1
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Florin TA, Freedman SB, Xie J, Funk AL, Tancredi DJ, Kim K, Neuman MI, Yock-Corrales A, Bergmann KR, Breslin KA, Finkelstein Y, Ahmad FA, Avva UR, Lunoe MM, Chaudhari PP, Shah NP, Plint AC, Sabhaney VJ, Sethuraman U, Gardiner MA, Sartori LF, Wright B, Navanandan N, Mintegi S, Gangoiti I, Borland ML, Chong SL, Kwok MY, Eckerle M, Poonai N, Romero CMA, Waseem M, Nebhrajani JR, Bhatt M, Caperell K, Campos C, Becker SM, Morris CR, Rogers AJ, Kam AJ, Pavlicich V, Palumbo L, Dalziel SR, Morrison AK, Rino PB, Cherry JC, Salvadori MI, Ambroggio L, Klassen TP, Payne DC, Malley R, Simon NJ, Kuppermann N. Features Associated With Radiographic Pneumonia in Children with SARS-CoV-2. J Pediatric Infect Dis Soc 2024; 13:257-259. [PMID: 38391389 DOI: 10.1093/jpids/piae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 02/24/2024]
Abstract
14% of children with SARS-CoV-2 infections had radiographic pneumonia. Hypoxemia, cough, higher temperature, and older age were associated with pneumonias. In children tested, SARS-CoV-2 test results were not associated with radiographic pneumonia.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, USA
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Canada
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York, USA
| | - Maren M Lunoe
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Michael A Gardiner
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, USA
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Meredith L Borland
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Perth, Australia
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Pediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, NY, New York, USA
| | - Michelle Eckerle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, USA
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | | | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, New York City, Bronx, New York, USA
| | | | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Kerry Caperell
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, USA
| | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah M Becker
- Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, USA
| | - Claudia R Morris
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor, USA
| | - April J Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Facultad de Medicina, Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Laura Palumbo
- Department of Pediatrics, ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Pedro B Rino
- Department of Pediatrics, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", RIDEPLA, Buenos Aires, Argentina
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Lilliam Ambroggio
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Norma-Jean Simon
- Data Analytics and Reporting and Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, USA
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2
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Xie J, Kuppermann N, Florin TA, Tancredi DJ, Funk AL, Kim K, Salvadori MI, Yock-Corrales A, Shah NP, Breslin KA, Chaudhari PP, Bergmann KR, Ahmad FA, Nebhrajani JR, Mintegi S, Gangoiti I, Plint AC, Avva UR, Gardiner MA, Malley R, Finkelstein Y, Dalziel SR, Bhatt M, Kannikeswaran N, Caperell K, Campos C, Sabhaney VJ, Chong SL, Lunoe MM, Rogers AJ, Becker SM, Borland ML, Sartori LF, Pavlicich V, Rino PB, Morrison AK, Neuman MI, Poonai N, Simon NJE, Kam AJ, Kwok MY, Morris CR, Palumbo L, Ambroggio L, Navanandan N, Eckerle M, Klassen TP, Payne DC, Cherry JC, Waseem M, Dixon AC, Ferre IB, Freedman SB. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children. Open Forum Infect Dis 2023; 10:ofad485. [PMID: 37869403 PMCID: PMC10588618 DOI: 10.1093/ofid/ofad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. Methods We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. Results We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Conclusions Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
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Affiliation(s)
| | - Nathan Kuppermann
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Todd A Florin
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Daniel J Tancredi
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Anna L Funk
- University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Nipam P Shah
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Fahd A Ahmad
- Washington University School of Medicine, St.Louis, Missouri, USA
| | | | - Santiago Mintegi
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Amy C Plint
- University of Ottawa, Ottawa, Ontario, Canada
| | - Usha R Avva
- Montefiore-Nyack Hospital, Nyack, NewYork, New York, USA
| | | | | | | | | | - Maala Bhatt
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Carmen Campos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Shu-Ling Chong
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Maren M Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah M Becker
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Laura F Sartori
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Pedro B Rino
- Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” RIDEPLA, Buenos Aires, Argentina
| | | | | | - Naveen Poonai
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Norma-Jean E Simon
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - April J Kam
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maria Y Kwok
- Columbia University Irving Medical Center, NewYork, New York, USA
| | - Claudia R Morris
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Palumbo
- ASST Spedali Civili di Brescia—Pronto Soccorso Pediatrico, Brescia, Italy
| | | | | | - Michelle Eckerle
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Grant R, Flechelles O, Elenga N, Tressières B, Gaete S, Hebert JC, Schaub B, Djossou F, Mallard A, Delver L, Ryan C, Funk AL, Cabié A, Fontanet A, Hoen B. Consequences of In Utero Zika Virus Exposure and Adverse Pregnancy and Early Childhood Outcomes: A Prospective Cohort Study. Viruses 2022; 14:v14122755. [PMID: 36560760 PMCID: PMC9788325 DOI: 10.3390/v14122755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed to describe adverse pregnancy outcomes among women who had symptomatic, RT-PCR-confirmed ZIKV infection and early childhood outcomes among their infants. We enrolled pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection in a prospective cohort study, and their infants in a prospective pediatric cohort study. We defined adverse pregnancy and early childhood outcomes based on selected neurologic, ophthalmologic, auditory, musculoskeletal, and anthropometric abnormalities. We used RT-PCR and serologic tests to determine the ZIKV infection status of the child. Between 10 March and 24 November 2016, we enrolled 546 pregnant women with RT-PCR-confirmed ZIKV infection. The overall risk of adverse pregnancy and early childhood outcomes possibly related to in utero ZIKV exposure was 15.7% (95% CI: 12.8-19.0), distributed as follows: 3.6% (95% CI: 2.3-5.6) severe sequelae or fatality; 2.7% (95% CI: 1.6-4.5) major abnormalities; 9.4% (95% CI:7.1-12.2) mild abnormalities. The risk of severe sequelae or fatality was higher when ZIKV infection occurred during the first trimester (7.0%), compared to the second (2.7%) or third trimester (1.4%) (p = 0.02). Among the infants for whom ZIKV infection status could be determined, the vertical transmission rate was 3.0% (5/167) (95% CI: 1.1-7.2). Among pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection, severe or major pregnancy or early childhood outcomes were present in 6.3% of fetuses and infants. Severe outcomes occurred more frequently in fetuses and infants whose mothers had been infected in the first trimester.
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Affiliation(s)
- Rebecca Grant
- Emerging Disease Epidemiology Unit, Institut Pasteur, 75015 Paris, France
- Sorbonne Université, 75006 Paris, France
| | - Olivier Flechelles
- Centre Hospitalier Universitaire de la Martinique, 97261 Fort-de-France, France
| | | | - Benoît Tressières
- Centre d’Investigation Clinique Antilles—Guyane, 97142 Pointe-à-Pitre, France
| | - Stanie Gaete
- Karubiotec™, Centre Hospitalier Universitaire de la Guadeloupe, 97142 Pointe-à-Pitre, France
| | | | - Bruno Schaub
- Centre Hospitalier Universitaire de la Martinique, 97261 Fort-de-France, France
| | - Felix Djossou
- Centre Hospitalier de Cayenne, Cayenne 97306, French Guiana
| | - Adeline Mallard
- Centre Hospitalier Universitaire de la Guadeloupe, 97142 Pointe-à-Pitre, France
| | - Lucetta Delver
- Centre Hospitalier de Basse-Terre, 97109 Basse-Terre, France
| | - Catherine Ryan
- Centre Hospitalier Universitaire de la Guadeloupe, 97142 Pointe-à-Pitre, France
| | - Anna L. Funk
- Emerging Disease Epidemiology Unit, Institut Pasteur, 75015 Paris, France
| | - André Cabié
- Centre Hospitalier Universitaire de la Martinique, 97261 Fort-de-France, France
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Université des Antilles, INSERM, EFS, 34394 Montpellier, France
- Centre d′Investigation Clinique 1424, INSERM, 97261 Fort-de-France, France
| | - Arnaud Fontanet
- Emerging Disease Epidemiology Unit, Institut Pasteur, 75015 Paris, France
- Conservatoire National des Arts et Métiers, 75003 Paris, France
- Correspondence: (A.F.); (B.H.)
| | - Bruno Hoen
- Centre d’Investigation Clinique Antilles—Guyane, 97142 Pointe-à-Pitre, France
- Correspondence: (A.F.); (B.H.)
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4
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Funk AL, Kuppermann N, Florin TA, Tancredi DJ, Xie J, Kim K, Finkelstein Y, Neuman MI, Salvadori MI, Yock-Corrales A, Breslin KA, Ambroggio L, Chaudhari PP, Bergmann KR, Gardiner MA, Nebhrajani JR, Campos C, Ahmad FA, Sartori LF, Navanandan N, Kannikeswaran N, Caperell K, Morris CR, Mintegi S, Gangoiti I, Sabhaney VJ, Plint AC, Klassen TP, Avva UR, Shah NP, Dixon AC, Lunoe MM, Becker SM, Rogers AJ, Pavlicich V, Dalziel SR, Payne DC, Malley R, Borland ML, Morrison AK, Bhatt M, Rino PB, Beneyto Ferre I, Eckerle M, Kam AJ, Chong SL, Palumbo L, Kwok MY, Cherry JC, Poonai N, Waseem M, Simon NJ, Freedman SB. Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Netw Open 2022; 5:e2223253. [PMID: 35867061 PMCID: PMC9308058 DOI: 10.1001/jamanetworkopen.2022.23253] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. OBJECTIVES To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. EXPOSURE SARS-CoV-2 detected via nucleic acid testing. MAIN OUTCOMES AND MEASURES Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. RESULTS Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Kristen A Breslin
- Department of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Michael A Gardiner
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego
| | | | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nidhya Navanandan
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Children's Hospital of Michigan, Detroit
- Department of Pediatrics, Central Michigan University, Mt Pleasant
| | - Kerry Caperell
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, Norton Children's Hospital, Louisville, Kentucky
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Andrew C Dixon
- University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Maren M Lunoe
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah M Becker
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah
| | - Alexander J Rogers
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro B Rino
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan," RIDEPLA, Buenos Aires, Argentina
| | | | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - April J Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia-Pronto soccorso pediatrico, Brescia, Italy
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, New York, New York
| | - Norma-Jean Simon
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Funk AL, Florin TA, Kuppermann N, Tancredi DJ, Xie J, Kim K, Neuman MI, Ambroggio L, Plint AC, Mintegi S, Klassen TP, Salvadori MI, Malley R, Payne DC, Simon NJ, Yock-Corrales A, Nebhrajani JR, Chaudhari PP, Breslin KA, Finkelstein Y, Campos C, Bergmann KR, Bhatt M, Ahmad FA, Gardiner MA, Avva UR, Shah NP, Sartori LF, Sabhaney VJ, Caperell K, Navanandan N, Borland ML, Morris CR, Gangoiti I, Pavlicich V, Kannikeswaran N, Lunoe MM, Rino PB, Kam AJ, Cherry JC, Rogers AJ, Chong SL, Palumbo L, Angelats CM, Morrison AK, Kwok MY, Becker SM, Dixon AC, Poonai N, Eckerle M, Wassem M, Dalziel SR, Freedman SB. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open 2022; 5:e2142322. [PMID: 35015063 PMCID: PMC8753506 DOI: 10.1001/jamanetworkopen.2021.42322] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. EXPOSURES Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. MAIN OUTCOMES AND MEASURES Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. RESULTS Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). CONCLUSIONS AND RELEVANCE In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
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Affiliation(s)
- Anna L. Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A. Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark I. Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Amy C. Plint
- Children’s Hospital of Eastern Ontario, Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Richard Malley
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C. Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma-Jean Simon
- Data Analytics and Reporting, Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carmen Campos
- Hospital Universitario Miguel Servet, Pediatric Emergency Department, Zaragoza, Spain
| | - Kelly R. Bergmann
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Maala Bhatt
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fahd A. Ahmad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael A. Gardiner
- Rady Children’s Hospital, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Usha R. Avva
- School of Medicine Hackensack Meridian Health, Hackensack, New Jersey
| | - Nipam P. Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Laura F. Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vikram J. Sabhaney
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Caperell
- Norton Children’s Hospital, University of Louisville, Louisville, Kentucky
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Meredith L. Borland
- Perth Children’s Hospital, Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | | | - Maren M. Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro B. Rino
- Hospital de Pediatría “Prof Dr Juan P. Garrahan”, RIDEPLA, Buenos Aires, Argentina
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jonathan C. Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | | | - Andrea K. Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maria Y. Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York
| | - Sarah M. Becker
- University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah
| | - Andrew C. Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Naveen Poonai
- Child Health Research Institute, Division of Paediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Freedman SB, Kuppermann N, Funk AL, Kim K, Xie J, Tancredi D, Dalziel SR, Neuman MI, Mintegi S, Plint AC, Gómez-Vargas J, Finkelstein Y, Ambroggio L, Klassen TP, Salvadori M, Malley R, Payne DC, Florin TA. Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments. Acad Pediatr 2022; 22:1200-1211. [PMID: 35462066 PMCID: PMC9023083 DOI: 10.1016/j.acap.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We sought to determine if corticosteroid administration is associated with a SARS-CoV-2 nucleic acid test-positive result and to describe therapies administered to SARS-CoV-2 infected children. METHODS We collected cross-sectional data from participants recruited in 41 pediatric emergency departments (ED) in 10 countries between March 2020 and June 2021. Participants were <18 years old, had signs or symptoms of, or risk factors for acute SARS-CoV-2 infection, and had nucleic acid testing performed. To determine if SARS-CoV-2 test status was independently associated with corticosteroid administration, we used a multivariable conditional logistic regression model matched by study site to compare treatments administered based on SARS-CoV-2 test and disposition status. This analysis was repeated for the subgroup of study participants who were hospitalized. RESULTS 30.3% (3,121/10,315) of participants were SARS-CoV-2-positive. Although remdesivir was more commonly administered to SARS-CoV-2-positive children, use was infrequent (25/3120 [0.8%] vs 1/7188 [0.01%]; P = .001). Corticosteroid use was less common among SARS-CoV-2-positive children (219/3120 [7.0%] vs 759/7190 [10.6%]; P < .001). Among hospitalized children, there were no differences in provision of inotropes, respiratory support, chest drainage or extracorporeal membrane oxygenation between groups. Corticosteroid administration was associated with age, history of asthma, wheezing, study month, hospitalization and intensive care unit admission; it was not associated with a positive SARS-CoV-2 test result overall (aOR: 0.91; 95%CI: 0.74, 1.12) or among the subgroup of those hospitalized (aOR: 1.04; 95%CI: 0.75, 1.44). CONCLUSIONS Few disease-specific treatments are provided to SARS-CoV-2-positive children; clinical trials evaluating therapies in children are urgently needed.
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Affiliation(s)
- Stephen B. Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine (SB Freedman), University of Calgary, Calgary, Canada,Address correspondence to Stephen Freedman MDCM, MSc, Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics (N Kuppermann), University of California (UC), Davis School of Medicine, and UC Davis Health, Sacramento, Calif
| | - Anna L. Funk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Kelly Kim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Jianling Xie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Daniel Tancredi
- Department of Pediatrics (D Tancredi), UC Davis School of Medicine, Sacramento, Calif
| | - Stuart R. Dalziel
- Departments of Surgery and Paediatrics, Child and Youth Health, The University of Auckland and Children's Emergency Department (SR Dalziel), Starship Children's Hospital, Auckland, New Zealand
| | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics (MI Neuman), Harvard Medical School, Boston, Mass
| | - Santiago Mintegi
- Pediatric Emergency Department (S Mintegi), Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine (AC Plint), University of Ottawa and Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jessica Gómez-Vargas
- Emergency Department (J Gómez-Vargas), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, CCSS, San José, Costa Rica
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics (Y Finkelstein), Hospital for Sick Children, Toronto, Canada
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics (L Ambroggio), University of Colorado, Denver, Colo
| | - Terry P. Klassen
- Children's Hospital Research Institute of Manitoba and Department of Pediatrics and Child Health (TP Klassen), University of Manitoba, Winnipeg, Canada
| | - Marina Salvadori
- Public Health Agency of Canada, Division of Infectious Diseases, Department of Pediatrics McGill University (M Salvadori), Montreal, Canada
| | - Richard Malley
- Division of Infectious Diseases (R Malley), Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Daniel C. Payne
- Centers for Disease Control and Prevention (DC Payne), Atlanta, United States
| | - Todd A. Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics (TA Florin), Northwestern University Feinberg School of Medicine, Chicago, Ill,Address correspondence to Todd Florin MD, MSCE, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, Il 60611
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7
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Sumner MW, Kanngiesser A, Lotfali-Khani K, Lodha N, Lorenzetti D, Funk AL, Freedman SB. Severe Outcomes Associated With SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:916655. [PMID: 35757137 PMCID: PMC9218576 DOI: 10.3389/fped.2022.916655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the proportion of SARS-CoV-2 infected children experiencing hospitalization, intensive care unit (ICU) admission, severe outcomes, and death. DATA SOURCES PubMed, Embase, and MedRxiv were searched for studies published between December 1, 2019 and May 28, 2021. References of relevant systematic reviews were also screened. STUDY SELECTION We included cohort or cross-sectional studies reporting on at least one outcome measure (i.e., hospitalization, ICU admission, severe outcomes, death) for ≥100 children ≤21 years old within 28 days of SARS-CoV-2 positivity; no language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed data extraction and risk of bias assessment. Estimates were pooled using random effects models. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Percentage of SARS-CoV-2 positive children experiencing hospitalization, ICU admission, severe outcome, and death. RESULTS 118 studies representing 3,324,851 SARS-CoV-2 infected children from 68 countries were included. Community-based studies (N = 48) reported that 3.3% (95%CI: 2.7-4.0%) of children were hospitalized, 0.3% (95%CI: 0.2-0.6%) were admitted to the ICU, 0.1% (95%CI: 0.0-2.2%) experienced a "severe" outcome and 0.02% (95%CI: 0.001-0.05%) died. Hospital-based screening studies (N = 39) reported that 23.9% (95%CI: 19.0-29.2%) of children were hospitalized, 2.9% (95%CI: 2.1-3.8%) were admitted to the ICU, 1.3% (95%CI: 0.5-2.3%) experienced a severe outcome, and 0.2% (95%CI: 0.02-0.5%) died. Studies of hospitalized children (N = 31) reported that 10.1% (95%CI: 6.1-14.9%) of children required ICU admission, 4.2% (95%CI: 0.0-13.8%) had a severe outcome and 1.1% (95%CI: 0.2-2.3%) died. Low risk of bias studies, those from high-income countries, and those reporting outcomes later in the pandemic presented lower estimates. However, studies reporting outcomes after May 31, 2020, compared to earlier publications, had higher proportions of hospitalized patients requiring ICU admission and experiencing severe outcomes. CONCLUSION AND RELEVANCE Among children tested positive for SARS-CoV-2, 3.3% were hospitalized, with rates being higher early in the pandemic. Severe outcomes, ICU admission and death were uncommon, however estimates vary by study population, pandemic timing, study risk of bias, and economic status of the country. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier [CRD42021260164].
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Affiliation(s)
- Madeleine W Sumner
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alicia Kanngiesser
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kosar Lotfali-Khani
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Nidhi Lodha
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Health Sciences Library and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Freedman SB, Xie J, Lee BE, Ali S, Pang XL, Chui L, Zhuo R, Vanderkooi OG, Tellier R, Funk AL, Tarr PI. Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care Due to Vomiting in the Absence of Diarrhea. Clin Infect Dis 2021; 73:1414-1423. [PMID: 33993272 PMCID: PMC9794187 DOI: 10.1093/cid/ciab451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As children with isolated vomiting are rarely able to provide a specimen suitable for routine pathogen testing, we have limited knowledge about their infecting pathogens. METHODS Between December 2014 and August 2018, children <18 years old with presumed acute gastroenteritis who presented to 2 emergency departments (EDs) in Alberta, Canada, were recruited. Eligible participants had ≥3 episodes of vomiting and/or diarrhea in a 24-hour period, <7 days of symptoms, and provided a rectal swab or stool specimen. We quantified the proportion of children with isolated vomiting in whom an enteropathogen was identified, and analyzed clinical characteristics, types of enteropathogens, resources used, and alternative diagnoses. RESULTS Of the 2695 participants, at the ED visit, 295 (10.9%), 1321 (49.0%), and 1079 (40.0%) reported having isolated diarrhea, vomiting and diarrhea, or isolated vomiting, respectively. An enteropathogen was detected most commonly in those with vomiting and diarrhea (1067/1321; 80.8%); detection did not differ between those with isolated diarrhea (170/295; 57.6%) and isolated vomiting (589/1079; 54.6%) (95% confidence interval of the difference: -3.4%, 9.3%). Children with isolated vomiting most often had a virus (557/1077; 51.7%), most commonly norovirus (321/1077; 29.8%); 5.7% (62/1079) had a bacterial pathogen. X-rays, ultrasounds, and urine tests were most commonly performed in children with isolated vomiting. Alternate etiologies were most common in those with isolated vomiting (5.7%; 61/1079). CONCLUSIONS The rate of enteropathogen identification in children with isolated vomiting using molecular diagnostic tests and rectal swabs is substantial. Molecular diagnostics offer an emerging diagnostic strategy in children with isolated vomiting.
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Affiliation(s)
- Stephen B Freedman
- Division of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Correspondence: S. B. Freedman, Professor of Pediatrics and Emergency Medicine, Alberta Children’s Hospital Foundation Professor in Child Health and Wellness, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB Canada T3B 6A8 ()
| | - Jianling Xie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Microbiology, Immunology, and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences. Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta,Canada
| | - Raymond Tellier
- Department of Medicine, McGill University and Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Funk AL, Hoen B, Vingdassalom I, Ryan C, Kadhel P, Schepers K, Gaete S, Tressières B, Fontanet A. Reassessment of the risk of birth defects due to Zika virus in Guadeloupe, 2016. PLoS Negl Trop Dis 2021; 15:e0009048. [PMID: 33657112 PMCID: PMC7928479 DOI: 10.1371/journal.pntd.0009048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the French Territories in the Americas (FTA), the risk of birth defects possibly associated with Zika virus (ZIKV) infection was 7.0% (95%CI: 5.0 to 9.5) among foetuses/infants of 546 women with symptomatic RT-PCR confirmed ZIKV infection during pregnancy. Many of these defects were isolated measurement-based microcephaly (i.e. without any detected brain or clinical abnormalities) or mild neurological conditions. We wanted to estimate the proportion of such minor findings among live births of women who were pregnant in the same region during the outbreak period but who were not infected with ZIKV. METHODS In Guadeloupe, pregnant women were recruited at the time of delivery and tested for ZIKV infection. The outcomes of live born infants of ZIKV non-infected women were compared to those of ZIKV-exposed live born infants in Guadeloupe, extracted from the FTA prospective cohort. RESULTS Of 490 live born infants without exposure to ZIKV, 42 infants (8.6%, 95%CI: 6.2-11.4) had mild abnormalities that have been described as 'potentially linked to ZIKV infection'; all but one of these was isolated measurement-based microcephaly. Among the 241 live born infants with ZIKV exposure, the proportion of such abnormalities, using the same definition, was similar (6.6%, 95%CI: 3.8-10.6). CONCLUSIONS Isolated anthropometric abnormalities and mild neurological conditions were as prevalent among infants with and without in-utero ZIKV exposure. If such abnormalities had not been considered as 'potentially linked to ZIKV' in the original prospective cohort in Guadeloupe, the overall estimate of the risk of birth defects considered due to the virus would have been significantly lower, at approximately 1.6% (95% CI: 0.4-4.1). TRIAL REGISTRATION ClinicalTrials.gov (NCT02916732).
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Affiliation(s)
- Anna L. Funk
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
- Sorbonne Université, Paris, France
| | - Bruno Hoen
- INSERM Centre d’Investigation Clinique 1424, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Ingrid Vingdassalom
- INSERM Centre d’Investigation Clinique 1424, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Catherine Ryan
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Philippe Kadhel
- Université des Antilles, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
- Institut de Recherche en Santé, Environnement et Travail (IRSET), Université de Rennes, Rennes, France
| | - Kinda Schepers
- Infectious Diseases Department, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Stanie Gaete
- Centre de Ressources Biologiques Karubiotec, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Benoit Tressières
- INSERM Centre d’Investigation Clinique 1424, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Arnaud Fontanet
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
- Unité Pasteur-CNAM Risques Infectieux et Émergents, Conservatoire National des Arts et Métiers, Paris, France
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10
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Funk AL, Florin TA, Dalziel SR, Mintegi S, Salvadori MI, Tancredi DJ, Neuman MI, Payne DC, Plint AC, Klassen TP, Malley R, Ambroggio L, Kim K, Kuppermann N, Freedman SB. Prospective cohort study of children with suspected SARS-CoV-2 infection presenting to paediatric emergency departments: a Paediatric Emergency Research Networks (PERN) Study Protocol. BMJ Open 2021; 11:e042121. [PMID: 33452195 PMCID: PMC7813043 DOI: 10.1136/bmjopen-2020-042121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Relatively limited data are available regarding paediatric COVID-19. Although most children appear to have mild or asymptomatic infections, infants and those with comorbidities are at increased risk of experiencing more severe illness and requiring hospitalisation due to COVID-19. The recent but uncommon association of SARS-CoV-2 infection with development of a multisystem inflammatory syndrome has heightened the importance of understanding paediatric SARS-CoV-2 infection. METHODS AND ANALYSIS The Paediatric Emergency Research Network-COVID-19 cohort study is a rapid, global, prospective cohort study enrolling 12 500 children who are tested for acute SARS-CoV-2 infection. 47 emergency departments across 12 countries on four continents will participate. At enrolment, regardless of SARS-CoV-2 test results, all children will have the same information collected, including clinical, epidemiological, laboratory, imaging and outcome data. Interventions and outcome data will be collected for hospitalised children. For all children, follow-up at 14 and 90 days will collect information on further medical care received, and long-term sequelae, respectively. Statistical models will be designed to identify risk factors for infection and severe outcomes. ETHICS AND DISSEMINATION Sites will seek ethical approval locally, and informed consent will be obtained. There is no direct risk or benefit of study participation. Weekly interim analysis will allow for real-time data sharing with regional, national, and international policy makers. Harmonisation and sharing of investigation materials with WHO, will contribute to synergising global efforts for the clinical characterisation of paediatric COVID-19. Our findings will enable the implementation of countermeasures to reduce viral transmission and severe COVID-19 outcomes in children. TRIAL REGISTRATION NUMBER NCT04330261.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Todd A Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand
- Children's Emergency Department, Starship Children's Health, Newmarket, Auckland, New Zealand
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel C Payne
- National Center for Emerging Zoonotic Infectious Diseases, Division of Foodborne Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy C Plint
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Malley
- Division of Infectious Disease, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilliam Ambroggio
- Sections of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Denver, Colorado, USA
| | - Kelly Kim
- Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Stephen B Freedman
- Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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11
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Boucheron P, Lu Y, Yoshida K, Zhao T, Funk AL, Lunel-Fabiani F, Guingané A, Tuaillon E, van Holten J, Chou R, Bulterys M, Shimakawa Y. Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis. Lancet Infect Dis 2020; 21:85-96. [PMID: 32805201 DOI: 10.1016/s1473-3099(20)30593-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) involves neonatal immunoprophylaxis, with a birth dose of hepatitis B vaccine and immune globulin, and provision of peripartum antiviral prophylaxis in highly viraemic women. However, access to assays to quantify HBV DNA levels remains inadequate in resource-poor settings. This study was commissioned by WHO and aimed to identify the HBV DNA threshold for MTCT, to assess the sensitivity and specificity of hepatitis B e antigen (HBeAg) testing to identify pregnant women with HBV DNA levels above this threshold, and to predict MTCT of HBV infection on the basis of HBeAg testing. METHODS For this systematic review and meta-analysis, we searched the PubMed, EMBASE, Scopus, CENTRAL, CNKI, and Wanfang databases for studies of pregnant women with chronic HBV infection without concurrent antiviral therapy, published between Jan 1, 2000, and April 3, 2019. Studies were eligible for inclusion if MTCT in mother-child pairs could be stratified by different levels of maternal HBV DNA during pregnancy, if maternal HBeAg status could be stratified by HBV DNA level, and if the MTCT status of infants could be stratified by maternal HBeAg status during pregnancy. Studies that selected pregnant women on the basis of HBeAg serostatus or HBV DNA levels were excluded. Aggregate data were extracted from eligible studies by use of a pre-piloted form; study authors were contacted to clarify any uncertainties about potential duplication or if crucial information was missing. To pool sensitivities and specificities of maternal HBeAg to identify highly viraemic women and to predict MTCT events, we used the DerSimonian-Laird bivariate random effects model. This study is registered with PROSPERO, CRD42019138227. FINDINGS Of 9007 articles identified, 67 articles (comprising 66 studies) met the inclusion criteria. The risk of MTCT despite infant immunoprophylaxis was negligible (0·04%, 95% CI 0·00-0·25) below a maternal HBV DNA level of 5·30 log10 IU/mL (200 000 IU/mL) and increased above this threshold. The pooled sensitivity of HBeAg testing to identify HBV DNA levels of 5·30 log10 IU/mL or greater in pregnant women was 88·2% (83·9-91·5) and pooled specificity was 92·6% (90·0-94·5). The pooled sensitivity of HBeAg testing in predicting MTCT of HBV infection despite infant immunoprophylaxis was 99·5% (95% CI 91·7-100) and pooled specificity was 62·2% (55·2-68·7). INTERPRETATION Maternal HBV DNA of 5·30 log10 IU/mL or greater appears to be the optimal threshold for MTCT of HBV infection despite infant immunoprophylaxis. HBeAg is accurate to identify women with HBV DNA levels above this threshold and has high sensitivity to predict cases of immunoprophylaxis failure. In areas where HBV DNA assays are unavailable, HBeAg can be used as an alternative to assess eligibility for antiviral prophylaxis. FUNDING World Health Organization.
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Affiliation(s)
- Pauline Boucheron
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Ying Lu
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Kyoko Yoshida
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tianshuo Zhao
- School of Public Health, Peking University, Beijing, China
| | - Anna L Funk
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Alice Guingané
- Département d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Edouard Tuaillon
- Département de Bactériologie-Virologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Judith van Holten
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Roger Chou
- Oregon Health & Science University, Portland, OR, USA
| | - Marc Bulterys
- Global Hepatitis Programme, World Health Organization, Geneva, Switzerland; US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
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12
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El Kassas M, Funk AL, Salaheldin M, Shimakawa Y, Eltabbakh M, Jean K, El Tahan A, Sweedy AT, Afify S, Youssef NF, Esmat G, Fontanet A. Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis. J Viral Hepat 2018; 25:623-630. [PMID: 29274197 DOI: 10.1111/jvh.12854] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
Abstract
In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.
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Affiliation(s)
- M El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - A L Funk
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - M Salaheldin
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Y Shimakawa
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - M Eltabbakh
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - K Jean
- Laboratoire MESuRS (EA 4628), Conservatoire National Des Arts et Métiers, Paris, France.,Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - A El Tahan
- New Cairo Viral Hepatitis Treatment Unit, Cairo, Egypt
| | - A T Sweedy
- New Cairo Viral Hepatitis Treatment Unit, Cairo, Egypt
| | - S Afify
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - N F Youssef
- Medical Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - G Esmat
- Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Fontanet
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France.,Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
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13
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El Kassas M, Funk AL, Abd El Latif Y, Vasiliu A, Sherief A, Shimakawa Y, Youssef N, El Tahan A, Elbadry M, Farid AM, El Shazly Y, Doss W, Esmat G, Fontanet A. Letter: concordance of SVR4 and SVR12 following direct-acting anti-viral treatment in Egypt. Aliment Pharmacol Ther 2018; 47:1564-1566. [PMID: 29878419 DOI: 10.1111/apt.14628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - A L Funk
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - Y Abd El Latif
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Vasiliu
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - A Sherief
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Y Shimakawa
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - N Youssef
- Medical Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - A El Tahan
- New Cairo Viral Hepatitis Treatment Unit, Cairo, Egypt
| | - M Elbadry
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Aswan University, Sahary City, Egypt
| | - A M Farid
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Y El Shazly
- Egyptian National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - W Doss
- Egyptian National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - G Esmat
- Egyptian National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - A Fontanet
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France.,Institut Pasteur, Conservatoire National des Arts et Métiers, Unité PACRI, Paris, France
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14
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Seck A, Ndiaye F, Maylin S, Ndiaye B, Simon F, Funk AL, Fontanet A, Takahashi K, Akbar SMF, Mishiro S, Bercion R, Vray M, Shimakawa Y. Poor Sensitivity of Commercial Rapid Diagnostic Tests for Hepatitis B e Antigen in Senegal, West Africa. Am J Trop Med Hyg 2018; 99:428-434. [PMID: 29869595 DOI: 10.4269/ajtmh.18-0116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Limited access to nucleic acid tests for hepatitis B virus (HBV) DNA is a significant barrier to the effective management of chronic HBV infection in resource-poor countries. Alternatively, HBV e antigen (HBeAg) may accurately indicate high viral replication. We assessed the diagnostic performance of three commercially available rapid diagnostic tests (RDTs) for HBeAg (SD Bioline, Insight and OneStep) against a quantitative chemiluminescent immunoassay (CLIA, Architect). Using stored sera from adults with chronic HBV infection, we tested RDTs in three groups in Senegal (48 HBeAg-positive, 196 HBeAg-negative, and 117 cases with high HBV DNA (≥ 106 IU/mL)) and one group in France (17 HBeAg-positive East Asians). In Senegal, the sensitivity and specificity for HBeAg detection were 29.8% and 100% for SD Bioline, 31.1% and 100% for Insight, and 42.5% and 98.4% for OneStep, respectively. The lower limits of detection of these RDTs were very high (> 2.5 log10 Paul Ehrlich Institut units/mL). Their low sensitivity was also confirmed in HBeAg-positive Asian samples (35.3-52.9%). The prevalence of HBeAg in highly viremic (≥ 106 IU/mL) Senegalese patients was low: 58.1% using CLIA and 24.5-37.5% using RDTs. Hepatitis B e antigen prevalence was similarly low in a subgroup of 28 Senegalese women of childbearing age with a high viral load (≥ 106 IU/mL). Approximately, half of highly viremic adults do not carry HBeAg in Africa, and HBeAg RDTs had remarkably poor analytical and diagnostic sensitivity. This implies that HBeAg-based antenatal screening, particularly if using the currently available HBeAg RDTs, may overlook most pregnant women at high risk of mother-to-child transmission in Africa.
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Affiliation(s)
- Abdoulaye Seck
- Faculté de Médecine, Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.,Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | | | - Sarah Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Babacar Ndiaye
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - François Simon
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Anna L Funk
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Arnaud Fontanet
- Unité PACRI, Conservatoire National des Arts et Métiers, Paris, France.,Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Kazuaki Takahashi
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | | | - Shunji Mishiro
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - Raymond Bercion
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - Muriel Vray
- Unité d'Épidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Sénégal.,Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
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15
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Hoen B, Schaub B, Funk AL, Ardillon V, Boullard M, Cabié A, Callier C, Carles G, Cassadou S, Césaire R, Douine M, Herrmann-Storck C, Kadhel P, Laouénan C, Madec Y, Monthieux A, Nacher M, Najioullah F, Rousset D, Ryan C, Schepers K, Stegmann-Planchard S, Tressières B, Voluménie JL, Yassinguezo S, Janky E, Fontanet A. Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas. N Engl J Med 2018. [PMID: 29539287 DOI: 10.1056/nejmoa1709481] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas. METHODS From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort. RESULTS Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001). CONCLUSIONS Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).
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Affiliation(s)
- Bruno Hoen
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Bruno Schaub
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Anna L Funk
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Vanessa Ardillon
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Manon Boullard
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - André Cabié
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Caroline Callier
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Gabriel Carles
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Sylvie Cassadou
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Raymond Césaire
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Maylis Douine
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Cécile Herrmann-Storck
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Philippe Kadhel
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Cédric Laouénan
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Yoann Madec
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Alice Monthieux
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Mathieu Nacher
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Fatiha Najioullah
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Dominique Rousset
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Catherine Ryan
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Kinda Schepers
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Sofia Stegmann-Planchard
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Benoît Tressières
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Jean-Luc Voluménie
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Samson Yassinguezo
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Eustase Janky
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
| | - Arnaud Fontanet
- From INSERM Centre d'Investigation Clinique 1424 (B.H., C.C., B.T.), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S.), Cellule d'Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K.), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R.), and Pôle Parent-Enfant (E.J.), Centre Hospitalier Universitaire (CHU) de Pointe-à-Pitre/Abymes, and Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud (B.H.), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l'Enfant (B.S.), INSERM Centre d'Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C.), Unit of Obstetrics and Gynecology, Maison de la Femme de la Mère et de l'Enfant (A.M., J.-L.V.), and Laboratoire de Virologie (F.N.), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) and Center for Global Health (A.F.), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L.), and Conservatoire National des Arts et Métiers, Unité Pasteur-Cnam Risques Infectieux et Émergents (A.F.), Paris; CIRE de Guyane, Santé Publique France (V.A.), Pôle Mère-Enfant, Centre Hospitalier de l'Ouest Guyanais (G.C.), INSERM Centre d'Investigation Clinique 1424 (M.D., M.N.), Laboratoire de Virologie, Institut Pasteur de la Guyane (D.R.), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y.), French Guiana; and Unité de Maladies Infectieuses, Centre Hospitalier Louis Constant Fleming, St. Martin (S.S.-P.) - all in France
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16
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Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M. The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver Int 2017; 37:45-53. [PMID: 27275625 PMCID: PMC5145777 DOI: 10.1111/liv.13186] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS In 2015, a national Egyptian health issue survey was conducted to describe the prevalence of hepatitis C virus (HCV) infection. In this paper, we describe the HCV burden in 2015, compare the results with the national survey conducted in 2008, and discuss the implications of the new findings on prevention of HCV in Egypt. METHODS A multistage probability sampling approach was used, similar to the national demographic survey conducted in 2008. More than 90% of sampled individuals complied with the interview and provided blood samples. RESULTS In the 15-59-year age groups, the prevalence of HCV antibody was found to be 10.0% (95% CI 9.5-10.5) and that of HCV RNA to be 7.0% (95% CI 6.6-7.4). In children, 1-14 years old, the prevalence of HCV antibody and HCV RNA were 0.4% (95% CI 0.3-0.5) and 0.2% (95% CI 0.1-0.3) respectively. Approximately, 3.7 million persons have chronic HCV infection in the age group 15-59 in 2015. An estimated 29% reduction in HCV RNA prevalence has been seen since 2008, which is largely attributable to the ageing of the group infected 40-50 years ago during the mass schistosomiasis treatment campaigns. Prevention efforts may have also contributed to this decline, with an estimated 75% (95% CI 6-45) decrease in HCV incidence in the 0-19 year age groups over the past 20 years. CONCLUSIONS These findings can be used to shape future HCV prevention policies in Egypt.
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Affiliation(s)
- Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Paris, France
| | - Maha Talaat
- Global Disease Detection Regional Center, US Centers for Disease Control and Prevention, Cairo, Egypt.,US Naval Medical Research Unit, No.3, Cairo, Egypt
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17
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Keane E, Funk AL, Shimakawa Y. Systematic review with meta-analysis: the risk of mother-to-child transmission of hepatitis B virus infection in sub-Saharan Africa. Aliment Pharmacol Ther 2016; 44:1005-1017. [PMID: 27630001 DOI: 10.1111/apt.13795] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/28/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risk of mother-to-child transmission of hepatitis B virus (HBV) has been quoted as 70-90% among women positive for hepatitis B surface antigen (HBsAg) and e antigen (HBeAg), and 5-30% among HBsAg-positive HBeAg-negative women. These risks are derived from Asia; little is known about sub-Saharan Africa. AIM To determine the risk of mother-to-child transmission in sub-Saharan Africa, according to maternal HBeAg and type of prophylaxis. METHODS We searched Medline, Global Health, Embase, African Journals Online and African Index Medicus. We included observational or interventional studies that enrolled infants of HBV-infected women, and that tested for HBsAg or HBV DNA between 3 and 12 months of age. RESULTS Fifteen articles from 11 African countries were included. Among HBeAg-positive women, the pooled risk was 38.3% (95% CI: 7.0-74.4%) without prophylaxis, which was significantly lower than the lower bound of 70-90% risk in the literature (P = 0.007). Among HBeAg-negative women, the pooled risk was 4.8% (95% CI: 0.1-13.3%) without prophylaxis, which lays within the lower range of the 5-30% risk in Asia. By extrapolating the pooled transmission risks to the number of births to infectious mothers, an estimated 1% of newborns (n = 367 250) are annually infected with HBV at birth in sub-Saharan Africa. CONCLUSIONS Compared to Asia, the risk of mother-to-child transmission is low in sub-Saharan Africa. However, the annual number of infants perinatally infected with HBV is twice the number of incident paediatric HIV infections in sub-Saharan Africa (n = 190 000). This highlights the importance of preventing mother-to-child transmission of HBV in sub-Saharan Africa, which has been long neglected.
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Affiliation(s)
- E Keane
- École Pasteur/CNAM de Santé Publique, Paris, France.,Mater Misercicordiae University Hospital, Dublin, Ireland
| | - A L Funk
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Y Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
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18
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Funk AL, Goutard FL, Miguel E, Bourgarel M, Chevalier V, Faye B, Peiris JSM, Van Kerkhove MD, Roger FL. MERS-CoV at the Animal-Human Interface: Inputs on Exposure Pathways from an Expert-Opinion Elicitation. Front Vet Sci 2016; 3:88. [PMID: 27761437 PMCID: PMC5051548 DOI: 10.3389/fvets.2016.00088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/14/2016] [Indexed: 12/30/2022] Open
Abstract
Nearly 4 years after the first report of the emergence of Middle-East respiratory syndrome Coronavirus (MERS-CoV) and nearly 1800 human cases later, the ecology of MERS-CoV, its epidemiology, and more than risk factors of MERS-CoV transmission between camels are poorly understood. Knowledge about the pathways and mechanisms of transmission from animals to humans is limited; as of yet, transmission risks have not been quantified. Moreover the divergent sanitary situations and exposures to animals among populations in the Arabian Peninsula, where human primary cases appear to dominate, vs. other regions in the Middle East and Africa, with no reported human clinical cases and where the virus has been detected only in dromedaries, represents huge scientific and health challenges. Here, we have used expert-opinion elicitation in order to obtain ideas on relative importance of MERS-CoV risk factors and estimates of transmission risks from various types of contact between humans and dromedaries. Fourteen experts with diverse and extensive experience in MERS-CoV relevant fields were enrolled and completed an online questionnaire that examined pathways based on several scenarios, e.g., camels-camels, camels-human, bats/other species to camels/humans, and the role of diverse biological substances (milk, urine, etc.) and potential fomites. Experts believed that dromedary camels play the largest role in MERS-CoV infection of other dromedaries; however, they also indicated a significant influence of the season (i.e. calving or weaning periods) on transmission risk. All experts thought that MERS-CoV-infected dromedaries and asymptomatic humans play the most important role in infection of humans, with bats and other species presenting a possible, but yet undefined, risk. Direct and indirect contact of humans with dromedary camels were identified as the most risky types of contact, when compared to consumption of various camel products, with estimated "most likely" incidence risks of at least 22 and 13% for direct and indirect contact, respectively. The results of our study are consistent with available, yet very limited, published data regarding the potential pathways of transmission of MERS-CoV at the animal-human interface. These results identify key knowledge gaps and highlight the need for more comprehensive, yet focused research to be conducted to better understand transmission between dromedaries and humans.
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Affiliation(s)
| | | | - Eve Miguel
- Cirad, UPR AGIRs Research Unit, Montpellier, France; UMR MIVEGEC, IRD 224-CNRS 5290-UM, Montpellier, France
| | | | | | - Bernard Faye
- Cirad, UPR AGIRs Research Unit , Montpellier , France
| | - J S Malik Peiris
- HKU-Pasteur Research Pole, Hong Kong, China; School of Public Health, University of Hong Kong, Hong Kong, China
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19
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de Wit M, Funk AL, Moussally K, Nkuba DA, Siddiqui R, Bil K, Piriou E, Bart A, Bahizi Bizoza P, Bousema T. In vivo efficacy of artesunate-amodiaquine and artemether-lumefantrine for the treatment of uncomplicated falciparum malaria: an open-randomized, non-inferiority clinical trial in South Kivu, Democratic Republic of Congo. Malar J 2016; 15:455. [PMID: 27599612 PMCID: PMC5013565 DOI: 10.1186/s12936-016-1444-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background Between 2009 and 2012, malaria cases diagnosed in a Médecins sans Frontières programme have increased fivefold in Baraka, South Kivu, Democratic Republic of the Congo (DRC). The cause of this increase is not known. An in vivo drug efficacy trial was conducted to determine whether increased treatment failure rates may have contributed to the apparent increase in malaria diagnoses. Methods In an open-randomized non-inferiority trial, the efficacy of artesunate–amodiaquine (ASAQ) was compared to artemether–lumefantrine (AL) for the treatment of uncomplicated falciparum malaria in 288 children aged 6–59 months. Included children had directly supervised treatment and were then followed for 42 days with weekly clinical and parasitological evaluations. The blood samples of children found to have recurring parasitaemia within 42 days were checked by PCR to confirm whether or not this was due to reinfection or recrudescence (i.e. treatment failure). Results Out of 873 children screened, 585 (67 %) were excluded and 288 children were randomized to either ASAQ or AL. At day 42 of follow up, the treatment efficacy of ASAQ was 78 % before and 95 % after PCR correction for re-infections. In the AL-arm, treatment efficacy was 84 % before and 99.0 % after PCR correction. Treatment efficacy after PCR correction was within the margin of non-inferiority as set for this study. Fewer children in the AL arm reported adverse reactions. Conclusions ASAQ is still effective as a treatment for uncomplicated malaria in Baraka, South Kivu, DRC. In this region, AL may have higher efficacy but additional trials are required to draw this conclusion with confidence. The high re-infection rate in South-Kivu indicates intense malaria transmission. Trial registration NCT02741024 Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1444-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marit de Wit
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands.
| | - Anna L Funk
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Krystel Moussally
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - David Aksanti Nkuba
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Ruby Siddiqui
- Manson Unit, Médecins Sans Frontières (MSF), 10 Furnival Street, London, EC4A 1AB, UK
| | - Karla Bil
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Erwan Piriou
- Médecins sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Aldert Bart
- Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Patrick Bahizi Bizoza
- Programme National de lutte contre le Paludisme, Kinshasa, South Kivu, Democratic Republic of the Congo
| | - Teun Bousema
- London School of Hygiene and Tropical Medicine, London, UK.,Radboud university medical center, Nijmegen, The Netherlands
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Funk AL, Boisson S, Clasen T, Ensink JHJ. Comparison of Kato-Katz, ethyl-acetate sedimentation, and Midi Parasep® in the diagnosis of hookworm, Ascaris and Trichuris infections in the context of an evaluation of rural sanitation in India. Acta Trop 2013; 126:265-8. [PMID: 23467010 DOI: 10.1016/j.actatropica.2013.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/15/2013] [Accepted: 02/22/2013] [Indexed: 11/16/2022]
Abstract
The Kato-Katz, conventional ethyl-acetate sedimentation, and Midi Parasep(®) methods for diagnosing infection with soil-transmitted helminths were compared. The Kato-Katz technique gave the best overall diagnostic performance with the highest results in all measures (prevalence, faecal egg count, sensitivity) followed by the conventional ethyl-acetate and then the Midi Parasep(®) technique. The Kato-Katz technique showed a significantly higher faecal egg count and sensitivity for both hookworm and Trichuris as compared to the Midi Parasep(®) technique. The conventional ethyl-acetate technique produced smaller pellets and showed lower pellet mobility as compared to the Midi Parasep(®).
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Affiliation(s)
- Anna L Funk
- Environmental Health Group, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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