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Di Chiara C, Boracchini R, Cantarutti A, Kakkar F, Oletto A, Padoan A, Donà D, Giaquinto C. Risk of SARS-CoV-2 Reinfection in Children Within the 12 Months Following Mild COVID-19: Insights From a Survey Study. Pediatr Infect Dis J 2024; 43:e128-e130. [PMID: 38241645 PMCID: PMC10919262 DOI: 10.1097/inf.0000000000004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
Understanding the correlation between immune response and protection from COVID-19 will play a pivotal role in predicting the effectiveness of vaccines in children. We studied SARS-CoV-2 reinfection risk in children 12 months post-mild COVID-19. Children under 5 years old exhibited lower reinfection risk than older infected or vaccinated siblings during 12 months postimmunization.
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Affiliation(s)
- Costanza Di Chiara
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
| | - Riccardo Boracchini
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | | | - Andrea Padoan
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Daniele Donà
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
| | - Carlo Giaquinto
- From the Department for Women's and Children's Health, University of Padua, Padua, Italy
- Penta - Child Health Research, Padua, Italy
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Zanré N, Carvalho S, Elwood C, Côté HCF, Kakkar F, Boucher M, Money D, Boucoiran I. Factors associated with HIV viral load control in the early postpartum period - a Canadian prospective cohort study. AIDS Care 2024:1-8. [PMID: 38500011 DOI: 10.1080/09540121.2024.2325082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
Despite success in managing HIV during pregnancy, challenges remain around sustained adherence with antiretroviral therapy (ART), and the suboptimal viral load (VL) suppression during the postpartum period. The objective of this study was to compare VL levels at delivery and during the postpartum period and assess factors associated with lack of viral suppression during the postpartum period in Canada. We combined data from two Canadian prospective cohorts, which included 286 HIV-positive women (352 pregnancies) who delivered between 2012 and 2020. Delivery VL, postpartum VL, and potential factors associated with an undetectable VL (<50 copies/mL), 2-18 weeks after delivery were assessed. To account for the correlation between multiple pregnancies from the same woman, generalized estimating equations were used to assess bivariate associations. Ninety-nine per cent of pregnant women were on ART during pregnancy compared to 93% during the postpartum period. Of those with available VL results (n = 214 pregnancies), 94% of women achieved an undetectable VL at delivery compared to 87% during the postpartum period. The postpartum period is a challenging time for ART use and VL control. Qualitative studies are needed to better understand these challenges and guide us in designing adequate interventions.
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Affiliation(s)
- Nadège Zanré
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Sabrina Carvalho
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fatima Kakkar
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Mother and Children Infectious Disease Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
- School of Public Health, University of Montreal, Montreal, QC, Canada
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Boucoiran I, Côté HCF, Jodoin C, Elwood C, Kakkar F, Valois S, Money DM, Soudeyns H. Variations in CD4 counts during pregnancy in women living with HIV. HIV Med 2024; 25:254-261. [PMID: 37879717 DOI: 10.1111/hiv.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Our objective was to determine the frequency at which CD4 counts drop below 200 cells/mm3 during pregnancy in women living with HIV and to identify factors associated with this. METHODS Data from 2005 to 2020 from two prospective Canadian cohorts of pregnant women living with HIV were extracted. As per national guidelines, women received antiretroviral therapy and CD4 counts were monitored once per trimester and at delivery. RESULTS Among 775 included cases, 72 (9.3%) had CD4 counts <200 cells/mm3 at the first pregnancy visit. Of the 703 remaining pregnancies with CD4 counts ≥200 cells/mm3 at the initial visit, 20 (2.8%) were associated with a drop to <200 cells/mm3 . In univariate analysis, factors associated with this drop were coinfection with hepatitis B virus or hepatitis C virus (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.52-10.50), lower first visit CD4 counts (OR 0.165, 95% CI 0.08-0.34), and baseline haemoglobin levels <11 g/dL (OR 2.89, 95% CI 1.04-8.00). In multivariable analysis, only CD4 count at first visit remained independently associated with this drop. A cut-off CD4 count ≤450 cells/mm3 at the first pregnancy visit had a sensitivity of 100% to detect cases of CD4 drop to <200 cells/mm3 . CONCLUSION A drop of CD4 count to <200 cells/mm3 is uncommon during pregnancy in women living with HIV. Our results suggest that CD4 monitoring only once in pregnancy would be safe in women whose CD4 count is >450 cells/mm3 at the first pregnancy visit.
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Affiliation(s)
- Isabelle Boucoiran
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du Centre hospitalier universitaire (CHU) Sainte-Justine (CR-CHUSJ), Montreal, Quebec, Canada
- Department of Obstetrics & Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal (ESPUM), Université de Montréal, Montreal, Quebec, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute (WHRI), Vancouver, British Columbia, Canada
| | - Caroline Jodoin
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du Centre hospitalier universitaire (CHU) Sainte-Justine (CR-CHUSJ), Montreal, Quebec, Canada
| | - Chelsea Elwood
- Women's Health Research Institute (WHRI), Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du Centre hospitalier universitaire (CHU) Sainte-Justine (CR-CHUSJ), Montreal, Quebec, Canada
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Silvie Valois
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du Centre hospitalier universitaire (CHU) Sainte-Justine (CR-CHUSJ), Montreal, Quebec, Canada
| | - Deborah M Money
- Women's Health Research Institute (WHRI), Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hugo Soudeyns
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du Centre hospitalier universitaire (CHU) Sainte-Justine (CR-CHUSJ), Montreal, Quebec, Canada
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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4
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Levison J, McKinney J, Duque A, Hawkins J, Bowden EVH, Dorland J, Bitnun A, Kazmi K, Campbell DM, MacGillivray J, Yudin MH, Powell A, Datta S, Abuogi L, Weinberg A, Rakhmanina N, Mareuil JW, Hitti J, Boucoiran I, Kakkar F, Rahangdale L, Seidman D, Widener R. Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study. Clin Infect Dis 2023; 77:1416-1422. [PMID: 37078712 PMCID: PMC10654886 DOI: 10.1093/cid/ciad235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.
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Affiliation(s)
- Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer McKinney
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Duque
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Emily Ver Hoeve Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Julie Dorland
- Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Kescha Kazmi
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Douglas M Campbell
- Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Anna Powell
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shreetoma Datta
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Natella Rakhmanina
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joanna Walsh Mareuil
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jane Hitti
- Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dominika Seidman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - Rebecca Widener
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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El Tal T, Morin MP, Morris SK, Farrar DS, Berard RA, Kakkar F, Moore Hepburn C, Baerg K, Beaufils C, Bennett TL, Benseler SM, Beaudoin-Bussières G, Chan K, Cyr C, Dahdah N, Donner EJ, Drouin O, Edjoc R, Eljaouhari M, Embree JE, Farrell C, Finzi A, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Lang B, Laxer RM, Luu TM, McCrindle BW, Orkin J, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung RSM. Paediatric inflammatory multisystem syndrome in Canada: population-based surveillance and role of SARS-CoV-2 linkage. Pediatr Res 2023; 94:1744-1753. [PMID: 37277605 PMCID: PMC10241135 DOI: 10.1038/s41390-023-02668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome (PIMS) is a rare condition temporally associated with SARS-CoV-2 infection. Using national surveillance data, we compare presenting features and outcomes among children hospitalized with PIMS by SARS-CoV-2 linkage, and identify risk factors for intensive care (ICU). METHODS Cases were reported to the Canadian Paediatric Surveillance Program by a network of >2800 pediatricians between March 2020 and May 2021. Patients with positive versus negative SARS-CoV-2 linkages were compared, with positive linkage defined as any positive molecular or serologic test or close contact with confirmed COVID-19. ICU risk factors were identified with multivariable modified Poisson regression. RESULTS We identified 406 children hospitalized with PIMS, including 49.8% with positive SARS-CoV-2 linkages, 26.1% with negative linkages, and 24.1% with unknown linkages. The median age was 5.4 years (IQR 2.5-9.8), 60% were male, and 83% had no comorbidities. Compared to cases with negative linkages, children with positive linkages experienced more cardiac involvement (58.8% vs. 37.4%; p < 0.001), gastrointestinal symptoms (88.6% vs. 63.2%; p < 0.001), and shock (60.9% vs. 16.0%; p < 0.001). Children aged ≥6 years and those with positive linkages were more likely to require ICU. CONCLUSIONS Although rare, 30% of PIMS hospitalizations required ICU or respiratory/hemodynamic support, particularly those with positive SARS-CoV-2 linkages. IMPACT We describe 406 children hospitalized with paediatric inflammatory multisystem syndrome (PIMS) using nationwide surveillance data, the largest study of PIMS in Canada to date. Our surveillance case definition of PIMS did not require a history of SARS-CoV-2 exposure, and we therefore describe associations of SARS-CoV-2 linkages on clinical features and outcomes of children with PIMS. Children with positive SARS-CoV-2 linkages were older, had more gastrointestinal and cardiac involvement, and hyperinflammatory laboratory picture. Although PIMS is rare, one-third required admission to intensive care, with the greatest risk amongst those aged ≥6 years and those with a SARS-CoV-2 linkage.
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Affiliation(s)
- Tala El Tal
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Shaun K Morris
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roberta A Berard
- Division of Rheumatology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montreal, QC, Canada
| | - Charlotte Moore Hepburn
- Department of Pediatrics, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Krista Baerg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
- Division of General Pediatrics, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | | | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Guillaume Beaudoin-Bussières
- Department of Microbiology, Immunology and Infectious Diseases, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Kevin Chan
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Children's and Women's Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Elizabeth J Donner
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | | | | | - Joanne E Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Andrés Finzi
- Department of Microbiology, Immunology and Infectious Diseases, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Ryan Giroux
- Women's and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kristopher T Kang
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON, Canada
| | | | - Bianca Lang
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Ronald M Laxer
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Brian W McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Department of Pediatrics, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine M Pound
- Division of Consulting Pediatrics, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Victoria E Price
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
- Division of Paediatric Infectious Diseases, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Roseline Thibeault
- Division of Pediatric Infectious Diseases, Department of Paediatrics, CHU de Quebec-University of Laval, Quebec City, QC, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children's Hospital/McGill University Health Centre, Montreal, QC, Canada
| | - Rae S M Yeung
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Cell Biology Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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6
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Dufour I, Fougère Y, Goetghebuer T, Hainaut M, Mbiya B, Kakkar F, Yombi JC, Van der Linden D. Gen Z and HIV-Strategies for Optimizing the Care of the Next Generation of Adolescents Living with HIV. Viruses 2023; 15:2023. [PMID: 37896800 PMCID: PMC10611287 DOI: 10.3390/v15102023] [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: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The management of adolescents living with HIV represents a particular challenge in the global response to HIV. The challenges specific to this age group include difficulties engaging and maintaining them in care, challenges with transition to adult care, and limited therapeutic options for treatment-experienced patients, all of which have been jeopardized by the COVID-19 pandemic. This paper summarizes some of the challenges in managing adolescents living with HIV, as well as some of the most recent and innovative therapeutic approaches in this population.
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Affiliation(s)
- Inès Dufour
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
| | - Yves Fougère
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Benoît Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo;
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
| | - Dimitri Van der Linden
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
- Pediatric Infectious Diseases, Service of Specialized Pediatrics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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7
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Di Chiara C, Boracchini R, Sturniolo G, Barbieri A, Costenaro P, Cozzani S, De Pieri M, Liberati C, Zin A, Padoan A, Bonfante F, Kakkar F, Cantarutti A, Donà D, Giaquinto C. Clinical features of COVID-19 in Italian outpatient children and adolescents during Parental, Delta, and Omicron waves: a prospective, observational, cohort study. Front Pediatr 2023; 11:1193857. [PMID: 37635788 PMCID: PMC10450148 DOI: 10.3389/fped.2023.1193857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction COVID-19 features changed with the Omicron variant of SARS-CoV-2 in adults. This study aims to describe COVID-19 symptoms in children and adolescents during the Parental, Delta, and Omicron eras. Methods A single-centre, prospective observational study was conducted on individuals aged 0-20 years attending the University Hospital of Padua (Italy) from April 2020 to December 2022. COVID-19 cases were defined by positive SARS-CoV-2 molecular detection and/or serology; patient/family symptoms and virological positivity were considered to determine the infection onset. Variables were summarized and compared using appropriate tests of descriptive statistics. Results A total of 509 cases [46% female, median age eight years (IQR: 4-12)] were studied. Three-hundred-eighty-seven (76%), 52 (10%), and 70 (14%) subjects experienced COVID-19 during the Parental, Delta, and Omicron waves, respectively. All subjects developed an asymptomatic/mild COVID-19. Overall, the most frequent symptoms were fever (47%) and rhinitis (21%), which showed a significant increasing incidence from the Parental to Omicron waves (p < 0.001). Conversely, diarrhea was most common during the pre-Omicron eras (p = 0.03). Stratifying symptoms according to the age group, fever, rhinitis, and skin rashes were observed more frequently among infants/toddlers; conversely, fatigue was more common in children older than five years. The duration of symptoms was similar across different SARS-CoV-2 variants of concern (VOCs); conversely, the number of symptoms varied according to the age group (p < 0.0001). Discussion This study showed differences in COVID-19 clinical presentation among infants, children, and adolescents and confirmed Omicron infection is more likely to be associated with upper respiratory symptoms. However, further population-based studies are needed to support these findings. In addition, active surveillance will play a crucial role in assessing the disease severity of future VOCs.
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Affiliation(s)
- Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
| | - Riccardo Boracchini
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giulia Sturniolo
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Alessia Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Paola Costenaro
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Sandra Cozzani
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Marica De Pieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Cecilia Liberati
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Annachiara Zin
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Andrea Padoan
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Francesco Bonfante
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Padua, Italy
- Penta – Child Health Research, Padua, Italy
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8
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Akiva MH, Hyde De Souza H, Lamarre V, Boucoiran I, Gantt S, Renaud C, Kakkar F. Identifying Clinical Criteria for an Expanded Targeted Approach to Screening for Congenital Cytomegalovirus Infection-A Retrospective Study. Int J Neonatal Screen 2023; 9:40. [PMID: 37489493 PMCID: PMC10366881 DOI: 10.3390/ijns9030040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023] Open
Abstract
Targeted screening for congenital CMV infection (cCMV), which entails CMV testing of infants who fail newborn hearing screening (NBHS), has become common practice. However, this strategy misses nearly all infected infants with normal hearing at birth who are nonetheless at high risk of subsequent hearing loss and would benefit from timely cCMV diagnosis. The objective of this study was to identify expanded criteria predictive of cCMV to increase the scope and utility of targeted newborn CMV screening. In this retrospective study, 465 newborns were tested for cCMV at a single tertiary care center with a targeted screening program between 2014 and 2018. Twenty-two infants were diagnosed with cCMV, representing 0.2% of the 12,189 births over this period and 4.7% of the infants tested. The highest prevalence of cCMV infection was among infants tested because of primary maternal CMV infection (8/42, 19%), followed by failed initial NBHS (10/88, 11.4%), maternal HIV infection (3/137, 2.2%), and clinical suspicion alone (5/232, 2.2%). The symptoms with the highest prevalence of infection among all infants tested included an enlarged liver and/or spleen (33.3%) (3/9), followed by petechiae (33.3%), microcephaly (9.4%), direct hyperbilirubinemia (7.7%), thrombocytopenia (6%), and growth impairment (4.3%). In addition to CMV screening of newborns who fail the NBHS, these data suggest that certain clinical signs of cCMV-in particular: thrombocytopenia, growth impairment, and HIV exposure in pregnancy-should be additional criteria for expanded targeted newborn CMV screening, where universal screening is not yet the standard of care.
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Affiliation(s)
- Maya Heled Akiva
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC H4A 3J1, Canada
| | - Hannah Hyde De Souza
- Sainte-Justine Research Center, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Valerie Lamarre
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Isabelle Boucoiran
- Sainte-Justine Research Center, Université de Montréal, Montreal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Soren Gantt
- Sainte-Justine Research Center, Université de Montréal, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Christian Renaud
- Department of Microbiology and Immunology, Université de Montréal, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Fatima Kakkar
- Sainte-Justine Research Center, Université de Montréal, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
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9
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Hindle S, Brien MÈ, Pelletier F, Giguère F, Trudel MJ, Dal Soglio D, Kakkar F, Soudeyns H, Girard S, Boucoiran I. Placenta analysis of Hofbauer cell profile according to the class of antiretroviral therapy used during pregnancy in people living with HIV. Placenta 2023; 139:120-126. [PMID: 37364521 DOI: 10.1016/j.placenta.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION The use of antiretroviral therapy drastically reduces vertical transmission of Human Immunodeficiency Virus. However, recent studies demonstrate associations between ART use during pregnancy and placental inflammation, particularly within protease inhibitor (PI)-based regimens. We sought to characterize placental macrophages, namely Hofbauer cells, according to the class of ART used during pregnancy. METHODS Using immunofluorescence and immunohistochemistry, placentas from 79 pregnant people living with HIV (PPLWH) and 29 HIV-uninfected people were analyzed to quantify the numbers and frequencies of leukocytes (CD45+) and Hofbauer cells (CD68+ and/or CD163+). PPLWH were stratified into three groups based on class of ART: non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, integrase strand-transfer inhibitor (INSTI)-based, and PI-based regimens. RESULTS Placentas of PPLWH contained significantly more leukocytes and Hofbauer cells than controls. Multivariable analyses revealed that this increase in immune cells was associated with a predominantly CD163+ profile in all ART subgroups compared to the HIV-negative group. This was characterized by an increase in total CD163+ cells in the PI and INSTI subgroups, and a higher frequency of CD163+ cells and CD163+/CD68+ ratio in the NNRTI and PI subgroups. DISCUSSION Placentas of PPLWH treated with any ART regimen during their entire pregnancy displayed a selection for CD163+ cells compared to the HIV-negative group, regardless of class of ART, suggesting that class of ART does not intrinsically affect selection of CD163+ and CD68+ Hofbauer cells. Further investigations into the role of Hofbauer cells in ART-associated placental inflammation are warranted to identify the mechanisms behind their potential involvement in maternal-fetal tolerance maintenance.
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Affiliation(s)
- Stephanie Hindle
- Department of Pharmacology and Physiology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Marie-Ève Brien
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Florence Pelletier
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Frédérique Giguère
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Mei Juan Trudel
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Dorothée Dal Soglio
- Department of Pathology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada.
| | - Fatima Kakkar
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada; Department of Pediatrics, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
| | - Hugo Soudeyns
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada; Department of Microbiology, Infectiology and Immunology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
| | - Sylvie Girard
- Department of Pharmacology and Physiology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada; Department of Obstetrics and Gynecology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Department of Microbiology, Infectiology and Immunology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Department of Obstetrics and Gynecology, Department of Immunology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1S2, Canada; Department of Obstetrics and Gynecology, Université de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
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10
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Farrar D, Hepburn CM, Drouin O, El Tal T, Morin MP, Berard R, King M, Thibodeau ML, Baerg K, Beaudoin-Bussières G, Beaufils C, Bennett TL, Benseler S, Chan K, Cyr C, Dahdah N, Donner E, Embree J, Farrell C, Finzi A, Forgie S, Giroux R, Kang K, Lang B, Laxer R, McCrindle B, Orkin J, Papenburg J, Pound C, Price V, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung R, Kakkar F, Morris S. Resource use and disease severity of children hospitalized for COVID-19 versus multisystem inflammatory syndrome in children (MIS-C) in Canada. Can Commun Dis Rep 2023; 49:103-112. [PMID: 38356877 PMCID: PMC10866613 DOI: 10.14745/ccdr.v49i04a03] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Direct comparisons of paediatric hospitalizations for acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) can inform health system planning. We describe the absolute and relative hospital burden of acute paediatric COVID-19 and MIS-C in Canada. Methods This national prospective study was conducted via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Children younger than 18 years old and hospitalized for acute COVID-19 or MIS-C were included in the analysis. Outcomes included supplemental oxygen (low-flow oxygen or high-flow nasal cannula), ventilation (non-invasive or conventional mechanical), vasopressors, paediatric intensive care unit (PICU) admission, or death. Adjusted risk differences (aRD) and 95% confidence intervals (CI) were calculated to identify factors associated with each diagnosis. Results Overall, we identified 330 children hospitalized for acute COVID-19 (including five deaths) and 208 hospitalized for MIS-C (including zero deaths); PICU admission was required for 49.5% of MIS-C hospitalizations versus 18.2% of acute COVID-19 hospitalizations (aRD 20.3; 95% CI, 9.9-30.8). Resource use differed by age, with children younger than one year hospitalized more often for acute COVID-19 (aRD 43.4% versus MIS-C; 95% CI, 37.7-49.1) and more children 5-11 years hospitalized for MIS-C (aRD 38.9% vs. acute COVID-19; 95% CI, 31.0-46.9). Conclusion While there were more hospitalizations and deaths from acute paediatric COVID-19, MIS-C cases were more severe, requiring more intensive care and vasopressor support. Our findings suggest that both acute COVID-19 and MIS-C should be considered when assessing the overall burden of severe acute respiratory syndrome coronavirus 2 in hospitalized children.
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Affiliation(s)
- Daniel Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
| | - Charlotte Moore Hepburn
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Olivier Drouin
- Division of General Paediatrics, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Tala El Tal
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Roberta Berard
- Division of Rheumatology, Department of Paediatrics, Children’s Hospital at London Health Sciences Centre, London, ON
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON
| | | | - Krista Baerg
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of General Paediatrics, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Guillaume Beaudoin-Bussières
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | | | - Susanne Benseler
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB
- Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB
| | - Kevin Chan
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Department of Children’s and Women’s Health, Trillium Health Partners, Mississauga, ON
- Institute for Better Health, Trillium Health Partners, Mississauga, ON
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Sainte-Justine, Department of Paediatrics, University of Montréal, Montréal, QC
| | - Elizabeth Donner
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Neurology, The Hospital for Sick Children, Toronto, ON
| | - Joanne Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
| | - Andrés Finzi
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Paediatrics, University of Alberta, Edmonton, AB
- Stollery Children’s Hospital, Edmonton, AB
| | - Ryan Giroux
- Women’s and Children’s Health Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON
| | - Kristopher Kang
- Department of Paediatrics, University of British Columbia, Vancouver, BC
| | - Bianca Lang
- Division of Rheumatology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Ronald Laxer
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Brian McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jesse Papenburg
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children’s Hospital, Montréal, QC
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, QC
| | - Catherine Pound
- Division of Consulting Paediatrics, Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON
| | - Victoria Price
- Division of Paediatric Hematology/Oncology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | | | - Rupeena Purewal
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of Paediatric Infectious Diseases, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Manish Sadarangani
- Department of Paediatrics, University of British Columbia, Vancouver, BC
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC
| | | | - Roseline Thibeault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Karina Top
- Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children’s Hospital and McGill University Health Centre, Montréal, QC
| | - Rae Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, QC
| | - Shaun Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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11
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Carvalho S, Sheehan NL, Valois S, Kakkar F, Boucher M, Ferreira E, Boucoiran I. Relationship between raltegravir trough plasma concentration and virologic response and the impact of therapeutic drug monitoring during pregnancy. Int J STD AIDS 2023; 34:175-182. [PMID: 36529684 PMCID: PMC9925909 DOI: 10.1177/09564624221144489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited data is available on raltegravir (RAL) pharmacokinetics during pregnancy and the value of therapeutic drug monitoring (TDM) in pregnancy is unknown. This study aims to describe RAL trough plasma concentrations (Ctrough) during pregnancy and review the impact of RAL TDM on outcomes. METHODS Women from the prospective mother-infant HIV cohort of Mother and Children's Infectious Diseases Center who received RAL during their pregnancy between 2011-2020 were included. TDM reports were reviewed and Ctrough values estimated when possible, using historical RAL half-lives. RESULTS We included 76 pregnant women of which 47 underwent TDM. We observed a significant association between virological response and Ctrough (p-value .034) with an increase of 0.1 mg/L corresponding to a 2.96 reduction in the risk of having a detectable viral load. The results indicated that in pregnant women a RAL Ctrough threshold of 0.04 mg/L has a higher specificity (75%) as compared to our current Ctrough target value of 0.02 mg/L (25%) and an acceptable sensitivity (77%). No significant differences were observed between Ctrough at each trimester. When comparing pregnancies with and without TDM, no statistically significant differences were observed in the virologic response during pregnancy and at delivery, or with the need for triple antiretroviral prophylaxis in newborns. CONCLUSIONS An association between RAL Ctrough and viral load was observed and achieving a RAL Ctrough of 0.04 mg/L or greater is a predictor of virologic response in pregnant women. The impact of TDM in pregnancy, however, could not be demonstrated.
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Affiliation(s)
- Sabrina Carvalho
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada,Mother and Children’s Infectious
Diseases Center, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, QC, Canada
| | - Nancy L. Sheehan
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada,Pharmacy Department and Chronic
Viral Illness Service, McGill University Health
Centre, Montréal, QC, Canada
| | - Silvie Valois
- Mother and Children’s Infectious
Diseases Center, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, QC, Canada
| | - Fatima Kakkar
- Mother and Children’s Infectious
Diseases Center, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, QC, Canada,Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
| | - Marc Boucher
- Mother and Children’s Infectious
Diseases Center, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, QC, Canada,Department of Obstetrics and
Gynecology, Université de Montréal, Montréal, QC, Canada
| | - Ema Ferreira
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada,Department of Pharmacy, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, Québec, Canada
| | - Isabelle Boucoiran
- Mother and Children’s Infectious
Diseases Center, Centre Hospitalier Universitaire
Sainte-Justine, Montréal, QC, Canada,Department of Obstetrics and
Gynecology, Université de Montréal, Montréal, QC, Canada,School of Public Health, Université de Montréal, Montréal, QC, Canada,Dr. Isabelle Boucoiran, Research Centre of
the Sainte-Justine University Hospital, Department of Obstetrics and Gynecology
3175, Chemin de la Côte-Sainte-Catherine, Bur. 4804, Montréal, QC H3T 1C.
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12
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Carvalho S, Lee T, Tulloch KJ, Sauve LJ, Samson L, Brophy JC, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Prescribing patterns of antiretroviral treatments during pregnancy for women living with HIV in Canada 2004-2020: A surveillance study. HIV Med 2023; 24:130-138. [PMID: 35699235 DOI: 10.1111/hiv.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. METHODS The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. RESULTS We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. CONCLUSION In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
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Affiliation(s)
- Sabrina Carvalho
- Faculty of Pharmacy, Université de Montréal, and Research Centre of the Saint-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Karen J Tulloch
- Department of Pharmacy, British Columbia Women's Hospital and Health Centre and Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura J Sauve
- Department of Pediatrics, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason C Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- Department of Health Care and Epidemiology, University of British Columbia and CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, British Columbia Women's Health Research Institute and Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, and Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Schneidman J, Lee T, Sauve L, Brophy J, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small-for-gestational age births in Canada, a retrospective cohort study. Int J Gynaecol Obstet 2023. [PMID: 36707102 DOI: 10.1002/ijgo.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational age (SGA) birth among pregnant women and people living with HIV in Canada. METHODS Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time-dependent Cox proportional hazards models. RESULTS Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor-(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor- (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005). CONCLUSION INSTI-based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV.
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Affiliation(s)
- Jillian Schneidman
- Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Laura Sauve
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
| | - Deborah Money
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Khan S, Tsang KK, Brophy J, Kakkar F, Kennedy VL, Boucoiran I, Yudin MH, Money D, Read S, Bitnun A. Canadian Paediatric and Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context. Journal of the Association of Medical Microbiology and Infectious Disease Canada 2023; 8:7-17. [PMID: 37008587 PMCID: PMC10052908 DOI: 10.3138/jammi-2022-11-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries. Methods: The Canadian Paediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and pediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure. Results: The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring, and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area. Conclusion: The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.
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Affiliation(s)
- Sarah Khan
- McMaster Children’s Hospital, Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kara K. Tsang
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - V Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital and Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark H. Yudin
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, an associate member in the Department of Medicine and the School of Population and Public Health, Faculty of Medicine, an Associate Member of the Department of Microbiology & Immunology, Faculty of Science, at the University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Read
- Department of Pediatrics and Pathobiology, University of Toronto, Toronto, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, and Professor, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention. RECENT FINDINGS High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods. SUMMARY More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.
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Affiliation(s)
- Alejandra Sandoval Carmona
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
| | - Fatima Kakkar
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
- Centre de Recherche du CHU Sainte-Justine, 3175 Ch. de La Côte-Sainte-Catherine, Montréal, Canada
| | - Soren Gantt
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
- Centre de Recherche du CHU Sainte-Justine, 3175 Ch. de La Côte-Sainte-Catherine, Montréal, Canada
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16
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Farrar DS, Drouin O, Moore Hepburn C, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Orkin J, Ouldali N, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Ricci C, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. The Lancet Regional Health - Americas 2022; 15:100337. [PMID: 35936225 PMCID: PMC9342862 DOI: 10.1016/j.lana.2022.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abda A, Drouin O, Kakkar F, Autmizguine J, del Giorgio F, Gauvin L. 88 Association between area level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health 2022; 27. [PMCID: PMC9586059 DOI: 10.1093/pch/pxac100.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. Objectives The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. Design/Methods We conducted a retrospective cohort study of all children (0-17 years of age) with a PCR-confirmed SARS-CoV-2 infection between March 1, 2020, and May 31, 2021, at a tertiary care pediatric hospital. Data were collected through chart review and included age, sex, and postal code. Postal codes were then assigned a dissemination area-level material deprivation score, measured via the Pampalon Material Deprivation Index (PMDI) quintiles. The Pampalon Material Deprivation Index (PMDI) uses postal codes to describe factors related to material deprivation obtained from the Canadian census, which are proxies for individual data in a geographic area. Specifically, the PMDI integrates data regarding (i) the proportion of persons without a high school diploma; (ii) the employment-to-population ratio; (iii) average personal income which is aggregated at the dissemination area level. We examined the association between PMDI quintiles and hospitalization using Poisson regression. Results During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized due to SARS-CoV-2 infection. Children from the most deprived PMDI quintile represented 31.6% of positive cases and 40.7% of hospitalizations (Figure 1 and 2). Both in bivariate and multivariable regression analyses, there was evidence of greater proportion of positive test results in the most deprived PMDI quintile (Quintile 5) compared to the least deprived quintile (Quintile 1) (rate ratio 1.77, 95%CI: 1.36; 2.62) (Table 1). The incidence of hospitalization due to SARS-CoV-2 infection was 2.42 times greater in the most deprived quintile compared to the least deprived quintile (95%CI: 1.33; 4.41) (table 1). In a post-hoc analysis, the risk for severe disease appeared higher for children living in Q5 areas relative to other areas but the difference did not reach statistical significance. Conclusion In conclusion, in this study we found evidence that Canadian children living in neighbourhoods with high material deprivation had a higher incidence of infection and hospitalizations related to SARS-Cov-2 compared to children living in neighbourhoods with less material deprivation. Public health authorities should take these disparities into account when devising public health policy and interventions especially at this crucial point in the pandemic. Special efforts should be deployed to protect children from these more disadvantaged areas, especially as vaccination is not yet available to a majority of children. ![]()
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Affiliation(s)
- Assil Abda
- Université de Montréal - CHU Sainte-Justine
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine
| | | | | | | | - Lise Gauvin
- School of Public Health, Université de Montréal
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18
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Piché-Renaud PP, Panetta L, Farrar D, Hepburn CM, Drouin O, Papenburg J, Salvadori M, Laffin-Thibodeau M, Kakkar F, Morris S. 58 Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada. Paediatr Child Health 2022. [PMCID: PMC9586112 DOI: 10.1093/pch/pxac100.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. Objectives The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2. Design/Methods This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged <1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 31st 2021, and were classified by disease severity and primary cause of hospitalization. Multivariable logistic regression was performed to identify infants' characteristics associated with hospitalization. Results A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions, and infants <1 month had higher odds of hospitalization than infants aged 1-3 months (Table). In total, 20 infants (3.8%) met criteria for severe disease. Conclusion We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group is uncommon with most infants having mild disease. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants. ![]()
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Affiliation(s)
| | - Luc Panetta
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | | | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine
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19
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Farrar D, Drouin O, Hepburn CM, Baerg K, Chan K, Cyr C, Donner E, Embree J, Farrell C, Forgie S, Giroux R, Kang K, King M, Laffin-Thibodeau M, Luu TM, Orkin J, Ouldali N, Papenburg J, Pound C, Price VE, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Kakkar F, Morris S. 50 Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. Paediatr Child Health 2022. [PMCID: PMC9586042 DOI: 10.1093/pch/pxac100.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Children living with chronic comorbid conditions are at increased risk for severe COVID-19 disease, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. Age-specific baseline indicators of COVID-19 severity are also needed to evaluate the effectiveness of SARS-CoV-2 vaccination strategies in the paediatric population. Objectives In this study, we aimed to 1) identify factors associated with severe COVID-19 in children, and 2) describe rates of hospitalization, intensive care unit (ICU) admission, and severe COVID-19 within specific pediatric age groups. Design/Methods We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020–May 2021. Cases were reported voluntarily by a network of >2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory or hemodynamic requirements, select organ system complications, or death. Outcomes were described among children aged <6 months, 6–23 months, 2–4 years, 5–11 years, and 12–17 years. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization. Results We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 2–4 years (48.7%) and 12–17 years (41.3%) (Table 1). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (e.g. epilepsy and chromosomal/genetic conditions) (aRR 1.87, 95% CI 1.34-2.61), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1.66, 95% CI 1.13-2.42). Conclusion While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. Children aged 2–4 years more commonly experienced severe COVID-19 in this study, which was conducted at a time when no children were eligible for SARS-CoV-2 vaccines. Notably, this high-risk group remains without access to approved vaccines. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children. ![]()
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Affiliation(s)
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine
| | | | | | | | - Claude Cyr
- Centre hospitalier universitaire de Sherbrooke
| | | | | | | | | | - Ryan Giroux
- St. Michael's Hospital, Unity Health Toronto
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20
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Tehseen S, Williams S, Robinson J, Morris SK, Bitnun A, Gill P, Tal TE, Yeh A, Yea C, Ulloa‐Gutierrez R, Brenes‐Chacon H, Yock‐Corrales A, Ivankovich‐Escoto G, Soriano‐Fallas A, Papenburg J, Lefebvre M, Scuccimarri R, Nateghian A, Aski BH, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Forbes M, Saux NL, Bowes J, Purewal R, Lautermilch J, Bayliss A, Wong JK, Leifso K, Foo C, Panetta L, Kakkar F, Piche D, Viel‐Theriault I, Merckx J, Lieberman L. Thrombosis and hemorrhage experienced by hospitalized children with SARS-CoV-2 infection or MIS-C: Results of the PICNIC registry. Pediatr Blood Cancer 2022; 69:e29793. [PMID: 35689507 PMCID: PMC9350140 DOI: 10.1002/pbc.29793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Coagulopathy and thrombosis associated with SARS-CoV-2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited. METHODS An international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS-CoV-2 and multisystem inflammatory syndrome (MIS-C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub-study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes. RESULTS Nine hundred eighty-five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection, 288 had MIS-C (31.4%), and 242 (26.4%) had SARS-CoV-2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p-value .007), respiratory support (p-value .006), central venous catheter (CVC) (p = .04) in children with primary SARS-CoV-2 and in those with MIS-C included respiratory support (p-value .03), obesity (p-value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS-CoV-2 infection and in those with MIS-C encompassed thrombocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage. CONCLUSION Thrombosis and hemorrhage are uncommon events in children with SARS-CoV-2; largely experienced by those with pre-existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS-CoV-2 infection requires ongoing research.
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Affiliation(s)
- Sarah Tehseen
- Department of Laboratory medicine and PediatricsUniversity of Saskatchewan, SHASaskatoonSaskatchewanCanada
| | - Suzan Williams
- Division of Hematology OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Joan Robinson
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Shaun K. Morris
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ari Bitnun
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Peter Gill
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Tala El Tal
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ann Yeh
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Carmen Yea
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Rolando Ulloa‐Gutierrez
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Helena Brenes‐Chacon
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Adriana Yock‐Corrales
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Gabriela Ivankovich‐Escoto
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Alejandra Soriano‐Fallas
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Jesse Papenburg
- Department of PediatricsMcGill UniversityMontrealQuebecCanada
| | | | | | - Alireza Nateghian
- Department of PediatricsIran University of Medical SciencesTehranIran
| | | | - Rachel Dwilow
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Jared Bullard
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Suzette Cooke
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Lea Restivo
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison Lopez
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manish Sadarangani
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Vaccine Evaluation CenterBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada
| | - Ashley Roberts
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Forbes
- Department of PediatricsWestern UniversityLondonOntarioCanada
| | - Nicole Le Saux
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Jennifer Bowes
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Rupeena Purewal
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Janell Lautermilch
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Ann Bayliss
- Department of PediatricsTrillium Health PartnersMississaugaOntarioCanada
| | | | - Kirk Leifso
- Department of PediatricsQueen's UniversityKingstonOntarioCanada
| | - Cheryl Foo
- Department of PediatricsMemorial UniversitySt John'sNewfoundland and LabradorCanada
| | - Luc Panetta
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Fatima Kakkar
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Dominique Piche
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lani Lieberman
- Department of Laboratory Medicine and PathobiologyUniversity Health NetworkTorontoOntarioCanada
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21
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Nicolau IA, Shokoohi M, McBane JE, Pogany L, Popovic N, Nicholson V, Hillier S, Aran N, Brophy J, Burt K, Cox J, de Pokomandy A, Kakkar F, Kelly D, Kerkerian G, Kogilwaimath S, Kroch A, Dias Lima V, Linthwaite B, Mbuagbaw L, McClarty L, Turvey S, Owino M, Martin C, Hogg RS, Loutfy M. A two-day workshop reviewing Canadian provincial and national HIV care cascade indicators, reporting, challenges, and recommendations. J Assoc Med Microbiol Infect Dis Can 2022; 7:247-268. [PMID: 36337608 PMCID: PMC9629730 DOI: 10.3138/jammi-2022-0007] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The HIV care cascade is an indicators-framework used to assess achievement of HIV clinical targets including HIV diagnosis, HIV care initiation and retention, initiation of antiretroviral therapy, and attainment of viral suppression for people living with HIV. METHODS The HIV Care Cascade Research Development Team at the CIHR Canadian HIV Trials Network Clinical Care and Management Core hosted a two-day virtual workshop to present HIV care cascade data collected nationally from local and provincial clinical settings and national cohort studies. The article summarizes the workshop presentations including the indicators used and available findings and presents the discussed challenges and recommendations. RESULTS Identified challenges included (1) inconsistent HIV care cascade indicator definitions, (2) variability between the use of nested UNAIDS's targets and HIV care cascade indicators, (3) variable analytic approaches based on differing data sources, (4) reporting difficulties in some regions due to a lack of integration across data platforms, (5) lack of robust data on the first stage of the care cascade at the sub-national level, and (6) inability to integrate key socio-demographic data to estimate population-specific care cascade shortfalls. CONCLUSION There were four recommendations: standardization of HIV care cascade indicators and analyses, additional funding for HIV care cascade data collection, database maintenance and analyses at all levels, qualitative interviews and case studies characterizing the stories behind the care cascade findings, and employing targeted positive-action programs to increase engagement of key populations in each HIV care cascade stage.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Joanne E McBane
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Pogany
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Nashira Popovic
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Valerie Nicholson
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Sean Hillier
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Niloufar Aran
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Jason Brophy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberley Burt
- HIV Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Joseph Cox
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Fatima Kakkar
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Deborah Kelly
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Geneviève Kerkerian
- Infectious Diseases Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Siddharth Kogilwaimath
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Lawrence Mbuagbaw
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Committee for Accessible AIDS Treatment, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Carrie Martin
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- Concordia, Montreal, Quebec, Canada
| | - Robert S Hogg
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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22
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Proulx C, Autmizgine J, Drouin O, Panetta L, Delisle GA, Luu TM, Quach C, Kakkar F. La rhinorrhée isolée en cas d’infection par le SRAS-CoV-2 chez les enfants d’âge préscolaire par rapport à ceux d’âge scolaire. Paediatr Child Health 2022; 27:S103-S107. [PMID: 36092295 PMCID: PMC9455650 DOI: 10.1093/pch/pxac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022] Open
Abstract
Objectifs Il est prioritaire de dépister et d’isoler rapidement les cas de SRAS-CoV-2 dans les milieux scolaires et les milieux de garde pour éviter de nouvelles éclosions. La présente étude visait à comparer les manifestations cliniques des infections par le SRAS-CoV-2 diagnostiquées chez des enfants d’âge préscolaire (moins de cinq ans) à celles des enfants d’âge scolaire (cinq ans ou plus), et notamment la probabilité qu’ils éprouvent un symptôme isolé comme une rhinorrhée ou un mal de gorge. Méthodologie Les chercheurs ont procédé à une étude rétrospective des enfants (de 18 ans ou moins) qui ont reçu un diagnostic de SRAS-CoV-2 à la clinique ambulatoire de COVID-19 ou à l’urgence du Centre hospitalier universitaire Sainte-Justine de Montréal, au Québec, entre février et mai 2020. Résultats Des 3 789 enfants soumis au dépistage, 105 (3 %) ont reçu un résultat positif au SRAS-CoV-2, et 104 ont été inclus dans l’analyse (49 de moins de cinq ans et 55 de cinq ans ou plus). La fièvre était le principal symptôme initial dans les deux groupes d’âge, mais en l’absence de fièvre, la majorité des cas (92 %) ressentait une combinaison d’au moins deux symptômes. La présence d’un seul symptôme isolé était peu courante (moins de 5 % des cas). Par-dessus tout, aucun enfant des deux groupes d’âge n’a souffert de rhinorrhée ou de mal de gorge isolé. Conclusion Les manifestations cliniques de la COVID-19 ne sont pas tout à fait les mêmes chez les enfants d’âge préscolaire et les enfants d’âge scolaire, mais dans les deux groupes d’âge, la rhinorrhée isolée n’était pas une manifestation de l’infection par le SRAS-CoV-2. Ces résultats pourraient contribuer à orienter les critères de dépistage et d’exclusion dans les milieux de garde et les milieux scolaires.
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Affiliation(s)
- Catherine Proulx
- Service de pédiatrie générale, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada
| | - Julie Autmizgine
- Département de pharmacologie et de physiologie, Université de Montréal, Montréal (Québec)Canada.,Centre de recherche, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Département de pédiatrie, Université de Montréal, Montréal (Québec)Canada.,Service d'infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada
| | - Olivier Drouin
- Service de pédiatrie générale, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Centre de recherche, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Département de pédiatrie, Université de Montréal, Montréal (Québec)Canada
| | - Luc Panetta
- Service d'infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada
| | - Gaelle A Delisle
- Unité de prévention et de contrôle des infections, département de pédiatrie et médecine de laboratoire, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada
| | - Thuy Mai Luu
- Service de pédiatrie générale, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Centre de recherche, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Département de pédiatrie, Université de Montréal, Montréal (Québec)Canada
| | - Caroline Quach
- Centre de recherche, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Service d'infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Unité de prévention et de contrôle des infections, département de pédiatrie et médecine de laboratoire, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Département de microbiologie, d'infectiologie et d'immunologie, Université de Montréal, Montréal (Québec)Canada
| | - Fatima Kakkar
- Centre de recherche, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada.,Département de pédiatrie, Université de Montréal, Montréal (Québec)Canada.,Service d'infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)Canada
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23
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Schober T, Caya C, Barton M, Bayliss A, Bitnun A, Bowes J, Brenes-Chacon H, Bullard J, Cooke S, Dewan T, Dwilow R, El Tal T, Foo C, Gill P, Haghighi Aski B, Kakkar F, Lautermilch J, Lefebvre MA, Leifso K, Le Saux N, Lopez A, Manafi A, Merckx J, Morris SK, Nateghian A, Panetta L, Petel D, Piché D, Purewal R, Restivo L, Roberts A, Sadarangani M, Scuccimarri R, Soriano-Fallas A, Tehseen S, Top KA, Ulloa-Gutierrez R, Viel-Theriault I, Wong J, Yea C, Yeh A, Yock-Corrales A, Robinson JL, Papenburg J. Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001440. [PMID: 36053578 PMCID: PMC9358955 DOI: 10.1136/bmjpo-2022-001440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection. DESIGN Multicentre retrospective cohort study. SETTING 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021. PATIENTS Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C). MAIN OUTCOME MEASURE Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses. RESULTS We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease. CONCLUSION We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatima Kakkar
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kirk Leifso
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Proulx C, Autmizgine J, Drouin O, Panetta L, Delisle GA, Luu TM, Quach C, Kakkar F. Isolated rhinorrhea in the presentation of SARS-CoV-2 infection among preschool- versus school-aged children. Paediatr Child Health 2022; 27:S22-S26. [PMID: 35620556 PMCID: PMC9126269 DOI: 10.1093/pch/pxab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Rapid identification and isolation of SARS-CoV-2 cases are priorities in school and child care settings to prevent further outbreaks. The objective of this study was to compare the clinical presentation of SARS-CoV-2 infections among preschool (<5 years) versus school-aged (≥5 years) children diagnosed with SARS-CoV-2 infection, and, specifically, the probability of presenting with an isolated symptom, such rhinorrhea or sore throat. Methods Retrospective study of children (≤18 years of age) diagnosed with SARS-CoV-2 in the outpatient COVID-19 clinic or the Emergency Department at the Centre Hospitalier Universitaire Sainte-Justine (Montreal, Quebec, Canada) February through May 2020. Results Of 3,789 children tested, 105 (3%) were positive for SARS-CoV-2, and 104 included in the analysis (n=49 age <5 years and n=55 age ≥5 years). While fever was the most common presenting symptom across both age groups, in the absence of fever, the presence of a combination of two or more symptoms identified the majority (92%) of cases. Isolated single symptom presentations were uncommon (<5% of cases). Most importantly, not a single child in either age group presented with isolated rhinorrhea or sore throat. Conclusions While there are differences in the clinical manifestations of COVID-19 in preschool- versus school-aged children, in both age groups, isolated rhinorrhea was not a manifestation of SARS-CoV-2 infection. These results could help further guide testing criteria and exclusion criteria in child care and school settings.
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Affiliation(s)
- Catherine Proulx
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Julie Autmizgine
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Luc Panetta
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Gaelle A Delisle
- Infection Prevention and Control Unit, Department of Pediatric Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Quach
- Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Infection Prevention and Control Unit, Department of Pediatric Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectious Disease and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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25
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Abda A, del Giorgio F, Gauvin L, Autmizguine J, Kakkar F, Drouin O. Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health 2022; 27:S27-S32. [PMID: 35620560 PMCID: PMC9126283 DOI: 10.1093/pch/pxab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. Methods We conducted a retrospective cohort study of all children (0 to 17 years of age) with a PCR-confirmed SARS-CoV-2 infection March 1, 2020 through May 31, 2021 at a tertiary-care paediatric hospital, in Montreal, Canada. Data were collected through chart review and included age, sex, and postal code, allowing linkage to dissemination area-level material deprivation, measured with the Pampalon Material Deprivation Index (PMDI) quintiles. We examined the association between PMDI quintiles and hospitalization using Poisson regression. Results During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized. Children living in the most deprived quintile of PMDI represented 40.7% of hospitalizations. Incidence rate ratio of hospitalization for this group compared to the most privileged quintile was 2.42 (95%CI: 1.33; 4.41). Conclusion Children living in the most materially deprived areas had more than twice the rate of hospitalizations for COVID-19 than children living in most privileged areas. Special efforts should be deployed to protect children who live in disadvantaged areas, especially pending vaccination of younger children.
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Affiliation(s)
- Assil Abda
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Francesca del Giorgio
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
| | - Lise Gauvin
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Olivier Drouin
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
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26
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Abda A, del Giorgio F, Gauvin L, Autmizguine J, Kakkar F, Drouin O. L’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisation chez les enfants infectés par le SRAS-CoV-2 à Montréal. Paediatr Child Health 2022; 27:S108-S114. [PMID: 36092292 PMCID: PMC9384184 DOI: 10.1093/pch/pxac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022] Open
Abstract
Historique Même si les facteurs sociodémographiques sont liés à l’infection par le SRAS-CoV-2 et aux hospitalisations chez les adultes, peu de données portent sur l’association entre ces caractéristiques et les hospitalisations attribuables au SRAS-CoV-2 chez les enfants. La présente étude visait à déterminer l’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisations à cause du SRAS-CoV-2 chez les enfants. Méthodologie Les chercheurs ont réalisé une étude de cohorte rétrospective de tous les enfants (de 0 à 17 ans) atteints d’une infection par le SRAS-CoV-2 confirmée par un test d’amplification en chaîne par polymérase après transcription inverse (PCR) entre le 1er mars et le 31 mai 2021 dans un hôpital pédiatrique de soins tertiaires de Montréal, au Canada. Ils ont colligé les données par examen des dossiers et ont inclus l’âge, le sexe et les codes postaux, afin de pouvoir lier la défavorisation matérielle à l’échelle de l’aire de diffusion, mesurée au moyen des quintiles de l’indice de défavorisation matérielle de Pampalon. Ils ont examiné l’association entre les quintiles de cet indice et les hospitalisations à l’aide de la régression de Poisson. Résultats Pendant la période de l’étude, 964 enfants ont reçu un résultat positif au SRAS-CoV-2 confirmé par un test PCR, et 124 d’entre eux ont été hospitalisés. Au total, 40,7 % des enfants hospitalisés habitaient dans le quintile le plus défavorisé d’après l’indice de défavorisation matérielle de Pampalon. Le rapport du taux d’incidence des hospitalisations dans ce groupe était de 2,42 (intervalle de confiance à 95 % : 1,33; 4,41) par rapport au quintile le plus privilégié. Conclusion Plus du double des enfants qui habitaient dans les quartiers les plus défavorisés sur le plan matériel étaient hospitalisés à cause de la COVID-19 par rapport à ceux qui habitaient dans les quartiers les plus privilégiés. Il faudrait déployer des efforts particuliers pour protéger les enfants qui habitent dans des quartiers défavorisés, particulièrement dans l’attente de la vaccination des plus jeunes.
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Affiliation(s)
- Assil Abda
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
| | - Francesca del Giorgio
- Faculté de médecine, Université McGill , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
| | - Lise Gauvin
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal , Montréal (Québec) Canada
| | - Julie Autmizguine
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Département de pharmacologie et de physiologie, faculté de médecine, Université de Montréal , Montréal (Québec) Canada
| | - Fatima Kakkar
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Service d’infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
| | - Olivier Drouin
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal , Montréal (Québec) Canada
- Service de pédiatrie générale, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
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Dionisopoulos Z, Kakkar F, Blanchard AC. Delayed diagnosis of maternal and congenital syphilis: An unrecognized epidemic? Can Commun Dis Rep 2022; 48:115-118. [PMID: 35342371 PMCID: PMC8890596 DOI: 10.14745/ccdr.v48i23a10] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Syphilis is an infection caused by Treponema pallidum spirochetes. The diagnosis of this sexually transmitted disease may be missed, partly due to the painless nature of genital ulcers in its primary stage. Women in Canada are screened for syphilis in their first trimester of pregnancy, but late pregnancy testing is not done in all provinces to date; therefore, undetected vertical transmission of syphilis may occur. This case emphasizes the importance of recognizing congenital syphilis in infants and young children with unexplained growth problems and biochemical and hematological abnormalities. Congenital syphilis remains a rare diagnosis, but in the context of increased syphilis rates in Canada during recent years, clinicians should consider this diagnosis in infants presenting with compatible clinical manifestations.
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Affiliation(s)
- Zachary Dionisopoulos
- Paediatrics Residency Program, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
| | - Ana C Blanchard
- Division of Infectious Diseases, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
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Piché-Renaud PP, Panetta L, Farrar D, Hepburn CM, Drouin O, Kakkar F, Morris S. 483. Disease Severity and Clinical Manifestations of SARS-CoV-2 Infection Among Infants Over the First Year of the Pandemic in Canada. Open Forum Infect Dis 2021. [PMCID: PMC8644518 DOI: 10.1093/ofid/ofab466.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background There is limited data on outcomes of SARS-CoV-2 infection among infants (< 1 year of age). In the absence of any approved vaccines for infants, understanding the risk factors for hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and targeted public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and risk factors for hospitalization among infants with SARS-CoV-2 infection in Canada. Methods This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged < 1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 11th 2021, and classified by disease severity, and primary cause of hospitalization. Logistic regression was performed to identify risk factors for hospitalization and severe disease. Results A total of 393 cases were reported, including 229 (58.3%) non-hospitalized and 164 (41.7%) hospitalized infants. The most common symptoms included fever (63.4%), runny nose (45.0%), cough (35.1%) and decreased oral intake (24.9%). Significant risk factors for hospitalization included younger age and presence of comorbid conditions (excluding prematurity), as shown in the Table. Among hospitalized infants, 108 (65.9%) were admitted because of COVID-19-related illness, and 52 (31.7%) were admitted for reasons other than COVID-19. A total of 31 (7.9%) infants developed severe or critical disease. Risk factors for severe disease included prematurity and younger age (Table). ![]()
Conclusion We describe one of the largest cohort of infants with SARS-CoV-2 infection. Severe disease in this age group is uncommon, with younger age and prematurity being significant risk factors for severe COVID-19. Disclosures Pierre-Philippe Piché-Renaud, MD, Pfizer Global Medical Grants (Competitive grant program) (Research Grant or Support, Investigator-led project on the impact of COVID-19 on routine childhood immunizations) Olivier Drouin, MDCM MsC MPH, Covis Pharma (Research Grant or Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)
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Affiliation(s)
| | - Luc Panetta
- Hôpital Femme Mère Enfant, Lyon, France, Lyon, Auvergne, France
| | - Daniel Farrar
- Centre for Global Child Health, Toronto, Ontario, Canada
| | | | | | | | - Shaun Morris
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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29
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Mentor G, Drouin O, Valois S, Taillefer S, Renaud C, Kakkar F. 462. Differences in the Humoral Response to SARS-CoV-2 Infection in Children vs. Adult. Open Forum Infect Dis 2021. [PMCID: PMC8690691 DOI: 10.1093/ofid/ofab466.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background One of the most striking observations of the COVID-19 pandemic has been the difference in infection among children vs. adults. Overall, children with SARS-CoV-2 infection generally had milder disease compared to adults, though the cause is not clear. The objective of this study was to compare the humoral response to infection in children vs. adults of a same family. Methods We performed a prospective cohort study at Sainte-Justine University Health Center in Montreal, Canada from July 2020 to March 2021. Children with a positive SARS-CoV-2 PCR were recruited from the COVID-19 clinic (index case), enrollment was offered to all household members. Serum IgG against SARS-CoV-2 native S1/S2 spike proteins was measured using the Diasorin (Liaison XL) assay, 4-6 months following a positive PCR. A mean antibody threshold of 15 Arbitrary unit per ml (AU/ml) was considered seropositive, with 94.4% positive agreement to plaque reduction neutralization tests (PRNT90) at a 1:40 ratio. Antibody titer was compared between children and adults. Results 111 participants (52 adults and 59 children) were recruited from 50 separate families. Characteristic of participants and their clinical symptoms are described in Table 1. Among all participants, 76.3% children were SARS-CoV-2 seropositive vs. 51.9% of adults (p=0.007). Median antibody titer was significantly higher in children vs. adults (82.8 AU, [IQR: 18.4-130], vs 17.0 AU, [IQR: 6.8-77.8], p=0.006); findings were similar among SARS-CoV-2 PCR positive participants only. Overall, 13 participants were PCR positive but seronegative, 7 were PCR negative and seropositive, while 61 were both PCR positive and seropositive. Older participants and those with any comorbidity. Among the PCR positive group, the seropositive participants were younger (median age 31±17 vs 19±17 years, p=0.003) and more likely to have comorbidity (69% vs 29%, p=0.007). ![]()
Conclusion These results suggest that children have a stronger antibody response to SARS-CoV-2 infection than adults, and that older age and presence of comorbidity are associated with a less robust humoral response. Further work on the differences in response between children and adults may help elucidate mechanisms underlying the severity of disease Disclosures Olivier Drouin, MDCM MsC MPH, Covis Pharma (Research Grant or Support)
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Affiliation(s)
| | | | - Silvie Valois
- Centre D’infectiologie Mere Enfant, Montreal, Quebec, Canada
| | | | - Christian Renaud
- Departement De Microbiologie, Infectiologie, Immunologie, Faculte De Medecine, Universite De Montreal, Montreal, Quebec, Canada
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30
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Morris SK, Giroux RJP, Consunji-Araneta R, Stewart K, Baikie M, Kakkar F, Zielinski D, Tse-Chang A, Cook VJ, Fisher DA, Salvadori MI, Pernica JM, Sauve LJ, Hui C, Miners A, Alvarez GG, Al-Azem A, Gallant V, Grueger B, Lam R, Langley JM, Radziminski N, Rea E, Wong S, Kitai I. Epidemiology, clinical features and outcomes of incident tuberculosis in children in Canada in 2013-2016: results of a national surveillance study. Arch Dis Child 2021; 106:1165-1170. [PMID: 34417191 DOI: 10.1136/archdischild-2021-322092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada. METHODS We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP). RESULTS In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children. CONCLUSION Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.
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Affiliation(s)
- Shaun K Morris
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada .,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan J P Giroux
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kristoffor Stewart
- Saskatchewan Infectious Disease Care Network, Saskatoon, Saskatchewan, Canada
| | | | - Fatima Kakkar
- Pediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - David Zielinski
- Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alena Tse-Chang
- University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Victoria J Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marina I Salvadori
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Laura J Sauve
- The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Charles Hui
- Childrens Hosp Eastern Ontario, Ottawa, Ontario, Canada
| | - Amber Miners
- Qikiqtani General Hospital, Iqaluit, Nunavut, Canada
| | - Gonzalo G Alvarez
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Assaad Al-Azem
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.,University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Ray Lam
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanne M Langley
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Nicole Radziminski
- Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | | | - Sam Wong
- University of Alberta, Edmonton, Alberta, Canada.,Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | - Ian Kitai
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Drouin O, Hepburn CM, Farrar DS, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin M, Luu TM, Orkin J, Papenburg J, Pound CM, Price VE, Purewal R, Sadarangani M, Salvadori MI, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Caractéristiques des hospitalisations au Canada d’enfants ayant contracté une infection aiguë par le SRAS-CoV-2 en 2020. CMAJ 2021; 193:E1774-E1785. [PMID: 34810167 PMCID: PMC8608451 DOI: 10.1503/cmaj.210053-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/05/2022] Open
Abstract
Contexte: Les facteurs de risque de complications graves de l’infection par le SRAS-CoV-2 n’ont pas été bien établis chez les enfants. Nous avons voulu décrire les hospitalisations pédiatriques associées au SRAS-CoV-2 au Canada et identifier les facteurs de risque de maladie grave. Méthodes: Nous avons procédé à une étude prospective nationale en utilisant l’infrastructure du Programme canadien de surveillance pédiatrique (PCSP). Les hospitalisations d’enfants ayant contracté une infection par le SRAS-CoV-2 confirmée en laboratoire de microbiologie ont été rapportées du 8 avril au 31 décembre 2020 au moyen de questionnaires hebdomadaires en ligne distribués au réseau du PCSP, qui compte plus de 2800 pédiatres. Nous avons catégorisé les hospitalisations comme suit : liées à la COVID-19, infections découvertes fortuitement, ou hospitalisations pour des raisons sociales ou de contrôle des infections, et dégagé les facteurs de risque associés à la gravité de la maladie chez les patients hospitalisés. Résultats: Sur les 264 hospitalisations d’enfants ayant contracté le SRAS-CoV-2 au cours de la période de l’étude de 9 mois, 150 (56,8 %) ont été associées à la COVID-19 et 100 (37,9 %) étaient des cas découverts fortuitement (admission pour d’autres raisons et découverte fortuite du SRAS-CoV-2 par dépistage positif). Les nourrissons (37,3 %) et les adolescents (29,6 %) représentaient la majorité des cas. Parmi les hospitalisations liées à la COVID-19, 52 patients (34,7 %) étaient atteints d’une forme grave de la maladie, dont 42 (28,0 % des cas liés à la COVID-19) ont eu besoin d’une forme d’assistance respiratoire ou hémodynamique, et 59 (39,3 %) présentaient au moins 1 comorbidité sous-jacente. Les enfants atteints d’obésité, de maladies neurologiques chroniques ou de maladies pulmonaires chroniques, à l’exclusion de l’asthme, étaient plus susceptibles de présenter une forme grave ou critique de la COVID-19. Interprétation: Parmi les enfants hospitalisés au Canada chez lesquels on a diagnostiqué une infection par le SRAS-CoV-2 au début de la pandémie de COVID-19, la découverte fortuite du SRAS-CoV-2 a été fréquente. Chez les enfants hospitalisés pour une COVID-19 aiguë, l’obésité et les comorbidités neurologiques et respiratoires ont été associées à une gravité accrue.
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Affiliation(s)
- Olivier Drouin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Charlotte Moore Hepburn
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Daniel S Farrar
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Krista Baerg
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Kevin Chan
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Claude Cyr
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Elizabeth J Donner
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Joanne E Embree
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Catherine Farrell
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Sarah Forgie
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Ryan Giroux
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Kristopher T Kang
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Melanie King
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Melanie Laffin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Thuy Mai Luu
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Julia Orkin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Jesse Papenburg
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Catherine M Pound
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Victoria E Price
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Rupeena Purewal
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Manish Sadarangani
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Marina I Salvadori
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Karina A Top
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Isabelle Viel-Thériault
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Fatima Kakkar
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont.
| | - Shaun K Morris
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont.
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Drouin O, Hepburn CM, Farrar DS, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin M, Luu TM, Orkin J, Papenburg J, Pound CM, Price VE, Purewal R, Sadarangani M, Salvadori MI, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Characteristics of children admitted to hospital with acute SARS-CoV-2 infection in Canada in 2020. CMAJ 2021; 193:E1483-E1493. [PMID: 34580141 PMCID: PMC8486480 DOI: 10.1503/cmaj.210053] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. Methods: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. Results: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. Interpretation: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.
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Affiliation(s)
- Olivier Drouin
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Charlotte Moore Hepburn
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Daniel S Farrar
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Krista Baerg
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Kevin Chan
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Claude Cyr
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Elizabeth J Donner
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Joanne E Embree
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Catherine Farrell
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Sarah Forgie
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Ryan Giroux
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Kristopher T Kang
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Melanie King
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Melanie Laffin
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Thuy Mai Luu
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Julia Orkin
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Jesse Papenburg
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Catherine M Pound
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Victoria E Price
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Rupeena Purewal
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Manish Sadarangani
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Marina I Salvadori
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Karina A Top
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Isabelle Viel-Thériault
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont
| | - Fatima Kakkar
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont.
| | - Shaun K Morris
- Divisions of General Pediatrics (Drouin, Luu) and Pediatric Intensive Care (Farrell), Department of Pediatrics, and Division of Infectious Diseases (Kakkar), Centre Hospitalier Universitaire Sainte-Justine; Department of Social and Preventive Medicine (Drouin), School of Public Health, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) and Child Health Evaluative Sciences (Morris, Orkin), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Moore Hepburn), and Departments of Pediatrics (Chan) and Clinical Public Health (Morris), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Pediatrics (Baerg, Purewal), University of Saskatchewan; Divisions of General Paediatrics (Baerg) and Pediatric Infectious Diseases (Purewal), Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, Sask.; Department of Children's and Women's Health (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre Hospitalier, and Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Que.; Departments of Paediatrics and Child Health (Embree), and Medical Microbiology and Infectious Diseases (Embree), University of Manitoba, Winnipeg, Man.; Division of Infectious Diseases (Forgie), Department of Pediatrics, University of Alberta; Stollery Children's Hospital (Forgie), Edmonton, Alta.; Department of Pediatrics (Sadarangani, Tang), University of British Columbia, Vancouver, BC; Canadian Paediatric Surveillance Program (King, Laffin), Canadian Paediatric Society, Ottawa, Ottawa, Ont.; Division of Pediatric Infectious Diseases (Papenburg), Department of Pediatrics, Montreal Children's Hospital; Division of Microbiology (Papenburg), Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Que.; Division of General Pediatrics (Pound), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Pediatric Hematology/Oncology (Price), Department of Pediatrics, Dalhousie University, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Department of Pediatrics (Top), Dalhousie University, Halifax, NS; Division of Infectious Diseases (Viel-Thériault), Department of Pediatrics, CHU de Québec-Université Laval, Québec, Que.; Divisions of Infectious Diseases (Morris) and Neurology (Donner), The Hospital for Sick Children; University of Toronto, Toronto, Ont.
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Boucoiran I, Roy M, Poliquin V, Elwood C, Sheehan NL, Thibaudeau R, Ferreira E, Autmizguine J, Kakkar F, Boucher M, Money D, Tulloch K. Evaluation of cabergoline for lactation inhibition in women living with HIV. Int J STD AIDS 2021; 32:654-661. [PMID: 33612017 DOI: 10.1177/0956462420984694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibition in women who live with HIV. In this multicenter prospective observational study, cabergoline was offered as a single oral dose of 1 mg within the first 48 h postpartum. Women were recruited if they delivered a live infant after 35 weeks of gestational age. Participants filled out a questionnaire regarding symptoms of lactation and cabergoline adverse effects on day 2 and day 14 postpartum. On day 14, they also completed a questionnaire about their satisfaction with cabergoline treatment. Prolactin serum level was measured on both visits. Among 68 participants, all but one received cabergoline. The overall effectiveness defined by partial or complete success at day 14 was 98.3% (confidence intervals: 89.5-99.9). At day 14, 67.4% of women who received cabergoline had prolactin serum levels <25 mcg/L (threshold necessary for galactopoiesis). Mild nonspecific adverse effects were experienced by 24 (29.9%) women on day 2 and 24 (41.4%) on day 14, and lasted 48 h or less. Overall, 96% of women were satisfied with cabergoline's ability to prevent postpartum lactation symptoms. In conclusion, cabergoline is an effective, well-accepted, and well-tolerated medication for lactation inhibition in WLWH.
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Affiliation(s)
- Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, 5622École de Santé Publique de Université de Montréal, Montreal, QC, Canada.,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
| | - Melissa Roy
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada
| | - Vanessa Poliquin
- Department of Obstetrics and Gynecology, 8664University of Manitoba, Winnipeg, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, 12358University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - Nancy L Sheehan
- Québec Antiretroviral Therapeutic Drug Monitoring Program, 54473McGill University Health Centre, Montréal, Canada.,Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada
| | - Rosie Thibaudeau
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada
| | - Ema Ferreira
- Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada.,Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada
| | - Julie Autmizguine
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada.,Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada.,Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, 5622Université de Montréal, Montreal, Canada
| | - Fatima Kakkar
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada.,Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, 5622Université de Montréal, Montreal, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada.,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, 12358University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - Karen Tulloch
- Department of Pharmacy, BC Women's Hospital and Health Centre, Vancouver, Canada
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Beaudoin ML, Renaud C, Boucher M, Kakkar F, Gantt S, Boucoiran I. Perspectives of women on screening and prevention of CMV in pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 258:409-413. [PMID: 33548895 DOI: 10.1016/j.ejogrb.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the choice and attitude of pregnant women regarding CMV serological screening and CMV prevention behaviors in pregnancy. STUDY DESIGN In this cross-sectional study, pregnant women were recruited in a single center during routine prenatal screening tests at 11-16 weeks. Participants filled out a questionnaire assessing knowledge about congenital CMV (cCMV) infection, risk perception and willingness to have CMV serological screening as well as their attitude toward CMV prevention behaviors. RESULTS Among 234 pregnant women, 74.4 % (95 % confidence interval: 68.8-80.0 %) wanted CMV serological screening in pregnancy. The factors significantly associated with the desire for screening were perceived risk and perceived severity of cCMV. An informed choice regarding CMV screening (value-consistent, based on good knowledge and deliberated) was performed by 54 % of women who chose the screening and 30 % of women who declined the screening (p = 0.039). The median scores regarding attitudes toward CMV prevention behaviors were 3.7/5 for avoiding sharing behaviors and 4.0/5 for not kissing a child on the lips. CONCLUSION The majority of pregnant women want to have CMV serological screening once informed about congenital CMV infection. New tools need to be developed to allow for informed choice regarding CMV serological screening in pregnancy.
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Affiliation(s)
- Meggie Lallier Beaudoin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Renaud
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Soren Gantt
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
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Bitnun A, Ransy DG, Brophy J, Kakkar F, Hawkes M, Samson L, Annabi B, Pagliuzza A, Morand JA, Sauve L, Chomont N, Lavoie S, Kim J, Sandstrom P, Wender PA, Lee T, Singer J, Read SE, Soudeyns H. Clinical Correlates of Human Immunodeficiency Virus-1 (HIV-1) DNA and Inducible HIV-1 RNA Reservoirs in Peripheral Blood in Children With Perinatally Acquired HIV-1 Infection With Sustained Virologic Suppression for at Least 5 Years. Clin Infect Dis 2021; 70:859-866. [PMID: 30919879 DOI: 10.1093/cid/ciz251] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Early Pediatric Initiation Canada Child Cure Cohort (EPIC4) study is a prospective, multicenter, Canadian cohort study investigating human immunodeficiency virus-1 (HIV-1) reservoirs, chronic inflammation, and immune responses in children with perinatally acquired HIV-1 infection. The focus of this report is HIV-1 reservoirs and correlates in the peripheral blood of children who achieved sustained virologic suppression (SVS) for ≥5 years. METHODS HIV-1 reservoirs were determined by measuring HIV-1 DNA in peripheral blood mononuclear cells and inducible cell-free HIV-1 RNA in CD4+ T-cells by a prostratin analogue stimulation assay. HIV serology was quantified by signal-to-cutoff ratio (S/CO). RESULTS Of 228 enrolled participants, 69 achieved SVS for ≥5 years. HIV-1 DNA, inducible cell-free HIV-1 RNA, and S/COs correlated directly with the age of effective combination antiretroviral therapy (cART) initiation (P < .001, P = .036, and P < .001, respectively) and age when SVS was achieved (P = .002, P = .038, and P < .001, respectively) and inversely with the proportion of life spent on effective cART (P < .001, P = .01, and P < .001, respectively) and proportion of life spent with SVS (P < .001, P = .079, and P < .001, respectively). Inducible cell-free HIV-1 RNA correlated with HIV-1 DNA, most particularly in children with SVS, without virologic blips, that was achieved with the first cART regimen initiated prior to 6 months of age (rho = 0.74; P = .037) or later (rho = 0.87; P < .001). S/COs correlated with HIV-1 DNA (P = .003), but less so with inducible cell-free HIV-1 RNA (P = .09). CONCLUSIONS The prostratin analogue stimulation assay, with its lower blood volume requirement, could be a valuable method for evaluating inducible HIV-1 reservoirs in children. Standard commercial HIV serology may be a practical initial indirect measure of reservoir size in the peripheral blood of children with perinatally acquired HIV-1 infection.
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Affiliation(s)
- Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario
| | - Doris G Ransy
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Quebec
| | - Michael Hawkes
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Bayader Annabi
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
| | - Amélie Pagliuzza
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec
| | - Jacob-Adams Morand
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
| | - Laura Sauve
- Oak Tree Clinic, Women's Hospital and Health Centre of British Columbia, Department of Pediatrics, University of British Columbia, Vancouver
| | - Nicolas Chomont
- Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec
| | - Stephanie Lavoie
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - John Kim
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul Sandstrom
- National Human Immunodeficiency Virus (HIV) & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul A Wender
- Department of Chemistry and Department of Chemical and Systems Biology, Stanford University, California
| | - Terry Lee
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia
| | - Joel Singer
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Stanley E Read
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario
| | - Hugo Soudeyns
- Centre de Recherche du Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, Quebec.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Quebec
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Panetta L, Proulx C, Drouin O, Autmizguine J, Luu TM, Quach C, Kakkar F. Clinical Characteristics and Disease Severity Among Infants With SARS-CoV-2 Infection in Montreal, Quebec, Canada. JAMA Netw Open 2020; 3:e2030470. [PMID: 33315110 PMCID: PMC7737086 DOI: 10.1001/jamanetworkopen.2020.30470] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This case series describes clinical characteristics and disease severity in infants who had SARS-CoV-2 infection in Montreal, Quebec, Canada.
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Affiliation(s)
- Luc Panetta
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Proulx
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Oliver Drouin
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Julie Autmizguine
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pharmacology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Thuy M. Luu
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Choudhury B, Brown J, Ransy DG, Brophy J, Kakkar F, Bitnun A, Samson L, Read S, Soudeyns H, Vaudry W, Houston S, Hawkes MT. Endothelial activation is associated with intestinal epithelial injury, systemic inflammation and treatment regimen in children living with vertically acquired HIV-1 infection. HIV Med 2020; 22:273-282. [PMID: 33151601 DOI: 10.1111/hiv.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Premature development of cardiovascular disease in children living with HIV-1 (CLWH) may be associated with compromised gut barrier function, microbial translocation, immune activation, systemic inflammation and endothelial activation. Biomarkers of these pathways may provide insights into pathogenesis of atherosclerotic disease in CLWH. METHODS This was a cross-sectional study of CLWH enrolled in the multicentre Early Pediatric Initiation-Canadian Child Cure Cohort (EPIC4 ) who were on antiretroviral therapy (ART) with undetectable viral load. Plasma biomarkers of intestinal epithelial injury [intestinal fatty acid binding protein-1 (IFABP)], systemic inflammation [tumour necrosis factor (TNF) and interleukin-6 (IL-6)] and endothelial activation [angiopoietin-2 (Ang2), soluble vascular endothelial growth factor-1 (sVEGFR1) and soluble endoglin (sEng)] were quantified by enzyme-linked immunosorbent assay. Correlation and factor analysis of biomarkers were used to examine associations between innate immune pathways. RESULTS Among 90 CLWH, 16% of Ang2, 15% of sVEGFR1 and 23% of sEng levels were elevated relative to healthy historic controls. Pairwise rank correlations between the three markers of endothelial activation were statistically significant (ρ = 0.69, ρ = 0.61 and ρ = 0.65, P < 0.001 for all correlations). An endothelial activation index, derived by factor analysis of the three endothelial biomarkers, was correlated with TNF (ρ = 0.47, P < 0.001), IL-6 (ρ = 0.60, P < 0.001) and intestinal fatty acid binding protein-1 (ρ = 0.67, P < 0.001). Current or past treatment with ritonavir-boosted lopinavir (LPV/r) was associated with endothelial activation (odds ratio = 5.0, 95% CI: 1.7-17, P = 0.0020). CONCLUSIONS Endothelial activation is prevalent in CLWH despite viral suppression with combination ART and is associated with intestinal epithelial injury, systemic inflammation and treatment with LPV/r.
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Affiliation(s)
- B Choudhury
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Brown
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D G Ransy
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada
| | - J Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - F Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - A Bitnun
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - L Samson
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - S Read
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - H Soudeyns
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, QC, Canada.,Department of Microbiology, Infectiology & Immunology, Université de Montréal, Montréal, QC, Canada
| | - W Vaudry
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - S Houston
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - M T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.,Stollery Science Lab, Edmonton, AB, Canada.,Women and Children's Health Research Institute, Edmonton, AB, Canada
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38
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Hsieh AY, Kimmel E, Pick N, Sauvé L, Brophy J, Kakkar F, Bitnun A, Murray MC, Côté HC. Inverse relationship between leukocyte telomere length attrition and blood mitochondrial DNA content loss over time. Aging (Albany NY) 2020; 12:15196-15221. [PMID: 32703912 PMCID: PMC7467389 DOI: 10.18632/aging.103703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/06/2020] [Indexed: 05/16/2023]
Abstract
Leukocyte telomere length (LTL) and whole blood mitochondrial DNA (WB mtDNA) content are aging markers impacted by chronic diseases such as human immunodeficiency virus (HIV) infection. We characterized the relationship between these two markers in 312 women ≥12 years of age living with HIV and 300 HIV-negative controls. We found no relationship between the two markers cross-sectionally. In multivariable models, age, ethnicity, HIV, and tobacco smoking were independently associated with shorter LTL, and the former three with lower WB mtDNA. Longitudinally, among a subgroup of 228 HIV participants and 68 HIV-negative controls with ≥2 biospecimens ≥1 year apart, an inverted pattern was observed between the rates of change in LTL and WB mtDNA content per year, whereby faster decline of one was associated with the preservation of the other. Furthermore, if HIV viral control was not maintained between visits, increased rates of both LTL attrition and WB mtDNA loss were observed. We describe a novel relationship between two established aging markers, whereby rates of change in LTL and WB mtDNA are inversely related. Our findings highlight the importance of maintaining HIV viral control, the complementary longitudinal relationship between the two markers, and the need to consider both in aging studies.
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Affiliation(s)
- Anthony Y.Y. Hsieh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Elana Kimmel
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
| | - Laura Sauvé
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver V6H 0B3, British Columbia, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa K1H 8L1, Ontario, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Centre Hospitalier Universtaire Sainte-Justine, Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto M5G 1X8, Ontario, Canada
| | - Melanie C.M. Murray
- Oak Tree Clinic, BC Women's Hospital, Vancouver V6H 3N1, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
| | - Hélène C.F. Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver V6T 2B5, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Women's Health Research Institute, Vancouver V6H 2N9, British Columbia, Canada
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Labuda SM, Huo Y, Kacanek D, Patel K, Huybrechts K, Jao J, Smith C, Hernandez-Diaz S, Scott G, Burchett S, Kakkar F, Chadwick EG, Van Dyke RB. Rates of Hospitalization and Infection-Related Hospitalization Among Human Immunodeficiency Virus (HIV)-Exposed Uninfected Children Compared to HIV-Unexposed Uninfected Children in the United States, 2007-2016. Clin Infect Dis 2020; 71:332-339. [PMID: 31504291 PMCID: PMC7353328 DOI: 10.1093/cid/ciz820] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Studies from multiple countries have suggested impaired immunity in perinatally human immunodeficiency virus (HIV)-exposed uninfected children (HEU), with elevated rates of all-cause hospitalization and infections. We estimated and compared the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU and HIV-unexposed uninfected children (HUU) in the United States. Among HEU, we evaluated associations of maternal HIV disease-related factors during pregnancy with risk of child hospitalization. METHODS HEU data from subjects enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study (SMARTT) cohort who were born during 2006-2017 were analyzed. HUU comparison data were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU using Poisson regression. Among HEU, multivariable Poisson regression models were fitted to evaluate associations of maternal HIV factors with risk of hospitalization. RESULTS A total of 2404 HEU and 3 605 864 HUU were included in the analysis. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUUs. There was no significant difference in mortality. Maternal HIV disease factors were not associated with the risk of child infection or hospitalization. CONCLUSIONS Compared with HUU, HEU children in the United States have higher rates of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.
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Affiliation(s)
- Sarah M Labuda
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yanling Huo
- Center for Biostatistics in AIDS Research,Boston, Massachusetts, USA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research,Boston, Massachusetts, USA
| | - Kunjal Patel
- Center for Biostatistics in AIDS Research,Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Krista Huybrechts
- Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Jao
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christiana Smith
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Gwendolyn Scott
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sandra Burchett
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Fatima Kakkar
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Russell B Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Ajaykumar A, Zhu M, Kakkar F, Brophy J, Bitnun A, Alimenti A, Soudeyns H, Saberi S, Albert AYK, Money DM, Côté HCF. Elevated Blood Mitochondrial DNA in Early Life Among Uninfected Children Exposed to Human Immunodeficiency Virus and Combination Antiretroviral Therapy in utero. J Infect Dis 2020; 223:621-631. [PMID: 32638023 DOI: 10.1093/infdis/jiaa410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) during pregnancy prevents vertical transmission, but many antiretrovirals cross the placenta and several can affect mitochondria. Exposure to maternal human immunodeficiency virus (HIV) and/or cART could have long-term effects on children who are HIV exposed and uninfected (CHEU). Our objective was to compare blood mitochondrial DNA (mtDNA) content in CHEU and children who are HIV unexposed and uninfected (CHUU), at birth and in early life. METHODS Whole-blood mtDNA content at birth and in early life (age 0-3 years) was compared cross-sectionally between CHEU and CHUU. Longitudinal changes in mtDNA content among CHEU was also evaluated. RESULTS At birth, CHEU status and younger gestational age were associated with higher mtDNA content. These remained independently associated with mtDNA content in multivariable analyses, whether considering all infants, or only those born at term. Longitudinally, CHEU mtDNA levels remained unchanged during the first 6 months of life, and gradually declined thereafter. A separate age- and sex-matched cross-sectional analysis (in 214 CHEU and 214 CHUU) illustrates that the difference in mtDNA between the groups remains detectable throughout the first 3 years of life. CONCLUSION The persistently elevated blood mtDNA content observed among CHEU represents a long-term effect, possibly resulting from in utero stresses related to maternal HIV and/or cART. The clinical impact of altered mtDNA levels is unclear.
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Affiliation(s)
- Abhinav Ajaykumar
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayanne Zhu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ariane Alimenti
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Hugo Soudeyns
- Unité d'Immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sara Saberi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deborah M Money
- BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
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Minsart AF, Rypens F, Smiljkovic M, Kakkar F, Renaud C, Lamarre V, Boucher M, Boucoiran I. Prenatal findings, neonatal symptoms and neurodevelopmental outcome of congenital cytomegalovirus infection in a university hospital in Montreal, Quebec. J Perinat Med 2020; 48:234-241. [PMID: 32031981 DOI: 10.1515/jpm-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/29/2019] [Indexed: 11/15/2022]
Abstract
Background Outcome of congenital cytomegalovirus (cCMV) infection in the absence of routine CMV screening and third-trimester scan in North America is scarcely documented. The aim of this study was to assess the severe outcomes related to cCMV according to the indication for screening. Methods This was a retrospective study of 84 mother-child pairs followed for cCMV between 2003 and 2017 at CHU Sainte-Justine in Montreal, Canada. Prenatal ultrasound, neonatal symptoms, neuroimaging and severe outcomes (cerebral palsy, severe cognitive impairment, bilateral hearing loss or neonatal death) were reviewed. Results Among 38 cases with abnormal prenatal ultrasound, 41.9% of live-born infants developed severe outcomes. Sixteen (42.1%) were detected in the third trimester. Among 16 cases diagnosed prenatally because of maternal history, all had normal prenatal ultrasound, and none developed severe outcomes. Among cases diagnosed postnatally because of neonatal symptoms, 25% developed severe outcomes. All infants who developed severe outcomes had moderate/severe neonatal symptoms. Conclusion Outcome of cCMV infection varies according to the reason for screening and timing of diagnosis. Any prenatal ultrasound anomaly might indicate a risk of severe outcome, and warrants a detailed ultrasound scan. However, late detection, or postnatal diagnosis, represented more than half of the cases, and awareness of this will help ensuring optimal management.
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Affiliation(s)
- Anne-Frédérique Minsart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Université de Montréal - Sainte-Justine University Hospital, Montreal, Canada
| | - Françoise Rypens
- Department of Radiology, Université de Montréal - Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Mina Smiljkovic
- Division of Infectious Diseases, Department of Pediatrics, Université de Montréal - Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, Université de Montréal - Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Christian Renaud
- Division of Infectious Diseases, Department of Pediatrics, Université de Montréal - Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Valérie Lamarre
- Division of Infectious Diseases, Department of Pediatrics, Université de Montréal - Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Marc Boucher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Université de Montréal - Sainte-Justine University Hospital, Montreal, Canada
| | - Isabelle Boucoiran
- Women and Children Infectious Diseases Center, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, H3T 1C5, QC, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
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McClymont E, Ogilvie G, Albert A, Johnston A, Raboud J, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Yudin MH, Klein MB, Harris M, Wobeser W, Bitnun A, Kakkar F, Samson L, Brophy J, Karatzios C, Money D. Impact of quadrivalent HPV vaccine dose spacing on immunologic response in women living with HIV. Vaccine 2020; 38:3073-3078. [PMID: 32147300 DOI: 10.1016/j.vaccine.2020.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing. Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer. Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age. Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.
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Affiliation(s)
- Elisabeth McClymont
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Angela Johnston
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janet Raboud
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharon Walmsley
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy Lipsky
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sylvie Trottier
- Infectious Diseases Research Centre - Université Laval, Québec City, QC, Canada
| | - Fiona Smaill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Mark H Yudin
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Wendy Wobeser
- Departments of Public Health and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Ari Bitnun
- Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montreal, QC, Canada
| | - Lindy Samson
- Department of Paediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Christos Karatzios
- Department of Paediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada; Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
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43
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Boucoiran I, Kakkar F, Renaud C. Maternal infections. Handb Clin Neurol 2020; 173:401-422. [PMID: 32958187 DOI: 10.1016/b978-0-444-64150-2.00029-0] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Congenital infections are infections transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). They have the potential to adversely affect fetal development and long-term neurodevelopmental outcome through inflammatory, destructive, developmental, or teratogenic lesions of the brain. Because the fetal/neonatal brain has a limited capacity to respond to injury, early inflammatory changes may be difficult to visualize and only manifest as neurocognitive disability later in life. Teratogenic effects, which may include aberrations of neuronal proliferation and migration, are more easily visible on imaging, but may be equally difficult to use to predict long-term neurocognitive outcomes. This chapter reviews the general pathophysiology of congenital infection and describes the epidemiology, the antenatal and postnatal diagnosis, and the treatment of congenital infections as well as the long-term neurodevelopmental outcomes.
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Affiliation(s)
- Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Christian Renaud
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Microbiology and Immunology, University of Montreal, Montreal, QC, Canada
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44
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Kennedy VL, Mellor KL, Brophy J, Bitnun A, Alimenti A, Kakkar F, Logie CH, Webster K, Proulx-Boucher K, Ding E, Jabbari S, Kaida A, de Pokomandy A, Loutfy M. Transition from Pediatric to Adult HIV Care for Young Women Living with HIV. J Int Assoc Provid AIDS Care 2020; 19:2325958220903574. [PMID: 32207355 PMCID: PMC7093690 DOI: 10.1177/2325958220903574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/15/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022] Open
Abstract
Transitioning from pediatric to adult care is a complicated process for youth with chronic illnesses. This study elucidates the unique factors affecting transition preparedness and perception of adult HIV care among a cohort of young women with HIV. Between 2013 and 2015, 48 women with HIV, who had experience with pediatric HIV care, were enrolled in a large Canadian cohort study. Variables were self-reported during peer-administered surveys. Only 60% reported feeling prepared for transition. Having never had contact with child protection services (P = .049), never been in foster care (P = .011), never been in a group home (P = .036), reporting a higher current CD4 count (P = .033), and reporting a younger ideal age for transition (P = .041) were associated with transition preparedness. Eighty-four percent reported equivalent or better HIV care following transition. Correlates of equivalent/better care following transition included lower personal income (P = .023), higher CD4 count (P = .021), care by an adult infectious diseases specialist (P = .002), and transition preparedness (P = .005). Our findings highlight the importance of adequate transition preparation and its effect on perception of care following transition.
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Affiliation(s)
| | - Kaitlyn Luisa Mellor
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, The Hospital for Sick Children, University of
Toronto, Toronto, Ontario, Canada
| | - Ariane Alimenti
- British Columbia Women’s Hospital and Health Centre, Vancouver, British
Columbia, Canada
| | - Fatima Kakkar
- Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec,
Canada
| | - Carmen Helen Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto,
Ontario Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British
Columbia, Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal,
Quebec, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British
Columbia, Canada
| | - Shahab Jabbari
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British
Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British
Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal,
Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec,
Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto,
Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Trahan MJ, Boucher M, Renaud C, Karatzios C, Metras ME, Valois S, Ransy DG, Lamarre V, Kakkar F. Pregnancies Among the First Generation of Survivors of Perinatal HIV Infection. J Obstet Gynaecol Can 2019; 42:446-452. [PMID: 31882286 DOI: 10.1016/j.jogc.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Little is known about pregnancy outcomes among women who have acquired human immunodeficiency virus (HIV) through perinatal infection and survived into adulthood. The objectives of this study were to describe pregnancy outcomes among women with perinatal HIV infection (PHIV) in Canada and to identify potential challenges in the prevention of perinatal HIV transmission in this population. METHODS A retrospective review of all pregnancies among women with PHIV who were previously followed as children at two tertiary care centres in Montréal, Québec, was conducted. Data were extracted from pediatric and obstetrical records. RESULTS There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional. Mean age at first pregnancy was 19.5 years (range 15-29 years). At the first prenatal visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count <200 mm3), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery, although all were prescribed ART, 50% of these women still had a detectable viral load, and 36% remained immunosuppressed. All of the women harboured mutations conferring drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant to nevirapine. None of the infants were HIV infected, although all received prophylaxis with agents to which their mother's virus was resistant. CONCLUSION Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were identified challenges in the management of pregnancies among women with PHIV. This study highlights a gap in the reproductive counselling of adolescents with PHIV and the need for close follow-up and adherence support during pregnancy in this population.
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Affiliation(s)
- Marie-Julie Trahan
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC; Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Christian Renaud
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Department of Microbiology and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Christos Karatzios
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatrics Infectious Diseases, McGill University Health Centre, Montréal, QC
| | - Marie-Elaine Metras
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Silvie Valois
- Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Doris G Ransy
- Centre Maternel et Infantile sur le SIDA, Montréal, QC
| | - Valérie Lamarre
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Fatima Kakkar
- Centre Maternel et Infantile sur le SIDA, Montréal, QC; Division of Pediatric Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC.
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46
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Djeha A, Girard S, Trottier H, Kakkar F, Soudeyns H, Boucher M, Lapointe N, Boucoiran I. No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study. BMC Pregnancy Childbirth 2019; 19:482. [PMID: 31815612 PMCID: PMC6902555 DOI: 10.1186/s12884-019-2600-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/14/2019] [Indexed: 01/18/2023] Open
Abstract
Background Early antiretroviral therapy (ART) during pregnancy has dramatically reduced the risk of perinatal HIV transmission. However, studies have shown an association between premature delivery and the use of ART during pregnancy (particularly protease inhibitor (PI)-based therapies), which could be explained by placental dysfunction. The objective of this study was to evaluate the association of ART (class, duration of exposure and time of initiation) with placental function by using angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) as biomarkers. Methods Clinical and biological data from 159 pregnant women living with HIV were analyzed. Levels of each biomarker were measured in the first and second trimester of pregnancy. After logarithmic transformation, we compared these using generalized estimating equations according to (a) the type of ART; (b) the duration of exposure to ART; and (c) the time of initiation of ART. Results After adjusting for variables such as ethnicity, maternal age, gestational age, body mass index, parity, smoking status, and sex of the fetus, we found no significant association between the class of ART (PI-based or not) and serum concentrations of PlGF or sFlt-1. Furthermore, no significant association was found between biomarker levels and the duration of ART exposure or the timing of ART initiation (pre- or post-conception). Conclusions This study suggests that first and second trimester angiogenic factor levels are not significantly associated with ART, regardless of the duration or type (with or without PI). These observations seem reassuring when considering the use of ART during early pregnancy.
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Affiliation(s)
- Ameyo Djeha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du CHU Sainte-Justine, Montreal, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du CHU Sainte-Justine, Montreal, Canada
| | - Fatima Kakkar
- Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Division of Infectious Diseases, CHU Sainte-Justine, Montreal, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hugo Soudeyns
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Canada.,Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Department of Obstetrics and Gynecology, Centre hospitalier universitaire (CHU) Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Normand Lapointe
- Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada. .,Department of Social and Preventive Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada. .,Centre de recherche du CHU Sainte-Justine, Montreal, Canada. .,Centre d'infectiologie Mère-Enfant, CHU Sainte-Justine, Montreal, Canada. .,Department of Obstetrics and Gynecology, Centre hospitalier universitaire (CHU) Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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47
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Smiljkovic M, Le Meur JB, Malette B, Boucoiran I, Minsart AF, Lamarre V, Tapiero B, Renaud C, Kakkar F. Blood viral load in the diagnostic workup of congenital cytomegalovirus infection. J Clin Virol 2019; 122:104231. [PMID: 31821950 DOI: 10.1016/j.jcv.2019.104231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is limited data on the role of cytomegalovirus (CMV) blood quantitative polymerase chain reaction (qPCR) in the diagnostic workup of congenital CMV (cCMV) infection. OBJECTIVES The objective of this study was to determine if CMV blood qPCR at the time diagnosis could differentiate between symptomatic and asymptomatic infants according to the recent consensus classification. STUDY DESIGN Retrospective study of children diagnosed with cCMV infection at CHU Sainte-Justine, Montreal, Canada, between 2008 and 2016. Cases for whom qPCR was done at baseline (<4 weeks of age) alongside a complete diagnostic workup were included. The association between CMV blood viral load (VL) and clinical severity group was determined. The probability of having moderate to severe symptoms was assessed using univariate logistic regression analysis. RESULTS Forty-seven patients were included in the analysis. Median VL was significantly higher among infants with moderate to severely symptomatic disease vs. those asymptomatic or asymptomatic with isolated sensorineural hearing loss (SNHL) (13 736 vs. 1876 copies/ml, p = 0.004), infants with moderate to severe disease or asymptomatic with isolated SNHL vs. asymptomatic (17 736 vs. 1496 copies/ml, p < 0.001), and in infants with baseline neurological involvement vs. those without (17 317 vs. 2641 copies/ml, p = 0.03). Using logistic regression, an infant would have a >75 % probability of being moderate to severely symptomatic above 18 770 copies/ml, with a threshold of 100 000 copies/ml approaching a 100 % probability. CONCLUSIONS Our baseline assessment of CMV blood VL suggests that that the level of CMV viremia correlates with symptom severity.
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Affiliation(s)
- Mina Smiljkovic
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Brigitte Malette
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada; Department of Social and Preventive Medicine, Université de Montréal, Québec, Canada
| | - Anne-Frédérique Minsart
- Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Valérie Lamarre
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Bruce Tapiero
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Christian Renaud
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada; Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
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48
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Gantt S, Brophy J, Dunn J, Vaudry W, Bitnun A, Renaud C, Kakkar F. AMMI Canada: Response to FAQs about the management of children with congenital cytomegalovirus infection in Canada. ACTA ACUST UNITED AC 2019; 4:208-214. [DOI: 10.3138/jammi.2019-08-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Soren Gantt
- BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Dunn
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Vaudry
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Ari Bitnun
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christian Renaud
- CHU Ste. Justine, Université de Montréal, Montréal, Québec, Canada
| | - Fatima Kakkar
- CHU Ste. Justine, Université de Montréal, Montréal, Québec, Canada
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49
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Money D, Lee T, O'Brien C, Brophy J, Bitnun A, Kakkar F, Boucoiran I, Alimenti A, Vaudry W, Singer J, Sauve LJ. Congenital anomalies following antenatal exposure to dolutegravir: a Canadian surveillance study. BJOG 2019; 126:1338-1345. [PMID: 31188522 DOI: 10.1111/1471-0528.15838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Dolutegravir is recommended worldwide as a first-line antiretroviral therapy (ART) for individuals living with HIV. A recent study reported increased rates of neural tube defects in infants of dolutegravir-treated women. This study examined rates of congenital anomalies in infants born to women living with HIV (WLWH) in Canada. DESIGN The Canadian Perinatal HIV Surveillance Programme captures surveillance data on pregnant WLWH and their babies and was analysed to examine the incidence of congenital anomalies. SETTING Paediatric HIV clinics. POPULATION Live-born infants born in Canada to WLWH between 2007 and 2017. METHODS Data on mother-infant pairs, including maternal ART use at conception and during pregnancy, are collected by participating sites. MAIN OUTCOME MEASURES Congenital anomalies. RESULTS Of the 2423 WLWH, 85 (3.5%, 95% CI 2.85-4.36%) had non-chromosomal congenital anomalies. There was no evidence of a significant difference in rates of congenital anomalies between women who were on ART in their first trimester (3.9%, CI 1.7-7.6%) or later in the pregnancy (3.9%, 95% CI 2.6-5.6%). Four of the 80 (5.0%, 95% CI 1.4-12.3%) neonates born to WLWH on dolutegravir during the first trimester had congenital anomalies, none were neural tube defects (95% CI 0.00-3.10%). CONCLUSION Despite recent evidence raising a safety concern, this analysis found no signal for increased congenital anomalies. TWEETABLE ABSTRACT Five percent of the infants of Canadian women living with HIV on dolutegravir at conception had congenital anomalies; none had neural tube defects.
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Affiliation(s)
- D Money
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - T Lee
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - C O'Brien
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - J Brophy
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - A Bitnun
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - F Kakkar
- CHU Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - I Boucoiran
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - A Alimenti
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada
| | - W Vaudry
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - J Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - L J Sauve
- Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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50
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Smiljkovic M, Renaud C, Tapiero B, Lamarre V, Kakkar F. Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection. BMC Pediatr 2019; 19:180. [PMID: 31167649 PMCID: PMC6549373 DOI: 10.1186/s12887-019-1562-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background Despite growing interest in universal screening for congenital CMV infection (cCMV), and data to support treatment for cases with central nervous system (CNS) involvement, there is limited regarding the optimal imaging modalities to identify CNS involvement. The objective of this study was to assess the concordance between head ultrasound (US) and magnetic resonance imaging (MRI) or computed tomography (CT), in identifying neurological abnormalities in infants with cCMV infection, and to determine whether the addition of advanced neuroimaging after US had an impact on clinical management. Methods Retrospective review of infants with cCMV infection, referred to the Centre d’Infectiologie Mère-Enfant (CIME) at Sainte-Justine Hospital Center in Montreal, between 2008 and 2016. Only patients who underwent head US followed by and brain MRI or CT scan were included in this analysis. Results Of 46 cases of cCMV identified during the study period, 34 (74%) had a head US followed by MRI (n = 28, 61%), or CT scan (n = 6, 13%). In the majority of cases (n = 24, 71%), both images were concordant (11 both reported abnormal, 13 both reported normal). In 5 cases, US was reported normal and subsequent imaging (MRI = 4, CT = 1); reported abnormal. In all 5 cases patients were clinically symptomatic and met treatment criteria even in the absence of neuroimaging findings. In 5 cases, US was reported abnormal with a subsequent normal MRI (4) or CT (1); in 2 of these cases, patients were clinically symptomatic and met treatment criteria regardless of neuroimaging findings. However, in 3 cases, the patients were clinically asymptomatic, and in 2 of these cases, treated based only on the abnormal US findings. Conclusions In this study, we found that that sequential US and MRI were concordant in the majority (71%) of cases in detecting abnormalities potentially associated with cCMV infection. While the addition of MRI to baseline head ultrasound did not influence the decision to treat in clinically symptomatic infants, the addition of MRI to infants with abnormal HUS imaging who are clinically asymptomatic could help refine treatment decisions in these cases.
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Affiliation(s)
- Mina Smiljkovic
- Department of Pediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christian Renaud
- Department of Microbiology and Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruce Tapiero
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC, Canada
| | - Valérie Lamarre
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC, Canada.
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