1
|
Tu WC, Jeacopello I, Blom A, Alfaro E, Shinkawa VAM, Hatchett DB, Sanchez JC, McManamen AM, Su X, Berthier E, Thongpang S, Wald ER, DeMuri GP, Theberge AB. Capture of Group A Streptococcus by Open-Microfluidic CandyCollect Device in Pediatric Patients. medRxiv 2024:2023.12.14.23299923. [PMID: 38168197 PMCID: PMC10760271 DOI: 10.1101/2023.12.14.23299923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Importance Obtaining high-quality samples to diagnose streptococcal pharyngitis in pediatric patients is challenging due to discomfort associated with traditional pharyngeal swabs. This may cause reluctance to go to the clinic, inaccurate diagnosis, or inappropriate treatment for children with sore throat. Objective Determine the efficacy of using CandyCollect, a lollipop-inspired open-microfluidic pathogen collection device, to capture Group A Streptococcus (GAS) and compare user preference for CandyCollect, conventional pharyngeal swabs, or mouth swabs among children with pharyngitis and their caregivers. Design Participants of this cohort study were recruited over a 7-month period in 2022 - 2023. Setting This study was conducted at an ambulatory care clinic that serves pediatric patients in the Madison, Wisconsin, metropolitan area. Participants Study participants were diagnosed with GAS pharyngitis using a traditional pharyngeal swab via rapid antigen detection test (RADT); those testing positive were approached or reached out to about participation in the study. A total of 74 caregiver/children dyads were contacted about the study: 23 declined to participate; 21 were not eligible; and 30 willing and eligible participants were admitted into the study. A caregiver provided verbal consent and parental permission, and all children provided verbal assent. Immediately after the standard of care visit in which the throat swab was obtained, a research nurse guided participants through collecting oral samples: CandyCollect device and mouth swab (ESwab TM ). CandyCollect and mouth swab samples were analyzed for GAS by quantitative polymerase chain reaction (qPCR) at the University of Washington. Exposure Detection of salivary GAS using qPCR analysis of samples obtained from CandyCollect devices and mouth swabs. Main Outcomes and Measures The proportion of pediatric patients with GAS pharyngitis, as determined by a positive pharyngeal swab tested via a RADT, who were also positive using a CandyCollect and mouth swab analyzed by qPCR. Results All child participants (30/30) were positive for GAS by qPCR on both the mouth swab and CandyCollect. Caregivers ranked CandyCollect as a good sampling method overall (27/30), and all caregivers (30/30) would recommend the CandyCollect for children 5 years and older. Twenty-three of 30 children "really like" the taste and 24/30 would prefer to use the CandyCollect if a future test was needed. All caregivers (30/30) and most children (28/30) would be willing to use the CandyCollect device at home. Conclusion and relevance All participants tested positive for GAS on all three collection methods (pharyngeal swab, mouth swab, and CandyCollect). While both caregivers and children like the CandyCollect device, some caregivers would prefer a shorter collection time. Future work includes additional studies with larger cohorts presenting with pharyngitis of unknown etiology and shortening collection time, while maintaining the attractive form of the device. Trial Registration Registry name: ClinicalTrials.gov ClinicalTrials.gov Identifier: NCT05175196 Weblink: https://classic.clinicaltrials.gov/ct2/show/NCT05175196. Key Points Question: In pediatric patients with Group A Streptococcus pharyngitis, how do test results and user experience compare across three sampling methods-CandyCollect devices, mouth swabs, and pharyngeal swabs?Findings: In this cohort study of 30 children, aged 5-14 years, saliva samples were collected with CandyCollect devices and mouth swabs and analyzed via qPCR. The results show CandyCollect, a pathogen collection tool preferred by children, had 100% concordance with the results from pharyngeal swabs positive with a rapid antigen detection test performed as part of their clinical care.Meaning: With further development and testing, the CandyCollect device may potentially become an alternative sampling tool for the diagnosis of streptococcal pharyngitis.
Collapse
|
2
|
Bochkov YA, Devries M, Tetreault K, Gangnon R, Lee S, Bacharier LB, Busse WW, Camargo CA, Choi T, Cohen R, De R, DeMuri GP, Fitzpatrick AM, Gergen PJ, Grindle K, Gruchalla R, Hartert T, Hasegawa K, Khurana Hershey GK, Holt P, Homil K, Jartti T, Kattan M, Kercsmar C, Kim H, Laing IA, Le Souëf PN, Liu AH, Mauger DT, Pappas T, Patel SJ, Phipatanakul W, Pongracic J, Seroogy C, Sly PD, Tisler C, Wald ER, Wood R, Lemanske RF, Jackson DJ, Gern JE. Rhinoviruses A and C elicit long-lasting antibody responses with limited cross-neutralization. J Med Virol 2023; 95:e29058. [PMID: 37638498 PMCID: PMC10484091 DOI: 10.1002/jmv.29058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Rhinoviruses (RVs) can cause severe wheezing illnesses in young children and patients with asthma. Vaccine development has been hampered by the multitude of RV types with little information about cross-neutralization. We previously showed that neutralizing antibody (nAb) responses to RV-C are detected twofold to threefold more often than those to RV-A throughout childhood. Based on those findings, we hypothesized that RV-C infections are more likely to induce either cross-neutralizing or longer-lasting antibody responses compared with RV-A infections. We pooled RV diagnostic data from multiple studies of children with respiratory illnesses and compared the expected versus observed frequencies of sequential infections with RV-A or RV-C types using log-linear regression models. We tested longitudinally collected plasma samples from children to compare the duration of RV-A versus RV-C nAb responses. Our models identified limited reciprocal cross-neutralizing relationships for RV-A (A12-A75, A12-A78, A20-A78, and A75-A78) and only one for RV-C (C2-C40). Serologic analysis using reference mouse sera and banked human plasma samples confirmed that C40 infections induced nAb responses with modest heterotypic activity against RV-C2. Mixed-effects regression modeling of longitudinal human plasma samples collected from ages 2 to 18 years demonstrated that RV-A and RV-C illnesses induced nAb responses of similar duration. These results indicate that both RV-A and RV-C nAb responses have only modest cross-reactivity that is limited to genetically similar types. Contrary to our initial hypothesis, RV-C species may include even fewer cross-neutralizing types than RV-A, whereas the duration of nAb responses during childhood is similar between the two species. The modest heterotypic responses suggest that RV vaccines must have a broad representation of prevalent types.
Collapse
Affiliation(s)
| | - Mark Devries
- University of Wisconsin-Madison, Madison, WI, United States
| | | | - Ronald Gangnon
- University of Wisconsin-Madison, Madison, WI, United States
| | - Sujin Lee
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Carlos A. Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Timothy Choi
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robyn Cohen
- Boston University, Boston, MA, United States
| | - Ramyani De
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter J. Gergen
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, United States
| | | | | | - Tina Hartert
- Vanderbilt University, Nashville, TN, United States
| | - Kohei Hasegawa
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Kiara Homil
- University of Turku and Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- University of Turku and Turku University Hospital, Turku, Finland
- PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Meyer Kattan
- Columbia University, New York, NY, United States
| | | | - Haejin Kim
- Henry Ford Health Systems, Detroit, MI, United States
| | | | | | - Andrew H. Liu
- Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Tressa Pappas
- University of Wisconsin-Madison, Madison, WI, United States
| | | | | | | | | | - Peter D. Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | | | - Ellen R. Wald
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robert Wood
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | - James E. Gern
- University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
3
|
Tu WC, McManamen AM, Su X, Jeacopello I, Takezawa MG, Hieber DL, Hassan GW, Lee UN, Anana EV, Locknane MP, Stephenson MW, Shinkawa VAM, Wald ER, DeMuri GP, Adams KN, Berthier E, Thongpang S, Theberge AB. At-Home Saliva Sampling in Healthy Adults Using CandyCollect, a Lollipop-Inspired Device. Anal Chem 2023; 95:10211-10220. [PMID: 37364037 DOI: 10.1021/acs.analchem.3c00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Respiratory infections are common in children, and there is a need for user-friendly collection methods. Here, we performed the first human subjects study using the CandyCollect device, a lollipop-inspired saliva collection device .We showed that the CandyCollect device can be used to collect salivary bacteria from healthy adults using Streptococcus mutans and Staphylococcus aureus as proof-of-concept commensal bacteria. We enrolled healthy adults in a nationwide (USA) remote study in which participants were sent study packages containing CandyCollect devices and traditional commercially available oral swabs and spit tubes. Participants sampled themselves at home, completed usability and user preference surveys, and mailed the samples back to our laboratory for analysis by qPCR. Our results showed that for participants in which a given bacterium (S. mutans or S. aureus) was detected in one or both of the commercially available methods (oral swab and/or spit tubes), CandyCollect devices had a 100% concordance with the positive result (n = 14 participants). Furthermore, the CandyCollect device was ranked the highest preference sampling method among the three sampling methods by 26 participants surveyed (combining survey results across two enrollment groups). We also showed that the CandyCollect device has a shelf life of up to 1 year at room temperature, a storage period that is convenient for clinics or patients to keep the CandyCollect device and use it any time. Taken together, we have demonstrated that the CandyCollect is a user-friendly saliva collection tool that has the potential to be incorporated into diagnostic assays in clinic visits and telemedicine.
Collapse
Affiliation(s)
- Wan-Chen Tu
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Anika M McManamen
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Xiaojing Su
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ingrid Jeacopello
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Meg G Takezawa
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Damielle L Hieber
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Grant W Hassan
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ulri N Lee
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Eden V Anana
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Mason P Locknane
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Molly W Stephenson
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Victoria A M Shinkawa
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, United States
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, United States
| | - Karen N Adams
- Institute of Translational Health Sciences, School of Medicine, University of Washington, Seattle, Washington 98109, United States
| | - Erwin Berthier
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Sanitta Thongpang
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom 73170, Thailand
| | - Ashleigh B Theberge
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
- Department of Urology, School of Medicine, University of Washington, Seattle, Washington 98195, United States
| |
Collapse
|
4
|
Gemmell M, Sherby MR, Walsh TJ, Kalb LG, Johnson SB, Coller RJ, DeMuri GP, Nuthals E, McBride J, Newland JG, Gurnett CA. Recommendations for SARS-CoV-2 Testing in Children With Disabilities and Medical Complexity. Pediatrics 2023; 152:e2022060352G. [PMID: 37394506 PMCID: PMC10312279 DOI: 10.1542/peds.2022-060352g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
Schools provide important services that cannot be provided virtually to children with medical complexity and children with intellectual and developmental disabilities, yet these children are among the most at risk from coronavirus disease 2019 (COVID-19). To keep schools open for children with medical complexity and/or intellectual and developmental disabilities during the COVID-19 pandemic, we implemented severe acute respiratory syndrome coronavirus 2 testing at 3 sites across the United States. We evaluated testing strategies for staff and students at each site, including specimen source (nasopharyngeal or saliva), test type (polymerase chain reaction or rapid antigen), and frequency and type (screening versus exposure/symptomatic) of testing provided. Among the greatest barriers to severe acute respiratory syndrome coronavirus 2 testing in these schools was the engagement of caregivers and challenges navigating legal guardianship for consenting adult students. Additionally, variability in testing strategies nationally and in the community, as well as surges in viral transmission across the United States during the course of the pandemic, led to testing hesitancy and variable participation rates. Essential to the successful implementation of testing programs is building a trusted relationship with school administrators and guardians. Leveraging our experiences with COVID-19 and forming lasting school partnerships can help keep schools for vulnerable children safe in future pandemics.
Collapse
Affiliation(s)
| | | | | | - Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erin Nuthals
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Joseph McBride
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | |
Collapse
|
5
|
Uthappa DM, Mann TK, Goldman JL, Schuster JE, Newland JG, Anderson WB, Dozier A, Inkelas M, Foxe JJ, Gwynn L, Gurnett CA, McDaniels-Davidson C, Walsh T, Watterson T, Holden-Wiltse J, Potts JM, D’Agostino EM, Zandi K, Corbett A, Spallina S, DeMuri GP, Wu YP, Pulgaron ER, Kiene SM, Oren E, Allison-Burbank JD, Okihiro M, Lee RE, Johnson SB, Stump TK, Coller RJ, Mast DK, Haroz EE, Kemp S, Benjamin DK, Zimmerman KO. Common Data Element Collection in Underserved School Communities: Challenges and Recommendations. Pediatrics 2023; 152:e2022060352N. [PMID: 37394503 PMCID: PMC10312277 DOI: 10.1542/peds.2022-060352n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
Collapse
Affiliation(s)
- Diya M. Uthappa
- Duke University School of Medicine, Doctor of Medicine Program
| | - Tara K. Mann
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | - Moira Inkelas
- Department of Health Policy and Management, UCLA Fielding School of Public Health UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - John J. Foxe
- The Del Monte Institute for Neuroscience and The Department of Neuroscience, University of Rochester School of Medicine, Rochester, New York
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tyler Walsh
- Department of Pediatrics, Division of Infectious Diseases
| | | | | | | | | | | | | | | | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yelena P. Wu
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, California
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, California
| | | | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, Hawaii
| | - Rebecca E. Lee
- Edson College of Nursing & Health Innovation, Center for Health Promotion and Disease Prevention, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, Arizona
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tammy K. Stump
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Emily E. Haroz
- Department of International Health & Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven Kemp
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| |
Collapse
|
6
|
Coller RJ, Kelly MM, Eickhoff J, Johnson SB, Zhao Q, Warner G, Katz B, Butteris SM, Ehlenbach ML, Koval S, Howell KD, DeMuri GP. School Attendance Decisions for Children With Medical Complexity During COVID-19. Pediatrics 2023; 152:e2022060352K. [PMID: 37394510 PMCID: PMC10312281 DOI: 10.1542/peds.2022-060352k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE School attendance by children with medical complexity (CMC) may be influenced by parent perceptions of their child's risk for coronavirus disease 2019 (COVID-19). The authors of this study aimed to quantify in-person school attendance and identify attendance predictors. METHODS From June to August 2021, surveys were collected from English- and Spanish-speaking parents of children aged 5 to 17 years with ≥1 complex chronic condition who received care at an academic tertiary children's hospital in the Midwestern United States and who attended school prepandemic. The outcome, in-person attendance, was defined dichotomously as any in-person attendance versus none. We evaluated parent-perceived school attendance benefits, barriers, motivation, and cues, COVID-19 severity and susceptibility using survey items derived from the health belief model (HBM). Latent HBM constructs were estimated with exploratory factor analysis. Associations between the outcome and the HBM were evaluated with multivariable logistic regression and structural equation models. RESULTS Among 1330 families (response rate 45%), 19% of CMC were not attending in-person school. Few demographic and clinical variables predicted school attendance. In adjusted models, family-perceived barriers, motivation, and cues predicted in-person attendance, whereas benefits, susceptibility, and severity did not. The predicted probability (95% confidence interval) of attendance ranged from 80% (70% to 87%) for high perceived barriers to 99% (95% to 99%) for low perceived barriers. Younger age (P <.01) and previous COVID-19 infection (P = .02) also predicted school attendance. CONCLUSIONS Overall, 1 in 5 CMC did not attend school at the end of the 2020 to 2021 academic year. Family perceptions of schools' mitigation policies and encouragement of attendance may be promising avenues to address this disparity.
Collapse
Affiliation(s)
| | | | - Jens Eickhoff
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Qianqian Zhao
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Shawn Koval
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
| | | | | |
Collapse
|
7
|
Goldman JL, Kalu IC, Schuster JE, Erickson T, Mast DK, Zimmerman K, Benjamin DK, Kalb LG, Gurnett C, Newland JG, Sherby M, Godambe M, Shinde N, Watterson T, Walsh T, Foxe J, Zand M, Dewhurst S, Coller R, DeMuri GP, Archuleta S, Ko LK, Inkelas M, Manuel V, Lee R, Oh H, Murugan V, Kramer J, Okihiro M, Gwynn L, Pulgaron E, McCulloh R, Broadhurst J, McDaniels-Davidson C, Kiene S, Oren E, Wu Y, Wetter DW, Stump T, Brookhart MA, Fist A, Haroz E. Building School-Academic Partnerships to Implement COVID-19 Testing in Underserved Populations. Pediatrics 2023; 152:e2022060352C. [PMID: 37394512 PMCID: PMC10312280 DOI: 10.1542/peds.2022-060352c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE In April 2021, the US government made substantial investments in students' safe return to school by providing resources for school-based coronavirus disease 2019 (COVID-19) mitigation strategies, including COVID-19 diagnostic testing. However, testing uptake and access among vulnerable children and children with medical complexities remained unclear. METHODS The Rapid Acceleration of Diagnostics Underserved Populations program was established by the National Institutes of Health to implement and evaluate COVID-19 testing programs in underserved populations. Researchers partnered with schools to implement COVID-19 testing programs. The authors of this study evaluated COVID-19 testing program implementation and enrollment and sought to determine key implementation strategies. A modified Nominal Group Technique was used to survey program leads to identify and rank testing strategies to provide a consensus of high-priority strategies for infectious disease testing in schools for vulnerable children and children with medical complexities. RESULTS Among the 11 programs responding to the survey, 4 (36%) included prekindergarten and early care education, 8 (73%) worked with socioeconomically disadvantaged populations, and 4 focused on children with developmental disabilities. A total of 81 916 COVID-19 tests were performed. "Adapting testing strategies to meet the needs, preferences, and changing guidelines," "holding regular meetings with school leadership and staff," and "assessing and responding to community needs" were identified as key implementation strategies by program leads. CONCLUSIONS School-academic partnerships helped provide COVID-19 testing in vulnerable children and children with medical complexities using approaches that met the needs of these populations. Additional work is needed to develop best practices for in-school infectious disease testing in all children.
Collapse
Affiliation(s)
- Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ibukunoluwa C. Kalu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Tyler Erickson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Kanecia Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Luther G. Kalb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina Gurnett
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jason G. Newland
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Sherby
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Maya Godambe
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nidhi Shinde
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Treymayne Watterson
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler Walsh
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - John Foxe
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Martin Zand
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Stephen Dewhurst
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Ryan Coller
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Gregory P. DeMuri
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Shannon Archuleta
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Linda K. Ko
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - Moira Inkelas
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Vladimir Manuel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | | | - Hyunsung Oh
- Center for Personalized Diagnostics, ASU Biodesign Clinical Testing Laboratory, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Vel Murugan
- Division of Primary, Complex, and Adolescent Medicine, Phoenix Children’s Hospital, Phoenix, Arizona
| | | | - May Okihiro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lisa Gwynn
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Russell McCulloh
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Jana Broadhurst
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | | | - Susan Kiene
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Eyal Oren
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - David W. Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tammy Stump
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Alex Fist
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Emily Haroz
- Johns Hopkins Center for Indigenous Health, Baltimore, Maryland
| |
Collapse
|
8
|
Tu WC, McManamen AM, Su X, Jeacopello I, Takezawa MG, Hieber DL, Hassan GW, Lee UN, Anana EV, Locknane MP, Stephenson MW, Shinkawa VAM, Wald ER, DeMuri GP, Adams K, Berthier E, Thongpang S, Theberge AB. At-home saliva sampling in healthy adults using CandyCollect, a lollipop-inspired device. bioRxiv 2023:2023.01.14.524039. [PMID: 36711895 PMCID: PMC9882111 DOI: 10.1101/2023.01.14.524039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Respiratory infections are common in children, and there is a need for user-friendly collection methods. Here, we performed the first human subjects study using the CandyCollect device, a lollipop inspired saliva collection device. 1 We showed the CandyCollect device can be used to collect salivary bacteria from healthy adults using Streptococcus mutans and Staphylococcus aureus as proof-of-concept commensal bacteria. We enrolled healthy adults in a nationwide (USA) remote study in which participants were sent study packages containing CandyCollect devices and traditional commercially available oral swabs and spit tubes. Participants sampled themselves at home, completed usability and user preference surveys, and mailed the samples back to our laboratory for analysis by qPCR. Our results showed that for participants in which a given bacterium ( S. mutans or S. aureus ) was detected in one or both of the commercially available methods (oral swab and/or spit tubes), CandyCollect devices had a 100% concordance with the positive result (n=14 participants). Furthermore, the CandyCollect device was ranked the highest preference sampling method among the three sampling methods by 26 participants surveyed (combining survey results across two enrollment groups). We also showed that the CandyCollect device has a shelf life of up to 1 year at room temperature, a storage period that is convenient for clinics or patients to keep the CandyCollect device and use it any time. Taken together, we have demonstrated that the CandyCollect is a user-friendly saliva collection tool that has the potential to be incorporated into diagnostic assays in clinic visits and telemedicine. For Table of Contents Only
Collapse
|
9
|
Schmit KM, DeMuri GP, Eickhoff JC, Bochkov Y, Gern JE, Wald ER. Genotypic Diversity of Childhood Rhinovirus Infections. J Pediatric Infect Dis Soc 2023; 12:239-241. [PMID: 37013688 PMCID: PMC10146928 DOI: 10.1093/jpids/piad018] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 04/05/2023]
Abstract
Our objective was to describe the distribution of rhinovirus (RV) by species and type in both symptomatic and asymptomatic children in a prospective study over multiple years. A large and diverse distribution of RV types was seen among children with and without symptoms. RV-A and RV-C were predominant at all visits.
Collapse
Affiliation(s)
- Kathryn M Schmit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yury Bochkov
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
10
|
Coller RJ, Kelly MM, Howell KD, Warner G, Butteris SM, Ehlenbach ML, Werner N, Katz B, McBride JA, Kieren M, Koval S, DeMuri GP. In-Home COVID-19 Testing for Children With Medical Complexity: Feasibility and Association With School Attendance and Safety Perceptions. Am J Public Health 2022; 112:S878-S882. [PMID: 36108256 PMCID: PMC9707728 DOI: 10.2105/ajph.2022.306971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 01/29/2023]
Abstract
The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen COVID-19 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. (Am J Public Health. 2022;112(S9):S878-S882. https://doi.org/10.2105/AJPH.2022.306971).
Collapse
Affiliation(s)
- Ryan J Coller
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Michelle M Kelly
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Kristina Devi Howell
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gemma Warner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Sabrina M Butteris
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Mary L Ehlenbach
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Nicole Werner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Barbara Katz
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Joseph A McBride
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Madeline Kieren
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Shawn Koval
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gregory P DeMuri
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| |
Collapse
|
11
|
Lee UN, Su X, Hieber DL, Tu WC, McManamen AM, Takezawa MG, Hassan GW, Chan TC, Adams KN, Wald ER, DeMuri GP, Berthier E, Theberge AB, Thongpang S. CandyCollect: at-home saliva sampling for capture of respiratory pathogens. Lab Chip 2022; 22:3555-3564. [PMID: 35983761 PMCID: PMC9931141 DOI: 10.1039/d1lc01132d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Streptococcus pyogenes is a major human-specific bacterial pathogen and a common cause of a wide range of symptoms from mild infection such as pharyngitis (commonly called strep throat) to life-threatening invasive infection and post-infectious sequelae. Traditional methods for diagnosis include collecting a sample using a pharyngeal swab, which can cause discomfort and even discourage adults and children from seeking proper testing and treatment in the clinic. Saliva samples are an alternative to pharyngeal swabs. To improve the testing experience for strep throat, we developed a novel lollipop-inspired sampling platform (called CandyCollect) to capture bacteria in saliva. The device can be used in clinics or in the home and shipped back to a lab for analysis, integrating with telemedicine. CandyCollect is designed to capture bacteria on an oxygen plasma treated polystyrene surface embedded with flavoring substances to enhance the experience for children and inform the required time to complete the sampling process. In addition, the open channel structure prevents the tongue from scraping and removing the captured bacteria. The flavoring substances did not affect bacterial capture and the device has a shelf life of at least 2 months (with experiments ongoing to extend the shelf life). We performed a usability study with 17 participants who provided feedback on the device design and the dissolving time of the candy. This technology and advanced processing techniques, including polymerase chain reaction (PCR), will enable user-friendly and effective diagnosis of streptococcal pharyngitis.
Collapse
Affiliation(s)
- Ulri N Lee
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Xiaojing Su
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Damielle L Hieber
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Wan-Chen Tu
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Anika M McManamen
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Meg G Takezawa
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Grant W Hassan
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Tung Ching Chan
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Karen N Adams
- Institute of Translational Health Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erwin Berthier
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Ashleigh B Theberge
- Department of Chemistry, University of Washington, Seattle, WA, USA.
- Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sanitta Thongpang
- Department of Chemistry, University of Washington, Seattle, WA, USA.
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom, Thailand
| |
Collapse
|
12
|
Howell KD, Kelly MM, DeMuri GP, McBride JA, Katz B, Edmonson MB, Sklansky DJ, Shadman KA, Ehlenbach ML, Butteris SM, Warner G, Zhao Q, Coller RJ. COVID-19 Vaccination Intentions for Children With Medical Complexity. Hosp Pediatr 2022; 12:e295-e302. [PMID: 36039687 PMCID: PMC10039457 DOI: 10.1542/hpeds.2022-006544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The chronic conditions and functional limitations experienced by children with medical complexity (CMC) place them at disproportionate risk for COVID-19 transmission and poor outcomes. To promote robust vaccination uptake, specific constructs associated with vaccine hesitancy must be understood. Our objective was to describe demographic, clinical, and vaccine perception variables associated with CMC parents' intention to vaccinate their child against COVID-19. METHODS We conducted a cross-sectional survey (June-August 2021) for primary caregivers of CMC between ages 5 to 17 at an academic medical center in the Midwest. Multivariable logistic regression examined associations between vaccination intent and selected covariates. RESULTS Among 1330 families, 65.8% indicated vaccination intent. In multivariable models, demographics had minimal associations with vaccination intent; however, parents of younger children (<12 years) had significantly lower adjusted odds of vaccination intent (adjusted odds ratio [95% confidence interval]: 0.26 [0.17-0.3]) compared to parents of older children (≥12 years). CMC with higher severity of illness, ie, those with ≥1 hospitalization in the previous year (versus none) or >1 complex chronic condition (vs 1), had higher adjusted odds of vaccination intent (1.82 [1.14-2.92] and 1.77 [1.16-2.71], respectively). Vaccine perceptions associated with vaccine intention included "My doctor told me to get my child a COVID-19 vaccine" (2.82 [1.74-4.55]); and "I'm concerned about my child's side effects from the vaccine" (0.18 [0.12-0.26]). CONCLUSIONS One-third of CMC families expressed vaccine hesitation; however, constructs strongly associated with vaccination intent are potentially modifiable. Pediatrician endorsement of COVID-19 vaccination and careful counseling on side effects might be promising strategies to encourage uptake.
Collapse
Affiliation(s)
- Kristina Devi Howell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joseph A. McBride
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - M. Bruce Edmonson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel J. Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristin A. Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
13
|
Barton HJ, Werner NE, Morgen M, DeMuri GP, Kelly MM, Wald ER, Warner G, Katz B, Coller RJ. Task Analysis of In-Home SARS-CoV-2 Rapid Antigen Testing by Families. Pediatrics 2022; 150:188098. [PMID: 35610754 PMCID: PMC9677708 DOI: 10.1542/peds.2022-056681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | | | | | | | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin-Madison
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin-Madison
| |
Collapse
|
14
|
Boutzoukas AE, Zimmerman KO, Inkelas M, Brookhart MA, Benjamin DK, Butteris S, Koval S, DeMuri GP, Manuel VG, Smith MJ, McGann KA, Kalu IC, Weber DJ, Falk A, Shane AL, Schuster JE, Goldman JL, Hickerson J, Benjamin V, Edwards L, Erickson TR, Benjamin DK. School Masking Policies and Secondary SARS-CoV-2 Transmission. Pediatrics 2022; 149:e2022056687. [PMID: 35260896 PMCID: PMC9647584 DOI: 10.1542/peds.2022-056687] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Throughout the COVID-19 pandemic, masking has been a widely used mitigation practice in kindergarten through 12th grade (K-12) school districts to limit within-school transmission. Prior studies attempting to quantify the impact of masking have assessed total cases within schools; however, the metric that more optimally defines effectiveness of mitigation practices is within-school transmission, or secondary cases. We estimated the impact of various masking practices on secondary transmission in a cohort of K-12 schools. METHODS We performed a multistate, prospective, observational, open cohort study from July 26, 2021 to December 13, 2021. Districts reported mitigation practices and weekly infection data. Districts that were able to perform contact tracing and adjudicate primary and secondary infections were eligible for inclusion. To estimate the impact of masking on secondary transmission, we used a quasi-Poisson regression model. RESULTS A total of 1 112 899 students and 157 069 staff attended 61 K-12 districts across 9 states that met inclusion criteria. The districts reported 40 601 primary and 3085 secondary infections. Six districts had optional masking policies, 9 had partial masking policies, and 46 had universal masking. In unadjusted analysis, districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts; and for every 100 community-acquired cases, universally masked districts had 7.3 predicted secondary infections, whereas optionally masked districts had 26.4. CONCLUSIONS Secondary transmission across the cohort was modest (<10% of total infections) and universal masking was associated with reduced secondary transmission compared with optional masking.
Collapse
Affiliation(s)
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | - Moira Inkelas
- Fielding School of Public Health
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
| | - M. Alan Brookhart
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Sabrina Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Shawn Koval
- University of Wisconsin Health, Healthy Kids Collaborative, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Vladimir G. Manuel
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
- University of California David Geffen School of Medicine, Los Angeles, California
| | | | | | | | - David J. Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Falk
- Department of Pediatrics, Aspirus Doctors Clinic, Wisconsin Rapids, Wisconsin
| | - Andi L. Shane
- Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | | | | | | | | | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| |
Collapse
|
15
|
Kelly MM, DeMuri GP, Barton HJ, Nacht CL, Butteris SM, Katz B, Burns R, Koval S, Ehlenbach ML, Stanley J, Wald ER, Warner G, Wilson LF, Myrah GE, Parker DE, Coller RJ. Priorities for Safer In-Person School for Children With Medical Complexity During COVID-19. Pediatrics 2022; 149:184886. [PMID: 35199167 PMCID: PMC9647557 DOI: 10.1542/peds.2021-054434] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method. METHODS We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when…" Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities. RESULTS From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school. CONCLUSIONS Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.
Collapse
Affiliation(s)
- Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,Address correspondence to Michelle M. Kelly, MD, MS Department of Pediatrics, University of Wisconsin, H4/419 CSC, 600 Highland Ave., Madison, WI 53792. E-mail:
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L. Nacht
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rebecca Burns
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Shawn Koval
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julia Stanley
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Gary E. Myrah
- Wisconsin Council of Administrators and Special Services, Wisconsin
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
16
|
Boutzoukas AE, Zimmerman KO, Benjamin DK, DeMuri GP, Kalu IC, Smith MJ, McGann KA, Koval S, Brookhart MA, Butteris SM. Secondary Transmission of COVID-19 in K-12 Schools: Findings From 2 States. Pediatrics 2022; 149:e2021054268K. [PMID: 34737171 PMCID: PMC9647774 DOI: 10.1542/peds.2021-054268k] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES We evaluated the impact of distancing practices on secondary transmission of severe acute respiratory syndrome coronavirus 2 and the degree of sports-associated secondary transmission across a large diverse cohort of schools during spring 2021. METHODS Participating districts in North Carolina and Wisconsin and North Carolina charter schools offering in-person instruction between March 15, 2021 and June 25, 2021 reported on distancing policies, community- and school-acquired infections, quarantines, and infections associated with school-sponsored sports. We calculated the ratio of school-acquired to community-acquired infection, secondary attack rates, and the proportion of secondary transmission events associated with sports. To estimate the effect of distancing and bus practices on student secondary transmission, we used a quasi-Poisson regression model with the number of primary student cases as the denominator. RESULTS During the study period, 1 102 039 students and staff attended in-person instruction in 100 North Carolina school districts, 13 Wisconsin school districts, and 14 North Carolina charter schools. Students and staff had 7865 primary infections, 386 secondary infections, and 48 313 quarantines. For every 20 community-acquired infections, there was 1 within-school transmission event. Secondary transmissions associated with school sports composed 46% of secondary transmission events in middle and high schools. Relaxed distancing practices (<3 ft, 3 ft) and increased children per bus seat were not associated with increased relative risk of secondary transmission. CONCLUSIONS With universal masking, in-person education was associated with low rates of secondary transmission, even with less stringent distancing and bus practices. Given the rates of sports-associated secondary transmission, additional mitigation may be warranted.
Collapse
Affiliation(s)
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | - Gregory P. DeMuri
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | | | | | | | - Shawn Koval
- Healthy Kids Collaborative, University of Wisconsin Health, Madison, Wisconsin
| | - M. Alan Brookhart
- Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Sabrina M. Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| |
Collapse
|
17
|
Goldman JL, Schuster JE, Maier VF, Anand R, Hill EE, Butteris SM, DeMuri GP, Omidfar SA, Brookhart MA, Pak J, Benjamin DK, Zimmerman KO. Urban Classification, Not COVID-19 Community Rates, Was Associated With Modes of Learning in US K-12 Schools? Pediatrics 2022; 149:e2021054268M. [PMID: 34737176 PMCID: PMC9647778 DOI: 10.1542/peds.2021-054268m] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To identify factors associated with the decision to provide in-person, hybrid, and remote learning in kindergarten through 12th grade school districts during the 2020-2021 school year. METHODS We performed a retrospective study evaluating school district mode of learning and community coronavirus 2019 (COVID-19) incidence and percentage positivity rates at 3 time points during the pandemic: (1) September 15, 2020 (the beginning of the school year, before Centers for Disease Control and Prevention guidance); (2) November 15, 2020 (midsemester after the release of Centers for Disease Control and Prevention guidance and an increase of COVID-19 cases); and (3) January 15, 2021 (start of the second semester and peak COVID-19 rates). Five states were included in the analysis: Michigan, Missouri, North Carolina, Ohio, and Wisconsin. The primary outcome was mode of learning in elementary, middle, and high schools during 3 time points. The measures included community COVID-19 incidence and percentage positivity rates, school and student demographics, and county size classification of school location. RESULTS No relationship between mode of learning and community COVID-19 rates was observed. County urban classification of school location was associated with mode of learning with school districts in nonmetropolitan and small metropolitan counties more likely to be in-person. CONCLUSIONS Community COVID-19 rates did not appear to influence the decision of when to provide in-person learning. Further understanding of factors driving the decisions to bring children back into the classroom are needed. Standardizing policies on how schools apply national guidance to local decision-making may decrease disparities in emergent crises.
Collapse
Affiliation(s)
- Jennifer L. Goldman
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri– Kansas City
| | - Jennifer E. Schuster
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri– Kansas City
| | | | - Rohit Anand
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Elizabeth E. Hill
- Department of Pediatrics, University of Michigan Health, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Joyce Pak
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel K. Benjamin
- School of Medicine
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- The ABC Science Collaborative
| | - Kanecia O. Zimmerman
- School of Medicine
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- The ABC Science Collaborative
| |
Collapse
|
18
|
Sherby MR, Kalb LG, Coller RJ, DeMuri GP, Butteris S, Foxe JJ, Zand MS, Freedman EG, Dewhurst S, Newland JG, Gurnett CA. Supporting COVID-19 School Safety for Children With Disabilities and Medical Complexity. Pediatrics 2022; 149:e2021054268H. [PMID: 34737172 PMCID: PMC8926067 DOI: 10.1542/peds.2021-054268h] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Children with intellectual and developmental disabilities (IDDs) and children with medical complexity (CMC) have been disproportionally impacted by the coronavirus disease 2019 pandemic, including school closures. Children with IDDs and CMC rely on schools for a vast array of educational, therapeutic, medical, and social needs. However, maintaining safe schools for children with IDDs and CMC during the coronavirus disease 2019 pandemic may be difficult because of the unique challenges of implementing prevention strategies, such as masking, social distancing, and hand hygiene in this high-risk environment. Furthermore, children with IDDs and CMC are at a higher risk of infectious complications and mortality, underscoring the need for effective mitigation strategies. The goal of this report is to describe the implementation of several screening testing models for severe acute respiratory syndrome coronavirus 2 in this high-risk population. By describing these models, we hope to identify generalizable and scalable approaches to facilitate safe school operations for children with IDDs and CMC during the current and future pandemics.
Collapse
Affiliation(s)
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - John J. Foxe
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Martin S. Zand
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Edward G. Freedman
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Stephen Dewhurst
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | | | | |
Collapse
|
19
|
Zimmerman KO, Goldman JL, Schuster JE, Mena A, Quiriconi M, Butteris SM, Koval S, DeMuri GP, Mueller NB, Benjamin DK, Armstrong SC, Kalu IC, Boutzoukas A, Moorthy GS, Lane H, Weber DJ, Newland JG. Building a National Framework to Pair Scientists and Schools During a Global Pandemic. Pediatrics 2022; 149:e2021054268D. [PMID: 34737179 PMCID: PMC9647736 DOI: 10.1542/peds.2021-054268d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic forced the suspension of in-person education in schools serving students in kindergarten through 12th grade (K-12) across the United States. As time passed, teachers, students, and parents struggled with remote education. With limited guidance at the federal level, physicians and school leaders across the country collaborated to develop local solutions for schools. This article describes the lessons learned from the development of 4 academic-community partnerships and collaboration among these partnerships to provide national leadership on managing COVID-19 mitigation in the K-12 environment. In addition, we describe a pathway forward for using academic-community partnerships to improve child health.
Collapse
Affiliation(s)
- Kanecia O. Zimmerman
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Jennifer L. Goldman
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Atenas Mena
- Children’s Mercy Kansas City, Kansas City, Missouri
| | | | - Sabrina M. Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Shawn Koval
- Healthy Kids Collaborative, University of Wisconsin Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Nancy B. Mueller
- Brown School Evaluation Center, Washington University in St Louis, St Louis, Missouri
| | - Daniel K. Benjamin
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Sarah C. Armstrong
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Ibukunoluwa C. Kalu
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | - Angelique Boutzoukas
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | | | - Hannah Lane
- Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - David J. Weber
- Departments of Internal Medicine and Pediatrics, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Jason G. Newland
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
20
|
DeMuri GP, Lehtoranta LM, Eickhoff JC, Lehtinen MJ, Wald ER. Ex vivo peripheral blood mononuclear cell response to R848 in children after supplementation with the probiotic Lactobacillus acidophilus NCFM/ Bifidobacterium lactis Bi-07. Benef Microbes 2021; 12:85-93. [PMID: 33550937 DOI: 10.3920/bm2020.0068] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Several studies have demonstrated a decrease in upper respiratory infection (URI) frequency and severity in subjects taking probiotic supplements. We hypothesised beneficial effects of probiotics on viral URI in children are due to modulation of inflammatory innate immune responses. We tested this hypothesis, providing children with a probiotic combination of Lactobacillus acidophilus/Bidfidobacterium animalis ssp. lactis Bi-07 (NCFM/Bi-07) and measuring levels of cytokines in response to stimulation of peripheral blood mononuclear cells (PBMCs) to toll-like receptor (TLR) 7/8 agonist resiquimod (R848). In this open label study, 21 (2 dropouts) children received probiotic containing 5×109 cfu each of NCFM/(Bi-07) daily for 30 days. Whole blood was taken from each subject at study entry and 30 days for culture of PBMCs. PBMCs stimulated with resiquimod (R848) or unstimulated were incubated and a panel of immune markers was measured. There was a significant decrease in the net (stimulated-null) level of myeloid progenitor inhibitory factor 1 (MPIF-1) (mean decrease 0.1 ng/ml, 95% confidence interval 0.01-0.24, P=0.032) following probiotic supplementation. The change in immune marker levels after supplementation, when analysed together with respect to expected inflammatory/anti-inflammatory effects, was increased for interleukin (IL)-10 and decreased for MPIF-1, IL-8, interferon gamma induced protein 10, macrophage inflammatory protein 3 alpha (MIP-3α) and E-selectin (P=0.01). Adverse events were mild. In conclusion, supplementation with this probiotic combination was safe and resulted in significant modulation of PBMC limited immune response to TLR7/8 agonist R848 and in levels of MPIF-1 and MIP-3α. The anti-inflammatory effect may be one mechanism by which probiotics modulate the immune system however further study is needed.
Collapse
Affiliation(s)
- G P DeMuri
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
| | - L M Lehtoranta
- DuPont Nutrition and Biosciences, Danisco Sweeteners Oy, Sokeritehtaantie 20, Kantvik 02460, Finland
| | - J C Eickhoff
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
| | - M J Lehtinen
- DuPont Nutrition and Biosciences, Danisco Sweeteners Oy, Sokeritehtaantie 20, Kantvik 02460, Finland
| | - E R Wald
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
| |
Collapse
|
21
|
DeMuri GP, Eickhoff JC, Gern JC, Wald ER. Clinical and Virological Characteristics of Acute Sinusitis in Children. Clin Infect Dis 2020; 69:1764-1770. [PMID: 30649261 PMCID: PMC7108184 DOI: 10.1093/cid/ciz023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/11/2018] [Accepted: 01/11/2019] [Indexed: 11/14/2022] Open
Abstract
Background Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain uncomplicated and those that precede an episode of sinusitis. We hypothesize that certain viruses are more likely to lead to acute sinusitis, and we compare viruses identified at the time of diagnosis of sinusitis with those identified early in the URI. Methods Children aged 48–96 months were followed longitudinally for 1 year. Nasal samples were obtained at surveillance visits, on Day 3–4 of the URI, and on Day 10, when sinusitis was diagnosed. Molecular diagnostic testing was performed on nasal washes for common respiratory viruses and pathogenic bacteria. A standardized score was used to quantify symptom severity. Results We evaluated 519 URIs, and 37 illnesses in 31 patients met the criteria for sinusitis. Respiratory syncytial virus was detected more frequently in URI visits that led to sinusitis, compared to in uncomplicated URIs (10.8% vs 3.4%; P = .05). New viruses were detected in 29% of sinusitis episodes, and their pattern was different than those patterns observed at surveillance. The median number of URIs per subject per year was 1 (range 0–9) in uncomplicated URI subjects and 3 (range 1–9) in sinusitis subjects (P < .001). Conclusions Children who developed sinusitis experienced more frequent URIs, compared to children whose URIs remained uncomplicated. When nasal samples were obtained on the day of diagnosis of acute sinusitis, nearly 30% of children had a new virus identified, suggesting that some children deemed to have sinusitis were experiencing sequential viral infections.
Collapse
Affiliation(s)
- Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - James C Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
22
|
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:1611-1615. [PMID: 31506700 DOI: 10.1093/cid/ciz021] [Citation(s) in RCA: 372] [Impact Index Per Article: 93.0] [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: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 11/14/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
Collapse
Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalpana Gupta
- Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts
| | | | - Richard Colgan
- Department of Family and Community Medicine, University of Maryland, Baltimore
| | - Gregory P DeMuri
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Dimitri Drekonja
- Division of Infectious Diseases, University of Minnesota, Minneapolis
| | - Linda O Eckert
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Béla Köves
- Department of Urology, South Pest Teaching Hospital, Budapest, Hungary
| | - Thomas M Hooton
- Division of Infectious Diseases, University of Miami, Florida
| | | | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Sanjay Saint
- Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor
| | | | - Barbara Trautner
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bjorn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund University, Sweden
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
23
|
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:e83-e110. [PMID: 30895288 DOI: 10.1093/cid/ciy1121] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [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: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
Collapse
Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalpana Gupta
- Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts
| | | | - Richard Colgan
- Department of Family and Community Medicine, University of Maryland, Baltimore
| | - Gregory P DeMuri
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Dimitri Drekonja
- Division of Infectious Diseases, University of Minnesota, Minneapolis
| | - Linda O Eckert
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Béla Köves
- Department of Urology, South Pest Teaching Hospital, Budapest, Hungary
| | - Thomas M Hooton
- Division of Infectious Diseases, University of Miami, Florida
| | | | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Sanjay Saint
- Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor
| | | | - Barbara Trautner
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bjorn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund, Sweden
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
24
|
DeMuri GP, Gern JE, Eickhoff JC, Lynch SV, Wald ER. Dynamics of Bacterial Colonization With Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis During Symptomatic and Asymptomatic Viral Upper Respiratory Tract Infection. Clin Infect Dis 2019; 66:1045-1053. [PMID: 29121208 PMCID: PMC6019034 DOI: 10.1093/cid/cix941] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background Virus is detected in about 80% of upper respiratory tract infections (URTIs) in children and is also detectable in the nasopharynx of 30% of asymptomatic children. The effect of asymptomatic viral infection on the dynamics of bacterial density and colonization of the nasopharynx has not been reported. The current study was performed to assess the presence and density of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the nasopharynx of 4–7-year-old children during URTI and when well. Methods Nasal samples were obtained during 4 surveillance periods when children were asymptomatic and whenever they had symptoms of URTI. Respiratory viruses and bacterial pathogens were identified and quantified using polymerase chain reaction. Results The proportion of children colonized with all 3 bacteria was higher during visits for acute URTI than during asymptomatic surveillance visits. Mean bacterial densities were significantly higher at all visits for all 3 pathogens when a virus was detected. The differences between the means were 1.0, 0.4, and 0.7 log10 colony-forming unit equivalents per milliliter for S. pneumoniae, H. influenzae, and M. catarrhalis, respectively, compared with visits in which virus was not detected. The percentage of children colonized and density were also higher at asymptomatic visits in which virus was detected than at visits in which virus was not detected. Conclusion The density and frequency of colonization with S. pneumoniae, H. influenzae, and M. catarrhalis in nasal wash samples increase during periods of both symptomatic and asymptomatic viral infection. Increases in bacterial colonization observed during asymptomatic viral infection were nearly the same magnitude as when children were symptomatic.
Collapse
Affiliation(s)
- Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Susan V Lynch
- Department of Medicine, University of California, San Francisco
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
25
|
DeMuri GP, Wald ER. 2179. Detection of Group A Streptococcus in the Saliva of Children Presenting With Pharyngitis Using the cobas®LIAT® PCR System. Open Forum Infect Dis 2019. [PMCID: PMC6809875 DOI: 10.1093/ofid/ofz360.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background CLIA waived polymerase chain reaction (PCR) has recently become available as a point of care test for Group A Streptococci (GAS) in individuals presenting with pharyngitis, enabling rapid and accurate diagnosis. However, swabbing the pharynx results in discomfort and is often dreaded by young children which may result in poor quality sampling. Objective In order to assess the viability of saliva as a sample specimen for GAS, this study compared saliva samples with pharynx swabs of children with sore throat, using swabs inoculated by children sucking on them as they would a lollipop in the context of newly available very sensitive techniques. Methods We enrolled children ages 5–15 years presenting with sore throat and known to have a positive rapid streptococcal antigen detection test (RADT) performed on a posterior pharyngeal swab, at the discretion of the primary care provider. The RADT used was the SureVue® (Fisher Scientific) system. A second swab was obtained by having the child suck on the swab in the anterior mouth for 30 seconds and a third swab was obtained from the posterior pharynx. PCR was performed on these two additional swabs using the cobas®LIAT® (Roche) system according to the manufacturer’s instructions. Results Seventeen children were enrolled in the study between January and April 2019. The mean age of enrollment was 9.6 years (range 6–15). By design all children were known to have a positive RADT for GAS. The LIAT posterior pharynx swab was positive in all 17 subjects. In addition, the LIAT saliva swab was positive in all 17 subjects. Conclusion In this small pilot study, there was 100% concordance between the RADT for GAS and both the posterior pharyngeal and saliva swab using the cobas®LIAT® PCR system. Performing saliva swabs will result in less discomfort and distress to children who are tested for GAS. Further study is needed to determine the sensitivity and specificity of saliva swabs for the detection of GAS in children presenting with acute pharyngitis. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Gregory P DeMuri
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Ellen R Wald
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
26
|
Abstract
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
Collapse
Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| |
Collapse
|
27
|
Santee CA, Nagalingam NA, Faruqi AA, DeMuri GP, Gern JE, Wald ER, Lynch SV. Nasopharyngeal microbiota composition of children is related to the frequency of upper respiratory infection and acute sinusitis. Microbiome 2016; 4:34. [PMID: 27364497 PMCID: PMC4929776 DOI: 10.1186/s40168-016-0179-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/13/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Upper respiratory infections (URI) and their complications are a major healthcare burden for pediatric populations. Although the microbiology of the nasopharynx is an important determinant of the complications of URI, little is known of the nasopharyngeal (NP) microbiota of children, the factors that affect its composition, and its precise relationship with URI. RESULTS Healthy children (n = 47) aged 49-84 months from a prospective cohort study based in Wisconsin, USA, were examined. Demographic and clinical data and NP swab samples were obtained from participants upon entry to the study. All NP samples were profiled for bacterial microbiota using a phylogenetic microarray, and these data were related to demographic characteristics and upper respiratory health outcomes. The composition of the NP bacterial community of children was significantly related prior to the history of acute sinusitis (R (2) = 0.070, P < 0.009). History of acute sinusitis was associated with significant depletion in relative abundance of taxa including Faecalibacterium prausnitzii and Akkermansia spp. and enrichment of Moraxella nonliquefaciens. Enrichment of M. nonliquefaciens was also a characteristic of baseline NP samples of children who subsequently developed acute sinusitis over the 1-year study period. Time to develop URI was significantly positively correlated with NP diversity, and children who experienced more frequent URIs exhibited significantly diminished NP microbiota diversity (P ≤ 0.05). CONCLUSIONS These preliminary data suggest that previous history of acute sinusitis influences the composition of the NP microbiota, characterized by a depletion in relative abundance of specific taxa. Diminished diversity was associated with more frequent URIs.
Collapse
Affiliation(s)
- Clark A Santee
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Nabeetha A Nagalingam
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
- Present address: Janssen Prevention Center, 2 Royal College Street, London, NW1 0TU, UK
| | - Ali A Faruqi
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA.
| |
Collapse
|
28
|
DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER. Clinical Features, Virus Identification, and Sinusitis as a Complication of Upper Respiratory Tract Illness in Children Ages 4-7 Years. J Pediatr 2016; 171:133-9.e1. [PMID: 26787374 PMCID: PMC4808614 DOI: 10.1016/j.jpeds.2015.12.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/05/2015] [Revised: 11/06/2015] [Accepted: 12/11/2015] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To determine the rate of sinusitis complicating upper respiratory tract illnesses (URIs) in children. We prospectively identified the clinical, virologic, and epidemiologic characteristics of URIs in a population of 4- to 7-year-old children followed for 1 year. STUDY DESIGN This was an observational cohort study in 2 primary care pediatric practices in Madison, Wisconsin. Nasal samples were obtained during 4 asymptomatic surveillance visits and during symptomatic URIs. A polymerase chain reaction-based assay for 9 respiratory viruses was performed on nasal samples. A diagnosis of sinusitis was based on published criteria. RESULTS Two hundred thirty-six children ages 48-96 months were enrolled. A total of 327 URIs were characterized. The mean number of URIs per child was 1.3 (range 0-9) per year. Viruses were detected in 81% of URIs; rhinovirus (RV) was most common. Seventy-two percent of URIs were resolved clinically by the 10th day. RV-A and RV-C were detected more frequently at URI visits; RV-B was detected at the same rate for both asymptomatic surveillance visits and URI visits. Sinusitis was diagnosed in 8.8% of symptomatic URIs. Viruses were detected frequently (33%) in samples from asymptomatic children. CONCLUSIONS Sinusitis occurred in 8.8% of symptomatic URIs in our study. The virus most frequently detected with URIs in children was RV; RV-A and RV-C detection but not RV-B detection were associated with illness. Viruses, especially RV, are detected frequently in asymptomatic children. Most URIs have improved or resolved by the 10th day after onset. Children experienced a mean of 1.3 URIs per year, which was lower than expected.
Collapse
Key Words
- adv, adenovirus
- cov, coronavirus
- ev, enterovirus
- flu, influenza virus
- gee, generalized estimating equation
- hbov, human bocavirus
- hmpv, human metapneumovirus
- piv, parainfluenza virus
- rsv, respiratory syncytial virus
- rv, rhinovirus
- uri, upper respiratory tract illness
Collapse
Affiliation(s)
- Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stacey C. Moyer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mary J. Lindstrom
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Susan V. Lynch
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
29
|
Abstract
Despite the common nature of group A streptococcal (GAS) infections, the carrier state of this organism is not well understood. In this article, we review the historical and recent research on the definition, epidemiology, and pathogenesis of the GAS carrier state. In addition, we outline trials of antimicrobial agents in the eradication of the carrier state and discuss indications for providing treatment to patients in the clinical setting.
Collapse
Affiliation(s)
- Gregory P DeMuri
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Ellen R Wald
- University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
30
|
Affiliation(s)
- Gregory P DeMuri
- Division of Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | | |
Collapse
|
31
|
Affiliation(s)
- Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Ave. Madison, WI 53792-4108, USA
| | | |
Collapse
|
32
|
Jagodzinski T, DeMuri GP. Horse-related injuries in children: a review. WMJ 2005; 104:50-4. [PMID: 15856743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Horseback riding is an increasingly popular activity among today's youth, providing them with the opportunity to learn responsibility and respect for animals. However, it can also be associated with severe injury, of which many physicians are unaware. In 2002, there were an estimated 13,400 emergency department visits nationwide for horse-related injuries among children younger than 15 years. When using a severity score to compare it with other childhood injuries, equestrian-related injury ranked second only to pedestrians being struck by a car, and had a higher score than all terrain vehicle, bicycle, and passenger motor vehicle crash injuries. Most serious injuries occur when a rider is thrown from a horse, which is often accompanied by being dragged or crushed by the horse. However, hoof kick injuries to an unmounted child represent about 30% of horse-related injuries and may result in more severe injury. Head injury is the injury most likely to result in hospitalization or death. The effectiveness of helmets in preventing serious head injury in horse-related accidents has been very well established. Recommendations for the prevention of horse-related injury include requiring helmet use on and near a horse, use of safety stirrups to prevent drag injury, matching rider skill with the appropriate horse, and providing close adult supervision.
Collapse
|
33
|
DeMuri GP, Purschwitz MA. Farm injuries in children: a review. WMJ 2000; 99:51-5. [PMID: 11220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Farming is one of the most dangerous occupations in the United States. Unfortunately, risk of injury and death extends not only to adults, but to children that live, play, and work on the farm. This article reviews the epidemiology, pathogenesis and prevention of farm injury in children and adolescents. In Wisconsin 39 children were killed in the agricultural setting between 1995 and 1999. Nationwide, over 100 children per year are killed and 27,000 injured on farms. The age distribution of injury in children is bimodal, with one peak at 3-4 years of age and a second peak at 13-16 years. Boys are much more likely to be injured on the farm than girls. Of the agents associated with the injury of children, tractors are most commonly implicated and are the most deadly. Drownings, injury by cows and horses, and other farm implements and machinery make up the remainder of most farm accidents. The head and face are the sites involved in preschoolers whereas the limbs are more likely to be injured in older children. Poor supervision, unreasonable expectations, financial difficulties and lack of safety devices are associated with risk of injury. Prevention or injury involves patient and family education, regulation and safety devices. Important resources are available for farm families and health care providers to prevent farm accidents in children.
Collapse
Affiliation(s)
- G P DeMuri
- Clinical Sciences Center H6/440, 600 Highland Ave, Madison, WI 53792-4116, USA.
| | | |
Collapse
|
34
|
Abstract
Afebrile or atypical pneumonia is a relatively common illness in infants. These children often present afebrile with diffuse or bilateral infiltrates on chest radiograph. The definition and causes of this clinical entity are discussed. The role of agents such as Chlamydia, Ureaplasma, Pneumocystis, and viruses is elucidated. Techniques for diagnosis and recommended treatment regimens are presented.
Collapse
Affiliation(s)
- G P DeMuri
- Division of General Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin 53792-4116, USA
| |
Collapse
|
35
|
Abstract
The binding of Candida tropicalis to fibronectin (FN) was studied in order to characterize the FN receptor in this species. FN binding was saturable at a concentration of 1.8 x 10(-9) M and exhibited a Kd of 2.3 x 10(-9) M and a receptor density of 854 receptors per cell. Extracts of C. tropicalis cell membrane at dilutions of 1:100-1:1000 significantly inhibited the binding of 3H-labeled FN to C. tropicalis cells (P < .03). Purified FN, antibodies to the integrin alpha 5 beta 1 (FN receptor on human placenta), and antibodies specific for the integrin beta 1 subunit recognized a C. tropicalis membrane protein of 125 +/- 25 kDa on immunoblots. Immunoprecipitation of radiolabeled proteins from C. tropicalis with purified human FN yielded a protein of 105 +/- 15 kDa. Thus, C. tropicalis expresses a protein with antigenic and functional similarity to the vertebrate beta 1 integrin FN receptor.
Collapse
Affiliation(s)
- G P DeMuri
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
| | | |
Collapse
|
36
|
Abstract
The marked increase in the number of patients with AIDS and other forms of immunocompromise has resulted in the emergence of fungi as predominant pathogens in many institutions. Unfortunately, with the widespread use of antifungal agents to combat these infections, reports of resistance to antifungal agents have proliferated. In the present environment, the occurrence of resistance to antifungal agents is neither rare nor of negligible clinical importance. The expanding demand for antifungal agents mandates a new sense of vigilance for resistance. Although newly proposed standards for in vitro susceptibility testing should help to remove the ambiguity surrounding quantitative measurement of fungal resistance, lessons learned in the treatment of bacteria clearly now apply to fungi also: prolonged use of an antimicrobial agent will result in the selection of resistant organisms. The enlarging spectrum of resistance to antifungal agents must prompt aggressive searches for new modes of therapy. Strategies to inhibit fungal colonization, to augment host defenses, or to develop novel antifungal agents from Pseudomonas syringae or from peptide nanotubes are helping to solve this pressing clinical need.
Collapse
Affiliation(s)
- G P DeMuri
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
| | | |
Collapse
|