriginal children receiving palivizumab and the effect of adherence on hospitalization. METHODS Palivizumab recipients in the Canadian registry from 2005 to 2014 were included. Adherence was determined by the number of palivizumab doses received during the RSV season and interdose time interval. Adherence proportions between groups were compared by χ test. Cox proportional hazard analysis determined the effect of Aboriginal status and adherence on the risk of RIH and RSVH. RESULTS Aboriginal infants comprised 3.6% (701/19,235) of the registry. HR was 1.6 [95% confidence interval (CI): 1.3-2.0, P < 0.001] and 1.2 (95% CI: 0.7-2.2, P = 0.383) for RIH and RSVH. Aboriginal infants were 62.8% and 63.3% adherent with all recommended injections and within stipulated time intervals, respectively, whereas 81.9% (χ = 162.45, df = 1, P < 0.001) and 72.4% (χ = 27.35, df = 1, P = 0.002) of non-Aboriginal infants were correspondingly adherent. Only 39.9% of Aboriginals were perfectly adherent (adherent to total number and injection intervals), compared with 61.7% of non-Aboriginals (χ = 133.89, df = 1, P < 0.001). Even after adjustment for known risk factors, being Aboriginal and nonadherent was associated with higher RIH hazard (HR = 1.4, 95% CI: 1.1-1.8; HR = 1.3, 95% CI: 1.1-1.4, P = 0.004), respectively. Aboriginals nonadherent with interdose intervals had a 2.2-fold increased HR for RSVH (HR = 2.2, 95% CI: 1.2-4.2, P = 0.015). CONCLUSIONS Prophylaxed Aboriginal infants have a significantly increased RIH and RSVH hazard than non-Aboriginal infants. Improving adherence especially interdose frequency may further reduce hospitalizations in this vulnerable population.
Collapse
|
28
|
Pignotti MS, Carmela Leo M, Pugi A, De Masi S, Biermann KP, Galli L, Vitali Rosati G, Buonocore G, Mugelli A, Dani C, Lucenteforte E, Bellini F, Donzelli G. Consensus conference on the appropriateness of palivizumab prophylaxis in respiratory syncytial virus disease. Pediatr Pulmonol 2016; 51:1088-1096. [PMID: 27618642 DOI: 10.1002/ppul.23561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/22/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
Respiratory syncytial virus infection represents a clinical burden among young children under 24 months. Palivizumab is the only drug licensed in Italy for the prevention of serious lower respiratory tract disease requiring hospitalization caused by respiratory syncytial virus in children at high risk. However recommendations for palivizumab prophylaxis are heterogeneous. Not all the published documents agree about the clinical indications of palivizumab; this could lead to different clinical practices and concerns about the appropriateness of prophylaxis. These issues and the lack of evidence about palivizumab prophylaxis efficacy in specific medical conditions brought on the idea of a consensus conference on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications. The goal was to perform a review of the evidence regarding the efficacy and the safety of palivizumab and give recommendations in order to harmonize its use. A structured and validated method to conduct the consensus process was adopted. The consensus conference recommends palivizumab prophylaxis in infants born before 29 weeks and younger than 12 months at the start of the epidemic season. According to evidence from literature and experts' opinion, palivizumab prophylaxis is not recommended in preterm infants of gestational age ≥29 weeks, without co-morbidity (i.e., cardiac, bronchopulmonary diseases). The experts identified some clinical rare conditions for which the decision of prophylaxis should be entrusted to the specialists. The evaluation of the appropriateness of palivizumab prophylaxis in the single patient should be documented by the specialists. Pediatr Pulmonol. 2016;51:1088-1096. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | - Alessandra Pugi
- Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | | | | | - Luisa Galli
- Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | | | | | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | | | | | | |
Collapse
|
29
|
Manikam L, Reed K, Venekamp RP, Hayward A, Littlejohns P, Schilder A, Lakhanpaul M. Limited Evidence on the Management of Respiratory Tract Infections in Down's Syndrome: A Systematic Review. Pediatr Infect Dis J 2016; 35:1075-9. [PMID: 27273687 PMCID: PMC5130062 DOI: 10.1097/inf.0000000000001243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To systematically review the effectiveness of preventative and therapeutic interventions for respiratory tract infections (RTIs) in people with Down's syndrome. METHODS Databases were searched for any published and ongoing studies of respiratory tract diseases in children and adults with Down's syndrome. These databases were searched for controlled trials, cohort studies and controlled before-after studies. Trial registries were searched for ongoing studies. Initially, all study types were included to provide a broad overview of the existing evidence base. However, those with a critical risk of bias were excluded using the Cochrane Risk of Bias tool. RESULTS A total of 13,575 records were identified from which 5 studies fulfilled the eligibility criteria and 3 fulfilled our criteria for data extraction. One randomized controlled trial of moderate risk of bias compared zinc therapy with placebo. Outcome data were only reported for 50 (78%) children who presented with extreme symptoms; no benefit of zinc therapy was found. One non-randomized controlled trial with serious risk of bias included 26 children and compared pidotimod (an immunostimulant) with no treatment; pidotimod was associated with fewer upper RTI recurrences compared with no treatment (1.43 vs. 3.82). A prospective cohort study with moderate risk of bias compared 532 palivizumab treated children with 233 untreated children and found that children treated with palivizumab had fewer respiratory syncytial virus-related hospitalization (23 untreated and 8 treated), but the same number of overall RTI-related hospitalizations (73 untreated and 74 treated) in the first 2 years of life. CONCLUSIONS The evidence base for the management of RTIs in people with Down's syndrome is incomplete; current studies included children only and carry a moderate to serious risk of bias. Methodologic rigorous studies are warranted to guide clinicians in how best to prevent and treat RTIs in children with Down's syndrome.
Collapse
Affiliation(s)
- Logan Manikam
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Kate Reed
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Roderick P. Venekamp
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Andrew Hayward
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Peter Littlejohns
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Anne Schilder
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| | - Monica Lakhanpaul
- From the Institute of Child Health, University College London; Guy’s King’s & St Thomas’ School of Medical Education, King’s College London, London, United Kingdom; Julius Center for Health Sciences and Primary Care and Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands; UCL Farr Institute of Health Informatics, University College London; Division of Health and Social Care Research, King’s College London; and evidENT, Ear Institute, University College London, London, United Kingdom
| |
Collapse
|
30
|
Millman AJ, Finelli L, Bramley AM, Peacock G, Williams DJ, Arnold SR, Grijalva CG, Anderson EJ, McCullers JA, Ampofo K, Pavia AT, Edwards KM, Jain S. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. J Pediatr 2016; 173:188-195.e4. [PMID: 27017483 PMCID: PMC4897771 DOI: 10.1016/j.jpeds.2016.02.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/28/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. STUDY DESIGN Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. RESULTS From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. CONCLUSIONS Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders.
Collapse
Affiliation(s)
- Alexander J. Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA,Reprint requests: Alexander J. Millman, MD, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop G-37, Atlanta, GA 30329.
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anna M. Bramley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Georgina Peacock
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Sandra R. Arnold
- Le Bonheur Children's Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Jonathan A. McCullers
- Le Bonheur Children's Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN,St. Jude Children's Research Hospital, Memphis, TN
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Andrew T. Pavia
- University of Utah Health Sciences Center, Salt Lake City, UT
| | | | - Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
31
|
Essaidi-Laziosi M, Lyon M, Mamin A, Fernandes Rocha M, Kaiser L, Tapparel C. A new real-time RT-qPCR assay for the detection, subtyping and quantification of human respiratory syncytial viruses positive- and negative-sense RNAs. J Virol Methods 2016; 235:9-14. [PMID: 27180039 DOI: 10.1016/j.jviromet.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022]
Abstract
Human respiratory syncytial virus (RSV) is a major health problem and the main cause of hospitalization due to bronchiolitis. RSV is divided into two antigenic subgroups, RSV-A and -B that co-circulate worldwide. Rapid and sensitive detection is desirable for proper patient handling while assessment of viral load may help to evaluate disease severity and progression. Finally RSV subtyping is needed to determine the prevalence and pathogenicity of each RSV subgroup, as well as their sensitivity to treatment. In this study, we took into account the most recent circulating RSV variants and designed two quantitative TaqMan one-step RT-PCR assays to detect and quantify both RSV subgroups separately. Standard dilutions of transcripts of positive and negative polarities were included in the assay validation to assess potential differences in sensitivity on negative-sense genomes and positive-sense RNAs. In addition, RSV detection in respiratory specimens of different types and sampled in different populations was compared to commercially available RSV diagnostic tools. Altogether, the RSV-A and -B assays revealed sensitive and quantitative over a wide range of viral loads, with a slight improved sensitivity of the RSV-B assay on positive sense transcripts, and allowed accurate RSV subtyping. We thus provide a useful tool for both RSV diagnostics and research.
Collapse
Affiliation(s)
- Manel Essaidi-Laziosi
- Faculty of Medicine of Geneva, Department of Microbiology and Molecular medicine, 1 rue Michel Servet, 1211 Geneva 4, Switzerland; Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| | - Matthieu Lyon
- Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| | - Aline Mamin
- Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| | - Mélanie Fernandes Rocha
- Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| | - Laurent Kaiser
- Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| | - Caroline Tapparel
- Faculty of Medicine of Geneva, Department of Microbiology and Molecular medicine, 1 rue Michel Servet, 1211 Geneva 4, Switzerland; Geneva University Hospitals, Infectious Diseases Divisions, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 4, Switzerland.
| |
Collapse
|
32
|
Doucette A, Jiang X, Fryzek J, Coalson J, McLaurin K, Ambrose CS. Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997-2012. PLoS One 2016; 11:e0152208. [PMID: 27050095 PMCID: PMC4822775 DOI: 10.1371/journal.pone.0152208] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/10/2016] [Indexed: 01/30/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB) hospitalization rates from 1997‒2012 among US high-risk infants. Methods The Kids’ Inpatient Database (KID) infant annual RSV (ICD-9 079.6, 466.11, 480.1) and UB (ICD-9 466.19, 466.1) hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]); congenital airway anomalies (CAA); congenital heart disease (CHD); Down syndrome (DS); and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$). Poisson and linear regression were used to test statistical significance of trends. Results RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%. Conclusions Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high-risk groups except higher-risk CHD, suggesting improvement in the health status of higher-risk CHD infants, potentially due to enhanced surgical interventions. Mechanical ventilation use and RSV and UB hospitalization costs increased while RSV mortality declined.
Collapse
Affiliation(s)
| | | | - Jon Fryzek
- Epidstat, Ann Arbor, MI, United States of America
| | | | | | | |
Collapse
|
33
|
Bollani L, Baraldi E, Chirico G, Dotta A, Lanari M, Del Vecchio A, Manzoni P, Boldrini A, Paolillo P, Di Fabio S, Orfeo L, Stronati M, Romagnoli C. Revised recommendations concerning palivizumab prophylaxis for respiratory syncytial virus (RSV). Ital J Pediatr 2015; 41:97. [PMID: 26670908 PMCID: PMC4681171 DOI: 10.1186/s13052-015-0203-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/25/2015] [Indexed: 11/12/2022] Open
Abstract
Respiratory Syncytial Virus infections are one of the leading causes of severe respiratory diseases that require hospitalization and, in some cases, intensive care. Once resolved, there may be respiratory sequelae of varying severity. The lack of effective treatments for bronchiolitis and the lack of vaccines for RSV accentuate the role of prevention in decreasing the impact of this disease. Prevention of bronchiolitis strongly relies on the adoption of environment and the hygienic behavior measures; an additional prophylactic effect may be offered, in selected cases, by Palivizumab, a humanized monoclonal antibody produced by recombinant DNA technology, able to prevent RSV infection by blocking viral replication.After many years the Italian Society of Neonatology, on the basis of the most recent scientific knowledge, has decided to revise recommendations for the use of palivizumab in the prevention of RSV infection.
Collapse
Affiliation(s)
- Lina Bollani
- Unità di Neonatologia, Patologia Neonatale e Terapia Intensiva, Policlinico S. Matteo, Pavia, Italy.
| | - Eugenio Baraldi
- U.O.C. Terapia Intensiva e patologia neonatale, A.O. Padova, Padova, Italy.
| | - Gaetano Chirico
- U.O. C. Neonatologia e Terapia Intensiva neonatale, A.O. Spedali civili, Brescia, Italy.
| | - Andrea Dotta
- U.O.C. Terapia intensiva neonatale, Ospedale pediatrico Bambino Gesù, Roma, Italy.
| | - Marcello Lanari
- U.O. Pediatria E Neonatologia , Ospedale Nuovo S. Maria della Scaletta, Imola, Italy.
| | - Antonello Del Vecchio
- U.O. Utin e Neonatologia, Azienda Ospedaliera di Venere e Giovanni XXIII, Bari, Italy.
| | - Paolo Manzoni
- U.O. Neonatologia e TIN ospedaliera, Azienda Ospedaliera OIRM-S. Anna, Torino, Italy.
| | - Antonio Boldrini
- U.O. Nido, Patologia Neonatale e Terapia Intensiva Neonatale, Ospedale Santa Chiara, Pisa, Italy.
| | | | - Sandra Di Fabio
- U.O. Neonatologia, Presidio Ospedaliero S. Salvatore, L'Aquila, Italy.
| | - Luigi Orfeo
- U.O. Nido, Patologia Neonatale e Terapia Intensiva Neonatale, Azienda Ospedaliera G. Rummo, Benevento, Italy.
| | - Mauro Stronati
- Unità di Neonatologia, Patologia Neonatale e Terapia Intensiva, Ospedale Policlinico S. Matteo, Pavia, Italy.
| | - Costantino Romagnoli
- U.O.C. Neonatologia, Policlinico Universitario A. Gemelli, Roma, Italy.
- Division of Neonatology, Department of Pediatrics, Catholic University S.H., Largo A. Gemelli,8, Rome, 00168, Italy.
| |
Collapse
|
34
|
Ting TW, Chan HY, Wong PPC, Testoni D, Lee JH. Down syndrome increases hospital length of stay in children with bronchiolitis. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815617773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Children with Down syndrome have an increased burden of respiratory infections. We hypothesized that children with Down syndrome hospitalized for bronchiolitis would stay longer compared with children without Down syndrome. Methods: We conducted a retrospective case–control study of children with Down syndrome who were hospitalized for bronchiolitis in Singapore from 2004 to 2012. Results: There were 27 and 43 admissions in the Down syndrome and control groups respectively. More children with Down syndrome had congenital heart defects (14 (52%) vs. none in controls). Children with Down syndrome stayed longer in hospital compared with controls (7 (interquartile range (IQR) 5–14) vs. 3 (IQR 2–4) days, p<0.001). In a subgroup analysis of patients without or surgically corrected congenital heart defects, children with Down syndrome still had a longer stay (6 (IQR 5–8) vs. 3 (IQR 2–4) days, p<0.001). Conclusion: Our study suggests that children with Down syndrome hospitalized for bronchiolitis stayed longer in hospital compared with those without Down syndrome.
Collapse
Affiliation(s)
- Teck Wah Ting
- Genetics Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | - Hiok Yang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Petrina Poh Chen Wong
- Respiratory Medicine Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | | | - Jan Hau Lee
- Children’s Intensive Care, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate School of Medicine, Singapore
| |
Collapse
|
35
|
Lizama Calvo M, Cerda Lorca J, Monge Iriarte M, Carrillo Mayanquer I, Clavería Rodríguez C, Castillo Moya A. [Hospital morbidity and mortality in children with Down's syndrome: Experience in a university hospital in Chile]. ACTA ACUST UNITED AC 2015; 87:102-9. [PMID: 26627695 DOI: 10.1016/j.rchipe.2015.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 06/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children with Down's syndrome (DS) have a higher risk of congenital malformations and acute diseases, with increased risk of hospital admissions compared with the general population. This study describes patterns of hospital admissions for children and adolescents with DS. PATIENTS AND METHODS A retrospective study of hospital admissions of children with DS, younger than 15 years old, and cared for by the Paediatric Department of the Hospital Clínico Pontificia Universidad Católica de Chile, between 2008 and 2011. RESULTS There were 222 admissions of 161 patients with DS during the study period, of which 110 were girls. The median age was 8 months, and the median hospital stay was 6 days. Just over half (56.7%) of the hospital stays were in the Paediatric Critic Care Unit. Heart surgery was performed on 59.4%, and the principal congenital heart defect attended was atrioventricular canal. The principal diagnosis, other than heart surgery, was lower respiratory tract infection. In this series, 3 children died. CONCLUSIONS Children with DS are a relevant group for inpatient care, because their high incidence in Chile, their respiratory and cardiovascular risk, prolonged hospitalizations, high frequency of critical care days and mortality risk. This group has special and complex needs during their hospitalizations and it is necessary to create a multidisciplinary team with competences to take care the particular characteristics of this vulnerable group.
Collapse
Affiliation(s)
- Macarena Lizama Calvo
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro UC Síndrome de Down, Santiago, Chile.
| | - Jaime Cerda Lorca
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Monge Iriarte
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Servicio de Pediatría, Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Irene Carrillo Mayanquer
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Clavería Rodríguez
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Cardiología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Castillo Moya
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Paciente Crítico Pediátrico, Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
36
|
|