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Willame C, Dodd C, Durán CE, Elbers RJHJ, Gini R, Bartolini C, Paoletti O, Wang L, Ehrenstein V, Kahlert J, Haug U, Schink T, Diez-Domingo J, Mira-Iglesias A, Carreras JJ, Vergara-Hernández C, Giaquinto C, Barbieri E, Stona L, Huerta C, Martín-Pérez M, García-Poza P, de Burgos A, Martínez-González M, Bryant V, Villalobos F, Pallejà-Millán M, Aragón M, Carreras JJ, Souverein P, Thurin NH, Weibel D, Klungel OH, Sturkenboom MCJM. Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study. Vaccine 2023; 41:251-262. [PMID: 36446653 PMCID: PMC9678835 DOI: 10.1016/j.vaccine.2022.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.
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Affiliation(s)
- C Willame
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - C Dodd
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - CE Durán
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - RJHJ Elbers
- Department of Data science & Biostatistic, Data manegement, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - R Gini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - C Bartolini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - O Paoletti
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - L Wang
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - U Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Faculty of Human and Health Sciences, University of Bremen, Germany
| | - T Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen, Germany
| | - J Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - A Mira-Iglesias
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Vergara-Hernández
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - E Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - L Stona
- Fondazione Penta ONLUS, Corso Stati Uniti 4, 35127 Padova, Italy
| | - C Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - M Martín-Pérez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - P García-Poza
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - A de Burgos
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - M Martínez-González
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - V Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - F Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - P Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - NH Thurin
- INSERM CIC-P1401, Bordeaux PharmacoEpi, Univ. Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - D Weibel
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - OH Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - MCJM Sturkenboom
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands,Corresponding author at: Department Datascience & Biostatistics Univerisity Medical Center Utrecht, Heidelberglaan 100, The Netherlands
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Sabatino J, Sirico D, Di Chiara C, Pogacnik P, Di Candia A, Bonfante F, Dona D, Costenaro P, Fumanelli J, Reffo E, Castaldi B, Biffanti R, Cerutti A, Giaquinto C, Di Salvo G. Mid- and long-term atrio-ventricular mechanics in children after recovery from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Eur Heart J 2022. [PMCID: PMC9619532 DOI: 10.1093/eurheartj/ehac544.154] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Clinical manifestations of children's coronavirus disease-2019 (COVID-19) were initially considered less severe compared with adult patients. However, there is now increasing evidence of a “long-tail” of COVID-19 related symptoms lasting for several months after recovery from the acute infection. Long COVID-19-related symptoms and mechanisms are poorly characterized and understood, with several phenotypes reported, often driven by long-term tissue damage (such as lung, heart and brain) and pathological inflammation due to viral persistence and/or immune deregulation. Purpose The objective of this study was to evaluate atrio-ventricular mechanics, by means of two-dimensional speckle-tracking echocardiography, in previously healthy children recovered from asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up. Methods We analysed a cohort of 157 paediatric patients, mean age 7±4 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study 148±68 days after diagnosis. One hundred seven age, sex, and body surface area comparable healthy subjects were used as control group. Results Left ventricular ejection fraction was within normal limits in postCOVID-19 cases and CTRL with no significant differences between the two groups (postCOVID-19: 65.6±4% vs CTRL: 65.0±5%, p=0.182). Left ventricular (LV) global longitudinal strain (postCOVID-19: −20.5±2.9%; CTRL: −21.8±1.7%; p<0.001) was significantly reduced in cases compared with CTRLs. An amount of 11 (7%) postCOVID-19 cases showed impaired GLS values < −17% and 95 subjects (60%) presented with a strain lower than −16% in more than 2 segments. These subjects did not show any difference regarding symptoms or serological findings. Moreover, GLS was significantly reduced in children with disease's onset during the second wave of COVID-19 pandemic, compared with those during the first wave (second wave: −20.2±2.6%; first wave: −21.2±3.4%; p=0.048). Finally, peak left atrial systolic strain was within the normal range in the postCOVID-19 group with no significant differences compared to CTRL (postCOVID-19: 49.1±12%; CTRL: 49.5±18%). Conclusions SARS-CoV-2 infection may affect left ventricular deformation in children despite an asymptomatic or only mildly symptomatic acute illness. Our data show an amount of 60% of children, recovering from asymptomatic or mildly symptomatic COVID-19, with still mild subclinical systolic cardiac impairment in the mid- and long-term follow-up after the infection. This subtle impairment was seen to be worse in children recovering from the second wave of COVID-19 compared to the first one. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
| | - D Sirico
- University of Padua , Padova , Italy
| | | | | | | | | | - D Dona
- University of Padua , Padova , Italy
| | | | | | - E Reffo
- University of Padua , Padova , Italy
| | | | | | - A Cerutti
- University of Padua , Padova , Italy
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3
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Sirico D, Costenaro P, Di Chiara C, Dona D, Cozzani S, Fumanelli J, Di Candia A, Biffanti R, Cerutti A, Reffo E, Castaldi B, Da Dalt L, Giaquinto C, Di Salvo G. Correction to: Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent SARS-CoV-2 infection. Eur Heart J Cardiovasc Imaging 2022; 23:e272. [PMID: 35134865 PMCID: PMC9383392 DOI: 10.1093/ehjci/jeac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Sirico D, Costenaro P, Di Chiara C, Dona" D, Cozzani S, Fumanelli J, Di Candia A, Biffanti R, Cerutti A, Reffo E, Castaldi B, Da Dalt L, Giaquinto C, Di Salvo G. Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent SARS-CoV-2 infection. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC7929072 DOI: 10.1093/ehjci/jeaa356.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background Evidence suggests that clinical manifestations of children’s COVID-19 may be less severe. However, it has been described the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) which resembles other inflammatory conditions (i.e. Kawasaki disease). Patients affected by PIMS-TS showed cardiac involvement with myocardial injury, reduced left ventricle systolic function and coronary artery abnormalities. Little is known regarding cardiac involvement in pediatric patients with asymptomatic or mildly symptomatic SARS-CoV-2 infection. Methods We analyzed 23 pediatric patients (13males, 56%) with diagnosis of SARS-CoV-2 infection based on PCR analysis of nasopharingeal swab (NPS), and asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram (TTE) within 2-3 month from diagnosis and after negative NPS for SARS-CoV-2. We performed offline analysis with GE EchoPAC software to measure global longitudinal strain (GLS) of the LV using 2D speckle tracking imaging. Therefore, we compared the results with a matched group of 23 controls (13males, 56%). Results Cases and controls were similar regarding age (5.9 ± 4.1years vs. 6.4 ± 4.4 years, p = 0.63), body surface area (0.98 ± 0.3m2 vs. 0.8 ± 0.4m2, p = 0.17), LV FS (37.9 ± 5.9% vs. 36.4 ± 8.3%, p = 0.74) and LV biplane EF (63.9 ± 5.2% vs. 66.4 ± 5.3%, p = 0.11). GLS analysis showed significant strain reduction of the LV mid-wall segments and of the basal anterior, posterior and septal inferior segments among cases compared to controls. Furthermore, in the case group there were 7 subjects (30%) with a strain below 16.5% in at least 3 segments. Conclusion SARS-CoV-2 infection may affect LV deformation in asymptomatic or only mildly symptomatic children, showing a peculiar pattern with lower longitudinal strain in all mid-wall segments of LV compared to control subjects. The clinical significance of this findings is unclear and follow-up is needed to verify the reversibility of this alterations.
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Affiliation(s)
- D Sirico
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - P Costenaro
- University of Padua, Department for Women"s and Children"s Health, Division of Pediatric Infectious , Padova, Italy
| | - C Di Chiara
- University of Padua, Department for Women"s and Children"s Health, Division of Pediatric Infectious , Padova, Italy
| | - D Dona"
- University of Padua, Department for Women"s and Children"s Health, Division of Pediatric Infectious , Padova, Italy
| | | | - J Fumanelli
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - A Di Candia
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - R Biffanti
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - A Cerutti
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - E Reffo
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - B Castaldi
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
| | - L Da Dalt
- University of Padua, Department of Woman and Child"s Health, Padova, Italy
| | - C Giaquinto
- University of Padua, Department for Women"s and Children"s Health, Division of Pediatric Infectious , Padova, Italy
| | - G Di Salvo
- University of Padua, Department of Woman and Child"s Health, Pediatric and Congenital Cardiology Unit, Padova, Italy
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Freguja R, Bamford A, Zanchetta M, Del Bianco P, Giaquinto C, Harper L, Dalzini A, Cressey TR, Compagnucci A, Saidi Y, Riault Y, Ford D, Gibb D, Klein N, De Rossi A. Long-term clinical, virological and immunological outcomes following planned treatment interruption in HIV-infected children. HIV Med 2020; 22:172-184. [PMID: 33124144 PMCID: PMC8436743 DOI: 10.1111/hiv.12986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/24/2019] [Revised: 08/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Planned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV-infected children to continuous ART (CT) vs. CD4-driven PTIs. We report 5 years' follow-up after the end of main trial. METHODS Post-trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub-study investigated more detailed immunophenotype. CT and PTI arms were compared using intention-to-treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time. RESULTS In all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post-trial follow-up. Post-trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post-trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub-study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post-trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT - PTI) = -0.15; 95% CI: -0.34-0.05), P = 0.14]. The sub-study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells. CONCLUSIONS Children tolerated PTI with few long-term clinical, virological or immunological consequences.
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Affiliation(s)
- R Freguja
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - A Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,MRC Clinical Trials Unit, London, UK
| | - M Zanchetta
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistic Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - C Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - L Harper
- MRC Clinical Trials Unit, London, UK
| | - A Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - T R Cressey
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology & Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, MA, USA.,Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - A Compagnucci
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Saidi
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - Y Riault
- INSERMSC10-US019, Essais thérapeutiques et maladies Infectieuses, Villejuif, France
| | - D Ford
- MRC Clinical Trials Unit, London, UK
| | - D Gibb
- MRC Clinical Trials Unit, London, UK
| | - N Klein
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
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Barbieri E, Cantarutti A, Porcu G, Hu T, Petigara T, Prandi GM, Alimenti C, Scamarcia A, Cantarutti L, Giaquinto C. A retrospective database analysis of burden of IPD and pneumonia in children <15y in Veneto region. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1414] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
IPD and pneumonia are associated with high mortality and healthcare resource utilization (HCRU). This analysis assessed incidence, HCRU and costs of IPD and pneumonia following PCV13 introduction in 2010 in Veneto.
Methods
IPD, unspecified invasive disease episodes, outpatient pneumococcal and unspecified pneumonia episodes were identified in Pedianet, a pediatric primary care database from 2010-2017. HCRU includes primary care and specialist visits, antibiotic prescriptions, diagnostics, ER visits and hospitalizations. Incidence rates (IRs) were numbers of episodes/1,000 person-years. Standardized regional incidence rates (SRIRs) were calculated by standardizing IRs with regional population data by age and year. Regional expenditures (€/1,000 person-years) were calculated by multiplying SRIRs with average costs per episode. Interrupted time series (ITS) analyses assessed trends in annual IRs in the early and late PCV13 (2010-2013, 2014-2017) periods.
Results
During 2010-2017, IPD and unspecified invasive disease incidence decreased from 0.40 to 0.31/1,000 person-years. While incidence was numerically lower in 2017 than in 2010, ITS analysis did not detect a significant trend in the early (coef=1.97; p = 0.63) or late PCV13 (coef=0.50; p = 0.90) periods. Average cost per episode was €4206 and average regional expenditure was €171/1,000 person-year. SRIR for outpatient pneumonia decreased from 13.35 to 5.48/1,000 person-year during 2010 to 2017. Pneumonia episodes were associated with 0.29 ER visits and 0.15 short stay and 0.06 long stay hospitalization. Average cost per episode was €345, majority of which was associated with ER visits (€50.8) and hospitalizations (€243.9). Regional expenditures decreased from €12852.31 to €5351.98/1,000 person-year.
Conclusions
IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction, while disease burden declined for outpatient pneumococcal and unspecified pneumonia.
Key messages
IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction. Disease burden declined for outpatient pneumococcal and unspecified pneumonia following PCV13.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padova, Padua, Italy
| | - A Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - T Hu
- Merck & Co. Inc., Kenilworth, NJ, USA
| | | | - G M Prandi
- Department for Woman and Child Health, University of Padova, Padua, Italy
- MSD Italia, Rome, Italy
| | | | | | | | - C Giaquinto
- Department for Woman and Child Health, University of Padova, Padua, Italy
- Pedianet Project, Padua, Italy
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7
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Barbieri E, Cantarutti A, Porcu G, Hu T, Petigara T, Prandi GM, Alimenti C, Scamarcia A, Cantarutti L, Giaquinto C. A retrospective database analysis to estimate the burden of AOM in children <15y in Veneto region. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1413] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Acute Otitis Media (AOM) causes substantial healthcare resource utilization (HCRU) in children. This analysis assessed AOM HCRU and costs following PCV13 introduction in 2010 in Veneto.
Methods
AOM episodes in children <15 years residing in Veneto were identified in Pedianet, a pediatric primary care, database from 2010-2017. Recurrent AOM was defined as at least three episodes in 6 months, or four or more episodes in 12 months. HCRU includes primary care visits, antibiotic prescriptions, diagnostic tests, specialist visits, emergency room (ER) visits and hospitalizations. Incidence rates (IRs) were numbers of episodes/1,000 person-years. Standardized regional incidence rates (SRIRs) were calculated by standardizing IRs with regional population data by age and year. Regional expenditures (€/1,000 person-years) were calculated by multiplying SRIRs with average cost per episode.
Results
Simple AOM episodes were associated with 1.03 primary care visits and 1.52 antibiotic prescriptions on average. Only 2.4% and 0.18% of simple AOM episodes included an ER visit, and a hospitalization respectively. Recurrent AOM episodes were associated with 1.06 primary care visits and 1.62 antibiotic prescriptions. Annual costs per episode were €50 for simple AOM and €54.2 for recurrent AOM, majority of which were associated with primary care visits and antibiotic prescriptions. Average antibiotic prescription costs were €14.2 for simple AOM and €16 for recurrent AOM. During 2010 and 2017, SRIRs declined from 100 to 72/1000 person-year for simple AOM and from 13 to 11/1,000 person-year for recurrent AOM. Regional expenditures decreased from €4702.7 to €3358.5/1,000 person-year for simple AOM and from €672.4 to €572.6/1000 person-year for recurrent AOM.
Conclusions
SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.
Key messages
SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padova, Padua, Italy
| | - A Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - T Hu
- Merck & Co. Inc, Kenilworth, NJ, USA
| | | | - G M Prandi
- Department for Woman and Child Health, University of Padova, Padua, Italy
- MSD Italia, Rome, Italy
| | | | | | | | - C Giaquinto
- Department for Woman and Child Health, University of Padova, Padua, Italy
- Pedianet Project, Padua, Italy
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Correction to: Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:59. [PMID: 32381059 PMCID: PMC7206826 DOI: 10.1186/s13756-020-00720-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- D Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
| | - E Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.
| | - M Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Fondazione Penta ONLUS, Padua, Italy
| | - T Zaoutis
- Fondazione Penta ONLUS, Padua, Italy.,Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
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9
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
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10
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Barbieri E, Donà D, Cantarutti A, Lundin R, Scamarcia A, Corrao G, Cantarutti L, Giaquinto C. Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients. Ital J Pediatr 2019; 45:103. [PMID: 31420054 PMCID: PMC6697973 DOI: 10.1186/s13052-019-0696-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used. Methods The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results. Results We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics. Conclusions Despite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0696-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padua, Padua, Italy.
| | - D Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy
| | - A Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | | | - G Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Pedianet Project, Padua, Italy
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11
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Foster C, Dominguez S, Tagarro A, Nastouli E, Palma P, Gkouleli R, Heaney J, Giaquinto C, Rossi P, Rojo P. The CARMA study – children on early suppressive therapy: total HIV-1 DNA quantitation 12 years post ART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Di Biagio A, Taramasso L, Gustinetti G, Burastero G, Giacomet V, La Rovere D, Genovese O, Giaquinto C, Rampon O, Carloni I, Hyppolite TK, Palandri L, Bernardi S, Bruzzese E, Badolato R, Gabiano C, Chiappini E, De Martino M, Galli L. Missed opportunities to prevent mother-to-child transmission of HIV in Italy. HIV Med 2019; 20:330-336. [PMID: 30924576 DOI: 10.1111/hiv.12728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vertical transmission of HIV can be effectively controlled through antenatal screening, antiretroviral treatment and the services provided during and after childbirth for mother and newborn. In Italy, the National Health Service guarantees universal access to prenatal care for all women, including women with HIV infection. Despite this, children are diagnosed with HIV infection every year. The aim of the study was to identify missed opportunities for prevention of mother-to-child transmission of HIV. METHODS The Italian Register for HIV Infection in Children, which was started in 1985 and involves 106 hospitals throughout the country, collects data on all new cases of HIV infection in children. For this analysis, we reviewed the database for the period 2005 to 2015. RESULTS We found 79 HIV-1-infected children newly diagnosed after birth in Italy. Thirty-two of the mothers were Italian. During the pregnancy, only 15 of 19 women with a known HIV diagnosis were treated with antiretroviral treatment, while, of 34 women who had received an HIV diagnosis before labour began, only 23 delivered by caesarean section and 17 received intrapartum prophylaxis. In 25 mothers, HIV infection was diagnosed during pregnancy or in the peripartum period. Thirty-one newborns received antiretroviral prophylaxis and 39 received infant formula. CONCLUSIONS We found an unacceptable number of missed opportunities to prevent mother-to-child transmission (MCTC). Eliminating HIV MTCT is a universal World Health Organization goal. Elucidating organization failures in Italy over the past decade should help to improve early diagnosis and to reach the zero transmission target in newborns.
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Affiliation(s)
- A Di Biagio
- Infectious Diseases Unit, Department of Internal Medicine, Policlinico San Martino Hospital, Genoa, Italy
| | - L Taramasso
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gustinetti
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - G Burastero
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - V Giacomet
- Department of Pediatrics, University of Milan, L. Sacco Hospital, Milan, Italy
| | - D La Rovere
- Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - O Genovese
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - C Giaquinto
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - O Rampon
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - I Carloni
- Pediatric Unit, Department of Child and Mother Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - T K Hyppolite
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - L Palandri
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - S Bernardi
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - E Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - R Badolato
- Department of Clinical and Experimental Sciences, Institute of Molecular Medicine 'Angelo Nocivelli', University of Brescia, Brescia, Italy
| | - C Gabiano
- SC Pediatric Unit, Regina Margherita Hospital, Turin, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - M De Martino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - L Galli
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
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13
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Zangari P, Palma P, Cotugno N, Rojo P, Tagarro A, Pepponi I, De Rossi A, Kuhn L, Pahwa S, Cameron M, Nastouli E, Watters S, Marceline AG, McCoy LE, Persaud D, Violari A, Chan M, Babiker AG, Foster C, Ananworanich J, Giaquinto C, Rossi P. Report from the First EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) General Assembly meeting, 9-11 November 2017, Rome, Italy. J Virus Erad 2018; 4:51-54. [PMID: 29568555 PMCID: PMC5851186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- P Zangari
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, Children's Hospital Bambino Gesù (OPBG),
Rome,
Italy
| | - P Palma
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, Children's Hospital Bambino Gesù (OPBG),
Rome,
Italy,Corresponding author: Paolo Palma,
Academic Department of Pediatrics (DPUO),
Research Unit in Congenital and Perinatal Infection,
Immune and Infectious Diseases Division,
Children's Hospital Bambino Gesù,
Piazza San’Onofrio,4,
Rome,
Italy
| | - N Cotugno
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, Children's Hospital Bambino Gesù (OPBG),
Rome,
Italy
| | - P Rojo
- Department of Pediatrics, Hospital 12 de Octubre,
Madrid,
Spain
| | - A Tagarro
- Department of Pediatrics, Hospital 12 de Octubre,
Madrid,
Spain
| | - I Pepponi
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, Children's Hospital Bambino Gesù (OPBG),
Rome,
Italy
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, and Istituto Oncologico Veneto,
Padova,
Italy
| | - L Kuhn
- Gertrude H Sergievsky Center, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center,
New York, NY,
USA
| | - S Pahwa
- Department of Microbiology and Immunology, Miami Center for AIDS Research, University of Miami, Miller School of Medicine,
Miami, FL,
USA
| | - M Cameron
- Department of Epidemiology and Biostatistics, Case Western Reserve University,
Cleveland, Ohio,
USA
| | - E Nastouli
- Department of Virology, University College London Hospitals,
London,
UK
| | - S Watters
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health,
London,
UK
| | - AG Marceline
- Sorbonne University, UPMC University of Paris 6, Service de Virologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP,
Paris,
France
| | - LE McCoy
- Division of Infection and Immunity, University College London,
UK
| | - D Persaud
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, School of Medicine,
Baltimore, MA,
USA
| | - A Violari
- Perinatal Health Research Unit, University of Witwatersrand,
Johannesburg,
South Africa
| | - M Chan
- MRC Clinical Trials Unit, University College London,
UK
| | - AG Babiker
- MRC Clinical Trials Unit, University College London,
UK
| | - C Foster
- Imperial College Healthcare National Health Service Trust,
London,
UK
| | - J Ananworanich
- Henry M Jackson Foundation for the Advancement of Military Medicine,
MA,
USA
| | - C Giaquinto
- Department of Women's and Child's Health, Paediatric Infectious Diseases Unit, University of Padova and PENTA Foundation,
Padova,
Italy
| | - P Rossi
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, Children's Hospital Bambino Gesù (OPBG),
Rome,
Italy
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14
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Zangari P, Palma P, Cotugno N, Rojo P, Tagarro A, Pepponi I, De Rossi A, Kuhn L, Pahwa S, Cameron M, Nastouli E, Watters S, Marceline A, McCoy L, Persaud D, Violari A, Chan M, Babiker A, Foster C, Ananworanich J, Giaquinto C, Rossi P. Report from the First EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) General Assembly meeting, 9–11 November 2017, Rome, Italy. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30240-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Donà D, Mozzo E, Mardegan V, Trafojer U, Lago P, Salvadori S, Baraldi E, Giaquinto C. Antibiotics Prescriptions in the Neonatal Intensive Care Unit: How to Overcome Everyday Challenges. Am J Perinatol 2017; 34:1169-1177. [PMID: 28395369 DOI: 10.1055/s-0037-1602426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 10/19/2022]
Abstract
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations. A robust ASP requires everyday multidisciplinary collaboration between ID physicians, neonatologist, clinical pharmacists, clinical microbiologists, infection control professionals, hospital epidemiologists, and information services specialists. Education and clinical pathways (e.g., sepsis or surgical prophylaxis pathways) are an excellent starting point if followed by proactive interventions such as prospective audits and feedback and formulary restriction with prior antimicrobial authorization. The current review outlines the problems faced in NICU antimicrobial prescribing and presents various solutions from the literature.
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Affiliation(s)
- D Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - E Mozzo
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - V Mardegan
- Neonatal Intensive Care Unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - U Trafojer
- Neonatal Intensive Care Unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - P Lago
- Neonatal Intensive Care Unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - S Salvadori
- Neonatal Intensive Care Unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - E Baraldi
- Neonatal Intensive Care Unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - C Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
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16
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Palma P, Foster C, Rojo P, Zangari P, Yates A, Cotugno N, Klein N, Luzuriaga K, Pahwa S, Nastouli E, Gibb DM, Borkowsky W, Bernardi S, Calvez V, Manno E, Mora N, Compagnucci A, Wahren B, Muñoz-Fernández MÁ, De Rossi A, Ananworanich J, Pillay D, Giaquinto C, Rossi P. The EPIICAL project: an emerging global collaboration to investigate immunotherapeutic strategies in HIV-infected children. J Virus Erad 2015; 1:134-139. [PMID: 26893908 PMCID: PMC4755515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) project arises from the firm belief that perinatally infected children treated with suppressive antiretroviral therapy (ART) from early infancy represent the optimal population model in which to study novel immunotherapeutic strategies aimed at achieving ART-free remission. This is because HIV-infected infants treated within 2-3 months of life have a much reduced viral reservoir size, and rarely show HIV-specific immunity but preserve normal immune development. The goal of EPIICAL is the establishment of an international collaboration to develop a predictive platform using this model to select promising HIV therapeutic vaccine candidates, leading to prioritisation or deprioritisation of novel immunotherapeutic strategies. To establish this platform, the EPIICAL Consortium aims to: develop predictive models of virological and immunological dynamics associated with response to early ART and to treatment interruption using available data from existing cohorts/studies of early-treated perinatally HIV-infected children; optimise methodologies to better characterise immunological, virological and genomic correlates/profiles associated with viral control; test novel immunotherapeutic strategies using in vivo proof-of-concept (PoC) studies with the aim of inducing virological, immunological and transcriptomic correlates/profiles equivalent to those defined by the predictive model. This approach will strengthen the capacity for discovery, development and initial testing of new therapeutic vaccine strategies through the integrated efforts of leading international scientific groups, with the aim of improving the health of HIV-infected individuals.
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Affiliation(s)
- P Palma
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Corresponding author: Paolo Palma,
University Department of Pediatrics Unit of Immune and Infectious Diseases,
Children's Hospital Bambino GesùPiazza Sant'Onofrio4-00165Rome,
Italy
| | - C Foster
- Imperial College Healthcare NHS Trust,
London,
UK
| | - P Rojo
- Department of Pediatrics,
Hospital 12 de Octubre,
Madrid,
Spain
| | - P Zangari
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - A Yates
- Institute of Infection, Immunity & Inflammation,
University of Glasgow,
Glasgow,
UK
| | - N Cotugno
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - N Klein
- Institute of Child Health,
University College London,
London,
UK
| | - K Luzuriaga
- Program in Molecular Medicine,
University of Massachusetts Medical School Worcester,
MA,
USA
| | - S Pahwa
- Miami Center for AIDS Research Department of Microbiology and Immunology,
University of Miami, Miller School of Medicine,
Miami,
FL,
USA
| | - E Nastouli
- Department of Virology,
University College London Hospitals,
London,
UK
| | - DM Gibb
- MRC Clinical Trials Unit,
London,
UK
| | | | - S Bernardi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy
| | - V Calvez
- Pierre et Marie Curie University and Pitié-Salpêtrière Hospital,
Paris,
France
| | - E Manno
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
| | - Nadia Mora
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy
| | - A Compagnucci
- INSERM SC10-US019 Clinical Trials and Infectious Diseases,
Villejuif Paris,
France
| | - B Wahren
- Department of Microbiology,
Tumor and Cell Biology, Karolinska Institutet,
Stockholm,
Sweden
| | - MÁ Muñoz-Fernández
- Department of Molecular ImmunoBiology,
Hospital General Universitario Gregorio Marañon,
Madrid,
Spain
| | - A De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology-DiSCOG,
University of Padova & Istituto Oncologico Veneto(IOV)-IRCCS,
Padova Padova,
Italy
| | - J Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research and Henry M Jackson Foundation for the Advancement of Military Medicine,
Maryland,
USA
| | - D Pillay
- Africa Centre,
KwaZulu Natal,
South Africa
| | - C Giaquinto
- Department of Women's and Child's Health, Paediatric Infectious Diseases Unit,
University of Padova and PENTA Foundation,
Italy
| | - P Rossi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases,
Children's Hospital Bambino Gesù,
Rome,
Italy,Chair of Pediatrics, Department of Systems Medicine,
University of Rome ‘Tor Vergata’,
Italy
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17
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Bamford A, Turkova A, Lyall H, Foster C, Klein N, Bastiaans D, Burger D, Bernadi S, Butler K, Chiappini E, Clayden P, Della Negra M, Giacomet V, Giaquinto C, Gibb D, Galli L, Hainaut M, Koros M, Marques L, Nastouli E, Niehues T, Noguera-Julian A, Rojo P, Rudin C, Scherpbier HJ, Tudor-Williams G, Welch SB. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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Affiliation(s)
- A Bamford
- Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK
| | - A Turkova
- Medical Research Council Clinical Trials Unit, London, UK
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - D Bastiaans
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - D Burger
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - S Bernadi
- University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy
| | - K Butler
- Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland
| | - E Chiappini
- Meyer University Hospital, Florence University, Florence, Italy
| | | | - M Della Negra
- Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - V Giacomet
- Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - C Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
| | - D Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - L Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - M Hainaut
- Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - M Koros
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - L Marques
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal
| | - E Nastouli
- Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK
| | - T Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - P Rojo
- 12th of October Hospital, Madrid, Spain
| | - C Rudin
- University Children's Hospital, Basel, Switzerland
| | - H J Scherpbier
- Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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de Jong MD, Reusken C, Horby P, Koopmans M, Bonten M, Chiche J, Giaquinto C, Welte T, Leus F, Schotsman J, Goossens H. Preparedness for admission of patients with suspected Ebola virus disease in European hospitals: a survey, August-September 2014. ACTA ACUST UNITED AC 2014; 19:20980. [PMID: 25496571 DOI: 10.2807/1560-7917.es2014.19.48.20980] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In response to the Ebola virus disease (EVD) outbreak in West Africa, the World Health Organization has advised all nations to prepare for the detection, investigation and management of confirmed and suspected EVD cases in order to prevent further spread through international travel. To gain insights into the state of preparedness of European hospitals, an electronic survey was circulated in August–September 2014 to 984 medical professionals representing 736 hospitals in 40 countries. The survey addressed the willingness and capacity to admit patients with suspected EVD as well as specific preparedness activities in response to the current Ebola crisis. Evaluable responses were received from representatives of 254 (32%) hospitals in 38 countries, mostly tertiary care centres, of which 46% indicated that they would admit patients with suspected EVD. Patient transfer agreements were in place for the majority of hospitals that would not admit patients. Compared with non-admitting hospitals, admitting hospitals were more frequently engaged in various preparedness activities and more often contained basic infrastructural characteristics such as admission rooms and laboratories considered important for infection control, but some gaps and concerns were also identified. The results of this survey help to provide direction towards further preparedness activities and prioritisation thereof.
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Affiliation(s)
- M D de Jong
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands
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19
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Huppertz HI, Borte M, Schuster V, Giaquinto C, Vesikari T. Report of the Third European Expert Meeting on Rotavirus Vaccination: Progress in rotavirus universal mass vaccination in Europe. Vaccine 2014; 32:4243-8. [DOI: 10.1016/j.vaccine.2014.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
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20
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Turner MA, Catapano M, Hirschfeld S, Giaquinto C. Paediatric drug development: the impact of evolving regulations. Adv Drug Deliv Rev 2014; 73:2-13. [PMID: 24556465 DOI: 10.1016/j.addr.2014.02.003] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 01/07/2023]
Abstract
Children deserve medicines that are adapted to their needs. The need to include children in drug development has been recognised increasingly over the past few decades. Legal and regulatory frameworks are well established in the EU and US. The amount of work done to study medicines for children is significantly greater than it was 10 years go. Proof-of-concept has been demonstrated for all segments of the paediatric drug development pipeline. It is now time to examine how the practice of developing medicines for children has evolved within those frameworks and to determine how that work should be generalised. This review describes the development of medicines for children and critically appraises the work that has been done within those frameworks. Significant effort is needed to realize the potential provided by the current regulatory framework. Using the work programme of the Global Research in Paediatrics (GRiP) Network of Excellence as a template we outline current work and future growing points.
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Affiliation(s)
- M A Turner
- University of Liverpool, Department of Women's and Children's Health, Institute of Translational Medicine, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, UK.
| | - M Catapano
- University of Pavia, Italian Group for the Study of Pharmacoeconomics (GISF), Via Luigi Porta 14, 27100 Pavia, Italy.
| | - S Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), 31 Center Drive, Building 31, Room 2A32, Bethesda, MD 20892-2425, USA.
| | - C Giaquinto
- Azienda Ospedaliera di Padova (AOPD), Department of Paediatrics, Via Giustiniani 1, 35128 Padova, Italy.
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21
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Giaquinto C. Second- and third-line treatment for pediatric patients failing ART. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Massavon W, Barlow-Mosha L, Mugenyi L, McFarland W, Gray G, Lundin R, Costenaro P, Nannyonga MM, Penazzato M, Bagenda D, Namisi CP, Wabwire D, Mubiru M, Kironde S, Bilardi D, Mazza A, Fowler MG, Musoke P, Giaquinto C. Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study. ISRN AIDS 2014; 2014:852489. [PMID: 25006529 PMCID: PMC4003865 DOI: 10.1155/2014/852489] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 12/28/2022]
Abstract
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11-109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
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Affiliation(s)
- W. Massavon
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - L. Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - L. Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - W. McFarland
- Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA
| | - G. Gray
- University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - R. Lundin
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - P. Costenaro
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - M. M. Nannyonga
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - M. Penazzato
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - D. Bagenda
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA
| | - C. P. Namisi
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Wabwire
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - M. Mubiru
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - S. Kironde
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Bilardi
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - A. Mazza
- Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy
| | - M. G. Fowler
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA
| | - P. Musoke
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - C. Giaquinto
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Petrara MR, Penazzato M, Massavon W, Nabachwa S, Nannyonga M, Mazza A, Gianesin K, Del Bianco P, Lundin R, Sumpter C, Zanchetta M, Giaquinto C, De Rossi A. Epstein-Barr Virus Load in Children Infected With Human Immunodeficiency Virus Type 1 in Uganda. J Infect Dis 2014; 210:392-9. [DOI: 10.1093/infdis/jiu099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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24
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Giaquinto C, Callegaro S, Andreola B, Bernuzzi M, Cantarutti L, D’Elia R, Drago S, De Marchi A, Falconi P, Felice M, Giancola G, Lista C, Manni C, Perin M, Pisetta F, Scamarcia A, Sidran MP, Largeron N, Trichard M, Da Dalt L. Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Tarricone R, Giaquinto C, Largeron N, Trichard M. Analisi economica dei costi e dei benefici dell’implementazione di un programma di prevenzione antirotavirus con il vaccino pentavalente in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Vaz P, Augusto O, Bila D, Macassa E, Vubil A, Jani IV, Pillon R, Sandstrom P, Sutherland D, Giaquinto C, Jordan MR, Bertagnolio S. Surveillance of HIV drug resistance in children receiving antiretroviral therapy: a pilot study of the World Health Organization's generic protocol in Maputo, Mozambique. Clin Infect Dis 2012; 54 Suppl 4:S369-74. [PMID: 22544205 DOI: 10.1093/cid/cis006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Between 2007 and 2008, the Mozambique Ministry of Health conducted an assessment of human immunodeficiency virus drug resistance (HIVDR) using World Health Organization (WHO) methods in a cohort of children initiating antiretroviral therapy (ART) at the main pediatric ART referral center in Mozambique. It was shown that prior to ART initiation 5.4% of children had HIVDR that was associated with nevirapine perinatal exposure (P < .001). Twelve months after ART initiation, 77% had viral load suppression (<1000 copies/mL), exceeding the WHO target of ≥ 70%; 10.3% had HIVDR at 12 months. Baseline HIVDR (P = .04), maternal prevention of mother-to-child transmission (P = .02), and estimated days of missed medication (P = .03) predicted HIVDR at 12 months. As efforts to eliminate pediatric AIDS are intensified, implementation of ritonavir-boosted protease inhibitor regimens in children with prevention of mother-to-child transmission exposure may reduce risk of virological failure in our setting.
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Affiliation(s)
- P Vaz
- Department of Pediatrics, Hospital Dia Pediátrico, Maputo Central Hospital, Maputo, Mozambique.
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27
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Lewis J, Walker AS, Castro H, De Rossi A, Gibb DM, Giaquinto C, Klein N, Callard R. Reply to Zhang, Poznansky, and Crumpacker. J Infect Dis 2012. [DOI: 10.1093/infdis/jis388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Nesti M, Carli E, Giaquinto C, Rampon O, Nastasio S, Giuca MR. Correlation between viral load, plasma levels of CD4 - CD8 T lymphocytes and AIDS-related oral diseases: a multicentre study on 30 HIV+ children in the HAART era. J BIOL REG HOMEOS AG 2012; 26:527-537. [PMID: 23034272] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This experimental retrospective multicenter study carried out on 30 seropositive children treated with Highly Active Antiretroviral Therapy (HAART), between the ages of 18 months and 14 years, in the clinical categories Centers for Disease Control (CDC) classification 1993 A (mildly symptomatic), B (moderately symptomatic) and C (severely symptomatic) aims to: 1) clinically and immunologically demonstrate the therapeutic benefits of HAART; 2) monitor the frequency of AIDS-related oral diseases in seropositive children with HAART therapy; 3) monitor the plasma levels of total CD4, CD4 percent, CD8 percent, CD4-CD8 lymphocytes and viral load from 1997 to 30 April, 2011. The statistic methods used are the analysis of covariance and the Bonferroni Test. More than 100 AIDS-related oral diseases were found in the study samples, the most frequent being: oral candidiasis, oropharyngeal candidiasis, HSV-1 herpetic esophagyitis, herpetic gingivolstomatitis (RHOG), recurrent aphthous stomatitis (RAS), parotid swelling, oral hairy leukoplakia (OHL), Herpes simplex 1 (HSV-1), linear gingival erythema (LGE), necrotizing gingivitis (NUG), facial lipodistrophy, facial-cervical lymphadenopathy (FCL), xerostomia, dysgeusia, hyposmia, oral mucosa hyperpigmentation (OMP). The Bonferroni test showed a significant difference between the mean plasma values (mpVTL) of total CD4, CD4 percentage, CD4-CD8 T lymphocytes and Viral Load (VL) of the various oral diseases found in the study samples. The therapeutic benefits of HAART are: immune reconstitution; reduction of the HIV/AIDS-related stomatology diseases; prevention and cure of the AIDS correlated neoplasias; reduction in maternal-fetal transmission of the HIV virus. The negative effects of HAART in relation to odontostomatolgy are: increase in oral lesions from HPV; xerostomia; dysgeusia/ageusia, hyposmia, perioral paresthesia; hyperpigmentation of oral mucosa; facial lipodystrophy, recurrent aphthous stomatitis (RAS). No case of immune reconstitution inflammatory syndrome or human papillomavirus (HPV)-related oral diseases were found in this study.
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Affiliation(s)
- M Nesti
- Dipartimento di Chirurgia, Sezione di Odontostomatologia, Università di Pisa, Italy.
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Chiappini E, Galli L, Lisi C, Gabiano C, Giaquinto C, Giacomet V, Buffolano W, Esposito S, Badolato R, Berbardi S, Cellini M, Dodi I, Faldella G, Osimani P, Genovese O, Nicastro E, Viscoli C, Salvini F, Tovo PA, Maurizio DM. Risk of Perinatal HIV Infection in Infants Born in Italy to Immigrant Mothers. Clin Infect Dis 2011; 53:310-3. [DOI: 10.1093/cid/cir344] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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30
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Freguja R, Gianesin K, Mosconi I, Zanchetta M, Carmona F, Rampon O, Giaquinto C, De Rossi A. Regulatory T cells and chronic immune activation in human immunodeficiency virus 1 (HIV-1)-infected children. Clin Exp Immunol 2011; 164:373-80. [PMID: 21438872 DOI: 10.1111/j.1365-2249.2011.04383.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The function of CD4(+) T cells with regulatory activity (T(regs)) is the down-regulation of immune responses. This suppressive activity may limit the magnitude of effector responses, resulting in failure to control human immunodeficiency virus 1 (HIV-1) infection, but may also suppress chronic immune activation, a characteristic feature of HIV-1 disease. We evaluated the correlation between viral load, immune activation and T(regs) in HIV-1-infected children. Eighty-nine HIV-1-infected children (aged 6-14 years) were included in the study and analysed for HIV-1 plasmaviraemia, HIV-1 DNA load, CD4 and CD8 cell subsets. T(reg) cells [CD4(+)CD25(high)CD127(low) forkhead box P3 (FoxP3(high))] and CD8-activated T cells (CD8(+)CD38(+)) were determined by flow cytometry. Results showed that the number of activated CD8(+)CD38(+)T cells increased in relation to HIV-1 RNA plasmaviraemia (r = 0·403, P < 0·0001). The proportion of T(regs) also correlated positively with HIV-1 plasmaviraemia (r = 0·323, P = 0·002), but correlated inversely with CD4(+) cells (r = -0·312, P = 0·004), thus suggesting a selective expansion along with increased viraemia and CD4(+) depletion. Interestingly, a positive correlation was found between the levels of T(regs) and CD8(+)CD38(+)T cells (r = 0·305, P = 0·005), and the percentage of T(regs) tended to correlate with HIV-1 DNA load (r = 0·224, P = 0·062). Overall, these findings suggest that immune activation contributes to the expansion of T(reg) cells. In turn, the suppressive activity of T(regs) may impair effector responses against HIV-1, but appears to be ineffective in limiting immune activation.
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Affiliation(s)
- R Freguja
- Department of Oncology and Surgical Sciences, Section of Oncology, AIDS Reference Center, Padova, Italy
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31
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Cocu M, Thorne C, Mătuşa R, Tica V, Florea C, Asandi S, Giaquinto C. Mother-to-child transmission of HIV infection in Romania: Results from an education and prevention programme. AIDS Care 2010; 17:76-84. [PMID: 15832835 DOI: 10.1080/09540120412331305142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A pilot prevention of mother-to-child transmission (PMTCT) programme was implemented in Constanta County, Romania, between 2000 and 2002. The programme consisted of clinician training, routine antenatal HIV counselling and testing and the care of HIV-infected pregnant women and their infants. A total of 11,423 pregnant women (10,192 (89%) white Europeans, 862 (7.5%) Rroma, 369 (3.2%) Central Asians) were tested during the pilot, at a median of 24 weeks' gestation. Rapid HIV testing at delivery was introduced during the pilot, to supplement the antenatal testing, both of which required informed consent. Overall seroprevalence was 1.75 per 1,000 (95% confidence interval (CI) 1.07-2.70 per 1,000). HIV infection was associated with having a high-risk partner, prostitution and non-Caucasian ethnicity. Twelve infected women completed their pregnancies, of whom seven received antenatal antiretroviral therapy (ART); all neonates received prophylactic ART and five were delivered by elective caesarean section. Three infants were HIV-infected, giving a vertical transmission rate of 25% (95% CI 5.49-57.2%); all three were born to mothers not identified as infected until delivery, and who therefore received no antenatal ART. A key challenge for PMTCT in Romania will be the prompt identification of pregnant HIV-infected women, to allow the optimum application of interventions.
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Affiliation(s)
- M Cocu
- Epidemiological Centre, Public Health Directorate, Constanta, Romania
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32
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Giaquinto C, Penazzato M, Rosso R, Bernardi S, Rampon O, Nasta P, Ammassari A, Antinori A, Badolato R, Castelli Gattinara G, d'Arminio Monforte A, De Martino M, De Rossi A, Di Gregorio P, Esposito S, Fatuzzo F, Fiore S, Franco A, Gabiano C, Galli L, Genovese O, Giacomet V, Giannattasio A, Gotta C, Guarino A, Martino A, Mazzotta F, Principi N, Regazzi MB, Rossi P, Russo R, Saitta M, Salvini F, Trotta S, Viganò A, Zuccotti G, Carosi G. Italian consensus statement on paediatric HIV infection. Infection 2010; 38:301-19. [PMID: 20514509 DOI: 10.1007/s15010-010-0020-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/17/2010] [Indexed: 02/01/2023]
Abstract
The objective of this document is to identify and reinforce current recommendations concerning the management of HIV infection in infants and children in the context of good resource availability. All recommendations were graded according to the strength and quality of the evidence and were voted on by the 57 participants attending the first Italian Consensus on Paediatric HIV, held in Siracusa in 2008. Paediatricians and HIV/AIDS care specialists were requested to agree on different statements summarizing key issues in the management of paediatric HIV. The comprehensive approach on preventing mother-to-child transmission (PMTCT) has clearly reduced the number of children acquiring the infection in Italy. Although further reduction of MTCT should be attempted, efforts to personalize intervention to specific cases are now required in order to optimise the treatment and care of HIV-infected children. The prompt initiation of treatment and careful selection of first-line regimen, taking into consideration potency and tolerance, remain central. In addition, opportunistic infection prevention, adherence to treatment, and long-term psychosocial consequences are becoming increasingly relevant in the era of effective antiretroviral combination therapies (ART). The increasing proportion of infected children achieving adulthood highlights the need for multidisciplinary strategies to facilitate transition to adult care and maintain strategies specific to perinatally acquired HIV infection.
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Affiliation(s)
- C Giaquinto
- Dipartimento di Pediatria, Università degli Studi di Padova, Padova, Italy
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Chiappini E, Galli L, Tovo PA, Gabiano C, Lisi C, Ferraris G, Viganò A, Giaquinto C, Bernardi S, Badolato R, Genovese O, Salvini F, Maccabruni A, Anzidei G, Rosso R, Buffolano W, Cellini M, Casadei AM, Faldella G, Ruggeri M, Osimani P, Manzionna MM, Dodi I, Gotta C, Esposito S, Gariel D, De Martino M. Low prevalence of selective IgA deficiency in infected children born to HIV-seropositive mothers: an in vivo model for speculation on selective IgA deficiency pathogenesis. Int J Immunopathol Pharmacol 2009; 21:1035-9. [PMID: 19144291 DOI: 10.1177/039463200802100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anecdotal reports of restored immunoglobulin production in individuals with common variable immunodeficiency after acquiring HIV infection suggest that perturbation of the immune system occurring during HIV infection may force some underlying functional defects. These findings raise intriguing questions about the pathogenesis of common variable immunodeficiency. No study has investigated the possible influence of HIV infection on the development of selective IgA deficiency, a primary immunologic defect genetically related to common variable immunodeficiency. IgA serum levels were evaluated in a large cohort of children born to HIV-infected mothers from 1985 to 2006. To avoid differences possibly due to different follow-up durations we considered only infected and non-infected children aged over 4 years at last-follow-up. The study included 1,157 non-infected children and 964 infected children, aged ≥ 4 years at last-follow-up and with availability of two or more serum IgA determinations over six months of age. No child displayed immunoglobulin values compatible with diagnosis of common variable immunodeficiency. However, 0/964 infected children vs. 5/1157 non-infected children had selective IgA deficiency (P=0.048). It may be speculated that several immunological alterations, occurring simultaneously in perinatal HIV infection, surpass the functional defect exhibited in some children with selective IgA deficiency. Our data may shed light on the pathogenesis of selective IgA deficiency.
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Altavilla A, Giaquinto C, Giocanti D, Manfredi C, Aboulker JP, Bartoloni F, Cattani E, Lo Giudice M, Mellado Peña M, Nagler R, Peterson C, Vajnerova O, Bonifazi F, Ceci A. Activity of Ethics Committees in Europe on issues related to clinical trials in paediatrics: Results of a survey. ACTA ACUST UNITED AC 2009. [DOI: 10.3233/ppl-2009-0208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Altavilla
- Mediterranean University – Espace Ethique Méditerranéen, Bioethics Research Centre, Marseille, France
| | - C. Giaquinto
- Department of Paediatrics, University of Padova, Padova, Italy
| | - D. Giocanti
- Mediterranean University – Division of Legal Medicine, Marseille, France
| | - C. Manfredi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - J.-P. Aboulker
- Institut National de la Sante et Recherche Medicale, Villejuif, France
| | - F. Bartoloni
- I.RI.D.I.A. srl, Health Care Engineering, Bari, Italy
| | - E. Cattani
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - M. Lo Giudice
- Family paediatrician, AUSL 6 Palermo, Palermo, Italy
| | | | - R. Nagler
- Department of Oral and Maxillofacial Surgical and Oral Biochemistry Laboratory, Rambam Medical Center and Rappaport, Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - C. Peterson
- Department of Clinical Pharmacology, Linkopings Universitet, Linkopings, Sweden
| | - O. Vajnerova
- Department of Neurophysiology of Memory and Computational Neuroscience, Institute of Physiology, Academy of Sciences, Prague, Czech Republic
| | - F. Bonifazi
- I.RI.D.I.A. srl, Health Care Engineering, Bari, Italy
| | - A. Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
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Giaquinto C, Callegaro S, Andreola B, Bernuzzi M, Cantarutti L, D'Elia R, Drago S, De Marchi A, Falconi P, Felice M, Giancola G, Lista C, Manni C, Perin M, Pisetta F, Scamarcia A, Sidran MP, Da Dalt L. Prospective study of the burden of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years of age, in Padova, Italy. Infection 2008; 36:351-7. [PMID: 18633575 DOI: 10.1007/s15010-008-7200-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines. MATERIALS AND METHODS As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004--2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy). RESULTS A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6-23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77-6.43) and 3.38 (95% CI: 2.28-5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis. CONCLUSION Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings.
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Affiliation(s)
- C Giaquinto
- Dept. of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
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Anselmi A, Vendrame D, Rampon O, Giaquinto C, Zanchetta M, De Rossi A. Immune reconstitution in human immunodeficiency virus type 1-infected children with different virological responses to anti-retroviral therapy. Clin Exp Immunol 2007; 150:442-50. [PMID: 17956580 DOI: 10.1111/j.1365-2249.2007.03526.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Immune repopulation, despite virological failure, often occurs in children under highly active anti-retroviral therapy (HAART). The aim of this study was to analyse the characteristics of immune repopulation and activation in children with and without virological response to HAART. Fourteen human immunodeficiency virus type 1 (HIV-1)-infected children with suppression of HIV-1 plasma viraemia (virological responders, VR) and 16 virological non-responders (VNR) to therapy were studied at baseline and after approximately 2 years of HAART. During therapy, CD4+ T cells increased in both groups, but were higher in the VR than in the VNR group. All CD4+ T cell subsets (naive, central memory, effector/memory and CD38+) increased significantly in VR children, while there was a significant increase only in naive cells in VNR children. Naive CD8+ T cells and T cell receptor rearrangement excision circles (TREC), an indicator of thymic output, increased in both VR and VNR children. Activated CD8+ CD38+ T cells decreased in VR but remained high in VNR children. Levels of circulating lipopolysaccharide (LPS), an indicator of microbial translocation, further increased in VNR children. In conclusion, HAART induced an increase in naive cells in all children, regardless of their virological response. However, the persistence of viraemia resulted in an impaired expansion of memory CD4+ T cells susceptible to HIV-1 infection, and together with the microbial translocation sustained the persistence of a high level of immune activation.
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Affiliation(s)
- A Anselmi
- Department of Oncology and Surgical Sciences, Oncology Section, Unit of Viral Oncology, AIDS Reference Center, University of Padova, IOV-IRCCS, Padova, Italy
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Green H, Gibb DM, Walker AS, Pillay D, Butler K, Candeias F, Castelli-Gattinara G, Compagnucci A, Della Negra M, de Rossi A, Feiterna-Sperling C, Giaquinto C, Harper L, Levy J, Saidi Y, Wintergerst U. Lamivudine/abacavir maintains virological superiority over zidovudine/lamivudine and zidovudine/abacavir beyond 5 years in children. AIDS 2007; 21:947-55. [PMID: 17457088 DOI: 10.1097/qad.0b013e3280e087e7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 11/27/2022]
Abstract
OBJECTIVE To describe the long-term efficacy over 5 years of regimens including combinations of abacavir, lamivudine and/or zidovudine in previously untreated children in the PENTA 5 trial. DESIGN PENTA 5 was a 48-week randomised controlled trial comparing three dual nucleoside reverse transcriptase inhibitor (NRTI) combinations as part of first triple antiretroviral therapy (ART). METHODS 128 ART-naïve children were randomised to zidovudine\lamivudine (n = 36), zidovudine\abacavir (45) or lamivudine\abacavir (47). Asymptomatic children (n = 55) were also randomised to nelfinavir or placebo; all other children received open-label nelfinavir. Analyses are intent-to-treat and adjusted for minor baseline imbalances and receipt of nelfinavir/placebo. RESULTS Median follow-up was 5.8 years. By 5 years, 17 (47%), 28 (64%) and 18 (39%) children had changed their randomised NRTIs in the zidovudine\lamivudine, zidovudine\abacavir and lamivudine\abacavir groups respectively, but 18%, 50% and 50% of these changes were either early single drug substitutions for toxicity or switches with viral suppression (HIV-1 RNA < 400 copies/ml; e.g. to simplify regimen delivery). At 5 years, 55%/32% zidovudine\lamivudine, 50%/25% zidovudine\abacavir and 79%/63% lamivudine\abacavir had HIV-1 RNA < 400/< 50 copies/ml respectively (p = 0.03/p = 0.003). Mean increase in height-for-age 0.42, 0.68, 1.05 (p = 0.02); weight-for-age 0.03, 0.13, 0.75 (p = 0.02). Reverse transcriptase resistance mutations emerging on therapy differed between the groups: zidovudine\lamivudine (M41L, D67N, K70R, M184V, L210W, T215Y); zidovudine\abacavir (M41L, D67N, K70R, L210W, T215F/Y, K219Q); lamivudine\abacavir (K65R, L74V, Y115F, M184V). CONCLUSIONS Five year data demonstrate that lamivudine\abacavir is more effective in terms of HIV-1 RNA suppression and growth changes, with lower rates of switching with detectable HIV-1 RNA than zidovudine\lamivudine or zidovudine\abacavir, and should be preferred as first-line NRTI backbone.
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Affiliation(s)
- H Green
- MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK.
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Ceci A, Felisi M, Baiardi P, Bonifazi F, Catapano M, Giaquinto C, Nicolosi A, Sturkenboom M, Neubert A, Wong I. Medicines for children licensed by the European Medicines Agency (EMEA): the balance after 10 years. Eur J Clin Pharmacol 2006; 62:947-52. [PMID: 17021892 DOI: 10.1007/s00228-006-0193-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Accepted: 07/28/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The 1995-2005 balance of EMEA activities in the field of paediatric medicines was evaluated, taking into account the number both of drugs authorised for children and paediatric studies supporting the Marketing Authorisation (MA). METHODS Data on drugs authorised by EMEA were extracted from EPARs (European Public Assessment Reports). Active substance, year of approval, anatomical, therapeutic and chemical (ATC) code, indication, orphan status, ages, and registrative clinical studies characteristics were assessed. RESULTS The percentage of authorised substances for paediatrics is 33.3%. This percentage decreased or increased when different subsets of medicines were considered [medicines for children under 2 years (23.4%), N-ATC code drugs (6%) and orphan drugs (46.4%)]. A total of 165 trials were included in the MA dossiers of 51 drugs at the time of approval, and additional 22 studies were added to the dossiers of 12 active substances submitted for paediatric variations. PK and Efficacy/Safety studies were performed for 32 (52%) active substances, while either one PK or one Efficacy/Safety study was carried out for 43 (69%) and 45 (73%) substances, respectively. CONCLUSIONS This report demonstrates that the total number of paediatric medicines approved by EMEA is stable over the 10-year period, while an increase in drugs to treat serious or orphan diseases has been observed. In addition, under the Centralised Procedure, a valuable number of paediatric trials have been submitted to support drug approval.
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Affiliation(s)
- A Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Palestro 26, 27100, Pavia, Italy.
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Berto P, Bassi M, Incorvaia C, Frati F, Puccinelli P, Giaquinto C, Cantarutti L, Ortolani C. Cost effectiveness of sublingual immunotherapy in children with allergic rhinitis and asthma. Eur Ann Allergy Clin Immunol 2005; 37:303-8. [PMID: 17066648] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Economic evaluations are increasingly relevant in order to provide support for decision makers when judging about alternative ways to allocate public funds. Aim of this study was to evaluate the economic effect of treatment with high dose sublingual immunotherapy (SLIT) in children. METHODS The study involved one allergy center, located in the north of Milan, Italy. From the existing records of patients seen for allergic disease, we extracted all children and adolescents with allergic disease, who had 1-year data prior to receiving SLIT and 3-year data on SLIT. Outcome measures (number of exacerbations, visits, absence from nursery or school), direct costs (euros spent on drugs, specialist visits, SLIT) and indirect costs (costs resulting from children school and parental work loss) were analysed. A second analysis compared a sub-group of allergic asthmatic children with a control group for costs, based on records of patients not SLIT-treated, extracted from a network-database of paediatricians. RESULTS 135 patients were extracted, of which 46 had perennial, and 89 had seasonal allergy with comparable gender and age distribution. A substantial reduction was found in all outcome measures during SLIT compared with the before period. The average annual cost/patient was 2672 before SLIT initiation and _629/year during SLIT. Similar results were found for allergen subgroups. The asthma sub-analysis involved 41 children with SLIT and 35 controls. Again, SLIT patients showed a substantial reduction in outcome measures; the direct cost/patient over the whole follow-up (4 years) was _1182 for SLIT patients and _1100 for controls. CONCLUSION High dose SLIT may be effective in reducing the cost of allergic rhinitis and asthma and comparably expensive to conventional treatment in children with allergic asthma over a 4 years follow-up.
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Affiliation(s)
- P Berto
- Pbe consulting, Verona, Italy.
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40
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De Rossi A, Walker AS, Forni DD, Klein N, Gibb DM, Aboulker JP, Babiker A, Compagnucci A, Darbyshire J, Debré M, Gersten M, Giaquinto C, Gibb DM, Jones A, Aboulker JP, Babiker A, Blanche S, Bohlin AB, Butler K, Castelli-Gattinara G, Clayden P, Darbyshire J, Debré M, de Groot R, Faye A, Giaquinto C, Gibb DM, Griscelli C, Grosch-Wörner I, Levy J, Lyall H, Mellado Pena M, Nadal D, Peckham C, Ramos Amador JT, Rosado L, Rudin C, Scherpbier H, Sharland M, Tovo PA, Valerius N, Wintergerst U, Boucher C, Clerici M, de Rossi A, Klein N, Loveday C, Muñoz-Fernandez M, Pillay D, Rouzioux C, Babiker A, Darbyshire J, Gibb DM, Harper L, Johnson D, Kelleher P, McGee L, Poland A, Walker AS, Aboulker JP, Carrière I, Compagnucci A, Debré M, Eliette V, Leonardo S, Moulinier C, Saidi Y, Galli L, Foot A, Kershaw H, Caul O, Tarnow-Mordi W, Petrie J, McIntyre P, Appleyard K, Gibb DM, Novelli V, Klein N, McGee L, Ewen S, Johnson M, Gibb DM, Cooper E, Fisher T, Barrie R, Norman J, King D, Larsson-Sciard EL. Relationship between Changes in Thymic Emigrants and Cell-Associated HIV-1 Dna in HIV-1-Infected Children Initiating Antiretroviral Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives and methods To investigate the relationship between cell-associated HIV-1 dynamics and recent thymic T-cell emigrants, HIV-1 DNA and T-cell receptor rearrangement excision circles (TREC, a marker of recent thymic emigrants) were measured in peripheral blood mononuclear cells in 181 samples from 33 HIV-1-infected children followed for 96 weeks after antiretroviral therapy (ART) initiation. Results At baseline, HIV-1 DNA was higher in children with higher TREC ( P=0.02) and was not related to age, CD4 or HIV-1 RNA in multivariate analyses ( P>0.3). Overall, TREC increased and HIV-1 DNA decreased significantly after ART initiation, with faster HIV-1 DNA declines in children with higher baseline TREC ( P=0.009). The greatest decreases in HIV-1 DNA occurred in children with the smallest increases in TREC levels during ART ( P=0.002). However, this inverse relationship between changes in HIV-1 DNA and TREC tended to vary according to the phase of HIV-1 RNA decline ( P=0.13); for the same increase in TREC, HIV-1 DNA decline was much smaller during persistent or transient viraemia compared with stable HIV-1 RNA suppression. Conclusions Overall, these findings indicate that TREC levels predict HIV-1 DNA response to ART and suggest that immune repopulation by thymic emigrants adversely affects HIV-1 DNA decline in the absence of persistent viral suppression, possibly by providing a cellular source for viral infection and replication.
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Affiliation(s)
| | - Anita De Rossi
- Department of Oncology and Surgical Sciences, AIDS Reference Centre, Padova, Italy
| | | | - Davide De Forni
- Department of Oncology and Surgical Sciences, AIDS Reference Centre, Padova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Foot
- PHL Regional Virus Laboratory, Bristol
| | - H Kershaw
- PHL Regional Virus Laboratory, Bristol
| | - O Caul
- Ninewells Hospital and Medical School, Dundee
| | | | | | | | | | - DM Gibb
- Newham General Hospital, London
| | | | - N Klein
- Newham General Hospital, London
| | - L McGee
- Newham General Hospital, London
| | - S Ewen
- Newham General Hospital, London
| | | | - DM Gibb
- St Bartholemew's Hospital, London
| | - E Cooper
- St Bartholemew's Hospital, London
| | - T Fisher
- St Bartholemew's Hospital, London
| | | | - J Norman
- Chelsea and Westminster Hospital, London
| | - D King
- University College London Medical School
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Giacomet V, Albano F, Starace F, de Franciscis A, Giaquinto C, Gattinara GC, Bruzzese E, Gabiano C, Galli L, Viganò A, Caselli D, Guarino A. Adherence to antiretroviral therapy and its determinants in children with human immunodeficiency virus infection: a multicentre, national study. Acta Paediatr 2004; 92:1398-402. [PMID: 14971789 DOI: 10.1080/08035250310006737] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIM To investigate rates and determinants of adherence to antiretroviral therapy in Italian children infected with the human immunodeficiency virus (HIV). METHODS An observational, cross-sectional multicentre study was performed through a structured interview with the caregivers of HIV-infected children. The interview included quantitative information on adherence in the 4 d before interview. Sociodemographic, clinical and psychosocial characteristics of children were recorded. RESULTS 129 children (median age 96 mo) were enrolled, of whom 94 were on highly active antiretroviral therapy (HAART). Twenty-one (16%) omitted more than 5% of total doses in 4 d and were considered non-adherent. However, only 11% of caregivers reported that therapy had been administered at the correct times. No significant difference was found between age and the stage of HIV infection. Children aware of their HIV status were less adherent. Individual drugs showed a broad adherence pattern and children who received HAART were more adherent. Children receiving therapy from foster parents were more adherent than those receiving drugs from biological parents or relatives. CONCLUSIONS Adherence is a major problem in children. Psychological rather than clinical or sociodemographic features and types of drug are major determinants of adherence.
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Affiliation(s)
- V Giacomet
- Department of Paediatrics, Federico II University, Naples, Italy
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Newell M, Dunn D, Peckham C, Ades A, Pardi G, Semprini A, Giaquinto C, Truscia D, De Rossi A, Chieco-Bianchi L, Zachello F, Grosch-Worner I, Vocks-Hauck M, Langhof M, Mok J, Omenaca Teres F, Bates I, Garcia-Rodrigues M, Canosa C. Risk factors for mother-to-child transmission of HIV-1. Int J Gynaecol Obstet 2004. [DOI: 10.1016/0020-7292(92)90272-k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aboulker JP, Babiker A, Chaix ML, Compagnucci A, Darbyshire J, Debré M, Faye A, Giaquinto C, Gibb DM, Harper L, Saïdi Y, Walker AS. Highly active antiretroviral therapy started in infants under 3 months of age: 72-week follow-up for CD4 cell count, viral load and drug resistance outcome. AIDS 2004; 18:237-45. [PMID: 15075541 DOI: 10.1097/00002030-200401230-00013] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the feasibility and impact of highly active antiretroviral therapy (HAART) started in vertically HIV-1-infected infants less than 3 months of age. DESIGN A multicentre, phase I/II, non-randomized, open-label study (PENTA 7). METHODS Adverse events, plasma HIV-1 RNA, CD4 cell counts, CD4 cell percentage (CD4%) and clinical progression were recorded at baseline and prospectively to 72 weeks in order to assess the toxicity, tolerability and efficacy of a combination of stavudine, didanosine and nelfinavir. Selection of genotypic resistance was also investigated. RESULTS Twenty infants, of whom only three had Centers for Disease Control and Prevention stage B, initiated HAART at median age 2.5 months (range, 0.9-4.7) with median HIV-1 RNA concentration 5.5 log10 copies/ml (range, 3.2-6.8) and CD4% 33% (range, 11-66). Median follow-up was 96 weeks (range, 60-144). At week 72, 11 infants were still taking the original treatment. Few adverse events were reported related to treatment, all minor and causing treatment interruption in only three infants. No AIDS-defining events occurred; one child died of non-HIV-related causes (prematurity). All but two had CD4% > 25% at 72 weeks; however, 14 infants had virological failure and six acquired resistance mutations. CONCLUSIONS Early treatment with stavudine, didanosine and nelfinavir was well tolerated and associated with good clinical and immunological outcomes at week 72. However, a high rate of virological failure with emergence of genotypic resistance is of great concern. More palatable drug combinations for infants and closer drug monitoring are required.
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Barbato A, Panizzolo C, Biserna L, Cantarutti L, Giaquinto C, Frati F, Marcucci F, Monciotti C, Testi R, di Blasi P, Sturkenboom MCJM. Asthma prevalence and drug prescription in asthmatic children. Eur Ann Allergy Clin Immunol 2003; 35:47-51. [PMID: 12674038] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A cross-sectional study was conducted on among 28,856 children aged from birth to 14 years to determine the prevalence of asthma and assess its treatment in a sample of asthmatic children. Children diagnosed with asthma were identified by a sensitive algorithm applied to the information stored in the computerized medical records between 1997 and 1998. Pediatricians then reviewed and validated the diagnosis. Specific information was obtained, after age stratification under 5 yrs and over 6 ys, from the medical records and by interview regarding their personal details and treatment of asthmatic patients. In all, 1,263 cases of asthma were identified (64% males) with a prevalence of 6.3% among males and 4% among females in under 5 year-olds, and 3.9% for males and 2.1% for females in over 6 year-olds. The prevalence of asthma diagnosed directly by the pediatrician was consequently higher among under 5 year-olds, in both genders, than among the older children. Contrary to the international guidelines, pediatricians prescribed more oral corticosteroids and nebulized short-acting beta-2 agonists for children under 5 ys olds than for over 6 year-olds (13.3% Vs 4.8% and 25% Vs 10.9%, respectively, p < 0.001). For the > or = 6 year-olds, the most commonly prescribed treatments were oral antihistamines (13.9% Vs 12.6%), inhaled corticosteroids via metered-dose inhaler (30.8% Vs 28.7%) and sodium cromoglycate (12.1% Vs 4.8%, p < 0.001).
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Affiliation(s)
- A Barbato
- Dept of Pediatrics, University of Padova, Italy
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45
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Giaquinto C, Sturkenboom M, Mannino S, Arpinelli F, Nicolosi A, Cantarutti L. [Epidemiology and outcomes of varicella in Italy: results of a prospective study of children (0-14 years old) followed up by pediatricians (Pedianet study)]. Ann Ig 2002; 14:21-7. [PMID: 12389301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- C Giaquinto
- Laboratorio di Epidemiologia e Biostatistica, CNR/ITBA, Milano.
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46
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Affiliation(s)
- C Peckham
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK.
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Giaquinto C, De Romeo A, Giacomet V, Rampon O, Ruga E, Burlina A, De Rossi A, Sturkenboom M, D'Elia R. Lactic acid levels in children perinatally treated with antiretroviral agents to prevent HIV transmission. AIDS 2001; 15:1074-5. [PMID: 11399997 DOI: 10.1097/00002030-200105250-00023] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Giaquinto
- Department of Pediatrics, University of Padova, Padua, Italy
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48
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Affiliation(s)
- D M Gibb
- MRC Clinical Trials Unit, London, UK.
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49
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Giaquinto C, Del Mistro A, De Rossi A, Bertorelle R, Giacomet V, Ruga E, Minucci D. Vulvar carcinoma in a 12-year-old girl with vertically acquired human immunodeficiency virus infection. Pediatrics 2000; 106:E57. [PMID: 11015552 DOI: 10.1542/peds.106.4.e57] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report the first case of a girl with vertically acquired human immunodeficiency virus (HIV) infection, who developed invasive squamous cell carcinoma of the vulva at 12 years of age. Lesions resembling bowenoid papulosis covered the perianal area as well. She underwent a nonmutilating surgical excision of the infiltrating lesion. More than 3 years later, her clinical condition is excellent, although dysplastic, noninfiltrating multifocal lesions persist. This case highlights the need to perform careful periodic genital examinations in all HIV-infected children and adolescents born to HIV-positive mothers.
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Affiliation(s)
- C Giaquinto
- Department of Pediatrics, University of Padova, Padova, Italy.
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50
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Sharland M, Gibb D, Giaquinto C. Current evidence for the use of paediatric antiretroviral therapy--a PENTA analysis. Paediatric European Network for the Treatment of AIDS Steering Committee. Eur J Pediatr 2000; 159:649-56. [PMID: 11014462 DOI: 10.1007/pl00008400] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED The introduction of combination antiretroviral therapy has been associated with a dramatic clinical improvement in children with human immunodeficiency virus infection. However, the uptake of antiretroviral therapy has been variable across Europe. The Paediatric European Network for the Treatment of AIDS Steering Committee has performed a systematic literature review of paediatric antiretroviral therapy trials. An analysis of the evidence base for the commencement and maintenance of antiretroviral therapy was produced. Suggestions for when to commence antiretroviral therapy, which drugs to start with and how to monitor and sequence drug regimens are given. CONCLUSION The aim of these guidelines is to help in obtaining equity of access to a uniformly high standard of care for children with human immunodeficiency virus infection in all European countries.
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Affiliation(s)
- M Sharland
- Paediatric Infectious Diseases Unit, St. George's Hospital, London, UK.
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