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Fernández-Sarmiento J, Acevedo L, Niño-Serna LF, Boza R, García-Silva J, Yock-Corrales A, Yamazaki-Nakashimada MA, Faugier-Fuentes E, Del Águila O, Camacho-Moreno G, Estripeaut D, Gutiérrez IF, Luciani K, Espada G, Álvarez-Olmos MI, Pérez-Camacho P, Duarte-Passos S, Cervi MC, Cantillano EM, Llamas-Guillén BA, Saltigeral-Simental P, Criales J, Chacon-Cruz E, García-Domínguez M, Aguilar KLB, Jarovsky D, Ivankovich-Escoto G, Tremoulet AH, Ulloa-Gutierrez R. Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network. J Intensive Care Med 2024:8850666241233189. [PMID: 38414438 DOI: 10.1177/08850666241233189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Lorena Acevedo
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | | | - Raquel Boza
- Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Adriana Yock-Corrales
- Servicio de Emergencias, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - German Camacho-Moreno
- Unidad de Infectología Pediátrica, Fundación Hospital Pediátrico La Misericordia (HOMI), Bogotá, Colombia
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Iván F Gutiérrez
- Servicio de Infectología, Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Ciudad de Panamá, Panamá
| | - Graciela Espada
- Servicio de Reumatología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Paola Pérez-Camacho
- Servicio de Infectología, Fundación Valle del Lili & Departamento de Pediatría, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Saulo Duarte-Passos
- Hospital Universitario de Faculdade de Medicina de Jundiai, Sao Paolo, Brazil
| | - Maria C Cervi
- Serviço de Infectología, Faculdade de Medicina de Ribeirāo Preto, Universidade de Sāo Paulo, Sao Paulo, Brazil
| | - Edwin M Cantillano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro de Sula, Honduras
| | | | - Patricia Saltigeral-Simental
- Servicio de Infectología, Star Médica Hospital Infantil Privado e Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Enrique Chacon-Cruz
- Servicio de Infectología. Hospital General de Tijuana, Tijuana, México
- Think Vaccines LLC, Houston, Texas, USA
| | - Miguel García-Domínguez
- Servicio de Alergología e Inmunología, Hospital Pediátrico de Sinaloa "Dr Rigoberto Aguilar Pico," Sinaloa, México
| | - Karla L Borjas Aguilar
- Servicio de Inmunología, Hospital María, Especialidades Pediátricas e Instituto Hondureño de Seguridad Social, Hospital de Especialidades, Tegucigalpa, Honduras
| | - Daniel Jarovsky
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Gabriela Ivankovich-Escoto
- Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego (UCSD) & Rady Children's Hospital, San Diego, California, USA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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2
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Yea C, Barton M, Bitnun A, Morris SK, El Tal T, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Gill P, Nateghian A, Aski BH, Manafi AA, Dwilow R, Bullard J, Papenburg J, Scuccimarri R, Lefebvre MA, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Wong J, Saux NL, Bowes J, Purewal R, Lautermilch J, Foo C, Merckx J, Robinson J, Yeh EA. Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study. Can J Neurol Sci 2024; 51:40-49. [PMID: 36597285 PMCID: PMC9947047 DOI: 10.1017/cjn.2022.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. METHODS This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020-May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. RESULTS One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15-2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46-5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46-3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58-3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08-3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49-5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58-4.82; p < 0.001). DISCUSSION In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.
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Affiliation(s)
- Carmen Yea
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Anari Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
- Division of Microbiology, Dept. of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rosie Scuccimarri
- Division of Rheumatology, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Marie-Astrid Lefebvre
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Manish Sadarangani
- BC Children’s Hospital, Vancouver, BC, Canada
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - E. Ann Yeh
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, The Hospital of Sick Children, Toronto, Ontario, Canada
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Gamez-Gonzalez LB, Ulloa-Gutierrez R, Yamazaki-Nakashimada MA. Notes on cutaneous manifestations of Kawasaki disease and multisystem inflammatory syndrome in children. Int J Rheum Dis 2023; 26:2596-2598. [PMID: 37439535 DOI: 10.1111/1756-185x.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Affiliation(s)
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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4
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Narayan HK, Lizcano A, Lam-Hine T, Ulloa-Gutierrez R, Bainto EV, Garrido-García LM, Estripeaut D, Del Aguila O, Gómez V, Faugier-Fuentes E, Miño-León G, Beltrán S, Cofré F, Chacon-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Dueñas L, Luciani K, Rodríguez-Quiroz FJ, Camacho Moreno G, Viviani T, Alvarez-Olmos MI, Marques HHDS, López-Medina E, Pirez MC, Tremoulet AH. Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network. J Pediatr 2023; 263:113346. [PMID: 36775190 DOI: 10.1016/j.jpeds.2023.02.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). STUDY DESIGN An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). RESULTS Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). CONCLUSION From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.
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Affiliation(s)
- Hari K Narayan
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | - Anel Lizcano
- Department of Biology, San Francisco State University, San Francisco, CA
| | - Tracy Lam-Hine
- School of Public Health, University of California Berkeley, Berkeley, CA; Department of Epidemiology & Public Health, Stanford University, Stanford, CA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Emelia V Bainto
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | | | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad Panamá, Panamá
| | - Olguita Del Aguila
- Unidad de Infectología Pediátrica, Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Virgen Gómez
- Servicio de Infectología, Centro Médico Universidad Central del Este Hospital y Hospital Infantil "Dr. Robert Reid Cabral", Santo Domingo, Dominican Republic
| | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Greta Miño-León
- Servicio de Infectología, Hospital del Niño "Francisco de Icaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología Pediátrica, Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | - Enrique Chacon-Cruz
- Servicio de Infectología Pediátrica, Hospital General de Tijuana, Tijuana, México
| | | | | | - Lourdes Dueñas
- Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panamá
| | | | - Germán Camacho Moreno
- Servicio de Infectología, HOMI, Fundación Hospital Pediátrico La Misericordia & Universidad Nacional de Colombia, Bogotá, Colombia
| | - Tamara Viviani
- Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
| | - Martha I Alvarez-Olmos
- Servicio de Infectología Pediátrica, Fundación Cardioinfantil & Universidad El Bosque, Bogotá, Colombia
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Departamento de Pediatría, Universidad del Valle y Centro Médico Imbanaco, Cali, Colombia, 25 Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - María C Pirez
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Adriana H Tremoulet
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA.
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Debbag R, Torres JR, Falleiros-Arlant LH, Avila-Aguero ML, Brea-del Castillo J, Gentile A, Saez-Llorens X, Mascarenas A, Munoz FM, Torres JP, Vazquez L, Safadi MA, Espinal C, Ulloa-Gutierrez R, Pujadas M, Lopez P, López-Medina E, Ramilo O. Are the first 1,000 days of life a neglected vital period to prevent the impact on maternal and infant morbimortality of infectious diseases in Latin America? Proceedings of a workshop of experts from the Latin American Pediatric Infectious Diseases Society, SLIPE. Front Pediatr 2023; 11:1297177. [PMID: 38098643 PMCID: PMC10720332 DOI: 10.3389/fped.2023.1297177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
While the first 1,000 days of life are a critical period in child's development, limited information on the main determinants affecting this period in the Latin America and the Caribbean (LAC) region is available. Therefore, the Latin American Pediatric Infectious Diseases Society (SLIPE) held an ad hoc workshop in May 2022 with an expert panel designed to analyze the main factors impacting the development of childhood in the region during this period and the main causes of maternal infant morbimortality. The aim was to identify priorities, generate recommendations, and advise practical actions to improve this situation. Considerations were made about the challenges involved in bridging the gap that separates the region from more developed countries regarding an optimal early childhood and maternal care. Extensive discussion was conducted to reach consensus recommendations on general strategies intended to reduce maternal and infant mortality associated with infections and immune-preventable diseases during the first 1,000 days of life in LAC.
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Affiliation(s)
- Roberto Debbag
- President of Sociedad Latinoamericana de Infectología Pediátrica, SLIPE, Buenos Aires, Argentina
| | - Jaime R. Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central De Venezuela, Caracas, Venezuela
| | - Luiza H. Falleiros-Arlant
- Department of Children’s Health, Faculdade De Medicina, Universidade Metropolitana De Santos, Santos, Brazil
| | - Maria L. Avila-Aguero
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
- Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University, New Haven, CT, United States
| | - Jose Brea-del Castillo
- Associated Researcher, Investigador Asociado Hospital Dr. Hugo Mendoza, Santo Domingo, Republic Dominicana
| | - Angela Gentile
- Epidemiology Department, Hospital de Niños “Ricardo Gutiérrez”, Buenos Aires University, Buenos Aires, Argentina
| | - Xavier Saez-Llorens
- Head of Infectious Diseases and Director of Clinical Research, Hospital del Niño “Dr. José Renán Esquivel”, Panama City, Panama
| | - Abiel Mascarenas
- Department of Pediatric Infectious Diseases, Hospital Universitario “José E. Gonzalez”, Universidad Autónoma De Nuevo León, Nuevo Leon, México
| | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Juan P. Torres
- Department of Pediatrics and Children Surgery, Universidad de Chile, Santiago, Chile
| | - Liliana Vazquez
- Pediatric Infectious Diseases, Clinica y Maternidad Suizo Argentina, Sanatorio Finochietto, Buenos Aires, Argentina
| | - Marco A. Safadi
- Department of Pediatrics, Faculda de de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Carlos Espinal
- Global Health Consortium, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Rolando Ulloa-Gutierrez
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
| | - Monica Pujadas
- Department of Epidemiology and Pediatric Infectious Diseases, Centro Hospitalario Pereira Rossell, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Pio Lopez
- Department of Pediatrics, Hospital Universitario del Valle, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clinica Imbanaco Grupo Quironsalud, Cali, Colombia
| | - Octavio Ramilo
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, United States
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6
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Pata D, Buonsenso D, Turriziani-Colonna A, Salerno G, Scarlato L, Colussi L, Ulloa-Gutierrez R, Valentini P. Role of Valganciclovir in Children with Congenital CMV Infection: A Review of the Literature. Children (Basel) 2023; 10:1246. [PMID: 37508743 PMCID: PMC10378502 DOI: 10.3390/children10071246] [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: 06/20/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common agent of congenital infection in humans. It is a main cause of neurodevelopmental delay and sensorineural hearing loss in infancy. Since the 2000s, a number of studies have used Valganciclovir as a therapy for children with congenital CMV infection. METHODS In order to evaluate the efficacy of Valganciclovir in preventing clinical sequelae and its possible side effects, we performed a review of the published literature. This search was completed via PubMed for manuscripts published from January 2007 to December 2021, combining the MeSH words "Valganciclovir", "Congenital", and "Cytomegalovirus". RESULTS A total of 27 articles were included (12 retrospective studies, 4 prospective studies, 1 randomized controlled trial, and 10 case reports). The clinical features were similar to those already described in the literature. The therapeutic protocols used were very different between the various studies included and neonatal antiviral treatments were only moderately effective. The therapy proved to be well-tolerated. CONCLUSIONS The quality of the included studies and the sample size were limited due to the rarity of the disease. The use of different therapeutic protocols in terms of starting dates, doses, and durations made it impossible to compare and correctly evaluate the efficacy of the treatments. Randomized controlled trials are needed to establish the correct effective dose with the fewest side effects and the most efficient duration of therapy.
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Affiliation(s)
- Davide Pata
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Danilo Buonsenso
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Arianna Turriziani-Colonna
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Gilda Salerno
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Lucia Scarlato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Lara Colussi
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectologia Pediatrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José P.O. Box 1654-1000, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José 10108, Costa Rica
- Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José 10108, Costa Rica
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
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Channon-Wells S, Vito O, McArdle AJ, Seaby EG, Patel H, Shah P, Pazukhina E, Wilson C, Broderick C, D'Souza G, Keren I, Nijman RG, Tremoulet A, Munblit D, Ulloa-Gutierrez R, Carter MJ, Ramnarayan P, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Blyuss O, Levin M. Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study. Lancet Rheumatol 2023; 5:e184-e199. [PMID: 36855438 PMCID: PMC9949883 DOI: 10.1016/s2665-9913(23)00029-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health.
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Affiliation(s)
- Samuel Channon-Wells
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ortensia Vito
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew J McArdle
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Eleanor G Seaby
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Genomic Informatics Group, University of Southampton, Southampton, UK
- Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Harsita Patel
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Priyen Shah
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Clare Wilson
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Claire Broderick
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Giselle D'Souza
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ilana Keren
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ruud G Nijman
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's hospital-Imperial College NHS Healthcare Trust, London, London, UK
| | - Adriana Tremoulet
- Department of Paediatrics, University of California San Diego-Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Daniel Munblit
- Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectologia Pediatrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
- Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Michael J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Padmanabhan Ramnarayan
- Anaesthetics, Pain Medicine, and Intensive Care (APMIC) Division, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tisham De
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Clive Hoggart
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elizabeth Whittaker
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Jethro A Herberg
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Myrsini Kaforou
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Aubrey J Cunnington
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Levin
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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8
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Avila-Agüero ML, Ospina-Henao S, Mariño C, Vázquez-Rivera M, Torres JP, Estripeaut D, Ulloa-Gutierrez R, Gentile A. Vaccination against pertussis in Latin American preterm and low-birth weight infants: experts opinion position for a neglected childhood age group. Expert Rev Vaccines 2023; 22:1126-1135. [PMID: 37814599 DOI: 10.1080/14760584.2023.2268712] [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: 07/20/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Pertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses' and boosters' implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce. RESEARCH DESIGN AND METHODS A retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile. RESULTS Chile had reports of adverse effects associated with vaccination of premature infants with the pentavalent vaccine, and their rationale to switching to the hexavalent vaccine. Colombia had reports of the justification for the use of hexavalent vaccine in prematures in the Neonatal Units and Kangaroo Mother Programs throughout the country. Mexico had selected publications of the vaccination status in prematures and low-birth weight infants. CONCLUSION Despite its importance, increased morbidity, and highest risk of complications in premature babies, there is a paucity of information of vaccine recommendations and coverage rates among selected Latin American infants.
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Affiliation(s)
- María L Avila-Agüero
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
- Sistema de Estudios de Posgrado, Universidad de Costa Rica (UCR), San José, Costa Rica
- Center for Infectious Disease Modelling and Analysis, Yale University, New Haven, TC, USA
| | - Sebastián Ospina-Henao
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
| | | | - Mirella Vázquez-Rivera
- Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Juan Pablo Torres
- Departamento de Pediatría, Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panamá
- Tecnología e Innovación, Sistema Nacional de Investigación (SIN) de la Secretaría Nacional de Ciencia, Tecnología e Innovación, Ciudad de Panamá, Panamá
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
- Sistema de Estudios de Posgrado, Universidad de Costa Rica (UCR), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Angela Gentile
- Departamento de Epidemiología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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9
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Hoste L, Soriano-Arandes A, Buddingh EP, Whittaker E, Belot A, Ulloa-Gutierrez R, Olbrich P, Haerynck F. Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in Children with a History of Multisystem Inflammatory Syndrome in Children: An International Survey. J Pediatr 2022; 248:114-118. [PMID: 35598642 PMCID: PMC9119291 DOI: 10.1016/j.jpeds.2022.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 12/16/2022]
Abstract
The optimal severe acute respiratory syndrome coronavirus 2 vaccine strategy for patients with a history of multisystem inflammatory syndrome in children (MIS-C) is unclear. We performed an international survey (32 countries) and found substantial variations in vaccine policies. Respondents did not report relapses of MIS-C or other severe inflammatory side effects after severe acute respiratory syndrome coronavirus 2 vaccination in 273 patients with a history of MIS-C.
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Affiliation(s)
- Levi Hoste
- Primary Immune Deficiency Research Laboratory, Department of Internal Diseases and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium,Department of Internal Medicine and Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Inborn Errors of Immunity, Ghent University Hospital, Ghent, Belgium
| | | | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | | | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom,Section of Paediatric Infectious Diseases, Imperial College, London, United Kingdom
| | - Alexandre Belot
- Pediatric Nephrology Rheumatology and Dermatology, CHU Lyon, Lyon, France
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (C.C.S.S.), San José, Costa Rica
| | - Peter Olbrich
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, Sevilla, Spain,Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - Filomeen Haerynck
- Primary Immune Deficiency Research Laboratory, Department of Internal Diseases and Pediatrics, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Inborn Errors of Immunity, Ghent University Hospital, Ghent, Belgium.
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10
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Robinson J, Dewan T, Morris SK, Bitnun A, Gill P, Tal TE, Laxer RM, Yeh EA, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Papenburg J, Lefebvre MA, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Le Saux N, Bowes J, Purewal R, Lautermilch J, Wong JK, Piche D, Top KA, Foo C, Panetta L, Merckx J, Barton M. SARS-CoV-2 infection in technology-dependent children: a multicenter case series. Infection 2022; 51:737-741. [PMID: 36038707 PMCID: PMC9423690 DOI: 10.1007/s15010-022-01910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. Methods Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. Results Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. Conclusion Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge.
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Affiliation(s)
- Joan Robinson
- Department of Pediatrics, University of Alberta, 3-556ECHA, Edmonton, AB, T6G 1C9, Canada.
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John's, NL, Canada
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON, Canada
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11
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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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12
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Yock-Corrales A, Gomez-Vargas J, Ulloa-Gutierrez R, Brizuela M, Del Aguila O, Kozicki V, Lenzi J, Buonsenso D. Clinical Outcomes of Pediatric COVID-19 During Two Waves of Different Variants Circulation in Latin America. Indian J Pediatr 2022; 89:727. [PMID: 35244879 PMCID: PMC8895099 DOI: 10.1007/s12098-022-04113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/24/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Adriana Yock-Corrales
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, 957-1100, Costa Rica.
| | - Jessica Gomez-Vargas
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, 957-1100, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Infectious Disease Division, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Martin Brizuela
- Pediatric Infectious Disease, Hospital Isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Olguita Del Aguila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Verónica Kozicki
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli and Global Health Research Institute, Istituto Di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
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13
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Ruvinsky S, Voto C, Roel M, Fustiñana A, Veliz N, Brizuela M, Rodriguez S, Ulloa-Gutierrez R, Bardach A. Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems. Front Pediatr 2022; 10:881765. [PMID: 35547540 PMCID: PMC9082071 DOI: 10.3389/fped.2022.881765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background With the emergence of the COVID-19 pandemic, increasing numbers of cases of the multisystem inflammatory syndrome in children (MIS-C) have been reported worldwide; however, it is unclear whether this syndrome has a differential pattern in children from Latin America and the Caribbean (LAC). We conducted a systematic review and meta-analysis to analyze the epidemiological, clinical, and outcome characteristics of patients with MIS-C in LAC countries. Methods A systematic literature search was conducted in the main electronic databases and scientific meetings from March 1, 2020, to June 30, 2021. Available reports on epidemiological surveillance of countries in the region during the same period were analyzed. Results Of the 464 relevant studies identified, 23 were included with 592 patients with MIS-C from LAC. Mean age was 6.6 years (IQR, 6-7.4 years); 60% were male. The most common clinical manifestations were fever, rash, and conjunctival injection; 59% showed Kawasaki disease. Pool proportion of shock was 52%. A total of 47% of patients were admitted to the pediatric intensive care unit (PICU), 23% required mechanical ventilation, and 74% required vasoactive drugs. Intravenous gamma globulin alone was administered in 87% of patients, and in combination with steroids in 60% of cases. Length of hospital stay was 10 days (IQR, 9-10) and PICU stay 5.75 (IQR, 5-6). Overall case fatality ratio was 4% and for those hospitalized in the PICU it was 7%. Conclusion Limited information was available on the clinical outcomes. Improvements in the surveillance system are required to obtain a better epidemiologic overview in the region.
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Affiliation(s)
- Silvina Ruvinsky
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carla Voto
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Macarena Roel
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Fustiñana
- Servicio de Emergencias, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia Veliz
- Área de Internación, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Martin Brizuela
- Hospital General de Agudos “Vélez Sarsfield”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana Rodriguez
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrrera, Caja Costarricense de Seguro Social & Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Ariel Bardach
- Center for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS) and National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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14
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Merckx J, Cooke S, El Tal T, Bitnun A, Morris SK, Yeh EA, Yea C, Gill P, Papenburg J, Lefebvre MA, Scuccimarri R, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Dewan T, Restivo L, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Leifso K, Foo C, Robinson J. Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study. CMAJ 2022; 194:E513-E523. [PMID: 35410860 PMCID: PMC9001008 DOI: 10.1503/cmaj.210873] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Suzette Cooke
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tala El Tal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ari Bitnun
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Shaun K Morris
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - E Ann Yeh
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Carmen Yea
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Peter Gill
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jesse Papenburg
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marie-Astrid Lefebvre
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rosie Scuccimarri
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rolando Ulloa-Gutierrez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Helena Brenes-Chacon
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Adriana Yock-Corrales
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Gabriela Ivankovich-Escoto
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alejandra Soriano-Fallas
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marcela Hernandez-de Mezerville
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tammie Dewan
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Lea Restivo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alireza Nateghian
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Behzad Haghighi Aski
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ali Manafi
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rachel Dwilow
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jared Bullard
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alison Lopez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Manish Sadarangani
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ashley Roberts
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Michelle Barton
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Dara Petel
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Nicole Le Saux
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jennifer Bowes
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rupeena Purewal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Janell Lautermilch
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Sarah Tehseen
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ann Bayliss
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jacqueline K Wong
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Kirk Leifso
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Cheryl Foo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Joan Robinson
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta.
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Carbonell-Estrany X, Simões EAF, Bont LJ, Gentile A, Homaira N, Scotta MC, Stein RT, Torres JP, Sheikh J, Broor S, Khuri-Bulos N, Nokes DJ, Munywoki PK, Bassat Q, Sharma AK, Basnet S, Garba M, De Jesus-Cornejo J, Lupisan SP, Nunes MC, Divarathna M, Fullarton JR, Rodgers-Gray BS, Keary I, Reñosa MDC, Verwey C, Moore DP, Noordeen F, Kabra S, do Vale MS, Paternina-De La Ossa R, Mariño C, Figueras-Aloy J, Krilov L, Berezin E, Zar HJ, Paudel K, Safadi MAP, Dbaibo G, Jroundi I, Jha R, Rafeek RAM, Pinheiro RDS, Bracht M, Muthugala R, Lanari M, Martinón-Torres F, Mitchell I, Irimu G, Pandey A, Krishnan A, Mejias A, da Costa MSC, Shrestha S, Pernica JM, de Carvalho FC, Jalango RE, Ibrahim H, Ewa A, Ensinck G, Ulloa-Gutierrez R, Miralha AL, Lucion MF, Hassan MZ, Akhtar Z, Aleem MA, Chowdhury F, Rojo P, Sande C, Musau A, Zaman K, Helena L, Arlant F, Ghimire P, Price A, Subedi KU, Brenes-Chacon H, Goswami DR, Rahman MZ, Hossain ME, Chisti MJ, Vain NE, Lim A, Chiu A, Papenburg J, Juarez MDV, Senaratne T, Arunasalam S, Strand TA, Ayuk A, Ogunrinde O, Tavares LVDS, Garba C, Garba BI, Dawa J, Gordon M, Osoro E, Agoti CN, Nyawanda B, Ngama M, Tabu C, Mathew JL, Cornacchia A, Rai GK, Jain A, Giongo MS, Paes BA. Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries. Front Pediatr 2022; 10:1033125. [PMID: 36440349 PMCID: PMC9682277 DOI: 10.3389/fped.2022.1033125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. METHODS A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. RESULTS Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. CONCLUSION Seven key actions for improving RSV prevention and management in LMICs are proposed.
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Affiliation(s)
| | - Eric A F Simões
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, United States.,Department of Epidemiology, Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Louis J Bont
- Laboratory of Translational Immunology and Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Angela Gentile
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | - Nusrat Homaira
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Marcelo Comerlato Scotta
- Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Renato T Stein
- Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Juan P Torres
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jarju Sheikh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shobha Broor
- All India Institute of Medical Sciences, New Delhi, India
| | | | - D James Nokes
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Patrick K Munywoki
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Arun K Sharma
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sudha Basnet
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,University of Bergen, Bergen, Norway
| | - Maria Garba
- Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
| | | | - Socorro P Lupisan
- RITM-Tohoku Research Collaborating Center for Emerging Infections, Manila, Philippines
| | - Marta C Nunes
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maduja Divarathna
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Ian Keary
- Violicom Medical Limited, Aldermaston, United Kingdom
| | | | - Charl Verwey
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faseeha Noordeen
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sushil Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Rolando Paternina-De La Ossa
- Hospital Santa Casa de Ribeirão Preto, São Paulo, Brazil.,Centro Universitário Barão de Mauá, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Leonard Krilov
- NYU Long Island School of Medicine, Mineola, NY, United States
| | | | - Heather J Zar
- Child Health and the SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics, University of Cape Town (UCT), Cape Town, South Africa
| | | | | | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Imane Jroundi
- School of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Runa Jha
- National Public Health Laboratory, Ministry of Health & Population, Teku, Kathmandu, Nepal
| | - Rukshan A M Rafeek
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | | | | | | | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Apsara Pandey
- Department of Pediatric Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal.,Pediatric Nurses Association of Nepal, Kathmandu, Nepal
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Asuncion Mejias
- Nationwide Childrens Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | - Hafsat Ibrahim
- Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Atana Ewa
- University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Gabriela Ensinck
- Hospital de Niños Víctor J. Vilela de Rosario, Santa Fe, Argentina
| | - Rolando Ulloa-Gutierrez
- Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | | | - Maria Florencia Lucion
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | - Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pablo Rojo
- University Hospital October 12, Madrid, Spain
| | - Charles Sande
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Luiza Helena
- Metropolitan University of Santos, São Paulo, Brazil
| | | | - Prakash Ghimire
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - April Price
- London Health Sciences Centre, London, ON, Canada
| | | | - Helena Brenes-Chacon
- Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Doli Rani Goswami
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Nestor E Vain
- Hospital Sanatorio Trinidad, Buenos Aires, Argentina
| | - Audrey Lim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Chiu
- The Children's Hospital of Winnipeg, Winnipeg, MB, Canada
| | | | - Maria Del Valle Juarez
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | | | - Shiyamalee Arunasalam
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Adaeze Ayuk
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | | | - Comfort Garba
- Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
| | - Bilkisu I Garba
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Jeanette Dawa
- Washington State University - Global Health Kenya, Nairobi, Kenya
| | - Michelle Gordon
- Orillia Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | - Eric Osoro
- Washington State University - Global Health Kenya, Nairobi, Kenya
| | - Charles N Agoti
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bryan Nyawanda
- Kenya Medical Research Institute- Center for Global Health Research, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Mwanajuma Ngama
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Joseph L Mathew
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Ganesh Kumar Rai
- Nepal Pediatric Society (NEPAS), Kanti Children's Hospital, Kathmandu, Nepal
| | - Amita Jain
- King George's Medical University, Uttar Pradesh, India
| | | | - Bosco A Paes
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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16
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Merckx J, Morris SK, Bitnun A, Gill P, El Tal T, Laxer RM, Yeh A, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Papenburg J, Lefebvre MA, Nateghian A, Haghighi Aski B, Manafi A, Dwilow R, Bullard J, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Viel-Thériault I, Piche D, Top KA, Leifso K, Foo C, Panetta L, Robinson J. Infants hospitalized for acute COVID-19: disease severity in a multicenter cohort study. Eur J Pediatr 2022; 181:2535-2539. [PMID: 35217918 PMCID: PMC8880297 DOI: 10.1007/s00431-022-04422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
Age is the most important determinant of COVID-19 severity. Infectious disease severity by age is typically J-shaped, with infants and the elderly carrying a high burden of disease. We report on the comparative disease severity between infants and older children in a multicenter retrospective cohort study of children 0 to 17 years old admitted for acute COVID-19 from February 2020 through May 2021 in 17 pediatric hospitals. We compare clinical and laboratory characteristics and estimate the association between age group and disease severity using ordinal logistic regression. We found that infants comprised one-third of cases, but were admitted for a shorter period (median 3 days IQR 2-5 versus 4 days IQR 2-7), had a lower likelihood to have an increased C-reactive protein, and had half the odds of older children of having severe or critical disease (OR 0.50 (95% confidence interval 0.32-0.78)). Conclusion: When compared to older children, there appeared to be a lower threshold to admit infants but their length of stay was shorter and they had lower odds than older children of progressing to severe or critical disease. What is Known: • A small proportion of children infected with SARS-CoV-2 require hospitalization for acute COVID-19 with a subgroup needing specialized intensive care to treat more severe disease. • For most infectious diseases including viral respiratory tract infections, disease severity by age is J-shaped, with infants having more severe disease compared to older children. What is New: • One-third of admitted children for acute COVID-19 during the first 14 months of the pandemic were infants. • Infants had half the odds of older children of having severe or critical disease.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ronald M. Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada ,Department of Pediatrics, McGill University, Montreal, QC Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Alison Lopez
- British Columbia Children’s Hospital, Vancouver, BC Canada
| | - Manish Sadarangani
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Ashley Roberts
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, ON Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, ON Canada
| | | | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Karina A. Top
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Kirk Leifso
- Department of Pediatrics, Queen’s University, Kingston, ON Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Luc Panetta
- Department of Pediatrics, Université de Montréal, Montreal, QC Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada
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17
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López-Medina E, Camacho-Moreno G, Brizuela ME, Dávalos DM, Torres JP, Ulloa-Gutierrez R, López P, Debbag R, Pérez P, Patiño J, Norero X, Mariño C, Luengas MA, Ensinck G, Daza C, Luciani K, Quintana Kuhner P, Rodriguez M, Rodríguez-Auad JP, Estrada-Villarroel A, Carnevale M, Mantese OC, Berezin EN, Castillo JI, Mascareñas A, Jimenez-Zambrano A, Dueñas L, Melgar M, Galvez N, Cantor E, Asturias EJ. Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America. Front Pediatr 2022; 10:868297. [PMID: 35498776 PMCID: PMC9048675 DOI: 10.3389/fped.2022.868297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. OBJECTIVE To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. METHOD Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. RESULTS A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. CONCLUSIONS In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia.,Clínica Imbanaco, Grupo Quirón Salud, Cali, Colombia
| | - German Camacho-Moreno
- Pediatric Infectious Disease Unit, Fundación HOMI Hospital Pediátrico de la Misericordia and Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martin E Brizuela
- Infectious Diseases Division, Hospital Zonal General de Agudos "Dr. Isidoro Iriarte", Buenos Aires, Argentina
| | - Diana M Dávalos
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Juan Pablo Torres
- Department of Pediatrics, Facultas de Medicina, Hospital Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Pio López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia
| | - Roberto Debbag
- Department of Infectious Diseases and Epidemiology, Hospital de Pediatría, Buenos Aires, Argentina
| | - Paola Pérez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Jaime Patiño
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Ximena Norero
- Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panama
| | | | | | - Gabriela Ensinck
- Servicio de Infectología, Hospital de Niños Víctor J. Vilela de Rosario, Rosario, Argentina
| | - Carlos Daza
- Hospital Materno Infantil José Domingo de Obaldía, Chiriquí, Panama
| | - Kathia Luciani
- Department of Infectious Diseases, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panama
| | | | - Mónica Rodriguez
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | | | - Mayli Carnevale
- Hospital Universitario Pediatria Agustin Zubillaga, Barquisimeto, Venezuela
| | | | - Eitan N Berezin
- Department of Pediatrics, Santa Casa de São Paulo Medical School, São Paulo, Brazil
| | | | - Abiel Mascareñas
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Nancy Galvez
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Erika Cantor
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Institute of Statistics, Universidad de Valparaíso, Valparaíso, Chile
| | - Edwin J Asturias
- Colorado School of Public Health, Center for Global Health, Aurora, CO, United States.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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18
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Avila-Agüero ML, Camacho-Badilla K, Ulloa-Gutierrez R, Espinal-Tejada C, Morice-Trejos A, Cherry JD. Epidemiology of pertussis in Costa Rica and the impact of vaccination: A 58-year experience (1961-2018). Vaccine 2021; 40:223-228. [PMID: 34903370 DOI: 10.1016/j.vaccine.2021.11.078] [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: 06/03/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
Costa Rica is an upper middle-income country in Central America with a vigorous public health system. We have studied the number of cases, hospitalizations, and deaths due to pertussis from 1961 to 2018, in relation to vaccine coverage. Following the introduction of the fourth and fifth doses of DTP (booster doses) in 1973 there was a marked reduction of reported pertussis. In 2002 pertussis surveillance and laboratory diagnosis were improved. In 2007, Tdap post-partum immunization was introduced and then switched to intrapartum Tdap immunization in 2011. Of these two strategies post-partum vaccination seemed to have a greater effect in decreasing hospitalizations and deaths, nevertheless, since 2011 there has been only 4 infant deaths due to pertussis.
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Affiliation(s)
- María L Avila-Agüero
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (C.C.S.S.), San José, Costa Rica; Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University, New Haven, CT, USA.
| | - Kattia Camacho-Badilla
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (C.C.S.S.), San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (C.C.S.S.), San José, Costa Rica; Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Carlos Espinal-Tejada
- Robert Stempel College of Public Health and Social Work, Florida International University, USA
| | - Ana Morice-Trejos
- Medical Epidemiologist, Independent Consultant, San José, Costa Rica
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Department of Pediatrics, Los Angeles, CA 90095, USA.
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19
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Saez-de-Ocariz M, Gámez-González LB, Rivas-Larrauri F, Castaño-Jaramillo LM, Toledo-Salinas C, Garrido-García LM, Ulloa-Gutierrez R, Santamaría-Piedra M, Orozco-Covarrubias MDLL, Scheffler-Mendoza S, Yamazaki-Nakashimada MA. Kawasaki disease mimickers. Pediatr Int 2021; 63:880-888. [PMID: 33249696 DOI: 10.1111/ped.14561] [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: 08/01/2020] [Revised: 10/14/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. METHODS We present five representative cases with KD-like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma-induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS-C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus. RESULTS Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. CONCLUSION The term 'Kawasaki syndrome' instead of 'Kawasaki disease' may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS-C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.
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Affiliation(s)
| | | | | | | | - Carla Toledo-Salinas
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáez Herrera", San José, Costa Rica
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20
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Gentile Á, Torres-Torreti JP, López-López P, Ulloa-Gutierrez R. Epidemiologic changes and novelties on vaccination against Bordetella pertussis in Latin America. Rev Chilena Infectol 2021; 38:232-242. [PMID: 34184715 DOI: 10.4067/s0716-10182021000200232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Although whooping cough is a vaccine-preventable disease (VPD), its epidemiologic characteristics in Latin America shows persistence of outbreaks in the region. This persistence is due, at least in part, to the presence of antivaccine movements, the diversity of the surveillance systems, and the lack of a uniform case definition for the region. Given the importance of whooping cough in Latin America and the changes in vaccine recommendations, this manuscript aims to review epidemiologic data and recent changes in the vaccination calendars and their impact on the pediatric disease by Bordetella pertussis in Latin America. Recent epidemiological data reveal that between regions, countries, and administrative units within each country there is a marked heterogeneity of vaccine coverage, with different outbreak patterns. Efforts in the region have tried to improve this situation by introducing acellular pertussis vaccines (aP) in the vaccine calendars, which are less reactogenic than whole-cell pertussis vaccines (wP). Moreover, some countries have improved the case definition. Some countries have implemented a confirmed case definition by introducing polymerase chain reaction (PCR) as a diagnostic criterion. As a response to the heterogeneities observed within and between countries and the regional epidemiologic profiles, a Steering Committee from the Latin American Society for Pediatric Infectiology (SLIPE) and the Latin American Association of Pediatrics (ALAPE) propose a unified case definition and recommendations to improve vaccine coverage and reduce the outbreaks of whooping cough in Latin America.
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Affiliation(s)
- Ángela Gentile
- Sociedad Latinoamericana de Infectología Pediátrica, Argentina
| | | | - Pío López-López
- Sociedad Latinoamericana de Infectología Pediátrica, Argentina
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21
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McArdle AJ, Vito O, Patel H, Seaby EG, Shah P, Wilson C, Broderick C, Nijman R, Tremoulet AH, Munblit D, Ulloa-Gutierrez R, Carter MJ, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Levin M. Treatment of Multisystem Inflammatory Syndrome in Children. N Engl J Med 2021; 385:11-22. [PMID: 34133854 PMCID: PMC8220965 DOI: 10.1056/nejmoa2102968] [Citation(s) in RCA: 205] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union's Horizon 2020 Program and others; BATS ISRCTN number, ISRCTN69546370.).
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Affiliation(s)
- Andrew J McArdle
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Ortensia Vito
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Harsita Patel
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Eleanor G Seaby
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Priyen Shah
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Clare Wilson
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Claire Broderick
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Ruud Nijman
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Adriana H Tremoulet
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Daniel Munblit
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Rolando Ulloa-Gutierrez
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Michael J Carter
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Tisham De
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Clive Hoggart
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Elizabeth Whittaker
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Jethro A Herberg
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Myrsini Kaforou
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Aubrey J Cunnington
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
| | - Michael Levin
- From the Department of Infectious Disease, Section of Pediatric Infectious Disease (A.J.M., O.V., H.P., E.G.S., P.S., C.W., C.B., R.N., T.D., E.W., J.A.H., M.K., A.J.C., M.L.), and the Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine (D.M.), Imperial College London, the Department of Pediatrics, Imperial College Healthcare NHS Trust (R.N., E.W., J.A.H., A.J.C., M.L.), and the Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital (M.J.C.), London, and the Genomic Informatics Group, University of Southampton, Southampton (E.G.S.) - all in the United Kingdom; the Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA (E.G.S.); the Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego (A.H.T.); the Department of Pediatrics and Pediatric Infectious Diseases, Sechenov University, Moscow (D.M.); Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social, San José, Costa Rica (R.U.-G.); and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (C.H.)
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Gámez-González LB, Ulloa-Gutierrez R, Murata C, Yamazaki-Nakashimada MA, Kim E, Estripeaut D, Del Águila O, Garrido-García LM, Gómez V, Faugier-Fuentes E, Miño G, Beltrán S, Cofré F, Chacón-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Tremoulet AH, Astigarraga N. Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network. Pediatr Int 2021; 63:643-648. [PMID: 33099854 DOI: 10.1111/ped.14521] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048). CONCLUSIONS Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.
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Affiliation(s)
- Luisa B Gámez-González
- Servicio Inmunología y Alergia, Hospital Infantil Especialidades de Chihuahua, Chihuahua, México
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional Pediatría, Mexico City, Mexico
| | | | - Elissa Kim
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño, Ciudad Panamá, Panamá
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins-Lima-Perú, Lince, Perú
| | | | - Virgen Gómez
- Servicio de Infectología, Centro Médico, Universidad Central del Este Hospital y Hospital Infantil "Dr Robert Reid Cabral", Santo Domingo, República Dominicana
| | | | - Greta Miño
- Servicio de Infectología, Hospital del Niño "Francisco de Ycaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología, Clínica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | | | | | | | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
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Zanin A, García-Salido A, Rodríguez-Rubio M, Camporesi A, Ulloa-Gutierrez R, Villar ME, González-Dambrauskas S, Kudchadkar SR, Carroll CL. Live Tweeting the Discovery of a New Coronavirus Disease 2019-Related Syndrome in Children. Pediatr Crit Care Med 2021; 22:e373-e375. [PMID: 33606475 PMCID: PMC8168931 DOI: 10.1097/pcc.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anna Zanin
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Alberto García-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Anna Camporesi
- Pediatric Intensive Care, Children's Hospital V Buzzi, Milano, Italy
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica. Red de Enfermedad de Kawasaki en América Latina (REKAMLATINA)
| | - Maria Elena Villar
- Department of Communication, Steven Cruz Institute for Science, Media & Technology, Miami, FL
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher L Carroll
- Pediatric Intensive Care Unit, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT
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Estripeaut D, Levy J, Luciani K, Tapia A, Daza C, Méndez-Ríos JD, Tremoulet AH, Ulloa-Gutierrez R. [Multicenter retrospective study about the epidemiological, clinical and therapeutic aspects of Kawasaki disease in children from Panama]. Rev Chilena Infectol 2021; 37:675-682. [PMID: 33844807 DOI: 10.4067/s0716-10182020000600675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of pediatric acquired heart disease in many countries, however, there are few published studies from Latin America (LA). AIM To describe the epidemiology, clinical aspects, and treatment of KD in children from Panama as part of the REKAMLATINA-2 in LA. METHODS Retrospective descriptive review of hospitalized patients diagnosed with KD, attended at three main pediatric hospitals of Panama from January-1-2009 to December-31-2013. RESULTS 111 patients were analyzed, 61(54.9 %) were male. All children were hospitalized, and had a mean length of hospitalization of 5.8 (4-7) days. Median age at admission was 28.9 (12-38) months. Prior to KD final diagnosis, 63.9% patients received antibiotics for other presumed diagnoses. 105 (94.6%) patients received IGIV, 10 (9.5%) were resistant. On initial echocardiogram, 11.7% of cardiovascular complications were reported, of which coronary artery lesions (CALs) were detected in 3 (2.9 %) patients. CONCLUSION The data suggest that KD in Panama has an incidence of about 2.05 x 100,000 in children under 15 years of age, and with a frequency 2.6 times higher in children under 3 years. A high rate of antibiotic misuse on outpatient prior to diagnostic confirmation was observed, suggesting KD unawareness and late recognition in Panamá.
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Affiliation(s)
- Dora Estripeaut
- Hospital del Niño Doctor José Renán Esquivel, Panamá, Panamá
| | - Jacqueline Levy
- Hospital del Niño Doctor José Renán Esquivel, Panamá, Panamá
| | - Kathia Luciani
- Hospital de Especialidades Pediátricas Omar Torrijos Herrera (HEPOTH) de la CSS, Panamá, Panamá
| | - Alex Tapia
- Hospital de Especialidades Pediátricas Omar Torrijos Herrera (HEPOTH) de la CSS, Panamá, Panamá
| | - Carlos Daza
- Hospital Materno Infantil José Domingo de Obaldía, David, Panamá
| | | | - Adriana H Tremoulet
- RadyChildren's Hospital San Diego, University of California, San Diego, CA, Estados Unidos
| | - Rolando Ulloa-Gutierrez
- Centro de Ciencias Médicas, Hospital Nacional de Niños, Caja Costarricense de Seguro Social, San José, Costa Rica
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Lopatynsky-Reyes EZ, Acosta-Lazo H, Ulloa-Gutierrez R, Ávila-Aguero ML, Chacon-Cruz E. BCG Scar Local Skin Inflammation as a Novel Reaction Following mRNA COVID-19 Vaccines in Two International Healthcare Workers. Cureus 2021; 13:e14453. [PMID: 33996313 PMCID: PMC8117721 DOI: 10.7759/cureus.14453] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bacillus Calmette-Guérin (BCG) local scar inflammatory reactions have been mostly associated with Kawasaki disease in children and less commonly with other viral infections (i.e., measles). BCG scar inflammation associated with or following vaccine administration has only been reported with the influenza vaccine. We describe the first reports in the literature of local BCG inflammation following two different available messenger ribonucleic acid (mRNA) anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) vaccines (mRNA-1273, and BNT162b2) in two young healthy physicians, one from Costa Rica, and another from the United States of America, with normal cell blood counts, flow cytometries, and negative for human immunodeficiency virus (HIV). In both cases, BCG scar inflammation appeared after 24 hours of vaccination of the second dose, without signs of reaction on the injection site, and resolved within four days. Dermoscopic findings in one case showed arborizing and comma-shaped vessels. Pharmacovigilance surveillance of BCG scar reactions following coronavirus disease 2019 (COVID-19) vaccines should be considered particularly in countries where BCG is part of their national immunization programs.
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Affiliation(s)
| | - Heidy Acosta-Lazo
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, CRI
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, CRI.,Cátedra de Pediatría, Universidad de Ciencias Médicas (UCIMED), San José, CRI
| | - María L Ávila-Aguero
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, CRI.,Pediatric Infectious Diseases, Center for Infectious Disease Modeling and Analysis (CIDMA) Yale School of Public Health, New Haven, USA
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Ávila-Morales S, Ospina-Henao S, Ulloa-Gutierrez R, Ávila-Agüero ML. Epidemiological and clinical profile between influenza A and B virus in Costa Rican children. Int J Infect Dis 2021; 105:763-768. [PMID: 33711523 DOI: 10.1016/j.ijid.2021.03.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the clinical and epidemiological behavior of influenza type A versus type B and analyze if there was any correlation or differences between the characteristics of both groups. METHODS An observational, retrospective, descriptive, and population-based study based of children who were hospitalized at the only national pediatric hospital of Costa Rica from January 1, 2010 to December 31, 2018 and had a confirmed influenza virus infection. RESULTS 336 patients were analyzed. Mean age was 35,6 ± 36,7 months (3,0 ± 3,1 years). The only significant variables at 25% in relation to influenza type A or B virus were: sex, month of diagnosis, fever, vomiting, cough, use of antibiotics and admission to the PICU. The hospitalization rate at our hospital increased between the months of October to December, with a higher percentage of cases in November and December, which reveals that the "real peak" in our population begins between 3 to 4 months after the end of the vaccination campaign. Patients with influenza A virus had a 2.5 times greater risk of being admitted to the PICU. Mortality rate was 0.6% and 0% among influenza A and B children, respectively. CONCLUSIONS Variables in which a causality was found with type A or B virus were: admission to the PICU, month of diagnosis, and cough. However, influenza B clinical behavior continues to be unpredictable.
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Affiliation(s)
- Silvia Ávila-Morales
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Sebastián Ospina-Henao
- Instituto de Investigación en Ciencias Médicas (IICIMED), Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED) San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Instituto de Investigación en Ciencias Médicas (IICIMED), Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED) San José, Costa Rica
| | - María L Ávila-Agüero
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Instituto de Investigación en Ciencias Médicas (IICIMED), Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED) San José, Costa Rica; Affiliated Researcher, Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University, New Haven CT, USA.
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Naranjo-Zúñiga G, Yock-Corrales A, Mora-Mesén C, Campos-Villalobos M, Ulloa-Gutierrez R. [Epidemiology, clinical manifestations and microbiology of children with necrotizing fasciitis in a Costa Rican pediatric hospital]. Rev Chilena Infectol 2021; 37:446-449. [PMID: 33399665 DOI: 10.4067/s0716-10182020000400446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the significant associated morbidity of necrotizing fasciitis (NF), few studies have been published and this is the larger pediatric series in Latin America. AIM To describe the epidemiology, clinical characteristics and microbiology of NF in Costa Rican children. METHODS Review of clinical and pathological records, period April 2002 to April 2014, in patients under 13 years of age. RESULTS 19/22 patients met the inclusion requirement, 12 had co-morbidity: 26% with a history of recent surgery and 21% were neonates. Etiology was documented in blood cultures in 26% and by tissue culture in 63% (one third of them polymicrobial). Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus were the three most common etiologic agents. Case fatality rate was 42%, one of the highest in our region. CONCLUSION NF is a serious, unusual pathology, frequently associated with neonatology and post-surgical patients, with a mixed etiology that requires the association of antimicrobials and early surgery. Its lethality is high in our setting, over previously published series.
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Affiliation(s)
| | | | - Cinthya Mora-Mesén
- Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños de Costa Rica, Costa Rica
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Sadarangani M, Kollmann T, Bjornson G, Heath P, Clarke E, Marchant A, Levy O, Leuridan E, Ulloa-Gutierrez R, Cutland CL, Kampmann B, Chaithongwongwatthana S, Dinleyici E, van Damme P, Munoz FM. The Fifth International Neonatal and Maternal Immunization Symposium (INMIS 2019): Securing Protection for the Next Generation. mSphere 2021; 6:e00862-20. [PMID: 33504658 PMCID: PMC7885317 DOI: 10.1128/msphere.00862-20] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite significant progress in reaching some milestones of the United Nations Sustainable Development Goals, neonatal and early infant morbidity and mortality remain high, and maternal health remains suboptimal in many countries. Novel and improved preventative strategies with the potential to benefit pregnant women and their infants are needed, with maternal and neonatal immunization representing effective approaches. Experts from immunology, vaccinology, infectious diseases, clinicians, industry, public health, and vaccine-related social sciences convened at the 5th International Neonatal and Maternal Immunization Symposium (INMIS) in Vancouver, Canada, from 15 to 17 September 2019. We critically evaluated the lessons learned from recent clinical studies, presented cutting-edge scientific progress in maternal and neonatal immunology and vaccine development, and discussed maternal and neonatal immunization in the broader context of infectious disease epidemiology and public health. Focusing on practical aspects of research and implementation, we also discussed the safety, awareness, and perception of maternal immunization as an existing strategy to address the need to improve maternal and neonatal health worldwide. The symposium provided a comprehensive scientific and practical primer as well as an update for all those with an interest in maternal and neonatal infection, immunity, and vaccination. The summary presented here provides an update of the current status of progress in maternal and neonatal immunization.
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Affiliation(s)
- Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tobias Kollmann
- Telethon Kids Institute, Perth Children's Hospital, University of Western Perth, Perth, Australia
| | - Gordean Bjornson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Paul Heath
- St. George's University of London, London, United Kingdom
| | - Ed Clarke
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Charleroi, Belgium
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT & Harvard, Cambridge, Massachusetts, USA
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rolando Ulloa-Gutierrez
- Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas C.C.S.S., San José, Costa Rica
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (ALIVE), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Beate Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
- The Vaccine Centre, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Surasith Chaithongwongwatthana
- Division of Infectious Disease in Gynecology and Obstetrics (InDiGO), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ener Dinleyici
- Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | - Pierre van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Flor M Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
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Garrido-García LM, Gaffare-Aranda S, Cravioto P, Galván F, Ulloa-Gutierrez R, Yamazaki-Nakashimada MA. [Kawasaki disease in infants under one year of age. A challenge for the diagnosis and treatment of patients. Experience in a hospital center in Mexico]. Rev Chilena Infectol 2021; 37:584-590. [PMID: 33399808 DOI: 10.4067/s0716-10182020000500584] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frequency of Kawasaki disease (KD) in infants is low in almost all countries. These patients are at higher risk of developing cardiac complications. AIM To evaluate the clinical features, treatment used and cardiac outcome in infants under one year of age attending for KD in a third level pediatric hospital in Mexico City, Mexico. METHODS A cross-sectional study was conducted in our hospital from August 1995 to August 2019. We analyzed the clinical features, laboratory results, treatment used and cardiac outcomes in infants younger than one year of age and compared them with older patients. RESULTS We included 687 patients, 152 were younger than one year of age (22.1%). There was a delayed diagnosis in younger patients with an increased frequency of incomplete clinical presentations. Coronary artery abnormalities were most common in younger infants who also had an increased frequency of giant coronary artery aneurysms. Two patients in the younger group died in the acute phase of KD of myocardial infarction. CONCLUSIONS Diagnosis of KD in infants younger than 1 year of age is a clinical challenge with an increased rate of incomplete clinical presentations and also an increased risk of development of severe cardiac complications.
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Montenegro-Villalobos J, Miranda-Jiménez B, Ávila-Aguero ML, Ulloa-Gutierrez R. Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease. Cureus 2020; 12:e10212. [PMID: 32905384 PMCID: PMC7470662 DOI: 10.7759/cureus.10212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Kawasaki disease is an acute systemic vasculitis and is the leading cause of acquired cardiac disease in children. Among the ocular manifestations in these patients, bilateral non-suppurative conjunctival injection and uveitis are the most common. We describe a six-year-old Costa Rican girl with acute Kawasaki disease who developed severe bilateral conjunctival injection with subsequent bilateral subconjunctival hemorrhages. For her ocular involvement, she was treated expectantly, and after six weeks there was complete resolution. To our knowledge, this is the first report from Latin America and among the few in the literature of a child in whom severe bilateral subconjunctival hemorrhages occur as a manifestation of Kawasaki disease.
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Soza G, González-Mata A, Tremoulet AH, Ulloa-Gutierrez R. Dr. Tomisaku Kawasaki (1925-2020) y su legado en América Latina. Rev Chilena Infectol 2020; 37:339-342. [DOI: 10.4067/s0716-10182020000400339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Indexed: 11/17/2022] Open
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Sevilla-Acosta F, Jiménez-Cruz E, Álvarez-Cabalceta H, Ulloa-Gutierrez R. Culture-Proven Disseminated and Meningeal Histoplasmosis Presenting as Septic Shock and Autoimmune Hemolytic Anemia in an Infant. Cureus 2020; 12:e8945. [PMID: 32765990 PMCID: PMC7398712 DOI: 10.7759/cureus.8945] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Falleiros-Arlant LH, Torres JR, Lopez E, Avila-Agüero ML, Ulloa-Gutierrez R, Mascareñas A, Brea J. Current regional consensus recommendations on infant vaccination of the Latin American pediatric infectious diseases society (SLIPE). Expert Rev Vaccines 2020; 19:491-498. [PMID: 32580593 DOI: 10.1080/14760584.2020.1775078] [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: 01/20/2023]
Abstract
INTRODUCTION The 1st Regional Experts on Infant Vaccination (REIV) meeting generated updated consensus recommendations to improve the control of various major vaccine preventable diseases (VPD) in Latin America. AREAS COVERED Workshops highlighted recent changes in immunization schedules within the region, experience of countries incorporating combined acellular pertussis vaccines schedules and parenteral inactivated polio vaccine (IPV). The need to definitively replace oral polio vaccine (OPV) by IPV, and potential benefits of introducing new combined vaccines, were extensively discussed. EXPERT OPINION REIV strongly advised immediate adoption of either complete IPV schedules for all Latin America or schedules including at least two initial doses of IPV. Use of fractional doses of intradermally administered IPV (fIPV ID) was not recommended due to lower immunogenicity, lack of evidence on long-term protection, and technical difficulty to implement. Routine pertussis vaccination of pregnant women in addition to health workers of neonatology units and any previously unimmunized parent was encouraged. Administration of HBV vaccine to newborns within the first 24 hours of life, and then at 2, 4, and 6 months, and of a booster dose of conjugate Hib vaccine at age 12 through 15 months, was also recommended. Incorporation of combined vaccines (CV) was considered potentially advantageous.
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Affiliation(s)
- Luiza H Falleiros-Arlant
- Departament of Children's Health, Faculdade De Medicina, Universidade Metropolitana De Santos , Santos, Brazil
| | - Jaime R Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central De Venezuela , Caracas, Venezuela
| | - Eduardo Lopez
- Departamento De Medicina, Hospital De Niños "Dr. Ricardo Gutiérrez" , Buenos Aires, Argentina
| | - Maria L Avila-Agüero
- Servicio De Infectología, Hospital Nacional De Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense De Seguro Social (CCSS) , San José, Costa Rica.,Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University , New Haven, CT, USA
| | - Rolando Ulloa-Gutierrez
- Servicio De Infectología Pediátrica, Hospital Nacional De Niños "Dr. Carlos Sáenz Herrera", Centro De Ciencias Médicas, Caja Costarricense Del Seguro Social (CCSS) , San José, Costa Rica
| | - Abiel Mascareñas
- Department of Pediatric Infectious Diseases, Hospital Universitario "José E. Gonzalez", Universidad Autónoma De Nuevo Leon , México
| | - Jose Brea
- Pediatrics Department, Centro Médico UCE , Santo Domingo, República Dominicana
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Segura-Perez E, Ulloa-Gutierrez R, Ávila-Aguero ML. Thoracic and Renal Actinomycosis Requiring Complete Right Nephrectomy in a Costa Rican Female Child. Cureus 2020; 12:e6879. [PMID: 32190442 PMCID: PMC7058395 DOI: 10.7759/cureus.6879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Actinomycosis is a relatively uncommon bacterial disease of childhood, especially when presenting as deep-seated infections. Only 10% of affected patients are younger than 18 years of age. In children, cervical actinomycosis is the most common form of clinical presentation, and among the abdominopelvic form, renal abscesses are rare. We describe an uncommon and severe case of a five-year-old Costa Rican girl with thoracic and renal actinomycosis who required a complete nephrectomy.
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Brenes-Chacón H, Ulloa-Gutierrez R, Soriano-Fallas A, Camacho-Badilla K, Valverde-Muñoz K, Ávila-Agüero ML. Bacterial Infections Associated with Viperidae Snakebites in Children: A 14-Year Experience at the Hospital Nacional de Niños de Costa Rica †. Am J Trop Med Hyg 2020; 100:1227-1229. [PMID: 30915952 DOI: 10.4269/ajtmh.18-1015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Secondary bacterial infections following Viperidae snakebite envenomation in children are common. Among 75 patients admitted because of snakebites at the only pediatric hospital in Costa Rica, 16 (21.3%) had a culture-confirmed secondary bacterial infection. Morganella morganii (37.5%), Aeromonas hydrophila (31.2%), and Providencia rettgeri (18.7%) were the most common pathogens. Empiric prophylaxis is still recommended and should be based on local etiological agents and antimicrobial susceptibilities.
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Affiliation(s)
- Helena Brenes-Chacón
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Kattia Camacho-Badilla
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Kathia Valverde-Muñoz
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - María L Ávila-Agüero
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University, New Haven, Connecticut.,Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
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Brenes-Chacon H, Gutierrez JM, Camacho-Badilla K, Soriano-Fallas A, Ulloa-Gutierrez R, Valverde K, Avila-Aguero ML. Long-term sequelae secondary to snakebite envenoming: a single centre retrospective study in a Costa Rican paediatric hospital. BMJ Paediatr Open 2020; 4:e000735. [PMID: 32995568 PMCID: PMC7497519 DOI: 10.1136/bmjpo-2020-000735] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Although devastating acute effects associated with snake envenoming are well described, the long-term sequelae resulting from these envenomings have not been adequately addressed, especially in the paediatric population. The aim of our study is to describe the clinical characteristics among paediatric patients in Costa Rica who developed long-term sequelae secondary to snakebite envenoming. DESIGN Retrospective descriptive study of paediatric patients under 13 years who were admitted with a history of a recent snakebite at the National Children's Hospital in Costa Rica from January 2001 to December 2014. RESULTS We enrolled 74 patients admitted to our centre due to envenoming, and separated those who did not develop sequelae (50 patients) from those who did (24 patients). Of those who presented acute complications during hospitalisation, local wound infection and clinically diagnosed compartmental syndrome were significantly higher in the group that developed sequelae thereafter. Hypertrophic scars (66.7%), functional limitation of affected limb (37.5%) and the need of skin graft (37.5%) were the most common sequelae. The median follow-up of patients with long-term sequelae after discharge was 25.4 months (5.6-59.4). No deaths were reported during this time period. CONCLUSIONS Given the high economic, personal and healthcare burden that entails follow-up of these patients, efforts should be carried out to prevent the factors associated with sequelae among the affected population.
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Affiliation(s)
- Helena Brenes-Chacon
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
| | - Jose M Gutierrez
- Universidad de Costa Rica Instituto Clodomiro Picado, San Jose, Costa Rica
| | - Kattia Camacho-Badilla
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
| | - Alejandra Soriano-Fallas
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
| | - Kattia Valverde
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
| | - María Luisa Avila-Aguero
- Universidad de Ciencias Medicas (UCIMED), San Jose, Costa Rica.,Caja Costarricense del Seguro Social (CCSS), Pediatric Infectious Diseases, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San Jose, Costa Rica
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Moreno E, Garcia SD, Bainto E, Salgado AP, Parish A, Rosellini BD, Ulloa-Gutierrez R, Garrido-Garcia LM, Dueñas L, Estripeaut D, Luciani K, Rodríguez-Quiroz FJ, Del Aguila O, Camacho-Moreno G, Gómez V, Viviani T, Alvarez-Olmos MI, de Souza Marques HH, Faugier-Fuentes E, Saltigeral-Simental P, López-Medina E, Miño-León G, Beltrán S, Martínez-Medina L, Pirez MC, Cofré F, Tremoulet AH. Presentation and Outcomes of Kawasaki Disease in Latin American Infants Younger Than 6 Months of Age: A Multinational Multicenter Study of the REKAMLATINA Network. Front Pediatr 2020; 8:384. [PMID: 32766186 PMCID: PMC7378383 DOI: 10.3389/fped.2020.00384] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/05/2020] [Indexed: 01/28/2023] Open
Abstract
Objective: To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants <6 months of age as compared to those ≥6 months in Latin America. Methods: We evaluated 36 infants <6 months old and 940 infants ≥6 months old diagnosed with KD in Latin America. We compared differences in laboratory data, clinical presentation, treatment response, and coronary artery outcomes between the two cohorts. Results: The majority (78.1%) of infants and children ≥6 months of age were initially diagnosed with KD, as compared to only 38.2% of infants <6 months. Clinical features of KD were more commonly observed in the older cohort: oral changes (92 vs. 75%, P = 0.0023), extremity changes (74.6 vs. 57.1%, P = 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%, P = 0.0004). Whether treated in the first 10 days of illness or after the 10th day, infants <6 months were at greater risk of developing a coronary artery aneurysm compared to KD patients ≥6 months treated at the same point in the course of illness [ ≤ 10 days (53.8 vs. 9.4%, P = 0.00012); >10 days (50 vs. 7.4%, P = 0.043)]. Conclusion: Our data show that despite treatment in the first 10 days of illness, infants <6 months of age in Latin America have a higher risk of developing a coronary artery aneurysm. Delay in the diagnosis leads to larger coronary artery aneurysms disproportionately in these infants. Thus, suspicion for KD should be high in this vulnerable population.
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Affiliation(s)
- Elizabeth Moreno
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - S Diana Garcia
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Emelia Bainto
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | | | - Austin Parish
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States.,Meta-Research Innovation Center at Stanford University, Stanford, CA, United States
| | - Benjamin D Rosellini
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San Jose, Costa Rica
| | | | - Lourdes Dueñas
- Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Panama City, Panama
| | | | - Olguita Del Aguila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Germán Camacho-Moreno
- Servicio de Infectología, Fundación HOMI Hospital Pediátrico de la Misericordia and Universidad Nacional de Colombia, Bogota, Colombia
| | - Virgen Gómez
- Servicio de Infectología, Centro Médico Universidad Central del Este, Santo Domingo, Dominican Republic
| | - Tamara Viviani
- Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
| | - Martha I Alvarez-Olmos
- Servicio de Infectología, Fundación Cardioinfantil and Universidad El Bosque, Bogota, Colombia
| | | | | | | | - Eduardo López-Medina
- Servicio de Infectología, Hospital Universitario del Valle & Centro Médico Imbanaco and Clínica Farallones, Cali, Colombia
| | - Greta Miño-León
- Servicio de Infectología, Hospital del Niño "Dr. Francisco de Icaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología, Clínica Colsanitas, Bogota, Colombia
| | | | - Maria C Pirez
- Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | - Adriana H Tremoulet
- California/Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
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Fortuna-Reyna B, Bainto EV, Ulloa-Gutierrez R, Garrido-García LM, Estripeaut D, Del Águila O, Gómez V, Faugier-Fuentes E, Miño-León G, Beltrán S, Cofré F, Chacón-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Dueñas L, Luciani K, Rodríguez-Quiroz FJ, Camacho-Moreno G, Viviani T, Alvarez-Olmos MI, Marques HHDS, López-Medina E, Pirez MC, Tremoulet AH. Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America. Front Pediatr 2020; 8:442. [PMID: 33194876 PMCID: PMC7646534 DOI: 10.3389/fped.2020.00442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America. Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017. Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries. Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.
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Affiliation(s)
- Brenda Fortuna-Reyna
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Emelia V Bainto
- University of California, San Diego, San Diego, CA, United States.,California/Rady Children's Hospital San Diego, San Diego, CA, United States
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica.,Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad Panamá, Panama
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Virgen Gómez
- Servicio de Infectología, Centro Médico Universidad Central del Este Hospital y Hospital Infantil "Dr. Robert Reid Cabral", Santo Domingo, Dominican Republic
| | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Greta Miño-León
- Servicio de Infectología, Hospital del Niño "Francisco de Icaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología, Clínica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | | | | | | | - Lourdes Dueñas
- Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panama
| | | | - German Camacho-Moreno
- Servicio de Infectología, Fundación HOMI Hospital Pediátrico de la Misericordia & Universidad Nacional de Colombia, Bogotá, Colombia
| | - Tamara Viviani
- Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
| | - Martha I Alvarez-Olmos
- Servicio de Infectología, Fundación Cardioinfantil & Universidad El Bosque, Bogotá, Colombia
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Departamento de Pediatría, Universidad del Valle y Centro Médico Imbanaco, Cali, Colombia
| | - María C Pirez
- Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Adriana H Tremoulet
- University of California, San Diego, San Diego, CA, United States.,California/Rady Children's Hospital San Diego, San Diego, CA, United States
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Brenes-Chacón H, Gutiérrez JM, Camacho-Badilla K, Soriano-Fallas A, Ulloa-Gutierrez R, Valverde-Muñoz K, Ávila-Agüero ML. Snakebite envenoming in children: A neglected tropical disease in a Costa Rican pediatric tertiary care center. Acta Trop 2019; 200:105176. [PMID: 31526777 DOI: 10.1016/j.actatropica.2019.105176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/25/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Introduced in June 2017 by the World Health Organization (WHO) as a Neglected Tropical Diseases, snakebite envenoming is a global health problem. In Costa Rica, an incidence of 15 per 100,000 inhabitants and a mortality rate of 0.15 per 100,000 inhabitants per year were reported from 2005-2012. Children are also affected and prone to complications. METHODS Retrospective descriptive 14-year study of children with envenomings by Viperidae snakebites managed at the tertiary pediatric hospital in Costa Rica. FINDINGS 80 patients (pts) were included and classified as having mild (17 pts, 29.3%), moderate (58 pts, 72.5%) or severe (5 pts, 6.2%) envenoming. 52/80 (65%) patients received treatment within the first four hours, three (3.75%) between 5-8 h, three between 9-12 h, four (4%) between 13-16 h, two (2.5%) between 17-20 h, and seven (8.75%) after 20 h. Edema was documented in 76/80 (95%), pain in 58 (72.5%), local bleeding in 23 (28.8%), emesis in 10 (12.5%), bullae formation in 8 (10%), and tissue necrosis in three (3.8%) pts. Complications presented according with degree of envenoming, being more common in severe cases: wound infection occurred in 14/58 (24.1%) with moderate envenoming and 5/5 pts with severe envenoming (p < 0.0001), bleeding presented in 3/58 (5.2%) with moderate cases, and 2/5 (40%) in pts with severe envenoming (p = 0.004); and compartmental syndrome occurred in 3/17 (17.6%) pts with mild envenoming, in 33/58 (56.9%), and 5/5 of moderate and severe envenomed pts, respectively (p = 0.0014). Sequelae were documented 25/80 (31%).
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Affiliation(s)
- Helena Brenes-Chacón
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Kattia Camacho-Badilla
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Kathia Valverde-Muñoz
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - María L Ávila-Agüero
- Pediatric Infectious Diseases Division, Pediatric Hemato-Oncology Division, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Affiliated Researcher, Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University New Haven, New Haven CT, USA.
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Gentile A, Bricks L, Ávila-Agüero ML, Kfouri RA, Torres JP, Ulloa-Gutierrez R, Glover RE, Sarti E. Pertussis in Latin America and the Hispanic Caribbean: a systematic review. Expert Rev Vaccines 2019; 18:829-845. [PMID: 31317794 DOI: 10.1080/14760584.2019.1643241] [Citation(s) in RCA: 5] [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] [Indexed: 12/20/2022]
Abstract
Introduction: Pertussis in Latin America continues to cause periodic epidemics with substantial morbidity particularly among young children. The disease has persisted despite long-standing vaccination programs in the region. Areas covered: We conducted a systematic review to characterize the recent epidemiology of pertussis in Latin America and Hispanic Caribbean. We undertook a holistic approach and attempted to include all available data concerning pertussis that may explain the changing dynamics of the disease. Expert opinion: There are wide disparities in the reported annual incidence rates of pertussis both within and between countries in the region. General trends in pertussis incidence are difficult to ascertain due to the heterogeneity in the epidemiological data. Available data suggests that the disease burden has changed over the years such that now it predominantly affects those <1 year. Coverage with three doses of the pertussis vaccine has been highly variable, and very few countries have consistently achieved ≥90% coverage annually since 2000. There remain inequalities in vaccination coverage in some regions/localities and specific groups, which sustains the risk of pertussis dissemination. The WHO considers that maternal pertussis immunization provides protection to infants too young to be vaccinated; >10 Latin American countries currently recommend vaccination of pregnant women.
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Affiliation(s)
- Angela Gentile
- a Department of Epidemiology, "R. Gutiérrez" Children's Hospital , Buenos Aires , Argentina
| | - Lucia Bricks
- b LATAM PPH, Sanofi Pasteur , São Paulo , Brazil
| | - María L Ávila-Agüero
- c Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS) , San José , Costa Rica.,d Center for Infectious Disease Modeling and Analysis (CIDMA), Yale University , New Haven , CT , USA
| | - Renato Avila Kfouri
- e Santa Joana Immunization Center, São Paulo and Brazilian Society of Immunization , São Paulo , Brazil
| | - Juan Pablo Torres
- f Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Hospital Luis Calvo Mackenna, Universidad de Chile , Santiago , Chile
| | - Rolando Ulloa-Gutierrez
- c Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS) , San José , Costa Rica
| | | | - Elsa Sarti
- h LATAM, Sanofi Pasteur, Coyoacán, CDMX , São Paulo , Mexico
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Hozbor D, Ulloa-Gutierrez R, Marino C, Wirsing von König CH, Tan T, Forsyth K. Pertussis in Latin America: Recent epidemiological data presented at the 2017 Global Pertussis Initiative meeting. Vaccine 2019; 37:5414-5421. [PMID: 31331774 DOI: 10.1016/j.vaccine.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/14/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
The Global Pertussis Initiative (GPI) is an expert scientific forum that publishes consensus recommendations for pertussis monitoring, prevention, and treatment across many regions of the world. Here, we report on the regional 2017 GPI meeting on the Americas, focusing on Latin America. Information on current pertussis epidemiology, surveillance, vaccine strategies, diagnostic capabilities, disease awareness, and major local obstacles was presented by researchers from Argentina, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela. Pertussis outbreaks have occurred during the last decade in the majority of participant countries and have been followed by improvements in surveillance. In the countries that introduced maternal immunization during pregnancy, a reduction in the infant case fatality rate has been detected. All countries need to maintain and improve pertussis surveillance to reach primary vaccination coverage >90%. Moreover, countries without maternal immunization programs should strongly consider them.
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Affiliation(s)
- Daniela Hozbor
- Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | | | - Cristina Marino
- Medico Infectólogo, Hospital Militar Central, Bogotá, Colombia
| | | | - Tina Tan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kevin Forsyth
- Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, Australia
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Ureña-Castro K, Ávila S, Gutierrez M, Naumova EN, Ulloa-Gutierrez R, Mora-Guevara A. Seasonality of Rotavirus Hospitalizations at Costa Rica's National Children's Hospital in 2010-2015. Int J Environ Res Public Health 2019; 16:E2321. [PMID: 31262051 PMCID: PMC6651376 DOI: 10.3390/ijerph16132321] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022]
Abstract
Rotavirus is a leading cause of acute diarrhea in children worldwide. Costa Rica recently started universal rotavirus vaccinations for infants with a two-dose schedule in February 2019. We aimed to study the seasonality of rotavirus during the pre-vaccination era. We retrospectively studied a six-year period of hospital admissions due to rotavirus gastroenteritis. We estimated seasonal peak timing and relative intensities using trend-adjusted negative binomial regression models with the δ-method. We assessed the relationship between rotavirus cases and weather characteristics and estimated their effects for the current month, one-month prior and two months prior, by using Pearson correlation coefficients. A total of 798 cases were analyzed. Rotavirus cases predominated in the first five months of the year. On average, the peak of admissions occurred between late-February and early-March. During the seasonal peaks, the monthly count tended to increase 2.5-2.75 times above the seasonal nadir. We found the strongest negative association of monthly hospitalizations and joint percentiles of precipitation and minimal temperature at a lag of two months (R = -0.265, p = 0.027) and we detected correlations of -0.218, -0.223, and -0.226 (p < 0.05 for all three estimates) between monthly cases and the percentile of precipitation at lags 0, 1, and 2 months. In the warm tropical climate of Costa Rica, the increase in rotavirus hospitalizations coincided with dry and cold weather conditions with a two-month lag. The findings serve as the base for predictive modeling and estimation of the impact of a nation-wide vaccination campaign on pediatric rotaviral infection morbidity.
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Affiliation(s)
- Katarina Ureña-Castro
- Servicio de Pediatría, Hospital William Allen Taylor, Caja Costarricense del Seguro Social (CCSS), Turrialba 30501, Costa Rica.
| | - Silvia Ávila
- Posgrado de Pediatría, Universidad de Costa Rica (UCR) & Caja Costarricense de Seguro Social (CCSS), San José 2060, Costa Rica
| | - Mariela Gutierrez
- Servicio de Emergencias, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José 10103, Costa Rica
| | - Elena N Naumova
- Division of Nutrition Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José 10103, Costa Rica
| | - Alfredo Mora-Guevara
- Servicio de Gastroenterología y Nutrición, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José 10103, Costa Rica
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Avila-Aguero ML, Ulloa-Gutierrez R, Falleiros-Arlant LH, Porras O. Pneumococcal conjugate vaccines in Latin America: are PCV10 and PCV13 similar in terms of protection against serotype 19A? Expert Rev Vaccines 2017; 16:1-4. [PMID: 28535704 DOI: 10.1080/14760584.2017.1334555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria L Avila-Aguero
- a Servicio de Infectología e Inmunología/Reumatología , Hospital Nacional de Niños 'Dr. Carlos Sáenz Herrera' , San José , Costa Rica
| | - Rolando Ulloa-Gutierrez
- a Servicio de Infectología e Inmunología/Reumatología , Hospital Nacional de Niños 'Dr. Carlos Sáenz Herrera' , San José , Costa Rica
| | | | - Oscar Porras
- a Servicio de Infectología e Inmunología/Reumatología , Hospital Nacional de Niños 'Dr. Carlos Sáenz Herrera' , San José , Costa Rica
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Phuong LK, Bonetto C, Buttery J, Pernus YB, Chandler R, Felicetti P, Goldenthal KL, Kucuku M, Monaco G, Pahud B, Shulman ST, Top KA, Trotta F, Ulloa-Gutierrez R, Varricchio F, de Ferranti S, Newburger JW, Dahdah N, Singh S, Bonhoeffer J, Burgner D. Kawasaki disease and immunisation: A systematic review. Vaccine 2017; 35:1770-1779. [PMID: 28259442 DOI: 10.1016/j.vaccine.2016.09.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 02/09/2023]
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Ulloa-Gutierrez R, Garrido-García LM, Estripeaut D, Rodríguez FJ, Saltigeral-Simental P, Águila OD, Miño G, Luque MT, Collia A, Faugier-Fuentes E, Marques HHDS, Álvarez-Olmos MI, Luciani K, Pirez MC, Cofre F, Camacho-Moreno G, Gomez V, Yamazaki-Nakashimada MA, López-Gallegos D, Calvache-Burbano A, Avila-Aguero ML, Izquierdo G, Camacho-Badilla K, Soriano-Fallas A, Valverde K, Rodriguez-Herrera R, Chacon-Cruz E, Fernández A, Martínez-Medina L, Gámez-González LB, Dueñas L, Pérez-Camacho P, Grazioso C, Franco L, Bueno N, Beltán S, Narváez JAV, Salgado AP, Tremoulet AH, Members SG. Kawasaki Disease (KD) in Children (Ch) Older Than 5 Years of Age Among 20 Latin American (LA) Countries: A Prospective Multinational Multicenter Study of the REKAMLATINA Network. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rolando Ulloa-Gutierrez
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - Luis M Garrido-García
- Servicio De Cardiología Pediátrica, Instituto Nacional de Pediatría (INP), Ciudad de México, Mexico
| | | | - Francisco J Rodríguez
- Servicio De Inmunología Pediátrica, Hospital de Especialidades Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | | | | | - Greta Miño
- Servicio De Infectología Pediátrica, Hospital del Niño "Francisco de Ycaza Bustamente", Guayaquil, Ecuador
| | - Marco T Luque
- Servicio De Infectología Pediátrica, Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Adrián Collia
- Servicio De Pediatría, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Enrique Faugier-Fuentes
- Servicio De Reumatología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | | | | | - Kathia Luciani
- Hospital de Especialidades Pediátricas de la Caja de Seguro Social, Panamá, Panama
| | - María C Pirez
- Servicio De Infectología Pediátrica, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Fernanda Cofre
- Infectious Diseases, Hospital de Niños Roberto Del Río, Santiago, Chile
| | | | - Virgen Gomez
- Infectious Diseases Department, Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | | | | | - Angélica Calvache-Burbano
- Servicio De Infectología Pediátrica, Hospital del Niño "Francisco de Ycaza Bustamente", Guayaquil, Ecuador
| | - María L Avila-Aguero
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - Giannina Izquierdo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Kattia Camacho-Badilla
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - Kathia Valverde
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | | | | | - Antonio Fernández
- Pediatrics Department, Hospital del Niño "Francisco de Ycaza Bustamente", Guayaquil, Ecuador
| | | | | | - Lourdes Dueñas
- Servicio De Infectología Pediátrica, Hospital Benjamín Bloom, San Salvador, El Salvador
| | | | - Carlos Grazioso
- Servicio De Infectología Pediátrica, Sanatorio Nuestra Señora del Pilar/Hospital General San Juan de Dios, Ciudad Guatemala, Guatemala
| | - Lorena Franco
- Servicio De Reumatología Pediátrica, Hospital Infantil Municipal de Córdoba, Córdoba, Argentina
| | - Nora Bueno
- Servicio De Cardiología Pediátrica, Hospital Infantil Municipal de Córdoba, Córdoba, Argentina
| | - Sandra Beltán
- Servicio De Infectología Pediátrica, Clínica Colsanitas, Bogotá, Colombia
| | - Jorge a Vázquez Narváez
- Servicio De Infectología Pediátrica, Hospital Infantil de Morelia “Eva Sámano de López Mateos”, Morelia, Mexico
| | - Andrea P. Salgado
- Servicio De Infectología Pediátrica, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Study Group Members
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica
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Estripeaut D, Levy J, Luciani K, Daza C, Salgado AP, Tremoulet AH, Ulloa-Gutierrez R. Multicenter Study of the Epidemiology, Clinical Aspects and Treatment of Kawasaki Disease (KD) in Children (Ch) From Panama (Pan): A 5-year (yr) Retrospective Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Kathia Luciani
- Hospital de Especialidades Pediátricas de la Caja de Seguro Social, Panamá, Panama
| | - Carlos Daza
- Infectious Diseases, Hospital Materno Infantil José Domingo De Obaldía, David, Panama
| | - Andrea P. Salgado
- Servicio De Infectología Pediátrica, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Rolando Ulloa-Gutierrez
- Servicio De Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, San José, Costa Rica
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Phuong LK, Bonetto C, Buttery J, Pernus YB, Chandler R, Goldenthal KL, Kucuku M, Monaco G, Pahud B, Shulman ST, Top KA, Ulloa-Gutierrez R, Varricchio F, de Ferranti S, Newburger JW, Dahdah N, Singh S, Bonhoeffer J, Burgner D. Kawasaki disease and immunisation: Standardised case definition & guidelines for data collection, analysis. Vaccine 2016; 34:6582-6596. [PMID: 27863715 DOI: 10.1016/j.vaccine.2016.09.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Linny Kimly Phuong
- Monash Children's Hospital, Clayton, Melbourne, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Jim Buttery
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Merita Kucuku
- Department of Vaccines Control, National Agency for Medicines and Medical Devices, Tirana, Albania
| | | | | | | | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Surjit Singh
- Post Graduate Institute of Medical Education and Research (PGIMER) - Chandigarh, India
| | - Jan Bonhoeffer
- The Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland.
| | - David Burgner
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Department of Paediatrics, Melbourne University, Parkville, Victoria, Australia
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48
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Avila-Aguero ML, Ulloa-Gutierrez R, Camacho-Badilla K, Soriano-Fallas A, Arroba-Tijerino R, Morice-Trejos A. Varicella prevention in Costa Rica: impact of a one-dose schedule universal vaccination. Expert Rev Vaccines 2016; 16:229-234. [DOI: 10.1080/14760584.2017.1247700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- María L. Avila-Aguero
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Kattia Camacho-Badilla
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Roberto Arroba-Tijerino
- Programa Ampliado de Inmunizaciones, Dirección de Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
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Taylor S, Lopez P, Weckx L, Borja-Tabora C, Ulloa-Gutierrez R, Lazcano-Ponce E, Kerdpanich A, Angel Rodriguez Weber M, Mascareñas de Los Santos A, Tinoco JC, Safadi MAP, Lim FS, Hernandez-de Mezerville M, Faingezicht I, Cruz-Valdez A, Feng Y, Li P, Durviaux S, Haars G, Roy-Ghanta S, Vaughn DW, Nolan T. Respiratory viruses and influenza-like illness: Epidemiology and outcomes in children aged 6 months to 10 years in a multi-country population sample. J Infect 2016; 74:29-41. [PMID: 27667752 PMCID: PMC7112512 DOI: 10.1016/j.jinf.2016.09.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/01/2016] [Accepted: 09/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Better population data on respiratory viruses in children in tropical and southern hemisphere countries is needed. METHODS The epidemiology of respiratory viruses among healthy children (6 months to <10 years) with influenza-like illness (ILI) was determined in a population sample derived from an influenza vaccine trial (NCT01051661) in 17 centers in eight countries (Australia, South East Asia and Latin America). Active surveillance for ILI was conducted for approximately 1 year (between February 2010 and August 2011), with PCR analysis of nasal and throat swabs. RESULTS 6266 children were included, of whom 2421 experienced 3717 ILI episodes. Rhinovirus/enterovirus had the highest prevalence (41.5%), followed by influenza (15.8%), adenovirus (9.8%), parainfluenza and respiratory syncytial virus (RSV) (both 9.7%), coronavirus (5.6%), human metapneumovirus (5.5%) and human bocavirus (HBov) (2.0%). Corresponding incidence per 100 person-years was 29.78, 11.34, 7.03, 6.96, 6.94, 4.00, 3.98 and 1.41. Except for influenza, respiratory virus prevalence declined with age. The incidence of medically-attended ILI associated with viral infection ranged from 1.03 (HBov) to 23.69 (rhinovirus/enterovirus). The percentage of children missing school or daycare ranged from 21.4% (HBov) to 52.1% (influenza). CONCLUSIONS Active surveillance of healthy children provided evidence of respiratory illness burden associated with several viruses, with a substantial burden in older children.
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Affiliation(s)
| | - Pio Lopez
- Centro de Estudios en Infectologia Pediatrica, Cali, Colombia
| | - Lily Weckx
- Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Charissa Borja-Tabora
- Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa City, Philippines
| | | | | | - Angkool Kerdpanich
- Infectious Diseases Unit, Department of Pediatrics, Phramongkutklao Hospital, Thailand
| | | | | | | | - Marco Aurelio P Safadi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo and Associação Fundo de Incentivo à Pesquisa, Department of Pediatrics, São Paulo, Brazil
| | - Fong Seng Lim
- National Healthcare Group Polyclinics, National University of Singapore, Singapore
| | | | - Idis Faingezicht
- Instituto Costarricense de Investigaciones Clínicas, San José, Costa Rica
| | | | | | - Ping Li
- GSK Vaccines, King of Prussia, PA, USA
| | | | | | | | | | - Terry Nolan
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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50
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Tan T, Dalby T, Forsyth K, Halperin SA, Heininger U, Hozbor D, Plotkin S, Ulloa-Gutierrez R, Wirsing von König CH. Pertussis Across the Globe: Recent Epidemiologic Trends From 2000 to 2013. Pediatr Infect Dis J 2015; 34:e222-32. [PMID: 26376316 DOI: 10.1097/inf.0000000000000795] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pertussis has reemerged as a problem across the world. To better understand the nature of the resurgence, we reviewed recent epidemiologic data and we report disease trends from across the world. Published epidemiologic data from January 2000 to July 2013 were obtained via PubMed searches and open-access websites. Data on vaccine coverage and reported pertussis cases from 2000 through 2012 from the 6 World Health Organization regions were also reviewed. Findings are confounded not only by the lack of systematic and comparable observations in many areas of the world but also by the cyclic nature of pertussis with peaks occurring every 3-5 years. It appears that pertussis incidence has increased in school-age children in North America and western Europe, where acellular pertussis vaccines are used, but an increase has also occurred in some countries that use whole-cell vaccines. Worldwide, pertussis remains a serious health concern, especially for infants, who bear the greatest disease burden. Factors that may contribute to the resurgence include lack of booster immunizations, low vaccine coverage, improved diagnostic methods, and genetic changes in the organism. To better understand the epidemiology of pertussis and optimize disease control, it is important to improve surveillance worldwide, irrespective of pertussis vaccine types and schedules used in each country.
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Affiliation(s)
- Tina Tan
- *Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; †Department of Immunology, Microbiology, and Molecular Biology, Statens Serum Institut, Copenhagen, Denmark; ‡Department of Pediatrics, Flinders University, Adelaide, Australia; §Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; ¶Department of Pediatrics, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland; ‖Department of Pediatrics, Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET La Plata, Argentina; **Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; ††Department of Pediatrics, Hospital Nacional de Niños de Costa Rica "Dr. Carlos Sáenz Herrera," San José, Costa Rica; and ‡‡Labor:Medizin Krefeld MVZ, Krefeld, Germany
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