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Shi Q, Castillo F, Viswanathan K, Kupferman F, MacDermid JC. Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital. J Prim Care Community Health 2021; 11:2150132720904518. [PMID: 31997703 PMCID: PMC6993153 DOI: 10.1177/2150132720904518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children's supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.
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Affiliation(s)
- Qiyun Shi
- Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.,McMaster University, Hamilton, Ontario, Canada
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2
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Hood AM, Strong H, Nwankwo C, Johnson Y, Peugh J, Mara CA, Shook LM, Brinkman WB, Real FJ, Klein MD, Hackworth R, Badawy SM, Thompson AA, Raphael JL, Yates AM, Smith-Whitley K, King AA, Calhoun C, Creary SE, Piccone CM, Hildenbrand AK, Reader SK, Neumayr L, Meier ER, Sobota AE, Rana S, Britto M, Saving KL, Treadwell M, Quinn CT, Ware RE, Crosby LE. Engaging Caregivers and Providers of Children With Sickle Cell Anemia in Shared Decision Making for Hydroxyurea: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27650. [PMID: 34018965 PMCID: PMC8178738 DOI: 10.2196/27650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is a genetic blood disorder that puts children at a risk of serious medical complications, early morbidity and mortality, and high health care utilization. Until recently, hydroxyurea was the only disease-modifying treatment for this life-threatening disease and has remained the only option for children younger than 5 years. Evidence-based guidelines recommend using a shared decision-making (SDM) approach for offering hydroxyurea to children with SCA (HbSS or HbS/β0 thalassemia) aged as early as 9 months. However, the uptake remains suboptimal, likely because caregivers lack information about hydroxyurea and have concerns about its safety and potential long-term side effects. Moreover, clinicians do not routinely receive training or tools, especially those that provide medical evidence and consider caregivers' preferences and values, to facilitate a shared discussion with caregivers. OBJECTIVE The aim of this study is to understand how best to help parents of young children with sickle cell disease and their clinicians have a shared discussion about hydroxyurea (one that considers medical evidence and parent values and preferences). METHODS We designed our study to compare the effectiveness of two methods for disseminating hydroxyurea guidelines to facilitate SDM: a clinician pocket guide (ie, usual care) and a clinician hydroxyurea SDM toolkit (H-SDM toolkit). Our primary outcomes are caregiver reports of decisional uncertainty and knowledge of hydroxyurea. The study also assesses the number of children (aged 0-5 years) who were offered and prescribed hydroxyurea and the resultant health outcomes. RESULTS The Ethics Committee of the Cincinnati Children's Hospital Medical Center approved this study in November 2017. As of February 2021, we have enrolled 120 caregiver participants. CONCLUSIONS The long-term objective of this study is to improve the quality of care for children with SCA. Using multicomponent dissemination methods developed in partnership with key stakeholders and designed to address barriers to high-quality care, caregivers of patients with SCA can make informed and shared decisions about their health. TRIAL REGISTRATION ClinicalTrials.gov NCT03442114; https://clinicaltrials.gov/ct2/show/NCT03442114. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27650.
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Affiliation(s)
- Anna M Hood
- Developmental Neurosciences, Institute of Child Health, University College London, London, United Kingdom
| | - Heather Strong
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Cara Nwankwo
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Yolanda Johnson
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Constance A Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lisa M Shook
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Rogelle Hackworth
- Cincinnati Children's Hospital Medical Center Partner, Cincinnati, OH, United States
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Alexis A Thompson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX, United States
| | - Amber M Yates
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, United States
| | - Kim Smith-Whitley
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison A King
- Program in Occupational Therapy and Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, United States
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cecelia Calhoun
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan E Creary
- Center for Innovation in Pediatric Practice, Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, United States
| | - Connie M Piccone
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States
- Division of Behavioral Health, Nemours/ Alfred I duPont Hospital for Children, Wilmington, DE, United States
| | - Steven K Reader
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States
- Division of Behavioral Health, Nemours/ Alfred I duPont Hospital for Children, Wilmington, DE, United States
| | - Lynne Neumayr
- Department of Hematology/Oncology, Children's Hospital Oakland, Oakland, CA, United States
- AbbVie, North Chicago, IL, United States
- University of California San Francisco, San Francisco, CA, United States
| | - Emily R Meier
- Pediatrics, Pediatric Hematology/Oncology, Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, United States
| | - Amy E Sobota
- Pediatric Hematology and Oncology, Boston Medical Center, Boston, MA, United States
| | - Sohail Rana
- Pediatrics and Child Health, College of Medicine, Howard University, Washington, DC, United States
| | - Maria Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kay L Saving
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL, United States
| | - Marsha Treadwell
- Department of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, Oakland, CA, United States
| | - Charles T Quinn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Russell E Ware
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lori E Crosby
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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3
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El Feghaly RE, Nolen JD, Lee BR, Abraham G, Nedved A, Hassan F, Selvarangan R. Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings. J Pediatr 2021; 228:271-277.e1. [PMID: 32828881 DOI: 10.1016/j.jpeds.2020.08.007] [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: 05/14/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings. STUDY DESIGN We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available. RESULTS We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P = .126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P < .0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P < .0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR. CONCLUSIONS Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.
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Affiliation(s)
- Rana E El Feghaly
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO
| | - John David Nolen
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Brian R Lee
- University of Missouri Kansas City, Kansas City, MO; Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO
| | - George Abraham
- University of Missouri Kansas City, Kansas City, MO; Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Amanda Nedved
- University of Missouri Kansas City, Kansas City, MO; Division of Urgent Care, Children's Mercy Kansas City, Kansas City, MO
| | - Ferdaus Hassan
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Rangaraj Selvarangan
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO.
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4
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Mathew S, Srinivasan M. Knowledge Base and Perceptions of Inpatient Providers and Parents About Influenza Vaccination in Hospitalized Children. Glob Pediatr Health 2020; 7:2333794X20947933. [PMID: 32851120 PMCID: PMC7425246 DOI: 10.1177/2333794x20947933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shakila Mathew
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Mythili Srinivasan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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5
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Ding X, Tian C, Wang H, Wang W, Luo X. Associations between family characteristics and influenza vaccination coverage among children. J Public Health (Oxf) 2020; 42:e199-e205. [PMID: 31553048 DOI: 10.1093/pubmed/fdz101] [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] [Received: 03/11/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To assess the associations between family characteristics and influenza vaccination coverage among children. METHODS Data were used from the National Health Interview Survey 2011-2016. RESULTS The number of children ranged from 10 720 to 12 991 per year from 2011 to 2016. After adjustment for the high-risk status of influenza complications, sex, age, region, race and office visits of children, children of adults who received influenza vaccination were 3.83-4.79 times (the lowest and the highest odds ratios from 2011 to 2016) more likely to be immunized for influenza. Health insurance (1.36-1.61) was also associated with vaccination in children. However, the education level of family adults (0.59-0.79) and marital status of being widowed/divorced/separated (0.74-0.79) were negatively associated with vaccination uptake in children. The following characteristics were not major concerns with influenza vaccination in children: class of worker, years on the job, physical activity, drinking, smoking, hepatitis B immunization, number of family members aged ≥65 years and the ratio of family income to the poverty threshold. Overall, results from the pooled analysis (2011-2016) were consistent with the above-mentioned findings. CONCLUSIONS Promoting parental influenza immunization and access to health insurance may be the most effective tools to promote the coverage of influenza vaccine among children.
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Affiliation(s)
- Xiaofei Ding
- Department of Immunization Planning, Kunshan Centers for Disease Control and Prevention, 215300 Kunshan, Jiangsu Province, China
| | - Changwei Tian
- Department of Immunization Planning, Kunshan Centers for Disease Control and Prevention, 215300 Kunshan, Jiangsu Province, China
| | - Hua Wang
- Department of Infectious Disease Control, Kunshan Centers for Disease Control and Prevention, 215300 Kunshan, Jiangsu Province, China
| | - Wenming Wang
- Department of Infectious Disease Control, Kunshan Centers for Disease Control and Prevention, 215300 Kunshan, Jiangsu Province, China
| | - Xiaoming Luo
- Department of Infectious Disease Control, Kunshan Centers for Disease Control and Prevention, 215300 Kunshan, Jiangsu Province, China
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6
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Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, Vangala S, Dickinson LM, Rand C, Humiston S, Szilagyi PG. Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey. Pediatrics 2020; 146:e20193852. [PMID: 32540985 PMCID: PMC7329256 DOI: 10.1542/peds.2019-3852] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization has designated vaccine hesitancy as 1 of the 10 leading threats to global health, yet there is limited current national data on prevalence of hesitancy among US parents. Among a nationally representative sample of US parents, we aimed to (1) assess and compare prevalence of hesitancy and factors driving hesitancy for routine childhood and influenza vaccination and (2) examine associations between sociodemographic characteristics and hesitancy for routine childhood or influenza vaccination. METHODS In February 2019, we surveyed families with children using the largest online panel generating representative US samples. After weighting, we assessed hesitancy using a modified 5-point Vaccine Hesitancy Scale and labeled parents as hesitant if they scored >3. RESULTS A total of 2176 of 4445 parents sampled completed the survey (response rate 49%). Hesitancy prevalence was 6.1% for routine childhood and 25.8% for influenza vaccines; 12% strongly and 27% somewhat agreed they had concerns about serious side effects of both routine childhood and influenza vaccines. A total of 70% strongly agreed that routine childhood vaccines are effective versus 26% for influenza vaccine (P < .001). In multivariable models, an educational level lower than a bachelor's degree and household income <400% of the federal poverty level predicted hesitancy about both routine childhood and influenza vaccines. CONCLUSIONS Almost 1 in 15 US parents are hesitant about routine childhood vaccines, whereas >1 in 4 are hesitant about influenza vaccine. Furthermore, 1 in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines, and only 1 in 4 believe influenza vaccine is effective. Vaccine hesitancy, particularly for influenza vaccine, is prevalent in the United States.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado;
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Christina Albertin
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Gregory Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Abigail Breck
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Cindy Rand
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York; and
| | - Sharon Humiston
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Peter G Szilagyi
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
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7
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Heo J, Jung HJ, Noh OK, Kim L, Park JE. Incidence of Influenza Among Childhood Cancer Survivors in South Korea: A Population-based Retrospective Analysis. In Vivo 2020; 34:929-933. [PMID: 32111806 PMCID: PMC7157854 DOI: 10.21873/invivo.11860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We quantified the incidence, and identified risk factors for influenza infection among childhood cancer survivors in South Korea, an at-risk population. PATIENTS AND METHODS Nationwide health insurance claims data were used to assess the frequency of influenza among childhood cancer survivors (aged <20 years) diagnosed between January 2009 and April 2016. A multivariable logistic regression was constructed to identify risk factors for influenza. RESULTS Of 6,457 children cancer survivors, 1,704 (27.0%) were diagnosed with influenza. Influenza was common in children <5 years old and infections were highest between late October and April. Over 60% of influenza treatment claims came from private clinics. Risk factors for influenza included age <9 years. CONCLUSION Childhood cancer survivors are particularly at-risk for influenza infection during the traditional influenza season. Identifying risks for influenza infection will help to establish countermeasures for reducing the influenza infections in at-risk cancer surviving children.
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Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
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Avalos LA, Ferber J, Zerbo O, Naleway AL, Bulkley J, Thompson M, Cragan J, Williams J, Odouli R, Kauffman TL, Ball S, Shifflett P, Li DK. Trivalent inactivated influenza vaccine (IIV3) during pregnancy and six-month infant development. Vaccine 2020; 38:2326-2332. [PMID: 32033850 PMCID: PMC7309563 DOI: 10.1016/j.vaccine.2020.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite recommendations by professional organizations that all pregnant women receive inactivated influenza vaccine, safety concerns remain a barrier. Our objective was to assess the effect of trivalent influenza vaccines (IIV3) during pregnancy on parent report 6-month infant development. METHODS We conducted a multi-site prospective birth cohort study during the 2010-2011 influenza season and followed pregnant women and their newborns through 6 months of age. Information on IIV3 during pregnancy was ascertained from the EHR and self-report. The Ages and Stages Questionnaire-3 (ASQ-3) was completed by the mother to assess 6-month infant neurodevelopment in five domains (communication, gross motor, fine motor, problem-solving, and personal adaptive skills). Scores for each domain above the cut-off point indicating typical development were categorized as "on schedule" while scores in the zones indicating the need for either monitoring or further assessment were categorized as "not on schedule". Multivariable logistic regression was conducted. RESULTS Of the 1225 infant-mother pairs, 65% received IIV3 during pregnancy. In bivariate analysis, infants of women who received IIV3 during pregnancy were moderately-less likely to need monitoring or further assessment in the personal social domain compared with infants of unvaccinated women (10.0% vs. 14.1%, p = 0.033; crude OR (cOR): 0.68(95%CI:0.48,0.97)). However, after controlling for potential confounders, the findings were no longer statistically significant (aOR:0.72,95%CI: 0.49,1.06,p = 0.46). No significant unadjusted or adjusted associations emerged in any other ASQ-3 domain. CONCLUSION There was no significant association between IIV3 exposure during pregnancy and 6-month infant development. Studies of IIV3 during pregnancy to assess longer-term developmental outcomes are indicated.
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Affiliation(s)
- Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
| | - Jeannette Ferber
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ousseny Zerbo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Joanna Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Mark Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet Cragan
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roxana Odouli
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Sarah Ball
- Abt Associates, Cambridge, MA, United States
| | | | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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9
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Kitt E, Drew RJ, Cunney R, Beekmann SE, Polgreen P, Butler K, Zaoutis T, Coffin SE. Diagnosis and Management of Pediatric Influenza in the Era of Rapid Diagnostics. J Pediatric Infect Dis Soc 2020; 9:51-55. [PMID: 30476135 DOI: 10.1093/jpids/piy118] [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: 03/19/2018] [Accepted: 10/24/2018] [Indexed: 01/29/2023]
Abstract
Influenza is a significant cause of childhood morbidity and death; it contributes to up to 16% of hospitalizations for respiratory illnesses worldwide. Novel rapid viral diagnostic tests, including molecular diagnostic tests, have the potential to significantly affect both time to diagnosis and selection of optimal anti-infective therapy. However, little is known about current treatment algorithms used in US hospitals. In this study, for hospitalized children in the United States, we aimed to define the current approaches to influenza diagnosis and treatment and to explore reasons for their potential variation. In this study, we aimed to define the current approaches to pediatric influenza diagnosis and treatment in US hospitals, and to explore reasons for their potential variation. Our results suggest a rise in the availability and use of rapid molecular diagnostic testing in addition to continued variability in anti-infective management, particularly with regard to antiviral use.
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Affiliation(s)
- Eimear Kitt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Richard J Drew
- Temple Street Children's University Hospital, Dublin, Ireland.,Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin
| | - Robert Cunney
- Temple Street Children's University Hospital, Dublin, Ireland
| | - Susan E Beekmann
- Emerging Infections Network, University of Iowa Carver College of Medicine, Iowa City
| | - Philip Polgreen
- Emerging Infections Network, University of Iowa Carver College of Medicine, Iowa City
| | - Karina Butler
- Temple Street Children's University Hospital, Dublin, Ireland.,School' of Medicine, University College Dublin, Ireland
| | - Theoklis Zaoutis
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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10
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Srinivasan M, Huntman J, Nelson M, Mathew S. Use of Peer Comparison, Provider Education, and Electronic Medical Record Triggers to Increase Influenza Vaccination Rates in Hospitalized Children. Hosp Pediatr 2020; 10:76-83. [PMID: 31818868 DOI: 10.1542/hpeds.2019-0076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The American Academy of Pediatrics recommends annual influenza vaccination for all children 6 months and older, yet only 59% of children nationally received the vaccine during the 2014-2016 influenza seasons. Of these, only 4% received the vaccine in a hospital setting. The goal of this quality improvement (QI) initiative was to increase influenza vaccination status at discharge at least twofold in children admitted to our hospital during the 2017-2018 influenza season compared with the 2016-2017 season. METHODS The QI initiative was conducted in the inpatient units at a tertiary care children's hospital. Interventions included electronic medical record triggers, provider education, and peer comparison. The primary outcome measure was the percentage of children discharged from the hospital with at least 1 dose of the influenza vaccine received either at the hospital or before admission. Queries about the influenza vaccination status of children were used as a process measure. Length of stay was used as a balancing measure. RESULTS The percentage of hospitalized children discharged with at least 1 dose of the vaccine increased 4.7-fold during the QI initiative (46%) compared with baseline (10%). There was a fourfold increase in parental query about the influenza vaccination status of their children (68%) during the QI initiative compared with the baseline period (16%). No significant difference occurred in the median length of stay among patients admitted during the QI initiative versus the baseline period. CONCLUSIONS We increased influenza vaccination status among children admitted to our hospital using electronic medical record triggers, provider education, and peer comparison.
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Affiliation(s)
- Mythili Srinivasan
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri; and
| | | | | | - Shakila Mathew
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri; and
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11
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Greydanus DE, Leonov A, Elisa A, Azmeh R. Should rare immunologic, neurologic, and other adverse events be indications to withhold vaccination? Transl Pediatr 2019; 8:419-427. [PMID: 31993356 PMCID: PMC6970121 DOI: 10.21037/tp.2019.06.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Millions of illnesses, hospitalizations, and deaths are prevented by vaccination worldwide. This discussion examines vaccine safety concerns from the past several decades of immunization research. Both immunologic and non-immunologic side effects are reviewed, and clarification is provided regarding some highly-publicized myths regarding vaccine safety.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Andrey Leonov
- Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.,DuPage Medical Group, Plainfield, IL, USA
| | - Ahmed Elisa
- Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Roua Azmeh
- Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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12
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Infections Caused by Influenza Viruses Among Children in Poland During the 2017/18 Epidemic Season. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31201622 PMCID: PMC7122975 DOI: 10.1007/5584_2019_393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Influenza is an infectious disease that is a threat to both children and adults. The most effective way to prevent infections among children is seasonal vaccination in every epidemic season, which is recommended from the age of 6 months onward. This study is a report of the prevalence of influenza infection in the population of children up to the age of 14 years and of the type of influenza virus involved during the 2017/18 epidemic season in Poland. We found that influenza A and B viruses co-dominated in the season. Among the influenza A viruses, A/H1N1/ pdm09 subtype was a more frequent source of infection than A/H3N2/ subtype. In addition, the prevalence of infection was re-analyzed in children stratified into the age groups of 0–4, 5–9, and 10–14 years old. We found a relation between the age of a child and the type of influenza virus causing infection. The youngest children under 4 years were the most vulnerable to both influenza and influenza-like infections; the former caused mostly by influenza A and the latter by RSV. In contradistinction, influenza B dominated in the oldest children aged 10–14 and RSV infections were not present in this age group. The characteristics of influenza viruses may however vary on the seasonal basis.
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13
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Sato M, Hashimoto K, Kawasaki Y, Hosoya M. Immune response after a single intravenous peramivir administration in children with influenza. Antivir Ther 2019; 23:435-441. [PMID: 29372885 DOI: 10.3851/imp3222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Immune response after intravenous peramivir administration, which is approved for children with influenza infection in Japan, is unclear. METHODS Kinetics of viral load and serum cytokine levels before and after peramivir therapy were analysed in 17 and 8 hospitalized children infected with influenza A and B, respectively. Additionally, haemagglutination inhibition (HI) titre was measured. The first day of hospital admission was defined as day 0. RESULTS Serum interleukin (IL)-6 levels in influenza-A-infected children significantly decreased after peramivir administration, unlike in those with influenza B where a decrease on day 1 was followed by an increase on day 2. Serum IL-6 kinetics were similar to viral load kinetics in both influenza-A- and B-infected children between days 0 and 2. Serum IL-8 levels gradually decreased after peramivir therapy in influenza-A-infected children but increased between days 1 and 2 in influenza-B-infected children. Conversely, serum IL-10 levels gradually decreased over time. Serum interferon-γ and granulocyte macrophage colony-stimulating factor levels remained low until day 5. Day 0-4 serum HI titres were <4-fold in all children infected with influenza A or B. Additionally, day 5 HI titres were positive in 4 of 6 influenza A cases and all 3 influenza B cases. CONCLUSIONS Our results suggest that viral load and inflammatory cytokine kinetics were associated with the antiviral therapy used and that second peramivir administration should be considered in influenza B. The results also highlight antiviral agents as key determinants of the clinical course of influenza virus infection in children.
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Affiliation(s)
- Masatoki Sato
- Department of Paediatrics, Fukushima Medical University, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Paediatrics, Fukushima Medical University, Fukushima, Japan
| | - Yukihiko Kawasaki
- Department of Paediatrics, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Paediatrics, Fukushima Medical University, Fukushima, Japan
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14
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Hirotsu N, Saisho Y, Hasegawa T, Kitano M, Shishido T. Antibody dynamics in Japanese paediatric patients with influenza A infection treated with neuraminidase inhibitors in a randomised trial. Sci Rep 2019; 9:11891. [PMID: 31417163 PMCID: PMC6695405 DOI: 10.1038/s41598-019-47884-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
Neuraminidase inhibitors (NAIs) complement influenza virus infection management by helping to clear virus, alleviate symptoms, and reduce transmission. In a previous randomised study, we examined the effect of 4 NAIs on virus clearance and influenza symptoms in Japanese paediatric patients. In this second analysis, we examined the effects of NAI treatment on antibody responses and virus clearance, and the relationships between antibody responses and patients' infection histories (previous infection; asymptomatic infection via household members of same virus type/subtype; vaccination), and between infection histories and viral kinetics. Haemagglutination inhibition (HI) antibody responses produced HI titres ≥40 by Day 14 of NAI treatment, in parallel with virus clearance (trend test P = 0.001). Comparing patients with and without influenza infection histories (directly or asymptomatic infection via household members) showed that infection history had a marked positive effect on HI antibody responses in patients vaccinated before the current influenza season (before enrolment). Current virus clearance was significantly faster in patients previously infected with the same virus type/subtype than in those not previously infected, and clearance pattern depended on the NAI. Assessment of anti-influenza effects of antiviral drugs and vaccines should consider virus and antibody dynamics in response to vaccination and natural infection histories.
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15
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Mameli C, Cocchi I, Fumagalli M, Zuccotti G. Influenza Vaccination: Effectiveness, Indications, and Limits in the Pediatric Population. Front Pediatr 2019; 7:317. [PMID: 31417886 PMCID: PMC6682587 DOI: 10.3389/fped.2019.00317] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Influenza vaccine is considered the most effective way to prevent influenza. Nonetheless, every year vaccine coverage is lower than recommended in the pediatric population. Many factors are supposed to contribute to this phenomenon such as the uncertainty about the indication for vaccination, and the suboptimal vaccine-effectiveness in pediatric age, especially in the youngest children. In this review we discuss the effectiveness, indications, and limits of influenza vaccination in the pediatric population based on the most recent evidences.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
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16
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Vaccine-associated hypersensitivity. J Allergy Clin Immunol 2019; 141:463-472. [PMID: 29413255 DOI: 10.1016/j.jaci.2017.12.971] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
Vaccine-associated hypersensitivity reactions are not infrequent; however, serious acute-onset, presumably IgE-mediated or IgG and complement-mediated anaphylactic or serious delayed-onset T cell-mediated systemic reactions are considered extremely rare. Hypersensitivity can occur because of either the active vaccine component (antigen) or one of the other components. Postvaccination acute-onset hypersensitivity reactions include self-limited localized adverse events and, rarely, systemic reactions ranging from urticaria/angioedema to full-blown anaphylaxis with multisystem involvement. Risk of anaphylaxis after all vaccines is estimated to be 1.31 (95% CI, 0.90-1.84) per million vaccine doses, respectively. Serious hypersensitivity reactions after influenza vaccines are particularly important because of the large number of persons vaccinated annually. Influenza vaccines are unique in requiring annual changes in the vaccines' antigenic composition to match the predicted circulating influenza strains. Recently, novel influenza vaccine types were introduced in the United States (recombinant vaccines, some with higher antigen content and a new adjuvanted vaccine). Providers should be aware of changing recommendations on the basis of recent published evidence for persons with a history of egg allergy to receive annual influenza vaccination. Further research is needed to elucidate the pathophysiology and risk factors for reported vaccine-associated adverse events. Further research is also needed to determine whether repeated annual inactivated influenza vaccination, the number of vaccine antigens administered at the same time, and the current timing of routine infant vaccinations are optimal for overall population well-being.
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Tagarro A, Cruz-Cañete M, Otheo E, Launes C, Couceiro JA, Pérez C, Alfayate S, Calvo C, de Liria CRG. Oseltamivir for the treatment of influenza in children and adolescents. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Miyakawa R, Barreto NB, Kato RM, Neely MN, Russell CJ. Early Use of Anti-influenza Medications in Hospitalized Children With Tracheostomy. Pediatrics 2019; 143:e20182608. [PMID: 30814271 PMCID: PMC6398370 DOI: 10.1542/peds.2018-2608] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early administration of anti-influenza medications is recommended for all children hospitalized with influenza. We investigated whether early use of anti-influenza medications is associated with improved outcomes in children with tracheostomy hospitalized with influenza. METHODS We performed a multicenter retrospective cohort study through the Pediatric Health Information System database for patients aged 30 days to 19 years who were discharged between October 1, 2007, and September 30, 2015 with diagnostic codes for both influenza and tracheostomy. Our primary predictor was receipt of anti-influenza medications on hospital day 0 or 1. We used propensity score matching to adjust for confounding by indication. Primary outcomes were length of stay (LOS) and 30-day all-cause revisit rate (emergency department visit or hospital admission). RESULTS Of 1436 discharges screened, 899 met inclusion criteria. The median admission age was 5 years (interquartile range: 2-10). The majority had multiple complex chronic conditions (median 3; interquartile range: 3-4) and technology dependence, such as gastrostomy tube (73.6%). After matching 772 unique admissions by propensity score, LOS was shorter for the cohort receiving early anti-influenza medications (6.4 vs 7.5 days; P = .01) without increase in revisit rate (27.5% vs 24.1%; P = .28). More than 80% in both cohorts received empirical antibiotics, and the duration of antibiotic therapy was similar (5.0 vs 5.6 days; P = .11). CONCLUSIONS Early use of anti-influenza medications in children with tracheostomy hospitalized with influenza is associated with shorter LOS, but these children continue to receive antibiotics despite identification and treatment of their viral infections.
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Affiliation(s)
- Ryo Miyakawa
- Divisions of Pediatric Pulmonology and Sleep Medicine
| | - Nicolas B Barreto
- Department of Psychology, Claremont Graduate University, Claremont, California; and
| | - Roberta M Kato
- Divisions of Pediatric Pulmonology and Sleep Medicine
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael N Neely
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Infectious Diseases, and
| | - Christopher J Russell
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
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19
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[Oseltamivir for the treatment of influenza in children and adolescents]. An Pediatr (Barc) 2019; 90:317.e1-317.e8. [PMID: 30797703 DOI: 10.1016/j.anpedi.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Influenza is a generally a benign disease, but occasionally it can cause serious complications. There is controversy about the benefits of antiviral treatment. OBJECTIVES To provide some recommendations on the treatment with oseltamivir in paediatric patients with influenza, based on the best data available and valid in our environment. METHODS The Respiratory Infections Group of the Spanish Society of Paediatric Infectious Diseases carried out a review of the literature. The findings were analysed using the GRADE methodology, and recommendations were made. RESULTS The systematic use of diagnostic tests for influenza in the outpatient setting, or in the emergency room, in immunocompetent patients with a compatible clinical picture is not recommended. If the aim is to prevent serious events, the use of antivirals is not recommended for the vast majority of healthy and asthmatic patients with influenza or suspected seasonal flu. The systematic use of oseltamivir in patients admitted to hospital with influenza is not recommended. Oseltamivir treatment is recommended in any patients with influenza and pneumonia or severe illness, and critically ill patients, especially during the first 48hours of illness. The treatment of patients with risk factors is recommended, considering their underlying disease. Influenza vaccination, together with basic isolation measures, continue to be the main tool in the prevention of influenza. CONCLUSION In some situations, there are sufficient data to issue clear recommendations. In other situations, the data are incomplete, and only allows weak recommendations.
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Abubakar A, Melhem N, Malik M, Dbaibo G, Khan WM, Zaraket H. Seasonal influenza vaccination policies in the Eastern Mediterranean Region: Current status and the way forward. Vaccine 2019; 37:1601-1607. [PMID: 30795940 DOI: 10.1016/j.vaccine.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/21/2019] [Accepted: 02/01/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The World Health Organization recommends annual influenza vaccination, especially in high-risk groups. Little is known about the adoption and implementation of influenza vaccination policies in the Eastern Mediterranean Region. METHODS A survey was distributed to country representatives at the ministries of health of the 22 countries of the Region between December 2016 and February 2017 to capture data on influenza immunization policies, recommendations, and practices in place. RESULTS Of the 20 countries that responded to the survey, 14 reported having influenza immunization policies during the 2015/2016 influenza season. All countries with an influenza immunization policy recommended vaccination for people with chronic medical conditions, healthcare workers and pilgrims. Two of the 20 countries did not target pregnant women. Eight countries used the northern hemisphere formulation, one used the southern hemisphere formulation and nine used both. Vaccination coverage was not monitored by all countries and for all target groups. Where reported, coverage of a number of target groups (healthcare workers, children) was generally low. Data on the burden of influenza and vaccine protection are scarce in the Region. CONCLUSIONS Despite widespread policy recommendations on influenza vaccination, attaining high coverage rates remains a challenge in the Eastern Mediterranean Region. Tackling disparities in influenza vaccine accessibility and strengthening surveillance systems may increase influenza vaccine introduction and use.
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Affiliation(s)
- Abdinasir Abubakar
- Infectious Hazard Management, Department of WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nada Melhem
- American University of Beirut, Faculty of Health Sciences, Medical Laboratory Sciences Program, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; American University of Beirut, Faculty of Medicine, Center for Infectious Diseases Research, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon
| | - Mamunur Malik
- Infectious Hazard Management, Department of WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ghassan Dbaibo
- American University of Beirut, Faculty of Medicine, Center for Infectious Diseases Research, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; American University of Beirut, Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon
| | - Wasiq Mehmood Khan
- Infectious Hazard Management, Department of WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hassan Zaraket
- American University of Beirut, Faculty of Medicine, Center for Infectious Diseases Research, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; American University of Beirut, Faculty of Medicine, Department of Experimental Pathology, Immunology & Microbiology, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon.
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21
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Zhu D, Lok C, Chao S, Chen L, Li R, Zhao Z, Dong J, Qin K, Zhao X. Detection and characterization of type B influenza virus from influenza-like illness cases during the 2017-2018 winter influenza season in Beijing, China. Arch Virol 2019; 164:995-1003. [PMID: 30729995 DOI: 10.1007/s00705-019-04160-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/04/2019] [Indexed: 12/15/2022]
Abstract
In the winter of 2017-2018, there was significant influenza activity in China, resulting in unprecedented usage of influenza rapid antigen tests (IRAT) and neuraminidase inhibitors (NAIs). The aim of this study was to characterize the most prevalent influenza virus type in a clinical setting with respect to diagnosis and concomitant NAI treatment. From Dec 2017 to Jan 2018, 3257 patients with influenza-like illness (ILI) were screened using IRAT. We summarized and compared the results with the last influenza season. Subtyping of influenza B viruses and identification of NAI drug resistance mutations were carried out by sequencing the HA and NA genes and aligning these with genetic isotypes. The performance of IRAT and RT-PCR was compared. Screening results indicated that influenza B virus was the leading cause of this influenza epidemic, with children being more susceptible to infection than adults. Phylogenetic analysis revealed that the prevailing influenza B virus belonged to the Yamagata lineage and were genetically similar to strains isolated from North America in the same influenza season. Cross-continental spread of influenza/B/Yamagata occurred. NAI resistance mutations were not identified in the 18 samples analyzed. The current antiviral protocol was still effective for influenza B control. RT-PCR positivity was significantly higher than that of IRAT (P = 0.004). IRAT and RT-PCR had a consistency rate of 86.9%, with the consistency rates of the positive and negative cases being 54.3% and 97.3%, respectively. Clinicians should be alert to the possibility of obtaining false negative results when using IRAT, and RT-PCR is recommended to improve the accuracy of pathogen detection.
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Affiliation(s)
- Dong Zhu
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Chonghou Lok
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Shuang Chao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Lingling Chen
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, China CDC, National Health and Family Planning Commission, Beijing, People's Republic of China
| | - Runqing Li
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Zhipeng Zhao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Jingxiao Dong
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Kun Qin
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, China CDC, National Health and Family Planning Commission, Beijing, People's Republic of China.
| | - Xiuying Zhao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China.
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Abstract
PURPOSE OF REVIEW Influenza remains a major cause of morbidity and mortality. The 2017-2018 season was one of the most severe in the past decade. The exact factors determining the severity of a particular influenza season are complex and often poorly understood. RECENT FINDINGS Factors impacting annual influenza severity include characteristics of the specific virus, influenza vaccination, and antiviral use. Although viral virulence factors are important in this context and our knowledge of these is growing, there is a complex interplay between expression of these factors and their impact on a particular patient population. Vaccination has demonstrated efficacy in preventing disease, but vaccination rates remain sub-optimal and vaccine effectiveness can vary significantly between influenza strains and patient populations. Finally, while antiviral treatment is available and has shown benefits, many patients with influenza do not receive treatment. SUMMARY Strides have been made in recent years towards understanding the many factors that contribute to the severity of any particular influenza season. Obvious areas for improvement include improved vaccination rates and antiviral use. Additionally, a more complete understanding of reasons for poor strain and population-specific vaccine effectiveness may help reduce the severity of future influenza seasons.
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Arístegui Fernández J, González Pérez-Yarza E, Mellado Peña MJ, Rodrigo Gonzalo de Liria C, Hernández Sampelayo T, García García JJ, Ruiz Contreras J, Moreno Pérez D, Garrote Llanos E, Ramos Amador JT, Cilla Eguiluz CG, Méndez Hernández M, Aristegui J, Garrote E, Larrauri A, Pérez-Yarza E, Cilla G, Unsain M, Contreras JR, García-Ochoa E, Gordillo J, Sampelayo TH, Rodríguez R, González F, Mellado M, Calvo C, Méndez A, Bustamante J, Salas D, Lacasta C, Ramos J, Illán M, Mendez M, Barjuan M, García J, Urraca S, Caballero M, Launes C, Rodrigo C, Fàbregas A, Esmel R, Antón A, Moreno D, Valdivielso A, Piñero P, Carazo B. Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016). An Pediatr (Barc) 2019; 90:86-93. [DOI: 10.1016/j.anpedi.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
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Shannon I, White CL, Murphy A, Qiu X, Treanor JJ, Nayak JL. Differences in the influenza-specific CD4 T cell immunodominance hierarchy and functional potential between children and young adults. Sci Rep 2019; 9:791. [PMID: 30692574 PMCID: PMC6349841 DOI: 10.1038/s41598-018-37167-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023] Open
Abstract
Studies of the B cell repertoire suggest that early childhood influenza infections profoundly shape later reactivity by creating an “imprint” that impacts subsequent vaccine responses and may provide lasting protection against influenza strains within the same viral group. However, there is little known about how these early childhood influenza exposures shape CD4 T cell reactivity later in life. To investigate the effect of age on influenza-specific CD4 T cell specificity and functionality, reactivity in cohorts of 2 year old children and young adult subjects was compared. Intracellular cytokine staining was used to determine the viral antigen specificity and expression levels of various cytokines following stimulation of peripheral blood mononuclear cells with complete peptide pools representing the entire translated sequences of the pH1, H3, HA-B, NP, and M1 proteins. We found that the influenza protein-specific immunodominance pattern in children differs from that in young adults, with much lower reactivity to the NP internal virion protein in young children. Alterations in CD4 T cell functionality were also noted, as responding CD4 T cells from children produced less IFNγ and were less likely to express multiple cytokines. These differences in the repertoire of influenza-specific CD4 T cells available for recall on influenza challenge in early childhood could possibly contribute to early imprinting of influenza-specific immunity as well as the increased susceptibility of children to this viral infection.
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Affiliation(s)
- Ian Shannon
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester Medical Center, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA
| | - Chantelle L White
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester Medical Center, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA
| | - Amy Murphy
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester Medical Center, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 265 Crittenden Blvd, Box 630, Rochester, NY, 14642, USA
| | - John J Treanor
- Biomedical Advanced Research and Development Authority (BARDA)/HHS/ASPR, Influenza and Emerging Diseases Division 21J14, 200 C St SW, Washington, DC, 20515, USA
| | - Jennifer L Nayak
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester Medical Center, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA.
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25
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Marien AG, Hochart A, Lagrée M, Diallo D, Martinot A, Dubos F. Parental acceptance of an intranasal vaccine: Example of influenza vaccine. Arch Pediatr 2019; 26:71-74. [PMID: 30658873 DOI: 10.1016/j.arcped.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/05/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza vaccination coverage of children with chronic disease is insufficient in France, although a nasal live attenuated influenza vaccine (LAIV) has been approved. OBJECTIVE We aimed to evaluate the acceptance of nasally administered vaccines by parents of children with chronic illness, by comparing LAIV vs. injectable inactivated influenza vaccine (IIV) acceptance. METHODS We performed a retrospective, observational study (December 2014 to April 2015) including parents of all children vaccinated with the LAIV during the 2013-2014 influenza vaccination campaign at our university hospital. It was an opinion survey on the tolerance and acceptance of the LAIV. RESULTS A standardized evaluation form was completed by 67/79 parents of all children who received the LAIV (mean age: 113±56 months; 64% with a chronic respiratory disease). The parents responded that vaccines in general were important (99%) but only 58% of them accepted the injectable route of administration. Of the 48 parents of children who had received both LAIV and IIV in the past, global opinion (P<0.0001) and tolerance (P<0.0001) were better for LAIV. For the future, 81% of parents would prefer LAIV, mainly because of needle absence and/or less painful character, and 18% IIV, mainly because of easier administration or habit. CONCLUSION The better acceptance of a nasally administrated vaccine could increase vaccination coverage in the future for nasal vaccines.
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Affiliation(s)
- A-G Marien
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - A Hochart
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Lagrée
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - D Diallo
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - A Martinot
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France
| | - F Dubos
- Pediatric emergency unit & infectious diseases, hôpital R. Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France.
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Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol 2019; 120:49-52. [PMID: 29273128 DOI: 10.1016/j.anai.2017.10.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022]
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Werk LN, Diaz MC, Cadilla A, Franciosi JP, Hossain MJ. Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice. J Prim Care Community Health 2019; 10:2150132719853061. [PMID: 31184255 PMCID: PMC6560788 DOI: 10.1177/2150132719853061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence. METHODS We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]). RESULTS During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P < .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P < .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes. CONCLUSIONS Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate.
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Affiliation(s)
- Lloyd N. Werk
- Nemours Children’s Hospital, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Maria Carmen Diaz
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Adriana Cadilla
- Nemours Children’s Hospital, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - James P. Franciosi
- Nemours Children’s Hospital, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Md Jobayer Hossain
- Nemours Children’s Health System, Wilmington, DE, USA
- University of Delaware, Wilmington, DE, USA
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Hijano DR, Maron G, Hayden RT. Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant. Front Microbiol 2018; 9:3097. [PMID: 30619176 PMCID: PMC6299032 DOI: 10.3389/fmicb.2018.03097] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/29/2018] [Indexed: 12/25/2022] Open
Abstract
Survival rates for pediatric cancer have steadily improved over time but it remains a significant cause of morbidity and mortality among children. Infections are a major complication of cancer and its treatment. Community acquired respiratory viral infections (CRV) in these patients increase morbidity, mortality and can lead to delay in chemotherapy. These are the result of infections with a heterogeneous group of viruses including RNA viruses, such as respiratory syncytial virus (RSV), influenza virus (IV), parainfluenza virus (PIV), metapneumovirus (HMPV), rhinovirus (RhV), and coronavirus (CoV). These infections maintain a similar seasonal pattern to those of immunocompetent patients. Clinical manifestations vary significantly depending on the type of virus and the type and degree of immunosuppression, ranging from asymptomatic or mild disease to rapidly progressive fatal pneumonia Infections in this population are characterized by a high rate of progression from upper to lower respiratory tract infection and prolonged viral shedding. Use of corticosteroids and immunosuppressive therapy are risk factors for severe disease. The clinical course is often difficult to predict, and clinical signs are unreliable. Accurate prognostic viral and immune markers, which have become part of the standard of care for systemic viral infections, are currently lacking; and management of CRV infections remains controversial. Defining effective prophylactic and therapeutic strategies is challenging, especially considering, the spectrum of immunocompromised patients, the variety of respiratory viruses, and the presence of other opportunistic infections and medical problems. Prevention remains one of the most important strategies against these viruses. Early diagnosis, supportive care and antivirals at an early stage, when available and indicated, have proven beneficial. However, with the exception of neuraminidase inhibitors for influenza infection, there are no accepted treatments. In high-risk patients, pre-emptive treatment with antivirals for upper respiratory tract infection (URTI) to decrease progression to LRTI is a common strategy. In the future, viral load and immune markers may prove beneficial in predicting severe disease, supporting decision making and monitor treatment in this population.
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Affiliation(s)
- Diego R. Hijano
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Randall T. Hayden
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, United States
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Rudenko L, Kiseleva I, Krutikova E, Stepanova E, Rekstin A, Donina S, Pisareva M, Grigorieva E, Kryshen K, Muzhikyan A, Makarova M, Sparrow EG, Torelli G, Kieny MP. Rationale for vaccination with trivalent or quadrivalent live attenuated influenza vaccines: Protective vaccine efficacy in the ferret model. PLoS One 2018; 13:e0208028. [PMID: 30507951 PMCID: PMC6277076 DOI: 10.1371/journal.pone.0208028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The majority of seasonal influenza vaccines are trivalent, containing two A virus strains (H1N1 and H3N2) and one B virus strain. The co-circulation of two distinct lineages of B viruses can lead to mismatch between the influenza B virus strain recommended for the trivalent seasonal vaccine and the circulating B virus. This has led some manufacturers to produce quadrivalent influenza vaccines containing one strain from each B lineage in addition to H1N1 and H3N2 strains. However, it is also important to know whether vaccines containing a single influenza B strain can provide cross-protectivity against viruses of the antigenically distinct lineage. The aim of this study was to assess in naïve ferrets the potential cross-protective activity of trivalent live attenuated influenza vaccine (T-LAIV) against challenge with a heterologous wild-type influenza B virus belonging to the genetically different lineage and to compare this activity with effectiveness of quadrivalent LAIV (Q-LAIV) in the ferret model. METHODS AND RESULTS Ferrets were vaccinated with either one dose of trivalent LAIV containing B/Victoria or B/Yamagata lineage virus, or quadrivalent LAIV (containing both B lineages), or placebo. They were then challenged with B/Victoria or B/Yamagata lineage wild-type virus 28 days after vaccination. The ferrets were monitored for clinical signs and morbidity. Nasal swabs and lung tissue samples were analyzed for the presence of challenge virus. Antibody response to vaccination was assessed by routine hemagglutination inhibition assay. All LAIVs tested were found to be safe and effective against wild-type influenza B viruses based on clinical signs, and virological and histological data. The absence of interference between vaccine strains in trivalent and quadrivalent vaccine formulations was confirmed. Trivalent LAIVs were shown to have the potential to be cross-protective against infection with genetically different influenza B/Victoria and B/Yamagata lineages. CONCLUSIONS In this ferret model, quadrivalent vaccine provided higher protection to challenge against both B/Victoria and B/Yamagata lineage viruses. However, T-LAIV provided some cross-protection in the case of a mismatch between circulating and vaccine type B strains. Notably, B/Victoria-based T-LAIV was more protective compared to B/Yamagata-based T-LAIV.
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MESH Headings
- Administration, Intranasal
- Animals
- Antibodies, Viral/blood
- Cross Protection/genetics
- Cross Protection/immunology
- Disease Models, Animal
- Female
- Ferrets
- Humans
- Immunogenicity, Vaccine
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza B virus/genetics
- Influenza B virus/immunology
- Influenza B virus/pathogenicity
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/blood
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
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Affiliation(s)
- Larisa Rudenko
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Irina Kiseleva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Elena Krutikova
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Ekaterina Stepanova
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Andrey Rekstin
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Svetlana Donina
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Maria Pisareva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Elena Grigorieva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Kirill Kryshen
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Arman Muzhikyan
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Marina Makarova
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Erin Grace Sparrow
- Universal Health Coverage and Health Systems, World Health Organization, Geneva, Switzerland
| | - Guido Torelli
- Universal Health Coverage and Health Systems, World Health Organization, Geneva, Switzerland
| | - Marie-Paule Kieny
- International Institutional Cooperation, Institut national de la santé et de la recherche médicale (INSERM), Paris, France
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Arabi H, Zaid AA, Alreefi M, Alahmed S. Suspected Oseltamivir-induced bradycardia in a pediatric patient: A case report from King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia. Clin Pract 2018; 8:1094. [PMID: 30595829 PMCID: PMC6280064 DOI: 10.4081/cp.2018.1094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
In recent years, influenza infection in the pediatric population has been a widescale issue that physicians face during the winter season. Medications used to treat and prevent such infections include Oseltamivir, an anti-viral neuraminidase inhibitor developed for both influenzas A and B. The most commonly well-known and manifesting adverse effects are nausea, vomiting and gastrointestinal upset. There is paucity of reports on other potential serious side effects of Oseltamivir in the pediatric population. One of the rarely reported adverse reactions in adult population is sinus bradycardia. This case reports the development of sinus bradycardia in a pediatric patient after administration of Oseltamivir. The previously healthy five-year-old patient was started on Oseltamivir after a positive polymerase chain reaction for influenza. The patient developed sinus bradycardia but remained hemodynamically stable. This finding led to consultations and investigations to determine the cause of bradycardia. It is pivotal to increase the awareness of the potential link between Oseltamivir and bradycardia in pediatric and adult populations to avoid unnecessary clinical investigations and to enhance physician decisionmaking. A prospective cohort study on Oseltamivir is needed for better understanding of its adverse effects in the pediatric population.
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Affiliation(s)
- Hisham Arabi
- King Abdullah Specialist Children's Hospital, National Guard Health Affairs
| | - Ahmed Abou Zaid
- King Abdullah Specialist Children's Hospital, National Guard Health Affairs
| | - Mohammed Alreefi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salman Alahmed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Wen Z, Xie G, Zhou Q, Qiu C, Li J, Hu Q, Dai W, Li D, Zheng Y, Wen F. Distinct Nasopharyngeal and Oropharyngeal Microbiota of Children with Influenza A Virus Compared with Healthy Children. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6362716. [PMID: 30581863 PMCID: PMC6276510 DOI: 10.1155/2018/6362716] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/24/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Influenza A virus (IAV) has had the highest morbidity globally over the past decade. A growing number of studies indicate that the upper respiratory tract (URT) microbiota plays a key role for respiratory health and that a dysfunctional respiratory microbiota is associated with disease; but the impact of microbiota during influenza is understudied. METHODS We recruited 180 children, including 121 IAV patients and 59 age-matched healthy children. Nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected to conduct 16S rDNA sequencing and compare microbiota structures in different individuals. RESULTS Both NP and OP microbiota in IAV patients differed from those in healthy individuals. The NP dominated genera in IVA patients, such as Moraxella, Staphylococcus, Corynebacterium, and Dolosigranulum, showed lower abundance than in healthy children. The Streptococcus significantly enriched in patients' NP and Phyllobacterium could be generally detected in patients' NP microbiota. The most abundant genera in OP microbiota showed a decline tendency in patients, including Streptococcus, Neisseria, and Haemophilus. The URT's bacterial concurrence network changed dramatically in patients. NP and OP samples were clustered into subgroups by different dominant genera; and NP and OP microbiota provided the precise indicators to distinguish IAV patients from healthy children. CONCLUSION This is the first respiratory microbiome analysis on pediatric IAV infection which reveals distinct NP and OP microbiota in influenza patients. It provides a new insight into IAV research from the microecology aspect and promotes the understanding of IAV pathogenesis.
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Affiliation(s)
- Zhixin Wen
- Department of Respiratory Diseases, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Gan Xie
- Department of Respiratory Diseases, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Qian Zhou
- Department of Microbial Research, WeHealthGene Institute, 3C19, No. 19 Building, Dayun Software Town, Shenzhen 518000, China
| | - Chuangzhao Qiu
- Department of Microbial Research, WeHealthGene Institute, 3C19, No. 19 Building, Dayun Software Town, Shenzhen 518000, China
| | - Jing Li
- Department of Respiratory Diseases, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Qian Hu
- Department of Respiratory Diseases, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Wenkui Dai
- Department of Microbial Research, WeHealthGene Institute, 3C19, No. 19 Building, Dayun Software Town, Shenzhen 518000, China
| | - Dongfang Li
- Department of Microbial Research, WeHealthGene Institute, 3C19, No. 19 Building, Dayun Software Town, Shenzhen 518000, China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518038, China
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Kim JH, Kwon JH, Lee JY, Lee JS, Ryu JM, Kim SH, Lim KS, Kim WY. Clinical features of Mycoplasma pneumoniae coinfection and need for its testing in influenza pneumonia patients. J Thorac Dis 2018; 10:6118-6127. [PMID: 30622783 DOI: 10.21037/jtd.2018.10.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the clinical features of coinfection due to Mycoplasma pneumoniae (M. pneumoniae), a common copathogen in influenza, in influenza pneumonia patients. Methods We reviewed 4,465 patients with influenza who visited a tertiary care hospital emergency department in Seoul (Korea) from 2010 through 2016, and underwent immunoglobulin M (IgM) serology or polymerase chain reaction (PCR) for M. pneumoniae. Influenza pneumonia was defined as laboratory-confirmed influenza plus radiographic pneumonia. Patients with healthcare-associated pneumonia or non-mycoplasma bacterial coinfection were excluded. Clinical, laboratory, and radiographic findings and outcomes of the influenza pneumonia patients with and without M. pneumoniae coinfection were compared. Multivariable logistic regression analysis was performed to identify factors associated with the coinfection. Results Of 244 influenza pneumonia patients, 41 (16.8%) had M. pneumoniae coinfection. These patients were younger with a higher frequency of age of 5-10 years, and had higher white blood cell (WBC) and lymphocyte counts; lower concentration of C-reactive protein (CRP). The coinfection had no association with specific radiographic findings and poor outcome. Multivariable analysis showed the age of 5-10 years (adjusted odds ratio, 18.83; 95% confidence interval, 5.899-60.08; P<0.001) as the factor associated with the coinfection. Conclusions M. pneumoniae coinfection in influenza pneumonia may be associated with the age of 5-10 years, and otherwise clinically indistinct from influenza pneumonia without the coinfection. This finding suggests the need for M. pneumoniae testing in patients aged 5-10 years with influenza pneumonia.
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Affiliation(s)
- Jung Heon Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hyun Kwon
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Seasonal Influenza Vaccination – Modern View to the Issue. Fam Med 2018. [DOI: 10.30841/2307-5112.4.2018.160201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schaffner W, van Buynder P, McNeil S, Osterhaus ADME. Seasonal influenza immunisation: Strategies for older adults. Int J Clin Pract 2018; 72:e13249. [PMID: 30216647 DOI: 10.1111/ijcp.13249] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
Adults over the age of 60-65 years suffer disproportionally from seasonal influenza, experiencing high rates of complications, exacerbation of underlying medical comorbidities, and excess mortality. Thus, older adults are an important priority for influenza immunisation campaigns. Unfortunately, older adults generally display lower immune responses to standard influenza vaccines because of immunosenescence, with resulting suboptimal vaccine effectiveness. Thus, the development of improved vaccines that heighten immune responses and improve effectiveness is an important medical need. To this end, enhanced influenza vaccines specifically targeting this age group have been developed, which seek to overcome the inherent limitations in the immune responses of older adults. Both the licensed high-dose trivalent influenza vaccine (hdTIV) containing fourfold higher antigen contents than standard vaccine, and the MF59® -adjuvanted trivalent influenza vaccine (aTIV) have been proven to be safe and well-tolerated while enhancing the immune response. Healthcare providers for populations of older adults should be advised to routinely use these enhanced influenza vaccines in seasonal immunisation campaigns to provide improved immunity against influenza and its consequences in this particularly susceptible age group.
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Affiliation(s)
| | - Paul van Buynder
- School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Center and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Albert D M E Osterhaus
- Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, LS, Germany
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Pando R, Sharabi S, Mandelboim M. Exceptional influenza morbidity in summer season of 2017 in Israel may predict the vaccine efficiency in the coming winter. Vaccine 2018; 36:1326-1329. [PMID: 29429813 DOI: 10.1016/j.vaccine.2018.01.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
Influenza infections are the leading cause of respiratory viral infections worldwide, and are mostly common in the winter season. The seasonal influenza vaccine is currently the most effective preventive modality against influenza infection. Immediately following each winter season the World Health Organization (WHO) announces the vaccine composition for the following winter. Unexpectedly, during the summer of 2017, in Israel, we observed in hospitalized patients, an exceptionally high numbers of Influenza positive cases. The majority of the influenza B infections were caused by influenza B/Yamagata lineage, which did not circulate in Israel in the previous winter, and most of the influenza A infections were caused by influenza A/H3N2, a strain similar to the strain that circulated in Israel in the previous winter. We therefore predict that these two viruses will circulate in the coming winter of 2017/18 and that the trivalent vaccine, which includes antigenically different viruses will be inefficient.
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Affiliation(s)
- Rakefet Pando
- The Israel Center for Disease Control, Israel Ministry of Health, Tel-Hashomer, Israel; Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Sivan Sharabi
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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36
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Abstract
Sepsis in children is typically presumed to be bacterial in origin until proven otherwise, but frequently bacterial cultures ultimately return negative. Although viruses may be important causative agents of culture-negative sepsis worldwide, the incidence, disease burden and mortality of viral-induced sepsis is poorly elucidated. Consideration of viral sepsis is critical as its recognition carries implications on appropriate use of antibacterial agents, infection control measures, and, in some cases, specific, time-sensitive antiviral therapies. This review outlines our current understanding of viral sepsis in children and addresses its epidemiology and pathophysiology, including pathogen-host interaction during active infection. Clinical manifestation, diagnostic testing, and management options unique to viral infections will be outlined.
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Affiliation(s)
- Neha Gupta
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert Richter
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Stephen Robert
- Division of Pediatric Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Subtype-specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children 1-5 Years of Age Treated in Outpatient Practices in Germany During Three Postpandemic Years, 2013-2015. Pediatr Infect Dis J 2018; 37:861-867. [PMID: 29406467 DOI: 10.1097/inf.0000000000001935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Limited data on the influenza burden in pediatric outpatients are available, especially regarding direct comparison of the cocirculating (sub)types A(H1N1)pdm09, A(H3N2) and B. METHODS Children 1-5 years of age, unvaccinated against influenza and presenting with febrile acute respiratory infections (ARIs), were enrolled in 33 pediatric practices in Germany from 2013 to 2015 (January-May). Influenza was confirmed by multiplex polymerase chain reaction from pharyngeal swabs and (sub)typed. RESULTS In 805 children with ARI, influenza was the most frequently detected respiratory virus (n = 305; 37.9%). Of 217 influenza patients included, 122 (56.2%) were infected with A(H3N2), 56 (25.8%) with A(H1N1)pdm09 and 39 (18.0%) with B. Median age was 3.7 years [interquartile range (IQR), 2.1-4.8]; 11% had underlying conditions. Median fever duration was 4 days (IQR, 3-5), and the disease duration was 9 days (IQR, 7-12). Most frequent diagnoses were pharyngitis (26%), bronchitis (18%) and acute otitis media (10%). Children received mainly antipyretics (86%) and adrenergic nasal drops/spray (53%); 9% received antibiotics and 3% oseltamivir. Thirty-six percent required at least 1 additional practice visit; 1% was hospitalized. Median absences from childcare were 5 days (IQR, 3-7); parents lost 4 workdays (IQR, 2-6). Symptoms, severity and impact on the family were largely unrelated to (sub)type. However, patients with A(H1N1)pdm09 had fewer underlying conditions (P = 0.017), whereas patients with B more often had pharyngitis (P = 0.022), acute otitis media (P = 0.012) and stenosing laryngotracheitis (P = 0.007). CONCLUSIONS Influenza was the most frequently detected viral pathogen in outpatient children with febrile, mostly uncomplicated ARI. In this setting, clinical manifestations and severity were similar across the (sub)types prevalent during the postpandemic seasons.
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Lu Z, Zheng Y, He Y, Chen H, Wang H, Cao L, Zhao D, Ji W, Shang Y, Li C, Chen Z, Zhao S, Nong G, Chen Q, Liu E, Wan C, Wang Y, Yang T, Wang Z, Deng L, Lu Q. Pandemic 2009 influenza A (H1N1)-associated deaths among children in China: A retrospective analysis. Pediatr Investig 2018; 2:166-171. [PMID: 32851255 PMCID: PMC7331416 DOI: 10.1002/ped4.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/05/2018] [Indexed: 11/12/2022] Open
Abstract
Importance A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A (H1N1) in China, but the risk factors and causes for death have not been clarified. Objective We describe the clinical findings regarding 2009 influenza A (H1N1)-associated pediatric deaths in China, including the risk factors for death. Methods The definition of 2009 influenza A (H1N1)-associated pediatric death is death in a child who is younger than 14 years and has laboratory-confirmed influenza. We collected data of total 810 hospitalized patients with 2009 influenza A (H1N1) infection from September 2009 to February 2010 in 17 hospitals across China. The clinical characteristics, laboratory abnormalities, and treatment course were retrospectively studied. Results Of the 810 patients hospitalized with 2009 influenza A (H1N1) infection, 19 (2.3%) died. Ten patients died from severe pneumonia and acute respiratory distress syndrome; eight died from encephalopathy/encephalitis; one died from secondary fungal meningitis. Patients who died were more likely than patients who survived to have neutrophilia, lymphopenia, elevated C-reactive protein, and elevations of lactate dehydrogenase, creatine kinase, creatine kinase-MB, aspartate aminotransferase and alanine aminotransferase. There were no significant differences in the median age, median time from onset of illness to admission, underlying chronic disease, and initiation of antiviral therapy within 48 hours of illness onset, between patients who died and those who survived. Interpretation The risk factors for pediatric death associated with 2009 influenza A (H1N1) infection are different from those of seasonal influenza. The most common causes of death are viral pneumonia, acute respiratory distress syndrome, and encephalopathy/encephalitis.
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Affiliation(s)
- Zhiwei Lu
- Department of Respiratory MedicineShenzhen Children's HospitalShenzhenGuangdongChina
| | - Yuejie Zheng
- Department of Respiratory MedicineShenzhen Children's HospitalShenzhenGuangdongChina
| | - Yanxia He
- Department of Respiratory MedicineShenzhen Children's HospitalShenzhenGuangdongChina
| | - Huizhong Chen
- Department of PulmonologyChildren's Hospital Affiliated to Capital Institute of PediatricsBeijingChina
| | - Heping Wang
- Department of Respiratory MedicineShenzhen Children's HospitalShenzhenGuangdongChina
| | - Ling Cao
- Department of PulmonologyChildren's Hospital Affiliated to Capital Institute of PediatricsBeijingChina
| | - Deyu Zhao
- Department of RespirationChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Wei Ji
- Department of RespirationChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yunxiao Shang
- Department of Pediatric Respiratory MedicineShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Changchong Li
- Department of RespirationYuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Zhimin Chen
- Department of PulmonologyThe Children's HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Shunying Zhao
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Guangmin Nong
- Department of PediatricsThe First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxiChina
| | - Qiang Chen
- Department of RespirationJiangxi Provincial Children's HospitalNanchangJiangxiChina
| | - Enmei Liu
- Department of RespirationChildren's Hospital Affiliated to Chongqing Medical UniversityChongqingChina
| | - Chaomin Wan
- Department of Infectious DiseaseWest China Second HospitalSichuan UniversityChengduSichuanChina
| | - Ying Wang
- Department of PediatricsGuilin People's HospitalGuilinGuangxiChina
| | - Tong Yang
- Department of PediatricsLiuzhou General HospitalLiuzhouGuangxiChina
| | - Zhenhua Wang
- Department of RespirationChangchun Children's HospitalChangchun, JilinChina
| | - Li Deng
- Department of RespirationGuangzhou Women and Children's Medical CenterGuangzhouGuangdongChina
| | - Quan Lu
- Department of RespirationChildren's Hospital of Shanghai Jiaotong UniversityShanghaiChina
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Wrotek A, Czajkowska M, Zawłocka E, Jackowska T. Influenza: Underestimated in Children Below 2 Years of Age. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1108:81-91. [PMID: 29995212 DOI: 10.1007/5584_2018_240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children under 2 years of age may receive antiviral therapy when influenza is suspected. Signs of influenza are frequently unclear and testing is indicated. The aim of the study was to assess the usefulness of clinical signs and the rapid influenza diagnostic test (RIDT) in diagnosing influenza and in choosing the appropriate treatment. In the 2015-2016 influenza season, 89 children under 2 years of age (56.7% of 157 children diagnosed with influenza) were hospitalized. There were 74 RIDT and 70 reverse transcription polymerase chain reactions (RT-PCR) performed for the purpose of diagnosis, either test per child. Eighty-three percent of children (74/89) presented with fever, 55.1% (49/89) with cough, and 39.3% (35/89) with both cough and fever. The RIDT was positive in 31.1% (23/74) of cases. The highest percentage of positive RIDT was within the first 24 h of disease, decreasing dramatically thereafter (70% vs. 13-17%, respectively). The RIDT shortened the time to diagnosis by 43.8 h/patient (an average €149 gain in treatment costs). The mean delay for RT-PCR-based diagnosis was 33.5 h/patient (an average €114 loss in treatment costs). We conclude that clinical signs have a low diagnostic sensitivity in children under 2 years of age. Likewise, RIDT is of low sensitivity, being diagnostically useful only in the first 24 h. The PCR is recommended for the diagnosis, but that requires a constant access to the method.
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Affiliation(s)
- A Wrotek
- Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland
| | - M Czajkowska
- Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland
| | - E Zawłocka
- Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland
| | - T Jackowska
- Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland.
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland.
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Kesinger E, Liu J, Jensen A, Chia CP, Demers A, Moriyama H. Influenza D virus M2 protein exhibits ion channel activity in Xenopus laevis oocytes. PLoS One 2018; 13:e0199227. [PMID: 29927982 PMCID: PMC6013169 DOI: 10.1371/journal.pone.0199227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/04/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A new type of influenza virus, known as type D, has recently been identified in cattle and pigs. Influenza D virus infection in cattle is typically asymptomatic; however, its infection in swine can result in clinical disease. Swine can also be infected with all other types of influenza viruses, namely A, B, and C. Consequently, swine can serve as a "mixing vessel" for highly pathogenic influenza viruses, including those with zoonotic potential. Currently, the only antiviral drug available targets influenza M2 protein ion channel is not completely effective. Thus, it is necessary to develop an M2 ion channel blocker capable of suppressing the induction of resistance to the genetic shift. To provide a basis for developing novel ion channel-blocking compounds, we investigated the properties of influenza D virus M2 protein (DM2) as a drug target. RESULTS To test the ion channel activity of DM2, the DNA corresponding to DM2 with cMyc-tag conjugated to its carboxyl end was cloned into the shuttle vector pNCB1. The mRNA of the DM2-cMyc gene was synthesized and injected into Xenopus oocytes. The translation products of DM2-cMyc mRNA were confirmed by immunofluorescence and mass spectrometry analyses. The DM2-cMyc mRNA-injected oocytes were subjected to the two-electrode voltage-clamp (TEVC) method, and the induced inward current was observed. The midpoint (Vmid) values in Boltzmann modeling for oocytes injected with DM2-cMyc RNA or a buffer were -152 and -200 mV, respectively. Assuming the same expression level in the Xenopus oocytes, DM2 without tag and influenza C virus M2 protein (CM2) were subjected to the TEVC method. DM2 exhibited ion channel activity under the condition that CM2 ion channel activity was reproduced. The gating voltages represented by Vmid for CM2 and DM2 were -141 and -146 mV, respectively. The reversal potentials observed in ND96 for CM2 and DM2 were -21 and -22 mV, respectively. Compared with intact DM2, DM2 variants with mutation in the YxxxK motif, namely Y72A and K76A DM2, showed lower Vmid values while showing no change in reversal potential. CONCLUSION The M2 protein from newly isolated influenza D virus showed ion channel activity similar to that of CM2. The gating voltage was shown to be affected by the YxxxK motif and by the hydrophobicity and bulkiness of the carboxyl end of the molecule.
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Affiliation(s)
- Evan Kesinger
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Jianing Liu
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Aaron Jensen
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Catherine P. Chia
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Andrew Demers
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Hideaki Moriyama
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
- * E-mail:
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Tian C, Wang H, Wang W, Luo X. Influenza vaccination coverage among US children from 2004/2005 to 2015/2016. J Public Health (Oxf) 2018; 41:e62-e69. [DOI: 10.1093/pubmed/fdy081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Changwei Tian
- Kunshan Centers for Disease Control and Prevention, Jiangsu, China
- Jiangsu Provincial Public Health Research Institute Kunshan Branch, Jiangsu, China
| | - Hua Wang
- Kunshan Centers for Disease Control and Prevention, Jiangsu, China
- Jiangsu Provincial Public Health Research Institute Kunshan Branch, Jiangsu, China
| | - Wenming Wang
- Kunshan Centers for Disease Control and Prevention, Jiangsu, China
- Jiangsu Provincial Public Health Research Institute Kunshan Branch, Jiangsu, China
| | - Xiaoming Luo
- Kunshan Centers for Disease Control and Prevention, Jiangsu, China
- Jiangsu Provincial Public Health Research Institute Kunshan Branch, Jiangsu, China
- Department of Public Health, Soochow University, Jiangsu, China
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Uyeki TM. Oseltamivir Treatment of Influenza in Children. Clin Infect Dis 2018; 66:1501-1503. [PMID: 29315362 PMCID: PMC6669028 DOI: 10.1093/cid/cix1150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rey-Jurado E, Tapia F, Muñoz-Durango N, Lay MK, Carreño LJ, Riedel CA, Bueno SM, Genzel Y, Kalergis AM. Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution. Front Immunol 2018; 9:26. [PMID: 29403503 PMCID: PMC5778105 DOI: 10.3389/fimmu.2018.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022] Open
Abstract
Vaccines have significantly reduced the detrimental effects of numerous human infectious diseases worldwide, helped to reduce drastically child mortality rates and even achieved eradication of major pathogens, such as smallpox. These achievements have been possible due to a dedicated effort for vaccine research and development, as well as an effective transfer of these vaccines to public health care systems globally. Either public or private institutions have committed to developing and manufacturing vaccines for local or international population supply. However, current vaccine manufacturers worldwide might not be able to guarantee sufficient vaccine supplies for all nations when epidemics or pandemics events could take place. Currently, different countries produce their own vaccine supplies under Good Manufacturing Practices, which include the USA, Canada, China, India, some nations in Europe and South America, such as Germany, the Netherlands, Italy, France, Argentina, and Brazil, respectively. Here, we discuss some of the vaccine programs and manufacturing capacities, comparing the current models of vaccine management between industrialized and developing countries. Because local vaccine production undoubtedly provides significant benefits for the respective population, the manufacture capacity of these prophylactic products should be included in every country as a matter of national safety.
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Affiliation(s)
- Emma Rey-Jurado
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Tapia
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Natalia Muñoz-Durango
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita K. Lay
- Departamento de Biotecnología, Facultad de Ciencias del Mar y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile
| | - Leandro J. Carreño
- Millennium Institute on Immunology and Immunotherapy, Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yvonne Genzel
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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