Paediatric Virology and its interaction between basic science and clinical practice (Review)

The foundation of the Institute of Paediatric Virology on the island of Euboea, Greece (Review)

The Institute of Paediatric Virology, founded on October 2019 on the island of Euboea in Greece, introduces medical students, paediatric and neonatal trainees, postgraduate students, virologists, paediatric and allied health professionals to the bold, new, scientific field of paediatric virology. The institute is committed to medical education and is the sequel of the Paediatric Virology Study Group (PVSG), which was formed in 2007 in the United Kingdom by a group of young paediatric trainees and junior researchers. The main mission of the institute is to provide an educational e-platform on neonatal and paediatric viral infections, to facilitate scientific discussion between virologists and paediatric health professionals and to develop an international network aiming to the promotion of children's health by the prevention and treatment of viral infectious diseases. The foundation of the institute is dedicated to three children from a small fishing village at the south of the island of Euboea in Greece, who survived the 1918 Spanish flu pandemic.

Update on current views and advances on RSV infection (Review)

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood.

The perspectives and the challenges of Paediatric Radiology: An interview with Dr Georgia Papaioannou, Head of the Paediatric Radiology Department at the 'Mitera' Children's Hospital in Athens, Greece

Dr Georgia Papaioannou, MD, PhD, Head of the Paediatric Radiology Department at ‘Mitera’ Children's Hospital in Athens (Greece), is one of the most talented Paediatric Radiologists in Greece. She graduated from the Medical School of Athens of the National and Kapodistrian University of Athens in 1996 and she was trained in Radiology at the 2nd Department of Radiology of the Medical School of Athens and in Paediatric Radiology in Great Ormond Street Hospital for Children (GOSH) in London (UK). Her special interests focus on foetal magnetic resonance imaging (MRI) and special applications of paediatric MRI, such as MR enterography and MR urography. According to Dr Papaioannou, medical education in Paediatric Radiology has to be of excellent quality, raising professional career and academic opportunities. Paediatric Radiology focuses on the diagnostic imaging of foetuses, neonates, infants, children and adolescents and represents the oldest subspecialty of Radiology. The advent in technology and computer science, which is strongly associated with Radiology, has launched a new era for Paediatric Radiology training and practice. Digital imaging and archiving, telemedicine, fused imaging, evolution of sonographic equipment, computed tomography (CT) and MRI scanners have opened new horizons to the understating of paediatric physiology and pathophysiology and have contributed significantly in precision Medicine and the implication of targeted therapies into clinical practice. Modern paediatric imaging focuses on radiation protection issues and launches faster sequences in all modalities, in order to reduce the number and duration of sedation. The diagnosis of neonatal and paediatric viral infections is routinely clinical and laboratory; however, Paediatric Radiology assists the diagnostic approach by excluding other entities, if that is required, i.e., in complex cases or hospitalized children, and mainly by revealing associated complications.

Paediatric Virology and innovation in medical education: An interview with Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea (Greece) and Coordinator of the Paediatric Virology Study Group

Born in Chalkida in Greece, Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea, studied Medicine at the University of Crete School of Medicine, where he received his MD in 2002 and his PhD in Clinical Virology in 2006. He was trained in Paediatrics and Neonatology in Merseyside (UK), attending the 'Alder Hey' Children's Hospital's specialty training (ST) rotation programme and in Athens (Greece) at the 'Penteli' Children's Hospital and the 'MAKKA' Paediatric Infectious Diseases (PID) Unit of the 'Aghia Sophia' Children's Hospital. On October 10th, 2015, he presented the Paediatric Virology subspecialty's proposal, which up-to-date has attracted the critical interest of several international experts in the scientific fields of Neonatology, Paediatrics, PID and Virology and has been evaluated as a unique project of innovation in medical education. According to Dr Mammas, Paediatrics is the specialty, which daily provides the opportunity to support with responsibility the children's smile, the hope of life and future. He highlights the significant role of the Paediatric Virology Study Group (PVSG), a paediatric think tank, which was established by a group of paediatric trainees and young paediatricians in 2007 and since then has been involved with enthusiasm in the perspectives of Paediatric Virology in medical education. Dr Mammas strongly believes that in the future, Paediatric Virology subspecialists will have a strategically principal role, both clinical and academic, at the fight against viral infections in childhood. This aim will be supported by the newly founded Institute of Paediatric Virology (IPV), the first scientific initiative in the world committed to medical education on neonatal and paediatric viral infections.

Clinical Virology research and medical education in Greece: An interview with Demetrios A. Spandidos, Professor of Clinical Virology at the University of Crete in Greece

Professor Demetrios A. Spandidos, Professor Emeritus of Clinical Virology at the University of Crete School of Medicine in Crete, Greece, is a pioneer in world research in Virology, Oncology and medical education. He has been the first Professor of Clinical Virology at the University of Crete School of Medicine, the only School of Medicine with a separate Department of Clinical Virology in Greece. According to Professor Spandidos, the understanding of the interactions of viruses with human host cells is what enables the development of new vaccines and new therapies against a wide range of diseases in humans, including cancer. Over the past two decades, the expansion of new knowledge, treatments, prevention and management options and the emerging needs on neonatal and paediatric viral infections have made the role of future paediatric virologists more than necessary. For this reason, he strongly believes that Paediatric Virology should be recognized as a new paediatric subspecialty. Professor Spandidos declares that medical education is a continuous sequence from undergraduate to postgraduate/specialty/subspecialty medical training and continuing learning. He also supports the concept that the future of medical education represents the future of Medicine.

Peripheral immune cell markers in children with recurrent respiratory infections in the absence of primary immunodeficiency

The immune system of a child has a degree of immaturity that is maintained until 6–7 years of age. Immaturity may be due to age-related functional disorders in the immune response. A healthy child can contract a series of infections which contribute to the maturation of the immune system during the pre-pubertal period. If repeated infections with prolonged or severe complications occur during childhood, the presence of an immunodeficiency should then be considered. Much more frequent than primary immunodeficiency are recurrent infections (frequently involving the upper respiratory tract), which are less severe and occur under the conditions of an immune system with no apparent major defects. A child can present with 4 to 8 episodes of respiratory infections within a year, during the first 5 years of its life. The average duration of infection is 8 days and up to 2 weeks; if the child presents with 3 episodes of acute infections over a period of 6 months, the respiratory infections are then considered recurrent. The aim of this study was to identify the immunological changes or deviations that cause this clinical syndrome in children. For this purpose, 30 children with recurrent respiratory infections and 10 healthy children were included. Immunoglobulin levels were examined and immunophenotyping was performed. We found that the serum immunoglobulin levels were in the normal range in 70% of the children. On the contrary, our data revealed changes in peripheral cell populations, the most important being the decrease in the T-cluster of differentiation (CD)8⁺ and total B cell percentages and the increase in the number of memory B cells. The data obtained herein indicated that the decrease in the number of total B cells was mainly due to the decrease in the number of naive IgD⁺ B cells. On the whole, the findings of this study indicate that recurrent respiratory infections may be associated with an altered cellular immune response. In such situations, the investigation of immunological parameters, such as T and B cell subtypes could complete the clinical diagnosis and guide the treatment strategy, thus increasing the quality of life of patients.

Paediatric virology and human papillomaviruses: An update

Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.

Evaluating the proposal of paediatric virology: An interview with Professor Tina Dalianis, Professor of Tumour Virology at Karolinska Institutet

Professor Tina Dalianis, Professor of Tumour Virology at Karolinska Institutet in Stockholm, Sweden, is a well-known virologist with a strong international reputation and seminal contributions in tumour virology in the fields of human papillomaviruses (HPVs) and polyomaviruses. According to Professor Dalianis, over the past decades virology has significantly contributed to the understanding of many infectious diseases in medicine. In addition, quite a few antiviral therapies have been developed in recent years that have been very helpful, while the study of viruses has also provided valuable information about their host cells and basic cell biology. She highlights the association of HPVs with tonsillar and base of tongue cancers, as well as their epidemic rise. She also refers to additional biomarkers, which are under investigation, in order to better individualise patient care, by for example, de-escalating or targeted therapy, whenever this is possible. She clarifies that the current prophylactic vaccines against HPVs are very efficient for the types they are directed against and she hopes that boys will also soon be vaccinated against HPVs, particularly in countries where there is a low percentage of girls being vaccinated. According to Professor Dalianis, the knowledge of virology is very useful in general paediatric practice; the proposal of paediatric virology as a medical subspecialty is absolutely correct and it would be very useful, as there is much to be done. In the context of the '4th Workshop on Paediatric Virology', Professor Tina Dalianis will give the plenary lecture of this scientific event and will focus on changes in the prevalence of different HPVs in genital and oral samples in some groups of youth in Sweden during the introduction of the vaccines against HPVs.

The future of medical education in neonatology, paediatrics and paediatric virology: An interview with Professor Alan Michael Weindling, Professor of Perinatal Medicine at the University of Liverpool

Professor Alan Michael Weindling, Emeritus Professor of Perinatal Medicine at the University of Liverpool in the UK, is one of the pioneers of modern neonatal care worldwide with an enormous contribution to the care of premature babies in the city of Liverpool. During the last 3 decades, his contributions focused on the development of the clinical service, the training provided and the strong research achievements at Liverpool Women's Hospital NHS Trust, one of the most widely respected centres for neonatal medicine in western Europe. According to Professor Weindling, teaching a commitment to continuing lifelong learning as well as trying to make clinical care cost-effective is really important. He highlights the value of humility, holistic scientific approach, evidence-based medicine and multidisciplinary team working to neonatal and paediatric care. Looking back to neonatology as practiced in the 1990s, he accepts that since then, the overall standard of care has improved enormously. He supports that further neonatal care research is required for the prevention and treatment of acquired brain damage as well as on looking at ways of minimising stress for families, who have a child in an intensive care unit. He could see how for most trainees a module or series of lectures in paediatric infectious diseases would be helpful as part of their training and he estimates that in the future paediatric virology may become a specialist interest for a limited number of paediatric trainees. In the context of the ‘4th Workshop on Paediatric Virology’, which will be held in Athens, Greece, on September 22nd, 2018, Professor Weindling will receive the ‘2018 Paediatric Virology Award in Neonatology and Medical Education’.

Paediatric virology as a candidate of paediatric subspecialisation: An interview with Assistant Professor of Molecular Microbiology-Virology Angeliki Melidou

According to Professor Angeliki Melidou, Assistant Professor of Molecular Microbiology-Virology at the School of Medicine of the Aristotle University of Thessaloniki in Greece, recent advances in modern virology have important implications in the successful clinical management of neonatal and paediatric viral infections. On the other hand, preventive measures for infectious diseases and their complications, including vaccinations, proper regular examinations and early diagnosis, are equally crucial. Molecular genetics reveals a new era both in the detection of viral infections and in following up the infection and treatment, as well as identifying genetic predisposition that would affect disease course and outcome. Professor Melidou supports that paediatric virology as a candidate of paediatric subspecialisation would definitely play an important role in preparing specialised medical scientists. These scientists would be properly educated for the management of emerging and re-emerging viral infections, treatment options and schemes according to children's special needs, available prevention strategies and diagnostic capacities. In the context of the ‘4th Workshop on Paediatric Virology’, Professor Melidou's lecture will focus on the epidemiology of influenza virus types and subtypes in childhood.