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Turkova A, Chan MK, Kityo C, Kekitiinwa AR, Musoke P, Violari A, Variava E, Archary M, Cressey TR, Chalermpantmetagul S, Sawasdichai K, Ounchanum P, Kanjanavanit S, Srirojana S, Srirompotong U, Welch S, Bamford A, Epalza C, Fortuny C, Colbers A, Nastouli E, Walker S, Carr D, Conway M, Spyer MJ, Parkar N, White I, Nardone A, Thomason MJ, Ferrand RA, Giaquinto C, Ford D. D3/Penta 21 clinical trial design: A randomised non-inferiority trial with nested drug licensing substudy to assess dolutegravir and lamivudine fixed dose formulations for the maintenance of virological suppression in children with HIV-1 infection, aged 2 to 15 years. Contemp Clin Trials 2024:107540. [PMID: 38636725 DOI: 10.1016/j.cct.2024.107540] [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: 01/04/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There is increasing interest in utilising two-drug regimens for HIV treatment with the goal of reducing toxicity and improve acceptability. The D3 trial evaluates the efficacy and safety of DTG/3TC in children and adolescents and includes a nested pharmacokinetics(PK) substudy for paediatric drug licensing. METHODS D3 is an ongoing open-label, phase III, 96-week non-inferiority randomised controlled trial(RCT) conducted in South Africa, Spain, Thailand, Uganda and the United Kingdom. D3 has enrolled 386 children aged 2- < 15 years, virologically suppressed for ≥6 months, with no prior treatment failure. Participants were randomised 1:1 to receive DTG/3TC or DTG plus two nucleoside reverse transcriptase inhibitors(NRTIs), stratified by region, age (2- < 6, 6- < 12, 12- < 15 years) and DTG use at enrolment (participants permitted to start DTG at enrolment). The primary outcome is confirmed HIV-1 RNA viral rebound ≥50 copies/mL by 96-weeks. The trial employs the Smooth Away From Expected(SAFE) non-inferiority frontier, which specifies the non-inferiority margin and significance level based on the observed event risk in the control arm. The nested PK substudy evaluates WHO weight-band-aligned dosing in the DTG/3TC arm. DISCUSSION D3 is the first comparative trial evaluating DTG/3TC in children and adolescents. Implications of integrating a PK substudy and supplying data for prompt regulatory submission, were carefully considered to ensure the integrity of the ongoing trial. The trial uses an innovative non-inferiority frontier for the primary analysis to allow for a lower-than-expected confirmed viral rebound risk in the control arm, while ensuring interpretability of results and maintaining the planned sample size in an already funded trial. TRIAL REGISTRATION International Standard Randomised Clinical Trial Number Register: ISRCTN17157458. European Clinical Trials Database: 2020-001426-57. CLINICALTRIALS gov: NCT04337450.
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Affiliation(s)
- Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, UK.
| | - Man K Chan
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Children Health, King Edward VIII Hospital, Enhancing Care Foundation, University of KwaZulu-Natal, Durban, South Africa
| | - Tim R Cressey
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suwalai Chalermpantmetagul
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Steven Welch
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cristina Epalza
- Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - Clàudia Fortuny
- Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Department of Surgery and Medico-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Medical InnovationHealth Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eleni Nastouli
- University College London Great Ormond Street Institute of Child Health, London, UK; University College London Hospitals NHS Trust, Advanced Pathogen Diagnostics Unit, London, UK
| | - Simon Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Dan Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| | | | - Moira J Spyer
- Medical Research Council Clinical Trials Unit at University College London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nazia Parkar
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Iona White
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Carlo Giaquinto
- Fondazione Penta ETS, Padova, Italy; University of Padova, Department of Women and Child Health, Padova, Italy
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, UK
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2
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Di Chiara C, Boracchini R, Cantarutti A, Kakkar F, Oletto A, Padoan A, Donà D, Giaquinto C. Risk of SARS-CoV-2 Reinfection in Children Within the 12 Months Following Mild COVID-19: Insights From a Survey Study. Pediatr Infect Dis J 2024; 43:e128-e130. [PMID: 38241645 PMCID: PMC10919262 DOI: 10.1097/inf.0000000000004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
Understanding the correlation between immune response and protection from COVID-19 will play a pivotal role in predicting the effectiveness of vaccines in children. We studied SARS-CoV-2 reinfection risk in children 12 months post-mild COVID-19. Children under 5 years old exhibited lower reinfection risk than older infected or vaccinated siblings during 12 months postimmunization.
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Affiliation(s)
- Costanza Di Chiara
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
| | - Riccardo Boracchini
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | | | - Andrea Padoan
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Daniele Donà
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
| | - Carlo Giaquinto
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
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3
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Gärtner K, Domínguez-Rodríguez S, Heaney J, Gkouleli T, Grant P, Dorgham K, Sauce D, Soulie C, Busby EJ, O'Sullivan DM, Spyer M, Botha JC, Muñoz-Fernandez MA, Tagarro A, Cotugno N, Huggett JF, Klein N, Palma P, Rojo Conejo P, Foster C, Giaquinto C, Rossi P, Persaud D, De Rossi A, Marcelin AG, Nastouli E. Low unspliced cell-associated HIV RNA in early treated adolescents living with HIV on long suppressive ART. Front Immunol 2024; 15:1334236. [PMID: 38444847 PMCID: PMC10912947 DOI: 10.3389/fimmu.2024.1334236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/23/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Initiation of antiretroviral treatment (ART) in patients early after HIV-infection and long-term suppression leads to low or undetectable levels of HIV RNA and cell-associated (CA) HIV DNA and RNA. Both CA-DNA and CA-RNA, overestimate the size of the HIV reservoir but CA-RNA as well as p24/cell-free viral RNA can be indicators of residual viral replication. This study describes HIV RNA amounts and levels of cytokines/soluble markers in 40 well-suppressed adolescents who initiated ART early in life and investigated which viral markers may be informative as endpoints in cure clinical trials within this population. Methods Forty adolescents perinatally infected with HIV on suppressive ART for >5 years were enrolled in the CARMA study. HIV DNA and total or unspliced CA-RNA in PBMCs were analyzed by qPCR/RT-qPCR and dPCR/RT-dPCR. Cell-free HIV was determined using an ultrasensitive viral load (US-VL) assay. Plasma markers and p24 were analyzed by digital ELISA and correlations between total and unspliced HIV RNA and clinical markers, including age at ART, Western Blot score, levels of cytokines/inflammation markers or HIV CA-DNA, were tested. Results CA-RNA was detected in two thirds of the participants and was comparable in RT-qPCR and RT-dPCR. Adolescents with undetectable CA-RNA showed significantly lower HIV DNA compared to individuals with detectable CA-RNA. Undetectable unspliced CA-RNA was positively associated with age at ART initiation and Western Blot score. We found that a higher concentration of TNF-α was predictive of higher CA-DNA and CA-RNA. Other clinical characteristics like US-VL, time to suppression, or percent CD4+ T-lymphocytes were not predictive of the CA-RNA in this cross-sectional study. Conclusions Low CA-DNA after long-term suppressive ART is associated with lower CA-RNA, in concordance with other reports. Patients with low CA-RNA levels in combination with low CA-DNA and low Western Blot scores should be further investigated to characterize candidates for treatment interruption trials. Unspliced CA-RNA warrants further investigation as a marker that can be prioritized in paediatric clinical trials where the sample volume can be a significant limitation.
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Affiliation(s)
- Kathleen Gärtner
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Sara Domínguez-Rodríguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Judith Heaney
- Advanced Pathogen Diagnostic Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Triantafylia Gkouleli
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Haematology Department, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Paul Grant
- Advanced Pathogen Diagnostic Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Karim Dorgham
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Delphine Sauce
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Cathia Soulie
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Inserm, AP HP, Hôpitaux Universtaires Pitié Salpêtrière - Charles Foix, Laboratoire de Virologie, Paris, France
| | - Eloise J Busby
- National Measurement Laboratory (NML), LGC Group, Teddington, United Kingdom
| | - Denise M O'Sullivan
- National Measurement Laboratory (NML), LGC Group, Teddington, United Kingdom
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, Istituto di RicerCa a Carattere Scientifico (IRCCS), Rome, Italy
| | - Moira Spyer
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Johannes C Botha
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Advanced Pathogen Diagnostic Unit, University College London Hospitals (UCLH), London, United Kingdom
| | | | - Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
- Department of Pediatrics, Infanta Sofía University Hospital, Fundación para la Investigación Biomédica e Innovación Hospital Universitario Infanta Sofía y Hospital del Henares (FIIB HUIS HHEN), Madrid, Spain
| | - Nicola Cotugno
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, Istituto di RicerCa a Carattere Scientifico (IRCCS), Rome, Italy
- Academic Department of Pediatrics, Research Unit in Congenital and Perinatal Infections, Bambino Gesu Children's Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Jim F Huggett
- National Measurement Laboratory (NML), LGC Group, Teddington, United Kingdom
- School of Biosciences & Medicine, University of Surrey, Guildford, United Kingdom
| | - Nigel Klein
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Paolo Palma
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, Istituto di RicerCa a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Pablo Rojo Conejo
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Caroline Foster
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Carlo Giaquinto
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Padova, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics, Research Unit in Congenital and Perinatal Infections, Bambino Gesu Children's Hospital, Rome, Italy
| | - Deborah Persaud
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anita De Rossi
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Padova, Italy
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Inserm, AP HP, Hôpitaux Universtaires Pitié Salpêtrière - Charles Foix, Laboratoire de Virologie, Paris, France
| | - Eleni Nastouli
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Advanced Pathogen Diagnostic Unit, University College London Hospitals (UCLH), London, United Kingdom
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Liberati C, Donà D, Maestri L, Petris MG, Barbieri E, Gallo E, Gallocchio J, Pierobon M, Calore E, Zin A, Brigadoi G, Mariani M, Mesini A, Saffioti C, Ugolotti E, Gregori D, Giaquinto C, Castagnola E, Biffi A. Application of the Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the empiric antibiotic treatment of febrile neutropenia in oncological paediatric patients: experience from two paediatric hospitals in Northern Italy. Ann Clin Microbiol Antimicrob 2024; 23:16. [PMID: 38360651 PMCID: PMC10870518 DOI: 10.1186/s12941-024-00673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres. METHODS We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution. RESULTS We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin-tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin-tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens. CONCLUSIONS The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.
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Affiliation(s)
- Cecilia Liberati
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.
| | - Linda Maestri
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Maria Grazia Petris
- Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Elisa Gallo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jacopo Gallocchio
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marta Pierobon
- Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Elisabetta Calore
- Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Annachiara Zin
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Giulia Brigadoi
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Marcello Mariani
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Carolina Saffioti
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Elisabetta Ugolotti
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Alessandra Biffi
- Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy
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5
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Minotti C, McKenzie C, Dewandel I, Bekker C, Sturniolo G, Doni D, Giaquinto C, Van Der Zalm MM, Donà D. How does post COVID differ from other post-viral conditions in childhood and adolescence (0-20 years old)? A systematic review. EClinicalMedicine 2024; 68:102436. [PMID: 38333536 PMCID: PMC10850405 DOI: 10.1016/j.eclinm.2024.102436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Background Post Coronavirus disease (COVID) and other post-viral infection syndromes present an overlap of pathogenesis, onset, progression, and symptom profile. We aimed to systematically describe studies on post-viral conditions and determine the entity of post COVID compared to other post-viral conditions in children. Methods We conducted a systematic search of the Embase, MEDLINE, Cochrane Library, and GoogleScholar databases (January 1946-3 November 2023), according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The main outcomes were differences in condition duration, symptom type, and development of chronic symptoms. This systematic review was registered on PROSPERO (CRD42023401789). Findings 35/5051 studies were included, with 42,934 children, adolescents and young adults (0-20 years old) overall. Twenty-eight studies focused on post COVID symptoms, followed by five papers on Respiratory Syncytial Virus (RSV) and Rhinovirus, one study on Epstein-Barr Virus (EBV), and one on gastrointestinal viruses. Studies on post COVID mainly reported data on older children/adolescents, describing long-lasting symptoms, including fatigue, neurologic, cardiorespiratory, musculoskeletal, mental health, and gastrointestinal symptoms. The maximum described symptoms duration was eighteen months, with an average follow-up of seven months. The development of chronic symptoms was reported by 30 studies (93.8%) for 10,473/28,474 patients (36.8%). Recovery was achieved in 18,001/28,474 cases (63.2%). The study on EBV reported persistent fatigue in adolescents for a similar duration (6 months, 46% chronic). Studies on RSV and Rhinovirus were mainly done in children under three years, with development of recurrent wheezing (up to 3 years). Interpretation Post-viral fatigue was a shared feature between post COVID and post EBV conditions. A better understanding of post COVID as a unique condition, sharing features with other post-viral syndromes, is needed. The healthcare burden and socio-economic consequences for children and their families warrant further investigation and development of appropriate healthcare management plans. The foremost requirement is the establishment of consistent and shareable definitions, as well as a consensus on outcomes, to effectively evaluate follow-up and quantify the burden of different viral infections. Funding EU Horizon, EDCTP, NIH.
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Affiliation(s)
- Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Italy
- PhD Program in Clinical Research, University Children's Hospital Basel, University of Basel, Switzerland
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Giulia Sturniolo
- Department of Women's and Children's Health, University of Padua, Italy
| | - Denis Doni
- Department of Women's and Children's Health, University of Padua, Italy
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padua, Italy
| | - Marieke M. Van Der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniele Donà
- Department of Women's and Children's Health, University of Padua, Italy
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6
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Brigadoi G, Demarin GC, Boracchini R, Pierantoni L, Rossin S, Barbieri E, Tirelli F, Cantarutti A, Tempo G, Giaquinto C, Lanari M, Da Dalt L, Donà D. Comparison between the Viral Illness Caused by SARS-CoV-2, Influenza Virus, Respiratory Syncytial Virus and Other Respiratory Viruses in Pediatrics. Viruses 2024; 16:199. [PMID: 38399975 PMCID: PMC10891516 DOI: 10.3390/v16020199] [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: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Respiratory tract infections (RTIs) are the most common infectious syndromes, primarily caused by viruses. The primary objective was to compare the illness courses between historical RTIs and recent SARS-CoV-2 infections. The study cohort consisted of RTI cases evaluated at the Pediatric Emergency Departments of Padua and Bologna, discharged or admitted with microbiologically confirmed viral RTI between 1 November 2018 and 30 April 2019 (historical period) and 1 March 2020 and 30 April 2021 (recent period). We evaluated the risk of oxygen or respiratory support, hospitalization, antibiotic therapy, and complications among different viral infections. The odds ratio (OR) and the 95% confidence intervals (CIs) were estimated through mixed-effect logistic regression models, including a random intercept on the individual and hospital. We identified 767 RTIs: 359 in the historical period compared with 408 SARS-CoV-2 infections. Infections of SARS-CoV-2 had a lower risk of being admitted (OR 0.04, 95% CI 0.03-0.07), receiving respiratory support (OR 0.19, 95% CI 0.06-0.58), needing antibiotic therapy (OR 0.35, 95% CI 0.22-0.56) and developing complications (OR 0.27, 95% CI 0.14-0.51) compared to all other viral RTIs. COVID-19 in children is clinically similar to other viral RTIs but is associated with a less severe infection course. Thus, most prevention strategies implemented for SARS-CoV-2 should still be considered during RSV and Influenza epidemics.
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Affiliation(s)
- Giulia Brigadoi
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (G.C.D.); (C.G.); (D.D.)
| | - Giulia Camilla Demarin
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (G.C.D.); (C.G.); (D.D.)
| | - Riccardo Boracchini
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (R.B.); (A.C.)
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (M.L.)
| | - Sara Rossin
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (S.R.); (F.T.); (L.D.D.)
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (G.C.D.); (C.G.); (D.D.)
| | - Francesca Tirelli
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (S.R.); (F.T.); (L.D.D.)
| | - Anna Cantarutti
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy; (R.B.); (A.C.)
| | - Gaia Tempo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A Gemelli” IRCCS, 00168 Rome, Italy;
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (G.C.D.); (C.G.); (D.D.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (M.L.)
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (S.R.); (F.T.); (L.D.D.)
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (G.C.D.); (C.G.); (D.D.)
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Di Chiara C, Cantarutti A, Raffaella Petrara M, Bonfante F, Benetti E, Boracchini R, Bosa L, Carmona F, Cosma C, Cotugno N, Le Prevost M, Martini G, Meneghel A, Pagliari M, Palma P, Ruffoni E, Zin A, De Rossi A, Giaquinto C, Donà D, Padoan A. Stronger and durable SARS-CoV-2 immune response to mRNA vaccines in 5-11 years old children with prior COVID-19. Vaccine 2024; 42:263-270. [PMID: 38071105 DOI: 10.1016/j.vaccine.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND AND OBJECTIVES mRNA vaccines elicit a durable humoral response to SARS-CoV-2 in adults, whereas evidence in children is scarce. This study aimed to assess the early and long-term immune response to the mRNA vaccine in children with or without previous SARS-CoV-2 infection. METHODS In a multicentre prospective observational study, we profiled the immune response to the Pfizer BioNTech (BNT162b2) vaccine in 5-11-year-old children attending the University Pediatric Hospital of Padua and Bambino-Gesù Hospital in Rome (Italy) from December-2021 to February-2023. Blood samples were collected pre-, 1-, and 6-months after vaccination. Neutralizing antibodies (NAbs) and anti-spike-receptor-binding-domain (anti-S-RBD) IgG titers were analyzed through Plaque Reduction Neutralization Test (PRNT) and chemiluminescent immune-enzymatic assay (CLIA), respectively. Immune cell phenotypes were analyzed by flow cytometry. RESULTS Sixty children (26 [43 %] female, median age = 8 years [IQR = 7-10.7]) were enrolled in the study, including 46 children with a laboratory-confirmed previous COVID-19 (SARS-CoV-2-recovered) and 14 SARS-CoV-2-naïve participants defined as the absence of antigen-specific antibodies before vaccination. SARS-CoV-2-recovered participants recorded higher anti-S-RBD IgG and Wild-type and Omicron BA.2 NAbs titers than SARS-CoV-2-naïve participants at both 1- and 6-months after vaccination. Antibody titers correlated with T (Tregs) and B (Bregs) regulatory cell frequencies in SARS-CoV-2-recovered children. Both SARS-CoV-2-recovered and SARS-CoV-2-naïve participants decreased antibody titers by approximately 100 to 250 % from 1 to 6 months. While children with immunocompromising underlying conditions developed immune responses comparable to those of healthy children, solid organ transplant recipients exhibited lower levels of NAbs and anti-S-RBD IgG titers, as well as reduced frequencies of Tregs and Bregs. CONCLUSIONS mRNA vaccination triggered a higher production of specific anti-SARS-CoV-2 antibodies along with increased levels of regulatory cells in children with previous SARS-CoV-2 infection up to the following 6 months. These findings provide insights into boosting pre-existing immunity.
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Affiliation(s)
- Costanza Di Chiara
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy; Penta - Child Health Research, Corso Stati Uniti, 4 - 35127 Padua, Italy.
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1 - 20126 Milan, Italy.
| | - Maria Raffaella Petrara
- Oncology and Immunology Section, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani, 2 - 35124 Padua, Italy.
| | - Francesco Bonfante
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10 - 35020 Legnaro (Padua), Italy.
| | - Elisa Benetti
- Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128 Padua, Italy.
| | - Riccardo Boracchini
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1 - 20126 Milan, Italy.
| | - Luca Bosa
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy.
| | - Francesco Carmona
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64 - 35128 Padua, Italy.
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padova, Via Giambattista Belzoni, 160 - 35121 Padua, Italy.
| | - Nicola Cotugno
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Piazza Sant'Onofrio, 4 - 00165 Rome, Italy.
| | - Marthe Le Prevost
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, United Kingdom.
| | - Giorgia Martini
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy.
| | - Alessandra Meneghel
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy.
| | - Matteo Pagliari
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10 - 35020 Legnaro (Padua), Italy.
| | - Paolo Palma
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Piazza Sant'Onofrio, 4 - 00165 Rome, Italy.
| | - Elena Ruffoni
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64 - 35128 Padua, Italy.
| | - Annachiara Zin
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy.
| | - Anita De Rossi
- Oncology and Immunology Section, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani, 2 - 35124 Padua, Italy; Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64 - 35128 Padua, Italy.
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy; Penta - Child Health Research, Corso Stati Uniti, 4 - 35127 Padua, Italy.
| | - Daniele Donà
- Department for Women's and Children's Health, University of Padova, Via Giustiniani, 3 - 35128 Padua, Italy; Penta - Child Health Research, Corso Stati Uniti, 4 - 35127 Padua, Italy.
| | - Andrea Padoan
- Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128 Padua, Italy.
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Padoan A, Cosma C, Di Chiara C, Furlan G, Gastaldo S, Talli I, Donà D, Basso D, Giaquinto C, Plebani M. Clinical and Analytical Performance of ELISA Salivary Serologic Assay to Detect SARS-CoV-2 IgG in Children and Adults. Antibodies (Basel) 2024; 13:6. [PMID: 38247570 PMCID: PMC10801479 DOI: 10.3390/antib13010006] [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: 11/20/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Saliva is a promising matrix with several purposes. Our aim is to verify if salivary anti-SARS-CoV-2 antibody determination is suitable for monitoring immune responses. One hundred eighty-seven subjects were enrolled at University-Hospital Padova: 105 females (56.1%) and 82 males (43.9%), 95 (50.8%) children and 92 (49.2%) adults. Subjects self-collected saliva using Salivette; nineteen subjects collected three different samples within the day. A serum sample was obtained for all individuals. The N/S anti-SARS-CoV-2 salivary IgG (sal-IgG) and serum anti-SARS-CoV-2 S-RBD IgG (ser-IgG) were used for determining anti-SARS-CoV-2 antibodies. The mean (min-max) age was 9.0 (1-18) for children and 42.5 (20-61) for adults. Of 187 samples, 63 were negative for sal-IgG (33.7%), while 7 were negative for ser-IgG (3.7%). Spearman's correlation was 0.56 (p < 0.001). Sal-IgG and ser-IgG levels were correlated with age but not with gender, comorbidities, prolonged therapy, previous SARS-CoV-2 infection, or time from last COVID-19 infection/vaccination. The repeatability ranged from 23.8% (7.4 kAU/L) to 4.0% (3.77 kAU/L). The linearity of the assay was missed in 4/6 samples. No significant intrasubject differences were observed in sal-IgG across samples collected at different time points. Sal-IgG has good agreement with ser-IgG. Noninvasive saliva collection represents an alternative method for antibody measurement, especially in children.
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Affiliation(s)
- Andrea Padoan
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (A.P.); (C.C.); (D.B.); (M.P.)
- UOC of Laboratory Medicine, University-Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, 35011 Padova, Italy;
| | - Chiara Cosma
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (A.P.); (C.C.); (D.B.); (M.P.)
- UOC of Laboratory Medicine, University-Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, 35011 Padova, Italy;
| | - Costanza Di Chiara
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy (S.G.); (D.D.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy
| | - Giulia Furlan
- QI.LAB.MED, Spin-off of the University of Padova, 35011 Padova, Italy;
| | - Stefano Gastaldo
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy (S.G.); (D.D.); (C.G.)
| | - Ilaria Talli
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (A.P.); (C.C.); (D.B.); (M.P.)
- UOC of Laboratory Medicine, University-Hospital of Padova, 35128 Padova, Italy
| | - Daniele Donà
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy (S.G.); (D.D.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy
| | - Daniela Basso
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (A.P.); (C.C.); (D.B.); (M.P.)
- UOC of Laboratory Medicine, University-Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, 35011 Padova, Italy;
| | - Carlo Giaquinto
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy (S.G.); (D.D.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy
| | - Mario Plebani
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (A.P.); (C.C.); (D.B.); (M.P.)
- UOC of Laboratory Medicine, University-Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, 35011 Padova, Italy;
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Lanera C, Lorenzoni G, Barbieri E, Piras G, Magge A, Weissenbacher D, Donà D, Cantarutti L, Gonzalez-Hernandez G, Giaquinto C, Gregori D. Monitoring the Epidemiology of Otitis Using Free-Text Pediatric Medical Notes: A Deep Learning Approach. J Pers Med 2023; 14:28. [PMID: 38248729 PMCID: PMC10817419 DOI: 10.3390/jpm14010028] [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: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Free-text information represents a valuable resource for epidemiological surveillance. Its unstructured nature, however, presents significant challenges in the extraction of meaningful information. This study presents a deep learning model for classifying otitis using pediatric medical records. We analyzed the Pedianet database, which includes data from January 2004 to August 2017. The model categorizes narratives from clinical record diagnoses into six types: no otitis, non-media otitis, non-acute otitis media (OM), acute OM (AOM), AOM with perforation, and recurrent AOM. Utilizing deep learning architectures, including an ensemble model, this study addressed the challenges associated with the manual classification of extensive narrative data. The performance of the model was evaluated according to a gold standard classification made by three expert clinicians. The ensemble model achieved values of 97.03, 93.97, 96.59, and 95.48 for balanced precision, balanced recall, accuracy, and balanced F1 measure, respectively. These results underscore the efficacy of using automated systems for medical diagnoses, especially in pediatric care. Our findings demonstrate the potential of deep learning in interpreting complex medical records, enhancing epidemiological surveillance and research. This approach offers significant improvements in handling large-scale medical data, ensuring accuracy and minimizing human error. The methodology is adaptable to other medical contexts, promising a new horizon in healthcare analytics.
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Affiliation(s)
- Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | - Gianluca Piras
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Arjun Magge
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Davy Weissenbacher
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | | | - Graciela Gonzalez-Hernandez
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
- Società Servizi Telematici—Pedianet, 35100 Padova, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
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10
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de Siqueira IC, de Almeida BL, Lage MLC, Serra L, Carvalho A, de Lima MM, Góes MDFN, Crispim MDSIN, da Costa Pereira MM, Costa BGG, Bailey H, Byrne T, Giaquinto C, Fernandes G, Ruiz-Burga E, Thorne C. Perinatal characteristics and longer-term outcomes in Brazilian children with confirmed or suspected congenital Zika infection: ZIKAction Paediatric Registry. Dialogues Health 2023; 2:100104. [PMID: 38515475 PMCID: PMC10953907 DOI: 10.1016/j.dialog.2023.100104] [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] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 03/23/2024]
Abstract
Background Despite growing scientific knowledge of Zika virus (ZIKV) infection, questions remain regarding ZIKV infection in pregnancy and congenital ZIKV syndrome (CZS). Methods The ZIKAction Paediatric Registry is an international registry of children with documented ZIKV exposure in utero and/or with confirmed or suspected CZS. Its aim is to characterize these children (i.e., clinical, radiological, neurodevelopmental features) and describe outcomes, longer-term sequelae and management through retrospective case note review. This analysis described the maternal and perinatal characteristics of children in the Registry's Bahia arm, assessed their neuroimaging, ophthalmic, hearing and electroencephalography abnormalities by microcephaly classification and reported on hospitalisations. Children born in 2015-2018 and enrolled 2020-2021 in three public health facilities in Salvador were included. Results Of 129 (57% female) children, 15 (11·6%) had laboratory-confirmed congenital ZIKV infection and 114 (88·4%) suspected CZS. At delivery, 15 (11·6%) were normocephalic, 30 (23·3%) moderately microcephalic, and 84 (65·1%) severely microcephalic. Median birth head circumference z-score was -3·51 [IQR, -4·69,-2·73]. During follow-up, all children had abnormal neuroimaging, 80·3% (94/117) abnormal electroencephalogram, 62·2% (77/120) ophthalmic abnormalities, and 27·4% (34/124) hearing impairment. Microcephaly classification was significantly associated with gestational age, and ophthalmological and electroencephalography abnormalities. Of 125 children with hospitalisation data, 52 (41·6%) had been hospitalised by most recent follow-up, at median age of 15·8 [4·0, 34·4] months; infections were the leading cause. Conclusion Congenital ZIKV infection is an emerging disease with a varied and incompletely understood spectrum. Continued long-term follow-up is essential to understand longer-term prognosis and to inform future health and educational needs.
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Affiliation(s)
| | - Breno Lima de Almeida
- Instituto Gonçalo Moniz-Fiocruz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil
| | - Maria Lucia Costa Lage
- Instituto Gonçalo Moniz-Fiocruz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil
| | - Leticia Serra
- Centro de Prevenção e Reabilitação da Pessoa com Deficiência – Cepred, Av. Antônio Carlos Magalhães, S/N, Parque Bela Vista, 40279-700 Salvador, BA, Brazil
| | - Alessandra Carvalho
- Rede SARAH de Hospitais de Reabilitação, Av. Tancredo Neves, 2782 - Caminho das Árvores, 41820-900 Salvador, BA, Brazil
| | - Maricélia Maia de Lima
- Universidade Estadual de Feira de Santana, Avenida Transnordestina, s/n - Novo Horizonte, 44036-900 Feira de Santana, BA, Brazil
| | | | | | | | | | - Heather Bailey
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Capper street, London WC1 6JB, UK
| | - Thomas Byrne
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Georgina Fernandes
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Elisa Ruiz-Burga
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Capper street, London WC1 6JB, UK
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK
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Barbieri E, Porcu G, Donà D, Cavagnis S, Cantarutti L, Scamarcia A, McGovern I, Haag M, Giaquinto C, Cantarutti A. Epidemiology and Burden of Influenza in Children 0-14 Years Over Ten Consecutive Seasons in Italy. Pediatr Infect Dis J 2023; 42:e440-e446. [PMID: 37725811 PMCID: PMC10629601 DOI: 10.1097/inf.0000000000004090] [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] [Indexed: 09/21/2023]
Abstract
BACKGROUND In Europe, influenza vaccination coverage in the pediatric population is low. This study describes the influenza incidence and associated healthcare utilization in the pediatric population in Italy. METHODS Deidentified data from electronic medical records for children 0-14 years old seen by >150 family pediatricians in the Pedianet network in Italy were evaluated for 10 influenza seasons spanning 2010-2020. Incidence of influenza (cases per 1000 person-months), related sequelae and associated healthcare resource use were determined using diagnostic, prescription and medical examination data. RESULTS Over 10 seasons, an average of 8892 influenza cases (range, 4700-12,419; total 88,921) were diagnosed in a cohort of 1,432,384 children 0-14 years of age. Influenza vaccination coverage was 3.6% among children with an influenza diagnosis and 6.8% among children without. Influenza-related healthcare resource utilization included 1.58 family pediatrician visits per influenza episode and 220 ED and 111 hospital admissions, with the highest resource usage among children 1-4 years and lowest among children <6 months old. The most common influenza complications were acute otitis media (2.9% of influenza cases) and pneumonia (0.5%). Antibiotics were prescribed in 38.7% of influenza cases; no antiviral agents were prescribed. One intensive care unit admission and 2 cases requiring ventilatory support were documented. No influenza-related deaths were reported. CONCLUSION Pediatric influenza vaccination was low despite the burden and healthcare use related to seasonal influenza in the pediatric population during a 10-year period in Italy.
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Affiliation(s)
- Elisa Barbieri
- From the Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Gloria Porcu
- Unit of Biostatistics, Epidemiology and Public Health
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniele Donà
- From the Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Sara Cavagnis
- Società Servizi Telematici (SoSeTe), Pedianet Project, Padova, Italy
| | - Luigi Cantarutti
- Società Servizi Telematici (SoSeTe), Pedianet Project, Padova, Italy
| | - Antonio Scamarcia
- Società Servizi Telematici (SoSeTe), Pedianet Project, Padova, Italy
| | | | - Mendel Haag
- Seqirus Netherlands BV, Amsterdam, The Netherlands
| | - Carlo Giaquinto
- From the Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Società Servizi Telematici (SoSeTe), Pedianet Project, Padova, Italy
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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12
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Di Chiara C, Barbieri E, Chen YX, Visonà E, Cavagnis S, Sturniolo G, Parca A, Liberati C, Cantarutti L, Lupattelli A, Le Prevost M, Corrao G, Giaquinto C, Donà D, Cantarutti A. Comparative study showed that children faced a 78% higher risk of new-onset conditions after they had COVID-19. Acta Paediatr 2023; 112:2563-2571. [PMID: 37688774 DOI: 10.1111/apa.16966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
AIM Children have largely been unaffected by severe COVID-19 compared to adults, but data suggest that they may have experienced new conditions after developing the disease. We compared outcomes in children who had experienced COVID-19 and healthy controls. METHODS A retrospective nested cohort study assessed the incidence rate of new-onset conditions after COVID-19 in children aged 0-14 years. Data were retrieved from an Italian paediatric primary care database linked to Veneto Region registries. Exposed children with a positive nasopharyngeal swab were matched 1:1 with unexposed children who had tested negative. Conditional Cox regression was fitted to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the exposure and outcome associations after adjusting for covariates. RESULTS We compared 1656 exposed and 1656 unexposed children from 1 February 2020 to 30 November 2021. The overall excess risk for new-onset conditions after COVID-19 was 78% higher in the exposed than unexposed children. We found significantly higher risks for some new conditions in exposed children, including mental health issues (aHR 1.8, 95% CI 1.1-3.0) and neurological problems (aHR 2.4, 95% CI 1.4-4.1). CONCLUSION Exposed children had a 78% higher risk of developing new conditions of interest after COVID-19 than unexposed children.
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Affiliation(s)
- Costanza Di Chiara
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta-Child Health Research, Padua, Italy
| | - Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta-Child Health Research, Padua, Italy
| | - Yu Xi Chen
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Elisa Visonà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Sara Cavagnis
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Giulia Sturniolo
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Agnese Parca
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Cecilia Liberati
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
| | | | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta-Child Health Research, Padua, Italy
- Società Servizi Telematici-Pedianet, Padua, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta-Child Health Research, Padua, Italy
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
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Benoni R, Casigliani V, Zin A, Giannini D, Ronzoni N, Di Chiara C, Chhaganlal K, Donà D, Merolle A, Dos Anjos HG, Chenene F, Tognon F, Putoto G, Giaquinto C. SARS-CoV-2 seroprevalence and associated factors, based on HIV serostatus, in young people in Sofala province, Mozambique. BMC Infect Dis 2023; 23:809. [PMID: 37978353 PMCID: PMC10656907 DOI: 10.1186/s12879-023-08808-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION In Sofala province (Mozambique), young people living with HIV (YPLHIV) are estimated at 7% among people aged 15-24 years. Even though the COVID-19 pandemic threatened HIV health services, data on the impact of COVID-19 on YPLHIV people are lacking. This study aimed at exploring the seroprevalence of SARS-CoV-2 and associated factors among young people based on their HIV status. METHODS A cross-sectional study was conducted, including people aged 18-24 attending a visit at one of the adolescent-friendly health services in Sofala province between October and November 2022. People vaccinated against SARS-COV-2 or YPLHIV with WHO stage III-IV were excluded. A SARS-CoV-2 antibodies qualitative test and a questionnaire investigating socio-demographic and clinical characteristics were proposed. SARS-CoV-2 seroprevalence was calculated with Clopper-Pearson method. The odds ratio (OR) of a positive SARS-CoV-2 antibodies test was estimated through multivariable binomial logistic regression. RESULTS In total, 540 young people including 65.8% women and 16.7% YPLHIV participated in the survey.. The mean age was 20.2 years (SD 2.0). Almost all the sample (96.1%) reported adopting at least one preventive measure for COVID-19. The weighted seroprevalence of SARS-CoV-2 in the whole sample was 46.8% (95%CI 42.6-51.2) and 35.9% (95%CI 25.3-47.5) in YPLHIV. The adjusted OR of testing positive at the SARS-CoV-2 antibodies test was higher in students compared to workers (aOR:2.02[0.95CI 1.01-4.21]) and in those with symptoms (aOR:1.52[0.95CI 1.01-2.30]). There were no differences based on HIV status(aOR:0.663[95%CI 0.406-1.069]). Overall, COVID-19 symptoms were reported by 68 (28.2%) people with a positive serological SARS-CoV-2 test and by 7 (21.7%) YPLHIV (p = 0.527). No one required hospitalization. CONCLUSIONS SARS-CoV-2 seroprevalence was 46.8% without differences in risk of infection or clinical presentation based on HIV status. This result may be influenced by the exclusion of YPLHIV with advanced disease. The higher risk among students suggests the schools' role in spreading the virus. It's important to continue monitoring the impact of COVID-19 on YPLHIV to better understand its effect on screening and adherence to treatment.
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Affiliation(s)
- Roberto Benoni
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Doctors with Africa CUAMM Mozambique, Beira, Mozambique.
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie, Verona, 8 - 37134, Italy.
| | - Virginia Casigliani
- Doctors with Africa CUAMM Mozambique, Beira, Mozambique
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Annachiara Zin
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Dara Giannini
- Doctors with Africa CUAMM Mozambique, Beira, Mozambique
| | - Niccolò Ronzoni
- Doctors with Africa CUAMM Mozambique, Beira, Mozambique
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Kajal Chhaganlal
- Faculdade de Ciências de Saúde, Universidade Católica de Moçambique, Beira, Mozambique
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ada Merolle
- Doctors with Africa CUAMM Mozambique, Beira, Mozambique
| | | | | | - Francesca Tognon
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
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14
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Donà D, Minotti C, Masini T, Penazzato M, Van Der Zalm MM, Judd A, Giaquinto C, Lallemant M. COVID-19 and MIS-C treatment in children-results from an international survey. Eur J Pediatr 2023; 182:5087-5093. [PMID: 37672062 PMCID: PMC10640428 DOI: 10.1007/s00431-023-05179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Children have been mostly excluded from COVID-19 clinical trials, and, as a result, most medicines approved for COVID-19 have no pediatric indication. In addition, access to COVID-19 therapeutics remains limited. Collecting physicians' experiences with off-label use of therapeutics is important to inform global prioritization processes and better target pediatric research and development. A standardized questionnaire was designed to explore the use of therapeutics used to treat COVID-19 and multisystem inflammatory syndrome in children (MIS-C) in pediatric patients globally. Seventy-three physicians from 29 countries participated. For COVID-19, steroids were used by 75.6% of respondents; remdesivir and monoclonal antibodies were prescribed by 48.6% and 27.1% of respondents, respectively. For MIS-C, steroids were prescribed by 79.1% of respondents and intravenous immunoglobulins by 69.6%. The use of these products depended on their pediatric approval and the limited availability of antivirals and most monoclonal antibodies in Africa, South America, Southeast Asia, and Eastern Europe. Off-label prescription resulted widespread due to the paucity of clinical trials in young children at the time of the survey; though, based on our survey results, it was generally safe and led to clinical benefits. Conclusion: This survey provides a snapshot of current practice for treating pediatric COVID-19 worldwide, informing global prioritization efforts to better target pediatric research and development for COVID-19 therapeutics. Off-label use of such medicines is widespread for the paucity of clinical trials under 12 years and 40 kg, though appears to be safe and generally results in clinical benefits, even in young children. However, access to care, including medicine availability, differs widely globally. Clinical development of COVID-19 antivirals and monoclonal antibodies requires acceleration to ensure pediatric indication and allow worldwide availability of therapeutics that will enable more equitable access to COVID-19 treatment. What is Known: • Children have been mostly excluded from COVID-19 clinical trials, and, as a result, most medicines approved for COVID-19 have no pediatric indication. • Access to care differs widely globally, so because of the diversity of national healthcare systems; the unequal availability of medicines for COVID-19 treatment represents an obstacle to the pediatric population's universal right to health care. What is New: • Off-label COVID-19 drug prescription is widespread due to the lack of clinical trials in children younger than 12 years and weighing less than 40 kg, but relatively safe and generally leading to clinical benefit. • The application of the GAP-f framework to COVID-19 medicines is crucial, ensuring widespread access to all safe and effective drugs, enabling the rapid development of age-appropriate formulations, and developing specific access plans (including stability, storage, packaging, and labeling) for distribution in low- and middle-income countries (LMICs). Antivirals and monoclonal antibodies may benefit from the acceleration to reach widespread and equal diffusion.
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Affiliation(s)
- Daniele Donà
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy
| | - Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy.
| | - Tiziana Masini
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Martina Penazzato
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Marieke M Van Der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy
| | - Marc Lallemant
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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15
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Turkova A, White E, Kekitiinwa AR, Mumbiro V, Kaudha E, Liberty A, Ahimbisibwe GM, Moloantoa T, Srirompotong U, Mosia NR, Puthanakit T, Kobbe R, Fortuny C, Kataike H, Bbuye D, Na-Rajsima S, Coelho A, Lugemwa A, Bwakura-Dangarembizi MF, Klein N, Mujuru HA, Kityo C, Cotton MF, Ferrand RA, Giaquinto C, Rojo P, Violari A, Gibb DM, Ford D. Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial. Lancet Child Adolesc Health 2023; 7:718-727. [PMID: 37562418 DOI: 10.1016/s2352-4642(23)00164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124-159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir. FUNDING Penta Foundation, ViiV Healthcare, and UK Medical Research Council.
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Affiliation(s)
- Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
| | - Ellen White
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Vivian Mumbiro
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | - Afaaf Liberty
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | | | - Tumelo Moloantoa
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | | | - Nozibusiso Rejoice Mosia
- Department of Paediatrics and Children Health, King Edward VIII Hospital, Enhancing Care Foundation, University of KwaZulu-Natal, Durban, South Africa
| | - Thanyawee Puthanakit
- HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand; Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Clàudia Fortuny
- Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Department of Surgery and Medico-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Hajira Kataike
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Alexandra Coelho
- INSERM/ANRS SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | | | | | - Nigel Klein
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, UK; Africa Health Research Institute, Kwazulu-Natal, South Africa
| | - Hilda A Mujuru
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Mark F Cotton
- Children's Infectious Diseases Clinical Research Unit, Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Rashida A Ferrand
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Carlo Giaquinto
- Department of Women and Child Health, Padova, University of Padova, Italy
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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16
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Lapi F, Cassano N, Barbieri E, Marconi E, Vena GA, Giaquinto C, Cricelli C. Epidemiology of pediatric psoriasis: a population-based study using two Italian data sources. Curr Med Res Opin 2023; 39:1257-1262. [PMID: 37526047 DOI: 10.1080/03007995.2023.2243216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Psoriasis can be associated with certain comorbidities. This information is important for family pediatricians (FPs) and general practitioners (GPs) who have a key role in the identification and management of skin diseases. This study aimed to assess the incidence and prevalence rates of pediatrics psoriasis and its association with specific comorbidities. METHODS A retrospective cohort study was performed in patients aged less than 18 years registered in two Italian primary care databases (Pedianet and HSD) between 2015 and 2019. Prevalence and incidence of psoriasis were estimated, and a case-control design was adopted to assess specific comorbidities in psoriasis patients. RESULTS The annual prevalence rate of psoriasis was 0.2% in Pedianet and between 0.5% and 0.7% in HSD. The incidence rate ranged from 0.47 to 0.58 and from 1.3 to 1.77 per 1000 person-years in Pedianet and HSD, respectively. Allergic rhinitis, asthma, celiac disease, other malabsorption disease and non-infective cutaneous diseases showed a statistically significant association with psoriasis in Pedianet, while no statistically significant difference was found in HSD. CONCLUSION Given the FP-GP transition of patients, there is a need for accurate registration of clinical correlates, enabling GPs to implement strategies to minimize the lifetime risk of psoriatic progression.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari, Italy
- Dermatology and Venereology Private Practice, Barletta, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari, Italy
- Dermatology and Venereology Private Practice, Barletta, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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17
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Barlow‐Mosha LN, Ahimbisibwe GM, Chappell E, Amuge PM, Nanduudu A, Kaudha E, Amukele T, Balamusani D, Kafufu B, Nimwesiga A, Kataike H, Namwanje R, Kasangaki G, Mulindwa A, Muzorah GA, Bbuye D, Musiime V, Mujyambere E, Ssenyonga M, Mulima D, Kyambadde RC, Namusanje J, Isabirye R, Nabalamba M, Nakirya BM, Kityo C, Kekitiinwa AR, Giaquinto C, Copp A, Gibb DM, Ford D, Musoke P, Turkova A. Effect of dolutegravir on folate, vitamin B12 and mean corpuscular volume levels among children and adolescents with HIV: a sub-study of the ODYSSEY randomized controlled trial. J Int AIDS Soc 2023; 26:e26174. [PMID: 37766505 PMCID: PMC10534059 DOI: 10.1002/jia2.26174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Dolutegravir-based antiretroviral therapy (ART) is the preferred antiretroviral treatment for children and adolescents living with HIV. A large surveillance study in Botswana previously raised concerns about an association between pre-conception dolutegravir and neural tube defects. Before these concerns were subsequently resolved, we set up a sub-study to look at the effect of dolutegravir on levels of folate and vitamin B12 in children and adolescents within the randomized ODYSSEY trial, as folate and vitamin B12 are known to play a crucial role in neural tube development. METHODS We conducted the sub-study among Ugandan ODYSSEY participants and compared folate and vitamin B12 between children randomized to dolutegravir-based ART (DTG) and non-dolutegravir-based standard-of-care treatment (SOC). Plasma folate was measured at enrolment and week 4 on stored samples; in addition, plasma and red blood cell (RBC) folate and vitamin B12 were assayed at week ≥96 in prospectively collected samples. RBC mean corpuscular volume (MCV) was measured 24-weekly in all ODYSSEY participants. Samples analysed in the sub-study were collected between September 2016 and October 2020. RESULTS A total of 229 children aged ≥6 years were included in the sub-study with median age at trial enrolment of 12.3 (interquartile range [IQR] 9.0, 14.7) years, and CD4 count of 501 (IQR 228, 695); 112 (49%) children were male. Most participants (225/229, 98%) had plasma folate results at enrolment and 214 (93%) children had results available for RBC folate, vitamin B12 and plasma folate at week ≥96. MCV results were analysed on 679 children aged ≥6 years enrolled in ODYSSEY. At week 4, mean plasma folate was significantly higher in the dolutegravir arm than in SOC (difference [DTG-SOC] 1.6 ng/ml, 95% CI 0.8, 2.3; p<0.001), and this difference persisted to week ≥96 (2.7 ng/ml, 95% CI 1.7, 3.7; p<0.001). Mean RBC folate at ≥96 weeks was also higher in the DTG arm (difference 73 ng/ml, 95% CI 3, 143; p = 0.041). There was no difference in the treatment arms for vitamin B12 levels at ≥96 weeks or change in MCV through trial follow-up. CONCLUSIONS Plasma and RBC folate levels were higher in children and adolescents receiving dolutegravir-based ART than on other ART regimens. Further studies are needed to clarify the mechanisms of these interactions and the clinical implications of increased blood folate levels.
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Affiliation(s)
| | | | - Elizabeth Chappell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | | | | | | | - Timothy Amukele
- Department of PathologyICON Central Laboratories IncFarmingdaleNew YorkUSA
| | | | - Bosco Kafufu
- Infectious Diseases Institute Core LaboratoryKampalaUganda
| | | | - Hajira Kataike
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | - Rosemary Namwanje
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | - Gladys Kasangaki
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | - Dickson Bbuye
- Baylor College of Medicine Children's Foundation‐UgandaKampalaUganda
| | - Victor Musiime
- Joint Clinical Research CentreKampalaUganda
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | | | - Mark Ssenyonga
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | | | - Richard Isabirye
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | - Barbara Musoke Nakirya
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Andrew Copp
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - Diana M. Gibb
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - Deborah Ford
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - Philippa Musoke
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | - Anna Turkova
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - the ODYSSEY trial team
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
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18
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Botha JC, Byott M, Spyer MJ, Grant PR, Gärtner K, Chen WX, Burton J, Bamford A, Waters LJ, Giaquinto C, Turkova A, Vavro CL, Nastouli E. Sensitive HIV-1 DNA Pol Next-Generation Sequencing for the Characterisation of Archived Antiretroviral Drug Resistance. Viruses 2023; 15:1811. [PMID: 37766218 PMCID: PMC10536450 DOI: 10.3390/v15091811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Modern HIV-1 treatment effectively suppresses viral amplification in people living with HIV. However, the persistence of HIV-1 DNA as proviruses integrated into the human genome remains the main barrier to achieving a cure. Next-generation sequencing (NGS) offers increased sensitivity for characterising archived drug resistance mutations (DRMs) in HIV-1 DNA for improved treatment options. In this study, we present an ultra-sensitive targeted PCR assay coupled with NGS and a robust pipeline to characterise HIV-1 DNA DRMs from buffy coat samples. Our evaluation supports the use of this assay for Pan-HIV-1 analyses with reliable detection of DRMs across the HIV-1 Pol region. We propose this assay as a new valuable tool for monitoring archived HIV-1 drug resistance in virologically suppressed individuals, especially in clinical trials investigating novel therapeutic approaches.
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Affiliation(s)
- Johannes C. Botha
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Trust, London NW1 2PG, UK
| | - Matthew Byott
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Trust, London NW1 2PG, UK
| | - Moira J. Spyer
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Trust, London NW1 2PG, UK
| | | | - Kathleen Gärtner
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
| | | | - James Burton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Alasdair Bamford
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Medical Research Council Clinical Trials Unit, University College London, London WC1E 6BT, UK
| | - Laura J. Waters
- Central and North West London NHS Foundation Trust, Mortimer Market, London WC1E 6JB, UK
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, 35122 Padova, Italy
- Fondazione Penta ETS, 35127 Padova, Italy
| | - Anna Turkova
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Medical Research Council Clinical Trials Unit, University College London, London WC1E 6BT, UK
| | | | - Eleni Nastouli
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK (E.N.)
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Trust, London NW1 2PG, UK
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Di Chiara C, Boracchini R, Sturniolo G, Barbieri A, Costenaro P, Cozzani S, De Pieri M, Liberati C, Zin A, Padoan A, Bonfante F, Kakkar F, Cantarutti A, Donà D, Giaquinto C. Clinical features of COVID-19 in Italian outpatient children and adolescents during Parental, Delta, and Omicron waves: a prospective, observational, cohort study. Front Pediatr 2023; 11:1193857. [PMID: 37635788 PMCID: PMC10450148 DOI: 10.3389/fped.2023.1193857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction COVID-19 features changed with the Omicron variant of SARS-CoV-2 in adults. This study aims to describe COVID-19 symptoms in children and adolescents during the Parental, Delta, and Omicron eras. Methods A single-centre, prospective observational study was conducted on individuals aged 0-20 years attending the University Hospital of Padua (Italy) from April 2020 to December 2022. COVID-19 cases were defined by positive SARS-CoV-2 molecular detection and/or serology; patient/family symptoms and virological positivity were considered to determine the infection onset. Variables were summarized and compared using appropriate tests of descriptive statistics. Results A total of 509 cases [46% female, median age eight years (IQR: 4-12)] were studied. Three-hundred-eighty-seven (76%), 52 (10%), and 70 (14%) subjects experienced COVID-19 during the Parental, Delta, and Omicron waves, respectively. All subjects developed an asymptomatic/mild COVID-19. Overall, the most frequent symptoms were fever (47%) and rhinitis (21%), which showed a significant increasing incidence from the Parental to Omicron waves (p < 0.001). Conversely, diarrhea was most common during the pre-Omicron eras (p = 0.03). Stratifying symptoms according to the age group, fever, rhinitis, and skin rashes were observed more frequently among infants/toddlers; conversely, fatigue was more common in children older than five years. The duration of symptoms was similar across different SARS-CoV-2 variants of concern (VOCs); conversely, the number of symptoms varied according to the age group (p < 0.0001). Discussion This study showed differences in COVID-19 clinical presentation among infants, children, and adolescents and confirmed Omicron infection is more likely to be associated with upper respiratory symptoms. However, further population-based studies are needed to support these findings. In addition, active surveillance will play a crucial role in assessing the disease severity of future VOCs.
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Affiliation(s)
- Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
| | - Riccardo Boracchini
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giulia Sturniolo
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Alessia Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Paola Costenaro
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Sandra Cozzani
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Marica De Pieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Cecilia Liberati
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Annachiara Zin
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Andrea Padoan
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Francesco Bonfante
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
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Sabatino J, Di Chiara C, Lauretta D, Fumanelli J, D’Ascoli GL, Donà D, Cozzani S, Oletto A, Giaquinto C, Di Salvo G. Cardiac Function Evaluation after SARS-CoV-2 mRNA Vaccination in Children and Adolescents: A Prospective Speckle-Tracking Echocardiography Study. Vaccines (Basel) 2023; 11:1348. [PMID: 37631916 PMCID: PMC10458879 DOI: 10.3390/vaccines11081348] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Possible cardiac impairment after SARS-CoV-2 mRNA vaccination is a common driver of parental vaccine hesitancy. We performed a comprehensive echocardiographic evaluation of biventricular function in vaccinated children with or without previous COVID-19 compared to healthy controls. METHODS We conducted a single-center, prospective, case-control study enrolling children and adolescents aged 5-18 years attending the pediatric clinic of the University Hospital of Padua from April to June 2022. Three months after receiving the primary mRNA vaccination or booster dose, the patients underwent a cardiac assessment, including standard echocardiography and speckle-tracking echocardiography (STE). A pre-pandemic historical cohort of age- and gender-matched healthy children were used as a control. RESULTS A total of 39 post-VACCINE cases (24, 61% female), mean age 12.6 ± 2.6 years (range 8-17), were enrolled in the study. Ninety percent (N = 35) of patients were previously healthy. No differences in left ventricular diameters, left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion (TAPSE) were observed between cases and controls. Global longitudinal strain (GLS) was in the normal range in all individuals, with no differences between post-VACCINE cases and controls (-21.7 ± 2.3% vs. 21.2 ± 1.8%; p = 0.338). However, GLS was found to be slightly but significantly reduced in post-VACCINE children with a previous COVID-19 compared to naïve-vaccinated individuals (post-VACCINE+COVID-19: -19.9 ± 1.1% vs. post-VACCINE-only: -22.0 ± 2.3%; p = 0.002). CONCLUSIONS We did not observe an impairment in GLS or in other indices of LV structure or function after mRNA COVID-19 vaccination.
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Affiliation(s)
- Jolanda Sabatino
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (D.L.); (J.F.); (G.D.S.)
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (C.D.C.); (D.D.); (S.C.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy;
| | - Daria Lauretta
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (D.L.); (J.F.); (G.D.S.)
| | - Jennifer Fumanelli
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (D.L.); (J.F.); (G.D.S.)
| | - Greta Luana D’Ascoli
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (D.L.); (J.F.); (G.D.S.)
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (C.D.C.); (D.D.); (S.C.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy;
| | - Sandra Cozzani
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (C.D.C.); (D.D.); (S.C.); (C.G.)
| | | | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (C.D.C.); (D.D.); (S.C.); (C.G.)
- Penta–Child Health Research, 35127 Padua, Italy;
| | - Giovanni Di Salvo
- Division of Pediatric Cardiology, Department for Women’s and Children’s Health, University of Padua, 35128 Padova, Italy; (D.L.); (J.F.); (G.D.S.)
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
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21
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Di Chiara C, Ponzoni M, Piché-Renaud PP, Mengato D, Giaquinto C, Morris SK, Donà D. Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature. Antibiotics (Basel) 2023; 12:1271. [PMID: 37627691 PMCID: PMC10451316 DOI: 10.3390/antibiotics12081271] [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: 07/09/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
As a synergistic treatment approach with systemic antimicrobial therapy or a systemic antibiotic-sparing strategy, the local administration of antimicrobial agents has been proposed as an alternative route for complicated infections. With the rationale of concentrating the active principle in the desired target site, avoiding potentially toxic systemic levels and bypassing anatomical and physiological barriers, local irrigation or infusion of antibiotics may effectively shorten the antimicrobial therapy course and reduce both infection-related and systemic therapy-related complications. Although evidence from the adult population supports its use in selected patients with an acceptable safety profile, data specifically focused on the pediatric population are limited. To provide a rapid and easily accessible tool for clinical practice, we synthesized the most relevant evidence on the use of local antimicrobial agents in common severe infections in children: meningitis, mediastinitis, pleural infections, recurrent urinary infections, and peritonitis. A literature search was performed using predefined combined keywords through an electronic research database (PubMed). Described molecules, dosages, routes, treated age groups, and related efficacy have been summarized for prompt application to clinical practice. It should, however, be noted that the evidence for the pediatric population remains limited, and the local administration of several molecules remains off-label. A careful multidisciplinary and patient-tailored evaluation, as well as a rational use of available guidelines, should always be the basis of clinical decision making in settings where local administration of antibiotics may be considered.
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Affiliation(s)
- Costanza Di Chiara
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Matteo Ponzoni
- Congenital Cardiac Surgery Unit, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Pierre-Philippe Piché-Renaud
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
| | - Daniele Mengato
- Hospital Pharmacy Department, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy;
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
| | - Shaun K. Morris
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5R 0A3, Canada
- Division of Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
| | - Daniele Donà
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
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Barbieri E, Minotti C, Cavagnis S, Giaquinto C, Cappello B, Penazzato M, Lallemant M. Paediatric medicine issues and gaps from healthcare workers point of view: survey results and a narrative review from the global accelerator for paediatric formulations project. Front Pharmacol 2023; 14:1200848. [PMID: 37529704 PMCID: PMC10390094 DOI: 10.3389/fphar.2023.1200848] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
The WHO Model List of Essential Medicines for Children (EMLc) has not been systematically revised in the last few years. We conducted a survey addressed to healthcare professionals prescribing, preparing, or administering medicines to children and a narrative review to identify problematic paediatric formulations or missing medicines in all therapeutic fields to inform the review of the EMLc in 2023. A total of 285 physicians (63%), 28 nurses (6%) and 142 pharmacists (31%), mostly working in the hospital setting, reported at least one problematic medicine. 290 medicines were reported as missing (completely or the child-appropriate formulation). The top three most mentioned were ciprofloxacin together with phenobarbital and omeprazole. 387 medicines were reported as problematic (34% were oral liquid formulations, 34% tablets, 18% parenteral preparations. Mostly of the products were antibacterials (27%), cardiovascular medicines (11%) and antivirals (11%). The obtained responses show the perspective of healthcare workers working around the world, particularly in the European region (25%), in the African region (24%), and in the Region of the Americas (19%), with limited representation from Northern Africa and the Middle East. Our results need to be analysed with the outputs of other ongoing works before specific products can enter the WHO-hosted Global Accelerator for Paediatric formulations network prioritisation process. Efforts to develop appropriate formulations for children should be accelerated so that the uncertainties associated with off-label drug preparation and use are minimised, and therapeutic benefits are optimised.
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Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
- Penta—Child Health Research, Padova, Italy
| | - Chiara Minotti
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | | | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
- Penta—Child Health Research, Padova, Italy
| | - Bernadette Cappello
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Martina Penazzato
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Marc Lallemant
- Penta—Child Health Research, Padova, Italy
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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23
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Pinon M, Giugliano L, Rocchi F, Cananzi M, Auriti C, Wade B, Calvo PL, Giaquinto C, Indolfi G. Inadequate Hospital Practices to Prevent Mother-to-Child Transmission of Hepatitis B Virus Infection: A European Survey. J Pediatr Gastroenterol Nutr 2023; 76:716-722. [PMID: 36930981 DOI: 10.1097/mpg.0000000000003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Prevention of vertical transmission of hepatitis B virus (HBV) infection is crucial to eliminate viral hepatitis as a major public health threat by 2030. We aimed to assess the current hospital policies and practices implemented before, at, and after birth, and to evaluate potential barriers to the full application of international guidelines. METHODS A web-based survey was supported by PENTA Foundation and distributed across Europe from October to December 2021. RESULTS Overall, 76 centers with delivery departments completed the survey. Hepatitis B surface antigen (HBsAg) maternal screening is performed in the first trimester of pregnancy in 53% of the centers and in the third in 46%. HBsAg positive pregnant women are tested for serologic HBV markers and HBV-DNA in 78% and 63% of the departments; 38% of the HBeAg positive women with high HBV-DNA levels are treated during the last trimester of pregnancy. At birth, 91% of the departments administer HBV vaccine to infants born to HBsAg positive mothers within 12 hours of birth; 74% test women with unknown HBsAg status and 78% of them wait for the maternal testing results before administering HBV vaccine to their newborns. After birth, 47% of the departments provide postvaccination serological testing for infants born to HBsAg positive mothers. The timing of the HBV vaccine schedule varies greatly. CONCLUSIONS There is significant heterogeneity in the hospital policies and correlated procedures. The implementation of a multidisciplinary clinical pathway is a must if a stronger connection between the prenatal, perinatal, and postnatal phases is to be established.
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Affiliation(s)
- Michele Pinon
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Laura Giugliano
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Rocchi
- the Center of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, INCiPiT Italian Network For Pediatric Clinical Trials, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Mara Cananzi
- the Unit of Gastroenterology, Digestive Endoscopy, Hepatology and Care of Children with Liver Transplantation, University Hospital of Padova, Padova, Italy
| | - Cinzia Auriti
- the Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - Barbara Wade
- the Faculty of Medicine, University of Turin, Turin, Italy
| | - Pier Luigi Calvo
- From the Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Giaquinto
- the Department of Women and Child Health, University of Padova, Padova, Italy
- PENTA Foundation, Padova, Italy
| | - Giuseppe Indolfi
- the Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy
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Compagnucci A, Chan MK, Saïdi Y, Cressey TR, Bamford A, Riault Y, Coelho A, Nolan A, Chalermpantmetagul S, Morkunaite G, Amuge P, Musiime V, Violari A, Cotton M, Kekitiinwa AR, Kaudha E, Groenewald M, Liberty AA, Kanjanavanit S, Volokha A, Bologna R, Pavia Ruz N, Prieto Tato L, Paioni P, Marques L, Reliquet V, Niehues T, Welch SB, Ford D, Giaquinto C, Gibb DM, Babiker A, Ramos Amador JT. Nucleoside/nucleotide reverse transcriptase inhibitor sparing regimen with once daily integrase inhibitor plus boosted darunavir is non-inferior to standard of care in virologically-suppressed children and adolescents living with HIV - Week 48 results of the randomised SMILE Penta-17-ANRS 152 clinical trial. EClinicalMedicine 2023; 60:102025. [PMID: 37304494 PMCID: PMC10251070 DOI: 10.1016/j.eclinm.2023.102025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Integrase inhibitor (INSTI) with boosted darunavir (DRV/r), a regimen with a high-resistance barrier, avoiding NRTI toxicities, might be a switching option in children living with HIV (CLWHIV). Methods SMILE is a randomised non-inferiority trial evaluating safety and antiviral efficacy of once-daily INSTI + DRV/r vs. continuing on current standard-of-care (SOC) triple ART (2NRTI + boosted PI/NNRTI) in virologically-suppressed CLWHIV aged 6-18 years. The primary outcome is the proportion with confirmed HIV-RNA ≥50 copies/mL by week 48, estimated by Kaplan-Meier method. Non-inferiority margin was 10%. Registration number for SMILE are: ISRCTN11193709, NCT #: NCT02383108. Findings Between 10th June 2016 and 30th August 2019, 318 participants were enrolled from Africa 53%, Europe 24%, Thailand 15% and Latin America 8%, 158 INSTI + DRV/r [153 Dolutegravir (DTG); 5 Elvitegravir (EVG)], 160 SOC. Median (range) age was 14.7 years (7.6-18.0); CD4 count 782 cells/mm3 (227-1647); 61% female. Median follow-up was 64.3 weeks with no loss to follow-up. By 48 weeks, 8 INSTI + DRV/r vs. 12 SOC had confirmed HIV-RNA ≥50 copies/mL; difference (INSTI + DRV/r-SOC) -2.5% (95% CI: -7.6, 2.5%), showing non-inferiority. No major PI or INSTI resistance mutations were observed. There were no differences in safety between arms. By week 48, difference (INSTI + DRV/r-SOC) in mean CD4 count change from baseline was -48.3 cells/mm3 (95% CI: -93.4, -3.2; p = 0.036). Difference (INSTI + DRV/r-SOC) in mean HDL change from baseline was -4.1 mg/dL (95% CI: -6.7, -1.4; p = 0.003). Weight and Body Mass Index (BMI) increased more in INSTI + DRV/r than SOC [difference: 1.97 kg (95% CI: 1.1, 2.9; p < 0.001), 0.66 kg/m2 (95% CI: 0.3, 1.0; p < 0.001)]. Interpretation In virologically-suppressed children, switching to INSTI + DRV/r was non-inferior virologically, with similar safety profile, to continuing SOC. Small but significant differences in CD4, HDL-cholesterol, weight and BMI were observed between INSTI + DRV/r vs. SOC although clinical relevance needs further investigation. SMILE data corroborate adult findings and provide evidence for this NRTI-sparing regimen for children and adolescents. Funding Fondazione Penta Onlus, Gilead, Janssen, INSERM/ANRS and UK MRC. ViiV-Healthcare provided Dolutegravir.
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Affiliation(s)
| | | | - Yacine Saïdi
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Tim R. Cressey
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCL, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Yoann Riault
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Alexandra Coelho
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | | | - Suwalai Chalermpantmetagul
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | | | - Pauline Amuge
- Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Lubowa, Kampala, Uganda
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Cotton
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | | | | | - Marisa Groenewald
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | - Afaaf A. Liberty
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alla Volokha
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | | | - Noris Pavia Ruz
- Clínica para niños con VIH, UNAM/HGM; Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Laura Marques
- Centro Materno-Infantil do Norte, CHU Porto, Porto, Portugal
| | - Véronique Reliquet
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413, Nantes University, Nantes, France
| | - Tim Niehues
- Centre for Child Health and Adolescence, Helios Klinikum Krefeld, Academic Hospital, RWTH Aachen, Krefeld, Germany
| | - Steven B. Welch
- Department of Paediatrics, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | - Jose Tomas Ramos Amador
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC); Fundación para la Investigación Biomédica HCSC; Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Barbieri E, Cavagnis S, Scamarcia A, Cantarutti L, Bertizzolo L, Bangert M, Parisi S, Cantarutti A, Baraldi E, Giaquinto C, Baldo V. Assessing the burden of bronchiolitis and lower respiratory tract infections in children ≤24 months of age in Italy, 2012-2019. Front Pediatr 2023; 11:1143735. [PMID: 37215598 PMCID: PMC10196108 DOI: 10.3389/fped.2023.1143735] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Bronchiolitis is the most common lower respiratory tract infection (LRTI) in children and is mainly caused by the Respiratory Syncytial Virus (RSV). Bronchiolitis presents seasonally and lasts about five months, usually between October to March, with peaks of hospitalizations between December and February, in the Northern Hemisphere. The burden of bronchiolitis and RSV in primary care is not well understood. Materials and methods This retrospective analysis used data from Pedianet, a comprehensive paediatric primary care database of 161 family paediatricians in Italy. We evaluated the incidence rates (IR) of all-cause bronchiolitis (ICD9-CM codes 466.1, 466.11 or 466.19), all-cause LRTIs, RSV-bronchiolitis and RSV-LRTIs in children from 0 to 24 months of age, between January 2012 to December 2019. The role of prematurity (<37 weeks of gestational age) as a bronchiolitis risk factor was evaluated and expressed as odds ratio. Results Of the 108,960 children included in the study cohort, 7,956 episodes of bronchiolitis and 37,827 episodes of LRTIs were recorded for an IR of 47 and 221 × 1,000 person-years, respectively. IRs did not vary significantly throughout the eight years of RSV seasons considered, showing a seasonality usually lasting five months, between October and March, while the peak of incidence was between December and February. Bronchiolitis and LRTI IRs were higher during the RSV season, between October and March, regardless of the month of birth, with bronchiolitis IR being higher in children aged ≤12 months. Only 2.3% of bronchiolitis and LRTI were coded as RSV-related. Prematurity and comorbidity increased the risk of bronchiolitis; however, 92% of cases happened in children born at term, and 97% happened in children with no comorbidities or otherwise healthy. Conclusions Our results confirm that all children aged ≤24 months are at risk of bronchiolitis and LRTI during the RSV season, regardless of the month of birth, gestational age or underlying health conditions. The IRs of bronchiolitis and LRTI RSV-related are underestimated due to the poor outpatient epidemiological and virological surveillance. Strengthening the surveillance system at the paediatric outpatient level, as well as at the inpatient level, is needed to unveil the actual burden of RSV-bronchiolitis and RSV-LRTI, as well as to evaluate the effectiveness of new preventive strategies for anti-RSV.
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Affiliation(s)
- Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Sara Cavagnis
- Societa' Servizi Telematici - Pedianet, Padua, Italy
| | | | | | | | | | | | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Westerhof I, de Hoog M, Ieven M, Lammens C, van Beek J, Rozhnova G, Eggink D, Euser S, Wildenbeest J, Duijts L, van Houten M, Goossens H, Giaquinto C, Bruijning-Verhagen P. The impact of variant and vaccination on SARS-CoV-2 symptomatology; three prospective household cohorts. Int J Infect Dis 2023; 128:140-147. [PMID: 36566773 PMCID: PMC9780022 DOI: 10.1016/j.ijid.2022.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/11/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We compared age-stratified SARS-CoV-2 symptomatology of wild-type/Alpha vs Omicron BA.1/BA.2 variant infected individuals and the impact of COVID-19 booster vaccination on Omicron symptom burden. METHODS Data from three European prospective household cohorts were used (April 2020 to April 2021 and January to March 2022). Standardized outbreak protocols included (repeated) polymerase chain reaction testing, paired serology, and daily symptom scoring for all household members. Comparative analyses were performed on 346 secondary household cases from both periods. RESULTS Children <12 years (all unvaccinated) experienced more symptoms and higher severity scores during Omicron compared with wild-type/Alpha period (P ≤0.01). In adults, Omicron disease duration and severity were reduced (P ≤ 0.095). Omicron was associated with lower odds for loss of smell or taste (adjusted odds ratio [aOR]: 0.14; 95% CI 0.03-0.50) and higher but non-significant odds for upper respiratory symptoms, fever, and fatigue (aORs: 1.85-2.23). No differences were observed in disease severity or duration between primary vs booster series vaccinated adults (P ≥0.12). CONCLUSION The Omicron variant causes higher symptom burden in children compared with wild-type/Alpha and lower in adults, possibly due to previous vaccination. A shift in symptoms occurred with reduction in loss of smell/taste for Omicron. No additional effect of booster vaccination on Omicron symptom burden was observed.
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Affiliation(s)
- Ilse Westerhof
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Marieke de Hoog
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Christine Lammens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Janko van Beek
- Department of Viroscience, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ganna Rozhnova
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal; Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
| | - Dirk Eggink
- World Health Organization COVID-19 Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sjoerd Euser
- Department of Epidemiology, Streeklaboratorium voor de Volksgezondheid Kennemerland, Haarlem, The Netherlands
| | - Joanne Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlies van Houten
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands; Spaarne Gasthuis Academy, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Patricia Bruijning-Verhagen
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Mavragani A, Sanchez T, Caranci N, Giaquinto C, Barbiellini Amidei C, Canova C. The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort. JMIR Public Health Surveill 2023; 9:e44234. [PMID: 36645419 PMCID: PMC9897308 DOI: 10.2196/44234] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined. OBJECTIVE We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort. METHODS A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)-a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years). RESULTS The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11-year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families. CONCLUSIONS This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity.
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Affiliation(s)
| | | | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Claudio Barbiellini Amidei
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
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Brigadoi G, Rossin S, Visentin D, Barbieri E, Giaquinto C, Da Dalt L, Donà D. The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review. Ther Adv Infect Dis 2023; 10:20499361221141771. [PMID: 36654872 PMCID: PMC9841878 DOI: 10.1177/20499361221141771] [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] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/07/2022] [Indexed: 01/14/2023] Open
Abstract
Background Antibiotics remain the most prescribed medicine in children worldwide, but half of the prescriptions are unnecessary or inappropriate, leading to an increase in antibiotic resistance. This study aims to systemically review the effects of different Antimicrobial Stewardship Programmes (ASPs) on reducing the rates of both antibiotic prescriptions and changes in antimicrobial resistance, and on the economic impact in paediatric emergency departments (PED) and primary care settings. Materials and methods Embase, MEDLINE, and Cochrane Library were systematically searched, combining Medical Subject Heading and free-text terms for 'children' and 'antimicrobial' and 'stewardship'. The search strategy involved restrictions on dates (from 1 January 2007 to 30 December 2020) but not on language. Randomized controlled trials, controlled and non-controlled before and after studies, controlled and non-controlled interrupted time series, and cohort studies were included for review. The review protocol was registered at the PROSPERO International Prospective Register of Systematic Reviews: Registration Number CRD42021270630. Results Of the 47,158 articles that remained after removing duplicates, 59 were eligible for inclusion. Most of the studies were published after 2015 (37/59, 62.7%) and in high-income countries (51/59, 86.4%). Almost half of the studies described the implementation of an ASP in the primary care setting (28/59, 47.5%), while 15 manuscripts described the implementation of ASPs in EDs (15/59, 25.4%). More than half of the studies (43/59, 72.9%) described the implementation of multiple interventions, whereas few studies considered the implementation of a single intervention. Antibiotic prescriptions and compliance with guidelines were the most frequent outcomes (47/59, 79.7% and 20/59, 33.9%, respectively). Most of the articles reported an improvement in these outcomes after implementing an ASP. Meanwhile, only very few studies focused on health care costs (6/59, 10.2%) and antimicrobial resistance (3/59 5.1%). Conclusion The implementation of ASPs has been proven to be feasible and valuable, even in challenging settings such as Emergency Departments and Primary care.
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Affiliation(s)
- Giulia Brigadoi
- Paediatric Emergency Department, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy,Division of Paediatric Infectious Diseases, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
| | - Sara Rossin
- Paediatric Emergency Department, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
| | - Davide Visentin
- Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
| | - Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Woman’s and Children’s Health, University of Padua, Padua, Italy
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Minotti C, Mengato D, De Pieri M, Trivellato S, Francavilla A, Di Chiara C, Liberati C, Mattera R, Biffi A, Giaquinto C, Venturini F, Donà D. Early Treatments of Fragile Children with COVID-19-Results of CLEVER (Children COVID Early Treatment), a Retrospective, Observational Study. Viruses 2023; 15:192. [PMID: 36680232 PMCID: PMC9867507 DOI: 10.3390/v15010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
(1) Background: SARS-CoV-2 infection is notably mild in children, though comorbidities may increase the risk of hospitalization and may represent a risk for increased disease severity. There is an urgent need for targeted therapies with an acceptable efficacy and safety profile. To date, most of the medicines for COVID-19-specific treatment are prescribed off-label for children due to a lack of clinical trials and consequent evidence in this population. (2) Methods: This was a retrospective, observational study investigating the safety of treatments for the prevention of severe COVID-19 in fragile pediatric patients who received monoclonal antibodies and antivirals for mild-to-moderate symptoms between December 2021 and July 2022. (3) Results: Thirty-two patients were included. Monoclonal antibodies were prescribed to 62%, intravenous antivirals to 22%, and oral antivirals to 16% of children. Sotrovimab was the most frequently prescribed drug among monoclonal antibodies and overall (59%). The second most prescribed drug was remdesivir (22%). No severe adverse drug reaction was reported. There was no progression to severe disease and no death cases due to COVID-19 or drug administration. At drug-type stratification, resolution of symptoms and swab positivity time showed no difference between the two groups at 7 and 28 days. Off-label prescriptions were 84% overall, and in similar proportions between the two groups. (4) Conclusions: in this small sample, antivirals seemed safe and showed no differences in efficacy as compared to MAbs for the early treatment of COVID-19 in fragile children, thus representing a valuable choice, even when administered off-label.
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Affiliation(s)
- Chiara Minotti
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Department, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Marica De Pieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Sabrina Trivellato
- Hospital Pharmacy Department, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131 Padova, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Cecilia Liberati
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Raffaele Mattera
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Alessandra Biffi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Francesca Venturini
- Hospital Pharmacy Department, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
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Willame C, Dodd C, Durán CE, Elbers RJHJ, Gini R, Bartolini C, Paoletti O, Wang L, Ehrenstein V, Kahlert J, Haug U, Schink T, Diez-Domingo J, Mira-Iglesias A, Carreras JJ, Vergara-Hernández C, Giaquinto C, Barbieri E, Stona L, Huerta C, Martín-Pérez M, García-Poza P, de Burgos A, Martínez-González M, Bryant V, Villalobos F, Pallejà-Millán M, Aragón M, Carreras JJ, Souverein P, Thurin NH, Weibel D, Klungel OH, Sturkenboom MCJM. Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study. Vaccine 2023; 41:251-262. [PMID: 36446653 PMCID: PMC9678835 DOI: 10.1016/j.vaccine.2022.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.
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Affiliation(s)
- C Willame
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - C Dodd
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - CE Durán
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - RJHJ Elbers
- Department of Data science & Biostatistic, Data manegement, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - R Gini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - C Bartolini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - O Paoletti
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - L Wang
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - U Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Faculty of Human and Health Sciences, University of Bremen, Germany
| | - T Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen, Germany
| | - J Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - A Mira-Iglesias
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Vergara-Hernández
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - E Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - L Stona
- Fondazione Penta ONLUS, Corso Stati Uniti 4, 35127 Padova, Italy
| | - C Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - M Martín-Pérez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - P García-Poza
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - A de Burgos
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - M Martínez-González
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - V Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - F Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - P Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - NH Thurin
- INSERM CIC-P1401, Bordeaux PharmacoEpi, Univ. Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - D Weibel
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - OH Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - MCJM Sturkenboom
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands,Corresponding author at: Department Datascience & Biostatistics Univerisity Medical Center Utrecht, Heidelberglaan 100, The Netherlands
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Minotti C, Tirelli F, Guariento C, Sturniolo G, Giaquinto C, Da Dalt L, Zulian F, Meneghel A, Martini G, Donà D. Impact of guidelines implementation on empiric antibiotic treatment for pediatric uncomplicated osteomyelitis and septic arthritis over a ten-year period: Results of the ELECTRIC study (ostEomyeLitis and sEptiC arThritis tReatment in children). Front Pediatr 2023; 11:1135319. [PMID: 36911022 PMCID: PMC9997840 DOI: 10.3389/fped.2023.1135319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background Due to the growing evidence of the efficacy of intravenous (IV) cefazolin with an early switch to oral cefalexin in uncomplicated pediatric osteomyelitis (OM) and septic arthritis (SA) in children, we changed our guidelines for empiric antibiotic therapy in these conditions. This study aims at evaluating the impact of the guidelines' implementation in reducing broad-spectrum antibiotic prescriptions, duration of IV antibiotic treatment and hospital stay, treatment failure and recurrence. Materials and methods This is a retrospective, observational, quasi-experimental study. The four years pre-intervention were compared to the six years, ten months post-intervention (January 2012, through December 2015; January 2016, through October 31st, 2022). All patients aged 3 months to 18 years with OM or SA were evaluated for inclusion. Each population was divided into three groups: pre-intervention, post-intervention not following the guidelines, and post-intervention following the guidelines. Differences in antibiotic prescriptions such as Days of Therapy (DOT), activity spectrum and Length of Therapy (LOT), length of hospital stay (LOS), broad-spectrum antibiotics duration (bsDOT), treatment failure and relapse at six months were analyzed as outcomes. Results Of 87 included patients, 48 were diagnosed with OM (8 pre-intervention, 9 post-intervention not following the guidelines and 31 post-intervention following the guidelines) and 39 with SA (9 pre-intervention, 12 post-intervention not following the guidelines and 18 post-intervention following the guidelines). In OM patients, IV DOT, DOT/LOT ratio, and bsDOT were significantly lower in the guidelines group, with also the lowest proportion of patients discharged on IV treatment. Notably, significantly fewer cases required surgery in the post-intervention groups. Considering SA, LOS, IV DOT, DOT/LOT ratio, and bsDOT were significantly lower in the guidelines group. The treatment failure rate was comparable among all groups for both OM and SA. There were no relapse cases. The overall adherence was between 72 and 100%. Conclusions The implementation of guidelines was effective in decreasing the extensive use of broad-spectrum antibiotics and combination therapy for both OM and SA. Our results show the applicability, safety, and efficacy of a narrow-spectrum IV empirical antibiotic regimen with cefazolin, followed by oral monotherapy with first/second-generation cephalosporins, which was non-inferior to broad-spectrum regimens.
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Affiliation(s)
- Chiara Minotti
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Francesca Tirelli
- Pediatric Rheumatology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.,Pediatric Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Chiara Guariento
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giulia Sturniolo
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Francesco Zulian
- Pediatric Rheumatology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Alessandra Meneghel
- Pediatric Rheumatology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giorgia Martini
- Pediatric Rheumatology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Sabatino J, Di Chiara C, Di Candia A, Sirico D, Donà D, Fumanelli J, Basso A, Pogacnik P, Cuppini E, Romano LR, Castaldi B, Reffo E, Cerutti A, Biffanti R, Cozzani S, Giaquinto C, Di Salvo G. Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19. J Clin Med 2022; 12:jcm12010186. [PMID: 36614987 PMCID: PMC9820895 DOI: 10.3390/jcm12010186] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Although most children may experience mild to moderate symptoms and do not require hospitalization, there are little data on cardiac involvement in COVID-19. However, cardiac involvement is accurately demonstrated in children with MISC. The objective of this study was to evaluate cardiac mechanics in previously healthy children who recovered from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up by means of two-dimensional speckle-tracking echocardiography (STE). Methods: We analyzed a cohort of 157 paediatric patients, mean age 7.7 ± 4.5 years (age range 0.3−18 years), who had a laboratory-confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent a standard transthoracic echocardiogram and STE at an average time of 148 ± 68 days after diagnosis and were divided in three follow-up groups (<180 days, 180−240 days, >240 days). Patients were compared with 107 (41 females—38%) age- and BSA-comparable healthy controls (CTRL). Results: Left ventricular (LV) global longitudinal strain (post-COVID-19: −20.5 ± 2.9%; CTRL: −21.8 ± 1.7%; p < 0.001) was significantly reduced in cases compared with CTRLs. No significant differences were seen among the three follow-up groups (p = NS). Moreover, regional longitudinal strain was significantly reduced in LV apical-wall segments of children with disease onset during the second wave of the COVID-19 pandemic compared to the first wave (second wave: −20.2 ± 2.6%; first wave: −21.2 ± 3.4%; p = 0.048). Finally, peak left atrial systolic strain was within the normal range in the post-COVID-19 group with no significant differences compared to CTRLs. Conclusions: Our study demonstrated for the first time the persistence of LV myocardial deformation abnormalities in previously healthy children with an asymptomatic or mildly symptomatic (WHO stages 0 or 1) COVID-19 course after an average follow-up of 148 ± 68 days. A more significant involvement was found in children affected during the second wave. These findings imply that subclinical LV dysfunction may also be a typical characteristic of COVID-19 infection in children and are concerning given the predictive value of LV longitudinal strain in the general population.
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Affiliation(s)
- Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
- Correspondence: (J.S.); (G.D.S.)
| | - Costanza Di Chiara
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Angela Di Candia
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Daniele Donà
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Jennifer Fumanelli
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Alessia Basso
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Pietro Pogacnik
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Elena Cuppini
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Letizia Rosa Romano
- Department of Medical and Surgical Sciences, Division of Cardiology, Magna Graecia University of Catanzaro, Viale Europa 1, 88100 Catanzaro, Italy
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Elena Reffo
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Alessia Cerutti
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Roberta Biffanti
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Sandra Cozzani
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
- Correspondence: (J.S.); (G.D.S.)
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Cuppini E, Sabatino J, Gozzi A, Cattapan I, Di Candia A, Di Chiara C, Sirico D, Donà D, Fumanelli J, Basso A, Pogancik P, Castaldi B, Reffo E, Cerutti A, Biffanti R, Cozzani S, Giaquinto C, Di Salvo G. 969 MID AND LONG TERM ATRIO-VENTRICULAR MECHANISM IN CHILDREN AFTER RECOVERY FROM ASYMPTOMATIC O MILDLY SYMPTOMATIC SARS COV2 INFECTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.387] [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: 12/23/2022]
Abstract
Abstract
Background
Clinical manifestations of children's coronavirus disease-2019 (COVID-19) were initially considered less severe compared with adult patients. However, there is now increasing evidence of a “long-tail” of COVID-19 related symptoms lasting for several months after recovery from the acute infection. Long COVID-19-related symptoms and mechanisms are poorly characterized and understood, with several phenotypes reported, often driven by long-term tissue damage (such as lung, heart and brain) and pathological inflammation due to viral persistence and/or immune deregulation.
Purpose
The objective of this study was to evaluate atrio-ventricular mechanics, by means of two-dimensional speckle-tracking echocardiography, in previously healthy children recovered from asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up.
Methods
We analysed a cohort of 157 paediatric patients, mean age 7 ± 4 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study 148 ± 68 days after diagnosis. One hundred seven age, sex, and body surface area comparable healthy subjects were used as control group.
Results
Left ventricular ejection fraction was within normal limits in postCOVID-19 cases and CTRL with no significant differences between the two groups (postCOVID-19: 65.6 ± 4% vs CTRL: 65.0 ± 5%, p = 0.182).Left ventricular (LV) global longitudinal strain (postCOVID-19: -20.5 ± 2.9%; CTRL: -21.8 ± 1.7%; p < 0.001) was significantly reduced in cases compared with CTRLs. An amount of 11 (7%) postCOVID-19 cases showed impaired GLS values < -17% and 95 subjects (60%) presented with a strain lower than -16% in more than 2 segments. These subjects did not show any difference regarding symptoms or serological findings. Moreover, GLS was significantly reduced in children with disease's onset during the second wave of COVID-19 pandemic, compared with those during the first wave (second wave: -20.2 ± 2.6%; first wave: -21.2 ± 3.4%; p = 0.048). Finally, peak left atrial systolic strain was within the normal range in the postCOVID-19 group with no significant differences compared to CTRL (postCOVID-19: 49.1 ± 12%; CTRL: 49.5 ± 18%).
Conclusions
SARS-CoV-2 infection may affect left ventricular deformation in children despite an asymptomatic or only mildly symptomatic acute illness. Our data show an amount of 60% of children, recovering from asymptomatic or mildly symptomatic COVID-19, with still mild subclinical systolic cardiac impairment in the mid- and long-term follow-up after the infection. This subtle impairment was seen to be worse in children recovering from the second wave of COVID-19 compared to the first one.
A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.
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Affiliation(s)
- Elena Cuppini
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Jolanda Sabatino
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Anna Gozzi
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Irene Cattapan
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Angela Di Candia
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Costanza Di Chiara
- Department Of Women And Children’s Health, University Hospital Of Padova, Division Of Pediatric Infectious Diseases
| | - Domenico Sirico
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Daniele Donà
- Department Of Women And Children’s Health, University Hospital Of Padova, Division Of Pediatric Infectious Diseases
| | - Jennifer Fumanelli
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Alessia Basso
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Pietro Pogancik
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Biagio Castaldi
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Elena Reffo
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Alessia Cerutti
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Roberta Biffanti
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
| | - Sandra Cozzani
- Department Of Women And Children’s Health, University Hospital Of Padova, Division Of Pediatric Infectious Diseases
| | - Carlo Giaquinto
- Department Of Women And Children’s Health, University Hospital Of Padova, Division Of Pediatric Infectious Diseases
| | - Giovanni Di Salvo
- Department Of Women And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit
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Williams PCM, Qazi SA, Agarwal R, Velaphi S, Bielicki JA, Nambiar S, Giaquinto C, Bradley J, Noel GJ, Ellis S, O’Brien S, Balasegaram M, Sharland M. Antibiotics needed to treat multidrug-resistant infections in neonates. Bull World Health Organ 2022; 100:797-807. [PMCID: PMC9706347 DOI: 10.2471/blt.22.288623] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022] Open
Abstract
Infections remain a leading cause of death in neonates. The sparse antibiotic development pipeline and challenges in conducting neonatal research have resulted in few effective antibiotics being adequately studied to treat multidrug-resistant (MDR) infections in neonates, despite the increasing global mortality burden caused by antimicrobial resistance. Of 40 antibiotics approved for use in adults since 2000, only four have included dosing information for neonates in their labelling. Currently, 43 adult antibiotic clinical trials are recruiting patients, compared with only six trials recruiting neonates. We review the World Health Organization (WHO) priority pathogens list relevant to neonatal sepsis and propose a WHO multiexpert stakeholder meeting to promote the development of a neonatal priority antibiotic development list. The goal is to develop international, interdisciplinary consensus for an accelerated neonatal antibiotic development programme. This programme would enable focused research on identified priority antibiotics for neonates to reduce the excess morbidity and mortality caused by MDR infections in this vulnerable population.
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Affiliation(s)
- Phoebe CM Williams
- School of Public Health, Faculty of Medicine, Edward Ford Building, The University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Ramesh Agarwal
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sithembiso Velaphi
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Julia A Bielicki
- Institute of Infection and Immunity, University of London, London, England
| | - Sumathi Nambiar
- Johnson & Johnson, Rockville, United States of America (USA)
| | - Carlo Giaquinto
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - John Bradley
- Department of Pediatric Infectious Diseases, University of California San Diego School of Medicine, San Diego, USA
| | - Gary J Noel
- Institute for Advanced Clinical Trials for Children, Weill Cornell Medical College, Rockville, USA
| | - Sally Ellis
- Global Antibiotic Research and Development Project, Geneva, Switzerland
| | - Seamus O’Brien
- Global Antibiotic Research and Development Project, Geneva, Switzerland
| | | | - Michael Sharland
- Institute of Infection and Immunity, University of London, London, England
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Wildenbeest JG, Billard MN, Zuurbier RP, Korsten K, Langedijk AC, van de Ven PM, Snape MD, Drysdale SB, Pollard AJ, Robinson H, Heikkinen T, Cunningham S, O'Neill T, Rizkalla B, Dacosta-Urbieta A, Martinón-Torres F, van Houten MA, Bont LJ, Billard MN, Zuurbier R, Korsten K, van Houten M, Langedijk A, van de Ven P, Bont L, Drysdale S, McGinley J, Lin GL, Snape M, Pollard A, Ives A, Wolfenden H, Salgia S, Shetty R, Dacosta-Urbieta A, Rivero-Calle I, Gómez-Carballa A, Pischedda S, Rodriguez-Tenreiro C, Martinón-Torres F, Heikkinen T, Cunningham S, Nair H, Campbell H, O'Neill T, Miller M, Baggott J, Beveridge C, McKernan R, Rizkalla B, Beutels P, Openshaw P, Meijer A, Kølsen Fischer T, van den Berge M, Giaquinto C, Abram M, Swanson K, Aerssens J, Vernhes C, Gallichan S, Kumar V, Molero E. The burden of respiratory syncytial virus in healthy term-born infants in Europe: a prospective birth cohort study. Lancet Respir Med 2022; 11:341-353. [PMID: 36372082 PMCID: PMC9764871 DOI: 10.1016/s2213-2600(22)00414-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of hospitalisation in infants. The burden of RSV infection in healthy term infants has not yet been established. Accurate health-care burden data in healthy infants are necessary to determine RSV immunisation policy when RSV immunisation becomes available. METHODS We performed a multicentre, prospective, observational birth cohort study in healthy term-born infants (≥37 weeks of gestation) in five sites located in different European countries to determine the health-care burden of RSV. The incidence of RSV-associated hospitalisations in the first year of life was determined by parental questionnaires and hospital chart reviews. We performed active RSV surveillance in a nested cohort to determine the incidence of medically attended RSV infections. The study is registered with ClinicalTrials.gov, NCT03627572. FINDINGS In total, 9154 infants born between July 1, 2017, and April 1, 2020, were followed up during the first year of life and 993 participated in the nested active surveillance cohort. The incidence of RSV-associated hospitalisations in the total cohort was 1·8% (95% CI 1·6-2·1). There were eight paediatric intensive care unit admissions, corresponding to 5·5% of 145 RSV-associated hospitalisations and 0·09% of the total cohort. Incidence of RSV infection in the active surveillance cohort confirmed by any diagnostic assay was 26·2% (24·0-28·6) and that of medically attended RSV infection was 14·1% (12·3-16·0). INTERPRETATION RSV-associated acute respiratory infection causes substantial morbidity, leading to the hospitalisation of one in every 56 healthy term-born infants in high-income settings. Immunisation of pregnant women or healthy term-born infants during their first winter season could have a major effect on the health-care burden caused by RSV infections. FUNDING Innovative Medicines Initiative 2 Joint Undertaking, with support from the EU's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marie-Noëlle Billard
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roy P Zuurbier
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Spaarne Gasthuis Academy, Hoofddorp and Haarlem, Netherlands
| | - Koos Korsten
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | - Annefleur C Langedijk
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter M van de Ven
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK,Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Thomas O'Neill
- Children's Clinical Research Facility, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
| | | | - Ana Dacosta-Urbieta
- Translational Paediatrics and Infectious Diseases, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain,Genetics, Vaccines and Infections Research Group, Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands,Correspondence to: Prof Louis J Bont, Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584EA Utrecht, Netherlands
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Dona’ D, Montagnani C, Di Chiara C, Venturini E, Galli L, Lo Vecchio A, Denina M, Olivini N, Bruzzese E, Campana A, Giacchero R, Salvini F, Meini A, Ponzoni M, Trapani S, Rossi E, Lombardi MH, Badolato R, Pierri L, Pruccoli G, Rossin S, Colomba C, Cazzato S, Pacati I, Nicolini G, Pierantoni L, Bianchini S, Krzysztofiak A, Garazzino S, Giaquinto C, Castelli Gattinara G. COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease? Viruses 2022; 14:v14102256. [PMID: 36298812 PMCID: PMC9612333 DOI: 10.3390/v14102256] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
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Affiliation(s)
- Daniele Dona’
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3388946412
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Nicole Olivini
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Campana
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | | | - Filippo Salvini
- Department of Pediatrics, Niguarda Hospital, 20162 Milan, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
| | - Sandra Trapani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | | | - Mary Haywood Lombardi
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
| | - Ilaria Pacati
- Paediatric Unit, Ospedale Bolognini ASST Bergamo Est, 24068 Seriate, Italy
| | | | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, 40138 Bologna, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
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Romaní N, Pieras M, Frick MA, Sulleiro E, Rodó C, Silgado A, Suy A, Espiau M, Thorne C, Giaquinto C, Felipe-Rucián A, Soler-Palacín P, Soriano-Arandes A. Neurological Short-Term Outcomes of a Cohort of Children Born to Zika Virus-Infected Mothers in Barcelona. Children (Basel) 2022; 9:children9101537. [PMID: 36291474 PMCID: PMC9599986 DOI: 10.3390/children9101537] [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] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Zika virus (ZIKV) is a vector-borne flavivirus with a known teratogenic effect, yet the full spectrum has not been delineated. Studies on endemic areas tried to characterize the clinical outcomes of ZIKV intrauterine exposure. We aimed to describe early neurodevelopmental outcomes on prenatally ZIKV-exposed children in a non-endemic ZIKV area. This is a prospective observational cohort study conducted from May 2016 to December 2021 at Hospital Universitari Vall d’Hebron in Barcelona, Catalonia, Spain. We monitored for up to 24 months 152 children extracted from a pregnant women cohort with suspected ZIKV infection; eleven women (11/150; 7.3%) fulfilled the criteria for a confirmed ZIKV infection. Among the 152 children included, we describe two cases of congenital ZIKV syndrome (CZS) born from women with a confirmed ZIKV infection. Additionally, we describe five cases of other potentially ZIKV-related outcomes (OPZROs), all with normal birth cranial circumference and born to women with probable ZIKV infection. The low exposed prevalence of adverse outcomes in asymptomatic children at birth in a non-endemic area suggests that close follow-up should be addressed by primary care pediatricians instead of pediatric specialists. Further studies are needed to assess the effects of ZIKV intrauterine exposure beyond two years of life.
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Affiliation(s)
- Natàlia Romaní
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Maria Pieras
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Department of Microbiology, Instituto de Salud Carlos III, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Carlota Rodó
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Aroa Silgado
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Department of Microbiology, Instituto de Salud Carlos III, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Maria Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Claire Thorne
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University-Hospital of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Ana Felipe-Rucián
- Pediatric Neurology Section, Pediatric Neurology Research Group, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Correspondence:
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Sabatino J, Sirico D, Di Chiara C, Pogacnik P, Di Candia A, Bonfante F, Dona D, Costenaro P, Fumanelli J, Reffo E, Castaldi B, Biffanti R, Cerutti A, Giaquinto C, Di Salvo G. Mid- and long-term atrio-ventricular mechanics in children after recovery from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Eur Heart J 2022. [PMCID: PMC9619532 DOI: 10.1093/eurheartj/ehac544.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Clinical manifestations of children's coronavirus disease-2019 (COVID-19) were initially considered less severe compared with adult patients. However, there is now increasing evidence of a “long-tail” of COVID-19 related symptoms lasting for several months after recovery from the acute infection. Long COVID-19-related symptoms and mechanisms are poorly characterized and understood, with several phenotypes reported, often driven by long-term tissue damage (such as lung, heart and brain) and pathological inflammation due to viral persistence and/or immune deregulation. Purpose The objective of this study was to evaluate atrio-ventricular mechanics, by means of two-dimensional speckle-tracking echocardiography, in previously healthy children recovered from asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up. Methods We analysed a cohort of 157 paediatric patients, mean age 7±4 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study 148±68 days after diagnosis. One hundred seven age, sex, and body surface area comparable healthy subjects were used as control group. Results Left ventricular ejection fraction was within normal limits in postCOVID-19 cases and CTRL with no significant differences between the two groups (postCOVID-19: 65.6±4% vs CTRL: 65.0±5%, p=0.182). Left ventricular (LV) global longitudinal strain (postCOVID-19: −20.5±2.9%; CTRL: −21.8±1.7%; p<0.001) was significantly reduced in cases compared with CTRLs. An amount of 11 (7%) postCOVID-19 cases showed impaired GLS values < −17% and 95 subjects (60%) presented with a strain lower than −16% in more than 2 segments. These subjects did not show any difference regarding symptoms or serological findings. Moreover, GLS was significantly reduced in children with disease's onset during the second wave of COVID-19 pandemic, compared with those during the first wave (second wave: −20.2±2.6%; first wave: −21.2±3.4%; p=0.048). Finally, peak left atrial systolic strain was within the normal range in the postCOVID-19 group with no significant differences compared to CTRL (postCOVID-19: 49.1±12%; CTRL: 49.5±18%). Conclusions SARS-CoV-2 infection may affect left ventricular deformation in children despite an asymptomatic or only mildly symptomatic acute illness. Our data show an amount of 60% of children, recovering from asymptomatic or mildly symptomatic COVID-19, with still mild subclinical systolic cardiac impairment in the mid- and long-term follow-up after the infection. This subtle impairment was seen to be worse in children recovering from the second wave of COVID-19 compared to the first one. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
| | - D Sirico
- University of Padua , Padova , Italy
| | | | | | | | | | - D Dona
- University of Padua , Padova , Italy
| | | | | | - E Reffo
- University of Padua , Padova , Italy
| | | | | | - A Cerutti
- University of Padua , Padova , Italy
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Barbieri E, Porcu G, Petigara T, Senese F, Prandi GM, Scamarcia A, Cantarutti L, Cantarutti A, Giaquinto C. The Economic Burden of Pneumococcal Disease in Children: A Population-Based Investigation in the Veneto Region of Italy. Children (Basel) 2022; 9:children9091347. [PMID: 36138656 PMCID: PMC9498138 DOI: 10.3390/children9091347] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022]
Abstract
Despite widespread childhood immunization programs, pneumococcal disease (PD) continues to be associated with significant clinical and economic burden worldwide. This retrospective study assessed the PD-related economic burden in children from the Veneto region of Italy following the introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) to the Italian immunization schedule in 2010. Between 2010 and 2017, the annual incidences of pneumonia, acute otitis media (AOM), and invasive pneumococcal disease (IPD), as well as syndromic-disease-related episodes, declined. In our analysis of data from regional expenditure and healthcare resource utilization (HCRU) databases related to children < 15 years of age, we found that regional expenditures decreased between 2010 and 2017 for pneumonia (EUR 8.88 to EUR 3.59 million), AOM (EUR 3.78 to EUR 2.76 million), and IPD (EUR 1.40 to EUR 1.00 million). Despite reductions in PD-related expenditure following the introduction of PCV13, there continues to be an economic burden associated with PD in Veneto, Italy.
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Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Gloria Porcu
- Unit of Biostatistics Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Tanaz Petigara
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ 07065, USA
| | | | | | | | | | - Anna Cantarutti
- Unit of Biostatistics Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy
- Pedianet Project, 35138 Padova, Italy
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Brigadoi G, Gastaldi A, Moi M, Barbieri E, Rossin S, Biffi A, Cantarutti A, Giaquinto C, Da Dalt L, Donà D. Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11091192. [PMID: 36139971 PMCID: PMC9494981 DOI: 10.3390/antibiotics11091192] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.
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Affiliation(s)
- Giulia Brigadoi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3476959589
| | - Andrea Gastaldi
- Department of Pediatrics, Women’s and Children’s Health, University of Verona, Piazz. Stefani 1, 37126 Verona, Italy
| | - Marco Moi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Amuge P, Lugemwa A, Wynne B, Mujuru HA, Violari A, Kityo CM, Archary M, Variava E, White E, Turner RM, Shakeshaft C, Ali S, Nathoo KJ, Atwine L, Liberty A, Bbuye D, Kaudha E, Mngqibisa R, Mosala M, Mumbiro V, Nanduudu A, Ankunda R, Maseko L, Kekitiinwa AR, Giaquinto C, Rojo P, Gibb DM, Turkova A, Ford D. Once-daily dolutegravir-based antiretroviral therapy in infants and children living with HIV from age 4 weeks: results from the below 14 kg cohort in the randomised ODYSSEY trial. Lancet HIV 2022; 9:e638-e648. [PMID: 36055295 PMCID: PMC9646993 DOI: 10.1016/s2352-3018(22)00163-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. METHODS ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and <14 kg). Children weighing less than 14 kg starting first-line or second-line ART were enrolled in seven HIV treatment centres in South Africa, Uganda, and Zimbabwe. Randomisation, which was computer generated by the trial statistician, was stratified by first-line or second-line ART and three weight bands. Dispersible 5 mg dolutegravir was dosed according to WHO weight bands. The primary outcome was the Kaplan-Meier estimated proportion of children with virological or clinical failure by 96 weeks, defined as: confirmed viral load of at least 400 copies per mL after week 36; absence of virological suppression by 24 weeks followed by a switch to second-line or third-line ART; all-cause death; or a new or recurrent WHO stage 4 or severe WHO stage 3 event. The primary outcome was assessed by intention to treat in all randomly assigned participants. A primary Bayesian analysis of the difference in the proportion of children meeting the primary outcome between treatment groups incorporated evidence from the higher weight cohort (≥14 kg) in a prior distribution. A frequentist analysis was also done of the lower weight cohort (<14 kg) alone. Safety analyses are presented for all randomly assigned children in this study (<14 kg cohort). ODYSSEY is registered with ClinicalTrials.gov, NCT02259127. FINDINGS Between July 5, 2018, and Aug 26, 2019, 85 children weighing less than 14 kg were randomly assigned to receive dolutegravir (n=42) or standard of care (n=43; 32 [74%] receiving protease inhibitor-based ART). Median age was 1·4 years (IQR 0·6-2·0) and median weight 8·1 kg (5·4-10·0). 72 (85%) children started first-line ART and 13 (15%) started second-line ART. Median follow-up was 124 weeks (112-137). By 96 weeks, treatment failure occurred in 12 children in the dolutegravir group (Kaplan-Meier estimated proportion 31%) versus 21 (48%) in the standard-of-care group. The Bayesian estimated difference in treatment failure (dolutegravir minus standard of care) was -10% (95% CI -19% to -2%; p=0·020), demonstrating superiority of dolutegravir. The frequentist estimated difference was -18% (-36% to 2%; p=0·057). 15 serious adverse events were reported in 11 (26%) children in the dolutegravir group, including two deaths, and 19 were reported in 11 (26%) children in the standard-of-care group, including four deaths (hazard ratio [HR] 1·08 [95% CI 0·47-2·49]; p=0·86). 36 adverse events of grade 3 or higher were reported in 19 (45%) children in the dolutegravir group, versus 34 events in 21 (49%) children in the standard-of-care group (HR 0·93 [0·50-1·74]; p=0·83). No events were considered related to dolutegravir. INTERPRETATION Dolutegravir-based ART was superior to standard of care (mainly protease inhibitor-based) with a lower risk of treatment failure in infants and young children, providing support for global dispersible dolutegravir roll-out for younger children and allowing alignment of adult and paediatric treatment. FUNDING Paediatric European Network for Treatment of AIDS Foundation, ViiV Healthcare, UK Medical Research Council.
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Affiliation(s)
- Pauline Amuge
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | | | - Ben Wynne
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Hilda A Mujuru
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | | | - Moherndran Archary
- Department of Paediatrics and Children Health, King Edward VIII Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Ebrahim Variava
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | - Ellen White
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Rebecca M Turner
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Clare Shakeshaft
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Shabinah Ali
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Kusum J Nathoo
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | - Afaaf Liberty
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | - Dickson Bbuye
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | | | - Rosie Mngqibisa
- Department of Paediatrics and Children Health, King Edward VIII Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Modehei Mosala
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | - Vivian Mumbiro
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | | | - Lindiwe Maseko
- Perinatal HIV Research Unit, University of the Witwatersrand, South Africa
| | | | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Italy; Penta Foundation, Padova, Italy
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
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Villabruna N, Izquierdo-Lara RW, Schapendonk CME, de Bruin E, Chandler F, Thao TTN, Westerhuis BM, van Beek J, Sigfrid L, Giaquinto C, Goossens H, Bielicki JA, Kohns Vasconcelos M, Fraaij PLA, Koopmans MPG, de Graaf M. Profiling of humoral immune responses to norovirus in children across Europe. Sci Rep 2022; 12:14275. [PMID: 35995986 PMCID: PMC9395339 DOI: 10.1038/s41598-022-18383-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Norovirus is a leading cause of epidemic acute gastroenteritis. More than 30 genotypes circulate in humans, some are common, and others are only sporadically detected. Here, we investigated whether serology can be used to determine which genotypes infect children. We established a multiplex protein microarray with structural and non-structural norovirus antigens that allowed simultaneous antibody testing against 30 human GI and GII genotypes. Antibody responses of sera obtained from 287 children aged < 1 month to 5.5 years were profiled. Most specific IgG and IgA responses were directed against the GII.2, GII.3, GII.4, and GII.6 capsid genotypes. While we detected antibody responses against rare genotypes, we found no evidence for wide circulation. We also detected genotype-specific antibodies against the non-structural proteins p48 and p22 in sera of older children. In this study, we show the age-dependent antibody responses to a broad range of norovirus capsid and polymerase genotypes, which will aid in the development of vaccines.
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Affiliation(s)
- Nele Villabruna
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Ray W Izquierdo-Lara
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | | | - Erwin de Bruin
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Felicity Chandler
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Tran Thi Nhu Thao
- Institute of Virology and Immunology (IVI), Bern, Switzerland.,Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.,Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Brenda M Westerhuis
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Janko van Beek
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Louise Sigfrid
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Julia A Bielicki
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Marion P G Koopmans
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Miranda de Graaf
- Department of Viroscience, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
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Chiusaroli L, Liberati C, Caseti M, Rulli L, Barbieri E, Giaquinto C, Donà D. Therapeutic Options and Outcomes for the Treatment of Neonates and Preterms with Gram-Negative Multidrug-Resistant Bacteria: A Systematic Review. Antibiotics (Basel) 2022; 11:antibiotics11081088. [PMID: 36009956 PMCID: PMC9404799 DOI: 10.3390/antibiotics11081088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Infections caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria represent a challenge in the neonatal population due to disease severity and limited therapeutic possibilities compared to adults. The spread of antimicrobial resistance and drug availability differ significantly worldwide. The incidence of MDR bacteria has constantly risen, causing an increase in morbidity, mortality, and healthcare costs in both high-income (HIC) and low- and middle-income countries (LMIC). Therefore, more evidence is needed to define the possible use of newer molecules and to optimize combination regimens for the oldest antimicrobials in neonates. This systematic review aims to identify and critically appraise the current antimicrobial treatment options and the relative outcomes for MDR and XDR Gram-negative bacterial infections in the neonatal population. (2) Methods: A literature search for the treatment of MDR Gram-negative bacterial infections in neonates (term and preterm) was conducted in Embase, MEDLINE, and Cochrane Library. Studies reporting data on single-patient-level outcomes related to a specific antibiotic treatment for MDR Gram-negative bacterial infection in children were included. Studies reporting data from adults and children were included if single-neonate-level information could be identified. We focused our research on four MDROs: Enterobacterales producing extended-spectrum beta-lactamase (ESBL) or carbapenemase (CRE), Pseudomonas aeruginosa, and Acinetobacter baumannii. PROSPERO registration: CRD42022346739 (3) Results: The search identified 11,740 studies (since January 2000), of which 22 fulfilled both the inclusion and exclusion criteria and were included in the analysis. Twenty of these studies were conducted in LMIC. Colistin is the main studied and used molecule to treat Gram-negative MDR bacteria for neonate patients in the last two decades, especially in LMIC, with variable evidence of efficacy. Carbapenems are still the leading antibiotics for ESBL Enterobacterales, while newer molecules (i.e., beta-lactam agents/beta-lactamase inhibitor combination) are promising across all analyzed categories, but data are few and limited to HICs. (4) Conclusions: Data about the treatment of Gram-negative MDR bacteria in the neonatal population are heterogeneous and limited mainly to older antimicrobials. Newer drugs are promising but not affordable yet for many LMICs. Therefore, strategies cannot be generalized but will differ according to the country’s epidemiology and resources. More extensive studies are needed to include new antimicrobials and optimize the combination strategies for the older ones.
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Sirico D, Di Chiara C, Costenaro P, Bonfante F, Cozzani S, Plebani M, Reffo E, Castaldi B, Donà D, Da Dalt L, Giaquinto C, Di Salvo G. Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-CoV-2 infection. Eur Heart J Cardiovasc Imaging 2022; 23:1083-1089. [PMID: 34219155 DOI: 10.1093/ehjci/jeab127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023] Open
Abstract
AIMS Compared with adult patients, clinical manifestations of children's coronavirus disease-2019 (COVID-19) are generally perceived as less severe. The objective of this study was to evaluate cardiac involvement in previously healthy children with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. METHODS AND RESULTS We analysed a cohort of 53 paediatric patients (29 males, 55%), mean age 7.5 ± 4.7 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. Thirty-two age, sex, and body surface area comparable healthy subjects were used as control group. Left ventricular ejection fraction was within normal limits but significantly lower in the cases group compared to controls (62.4 ± 4.1% vs. 65.2 ± 5.5%; P = 0.012). Tricuspid annular plane systolic excursion (20.1 ± 3 mm vs. 19.8 ± 3.4 mm; P = 0.822) and left ventricular (LV) global longitudinal strain (-21.9 ± 2.4% vs. -22.6 ± 2.5%; P = 0.208) were comparable between the two groups. Regional LV strain analysis showed a significant reduction of the LV mid-wall segments strain among cases compared to controls. Furthermore, in the cases group, there were 14 subjects (26%) with a regional peak systolic strain below -16% (-2.5 Z score in our healthy cohort) in at least two segments. These subjects did not show any difference regarding symptoms or serological findings. CONCLUSION SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.
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Affiliation(s)
- Domenico Sirico
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Costanza Di Chiara
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Paola Costenaro
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università 10, 35020 Legnaro, Italy
| | - Sandra Cozzani
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Elena Reffo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Biagio Castaldi
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Daniele Donà
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Liviana Da Dalt
- Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
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Cohen-Stavi CJ, Magen O, Barda N, Yaron S, Peretz A, Netzer D, Giaquinto C, Judd A, Leibovici L, Hernán MA, Lipsitch M, Reis BY, Balicer RD, Dagan N. BNT162b2 Vaccine Effectiveness against Omicron in Children 5 to 11 Years of Age. N Engl J Med 2022; 387:227-236. [PMID: 35767475 PMCID: PMC9258754 DOI: 10.1056/nejmoa2205011] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Limited evidence is available on the real-world effectiveness of the BNT162b2 vaccine against coronavirus disease 2019 (Covid-19) and specifically against infection with the omicron variant among children 5 to 11 years of age. METHODS Using data from the largest health care organization in Israel, we identified a cohort of children 5 to 11 years of age who were vaccinated on or after November 23, 2021, and matched them with unvaccinated controls to estimate the vaccine effectiveness of BNT162b2 among newly vaccinated children during the omicron wave. Vaccine effectiveness against documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and symptomatic Covid-19 was estimated after the first and second vaccine doses. The cumulative incidence of each outcome in the two study groups through January 7, 2022, was estimated with the use of the Kaplan-Meier estimator, and vaccine effectiveness was calculated as 1 minus the risk ratio. Vaccine effectiveness was also estimated in age subgroups. RESULTS Among 136,127 eligible children who had been vaccinated during the study period, 94,728 were matched with unvaccinated controls. The estimated vaccine effectiveness against documented infection was 17% (95% confidence interval [CI], 7 to 25) at 14 to 27 days after the first dose and 51% (95% CI, 39 to 61) at 7 to 21 days after the second dose. The absolute risk difference between the study groups at days 7 to 21 after the second dose was 1905 events per 100,000 persons (95% CI, 1294 to 2440) for documented infection and 599 events per 100,000 persons (95% CI, 296 to 897) for symptomatic Covid-19. The estimated vaccine effectiveness against symptomatic Covid-19 was 18% (95% CI, -2 to 34) at 14 to 27 days after the first dose and 48% (95% CI, 29 to 63) at 7 to 21 days after the second dose. We observed a trend toward higher vaccine effectiveness in the youngest age group (5 or 6 years of age) than in the oldest age group (10 or 11 years of age). CONCLUSIONS Our findings suggest that as omicron was becoming the dominant variant, two doses of the BNT162b2 messenger RNA vaccine provided moderate protection against documented SARS-CoV-2 infection and symptomatic Covid-19 in children 5 to 11 years of age. (Funded by the European Union through the VERDI project and others.).
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Affiliation(s)
- Chandra J Cohen-Stavi
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ori Magen
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Noam Barda
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Shlomit Yaron
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Alon Peretz
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Doron Netzer
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Carlo Giaquinto
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ali Judd
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Leonard Leibovici
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Miguel A Hernán
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Marc Lipsitch
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ben Y Reis
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ran D Balicer
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Noa Dagan
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
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Fernández-Luis S, Lain MG, Serna-Pascual M, Domínguez-Rodríguez S, Kuhn L, Liberty A, Barnabas S, Lopez-Varela E, Otwombe K, Danaviah S, Nastouli E, Palma P, Cotugno N, Spyer M, Giannuzzi V, Giaquinto C, Violari A, Cotton MF, Nhampossa T, Klein N, Ramsagar N, van Rensburg AJ, Behuhuma O, Vaz P, Maiga AI, Oletto A, Naniche D, Rossi P, Rojo P, Tagarro A. Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence. BMC Public Health 2022; 22:1312. [PMID: 35804333 PMCID: PMC9264598 DOI: 10.1186/s12889-022-13543-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) risk assessment algorithm for vertical transmission of HIV (VT) assumes the availability of maternal viral load (VL) result at delivery and early viral control 4 weeks after initiating antiretroviral treatment (ART). However, in many low-and-middle-income countries, VL is often unavailable and mothers' ART adherence may be suboptimal. We evaluate the inclusion of the mothers' self-reported adherence into the established WHO-algorithm to identify infants eligible for enhanced post-natal prophylaxis when mothers' VL result is not available at delivery. METHODS We used data from infants with perinatal HIV infection and their mothers enrolled from May-2018 to May-2020 in Mozambique, South Africa, and Mali. We retrospectively compared the performance of the WHO-algorithm with a modified algorithm which included mothers' adherence as an additional factor. Infants were considered at high risk if born from mothers without a VL result in the 4 weeks before delivery and with adherence <90%. RESULTS At delivery, 143/184(78%) women with HIV knew their status and were on ART. Only 17(12%) obtained a VL result within 4 weeks before delivery, and 13/17(76%) of them had VL ≥1000 copies/ml. From 126 women on ART without a recent VL result, 99(79%) had been on ART for over 4 weeks. 45/99(45%) women reported suboptimal (< 90%) adherence. A total of 81/184(44%) infants were classified as high risk of VT as per the WHO-algorithm. The modified algorithm including self-adherence disclosure identified 126/184(68%) high risk infants. CONCLUSIONS In the absence of a VL result, mothers' self-reported adherence at delivery increases the number of identified infants eligible to receive enhanced post-natal prophylaxis.
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Affiliation(s)
- Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique. .,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | | | - Miquel Serna-Pascual
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shaun Barnabas
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siva Danaviah
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
| | - Eleni Nastouli
- Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Paolo Palma
- Research Unit in Clinical Immunology and Vaccinology, Bambino Gesu' Children's Hospital, 00165, Rome, Italy.,Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Nicola Cotugno
- Research Unit in Clinical Immunology and Vaccinology, Bambino Gesu' Children's Hospital, 00165, Rome, Italy.,Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Moira Spyer
- Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Mozambique, Maputo, Mozambique
| | - Nigel Klein
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa.,Great Ormond Street Institute for Child Health (GOS ICH), University College London (UCL), London, UK
| | - Nastassja Ramsagar
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anita Janse van Rensburg
- Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Osee Behuhuma
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
| | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | | | | | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Maputo, Mozambique.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Rossi
- Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Pablo Rojo
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Alfredo Tagarro
- Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Pediatrics Department, Hospital Universitario Infanta Sofía; Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), San Sebastián de los Reyes, Madrid, Spain.,Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
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47
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Di Chiara C, Cantarutti A, Costenaro P, Donà D, Bonfante F, Cosma C, Ferrarese M, Cozzani S, Petrara MR, Carmona F, Liberati C, Palma P, Di Salvo G, De Rossi A, Plebani M, Padoan A, Giaquinto C. Long-term Immune Response to SARS-CoV-2 Infection Among Children and Adults After Mild Infection. JAMA Netw Open 2022; 5:e2221616. [PMID: 35816313 PMCID: PMC9280400 DOI: 10.1001/jamanetworkopen.2022.21616] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Understanding the long-term immune response against SARS-CoV-2 infection in children is crucial to optimize vaccination strategies. Although it is known that SARS-CoV-2 antibodies may persist in adults 12 months after infection, data are limited in the pediatric population. OBJECTIVE To examine long-term anti-SARS-CoV-2 spike receptor-binding domain (S-RBD) IgG kinetics in children after SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS In this single-center, prospective cohort study, patients were enrolled consecutively from April 1, 2020, to August 31, 2021, at the COVID-19 Family Cluster Follow-up Clinic, Department of Women's and Children's Health, University Hospital of Padua. A cohort of 252 COVID-19 family clusters underwent serologic follow-up at 1 to 4, 5 to 10, and more than 10 months after infection with quantification of anti-S-RBD IgG by chemiluminescent immunoassay. EXPOSURES SARS-CoV-2 infection. RESULTS Among 902 study participants, 697 had confirmed SARS-CoV-2 infection, including 351 children or older siblings (mean [SD] age, 8.6 [5.1] years) and 346 parents (mean [SD] age, 42.5 [7.1] years). Among 697 cases, 674 (96.7%) were asymptomatic or mild. Children had significantly higher S-RBD IgG titers than older patients across all follow-up time points, with an overall median S-RBD IgG titer in patients younger than 3 years 5-fold higher than adults (304.8 [IQR, 139.0-516.6] kBAU/L vs 55.6 [24.2-136.0] kBAU/L, P < .001). Longitudinal analysis of 56 study participants sampled at least twice during follow-up demonstrated the persistence of antibodies up to 10 months from infection in all age classes, despite a progressive decline over time. CONCLUSIONS AND RELEVANCE In this cohort study of Italian children and adults following SARS-CoV-2 infection different kinetics of SARS-CoV-2 antibodies were found across several age classes of individuals with asymptomatic or mild COVID-19, which could help in optimizing COVID-19 vaccination strategies and prevention policies. This work provides further evidence of sustained immune response in children up to 1 year after primary SARS-CoV-2 infection.
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Affiliation(s)
- Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Paola Costenaro
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Francesco Bonfante
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
| | - Martina Ferrarese
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Sandra Cozzani
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Maria Raffaella Petrara
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padua, Italy
| | | | - Cecilia Liberati
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Di Salvo
- Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Anita De Rossi
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padua, Italy
- Istituto Oncologico Veneto - IRCCS, Padua, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | - Andrea Padoan
- Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
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48
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Le Duff Y, Gärtner K, Busby EJ, Dalzini A, Danaviah S, Fuentes JLJ, Giaquinto C, Huggett JF, Hurley M, Marcellin AG, Muñoz-Fernández MÁ, O’Sullivan DM, Persaud D, Powell L, Rigsby P, Rossi P, de Rossi A, Siems L, Smit T, Watters SA, Almond N, Nastouli E. Assessing the Variability of Cell-Associated HIV DNA Quantification through a Multicenter Collaborative Study. Microbiol Spectr 2022; 10:e0024322. [PMID: 35658711 PMCID: PMC9241949 DOI: 10.1128/spectrum.00243-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Reliable and accurate quantification of cell-associated HIV DNA (CA HIV DNA) is critical for early infant diagnosis, clinical management of patients under therapy, and to inform new therapeutics efficacy. The present study assessed the variability of CA HIV DNA quantification obtained from various assays and the value of using reference materials to help harmonize the measurements. Using a common set of reagents, our multicenter collaborative study highlights significant variability of CA HIV DNA quantification and lower limit of quantification across assays. The quantification of CA HIV DNA from a panel of infected PBMCs can be harmonized through cross-subtype normalization but assay calibration with the commonly used 8E5 cell line failed to reduce quantification variability between assays, demonstrating the requirement to thoroughly evaluate reference material candidates to help improve the comparability of CA HIV DNA diagnostic assay performance. IMPORTANCE Despite a global effort, HIV remains a major public health burden with an estimated 1.5 million new infections occurring in 2020. HIV DNA is an important viral marker, and its monitoring plays a critical role in the fight against HIV: supporting diagnosis in infants and underpinning clinical management of patients under therapy. Our study demonstrates that HIV DNA measurement of the same samples can vary significantly from one laboratory to another, due to heterogeneity in the assay, protocol, and reagents used. We show that when carefully selected, reference materials can reduce measurement variability and harmonize HIV DNA quantification across laboratories, which will help contribute to improved diagnosis and clinical management of patients living with HIV.
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Affiliation(s)
- Yann Le Duff
- Division of Infectious Disease Diagnostics, Centre for AIDS Reagent, National Institute for Biological Standards and Control, South Mimms, United Kingdom
| | - Kathleen Gärtner
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Eloise J. Busby
- National Measurement Laboratory, LGC group Teddington, Middlesex, United Kingdom
| | - Annalisa Dalzini
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | - José Luis Jiménez Fuentes
- Instituto Investigación Sanitaria Gregorio Marañón, Laboratorio InmunoBiología Molecular and Spanish HIV HGM BioBank, Madrid, Spain
| | - Carlo Giaquinto
- Department for Woman’s and Child’s Health, University of Padova, Padua, Italy
| | - Jim F. Huggett
- National Measurement Laboratory, LGC group Teddington, Middlesex, United Kingdom
| | - Matthew Hurley
- Division of Infectious Disease Diagnostics, Centre for AIDS Reagent, National Institute for Biological Standards and Control, South Mimms, United Kingdom
| | - Anne-Geneviève Marcellin
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié Salpêtrière Hospital, Department of Virology, Paris, France
| | - María Ángeles Muñoz-Fernández
- Instituto Investigación Sanitaria Gregorio Marañón, Laboratorio InmunoBiología Molecular and Spanish HIV HGM BioBank, Madrid, Spain
| | - Denise M. O’Sullivan
- National Measurement Laboratory, LGC group Teddington, Middlesex, United Kingdom
| | - Deborah Persaud
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Powell
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Rigsby
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control, South Mimms, United Kingdom
| | - Paolo Rossi
- Department of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Anita de Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Lilly Siems
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Theresa Smit
- Africa Health Research Institute, Durban, South Africa
| | - Sarah A. Watters
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil Almond
- Division of Infectious Disease Diagnostics, Centre for AIDS Reagent, National Institute for Biological Standards and Control, South Mimms, United Kingdom
| | - Eleni Nastouli
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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49
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Lyons A, Thompson L, Chappell E, Ene L, Galli L, Goetghebuer T, Jourdain G, Noguera-Julian A, Kahlert CR, Königs C, Kosalaraksa P, Lumbiganon P, Marczyńska M, Marques L, Navarro M, Naver L, Okhonskaia L, Prata F, Puthanakit T, Ramos JT, Samarina A, Thorne C, Voronin E, Turkova A, Giaquinto C, Judd A, Collins IJ. Outcomes of etravirine-based antiretroviral treatment in treatment-experienced children and adolescents living with HIV in Europe and Thailand. Antivir Ther 2022; 27:13596535221092182. [PMID: 36029009 DOI: 10.1177/13596535221092182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Etravirine (ETR) is approved as a component of second or third-line antiretroviral treatment (ART) for children living with HIV. We assessed the outcomes of ETR-based ART in children in routine care in Europe and Thailand. METHODS Data on children aged <18 years at ETR start were pooled from 17 observational cohorts. Characteristics at ETR start, immunological and virological outcomes at 12 months, discontinuations, adverse events (AEs) and serious adverse events (SAEs) were described. Follow-up was censored at ETR discontinuation, death or last visit. RESULTS 177 children ever received ETR. At ETR start, median [IQR] age was 15 [12,16] years, CD4 count 480 [287, 713] cells/mm3, 70% had exposure to ≥3 ART classes and 20% had viral load (VL) <50 copies/mL. 95% received ETR in combination with ≥1 potent drug class, mostly protease inhibitor-based regimens. Median time on ETR was 24 [7, 48] months. Amongst those on ETR at 12 months (n=141), 69% had VL<50 copies/mL. Median CD4 increase since ETR start (n=83) was 147 [16, 267] cells/mm3. Overall, 81 (46%) discontinued ETR by last follow-up. Median time to discontinuation was 23 [8, 47] months. Common reasons for discontinuation were treatment simplification (19%), treatment failure (16%) and toxicity (12%). Eight children (5%) had AEs causally associated with ETR, all dermatological/hypersensitivity reactions. Two were SAEs, both Stevens-Johnson Syndrome in children on regimens containing ETR and darunavir and were causally related to either drugs; both resolved following ART discontinuation. CONCLUSION Children receiving ETR were predominantly highly treatment-experienced, over two-thirds were virally suppressed at 12 months.
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Affiliation(s)
- Alex Lyons
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Lindsay Thompson
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Elizabeth Chappell
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Luminita Ene
- Clinical Department of Infectious Diseases (HIV Department), Dr. Victor Babeș Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children's Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD)-PHPT, Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
| | - Christian R Kahlert
- Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland and Cantonal Hospital, St Gallen, Switzerland
| | - Christoph Königs
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Pope Kosalaraksa
- Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | | | - Magdalena Marczyńska
- Hospital of Infectious Diseases, 37803Medical University of Warsaw, Warsaw, Poland
| | - Laura Marques
- Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Marissa Navarro
- Hospital General Universitario "Gregorio Marañón", Madrid, Spain
- 16734Universidad Complutense, Madrid, Spain
- 559924Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Lars Naver
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Liubov Okhonskaia
- Federal Budgetary Institution "Republican Clinical Infectious Hospital" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, 26683Chulalongkorn University and HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Jose T Ramos
- Departamento de Salud Pública y Materno-infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Anna Samarina
- The City HIV Centre, St Petersburg City AIDS Center, St Petersburg, Russian Federation
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Evgeny Voronin
- Federal Budgetary Institution "Republican Clinical Infectious Hospital" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Anna Turkova
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
- 4956Great Ormond Street Hospital, London, UK
| | - Carlo Giaquinto
- 561043Paediatric European Network for the Treatment of AIDS (Penta), Padova, Italy
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Intira J Collins
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
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van Beek J, Fraaij PLA, Giaquinto C, Shingadia D, Horby P, Indolfi G, Koopmans M. Case numbers of acute hepatitis of unknown aetiology among children in 24 countries up to 18 April 2022 compared to the previous 5 years. Euro Surveill 2022; 27:2200370. [PMID: 35551703 PMCID: PMC9101970 DOI: 10.2807/1560-7917.es.2022.27.19.2200370] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 12/29/2022] Open
Abstract
An increase of acute hepatitis of unknown aetiology has been reported among children in multiple countries worldwide. With a rapid online survey among hospitals in and outside of Europe, we describe case numbers recorded from 1 January to 18 April 2022 vs the previous 5 years. Of 24 countries that responded, we identified 5/17 European and 1/7 non-European countries with an elevation in probable cases of unexplained acute hepatitis, and severe cases were elevated in five European countries.
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Affiliation(s)
- Janko van Beek
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter LA Fraaij
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Delane Shingadia
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Peter Horby
- Pandemic Sciences Institute, ISARIC, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence, Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - Marion Koopmans
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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