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Bitnun A, Baron-Forbes M, Sauvé L, Fanella S. Hepatitis B prophylaxis of infants born to mothers with no antenatal care: Understanding the nuances in Canada. Paediatr Child Health 2024; 29:71. [PMID: 38586490 PMCID: PMC10996574 DOI: 10.1093/pch/pxad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 04/09/2024] Open
Affiliation(s)
- Ari Bitnun
- Hospital for Sick Children, Department of Pediatrics, University of Toronto
| | | | - Laura Sauvé
- Department of Pediatrics, Faculty of Medicine, UBC
| | - Sergio Fanella
- Pediatric Infectious Diseases Max Rady College of Medicine, Rady Faculty of Health Sciences
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Yea C, Barton M, Bitnun A, Morris SK, El Tal T, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Gill P, Nateghian A, Aski BH, Manafi AA, Dwilow R, Bullard J, Papenburg J, Scuccimarri R, Lefebvre MA, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Wong J, Saux NL, Bowes J, Purewal R, Lautermilch J, Foo C, Merckx J, Robinson J, Yeh EA. Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study. Can J Neurol Sci 2024; 51:40-49. [PMID: 36597285 PMCID: PMC9947047 DOI: 10.1017/cjn.2022.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. METHODS This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020-May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. RESULTS One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15-2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46-5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46-3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58-3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08-3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49-5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58-4.82; p < 0.001). DISCUSSION In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.
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Affiliation(s)
- Carmen Yea
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Anari Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
- Division of Microbiology, Dept. of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rosie Scuccimarri
- Division of Rheumatology, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Marie-Astrid Lefebvre
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Manish Sadarangani
- BC Children’s Hospital, Vancouver, BC, Canada
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - E. Ann Yeh
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, The Hospital of Sick Children, Toronto, Ontario, Canada
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Young JM, Chen V, Bitnun A, Read SE, Smith ML. Attention and neurodevelopment in young children who are HIV-exposed uninfected. AIDS Care 2024; 36:26-35. [PMID: 37523616 DOI: 10.1080/09540121.2023.2240069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACTChildren HIV-exposed, uninfected (CHEU) are at risk for compromised developmental outcomes. Attention is important for behavioural, cognitive and academic skills, yet has not been thoroughly investigated compared to children HIV-unexposed uninfected (CHUU). Fifty-five CHEU and 51 CHUU children were recruited at 5.5 years of age. Measures of inattention (IA), hyperactivity/impulsivity (HI) and total scores were collected using the parent-reported ADHD-Rating-Scale-IV. Measures of intelligence, visuomotor skills, academics and adaptive functioning were obtained. Analyses of between-group differences were performed as were correlational and multiple regression models, accounting for maternal education, employment and delivery type. Few children met clinical cut-offs for probable ADHD (3.6% CHEU, 2.0% CHUU), and no group differences in measures of IA, HI and combined scores were found. CHEU scored significantly lower than CHUU on intelligence, visuomotor function, academic skills and aspects of adaptive behaviour, though within age expectations. Lower Full-Scale IQ and Processing Speed were associated with higher IA in CHEU and lower adaptive functioning with higher IA in CHUU. Across both groups, children of unemployed mothers had more HI symptoms. CHEU were not at increased risk for attention difficulties at 5.5 years of age. Maternal employment status highlights the contribution of sociodemographic factors in shaping behaviour and neurodevelopment.
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Affiliation(s)
- Julia M Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Vanessa Chen
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
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Erdman LK, Boggild AK, Bitnun A. Imported congenital malaria caused by Plasmodium ovale: A case report. Ther Adv Infect Dis 2024; 11:20499361241229263. [PMID: 38312850 PMCID: PMC10838024 DOI: 10.1177/20499361241229263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/12/2024] [Indexed: 02/06/2024] Open
Abstract
We describe a 5-week-old term infant with Plasmodium ovale severe congenital malaria in a non-endemic setting. She presented with diarrhea, poor feeding, lethargy, hepatosplenomegaly, and severe anemia. She was fortuitously diagnosed with malaria on routine blood smear, and successfully treated with intravenous artesunate. Subsequent history revealed maternal malaria diagnosis and treatment during pregnancy in Nigeria. This case underscores the importance of obtaining maternal exposure history and considering malaria testing in pregnant women and infants with unexplained illness. It also contributes to the limited literature on congenital malaria and severe malaria caused by P. ovale.
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Affiliation(s)
- Laura K. Erdman
- Division of Pediatric Infectious Diseases, McMaster Children’s Hospital, 1200 Main St West, Hamilton, ON L8N 3Z5, Canada
| | - Andrea K. Boggild
- Tropical Disease Unit, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Division of Pediatric Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
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Smiljkovic M, Tat J, Richardson SE, Campigotto A, Cushing SL, Wolter NE, Dirks P, Bitnun A. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children. Pediatr Infect Dis J 2023:00006454-990000000-00607. [PMID: 37851970 DOI: 10.1097/inf.0000000000004140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Intracranial pyogenic complications of sinusitis in children can lead to serious sequelae. We characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period. METHODS Single-center retrospective chart review. Cases were identified based on International Classification of Diseases diagnostic codes (ICD)-9 and ICD-10 depending on the year and by reviewing all intracranial microbiological samples. RESULTS A total of 104 cases of complicated sinusitis were included after review of 1591 charts. Median age was 12 (IQR 9-14); 72 were male (69%). The most frequent complications were epidural empyema (n = 50, 48%), subdural empyema (n = 46, 44%) and Pott's puffy tumor (n = 27, 26%). 52% (n = 54) underwent neurosurgery and 46% (n = 48) underwent otolaryngological surgery. The predominant pathogen isolated from sterile site specimens was Streptococcus anginosus (n = 40, 63%), but polymicrobial growth was common (n = 24; 38%). The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). Persistent neurological sequelae (or death, n = 1) were found in 24% (n = 25) and were associated with the presence of cerebritis and extensive disease on neuroimaging ( P = 0.02 and P = 0.04, respectively). CONCLUSIONS Intracranial complications of sinusitis continue to cause significant morbidity in children. Polymicrobial infections are common, which reinforces the need for broad-spectrum empiric antibiotic therapy and cautious adjustment of the antibiotic regimen based primarily on sterile site cultures. The association of neurologic sequelae with the presence of cerebritis and extensive intracranial involvement on neuroimaging suggest that delayed diagnosis may be a contributor to adverse outcome.
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Affiliation(s)
- Mina Smiljkovic
- From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Tat
- From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatric Laboratory Medicine
| | | | | | | | | | - Peter Dirks
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Levison J, McKinney J, Duque A, Hawkins J, Bowden EVH, Dorland J, Bitnun A, Kazmi K, Campbell DM, MacGillivray J, Yudin MH, Powell A, Datta S, Abuogi L, Weinberg A, Rakhmanina N, Mareuil JW, Hitti J, Boucoiran I, Kakkar F, Rahangdale L, Seidman D, Widener R. Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study. Clin Infect Dis 2023; 77:1416-1422. [PMID: 37078712 PMCID: PMC10654886 DOI: 10.1093/cid/ciad235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.
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Affiliation(s)
- Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer McKinney
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Duque
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Emily Ver Hoeve Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Julie Dorland
- Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Kescha Kazmi
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Douglas M Campbell
- Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Anna Powell
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shreetoma Datta
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Natella Rakhmanina
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joanna Walsh Mareuil
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jane Hitti
- Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dominika Seidman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - Rebecca Widener
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Bitnun A, Sauvé L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Paediatr Child Health 2023; 28:307-323. [PMID: 37484040 PMCID: PMC10362956 DOI: 10.1093/pch/pxad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Bitnun A, Sauvé L, Fanella S. La réduction du risque d'infection périnatale chez les nouveau-nés de mères dont les soins prénatals étaient inappropriés. Paediatr Child Health 2023; 28:307-323. [PMID: 37484035 PMCID: PMC10362960 DOI: 10.1093/pch/pxad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Le risque que des infections maternelles ne soient ni décelées ni traitées augmente lorsque les soins prénatals sont inappropriés, ce qui met la santé de la mère et de son nouveau-né à risque. Lorsqu'une femme enceinte se présente tardivement pour recevoir des soins, les tests systématiques qui influent sur la prise en charge du nouveau-né devraient inclure l'antigène de surface de l'hépatite B (AgHBs), la sérologie du virus de l'hépatite C (VHC), du virus de l'immunodéficience humaine (VIH) et de la syphilis, de même que le dépistage de la Chlamydia trachomatis et de la Neisseria gonorrhoeae. Si la mère ne s'est pas soumise aux dépistages avant ou après l'accouchement et qu'elle n'est pas disponible pour s'y soumettre, il faudrait procéder au dépistage du VIH, du virus de l'hépatite B (VHB), du VHC et de la syphilis chez le nouveau-né. Le dépistage de la C. trachomatis et de la N. gonorrhoeae est toutefois réservé aux cas où le nouveau-né démontre des manifestations cliniques compatibles avec ces infections. Il est optimal d'obtenir rapidement les résultats du dépistage du VIH, du VHB et de la syphilis, car l'utilisation des traitements préventifs est circonscrite dans le temps. Il existe des interventions préventives précoces et efficaces pour les nouveau-nés à risque de VIH, de VHB, de syphilis ou de gonorrhée. Un suivi clinique étroit et des tests de suivi s'imposent auprès des nouveau-nés de mères dont les soins prénatals étaient inappropriés, car il est impossible d'exclure pleinement toutes les infections pendant la période périnatale.
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Affiliation(s)
- Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Laura Sauvé
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Sergio Fanella
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
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Campigotto A, Chris A, Orkin J, Lau L, Marshall C, Bitnun A, Buchan SA, MacDonald L, Thampi N, McCready J, Juni P, Parekh RS, Science M. Utility of SARS-CoV-2 Genomic Sequencing for Understanding Transmission and School Outbreaks. Pediatr Infect Dis J 2023; 42:324-331. [PMID: 36795555 PMCID: PMC9990487 DOI: 10.1097/inf.0000000000003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE An understanding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in schools is important. It is often difficult, using epidemiological information alone, to determine whether cases associated with schools represent multiple introductions from the community or transmission within the school. We describe the use of whole genome sequencing (WGS) in multiple schools to investigate outbreaks of SARS-CoV-2 in the pre-Omicron period. STUDY DESIGN School outbreaks were identified for sequencing by local public health units based on multiple cases without known epidemiological links. Cases of SARS-CoV-2 from students and staff from 4 school outbreaks in Ontario underwent WGS and phylogenetic analysis. The epidemiological clinical cohort data and genomic cluster data are described to help further characterize these outbreaks. RESULTS A total of 132 positive SARS-CoV-2 cases among students and staff from 4 school outbreaks were identified with 65 (49%) of cases able to be sequenced with high-quality genomic data. The 4 school outbreaks consisted of 53, 37, 21 and 21 positive cases; within each outbreak there were between 8 and 28 different clinical cohorts identified. Among the sequenced cases, between 3 and 7 genetic clusters, defined as different strains, were identified in each outbreak. We found genetically different viruses within several clinical cohorts. CONCLUSIONS WGS, together with public health investigation, is a useful tool to investigate SARS-CoV-2 transmission within schools. Its early use has the potential to better understand when transmission may have occurred, can aid in evaluating how well mitigation interventions are working and has the potential to reduce unnecessary school closures when multiple genetic clusters are identified.
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Affiliation(s)
- Aaron Campigotto
- From the Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | | | | | - Lynette Lau
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine
| | - Christian Marshall
- Department of Laboratory Medicine and Pathobiology, University of Toronto
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine
| | - Ari Bitnun
- Department of Paediatrics
- Division of Infectious Diseases, The Hospital for Sick Children
| | - Sarah A Buchan
- Public Health Ontario
- Dalla Lana School of Public Health, University of Toronto
| | | | - Nisha Thampi
- Department of Paediatrics, Children’s Hospital of Eastern Ontario
| | - Janine McCready
- Division of Infectious Diseases, Department of Medicine, Michael Garron Hospital
| | - Peter Juni
- St. Michael’s Hospital, Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto
| | - Rulan S Parekh
- Department of Medicine, Women’s College Hospital, Toronto, ON, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children
- Public Health Ontario
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Carvalho S, Lee T, Tulloch KJ, Sauve LJ, Samson L, Brophy JC, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Prescribing patterns of antiretroviral treatments during pregnancy for women living with HIV in Canada 2004-2020: A surveillance study. HIV Med 2023; 24:130-138. [PMID: 35699235 DOI: 10.1111/hiv.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. METHODS The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. RESULTS We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. CONCLUSION In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
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Affiliation(s)
- Sabrina Carvalho
- Faculty of Pharmacy, Université de Montréal, and Research Centre of the Saint-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Karen J Tulloch
- Department of Pharmacy, British Columbia Women's Hospital and Health Centre and Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura J Sauve
- Department of Pediatrics, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason C Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- Department of Health Care and Epidemiology, University of British Columbia and CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, British Columbia Women's Health Research Institute and Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, and Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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11
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Schneidman J, Lee T, Sauve L, Brophy J, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small-for-gestational age births in Canada, a retrospective cohort study. Int J Gynaecol Obstet 2023. [PMID: 36707102 DOI: 10.1002/ijgo.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational age (SGA) birth among pregnant women and people living with HIV in Canada. METHODS Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time-dependent Cox proportional hazards models. RESULTS Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor-(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor- (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005). CONCLUSION INSTI-based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV.
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Affiliation(s)
- Jillian Schneidman
- Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Laura Sauve
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
| | - Deborah Money
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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12
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Khan S, Tsang KK, Brophy J, Kakkar F, Kennedy VL, Boucoiran I, Yudin MH, Money D, Read S, Bitnun A. Canadian Paediatric and Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context. Journal of the Association of Medical Microbiology and Infectious Disease Canada 2023; 8:7-17. [PMID: 37008587 PMCID: PMC10052908 DOI: 10.3138/jammi-2022-11-03] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries. Methods: The Canadian Paediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and pediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure. Results: The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring, and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area. Conclusion: The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.
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Affiliation(s)
- Sarah Khan
- McMaster Children’s Hospital, Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kara K. Tsang
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - V Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital and Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark H. Yudin
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, an associate member in the Department of Medicine and the School of Population and Public Health, Faculty of Medicine, an Associate Member of the Department of Microbiology & Immunology, Faculty of Science, at the University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Read
- Department of Pediatrics and Pathobiology, University of Toronto, Toronto, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, and Professor, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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13
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Sehr Ansari N, Watson DC, Campbell DM, Sarhan MA, Bitnun A, Gauda EB. SARS-CoV-2 Infection of Young Infants during the Omicron Wave: A Case Series. Biomed Hub 2023; 8:10-14. [PMID: 36747882 PMCID: PMC9892994 DOI: 10.1159/000528534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023] Open
Abstract
We describe the clinical course of 4 infants infected with severe acute respiratory syndrome coronavirus 2. All were admitted to our tertiary care neonatal intensive care unit during the Omicron variant wave in our region. All 4 infants, who were less than 3 months of age, including three born prematurely, presented with critical illness. However, their clinical presentation varied considerably. Of them, two infants presented with apnea, one with respiratory distress, and one with gastrointestinal manifestation. Our experience with these four infants provides evidence for a severe form of disease and varied clinical presentation in neonates and young infants speculated to be infected with Omicron variant.
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Affiliation(s)
- Najmus Sehr Ansari
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada,*Najmus Sehr Ansari,
| | - Douglas C. Watson
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Mohammed A. Sarhan
- Division of Medical Microbiology, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Estelle B. Gauda
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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14
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Aoki H, Bitnun A, Kitano T. The cost-effectiveness of maternal and neonatal screening for congenital cytomegalovirus infection in Japan. J Med Virol 2023; 95:e28391. [PMID: 36484373 DOI: 10.1002/jmv.28391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/08/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Congenital cytomegalovirus infection is the most common congenital infection. Using a decision tree model, cost-effectiveness of maternal screening with subsequent prenatal valacyclovir treatment and newborn screening with neonatal valganciclovir treatment was evaluated. The incremental cost-effectiveness ratio (ICER) was calculated for (1) universal maternal antibody screening with prenatal valacyclovir treatment compared to targeted newborn screening, and (2) universal newborn screening with postnatal valganciclovir treatment compared to targeted newborn screening. We performed a one-way sensitivity analysis. Compared to targeted newborn screening, the ICERs for universal newborn screening and maternal screening were 2 966 296 Japanese Yen (JPY) (21 188 USD) and 1 026 984 JPY (7336 USD), respectively. In all scenarios in the one-way sensitivity analysis, the ICERs of the maternal screening and the universal newborn screening strategies were less than three gross domestic product per capita compared with the targeted newborn screening strategy. Both maternal and universal newborn screening strategies may be cost-effective than a targeted newborn screening program. The potential utility of the maternal screening with valacyclovir treatment strategy, while potentially cost effective in regions with lower baseline seroprevalence rates, requires further study as the modeling was based on limited evidence.
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Affiliation(s)
- Hirosato Aoki
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Ari Bitnun
- Department of Paediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taito Kitano
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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Science M, Caldeira-Kulbakas M, Parekh RS, Maguire BR, Carroll S, Anthony SJ, Bitnun A, Bourns LE, Campbell DM, Cohen E, Dodds A, Dubey V, Friedman JN, Greenwood JL, Hopkins JP, Imgrund R, Korczak DJ, Looi T, Louca E, Mertz D, Nashid J, Panzera G, Schneiderman JE, Schwartz KL, Streitenberger L, Vuppal S, Walsh CM, Jüni P, Matava CT, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. Effect of Wearing a Face Mask on Hand-to-Face Contact by Children in a Simulated School Environment: The Back-to-School COVID-19 Simulation Randomized Clinical Trial. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. INTERVENTIONS Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). MAIN OUTCOMES AND MEASURES The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. RESULTS A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). CONCLUSIONS AND RELEVANCE In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
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16
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Tehseen S, Williams S, Robinson J, Morris SK, Bitnun A, Gill P, Tal TE, Yeh A, Yea C, Ulloa‐Gutierrez R, Brenes‐Chacon H, Yock‐Corrales A, Ivankovich‐Escoto G, Soriano‐Fallas A, Papenburg J, Lefebvre M, Scuccimarri R, Nateghian A, Aski BH, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Forbes M, Saux NL, Bowes J, Purewal R, Lautermilch J, Bayliss A, Wong JK, Leifso K, Foo C, Panetta L, Kakkar F, Piche D, Viel‐Theriault I, Merckx J, Lieberman L. Thrombosis and hemorrhage experienced by hospitalized children with SARS-CoV-2 infection or MIS-C: Results of the PICNIC registry. Pediatr Blood Cancer 2022; 69:e29793. [PMID: 35689507 PMCID: PMC9350140 DOI: 10.1002/pbc.29793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Coagulopathy and thrombosis associated with SARS-CoV-2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited. METHODS An international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS-CoV-2 and multisystem inflammatory syndrome (MIS-C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub-study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes. RESULTS Nine hundred eighty-five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection, 288 had MIS-C (31.4%), and 242 (26.4%) had SARS-CoV-2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p-value .007), respiratory support (p-value .006), central venous catheter (CVC) (p = .04) in children with primary SARS-CoV-2 and in those with MIS-C included respiratory support (p-value .03), obesity (p-value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS-CoV-2 infection and in those with MIS-C encompassed thrombocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage. CONCLUSION Thrombosis and hemorrhage are uncommon events in children with SARS-CoV-2; largely experienced by those with pre-existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS-CoV-2 infection requires ongoing research.
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Affiliation(s)
- Sarah Tehseen
- Department of Laboratory medicine and PediatricsUniversity of Saskatchewan, SHASaskatoonSaskatchewanCanada
| | - Suzan Williams
- Division of Hematology OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Joan Robinson
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Shaun K. Morris
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ari Bitnun
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Peter Gill
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Tala El Tal
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ann Yeh
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Carmen Yea
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Rolando Ulloa‐Gutierrez
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Helena Brenes‐Chacon
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Adriana Yock‐Corrales
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Gabriela Ivankovich‐Escoto
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Alejandra Soriano‐Fallas
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Jesse Papenburg
- Department of PediatricsMcGill UniversityMontrealQuebecCanada
| | | | | | - Alireza Nateghian
- Department of PediatricsIran University of Medical SciencesTehranIran
| | | | - Rachel Dwilow
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Jared Bullard
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Suzette Cooke
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Lea Restivo
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison Lopez
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manish Sadarangani
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Vaccine Evaluation CenterBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada
| | - Ashley Roberts
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Forbes
- Department of PediatricsWestern UniversityLondonOntarioCanada
| | - Nicole Le Saux
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Jennifer Bowes
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Rupeena Purewal
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Janell Lautermilch
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Ann Bayliss
- Department of PediatricsTrillium Health PartnersMississaugaOntarioCanada
| | | | - Kirk Leifso
- Department of PediatricsQueen's UniversityKingstonOntarioCanada
| | - Cheryl Foo
- Department of PediatricsMemorial UniversitySt John'sNewfoundland and LabradorCanada
| | - Luc Panetta
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Fatima Kakkar
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Dominique Piche
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lani Lieberman
- Department of Laboratory Medicine and PathobiologyUniversity Health NetworkTorontoOntarioCanada
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17
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Robinson J, Dewan T, Morris SK, Bitnun A, Gill P, Tal TE, Laxer RM, Yeh EA, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Papenburg J, Lefebvre MA, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Le Saux N, Bowes J, Purewal R, Lautermilch J, Wong JK, Piche D, Top KA, Foo C, Panetta L, Merckx J, Barton M. SARS-CoV-2 infection in technology-dependent children: a multicenter case series. Infection 2022; 51:737-741. [PMID: 36038707 PMCID: PMC9423690 DOI: 10.1007/s15010-022-01910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. Methods Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. Results Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. Conclusion Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge.
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Affiliation(s)
- Joan Robinson
- Department of Pediatrics, University of Alberta, 3-556ECHA, Edmonton, AB, T6G 1C9, Canada.
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John's, NL, Canada
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON, Canada
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18
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Kordy F, Nashid N, Khan S, Read S, Macdougall G, Louch D, Arneson C, Bitnun A. Video directly observed therapy to improve adherence of human immunodeficiency virus infected adolescents to combination antiretroviral therapy: a proof-of-concept study. AIDS Care 2022; 35:417-424. [PMID: 35914111 DOI: 10.1080/09540121.2022.2104794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Adherence to antiretroviral therapy (ART) is a major challenge for many youth living with HIV (YLWH). In this prospective proof-of-concept study, we assessed the feasibility and acceptability of conducting a study of video directly observed therapy (VDOT) as a method of improving medication adherence in YLWH who had a history of poor adherence to ART. The study had four phases; phase I - VDOT daily (4 months) using Facetime®; phase II - daily texting (2 months); phase III - weekly texting (3 months); phase IV - no intervention (3 months). Participants were seen in clinic on a monthly basis for assessment and laboratory evaluation. Five of eight eligible participants were enrolled. All achieved virologic suppression one month after enrollment. Three of five completed the study protocol and maintained virologic suppression through the 12-month period of study. Participant responses to the end-of-study questionnaire indicated satisfaction with the intervention and thought VDOT was helpful to them. Healthcare providers thought that the intervention was effective for some youth but was at times burdensome. This proof-of-concept study demonstrated that VDOT may be effective at improving medication adherence in previously poorly adherent YLWH and that larger studies of VDOT for such patients are both feasible and warranted.
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Affiliation(s)
- Faisal Kordy
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Nancy Nashid
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sarah Khan
- Department of Pediatrics, McMaster Children's Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Stanley Read
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Georgina Macdougall
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Debra Louch
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Cheryl Arneson
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
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19
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Schober T, Caya C, Barton M, Bayliss A, Bitnun A, Bowes J, Brenes-Chacon H, Bullard J, Cooke S, Dewan T, Dwilow R, El Tal T, Foo C, Gill P, Haghighi Aski B, Kakkar F, Lautermilch J, Lefebvre MA, Leifso K, Le Saux N, Lopez A, Manafi A, Merckx J, Morris SK, Nateghian A, Panetta L, Petel D, Piché D, Purewal R, Restivo L, Roberts A, Sadarangani M, Scuccimarri R, Soriano-Fallas A, Tehseen S, Top KA, Ulloa-Gutierrez R, Viel-Theriault I, Wong J, Yea C, Yeh A, Yock-Corrales A, Robinson JL, Papenburg J. Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001440. [PMID: 36053578 PMCID: PMC9358955 DOI: 10.1136/bmjpo-2022-001440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection. DESIGN Multicentre retrospective cohort study. SETTING 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021. PATIENTS Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C). MAIN OUTCOME MEASURE Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses. RESULTS We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease. CONCLUSION We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatima Kakkar
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kirk Leifso
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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20
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Affiliation(s)
- Michael Prodanuk
- Department of Paediatrics (Prodanuk, Arje, Bitnun), Faculty of Medicine, University of Toronto; Division of Infectious Diseases (Groves, Bitnun), The Hospital for Sick Children, Toronto, Ont.
| | - Helen Groves
- Department of Paediatrics (Prodanuk, Arje, Bitnun), Faculty of Medicine, University of Toronto; Division of Infectious Diseases (Groves, Bitnun), The Hospital for Sick Children, Toronto, Ont
| | - Danielle Arje
- Department of Paediatrics (Prodanuk, Arje, Bitnun), Faculty of Medicine, University of Toronto; Division of Infectious Diseases (Groves, Bitnun), The Hospital for Sick Children, Toronto, Ont
| | - Ari Bitnun
- Department of Paediatrics (Prodanuk, Arje, Bitnun), Faculty of Medicine, University of Toronto; Division of Infectious Diseases (Groves, Bitnun), The Hospital for Sick Children, Toronto, Ont
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21
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Tam J, Lau E, Read S, Bitnun A. Is Routine Therapeutic Drug Monitoring of Anti-Retroviral Agents Warranted in Children Living with HIV? J Pediatr Pharmacol Ther 2022; 27:551-557. [DOI: 10.5863/1551-6776-27.6.551] [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] [Received: 05/09/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
The utility of routine therapeutic drug monitoring (TDM) in children living with HIV has not been extensively studied. The purpose of this study was to assess this strategy.
METHODS
This was a single-center, prospective observational study of routine TDM for protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and integrase strand transfer inhibitors (INSTIs) in children living with HIV who were receiving antiretroviral therapy (ART) between February and December 2014. Outcome measures included the proportion of serum antiretroviral (ARV) medication concentrations in the therapeutic range (target values extrapolated from adult data) and the effect of serum concentrations on virologic control, medication adherence, and toxicity.
RESULTS
Forty-eight children with a median age of 13 years (interquartile range, 3–18) were included. Median viral load (VL) and CD4% were <40 copies/mL (range, <40–124) and 37.4% (range, 8.4–47.9), respectively. Adherence was considered excellent in 95.8% of patients. Of the 50 serum trough concentrations (PI n = 19 [38%]; NNRTI n = 27 [54%]; INSTI n = 4 [8%]), 66% (n = 33) were in the therapeutic range, 12% (n = 6) were subtherapeutic, and 22% (n = 11) were supratherapeutic. There was no statistically significant correlation between serum ARV concentrations and patient demographics, VL, CD4%, or adherence. No clinically significant adverse events were noted. One dose adjustment was made for a subtherapeutic serum raltegravir concentration, likely attributable to interaction with ritonavir.
CONCLUSIONS
This study does not support routine TDM in healthy children living with HIV who are well controlled on antiretroviral medication regimens. A more targeted strategy, such as when adherence is questioned or when there are suspected drug interactions, may be more appropriate.
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Affiliation(s)
- Jennifer Tam
- Division of Infectious Diseases, Department of Pediatrics (JT, SR, AB), The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto (JT, EL, SR, AB), Toronto, ON, Canada
- Division of Infectious Diseases, Department of Pediatrics (JT), BC Children's Hospital, Vancouver, BC, Canada
| | - Elaine Lau
- University of Toronto (JT, EL, SR, AB), Toronto, ON, Canada
- Department of Pharmacy (EL), The Hospital for Sick Children, Toronto, ON, Canada
| | - Stanley Read
- Division of Infectious Diseases, Department of Pediatrics (JT, SR, AB), The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto (JT, EL, SR, AB), Toronto, ON, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics (JT, SR, AB), The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto (JT, EL, SR, AB), Toronto, ON, Canada
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22
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Sarhan MA, Casalino M, Paopongsawan P, Gryn D, Kulkarni T, Bitnun A, Gauda EB. SARS-CoV-2 Associated Respiratory Failure in a Preterm Infant and the Outcome after Remdesivir Treatment. Pediatr Infect Dis J 2022; 41:e233-e234. [PMID: 35213865 PMCID: PMC8997016 DOI: 10.1097/inf.0000000000003504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/29/2022]
Abstract
Severe coronavirus disease 2019 (COVID-19) occurs in approximately 10% of neonates infected with severe acute respiratory syndrome coronavirus 2. Guidelines for optimal management of severe COVID-19 in neonates do not exist. In this report, we describe a late-preterm neonate with severe COVID-19, requiring invasive mechanical ventilation who recovered following treatment with remdesivir and high dose dexamethasone.
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Affiliation(s)
- Mohammed A Sarhan
- From the Division of Medical Microbiology, Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Maria Casalino
- Laboratory Medicine and Pathobiology, Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pongsatorn Paopongsawan
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Khon Kaen, Thailand
| | - David Gryn
- Department of Pediatrics, Mackenzie Health, Richmond Hill, Ontario
| | - Tapas Kulkarni
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Estelle B Gauda
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
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23
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Merckx J, Cooke S, El Tal T, Bitnun A, Morris SK, Yeh EA, Yea C, Gill P, Papenburg J, Lefebvre MA, Scuccimarri R, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Dewan T, Restivo L, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Leifso K, Foo C, Robinson J. Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study. CMAJ 2022; 194:E513-E523. [PMID: 35410860 PMCID: PMC9001008 DOI: 10.1503/cmaj.210873] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Suzette Cooke
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tala El Tal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ari Bitnun
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Shaun K Morris
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - E Ann Yeh
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Carmen Yea
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Peter Gill
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jesse Papenburg
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marie-Astrid Lefebvre
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rosie Scuccimarri
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rolando Ulloa-Gutierrez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Helena Brenes-Chacon
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Adriana Yock-Corrales
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Gabriela Ivankovich-Escoto
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alejandra Soriano-Fallas
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marcela Hernandez-de Mezerville
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tammie Dewan
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Lea Restivo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alireza Nateghian
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Behzad Haghighi Aski
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ali Manafi
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rachel Dwilow
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jared Bullard
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alison Lopez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Manish Sadarangani
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ashley Roberts
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Michelle Barton
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Dara Petel
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Nicole Le Saux
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jennifer Bowes
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rupeena Purewal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Janell Lautermilch
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Sarah Tehseen
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ann Bayliss
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jacqueline K Wong
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Kirk Leifso
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Cheryl Foo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Joan Robinson
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta.
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24
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Cushing SL, Purcell PL, Papaiaonnou V, Neghandi J, Daien M, Blaser SI, Ertl-Wagner B, Wagner M, Sheng M, James AL, Bitnun A, Papsin BC, Gordon KA. Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences. Laryngoscope 2022; 132 Suppl 11:S1-S24. [PMID: 35302239 DOI: 10.1002/lary.30108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. METHODS In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. RESULTS All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. CONCLUSIONS cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia L Purcell
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vicky Papaiaonnou
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Neghandi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maya Daien
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics (Infectious Diseases), University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Young JM, Bitnun A, Read SE, Smith ML. Neurodevelopment of HIV-exposed uninfected children compared with HIV-unexposed uninfected children during early childhood. Dev Psychol 2022; 58:551-559. [PMID: 35286108 DOI: 10.1037/dev0001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
HIV-exposed uninfected (HEU) children during the preschool and early school ages may be at-risk for neurodevelopmental challenges due to in utero and perinatal exposure to HIV and/or antiretroviral (ARV) medications. HEU children and HIV-unexposed uninfected (HUU) children from the community were recruited and tested at 3 to 4 and 5 to 6 years of age. Demographic information, HIV/ARV exposure and measures of intelligence, visuomotor skills, and adaptive functioning were obtained. Nonparametric tests assessed group differences and multiple regression analyses adjusted for demographic variables. Additional multiple regression analyses were performed within the HEU group to investigate associations between neurodevelopmental measures and variables of HIV/ARV exposure. At 3 to 4 years, 211 HEU children and 31 HUU children were assessed, and 144 HEU children and 58 HUU children were assessed at 5 to 6 years of age. At 3 to 4 years of age, HEU children scored significantly lower on measures of Full-Scale IQ, Performance IQ, visual motor integration, and adaptive functioning. At 5 to 6 years of age, HEU children scored significantly lower on all neurodevelopmental measures. At both ages, children who were female and those with mothers who were employed achieved higher scores on measures intellectual ability and/or adaptive functioning. Within the HEU group, no consistent associations were found between neurodevelopmental measures and HIV/ARV specific variables. HEU children demonstrated significantly lower scores on neurodevelopmental measures than HUU children during early childhood. Gaps in verbal intellectual abilities were identified with age, highlighting the importance of monitoring neurodevelopment in this population over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Julia M Young
- Department of Psychology, The Hospital for Sick Children
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children
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26
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Merckx J, Morris SK, Bitnun A, Gill P, El Tal T, Laxer RM, Yeh A, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Papenburg J, Lefebvre MA, Nateghian A, Haghighi Aski B, Manafi A, Dwilow R, Bullard J, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Viel-Thériault I, Piche D, Top KA, Leifso K, Foo C, Panetta L, Robinson J. Infants hospitalized for acute COVID-19: disease severity in a multicenter cohort study. Eur J Pediatr 2022; 181:2535-2539. [PMID: 35217918 PMCID: PMC8880297 DOI: 10.1007/s00431-022-04422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
Age is the most important determinant of COVID-19 severity. Infectious disease severity by age is typically J-shaped, with infants and the elderly carrying a high burden of disease. We report on the comparative disease severity between infants and older children in a multicenter retrospective cohort study of children 0 to 17 years old admitted for acute COVID-19 from February 2020 through May 2021 in 17 pediatric hospitals. We compare clinical and laboratory characteristics and estimate the association between age group and disease severity using ordinal logistic regression. We found that infants comprised one-third of cases, but were admitted for a shorter period (median 3 days IQR 2-5 versus 4 days IQR 2-7), had a lower likelihood to have an increased C-reactive protein, and had half the odds of older children of having severe or critical disease (OR 0.50 (95% confidence interval 0.32-0.78)). Conclusion: When compared to older children, there appeared to be a lower threshold to admit infants but their length of stay was shorter and they had lower odds than older children of progressing to severe or critical disease. What is Known: • A small proportion of children infected with SARS-CoV-2 require hospitalization for acute COVID-19 with a subgroup needing specialized intensive care to treat more severe disease. • For most infectious diseases including viral respiratory tract infections, disease severity by age is J-shaped, with infants having more severe disease compared to older children. What is New: • One-third of admitted children for acute COVID-19 during the first 14 months of the pandemic were infants. • Infants had half the odds of older children of having severe or critical disease.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ronald M. Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada ,Department of Pediatrics, McGill University, Montreal, QC Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Alison Lopez
- British Columbia Children’s Hospital, Vancouver, BC Canada
| | - Manish Sadarangani
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Ashley Roberts
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, ON Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, ON Canada
| | | | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Karina A. Top
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Kirk Leifso
- Department of Pediatrics, Queen’s University, Kingston, ON Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Luc Panetta
- Department of Pediatrics, Université de Montréal, Montreal, QC Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada
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27
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Tat J, Smiljkovic M, Richardson SE, Campigotto A, Cushing S, Wolter NE, Dirks P, Bitnun A. 264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.466] [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
Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019).
Methods
Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid.
Results
108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019.
Conclusion
Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment.
Disclosures
Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)
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Affiliation(s)
- Jennifer Tat
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Sharon Cushing
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Peter Dirks
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Hospital for Sick Children, Toronto, ON, Canada
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Yeung T, Chung E, Chen J, Erdman LK, Smiljkovic M, Wong W, Rolnitsky A, Morris SK, El Shahed A, Banihani R, Bitnun A, Tomlinson C. Therapeutic Drug Monitoring of Moxifloxacin to Guide Treatment of Mycoplasma hominis Meningitis in an Extremely Preterm Infant. J Pediatr Pharmacol Ther 2021; 26:857-862. [PMID: 34790077 DOI: 10.5863/1551-6776-26.8.857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Abstract
Mycoplasma hominis (M hominis) is a rare cause of neonatal bacterial meningitis. Treatment can be challenging because of M hominis' intrinsic antibiotic resistance and the difficulty in accessing antimicrobial susceptibility testing. In this report, we describe an extremely preterm male infant with seizures who had a subsequent diagnosis of M hominis meningitis. Because of severity of illness, doxycycline (4 mg/kg IV every 24 hours) and moxifloxacin (5 mg/kg IV every 24 hours) were started empirically. Repeat cerebrospinal fluid cultures were negative and showed decreasing pleiocytosis. Given the concentration-dependent killing of moxifloxacin and concern for endovascular infection from a concomitant cerebral venous sinus thrombosis, serum concentrations of moxifloxacin were obtained to estimate pharmacokinetic and pharmacodynamic parameters. These were compared to the targets described in other case reports of M hominis meningitis. The maximum serum concentration (Cmax) was 2.5 mg/L, volume of distribution was 2.2 L/kg, clearance was 0.18 L/kg/hr, terminal half-life was 8.6 hours, and area-under-the-concentration-time curve (AUC) was 28.1 mg•hr/L. Using the range of minimum inhibitory concentrations (MICs) reported in the literature, the estimated Cmax/MIC for this patient was 21 to 158 (target Cmax/MIC: >10) and AUC/MIC was 234 to 1757 (target AUC/MIC: ≥100). Doxycycline and moxifloxacin were continued for 6 weeks. No adverse events to moxifloxacin or doxycycline were observed in the NICU. This report describes the successful treatment of M hominis neonatal meningitis and adds to the knowledge of pharmacokinetic and pharmacodynamic parameters of moxifloxacin in neonates. Additional data will help to confirm the role for routine therapeutic drug monitoring of moxifloxacin in neonates.
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29
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Bitnun A. The management of infants, children, and youth at risk for hepatitis C virus infection. Paediatr Child Health 2021; 26:440-441. [PMID: 34777665 DOI: 10.1093/pch/pxab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
Hepatitis C virus (HCV) infection affects 0.5% to 1.0% of the Canadian population. Most paediatric HCV infections are a consequence of vertical transmission or, among youth and young adults, the result of engaging in high-risk behaviours, such as injection drug use and unprotected sexual activity. It is now recommended that all infants, children, and youth with one or more risk factors be screened for HCV infection. Treating chronic HCV infection with direct-acting antivirals has been shown to achieve sustained virologic suppression in 97% to 100% of children as young as 3 years old. Paediatricians and family physicians have an important role in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for comprehensive harm reduction interventions targeting at-risk youth, accessible treatments, and routine prenatal screening for HCV.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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30
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Bitnun A. La prise en charge des nourrissons, des enfants et des adolescents vulnérables à l’infection par le virus de l’hépatite C. Paediatr Child Health 2021; 26:441-441. [PMCID: PMC8581528 DOI: 10.1093/pch/pxab072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/10/2021] [Indexed: 07/25/2023] Open
Abstract
L’infection par le virus de l’hépatite C touche de 0,5 % à 1,0 % de la population canadienne. La plupart des infections pédiatriques découlent d’une transmission verticale ou, chez les adolescents et les jeunes adultes, de comportements à haut risque comme l’utilisation de drogues injectables et les activités sexuelles non protégées. Il est désormais recommandé que tous les nourrissons, les enfants et les adolescents qui présentent au moins un facteur de risque soient soumis au dépistage de l’infection par le virus de l’hépatite C. Il est démontré que le traitement de la forme chronique de cette infection au moyen d’antiviraux à action directe provoque une suppression virologique soutenue chez 97 % à 100 % des enfants dès l’âge de trois ans. Les pédiatres et les médecins de famille ont un rôle important à jouer pour informer les adolescents des risques et des modes de prévention de l’infection par le virus de l’hépatite C, ainsi que pour revendiquer, auprès du gouvernement et des autorités sanitaires, l’adoption de stratégies d’intervention globales de réduction des méfaits ciblant les jeunes à risque, des traitements accessibles et le dépistage prénatal systématique de ce virus.
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Affiliation(s)
- Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d’immunisation, Ottawa (Ontario)Canada
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31
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Yeh EA, Yea C, Bitnun A. Infection-Related Myelopathies. Annu Rev Pathol 2021; 17:141-158. [PMID: 34637338 DOI: 10.1146/annurev-pathmechdis-040121-022818] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent years have seen growing attention to inflammatory and infectious disorders of the spinal cord, not only due to the discovery of autoantibody-mediated disorders of the spinal cord [e.g., aquaporin-4 immunoglobulin G (IgG) antibodies and myelin oligodendrocyte glycoprotein IgG antibodies], but also due to the emergence of clusters of infection-related myelopathy, now known as acute flaccid myelitis. We review the spectrum of infection-related myelopathies and outline a nosological classification system based on association with infection. We describe the epidemiology and definitions of myelopathies, with a discussion of clinical presentation and neuroimaging features, and then turn to specific discussion of myelopathies due to direct pathogen invasion and those considered to be post- or parainfectious. Expected final online publication date for the Annual Review of Pathology: Mechanisms of Disease, Volume 17 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- E Ann Yeh
- Division of Neurology, Department of Pediatrics, and Division of Neuroscience and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; , .,Faculty of Medicine, University of Toronto, Toronto, Ontario M5G 1X8, Canada;
| | - Carmen Yea
- Division of Neurology, Department of Pediatrics, and Division of Neuroscience and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; ,
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario M5G 1X8, Canada;
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32
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Morris SK, Farrar DS, Miller SP, Ofner M, Bitnun A, Nelson CRM, Shevell M, Moore AM, Tataryn J, Evans JA, Zipursky AR, Moore Hepburn C. Population-based surveillance of severe microcephaly and congenital Zika syndrome in Canada. Arch Dis Child 2021; 106:855-861. [PMID: 33419730 DOI: 10.1136/archdischild-2020-320968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To estimate the minimum incidence of congenital Zika syndrome (CZS) and severe microcephaly in Canada and describe key clinical, epidemiological, aetiological and outcome features of these conditions. METHODS Two separate national surveillance studies were conducted on CZS and severe microcephaly using the well-established Canadian Paediatric Surveillance Program from 2016 to 2019. Over 2700 paediatricians across Canada were surveyed monthly and asked to report demographic details, pregnancy and travel history, infant anthropometry, clinical features and laboratory findings of newly identified cases. Reports were reviewed to assign an underlying aetiology of severe microcephaly. Incidence rates were estimated using monthly live birth denominators. RESULTS Thirty-four infants met the case definition for severe microcephaly and <5 met the case definition for CZS. The associated minimum incidence rates were 4.5 per 100 000 live births for severe microcephaly and 0.1-0.5 per 100 000 live births for CZS. Of severe microcephaly cases, 53% were attributed to genetic causes, 15% to infectious or ischaemic causes and 32% to unknown causes. The median head circumference-for-age Z-score at birth was -3.2 (IQR -3.8 to -2.6), and catch-up growth was often not achieved. Common clinical features included intracranial abnormalities (n=23), dysmorphology (n=19) and developmental delays (n=14). Mothers of infants with non-genetic aetiologies travelled during pregnancy more often (10/16) than mothers of infants with genetic aetiologies (<5/18; p<0.01). CONCLUSION Severe microcephaly and CZS are both rare in Canada. Minimum incidence rates can be used as a baseline against which novel or re-emergent causes of severe microcephaly or CZS can be compared.
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Affiliation(s)
- Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada .,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven P Miller
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianna Ofner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Chantal R M Nelson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Aideen M Moore
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Tataryn
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jane A Evans
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy R Zipursky
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charlotte Moore Hepburn
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, Sun RD, Isabel S, García-Ascaso MT, Hibino H, Camara B, Isabel M, Cho L, Groves HE, Piché-Renaud PP, Kossov M, Kou I, Jon I, Blanchard AC, Matsuda N, Mahood Q, Wadhwa A, Bitnun A, Morris SK. The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: A systematic review of fatality and ICU admission in children worldwide. PLoS One 2021; 16:e0246326. [PMID: 33513204 PMCID: PMC7845974 DOI: 10.1371/journal.pone.0246326] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The overall global impact of COVID-19 in children and regional variability in pediatric outcomes are presently unknown. METHODS To evaluate the magnitude of global COVID-19 death and intensive care unit (ICU) admission in children aged 0-19 years, a systematic review was conducted for articles and national reports as of December 7, 2020. This systematic review is registered with PROSPERO (registration number: CRD42020179696). RESULTS We reviewed 16,027 articles as well as 225 national reports from 216 countries. Among the 3,788 global pediatric COVID-19 deaths, 3,394 (91.5%) deaths were reported from low- and middle-income countries (LMIC), while 83.5% of pediatric population from all included countries were from LMIC. The pediatric deaths/1,000,000 children and case fatality rate (CFR) were significantly higher in LMIC than in high-income countries (HIC) (2.77 in LMIC vs 1.32 in HIC; p < 0.001 and 0.24% in LMIC vs 0.01% in HIC; p < 0.001, respectively). The ICU admission/1,000,000 children was 18.80 and 1.48 in HIC and LMIC, respectively (p < 0.001). The highest deaths/1,000,000 children and CFR were in infants < 1 year old (10.03 and 0.58% in the world, 5.39 and 0.07% in HIC and 10.98 and 1.30% in LMIC, respectively). CONCLUSIONS The study highlights that there may be a larger impact of pediatric COVID-19 fatality in LMICs compared to HICs.
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Affiliation(s)
- Taito Kitano
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Mao Kitano
- Mikage Child Dental Clinic, Kobe, Hyogo, Japan
| | - Carsten Krueger
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hassan Jamal
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hatem Al Rawahi
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Rose Doulin Sun
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sandra Isabel
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Marta Taida García-Ascaso
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hiromi Hibino
- McEwen Stem Cell Institute, Universal Health Network, Toronto, ON, Canada
| | - Bettina Camara
- Faculty of Immunology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Isabel
- Département de mathématique, Faculté des sciences et génie, Université Laval, Pavillon Alexandre-Vachon, Québec, QC, Canada
| | - Leanna Cho
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Helen E. Groves
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Michael Kossov
- Department Laboratory Medicine and Pathobiology, Division of Medical Microbiology, The Hospital for Sick Children at University of Toronto, Toronto, ON, Canada
| | - Ikuho Kou
- Kaji Dental Clinic, Kobe, Hyogo, Japan
| | - Ilsu Jon
- Utsunomiya Kyoritsu Clinic, Utsunomiya, Tochigi, Japan
| | - Ana C. Blanchard
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nao Matsuda
- Alpaca Child Dental Clinic, Hiroshima, Hiroshima, Japan
| | - Quenby Mahood
- Hospital Library and Archives, Learning Institute, The Hospital for Sick Children at University of Toronto, Toronto, ON, Canada
| | - Anupma Wadhwa
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shaun K. Morris
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
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Young JM, Bitnun A, Read SE, Smith ML. Early academic achievement of HIV-exposed uninfected children compared to HIV-unexposed uninfected children at 5 years of age. Child Neuropsychol 2021; 27:532-547. [PMID: 33461418 DOI: 10.1080/09297049.2021.1871891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV-exposed uninfected (HEU) children may be at-risk for poorer academic achievement compared to HIV-unexposed uninfected (HUU) children due to in utero and perinatal exposure to HIV and/or anti-retroviral (ARV) medication. Understanding the risk factors for academic underachievement is important for implementing timely intervention and academic supports. HEU (N = 110, mean (SD) age 5.59 (0.22) years) and HUU (N = 43, mean (SD) age 5.73 (0.64) years) children completed assessments of general intelligence (WPPSI-III) and academic achievement (WRAT-4). Parent interviews and medical record reviews were used to obtain sociodemographic and maternal health data. HUU children scored significantly higher than HEU children on single word reading (p = 0.006), math calculation skills (p = 0.003), Verbal IQ, Performance IQ, Full Scale IQ, and Processing Speed (all WPPSI-III measures p < 0.001). Verbal IQ at 3-4 years predicted academic achievement at 5-6 years of age, yet sociodemographic and medical factors did not. These findings demonstrate that HEU children obtained significantly lower scores of intellectual, reading, and math abilities during early childhood. Addressing these early gaps before HEU children enter primary school will be critical for optimizing their learning and academic potential.
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Affiliation(s)
- Julia M Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
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Bitnun A, Ransy DG, Brophy J, Kakkar F, Hawkes M, Samson L, Annabi B, Pagliuzza A, Morand JA, Sauve L, Chomont N, Lavoie S, Kim J, Sandstrom P, Wender PA, Lee T, Singer J, Read SE, Soudeyns H. Clinical Correlates of Human Immunodeficiency Virus-1 (HIV-1) DNA and Inducible HIV-1 RNA Reservoirs in Peripheral Blood in Children With Perinatally Acquired HIV-1 Infection With Sustained Virologic Suppression for at Least 5 Years. Clin Infect Dis 2021; 70:859-866. [PMID: 30919879 DOI: 10.1093/cid/ciz251] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Early Pediatric Initiation Canada Child Cure Cohort (EPIC4) study is a prospective, multicenter, Canadian cohort study investigating human immunodeficiency virus-1 (HIV-1) reservoirs, chronic inflammation, and immune responses in children with perinatally acquired HIV-1 infection. The focus of this report is HIV-1 reservoirs and correlates in the peripheral blood of children who achieved sustained virologic suppression (SVS) for ≥5 years. METHODS HIV-1 reservoirs were determined by measuring HIV-1 DNA in peripheral blood mononuclear cells and inducible cell-free HIV-1 RNA in CD4+ T-cells by a prostratin analogue stimulation assay. HIV serology was quantified by signal-to-cutoff ratio (S/CO). RESULTS Of 228 enrolled participants, 69 achieved SVS for ≥5 years. HIV-1 DNA, inducible cell-free HIV-1 RNA, and S/COs correlated directly with the age of effective combination antiretroviral therapy (cART) initiation (P < .001, P = .036, and P < .001, respectively) and age when SVS was achieved (P = .002, P = .038, and P < .001, respectively) and inversely with the proportion of life spent on effective cART (P < .001, P = .01, and P < .001, respectively) and proportion of life spent with SVS (P < .001, P = .079, and P < .001, respectively). Inducible cell-free HIV-1 RNA correlated with HIV-1 DNA, most particularly in children with SVS, without virologic blips, that was achieved with the first cART regimen initiated prior to 6 months of age (rho = 0.74; P = .037) or later (rho = 0.87; P < .001). S/COs correlated with HIV-1 DNA (P = .003), but less so with inducible cell-free HIV-1 RNA (P = .09). CONCLUSIONS The prostratin analogue stimulation assay, with its lower blood volume requirement, could be a valuable method for evaluating inducible HIV-1 reservoirs in children. Standard commercial HIV serology may be a practical initial indirect measure of reservoir size in the peripheral blood of children with perinatally acquired HIV-1 infection.
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Affiliation(s)
- Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario
| | - Doris G Ransy
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Quebec
| | - Michael Hawkes
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Bayader Annabi
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
| | - Amélie Pagliuzza
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec
| | - Jacob-Adams Morand
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
| | - Laura Sauve
- Oak Tree Clinic, Women's Hospital and Health Centre of British Columbia, Department of Pediatrics, University of British Columbia, Vancouver
| | - Nicolas Chomont
- Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec
| | - Stephanie Lavoie
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - John Kim
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul Sandstrom
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul A Wender
- Department of Chemistry and Department of Chemical and Systems Biology, Stanford University, California
| | - Terry Lee
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia
| | - Joel Singer
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Stanley E Read
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario
| | - Hugo Soudeyns
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
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Khan S, Kennedy VL, Loutfy M, MacGillivray J, Yudin M, Read S, Bitnun A. "It's Not Easy": Infant Feeding in the Context of HIV in a Resource-Rich Setting: Strengths, Challenges and Choices, a Qualitative Study. J Assoc Nurses AIDS Care 2021; 32:105-114. [PMID: 33177433 DOI: 10.1097/jnc.0000000000000216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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)
- Sarah Khan
- Sarah Khan, MD, MSc, is an Assistant Professor, Department of Pediatrics, McMaster University, Hamilton, Canada. V. Logan Kennedy, RN, MD, is a Research Associate and Clinical Nursing Specialist, Women's College Research Institute, Women's College Hospital and Maple Leaf Medical Clinic, Toronto, Canada. Mona Loutfy, MD, MPH, is a Senior Scientist and Director, Women HIV Research Program, Women's College Research Institute, Women's College Hospital, and Professor, Department of Medicine, University of Toronto, Toronto, Canada. Jay MacGillivray, RM, is a Registered Midwife and Adjunct Professor, Ryerson University, Co-Director Positive Pregnancy Program, St. Michael's Hospital, Toronto, Canada. Mark Yudin, MD, MSc, is an Associate Scientist and Staff Physician, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada. Stanley Read, MD, MSc, PhD, is the Chair of CANFAR's Scientific Advisory Committee and Professor Emeritus, Department of Pediatrics and Pathobiology, University of Toronto, Toronto, Canada. Ari Bitnun, MD, MSc, is an Academic Clinician, The Hospital for Sick Children, and Professor, Department of Paediatrics, University of Toronto, Toronto, Canada
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Yea C, Bitnun A, Branson HM, Ciftci-Kavaklioglu B, Rafay MF, Fortin O, Moresoli P, Sébire G, Srour M, Decaluwe H, Marois L, Pelletier F, Barton M, Nouri MN, Brophy J, Venkateswaran S, Pohl D, Selby K, Jones K, Robinson J, Mineyko A, Licht C, Ertl-Wagner B, Yeh EA. Association of outcomes in acute flaccid myelitis with identification of enterovirus at presentation: a Canadian, nationwide, longitudinal study. Lancet Child Adolesc Health 2020; 4:828-836. [PMID: 33068549 DOI: 10.1016/s2352-4642(20)30176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is characterised by rapid onset of limb weakness with spinal cord grey-matter abnormalities on MRI scan. We aimed to assess whether detection of enterovirus in respiratory or other specimens can help predict prognosis in children with AFM. METHODS In this nationwide, longitudinal study, we evaluated the significance of detection of enterovirus in any sample in predicting outcomes in a cohort of Canadian children younger than 18 years presenting with AFM to tertiary paediatric hospitals in Canada in 2014 and 2018. All patients fulfilled the 2015 US Centers for Disease Control and Prevention case definition for definite AFM or probable AFM. Clinical data, laboratory findings, treatment, and neuroimaging results were collected (follow up period up to 5 years). We assessed neurological function and motor outcomes using Kurtzke's Expanded Disability Status Scale (EDSS) and a Weakest Limb Score. FINDINGS 58 children with AFM (median age 5·1 years, IQR 3·8-8·3) were identified across five of Canada's ten provinces and three territories. 25 (43%) children had enterovirus detected in at least one specimen: 16 (64%) with EV-D68, two (8%) with EV-A71, two (8%) with coxsackievirus, 10 (40%) with untyped enterovirus. Children who were enterovirus positive were more likely than those that were negative to have had quadriparesis (12 [48%] of 25 vs four [13%] of 30; p=0·028), bulbar weakness (11 [44%] of 25 vs two [7%] of 30; p=0·028), bowel or bladder dysfunction (14 [56%] of 25 vs seven [23%] of 30; p=0·040), cardiovascular instability (nine [36%] of 25 vs one [3%] of 30; p=0·028), and were more likely to require intensive care unit admission (13 [52%] of 25 vs 5 [17%] of 30; p=0·028). On MRI, most children who were enterovirus positive showed brainstem pontine lesions (14 [61%] of 23), while other MRI parameters did not correlate with enterovirus status. Median EDSS of enterovirus positive (EV+) and enterovirus negative (EV-) groups was significantly different at all timepoints: baseline (EDSS 8·5, IQR 4·1-9·5 vs EDSS 4·0, IQR 3·0-6·0; p=0·0067), 3 months (EDSS 4·0, IQR 3·0-7·4 vs EDSS 3·0, IQR 1·5-4·3; p=0·0067), 6 months (EDSS 3·5, IQR 3·0-7·0 vs EDSS 3·0, IQR 1·0-4·0; p=0·029), and 12 months (EDSS 3·0, IQR 3·0-6·9 vs EDSS 2·5 IQR 0·3-3·0; p=0·0067). Kaplan-Meier survival analysis of a subgroup of patients showed significantly poorer motor recovery among children who tested positive for enterovirus than for those who tested negative (p=0·037). INTERPRETATION Detection of enterovirus in specimens from non-sterile sites at presentation correlated with more severe acute motor weakness, worse overall outcomes and poorer trajectory for motor recovery. These results have implications for rehabilitation planning as well as counselling of families of children with these disorders. The findings of this study support the need for early testing for enterovirus in non-CNS sites in all cases of AFM. FUNDING None.
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Affiliation(s)
- Carmen Yea
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Helen M Branson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Mubeen F Rafay
- Department of Pediatric and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Olivier Fortin
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Paola Moresoli
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Guillaume Sébire
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Myriam Srour
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Hélène Decaluwe
- Division of Immunology and Rheumatology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Louis Marois
- Division of Immunology and Rheumatology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Félixe Pelletier
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Michelle Barton
- Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | | | - Jason Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sunita Venkateswaran
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Selby
- Division of Pediatric Neurology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Kevin Jones
- Division of Neurology, Department of Pediatrics McMaster Children's Hospital, Hamilton, ON, Canada
| | - Joan Robinson
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - E Ann Yeh
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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Choudhury B, Brown J, Ransy DG, Brophy J, Kakkar F, Bitnun A, Samson L, Read S, Soudeyns H, Vaudry W, Houston S, Hawkes MT. Endothelial activation is associated with intestinal epithelial injury, systemic inflammation and treatment regimen in children living with vertically acquired HIV-1 infection. HIV Med 2020; 22:273-282. [PMID: 33151601 DOI: 10.1111/hiv.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Premature development of cardiovascular disease in children living with HIV-1 (CLWH) may be associated with compromised gut barrier function, microbial translocation, immune activation, systemic inflammation and endothelial activation. Biomarkers of these pathways may provide insights into pathogenesis of atherosclerotic disease in CLWH. METHODS This was a cross-sectional study of CLWH enrolled in the multicentre Early Pediatric Initiation-Canadian Child Cure Cohort (EPIC4 ) who were on antiretroviral therapy (ART) with undetectable viral load. Plasma biomarkers of intestinal epithelial injury [intestinal fatty acid binding protein-1 (IFABP)], systemic inflammation [tumour necrosis factor (TNF) and interleukin-6 (IL-6)] and endothelial activation [angiopoietin-2 (Ang2), soluble vascular endothelial growth factor-1 (sVEGFR1) and soluble endoglin (sEng)] were quantified by enzyme-linked immunosorbent assay. Correlation and factor analysis of biomarkers were used to examine associations between innate immune pathways. RESULTS Among 90 CLWH, 16% of Ang2, 15% of sVEGFR1 and 23% of sEng levels were elevated relative to healthy historic controls. Pairwise rank correlations between the three markers of endothelial activation were statistically significant (ρ = 0.69, ρ = 0.61 and ρ = 0.65, P < 0.001 for all correlations). An endothelial activation index, derived by factor analysis of the three endothelial biomarkers, was correlated with TNF (ρ = 0.47, P < 0.001), IL-6 (ρ = 0.60, P < 0.001) and intestinal fatty acid binding protein-1 (ρ = 0.67, P < 0.001). Current or past treatment with ritonavir-boosted lopinavir (LPV/r) was associated with endothelial activation (odds ratio = 5.0, 95% CI: 1.7-17, P = 0.0020). CONCLUSIONS Endothelial activation is prevalent in CLWH despite viral suppression with combination ART and is associated with intestinal epithelial injury, systemic inflammation and treatment with LPV/r.
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Affiliation(s)
- B Choudhury
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Brown
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D G Ransy
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada
| | - J Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - F Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - A Bitnun
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - L Samson
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - S Read
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - H Soudeyns
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Montréal, QC, Canada
| | - W Vaudry
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - S Houston
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - M T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.,Stollery Science Lab, Edmonton, AB, Canada.,Women and Children's Health Research Institute, Edmonton, AB, Canada
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39
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L'Huillier AG, Lau R, Bitnun A, Boggild AK. Atovaquone-proguanil treatment failure in a case of pediatric Plasmodium falciparum infection: Malabsorption and resistance. Travel Med Infect Dis 2020; 37:101829. [PMID: 32763494 DOI: 10.1016/j.tmaid.2020.101829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Arnaud G L'Huillier
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Rachel Lau
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
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40
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Hsieh AY, Kimmel E, Pick N, Sauvé L, Brophy J, Kakkar F, Bitnun A, Murray MC, Côté HC. Inverse relationship between leukocyte telomere length attrition and blood mitochondrial DNA content loss over time. Aging (Albany NY) 2020; 12:15196-15221. [PMID: 32703912 PMCID: PMC7467389 DOI: 10.18632/aging.103703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/06/2020] [Indexed: 05/16/2023]
Abstract
Leukocyte telomere length (LTL) and whole blood mitochondrial DNA (WB mtDNA) content are aging markers impacted by chronic diseases such as human immunodeficiency virus (HIV) infection. We characterized the relationship between these two markers in 312 women ≥12 years of age living with HIV and 300 HIV-negative controls. We found no relationship between the two markers cross-sectionally. In multivariable models, age, ethnicity, HIV, and tobacco smoking were independently associated with shorter LTL, and the former three with lower WB mtDNA. Longitudinally, among a subgroup of 228 HIV participants and 68 HIV-negative controls with ≥2 biospecimens ≥1 year apart, an inverted pattern was observed between the rates of change in LTL and WB mtDNA content per year, whereby faster decline of one was associated with the preservation of the other. Furthermore, if HIV viral control was not maintained between visits, increased rates of both LTL attrition and WB mtDNA loss were observed. We describe a novel relationship between two established aging markers, whereby rates of change in LTL and WB mtDNA are inversely related. Our findings highlight the importance of maintaining HIV viral control, the complementary longitudinal relationship between the two markers, and the need to consider both in aging studies.
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Affiliation(s)
- Anthony Y.Y. Hsieh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Elana Kimmel
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
| | - Laura Sauvé
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver V6H 0B3, British Columbia, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa K1H 8L1, Ontario, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Centre Hospitalier Universtaire Sainte-Justine, Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto M5G 1X8, Ontario, Canada
| | - Melanie C.M. Murray
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
| | - Hélène C.F. Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
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41
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Ajaykumar A, Zhu M, Kakkar F, Brophy J, Bitnun A, Alimenti A, Soudeyns H, Saberi S, Albert AYK, Money DM, Côté HCF. Elevated Blood Mitochondrial DNA in Early Life Among Uninfected Children Exposed to Human Immunodeficiency Virus and Combination Antiretroviral Therapy in utero. J Infect Dis 2020; 223:621-631. [PMID: 32638023 DOI: 10.1093/infdis/jiaa410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) during pregnancy prevents vertical transmission, but many antiretrovirals cross the placenta and several can affect mitochondria. Exposure to maternal human immunodeficiency virus (HIV) and/or cART could have long-term effects on children who are HIV exposed and uninfected (CHEU). Our objective was to compare blood mitochondrial DNA (mtDNA) content in CHEU and children who are HIV unexposed and uninfected (CHUU), at birth and in early life. METHODS Whole-blood mtDNA content at birth and in early life (age 0-3 years) was compared cross-sectionally between CHEU and CHUU. Longitudinal changes in mtDNA content among CHEU was also evaluated. RESULTS At birth, CHEU status and younger gestational age were associated with higher mtDNA content. These remained independently associated with mtDNA content in multivariable analyses, whether considering all infants, or only those born at term. Longitudinally, CHEU mtDNA levels remained unchanged during the first 6 months of life, and gradually declined thereafter. A separate age- and sex-matched cross-sectional analysis (in 214 CHEU and 214 CHUU) illustrates that the difference in mtDNA between the groups remains detectable throughout the first 3 years of life. CONCLUSION The persistently elevated blood mtDNA content observed among CHEU represents a long-term effect, possibly resulting from in utero stresses related to maternal HIV and/or cART. The clinical impact of altered mtDNA levels is unclear.
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Affiliation(s)
- Abhinav Ajaykumar
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayanne Zhu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ariane Alimenti
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Hugo Soudeyns
- Unité d'Immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sara Saberi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deborah M Money
- BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
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Petel D, Barton M, Renaud C, Ouchenir L, Brophy J, Bowes J, Khan S, Bitnun A, McDonald J, Boisvert AA, Ting J, Roberts A, Robinson JL. Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators' Collaborative Network on Infections in Canada (PICNIC) study. BMC Pediatr 2020; 20:252. [PMID: 32456669 PMCID: PMC7249448 DOI: 10.1186/s12887-020-02151-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/18/2020] [Indexed: 01/27/2023] Open
Abstract
Background The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. Methods In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. Results Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002). Conclusions Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures.
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Affiliation(s)
- Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Christian Renaud
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lynda Ouchenir
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Khan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jane McDonald
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | - Joseph Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, 4-590 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
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43
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Nashid N, Khan S, Loutfy M, MacGillivray J, Yudin MH, Campbell DM, Barozzino T, Baqi M, Read SE, Bitnun A. Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes. J Pediatric Infect Dis Soc 2020; 9:228-231. [PMID: 30753640 DOI: 10.1093/jpids/piz003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/10/2019] [Indexed: 11/14/2022]
Abstract
The reduction in human immunodeficiency virus (HIV) transmission through breastmilk with maternal combination antiretroviral therapy (cART) has led many pregnant women living with HIV and healthcare providers to question exclusive formula feeding in resource-rich settings. Here, we describe cART prophylaxis in 3 breastfed infants whose mothers had sustained virologic suppression; all 3 of these infants remained uninfected.
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Affiliation(s)
- N Nashid
- Department of Pediatrics, The Hospital For Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - S Khan
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - M Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - J MacGillivray
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON, Canada.,Midwifery Education Program, Ryerson University, Toronto, ON, Canada
| | - M H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - D M Campbell
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - T Barozzino
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - M Baqi
- Department of Medicine, William Osler Health System, Toronto, ON, Canada
| | - S E Read
- Department of Pediatrics, The Hospital For Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - A Bitnun
- Department of Pediatrics, The Hospital For Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020; 99:565-568. [PMID: 32277845 PMCID: PMC7262318 DOI: 10.1111/aogs.13870] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Yenge Diambomba
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Disease, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Disease, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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45
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McClymont E, Ogilvie G, Albert A, Johnston A, Raboud J, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Yudin MH, Klein MB, Harris M, Wobeser W, Bitnun A, Kakkar F, Samson L, Brophy J, Karatzios C, Money D. Impact of quadrivalent HPV vaccine dose spacing on immunologic response in women living with HIV. Vaccine 2020; 38:3073-3078. [PMID: 32147300 DOI: 10.1016/j.vaccine.2020.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing. Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer. Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age. Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.
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Affiliation(s)
- Elisabeth McClymont
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Angela Johnston
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janet Raboud
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharon Walmsley
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy Lipsky
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sylvie Trottier
- Infectious Diseases Research Centre - Université Laval, Québec City, QC, Canada
| | - Fiona Smaill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Mark H Yudin
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Wendy Wobeser
- Departments of Public Health and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Ari Bitnun
- Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montreal, QC, Canada
| | - Lindy Samson
- Department of Paediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Christos Karatzios
- Department of Paediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada; Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
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Kennedy VL, Mellor KL, Brophy J, Bitnun A, Alimenti A, Kakkar F, Logie CH, Webster K, Proulx-Boucher K, Ding E, Jabbari S, Kaida A, de Pokomandy A, Loutfy M. Transition from Pediatric to Adult HIV Care for Young Women Living with HIV. J Int Assoc Provid AIDS Care 2020; 19:2325958220903574. [PMID: 32207355 PMCID: PMC7093690 DOI: 10.1177/2325958220903574] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/15/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022] Open
Abstract
Transitioning from pediatric to adult care is a complicated process for youth with chronic illnesses. This study elucidates the unique factors affecting transition preparedness and perception of adult HIV care among a cohort of young women with HIV. Between 2013 and 2015, 48 women with HIV, who had experience with pediatric HIV care, were enrolled in a large Canadian cohort study. Variables were self-reported during peer-administered surveys. Only 60% reported feeling prepared for transition. Having never had contact with child protection services (P = .049), never been in foster care (P = .011), never been in a group home (P = .036), reporting a higher current CD4 count (P = .033), and reporting a younger ideal age for transition (P = .041) were associated with transition preparedness. Eighty-four percent reported equivalent or better HIV care following transition. Correlates of equivalent/better care following transition included lower personal income (P = .023), higher CD4 count (P = .021), care by an adult infectious diseases specialist (P = .002), and transition preparedness (P = .005). Our findings highlight the importance of adequate transition preparation and its effect on perception of care following transition.
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Affiliation(s)
| | - Kaitlyn Luisa Mellor
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, The Hospital for Sick Children, University of
Toronto, Toronto, Ontario, Canada
| | - Ariane Alimenti
- British Columbia Women’s Hospital and Health Centre, Vancouver, British
Columbia, Canada
| | - Fatima Kakkar
- Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec,
Canada
| | - Carmen Helen Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto,
Ontario Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British
Columbia, Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal,
Quebec, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British
Columbia, Canada
| | - Shahab Jabbari
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British
Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British
Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal,
Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec,
Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Duby J, Bitnun A, Shah V, Shannon P, Shinar S, Whyte H. Non-immune Hydrops Fetalis and Hepatic Dysfunction in a Preterm Infant With Congenital Syphilis. Front Pediatr 2019; 7:508. [PMID: 31921721 PMCID: PMC6927290 DOI: 10.3389/fped.2019.00508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
We report a case of a preterm infant with congenital syphilis who presented with non-immune hydrops fetalis. Hepatic dysfunction was present at birth and acutely worsened following antibiotic administration. Placental pathology demonstrated infiltration with numerous spirochetes. Although critically ill, the infant recovered with intravenous penicillin G and supportive care. This case demonstrates that congenital syphilis remains a contemporary disease demanding enhanced awareness from clinicians. Manifestations evident in utero or in the newborn can be severe and may result in fetal demise or neonatal death. Moreover, we hypothesize that the treatment resulted in a Jarisch-Herxheimer reaction as manifested by the hepatic deterioration. The incidence of congenital syphilis and its associated complications can be greatly reduced with strict adherence to universal prenatal testing and comprehensive follow-up.
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Affiliation(s)
- Jessica Duby
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Hilary Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Gantt S, Brophy J, Dunn J, Vaudry W, Bitnun A, Renaud C, Kakkar F. AMMI Canada: Response to FAQs about the management of children with congenital cytomegalovirus infection in Canada. ACTA ACUST UNITED AC 2019; 4:208-214. [DOI: 10.3138/jammi.2019-08-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Soren Gantt
- BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Dunn
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Vaudry
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Ari Bitnun
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christian Renaud
- CHU Ste. Justine, Université de Montréal, Montréal, Québec, Canada
| | - Fatima Kakkar
- CHU Ste. Justine, Université de Montréal, Montréal, Québec, Canada
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49
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Frankel C, Whyte H, Chau V, MacGregor D, Mahant S, Branson H, Campigotto A, Bitnun A. 2587. Etiology and Outcome of Acute Neonatal Infectious Encephalitis. Open Forum Infect Dis 2019. [PMCID: PMC6810542 DOI: 10.1093/ofid/ofz360.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background There are very few studies on acute encephalitis with onset during the neonatal period. The objectives of this study were to investigate the etiology and salient clinical features of neonatal encephalitis. Methods Neonates with possible infectious encephalitis (IE) were prospectively enrolled. Inclusion criteria included encephalopathy (altered/fluctuating level of consciousness ≥24 hours) plus ≥2 of: fever/temperature instability; seizure(s); focal neurologic findings; CSF pleocytosis; EEG abnormalities consistent with encephalitis; neuroimaging abnormalities consistent with encephalitis. Neonates with a clear diagnosis of post-perinatal asphyxial encephalopathy or culture proven bacterial meningitis were excluded. Results shown as absolute numbers, proportions or medians [interquartile range] as appropriate. Results Fifty-nine neonates fulfilled the inclusion/exclusion criteria (June 2013–November 2018). Empiric acyclovir was initiated in 49 (83.1%) cases. An infectious etiology was identified in 25 (42.4%): enteroviruses (n = 15), HSV (n = 5), HHV6 (n = 2), parainfluenza 3 (n = 1), influenza A (n = 1), CMV (n = 1). A noninfectious cause was confirmed in 20 (33.9%): missed hypoxic-ischemic encephalopathy (n = 10), genetic/metabolic disorders (n = 7), ischemic/hemorrhagic stroke (n = 3). No specific etiology was identified in 14 (23.7%). Thirteen (52%) neonates with IE either died (n = 7) or suffered neurologic sequelae (n = 6). Deaths were attributable to HSV (n = 4), enteroviruses (n = 2) and HHV6 (n = 1). Neurocognitive sequelae were documented in one case each of enterovirus, HSV2, HHV6, CMV, parainfluenza 3 and influenza A. Differences between neonates with and without IE, respectively, included age in days of symptom onset (7 [6, 10] vs. 1 [0, 3]; P < 0.001), gestational age (37.0 [36.0, 39.0] vs. 38.6 [37.6, 40.0]; P = 0.045), peripheral leukocyte count (10.5 [IQR 5.9, 14.6] vs. 14.3 [IQR 10.7, 21.7]; P = 0.008) and CSF glucose (2.80 [IQR 2.3, 3.2] vs. 3.10 [2.8, 3.8]; P = 0.003). Conclusion Enteroviruses and HSV are the predominant causes of neonatal IE. Outcome of neonatal IE is poor with approximately half dying or suffering neurologic sequelae. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Vann Chau
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Ari Bitnun
- Hospital for Sick Children, Toronto, ON, Canada
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50
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Affiliation(s)
- Peter J Gill
- Divisions of Paediatric Medicine (Gill), infectious Diseases (Bitnun) and Neurology (Yeh), The Hospital for Sick Children; Department of Paediatrics (Gill, Bitnun, Yeh), University of Toronto; Department of Pediatrics (Gill, Bitnun, Yeh), Division of Neurosciences and Mental Health (Yeh), SickKids Research Institute, University of Toronto, Toronto, Ont.
| | - Ari Bitnun
- Divisions of Paediatric Medicine (Gill), infectious Diseases (Bitnun) and Neurology (Yeh), The Hospital for Sick Children; Department of Paediatrics (Gill, Bitnun, Yeh), University of Toronto; Department of Pediatrics (Gill, Bitnun, Yeh), Division of Neurosciences and Mental Health (Yeh), SickKids Research Institute, University of Toronto, Toronto, Ont
| | - E Ann Yeh
- Divisions of Paediatric Medicine (Gill), infectious Diseases (Bitnun) and Neurology (Yeh), The Hospital for Sick Children; Department of Paediatrics (Gill, Bitnun, Yeh), University of Toronto; Department of Pediatrics (Gill, Bitnun, Yeh), Division of Neurosciences and Mental Health (Yeh), SickKids Research Institute, University of Toronto, Toronto, Ont
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