1
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Wadhwa V, Wurzel D, Dharmage SC, Abramson MJ, Lodge C, Russell M. Do early-life allergic sensitization and respiratory infection interact to increase asthma risk? J Asthma 2024:1-10. [PMID: 38551488 DOI: 10.1080/02770903.2024.2333473] [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: 01/08/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The 'two-hit' hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk. METHODS We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6-7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported "cough, rattle, or wheeze" and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6-7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders. RESULTS Odds of asthma were higher in sensitized compared to nonsensitized children at age 6-7 years (OR = 14.46; 95% CI 3.99-52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6-7 years in both sensitized (OR = 1.13; 95% CI 1.02-1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11-1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker. CONCLUSIONS Our findings do not support 'two-hit' interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma.
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Affiliation(s)
- Vikas Wadhwa
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Danielle Wurzel
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Russell
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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2
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Anderson J, Imran S, Ng YY, Wang T, Ashley S, Minh Thang C, Quang Thanh L, Thi Trang Dai V, Van Thanh P, Thi Hong Nhu B, Ngoc Xuan Trang D, Thi Phuong Trinh P, Thanh Binh L, Thuong Vu N, Trong Toan N, Novakovic B, Tang MLK, Wurzel D, Mulholland K, Pellicci DG, Do LAH, Licciardi PV. Differential anti-viral response to respiratory syncytial virus A in preterm and term infants. EBioMedicine 2024; 102:105044. [PMID: 38447274 PMCID: PMC10933467 DOI: 10.1016/j.ebiom.2024.105044] [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: 09/26/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Preterm infants are more likely to experience severe respiratory syncytial virus (RSV) disease compared to term infants. The reasons for this are multi-factorial, however their immature immune system is believed to be a major contributing factor. METHODS We collected cord blood from 25 preterm (gestational age 30.4-34.1 weeks) and 25 term infants (gestation age 37-40 weeks) and compared the response of cord blood mononuclear cells (CBMCs) to RSVA and RSVB stimulation using neutralising assays, high-dimensional flow cytometry, multiplex cytokine assays and RNA-sequencing. FINDINGS We found that preterm and term infants had similar maternally derived neutralising antibody titres to RSVA and RSVB. Preterm infants had significantly higher myeloid dendritic cells (mDC) RSV infection compared to term infants. Differential gene expression analysis of RSVA stimulated CBMCs revealed enrichment of genes involved in cytokine production and immune regulatory pathways involving IL-10, IL-36γ, CXCL1, CXCL2, SOCS1 and SOCS3 in term infants, while differentially expressed genes (DEGs) in preterm infants were related to cell cycle (CDK1, TTK, ESCO2, KNL1, CDC25A, MAD2L1) without associated expression of immune response genes. Furthermore, enriched genes in term infants were highly correlated suggesting an increased co-ordination of their immune response to RSVA. When comparing DEGs in preterm and term infants following RSVB stimulation, no differences in immune response genes were identified. INTERPRETATION Overall, our data suggests that preterm infants have a more restricted immunological response to RSVA compared with term infants. While further studies are required, these findings may help to explain why preterm infants are more susceptible to severe RSV disease and identify potential therapeutic targets to protect these vulnerable infants. FUNDING Murdoch Children's Research Institute Infection and Immunity theme grant.
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Affiliation(s)
- Jeremy Anderson
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Samira Imran
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yan Yung Ng
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tongtong Wang
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Ashley
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | | | - Boris Novakovic
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Mimi L K Tang
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia
| | - Danielle Wurzel
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Kim Mulholland
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel G Pellicci
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Lien Anh Ha Do
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Paul V Licciardi
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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3
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Anderson J, Do LAH, Wurzel D, Licciardi PV. Understanding the increased susceptibility to asthma development in preterm infants. Allergy 2023; 78:928-939. [PMID: 36719074 DOI: 10.1111/all.15662] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
Preterm birth is associated with aberrant pulmonary development and increased susceptibility to a range of chronic lung diseases. Even in healthy preterms, the prevalence of physician-diagnosed asthma is far higher than in infants born at term. While physiological, environmental, and genetic factors have been studied extensively, few studies have investigated the immunological factors underpinning this increased susceptibility. Lower rates of atopy and allergic sensitization in preterm compared to term infants suggests non-allergic mechanisms may be driving asthma development in preterms. Preterm infants are more likely to develop severe RSV and HRV disease and have altered microbiomes compared to term infants. Therefore, investigating the differences in immunological interactions (e.g., response to viral infections, microbiome) between children born preterm and term will aid in understanding the immunological basis for their increased susceptibility to asthma development. This is critical to inform the development of interventions to reduce the burden of asthma in this highly vulnerable demographic.
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Affiliation(s)
- Jeremy Anderson
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lien Anh Ha Do
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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4
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Ride J, Cameron L, Jones R, Dalziel K, Wurzel D, Kao KT, Freeman JL, Hiscock H. Preferences of parents for mental health services to suit children with chronic medical conditions. AUST HEALTH REV 2022; 46:722-730. [PMID: 36192367 DOI: 10.1071/ah22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
Objectives To identify features of mental health services that affect the uptake of services among parents of children with chronic medical conditions, to inform the design of pathways into mental health care. Methods A discrete choice experiment in which participants made choices between hypothetical mental health services described in terms of service features: cost, wait time, provider knowledge of chronic medical conditions, recommendations, opening hours, and travel time. Participants were parents of children attending The Royal Children's Hospital outpatient clinics for the management of a chronic medical condition who completed the online survey between August 2020 and January 2021. The uptake of mental health services with differing features was predicted based on regression models examining the relationship between choice and service features, and accounting for participant characteristics and unobserved heterogeneity. Results The sample comprised 112 parents, of whom 52% reported unmet needs. The most influential service features were wait times, cost, recommendation from medical specialists, and mental health provider knowledge of chronic medical conditions. Predicted uptake of a realistic service showed inequalities across income, parental education, and single parent status. A service comprising preferred features was predicted to eliminate these inequalities. Conclusions Reducing cost and wait time for mental health services could reduce unmet need among children with chronic medical conditions. Specific approaches to tackle the high levels of unmet needs in this group include equipping medical specialists to recommend mental health providers and training mental health providers on the impacts of chronic medical conditions on children. Offering preferred services could increase uptake and reduce inequalities in mental health care.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Lachlan Cameron
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Renee Jones
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia; and Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic., Australia
| | - Danielle Wurzel
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic., Australia; and Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Respiratory Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Diabetes Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia
| | - Jeremy L Freeman
- Respiratory Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia; and Department of Neurology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia
| | - Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia; and Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Vic., Australia; and Health Services Research Unit, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Vic., Australia
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5
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Abrehart T, Suryadinata R, McCafferty C, Jacobson J, Ignjatovic V, Robinson P, Crawford NW, Monagle P, Subbarao K, Satzke C, Wurzel D. Age-related differences in SARS-CoV-2 binding factors: An explanation for reduced susceptibility to severe COVID-19 among children? Paediatr Respir Rev 2022; 44:61-69. [PMID: 35227628 PMCID: PMC8823960 DOI: 10.1016/j.prrv.2022.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT In contrast with other respiratory viruses, children infected with SARS-CoV-2 are largely spared from severe COVID-19. OBJECTIVES To critically assess age-related differences in three host proteins involved in SARS-CoV-2 cellular entry: angiotensin-converting enzyme 2 (ACE2), transmembrane serine protease 2 (TMPRSS2) and furin. METHODS We systematically searched Medline, Embase, and PubMed databases for relevant publications. Studies were eligible if they evaluated ACE2, TMPRSS2 or furin expression, methylation, or protein level in children. RESULTS Sixteen papers were included. Age-dependent differences in membrane-bound and soluble ACE2 were shown in several studies, with ACE2 expression increasing with age. TMPRSS2 and furin are key proteases involved in SARS-CoV-2 spike protein cleavage. TMPRSS2 expression is increased by circulating androgens and is thus low in pre-pubertal children. Furin has not currently been well researched. LIMITATIONS High levels of study heterogeneity. CONCLUSIONS Low expression of key host proteins may partially explain the reduced incidence of severe COVID-19 among children, although further research is needed.
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Affiliation(s)
- Thomas Abrehart
- Department of Paediatrics, the University of Melbourne, Parkville, Australia.
| | - Randy Suryadinata
- Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Conor McCafferty
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jonathan Jacobson
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Phil Robinson
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Nigel W. Crawford
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Paul Monagle
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Haematology, Royal Children’s Hospital, Parkville, Australia,Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza, the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catherine Satzke
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Victoria, Australia
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6
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Binns E, Tuckerman J, Licciardi PV, Wurzel D. Respiratory syncytial virus, recurrent wheeze and asthma: A narrative review of pathophysiology, prevention and future directions. J Paediatr Child Health 2022; 58:1741-1746. [PMID: 36073299 PMCID: PMC9826513 DOI: 10.1111/jpc.16197] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 01/11/2023]
Abstract
Globally, respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in young children, and the association between severe RSV disease and later recurrent wheeze and asthma is well established. Whilst a causal link between RSV and wheeze/asthma is not yet proven, immunological evidence suggests skewing towards a Th2-type response, and dampening of IFN-γ antiviral immunity during RSV infection underpins airway hyper-reactivity in a subset of susceptible children after RSV infection. Age at primary RSV infection, viral co-infection and genetic influences may act as effect-modifiers. Despite the significant morbidity and mortality burden of RSV disease in children, there is currently no licensed vaccine. Recent advancements in RSV preventatives, including long-acting monoclonal antibodies and maternal vaccinations, show significant promise and we are on the cusp of a new era in RSV prevention. However, the potential impact of RSV preventatives on subsequent wheeze and asthma remains unclear. The ongoing COVID-19 pandemic and associated public health measures have disrupted the usual seasonality of RSV. Whilst this has posed challenges for health-care services it has also enhanced our understanding of RSV transmission. The near absence of RSV cases during the first year of the pandemic in the context of strict public health measures has provided a rare opportunity to study the impact of delayed age of primary RSV infection on asthma prevalence. In this review, we summarise current understanding of the association between RSV, recurrent wheeze and asthma with a focus on pathophysiology, preventative strategies and future research priorities.
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Affiliation(s)
- Elly Binns
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,The Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Jane Tuckerman
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Paul V Licciardi
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia,Department of Respiratory MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
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7
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Wurzel D, Licciardi PV. Targeted strategies are needed to prevent childhood asthma. Eur Respir J 2022; 60:60/1/2200378. [PMID: 35835473 DOI: 10.1183/13993003.00378-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Dept of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia .,Dept of Paediatrics, University of Melbourne, Melbourne, Australia
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8
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Perret JL, Wurzel D, Walters EH, Lowe AJ, Lodge CJ, Bui DS, Erbas B, Bowatte G, Russell MA, Thompson BR, Gurrin L, Thomas PS, Hamilton G, Hopper JL, Abramson MJ, Chang AB, Dharmage SC. Childhood 'bronchitis' and respiratory outcomes in middle-age: a prospective cohort study from age 7 to 53 years. BMJ Open Respir Res 2022; 9:9/1/e001212. [PMID: 35725733 PMCID: PMC9240942 DOI: 10.1136/bmjresp-2022-001212] [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: 01/21/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic bronchitis in childhood is associated with a diagnosis of asthma and/or bronchiectasis a few years later, however, consequences into middle-age are unknown. Objective To investigate the relationship between childhood bronchitis and respiratory-related health outcomes in middle-age. Design Cohort study from age 7 to 53 years. Setting General population of European descent from Tasmania, Australia. Participants 3202 participants of the age 53-year follow-up (mean age 53, range 51–55) of the Tasmanian Longitudinal Health Study cohort who were born in 1961 and first investigated at age 7 were included in our analysis. Statistical methods Multivariable linear and logistic regression. The association between parent reported childhood bronchitis up to age 7 and age 53-year lung conditions (n=3202) and lung function (n=2379) were investigated. Results Among 3202 participants, 47.5% had one or more episodes of childhood bronchitis, classified according to severity based on the number of episodes and duration as: ‘non-recurrent bronchitis’ (28.1%); ‘recurrent non-protracted bronchitis’ (18.1%) and ‘recurrent-protracted bronchitis’ (1.3%). Age 53 prevalence of doctor-diagnosed asthma and pneumonia (p-trend <0.001) and chronic bronchitis (p-trend=0.07) increased in accordance with childhood bronchitis severities. At age 53, ‘recurrent-protracted bronchitis’ (the most severe subgroup in childhood) was associated with doctor-diagnosed current asthma (OR 4.54, 95% CI 2.31 to 8.91) doctor-diagnosed pneumonia (OR=2.18 (95% CI 1.00 to 4.74)) and, paradoxically, increased transfer factor for carbon monoxide (z-score +0.51 SD (0.15–0.88)), when compared with no childhood bronchitis. Conclusion In this cohort born in 1961, one or more episodes of childhood bronchitis was a frequent occurrence. ‘Recurrent-protracted bronchitis’, while uncommon, was especially linked to multiple respiratory outcomes almost five decades later, including asthma, pneumonia and raised lung gas transfer. These findings provide insights into the natural history of childhood ‘bronchitis’ into middle-age.
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Affiliation(s)
- Jennifer L Perret
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia .,Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Gayan Bowatte
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa A Russell
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul S Thomas
- Prince of Wales' Clinical School, and Mechanisms of Disease and Translational Research, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Garun Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Nair H. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet 2022; 399:2047-2064. [PMID: 35598608 PMCID: PMC7613574 DOI: 10.1016/s0140-6736(22)00478-0] [Citation(s) in RCA: 377] [Impact Index Per Article: 188.5] [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] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0-60 months, resulting in a total of 118 200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0-60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development. METHODS In this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0-60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400). FINDINGS In addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4-44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9-4·6 million), 26 300 RSV-associated acute lower respiratory infection in-hospital deaths (15 100-49 100), and 101 400 RSV-attributable overall deaths (84 500-125 200) in children aged 0-60 months. In infants aged 0-6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6-9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0-2·0 million), 13 300 RSV-associated acute lower respiratory infection in-hospital deaths (6800-28 100), and 45 700 RSV-attributable overall deaths (38 400-55 900). 2·0% of deaths in children aged 0-60 months (UR 1·6-2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0-4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs). INTERPRETATION RSV contributes substantially to morbidity and mortality burden globally in children aged 0-60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0-60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented. FUNDING EU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).
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Affiliation(s)
- You Li
- School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Xin Wang
- School of Public Health, Nanjing Medical University, Nanjing, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Daniel R Feikin
- Department of Immunizations, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; African Leadership Initiative in Vaccinology Expertise, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO, USA; Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ana Bermejo Pariente
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Darmaa Bardach
- National Center for Communicable Diseases (Mongolia), Ulaanbaatar, Mongolia
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Jean-Sebastien Casalegno
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Institut des Agents Infectieux, Laboratoire de Virologie, Lyon, France
| | | | - Nigel Crawford
- The Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Daria Danilenko
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russia
| | - Lien Anh Ha Do
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Marcela Echavarria
- Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | - Angela Gentile
- Ricardo Gutierrez Children Hospital, Buenos Aires, Argentina
| | - Aubree Gordon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Q Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Sophie Jullien
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Jigme Dorji Wangchuck National Referral Hospital, Gongphel Lam, Thimphu, Bhutan
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Eduardo Luis Lopez
- Hospital de Niños Dr. Ricardo Gutiérrez, Department of Medicine, Pediatric Infectious Diseases Program, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Joško Markić
- Department of Pediatrics, University Hospital Split, Split, Croatia; University of Split, School of Medicine, Split, Croatia
| | - Ainara Mira-Iglesias
- Área de Investigación en Vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Salud Pública, Valencia, Spain
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jocelyn Moyes
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - D James Nokes
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Evangeline Obodai
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Nandhini Palani
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Euri Seo
- Department of Pediatrics, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Zakhar Shchomak
- Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Kirill Stolyarov
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russia
| | | | - Anne von Gottberg
- School of Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chee Fu Yung
- Infectious Diseases Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Imperial College, Nanyang Technological University, Singapore
| | - Heather J Zar
- Department of Paediatrics and Child Health, and South African Medical Research Council Unit on Child & Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; Respiratory Syncytial Virus Network Foundation, Zeist, Netherlands, on behalf of the Respiratory Virus Global Epidemiology Network, and the RESCEU investigators.
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10
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Chang AB, Morgan LC, Duncan EL, Chatfield MD, Schultz A, Leo PJ, McCallum GB, McInerney-Leo AM, McPhail SM, Zhao Y, Kruljac C, Smith-Vaughan HC, Morris PS, Marchant JM, Yerkovich ST, Cook AL, Wurzel D, Versteegh L, O'Farrell H, McElrea MS, Fletcher S, D'Antoine H, Stroil-Salama E, Robinson PJ, Grimwood K. Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001236. [PMID: 35534039 PMCID: PMC9086630 DOI: 10.1136/bmjresp-2022-001236] [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: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance. Methods and analysis We are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance. Ethics and dissemination Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians. Trial registration number ACTRN12619000564156.
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Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lucy C Morgan
- Department of Health and Ageing, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Emma L Duncan
- School of Life Course & Population Sciences, King's College London, London, UK.,Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Paul J Leo
- Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Aideen M McInerney-Leo
- University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yuejen Zhao
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | | | - Heidi C Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anne L Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Danielle Wurzel
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lesley Versteegh
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sabine Fletcher
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Heather D'Antoine
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Enna Stroil-Salama
- Lung Foundation of Australia, Metro South Health, Brisbane, Queensland, Australia.,Brisbane South Palliative Care Collaborative, Metro South, Queensland Health, Brisbane, Queensland, Australia
| | - Phil J Robinson
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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11
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Anderson J, Oeum M, Verkolf E, Licciardi PV, Mulholland K, Nguyen C, Chow K, Waller G, Costa AM, Daley A, Crawford NW, Babl FE, Duke T, Do LAH, Wurzel D. Factors associated with severe respiratory syncytial virus disease in hospitalised children: a retrospective analysis. Arch Dis Child 2022; 107:359-364. [PMID: 34526293 DOI: 10.1136/archdischild-2021-322435] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early recognition of children at risk of severe respiratory syncytial virus (RSV) lower respiratory tract infection is important as it informs management decisions. We aimed to evaluate factors associated with severe disease among young children hospitalised with RSV infection. METHODS We conducted a retrospective cohort study of all children <2 years of age hospitalised for RSV lower respiratory tract infection at a single tertiary paediatric hospital over three RSV seasons (January 2017-December 2019). We classified children as having 'moderate' or 'severe' disease based on the level of respiratory intervention and used univariable and multivariable regression models to determine factors associated with severe disease. RESULTS Of 970 hospitalised children, 386 (40%) were classified as having 'severe' and 584 (60%) as having 'moderate' RSV disease. On multivariable analyses, age <2 months (OR: 2.3, 95% CI 1.6 to 3.3, p<0.0001), prematurity (OR: 1.6, 95% CI 1.1 to 2.4, p=0.02) and RSV-parainfluenza virus type 3 (PIV3) codetection (OR: 2.6, 95% CI 1.05 to 6.5, p=0.04) were independently associated with severe disease. CONCLUSION Younger age, prematurity and PIV3 codetection were associated with severe RSV disease in children <2 years of age hospitalised with RSV infection. The association between PIV3 and severe RSV disease is a novel finding and warrants further investigation.
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Affiliation(s)
- Jeremy Anderson
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Michelle Oeum
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Eva Verkolf
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,London School of Hygiene & Tropical Medicine, London, UK
| | - Cattram Nguyen
- The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Kim Chow
- Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Gregory Waller
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Andrew Daley
- Microbiology and Infection Control, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel W Crawford
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Trevor Duke
- Intensive Care Unit and Department of Paediatrics, The Royal Children's Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Lien Anh Ha Do
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Tosif S, Ibrahim LF, Hughes R, R Cheng D, Wurzel D, Overmars I, Steer AC, Bryant PA, Duke T, Lewena S, Babl FE, McNab S, Crawford N. Characteristics and outcomes of SARS-CoV-2 infection in Victorian children at a tertiary paediatric hospital. J Paediatr Child Health 2022; 58:618-623. [PMID: 34693586 PMCID: PMC8662161 DOI: 10.1111/jpc.15786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/10/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022]
Abstract
AIM Victoria experienced two 'waves' of COVID-19 between March and September 2020 and more cases than any other jurisdiction in Australia. Although world-wide reports of COVID-19 reflect that children are less likely to experience severe disease compared with adults, hospitalisations and deaths have been reported. We report testing and outcomes of children with SARS-CoV-2 infection presenting to a tertiary paediatric hospital in Melbourne. METHODS We conducted a prospective cohort study at The Royal Children's Hospital (RCH), including all children and adolescents (aged 0-18 years) who presented and were tested for SARS-CoV-2 over a 6-month period, between 21 March 2020, up to the 21 September 2020. Detailed epidemiological and clinical data were recorded. RESULTS A total of 19 708 tests for SARS-CoV-2 were performed in 14 419 patients. One hundred and eighty patients tested positive for SARS-CoV-2 (1.2%). 110 (61%) were symptomatic, 60 (33%) were asymptomatic and 10 (6%) were pre-symptomatic. Close contacts of a positive case were associated with a higher risk of a testing positive for SARS-CoV-2 (120/2027 (6%) vs. 60/14589 (0.4%), RD 5.5 (95% CI 4.5 to 6.5), P < 0.001). Eighteen (10%) SARS-CoV-2-positive patients were admitted to hospital with one patient requiring intensive care. All patients recovered fully with no deaths. CONCLUSION In Victorian children presenting to a tertiary hospital, SARS-CoV-2 infection caused predominantly mild or asymptomatic infection, with most children not requiring hospitalisation.
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Affiliation(s)
- Shidan Tosif
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Laila F Ibrahim
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Rebecca Hughes
- Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Daryl R Cheng
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia,Department of Respiratory MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Isabella Overmars
- Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Andrew C Steer
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Penelope A Bryant
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Trevor Duke
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Intensive Care UnitThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Stuart Lewena
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Franz E Babl
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Sarah McNab
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel Crawford
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
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13
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Jones R, Hiscock H, Wurzel D, Kao KT, Freeman JL, Ride J. Mental healthcare for children with chronic conditions: a qualitative study. Arch Dis Child 2022; 107:134-140. [PMID: 35058237 DOI: 10.1136/archdischild-2021-321795] [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: 02/04/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore parent perspectives on accessing mental healthcare for children with a chronic physical health condition. DESIGN Qualitative research using semistructured interviews and Framework Analysis. Rankings were used to select attributes for a Discrete Choice Experiment (DCE). SETTING Four specialty outpatient clinics (diabetes, epilepsy, bronchiectasis unrelated to cystic fibrosis and epidermolysis bullosa) at an Australian tertiary paediatric hospital. PARTICIPANTS Eighteen parents of children with a chronical physical health condition. RESULTS Most parents identified the child's general practitioner and/or hospital team as an initial pathway to seek help if they were worried about their child's mental health. Parents see mental healthcare as part of care for the whole child and want the outpatient clinics to proactively discuss child and family mental health, as well as refer to appropriate services as needed. The hospital being a familiar, child-friendly environment was identified as a key reason the hospital might be a desired place to access mental healthcare, as previous research has found. Six attributes of mental health services were identified as important and will be included in an upcoming DCE: travel time, cost, wait time, available hours, knowledge of physical health condition, and recommendation. CONCLUSIONS This study highlights the opportunity presented in specialist outpatient clinics to address the often unmet mental healthcare needs of children with chronic physical health conditions. Parents identified practical ways for outpatient clinics to better facilitate access to mental healthcare. These will be further explored through a quantitative study of parent preferences.
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Affiliation(s)
- Renee Jones
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Danielle Wurzel
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Health, Allergy and Lung Health Unit, The University of Melbourne School of Population and Global Health, Parkville, Victoria, Australia
| | - Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Diabetes Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeremy L Freeman
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurosciences Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jemimah Ride
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Economics Unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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14
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Howard‐Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Britton PN. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health 2022; 58:46-53. [PMID: 34694037 PMCID: PMC8662268 DOI: 10.1111/jpc.15811] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022]
Abstract
The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern. The acute infection with SARS-CoV-2 is generally mild in children, whilst the post-infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and 'long COVID' in children, are more complex. Given that most research on COVID-19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID-19 in children needs to be prioritised.
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Affiliation(s)
- Annaleise R Howard‐Jones
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,NSW Health Pathology‐NepeanNepean HospitalSydneyNew South WalesAustralia
| | - David P Burgner
- Infectious Diseases UnitDepartment of General Medicine, Royal Children's HospitalMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Nigel W Crawford
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Emma Goeman
- Department of Infectious Diseases and MicrobiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Paul E Gray
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Peter Hsu
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of ImmunologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Stephanie Kuek
- Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Brendan J McMullan
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Shidan Tosif
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Asha C Bowen
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Margie Danchin
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Archana Koirala
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Infectious DiseasesNepean HospitalPenrithNew South WalesAustralia
| | - Ketaki Sharma
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Daniel K Yeoh
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Philip N Britton
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Infectious Diseases and MicrobiologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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15
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Howard‐Jones AR, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Britton PN. COVID-19 in children: I. Epidemiology, prevention and indirect impacts. J Paediatr Child Health 2022; 58:39-45. [PMID: 34643307 PMCID: PMC8662210 DOI: 10.1111/jpc.15791] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 01/06/2023]
Abstract
Children globally have been profoundly impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review explores the direct and indirect public health impacts of COVID-19 on children. We discuss in detail the transmission dynamics, vaccination strategies and, importantly, the 'shadow pandemic', encompassing underappreciated indirect impacts of the pandemic on children. The indirect effects of COVID-19 will have a long-term impact beyond the immediate pandemic period. These include the mental health and wellbeing risks, disruption to family income and attendant stressors including increased family violence, delayed medical attention and the critical issue of prolonged loss of face-to-face learning in a normal school environment. Amplification of existing inequities and creation of new disadvantage are likely additional sequelae, with children from vulnerable families disproportionately affected. We emphasise the responsibility of paediatricians to advocate on behalf of this vulnerable group to ensure the longer-term effects of COVID-19 public health responses on the health and wellbeing of children are fully considered.
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Affiliation(s)
- Annaleise R Howard‐Jones
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,NSW Health Pathology‐NepeanNepean HospitalSydneyNew South WalesAustralia
| | - Asha C Bowen
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Wesfarmers Centre for Vaccines and Infectious DiseasesTelethon Kids Institute, University of Western AustraliaPerthWestern AustraliaAustralia
| | - Margie Danchin
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Archana Koirala
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Infectious DiseasesNepean HospitalPenrithNew South WalesAustralia
| | - Ketaki Sharma
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Daniel K Yeoh
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - David P Burgner
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel W Crawford
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Emma Goeman
- Department of Infectious Diseases and MicrobiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Paul E Gray
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Peter Hsu
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of ImmunologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Stephanie Kuek
- Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Brendan J McMullan
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Shidan Tosif
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Philip N Britton
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of Infectious Diseases and MicrobiologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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16
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Du Berry C, Saunders T, McMinn A, Tosif S, Shanthikumar S, Vandeleur M, Harrison J, Burgner D, Ranganathan S, Crawford N, Wurzel D. Is cardiorespiratory disease associated with increased susceptibility of SARS-CoV-2 in children? Pediatr Pulmonol 2021; 56:3664-3668. [PMID: 34473903 PMCID: PMC8661609 DOI: 10.1002/ppul.25642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are limited data in pediatric populations evaluating whether chronic cardiorespiratory conditions are associated with increased risk of coronavirus disease 2019 (COVID-19). We aimed to compare the rates of chronic cardiac and respiratory disease in children testing positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2[+]) compared with those testing negative (SARS-CoV-2[-]) at our institution. METHOD Prospective cohort with nested case-control study of all children tested by polymerase chain reaction (PCR) for SARS-CoV-2 by nasopharyngeal/oropharyngeal sampling between March and October 2020. Children were identified prospectively via laboratory notification with age and sex-matching of SARS-CoV-2[+] to SARS-CoV-2[-] (1:2). Clinical data were extracted from the electronic medical record. RESULTS In total, 179 SARS-CoV-2[+] children (44% females, median age 3.5 years, range: 0.1-19.0 years) were matched to 391 SARS-CoV-2[-] children (42% female, median age 3.7 years, range: 0.1-18.3 years). The commonest comorbidities showed similar frequencies in the SARS-CoV-2[+] and [-] groups: asthma (n = 9, 5% vs. n = 17, 4.4%, p = 0.71), congenital heart disease (n = 6, 3.4% vs. n = 7, 1.8%, p = 0.25) and obstructive sleep apnoea (n = 4, 2.2% vs. n = 10, 2.3%, p = 0.82). In the SARS-CoV-2[+] group, the prevalence of symptomatic disease was similar among children with and without cardiorespiratory comorbidities (n = 12, 75% vs. n = 103, 57%, p = 0.35). A high proportion of children hospitalized with SARS-CoV-2 infection had cardiac comorbidities (23.8%). CONCLUSIONS In this single site data set, rates of pre-existing cardiorespiratory disease were similar in SARS-CoV-2[+] and SARS-CoV-2[-] children. Rates of symptomatic infection were similar between children with and without cardiorespiratory comorbidity. High rates of comorbid cardiac disease were observed among hospitalized children with COVID-19 warranting further research to inform vaccine prioritization.
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Affiliation(s)
- Cassidy Du Berry
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Thomas Saunders
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Alissa McMinn
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Shidan Tosif
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Shivanthan Shanthikumar
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Moya Vandeleur
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Joanne Harrison
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - David Burgner
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Sarath Ranganathan
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Nigel Crawford
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Danielle Wurzel
- Division of Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Abo Y, Clifford V, Lee L, Costa A, Crawford N, Wurzel D, Daley AJ. COVID-19 public health measures and respiratory viruses in children in Melbourne. J Paediatr Child Health 2021; 57:1886-1892. [PMID: 34080245 PMCID: PMC8242487 DOI: 10.1111/jpc.15601] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023]
Abstract
AIM To describe the epidemiology of respiratory viruses in children before and during the 2020 SARS-CoV-2 pandemic and the relationship to public health measures instituted by the Victorian government. METHODS Retrospective audit of respiratory viruses at a tertiary paediatric hospital in Melbourne from January 2015 up to week 47, 2020 in children under 18 years of age. The proportion of positive cases in weeks 1-47 in 2015-2019 (period 1) were compared to weeks 1-47, 2020 (period 2), and reviewed in the context of public health restrictions in Victoria. RESULTS An annual average of 4636 tests were performed in period 1 compared to 3659 tests in period 2. Proportions of positive influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human parainfluenza virus were significantly reduced in period 2 compared to period 1: 77.3, 89.4, 68.6 and 66.9% reductions, respectively (all P < 0.001). From week 12-47, 2020, 28 893 SARS-CoV-2 tests were performed with a 0.64% positivity rate. Influenza viruses were not detected after week 17, RSV was not detected after week 35. CONCLUSIONS Strict public health measures and border closures were successful in eliminating community transmission of SARS-CoV-2 in Melbourne. This was associated with a significant reduction in other respiratory virus infections in children. Identifying sustainable and effective ongoing public health interventions to reduce transmission of RSV and influenza could result in reduced morbidity and mortality in children and requires further research.
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Affiliation(s)
- Yara‐Natalie Abo
- Department of MicrobiologyRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Vanessa Clifford
- Department of MicrobiologyRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Lai‐Yang Lee
- Department of MicrobiologyRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Anna‐Maria Costa
- Department of MicrobiologyRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel Crawford
- Murdoch Children's Research Institute, Royal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Royal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Department of Respiratory and Sleep MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Andrew J Daley
- Department of MicrobiologyRoyal Children's HospitalMelbourneVictoriaAustralia
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18
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Pattie P, Ranganathan S, Harrison J, Vidmar S, Hall GL, Foong RE, Harper A, Ramsey K, Wurzel D. Quality of life is poorly correlated to lung disease severity in school-aged children with cystic fibrosis. J Cyst Fibros 2021; 21:e188-e203. [PMID: 34801433 DOI: 10.1016/j.jcf.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no data exclusively on the relationship between health-related quality-of-life (HRQOL) and lung disease severity in early school-aged children with cystic fibrosis (CF). Using data from the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) we assessed the relationships between HRQOL, lung function and structure. METHODS 125 children aged 6.5-10 years enrolled in the AREST CF program were included from CF clinics at Royal Children's Hospital (RCH), Melbourne (n = 66) and Perth Children's Hospital (PCH), Perth (n = 59), Australia. Demographics, HRQOL measured by Cystic Fibrosis Questionnaire-Revised (CFQ-R), spirometry, multiple-breath washout (MBW) and chest CT were collected across two years. Correlation between CFQ-R scores and lung structure/function parameters and agreement between parent-proxy and child-reported HRQOL were evaluated. RESULTS No correlation was observed between most CFQ-R domain scores and FEV1 z-scores, excepting weak-positive correlation with parent CFQ-R Physical (rho = 0.21, CI 0.02-0.37), and Weight (rho = 0.21, CI 0.03-0.38) domain and child Body domain (rho = 0.26, CI 0.00-0.48). No correlation between most CFQ-R domain scores and LCI values was noted excepting weak-negative correlation with parent Respiratory (rho = -0.23, CI -0.41--0.05), Emotional (rho = -0.24, CI -0.43--0.04), and Physical (-0.21, CI -0.39--0.02) domains. Furthermore, structural lung disease on CT data demonstrated little to no association with CFQ-R parent and child domain scores. Additionally, no agreement between child self-report and parent-proxy CFQ-R scores was observed across the majority of domains and visits. CONCLUSION HRQOL correlated poorly with lung function and structure in early school-aged children with CF, hence clinical trials should consider these outcomes independently when determining study end-points.
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Affiliation(s)
- Phillip Pattie
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia.
| | - Sarath Ranganathan
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Joanne Harrison
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Suzanna Vidmar
- Department of Paediatrics, The University of Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Graham L Hall
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rachel E Foong
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alana Harper
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Kathryn Ramsey
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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19
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Wurzel D, McMinn A, Hoq M, Blyth CC, Burgner D, Tosif S, Buttery J, Carr J, Clark JE, Cheng AC, Dinsmore N, Francis JR, Kynaston A, Lucas R, Marshall H, McMullan B, Singh-Grewal D, Wood N, Macartney K, Britton PN, Crawford NW. Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study. BMJ Open 2021; 11:e054510. [PMID: 34750151 PMCID: PMC8576200 DOI: 10.1136/bmjopen-2021-054510] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To present Australia-wide data on paediatric COVID-19 and multisystem inflammatory syndromes to inform health service provision and vaccination prioritisation. DESIGN Prospective, multicentre cohort study. SETTING Eight tertiary paediatric hospitals across six Australian states and territories in an established research surveillance network-Paediatric Active Enhanced Disease (PAEDS). PARTICIPANTS All children aged <19 years with SARS-CoV-2 infection including COVID-19, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and Kawasaki-like disease TS infection (KD-TS) treated at a PAEDS site from 24 March 2020 to 31 December 2020. INTERVENTION Laboratory-confirmed SARS-CoV-2 infection. MAIN OUTCOME Incidence of severe disease among children with COVID-19, PIMS-TS and KD-TS. We also compared KD epidemiology before and during the COVID-19 pandemic. RESULTS Among 386 children with SARS-CoV-2 infection, 381 (98.7%) had COVID-19 (median 6.3 years (IQR 2.1-12.8),53.3% male) and 5 (1.3%) had multisystem inflammatory syndromes (PIMS-TS, n=4; KD-TS, n=1) (median 7.9 years (IQR 7.8-9.8)). Most children with COVID-19 (n=278; 73%) were Australian-born from jurisdictions with highest community transmission. Comorbidities were present in 72 (18.9%); cardiac and respiratory comorbidities were most common (n=32/72;44%). 37 (9.7%) children with COVID-19 were hospitalised, and two (0.5%) required intensive care. Postinfective inflammatory syndromes (PIMS-TS/KD-TS) were uncommon (n=5; 1.3%), all were hospitalised and three (3/5; 60%) required intensive care management. All children recovered and there were no deaths. KD incidence remained stable during the pandemic compared with prepandemic. CONCLUSIONS Most children with COVID-19 had mild disease. Severe disease was less frequent than reported in high prevalence settings. Preventative strategies, such as vaccination, including children and adolescents, could reduce both the acute and postinfective manifestations of the disease.
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Affiliation(s)
- Danielle Wurzel
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alissa McMinn
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Shidan Tosif
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jim Buttery
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Carr
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Julia E Clark
- Infectious Diseases, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Allen C Cheng
- Infectious Disease Epidemiology Unit - School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole Dinsmore
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
| | - Joshua Reginald Francis
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Anne Kynaston
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ryan Lucas
- General Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Helen Marshall
- Discipline of Paediatrics, Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, The Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristine Macartney
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia
- Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Phil N Britton
- Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nigel W Crawford
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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20
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Fraile Navarro D, Tendal B, Tingay D, Vasilunas N, Anderson L, Best J, Burns P, Cheyne S, Craig SS, Erickson SJ, Fancourt NS, Goff Z, Kapuya V, Keyte C, Malyon L, McDonald S, White H, Wurzel D, Bowen AC, McMullan B. Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:255-263. [PMID: 34689329 PMCID: PMC8661691 DOI: 10.5694/mja2.51305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, Monash University, Melbourne, VIC.,Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | - David Tingay
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Nan Vasilunas
- Women's and Children's Health Network, Women's and Children's Hospital Adelaide, Adelaide, SA
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services Council, Broome, WA.,Junction Street Family Practice, Sydney, NSW
| | - James Best
- Junction Street Family Practice, Sydney, NSW
| | - Penelope Burns
- Australian National University, Canberra, ACT.,Northern Beaches Hospital, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Saskia Cheyne
- Cochrane Australia, Monash University, Melbourne, VIC.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - Simon S Craig
- Monash University, Melbourne, VIC.,Monash Medical Centre, Monash Health, Melbourne, VIC
| | | | | | - Zoy Goff
- Perth Children's Hospital, Perth, WA
| | - Vimbai Kapuya
- Charles Darwin University, Darwin, NT.,Australian College of Rural and Remote Medicine, Brisbane, QLD
| | - Catherine Keyte
- Queensland Children's Hospital, Brisbane, QLD.,Australian College of Nursing, Canberra, ACT
| | - Lorelle Malyon
- College of Emergency Nursing Australasia, Melbourne, VIC
| | | | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Asha C Bowen
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Sydney, NSW.,University of New South Wales, Sydney, NSW
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21
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Smith EL, Gwee A, Roberts JA, Molton JS, Wurzel D, Hughes CM, Rogers B. Prospective Study of Policies and Use of Therapies for COVID-19 Amongst Australian Health Services during 2020. Intern Med J 2021; 52:214-222. [PMID: 34490712 PMCID: PMC8653236 DOI: 10.1111/imj.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has generated significant debate about how emerging infections can be treated in the absence of evidence-based therapies to combat disease. In particular, the use of off-label therapies outside of a clinical trial setting has been controversial. AIM We aimed to longitudinally study policies and prescribing practices pertaining to therapies for COVID-19 in Australian Health Services in 2020. METHODS Prospective data was collected from participating Australian health services who may care for patients with COVID-19 via an electronic portal. A single informant from each health service was emailed a survey link at regular intervals. Information was sought regarding changes to COVID-19 policy at their service and use of therapies for COVID-19. RESULTS Overall, 78 hospitals were represented from 39 respondents with longitudinal data collection from May to December 2020. All Australian states/territories were represented with the majority of respondents located in a major city (34/39; 87%). Just over half (20/39) of respondents had a written policy for COVID-19 therapy use at their health service at survey enrolment and policies changed frequently throughout the pandemic. Therapy use outside of a clinical trial was reported in 54% of health services, most frequently in Victoria, correlating with higher numbers of COVID-19 cases. At study commencement hydroxychloroquine was most frequently used, with corticosteroids and remdesivir use increasingly throughout the study period. CONCLUSION Our results reflect the reactive nature of prescribing of therapies for COVID-19 and highlight the importance of evidence-based guidelines to assist prescribers. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- E L Smith
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria
| | - A Gwee
- Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - J A Roberts
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland.,Departments of Pharmacy and Critical Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | | | - D Wurzel
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - C M Hughes
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria.,Department of Microbiology, Monash Pathology, Monash Health, Melbourne, Victoria
| | - B Rogers
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria.,Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria
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22
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Tuckerman J, Lee L, Wurzel D, Tosif S, Clifford V, McMinn A, O'Donaghue K, Rautenbacher K, Licciardi PV, Toh R, Daley A, Crawford NW. Seroprevalence of SARS-CoV-2 antibodies in health-care workers at a tertiary paediatric hospital. J Paediatr Child Health 2021; 57:1136-1139. [PMID: 34216170 PMCID: PMC8447152 DOI: 10.1111/jpc.15585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Tuckerman
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia
| | - Lai‐Yang Lee
- Microbiology, Laboratory ServicesThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,School of Population and Global HealthThe University of MelbourneVictoriaAustralia,Respiratory MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Shidan Tosif
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia,General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Immunisation ServiceRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Vanessa Clifford
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia,Microbiology, Laboratory ServicesThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Alissa McMinn
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia
| | - Kate O'Donaghue
- Infection Prevention and ControlThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Karin Rautenbacher
- Microbiology, Laboratory ServicesThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Paul V Licciardi
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia
| | - Ryan Toh
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia
| | - Andrew Daley
- Department of PaediatricsUniversity of MelbourneVictoriaAustralia,Microbiology, Laboratory ServicesThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel W Crawford
- Infection and ImmunityMurdoch Children's Research InstituteVictoriaAustralia,Department of PaediatricsUniversity of MelbourneVictoriaAustralia,General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Immunisation ServiceRoyal Children's HospitalMelbourneVictoriaAustralia
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23
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Say D, Crawford N, McNab S, Wurzel D, Steer A, Tosif S. Post-acute COVID-19 outcomes in children with mild and asymptomatic disease. Lancet Child Adolesc Health 2021; 5:e22-e23. [PMID: 33891880 PMCID: PMC8057863 DOI: 10.1016/s2352-4642(21)00124-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Daniela Say
- Immunisation Service, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Nigel Crawford
- Immunisation Service, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Sarah McNab
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Steer
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Shidan Tosif
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia.
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24
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McNab S, Ha Do LA, Clifford V, Crawford NW, Daley A, Mulholland K, Cheng D, South M, Waller G, Barr I, Wurzel D. Changing Epidemiology of Respiratory Syncytial Virus in Australia - delayed re-emergence in Victoria compared to WA/NSW after prolonged lock-down for COVID-19. Clin Infect Dis 2021; 73:2365-2366. [PMID: 33735388 PMCID: PMC7989588 DOI: 10.1093/cid/ciab240] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah McNab
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Lien Anh Ha Do
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Vanessa Clifford
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Andrew Daley
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daryl Cheng
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Mike South
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Greg Waller
- Royal Children's Hospital, Melbourne, Australia
| | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Microbiology and Immunology, The University of Melbourne, Australia
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,School of Population and Global Health, The University of Melbourne, Australia
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25
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Anderson J, Do LAH, Wurzel D, Quan Toh Z, Mulholland K, Pellicci DG, Licciardi PV. Severe respiratory syncytial virus disease in preterm infants: a case of innate immaturity. Thorax 2021; 76:942-950. [PMID: 33574121 DOI: 10.1136/thoraxjnl-2020-216291] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/03/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common viral pathogen associated with acute lower respiratory tract infection (LRTI) in children under 5 years of age. Severe RSV disease is associated with the development of chronic respiratory complications such as recurrent wheezing and asthma. A common risk factor for developing severe RSV disease is premature gestation and this is largely due to an immature innate immune system. This increases susceptibility to RSV since the innate immune system is less able to protect against pathogens at a time when adaptive immunity has not fully developed. This review focuses on comparing different aspects of innate immunity between preterm and term infants to better understand why preterm infants are more susceptible to severe RSV disease. Identifying early life innate immune biomarkers associated with the development of severe RSV disease, and understanding how these compare between preterm and term infants, remains a critically important question that would aid the development of interventions to reduce the burden of disease in this vulnerable population.
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Affiliation(s)
- Jeremy Anderson
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lien Anh Ha Do
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia.,The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia.,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel G Pellicci
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Department of Pediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
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26
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Pham H, Thompson J, Wurzel D, Duke T. Ten years of severe respiratory syncytial virus infections in a tertiary paediatric intensive care unit. J Paediatr Child Health 2020; 56:61-67. [PMID: 31095832 DOI: 10.1111/jpc.14491] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 11/29/2022]
Abstract
AIM To describe the epidemiology and treatment of respiratory syncytial virus (RSV) infection in a tertiary paediatric intensive care unit (PICU), including the clinical presentations, comorbidities, respiratory support required, costs and outcomes. METHODS This study was an analysis of a database for all children with RSV infections admitted to the PICU in Melbourne between 2005 and 2015. RESULTS A total of 604 episodes of community-acquired RSV infections were analysed, and the median age of children was 4 months (interquartile range 2-14 months); 94% of cases had lower respiratory tract infection, principally bronchiolitis, and 8.9% presented with extrapulmonary features. Respiratory support included humidified high-flow nasal cannula oxygen therapy (76% of patients since its introduction in 2011), non-invasive ventilation (41%) and intubation and mechanical ventilation (32%). Almost half (n = 270; 45%) had one or more pre-existing comorbid condition. Risk factors for intubation and mechanical ventilation were presence of comorbidities (odds ratio 1.97; confidence interval 1.39-2.79, P < 0.001) and transfer from an external hospital (odds ratio 1.82; confidence interval 1.58-2.57, P < 0.001). Of the children without pre-existing comorbidities, 25% required intubation and mechanical ventilation. Following the introduction of humidified high-flow nasal cannula oxygen therapy, the number of annual PICU admissions for RSV infection doubled; however, the number of children requiring intubation remained unchanged. The median length of intensive care unit stay was 3.7 days and further hospital stay was 3.6 days, and the average cost per case was approximately AU$20000. CONCLUSIONS RSV infection carries a high burden in PICU, in bed-days and cost. Chronic comorbidities and transfer from a peripheral hospital were associated with a higher rate of need for mechanical ventilation.
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Affiliation(s)
- Hiep Pham
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jenny Thompson
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Trevor Duke
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
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27
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Pantalos G, Chaing B, Bishop D, Perkins P, Yu LS, Jansen J, Socha P, Marks J, Riebman J, Burns G, Kolff W, Hansen G, Wildevuur W, Wurzel D, Brownstein L, Kolff J. Development of Smaller Artificial Ventricles and Valves Made by Vacuum Forming. Int J Artif Organs 2018. [DOI: 10.1177/039139888801100512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Implantable prosthetic ventricles and trileaflet valves made by vacuum forming have been developed and implant tested. All components are made from Pellethane®. Recognizing the need for smaller as well as larger ventricles, designs with effective stroke volumes of 50, 85, 100 and 130 cc have been tested with several valve types. The pneumatically driven Utah ventricular assist device (UVAD) can be used as a total artificial heart (TAH) or ventricular assist device (VAD) by using the appropriate inflow and outflow adapters. In vitro durability testing has demonstrated ventricular lifetime beyond two years and valve lifetime to nearly one and one half years. The polymer valves have lower regurgitation than mechanical valves. Animal implantation experience includes 21 TAH implants and 16 left ventricular assist device (LVAD) implantations. TAH survival ranges from 2 to 210 days. LVAD animals have lived up to 116 days before elective termination. The animal were healthy and grew normally. The devices exhibit a “Starling's Law” response. One TAH animal survived 72 days before successful explantation followed by transplantation. At autopsy, this animal had no renal infarcts. Hematology data has demonstrated the existence of little or no intravascular hemolysis (PF Hb < 5 mg%). The “Philadelphia” version of the UVAD vacuum formed ventricles are small enough to be implanted without thrombus provoking connectors. Eight animals have received this TAH and survived up to 120 days. Vacuum forming offers a rapid and inexpensive way to produce reliable and effective total artificial hearts and valves for widespread, temporary clinical application in any size adult human.
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Affiliation(s)
- G.M. Pantalos
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - B.Y. Chaing
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - D.N. Bishop
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - P.A. Perkins
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - LS. Yu
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - J. Jansen
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - P.A. Socha
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - J.D. Marks
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - J.B. Riebman
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - G.L Burns
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - W.J. Kolff
- Department of Surgery, Division of Artificial Organs and Institute for Biomedical Engineering, Artificial Heart Research Laboratory, University of Utah, Salt Lake City, Utah - U.S.A
| | - G. Hansen
- Department of Surgery, Division of Cardiothoracic Surgery, Temple University Hospital Philadelphia, Pennsylvania - U.S.A
| | - W. Wildevuur
- Department of Surgery, Division of Cardiothoracic Surgery, Temple University Hospital Philadelphia, Pennsylvania - U.S.A
| | - D. Wurzel
- Department of Surgery, Division of Cardiothoracic Surgery, Temple University Hospital Philadelphia, Pennsylvania - U.S.A
| | - L. Brownstein
- Department of Surgery, Division of Cardiothoracic Surgery, Temple University Hospital Philadelphia, Pennsylvania - U.S.A
| | - J. Kolff
- Department of Surgery, Division of Cardiothoracic Surgery, Temple University Hospital Philadelphia, Pennsylvania - U.S.A
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28
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Treppmann D, Hornbogen E, Wurzel D. The Effect of Combined Recrystallization and Precipitation Processes on the Functional and Structural Properties in NiTi Alloys. ACTA ACUST UNITED AC 2014. [DOI: 10.1051/jp4/199558569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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29
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Abstract
BACKGROUND Bronchiectasis is an important cause of respiratory morbidity in both developing and developed countries. Antibiotics are considered standard therapy in the treatment of this condition but it is unknown whether short courses (four weeks or less) are efficacious. OBJECTIVES To determine whether short courses of antibiotics (i.e. less than or equal to four weeks) for treatment of acute and stable state bronchiectasis, in adults and children, are efficacious when compared to placebo or usual care. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, OLDMEDLINE, CINAHL, AMED and PsycINFO and handsearching of respiratory journals and meeting abstracts were performed by the Cochrane Airways Group up to February 2011. SELECTION CRITERIA Only randomised controlled trials were considered. Adults and children with bronchiectasis (defined clinically or radiologically) were included. Patients with cystic fibrosis were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the titles, abstracts and citations to assess eligibility for inclusion. Only one study fulfilled the inclusion criteria and thus meta-analysis could not be performed. MAIN RESULTS The single eligible study showed a small benefit, when compared to placebo, of four weeks of inhaled antibiotic therapy in adults with bronchiectasis and pseudomonas in their sputum. There were no studies in children and no studies on oral or intravenous antibiotics. AUTHORS' CONCLUSIONS There is insufficient evidence in the current literature to make reasonable conclusions about the efficacy of short course antibiotics in the management of adults and children with bronchiectasis. Until further evidence is available, adherence to current treatment guidelines is recommended.
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Affiliation(s)
- Danielle Wurzel
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston Road, Brisbane, Queensland, Australia, 4029
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30
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Abstract
Endobronchial ultrasound (EBUS) is a recently introduced technique that has significantly advanced bronchoscopic techniques in adult medicine. Use of ultrasound allows far more accurate localization and sampling of both peripheral pulmonary, as well as mediastinal and hilar lesions. This has led to greater diagnostic success, with a reduced rate of complications. Its performance characteristics in adult populations are equivalent to surgical procedures previously considered gold standard, but it has dramatically reduced morbidity and mortality among patients requiring invasive diagnostic procedures, when compared to surgical approaches. We describe the types of EBUS in clinical use, the method of use, the clinical indications for each procedure, and the potential role for EBUS in pediatric pulmonology. Radial probe EBUS is used in the investigation of peripheral lung lesions and could be adopted in children to achieve accurate biopsy of such lesions. Linear probe EBUS allows minimally invasive biopsy of mediastinal and hilar lesions. It has potentially greater performance characteristics than current biopsy techniques, with no significant complications reported to date. It may be useful in the diagnosis of lymphoma, or neurogenic tumors, as well as many other diseases resulting in mediastinal or hilar lymphadenopathy. EBUS is a minimally invasive technique that allows tissue sampling of peripheral lung lesions, or mediastinal/hilar masses, with a high diagnostic accuracy, and a significantly lower morbidity and mortality than alternative approaches. The indications for and the use of EBUS in pediatric patients is certain to increase in the future.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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31
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Kolff J, Ankney RN, Wurzel D, Devineni R. Centrifugal pump failures. J Extra Corpor Technol 1996; 28:118-22. [PMID: 10163498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Centrifugal pumps will not pass gross quantities of gaseous emboli due to the nonocclusive nature of the pump. However, retrograde flow can occur under circumstances that include: product malfunctions, low flows, and human errors. Negative pressure created by falling arterial perfusate can draw air into the cannula. Food and Drug Administration (FDA) records about centrifugal pump malfunctions were obtained. Out of 350,000 cases completed with centrifugal pumps over a 23 month period, the FDA received reports of 68 malfunctions, 22 electrical burning smells, and three speed surges, yielding a failure rate of 1 in 3,763 cases. FDA records revealed five death reports and three serious injury reports. A survey was sent to 2,424 Society of Thoracic Surgeons' members to obtain more information; 285 who use centrifugal pumps responded. Sixty surgeons (21%) reported 108 malfunctions, including 46 complete pump failures. Fifty-one of 243 surgeons (21%) who use centrifugal pumps for bypass reported that perfusionists have forgotten to clamp the pump line, resulting in backflow. We conclude centrifugal pumps are generally safe, but malfunctions, low flows, and human errors can lead to retrograde flow and occasionally air embolization. There are valves that can be added to the bypass circuitry to prevent this risk.
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Affiliation(s)
- J Kolff
- Department of Surgery, Temple University/Conemaugh's Memorial Medical Center, Johnstown, Pennsylvania 15905, USA
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32
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Esper E, Devineni R, Shah NS, Wurzel D, Brownstein L, Heagney MG, Slukis MJ, Kolff J. Results of the unidirectional Centri-Safe arterial valve for prevention of retrograde flow during cardiopulmonary bypass. ASAIO J 1994; 40:M540-6. [PMID: 8555574 DOI: 10.1097/00002480-199407000-00058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Retrograde blood from the aortic cannula into the cardiopulmonary circuit may lead to aortic air emboli when nonocclusive centrifugal pumps are used. The authors tested a nonregurgitant, unidirectional valve containing a Teflon ball occluder to prevent backflow. In vitro measurements of leakage rate, forward flow pressure drop, burst strength, and hemolysis levels along with animal (n = 12) and human (n = 12) in vivo hematologic and hemolysis levels were measured. Data were analyzed by paired and unpaired Student's t-test. Pressure drop differences at flows of 5 l/min were 7.3 +/- 0.3 mmHg before and 7.6 +/- 0.1 mmHg after 10,800 cycles of pulsatile pumping. (P = NS). Leakage rate during this period at pressures of 100 mmHg was not significant. Volume required to close the Teflon ball was less than 1 ml. Hemolysis analysis done in vitro and in vivo in control (no valve) and experimental (valve) groups used hemoglobin, hematocrit, platelets, plasma free hemoglobin, and lactic dehydrogenase as hemolysis indices. There were no statistical differences. The authors conclude that the CentriSafe valve (Cardiac Systems, Inc., Conshohocken, PA) is safe and prevents fatal backflow and air emboli. The valve is nonthrombotic in anticoagulated blood, can be opened and closed thousands of times, and has a burst strength equal to or greater than other components in the perfusion setup.
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Affiliation(s)
- E Esper
- Department of Surgery, Temple University/Conemaugh Memorial Hospital, Johnstown, Pennsylvania 15905, USA
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33
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Chandran KB, Lee CS, Shipkowitz T, Chen LD, Yu LS, Wurzel D. In vitro hemodynamic analysis of flexible artificial ventricles. Artif Organs 1991; 15:420-6. [PMID: 1741689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An in vitro fluid dynamic study was performed to compare the hemodynamic characteristics of a rigid and a flexible total artificial heart. The artificial ventricles were incorporated into a mock circulatory system, and pressure signals within the ventricular chamber, proximal to the inflow valve and distal to the outflow valve, were obtained. The instantaneous flow rate through the inflow and outflow valves was measured with electromagnetic flow probes. Flow visualization studies performed on the flexible ventricle suggested a vortical motion within the chamber with a smooth washout of fluid in the next pumping phase, but flow disturbances were observed near the wall of the ventricle as well as near the outflow valve. The rate of pressure increase (dP/dt) was smaller in the flexible ventricle as compared with the rigid ventricle for comparable flows and heart rates. The results of the present study indicated that the flexible ventricle with polyurethane valves, having the advantage of ease of implantation and cost savings, can be a viable alternative as a bridge to transplant.
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Affiliation(s)
- K B Chandran
- Department of Biomedical Engineering, University of Iowa, Iowa City 52242
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34
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Wurzel D, Panidis I, Gonzales R. In vitro continuous wave Doppler gradients of mechanical valves in less than optimal orientations. ASAIO Trans 1991; 37:M448-51. [PMID: 1751232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Continuous wave Doppler ultrasound is a noninvasive method of determining transvalvular gradients that may overestimate the gradients of prosthetic valves. It is theorized that a valve rotated or tilted in its annulus will create abnormally high velocities that calculate into derived gradients that are greater than those actually present. An in vitro apparatus was constructed to analyze the velocities and the actual and derived gradients of prosthetic valves in less than optimal orientations. Continuous flow studies of a 27 mm Omniscience prosthesis indicated good agreement between the actual and derived gradients with the valve's major orifice oriented toward the aorta's larger radius. These values increase as the valve is tilted to decrease its net opening angle. When the valve is rotated 180 degrees, the Doppler gradients tend to overestimate the actual pressure drops. These data indicate that certain valve misorientations create velocities that overestimate the transvalvular gradients.
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Affiliation(s)
- D Wurzel
- Cardiac Systems, Inc., Conshohocken, Pennsylvania 19428
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35
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Chandran KB, Fatemi R, Schoephoerster R, Wurzel D, Hansen G, Pantalos G, Yu LS, Kolff WJ. In vitro comparison of velocity profiles and turbulent shear distal to polyurethane trileaflet and pericardial prosthetic valves. Artif Organs 1989; 13:148-54. [PMID: 2705886 DOI: 10.1111/j.1525-1594.1989.tb02850.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A comparative study of flow dynamics past biomer trileaflet valves and a pericardial bioprosthetic valve under steady and physiological pulsatile flow conditions in vitro is reported in this paper. The velocity profiles and the turbulent shear stresses distal to the valves were measured using laser Doppler anemometry. The authors' results showed that the velocity profiles distal to the trileaflet valves were similar to that measured distal to the pericardial valve. Higher magnitudes of absolute turbulent shear stresses were measured distal to the synthetic valves in comparison to the pericardial valves. However, when the stresses were nondimensionalized with respect to the orifice diameter at the inlet aspect, the stresses were comparable for all of the three valves. With design modifications to increase the orifice diameter at the inlet aspect of the polyurethane valves, the turbulent stresses distal to the valves can be minimized. Such in vitro studies on the flow dynamics past the polyurethane valves can provide information towards design changes to improve the performance characteristics of these valves. Polyurethane valves with flow characteristics comparable to the pericardial valves can be manufactured relatively inexpensively compared to mechanical or tissue valve prosthesis. Hence, the synthetic valves may be a viable alternative for short-term use in total artificial heart devices as a bridge to transplant.
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Affiliation(s)
- K B Chandran
- Department of Biomedical Engineering, University of Iowa, Iowa City 52242
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36
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Chandran KB, Schoephoerster RT, Wurzel D, Hansen G, Yu LS, Pantalos G, Kolff WJ. Hemodynamic comparisons of polyurethane trileaflet and bioprosthetic heart valves. ASAIO Trans 1989; 35:132-8. [PMID: 2730811 DOI: 10.1097/00002480-198904000-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hemodynamic comparison of two polyurethane prosthetic heart valves with a bioprosthetic valve is presented. The valves were incorporated in a pulse duplicator simulating physiologic pulsatile flow, and comparisons between the valves were made on the transvalvular pressure drop, percent regurgitation, valve orifice area, rate of opening and closing as well as the performance index. The results showed that the functional characteristics of the polyurethane valve compared favorably with that of the bioprosthetic valve. The polyurethane valve can be a viable and inexpensive alternative, especially for short-term use in a total artificial heart as a bridge to transplant.
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Affiliation(s)
- K B Chandran
- Department of Biomedical Engineering, University of Iowa, Iowa City 52242
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37
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Abstract
A new pneumatic artificial heart system has been developed. The design criteria have been to produce an integrated series of blood pumps and drive systems that would reduce blood trauma and reactivity, while incorporating industrial, mass-production techniques. The system attempts to reproduce the natural heart's pressure and flow waveforms and allows the prosthetic valves to be installed in a manner consistent with their design. The system's ventricles are constructed entirely of polyurethane by a combination of vacuum-forming and solution-casting techniques. The atrial cuffs and arterial grafts are permanently attached to the pumps and do not incorporate a quick connect system. The prosthetic valves are sewn into the inflow and outflow tracts using their clinical sewing rings. Besides eliminating the crevices normally found in quick connect systems, this method mounts the valves in an extremely compliant housing to increase shock absorption. The drive system produces a systolic air flow with a variable pressure rise (dP/dt) to reduce mitral valve closing velocity. This system has been implanted into 25 calves to date, of which 17 were chronic experiments. In 14 animals, St. Jude bileaflet valves were used and these animals had a mean survival of 39 days. Six of these animals survived over 30 days, with the longest being 129 days. All of the animals showed the characteristic postoperative drop in red blood cell count and hematocrit that returned to near preoperative values in about 3 weeks. The plasma free hemoglobin values generally remained below 5 mg/dl. The necropsies performed on several of the earlier animals revealed renal infarcts. However, in two of the later experiments, no kidney damage was found. The blood contacting surfaces of the atrial cuffs from the animals surviving over 100 days were covered with a fibroproliferative pseudoneointimal growth that extended from the sewing rings to the natural atrial tissue. Grossly, this appears to be the same type of tissue response seen when only a valve is implanted in a natural calf heart.
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Affiliation(s)
- D Wurzel
- Cardiac Systems, Inc., Conshohocken, PA 19428
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