1
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Preiksaitis J, Allen U, Bollard CM, Dharnidharka VR, Dulek DE, Green M, Martinez OM, Metes DM, Michaels MG, Smets F, Chinnock RE, Comoli P, Danziger-Isakov L, Dipchand AI, Esquivel CO, Ferry JA, Gross TG, Hayashi RJ, Höcker B, L'Huillier AG, Marks SD, Mazariegos GV, Squires J, Swerdlow SH, Trappe RU, Visner G, Webber SA, Wilkinson JD, Maecker-Kolhoff B. The IPTA Nashville Consensus Conference on Post-Transplant lymphoproliferative disorders after solid organ transplantation in children: III - Consensus guidelines for Epstein-Barr virus load and other biomarker monitoring. Pediatr Transplant 2024; 28:e14471. [PMID: 37294621 DOI: 10.1111/petr.14471] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 01/02/2023] [Indexed: 06/11/2023]
Abstract
The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders after solid organ transplantation in children. In this report from the Viral Load and Biomarker Monitoring Working Group, we reviewed the existing literature regarding the role of Epstein-Barr viral load and other biomarkers in peripheral blood for predicting the development of PTLD, for PTLD diagnosis, and for monitoring of response to treatment. Key recommendations from the group highlighted the strong recommendation for use of the term EBV DNAemia instead of "viremia" to describe EBV DNA levels in peripheral blood as well as concerns with comparison of EBV DNAemia measurement results performed at different institutions even when tests are calibrated using the WHO international standard. The working group concluded that either whole blood or plasma could be used as matrices for EBV DNA measurement; optimal specimen type may be clinical context dependent. Whole blood testing has some advantages for surveillance to inform pre-emptive interventions while plasma testing may be preferred in the setting of clinical symptoms and treatment monitoring. However, EBV DNAemia testing alone was not recommended for PTLD diagnosis. Quantitative EBV DNAemia surveillance to identify patients at risk for PTLD and to inform pre-emptive interventions in patients who are EBV seronegative pre-transplant was recommended. In contrast, with the exception of intestinal transplant recipients or those with recent primary EBV infection prior to SOT, surveillance was not recommended in pediatric SOT recipients EBV seropositive pre-transplant. Implications of viral load kinetic parameters including peak load and viral set point on pre-emptive PTLD prevention monitoring algorithms were discussed. Use of additional markers, including measurements of EBV specific cell mediated immunity was discussed but not recommended though the importance of obtaining additional data from prospective multicenter studies was highlighted as a key research priority.
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Affiliation(s)
- Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Upton Allen
- Division of Infectious Diseases and the Transplant and Regenerative Medicine Center, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA
| | - Vikas R Dharnidharka
- Department of Pediatrics, Division of Pediatric Nephrology, Hypertension & Pheresis, Washington University School of Medicine & St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Daniel E Dulek
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Olivia M Martinez
- Department of Surgery and Program in Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Diana M Metes
- Departments of Surgery and Immunology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Françoise Smets
- Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | | | - Patrizia Comoli
- Cell Factory & Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico, Pavia, Italy
| | - Lara Danziger-Isakov
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Judith A Ferry
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas G Gross
- Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Britta Höcker
- University Children's Hospital, Pediatrics I, Heidelberg, Germany
| | - Arnaud G L'Huillier
- Faculty of Medicine, Pediatric Infectious Diseases Unit and Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - George Vincent Mazariegos
- Department of Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Steven H Swerdlow
- Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ralf U Trappe
- Department of Hematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Germany
- Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Gary Visner
- Division of Pulmonary Medicine, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - James D Wilkinson
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
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Wilkinson JD, Allen U, Green M, Dipchand AI, Dharnidharka VR, Esquivel CO, Maecker-Kolhoff B, Preiksaitis J, Swerdlow SH, Webber SA. The IPTA Nashville consensus conference on post-transplant lymphoproliferative disorders after solid organ transplantation in children: I-Methodology for the development of consensus practice guidelines. Pediatr Transplant 2024; 28:e14333. [PMID: 36369733 DOI: 10.1111/petr.14333] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022]
Abstract
The International Pediatric Transplant Association (IPTA) Consensus Conference on Practice Guidelines for the Diagnosis, Prevention, and Management of Post-Transplant Lymphoproliferative Disorders after Solid Organ Transplantation in Children took place on March 12-13, 2019, and the work of conference members continued until the end of December 2021. The goal was to produce evidence-based consensus guidelines on the definitions, diagnosis, prevention, and management of PTLD and related disorders based on the critical review of the literature and consensus of experts. This report describes the goals, organization, and methodology of the consensus conference and follow-up activities. The results of each working group (Definitions, Prevention, Management, and Epstein-Barr viral [EBV] load/Biomarker Monitoring) are presented in separate manuscripts within this volume of Pediatric Transplantation.
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Affiliation(s)
- James D Wilkinson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Upton Allen
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anne I Dipchand
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children' s Hospital, St. Louis, Missouri, USA
| | - Carlos O Esquivel
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven H Swerdlow
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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3
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Green M, Squires JE, Chinnock RE, Comoli P, Danziger-Isakov L, Dulek DE, Esquivel CO, Höcker B, L'Huillier AG, Mazariegos GV, Visner GA, Bollard CM, Dipchand AI, Ferry JA, Gross TG, Hayashi R, Maecker-Kolhoff B, Marks S, Martinez OM, Metes DM, Michaels MG, Preiksaitis J, Smets F, Swerdlow SH, Trappe RU, Wilkinson JD, Allen U, Webber SA, Dharnidharka VR. The IPTA Nashville consensus conference on Post-Transplant lymphoproliferative disorders after solid organ transplantation in children: II-consensus guidelines for prevention. Pediatr Transplant 2024; 28:e14350. [PMID: 36369745 DOI: 10.1111/petr.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022]
Abstract
The International Pediatric Transplant Association (IPTA) convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorder after solid organ transplantation in children. In this report from the Prevention Working Group, we reviewed the existing literature regarding immunoprophylaxis and chemoprophylaxis, and pre-emptive strategies. While the group made a strong recommendation for pre-emptive reduction of immunosuppression at the time of EBV DNAemia (low to moderate evidence), no recommendations for use could be made for any prophylactic strategy or alternate pre-emptive strategy, largely due to insufficient or conflicting evidence. Current gaps and future research priorities are highlighted.
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Affiliation(s)
- Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Patrizia Comoli
- Cell Factory & Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
| | - Lara Danziger-Isakov
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel E Dulek
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Britta Höcker
- Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Arnaud G L'Huillier
- Pediatric Infectious Diseases Unit and Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - George Vincent Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gary A Visner
- Division of Pulmonary Medicine, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Judith A Ferry
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas G Gross
- Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Robert Hayashi
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | | | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Olivia M Martinez
- Department of Surgery and Program in Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Diana M Metes
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Françoise Smets
- Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stephen H Swerdlow
- Division of Hematopathology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ralf U Trappe
- Department of Hematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Germany and Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - James D Wilkinson
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Upton Allen
- Division of Infectious Diseases and the Transplant and Regenerative Medicine Center, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Vikas R Dharnidharka
- Department of Pediatrics, Division of Pediatric Nephrology, Hypertension & Pheresis, Washington University School of Medicine & St. Louis Children's Hospital, St. Louis, Missouri, USA
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4
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Geerlinks AV, Allen U, Ngan BY, Punnett A. PD-L1 and PD-1 expression in pediatric post-transplant Burkitt lymphoma and other monomorphic post-transplant lymphoproliferative disorders. Pediatr Blood Cancer 2023; 70:e30674. [PMID: 37715724 DOI: 10.1002/pbc.30674] [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: 03/14/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorders (PTLD) develop as a consequence of immune suppression. Programmed death protein 1 (PD-1), a regulator of host immune activation, binds to programmed death-ligand 1 (PD-L1) to suppress the T-cell immune response. PD-1/PD-L1 pathway may play a role in PTLD. The objective was to describe intratumoral expression of PD-L1 and PD-1 in pediatric monomorphic PTLD, and assess if density of these cells is associated with progression-free survival (PFS) and overall survival (OS). PROCEDURE Clinical variables and outcome data were collected on B-cell monomorphic PTLD treated in Toronto, Canada between 2000 and 2017. Diagnostic area from tumor tissue was identified to count CD3-positive or PD-1-positive cells and CD3-negative lymphoma B cells or PD-L1-positive cells. CD3+ , PD-1+ , and PD-L1+ cell densities were compared between cases of PTLD. OS and PFS were analyzed. RESULTS We identified 25 cases of B-cell monomorphic PTLD; majority Burkitt lymphoma (32%) and diffuse large B-cell lymphoma (56%). All cases had CD3+ cells infiltrating the tumor, and median percentage of CD3+ cells was 14% (interquartile range: 6.2%-25%). Twelve cases (48%) had PD-1+ cell infiltrating (range: 1%-83%) and 13 cases (52%) had no PD-1+ cells infiltrating. Sixteen cases (64%) had PD-L1+ cells present; however, there was no PD-L1 expression on any Burkitt lymphoma tissue. When comparing PD-1 and PD-L1 expression, there was no difference in OS or PFS. CONCLUSION Intratumoral presence of PD-1+ and PD-L1+ cells varied in pediatric patients with monomorphic PTLD; however, no relationship to OS and PFS was identified.
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Affiliation(s)
- Ashley V Geerlinks
- Pediatric Hematology/Oncology, Children's Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Upton Allen
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bo-Yee Ngan
- Division of Pathology, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela Punnett
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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5
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Reece-Mills M, Bodkyn C, Baxter JAB, Allen U, Alexis C, Browne-Farmer C, Craig J, de Young S, Denburg A, Dindial K, Fleming-Carroll B, Gibson T, Gupta S, Knight-Madden J, Manley-Kucey M, Mclean-Salmon S, Ocho ON, Orrigio K, Read S, Sin Quee C, Smith B, Thame M, Wharfe G, Whitlock JA, Zlotkin S, Blanchette V. Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI). Lancet Reg Health Am 2023; 26:100592. [PMID: 37727865 PMCID: PMC10506063 DOI: 10.1016/j.lana.2023.100592] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.
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Affiliation(s)
- Michelle Reece-Mills
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Curt Bodkyn
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Jo-Anna B. Baxter
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Upton Allen
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Cheryl Alexis
- Haematology/Oncology Department, Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - Jenna Craig
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephanie de Young
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kevon Dindial
- Department of Paediatrics, Eric Williams Medical Sciences Complex, San Juan, Trinidad and Tobago
| | - Bonnie Fleming-Carroll
- Learning Institute, Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey Gibson
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | - Oscar Noel Ocho
- Faculty of Medical Sciences, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
- PAHO/WHO Collaborating Centre for Nursing and Midwifery Development in the Caribbean, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Kadine Orrigio
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Stanley Read
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
| | - Corrine Sin Quee
- School of Clinical Medicine and Research, The University of the West Indies, Nassau, The Bahamas
| | - Brian Smith
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Minerva Thame
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Gilian Wharfe
- Department of Haematology/Oncology, The University of the West Indies, Kingston, Jamaica
| | - James A. Whitlock
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Victor Blanchette
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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6
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Yoo S, Garg E, Elliott LT, Hung RJ, Halevy AR, Brooks JD, Bull SB, Gagnon F, Greenwood C, Lawless JF, Paterson AD, Sun L, Zawati MH, Lerner-Ellis J, Abraham R, Birol I, Bourque G, Garant JM, Gosselin C, Li J, Whitney J, Thiruvahindrapuram B, Herbrick JA, Lorenti M, Reuter MS, Adeoye OO, Liu S, Allen U, Bernier FP, Biggs CM, Cheung AM, Cowan J, Herridge M, Maslove DM, Modi BP, Mooser V, Morris SK, Ostrowski M, Parekh RS, Pfeffer G, Suchowersky O, Taher J, Upton J, Warren RL, Yeung R, Aziz N, Turvey SE, Knoppers BM, Lathrop M, Jones S, Scherer SW, Strug LJ. HostSeq: a Canadian whole genome sequencing and clinical data resource. BMC Genom Data 2023; 24:26. [PMID: 37131148 PMCID: PMC10152008 DOI: 10.1186/s12863-023-01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/22/2023] [Indexed: 05/04/2023] Open
Abstract
HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.
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Affiliation(s)
- S Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - E Garg
- Simon Fraser University, Burnaby, BC, Canada
| | - L T Elliott
- Simon Fraser University, Burnaby, BC, Canada
| | - R J Hung
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - A R Halevy
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J D Brooks
- University of Toronto, Toronto, ON, Canada
| | - S B Bull
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - F Gagnon
- University of Toronto, Toronto, ON, Canada
| | - Cmt Greenwood
- McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - J F Lawless
- University of Waterloo, Waterloo, ON, Canada
| | - A D Paterson
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L Sun
- University of Toronto, Toronto, ON, Canada
| | | | - J Lerner-Ellis
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Rjs Abraham
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - I Birol
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - G Bourque
- McGill University, Montreal, QC, Canada
| | - J-M Garant
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - C Gosselin
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Li
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Whitney
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - J-A Herbrick
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M Lorenti
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M S Reuter
- The Hospital for Sick Children, Toronto, ON, Canada
| | - O O Adeoye
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S Liu
- The Hospital for Sick Children, Toronto, ON, Canada
| | - U Allen
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - F P Bernier
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - C M Biggs
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - J Cowan
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Herridge
- University Health Network, Toronto, ON, Canada
| | | | - B P Modi
- BC Children's Hospital, Vancouver, BC, Canada
| | - V Mooser
- McGill University, Montreal, QC, Canada
| | - S K Morris
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - M Ostrowski
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - R S Parekh
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - G Pfeffer
- University of Calgary, Calgary, AB, Canada
| | | | - J Taher
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - J Upton
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - R L Warren
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Rsm Yeung
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - N Aziz
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S E Turvey
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | | | - M Lathrop
- McGill University, Montreal, QC, Canada
| | - Sjm Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - S W Scherer
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L J Strug
- The Hospital for Sick Children, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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7
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Vaisbourd Y, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, BScPhm JH, Schiff J, Phan V, De Geest S, Allen U, Avitzur Y, Mital S, Foster BJ. Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients. Pediatr Transplant 2023; 27:e14446. [PMID: 36478059 DOI: 10.1111/petr.14446] [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: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. METHODS This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. RESULTS Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. CONCLUSION Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Medicine, McGill University, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | | | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Harrison BScPhm
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Center of Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Bethany J Foster
- Department of Pediatrics, McGill University, Quebec, Canada.,Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
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8
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Kitano T, Schwartz KL, Abdulnoor M, Garfield H, Booran NK, Avitzur Y, Teoh CW, Hébert D, Allen U. Immunogenicity of a quadrivalent human papillomavirus vaccine in pediatric kidney and liver transplant recipients. Pediatr Transplant 2023; 27:e14476. [PMID: 36740761 DOI: 10.1111/petr.14476] [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: 08/26/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Solid-organ transplant recipients are at increased risk of developing human papillomavirus-related diseases. METHODS To evaluate the immunogenicity of a quadrivalent vaccine, a prospective observational study included females aged 12-19 years who had received kidney or liver transplants, or were otherwise healthy volunteers. With the three-dose vaccination, serum antibodies were measured. RESULTS The study included 17 transplant recipients (seven kidney and 10 liver) and 16 healthy participants. Six of seven kidney transplant recipients were on three immunosuppressive medications, whereas 9 of the 10 liver transplant recipients were on one. For the serology within 6 months from the last vaccine dose, the geometric mean titers of human papillomavirus types 6, 11, 16, and 18 were 26.7, 8.6, 35.7, and 42.4 (kidney transplant); 579.2, 569.3, 3097.3, and 835.7 (liver transplant); and 860.5, 638.8, 4391.6, and 902.6 milli-Merck Units/ml (healthy). The seropositivity rates of kidney transplant recipients for the four serotypes ranged from 50% to 75%, while all liver transplant recipients and healthy participants had 100% seropositivity rates for all four types. While there were no statistical differences of titers between liver transplant recipients and healthy participants, the titers of kidney transplant recipients were lower than those of healthy participants for type 6 (p = .034), type 11 (p = .032), and type 16 (p = .032). CONCLUSIONS The results support the recommendation of human papillomavirus vaccination in pediatric transplant recipients given the significant risk of human papillomavirus-related diseases in this population, though immunogenicity was lower in kidney transplant recipients on multiple immunosuppressive medications.
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Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, St. Joseph Health Centre, Toronto, Ontario, Canada
| | - Mariana Abdulnoor
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hartley Garfield
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nasser Khodai Booran
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chia Wei Teoh
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Diane Hébert
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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9
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Piché‐Renaud P, Kitano T, Campigotto A, Teoh CW, Allen U. The SARS-CoV-2-positive donor in pediatric organ transplantation. Pediatr Transplant 2022:e14450. [PMID: 36518032 PMCID: PMC9877656 DOI: 10.1111/petr.14450] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Pierre‐Philippe Piché‐Renaud
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Taito Kitano
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Chia Wei Teoh
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
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10
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Science M, Caldeira-Kulbakas M, Parekh RS, Maguire BR, Carroll S, Anthony SJ, Bitnun A, Bourns LE, Campbell DM, Cohen E, Dodds A, Dubey V, Friedman JN, Greenwood JL, Hopkins JP, Imgrund R, Korczak DJ, Looi T, Louca E, Mertz D, Nashid J, Panzera G, Schneiderman JE, Schwartz KL, Streitenberger L, Vuppal S, Walsh CM, Jüni P, Matava CT, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. Effect of Wearing a Face Mask on Hand-to-Face Contact by Children in a Simulated School Environment: The Back-to-School COVID-19 Simulation Randomized Clinical Trial. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. INTERVENTIONS Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). MAIN OUTCOMES AND MEASURES The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. RESULTS A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). CONCLUSIONS AND RELEVANCE In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
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11
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Adeagbo M, Olukotun M, Musa S, Alaazi D, Allen U, Renzaho AMN, Sekyi-Otu A, Salami B. Improving COVID-19 Vaccine Uptake among Black Populations: A Systematic Review of Strategies. Int J Environ Res Public Health 2022; 19:11971. [PMID: 36231270 PMCID: PMC9565689 DOI: 10.3390/ijerph191911971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 05/28/2023]
Abstract
Given the growing body of evidence on COVID-19 vaccine hesitancy among Black populations, the aim of this systematic review was to identify the interventions and strategies used to improve COVID-19 vaccine confidence and uptake among Black populations globally. To identify relevant studies, we conducted a systematic review of the literature based on a systematic search of 10 electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Cochrane Library, Web of Science, Sociological Abstracts, Dissertations and Theses Global, and SocINDEX. We screened a total of 1728 records and included 14 peer-reviewed interventional studies that were conducted to address COVID-19 vaccine hesitancy among Black populations. A critical appraisal of the included studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The intervention strategies for increasing COVID-19 vaccine uptake were synthesized into three major categories: communication and information-based interventions, mandate-based interventions, and incentive-based interventions. Interventions that incorporated communication, community engagement, and culturally inclusive resources significantly improved vaccine uptake among Black populations, while incentive- and mandate-based interventions had less impact. Overall, this systematic review revealed that consideration of the sociocultural, historical, and political contexts of Black populations is important, but tailored interventions that integrate culture-affirming strategies are more likely to decrease COVID-19 vaccine hesitancy and increase uptake among Black populations.
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Affiliation(s)
- Morolake Adeagbo
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mary Olukotun
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Salwa Musa
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Dominic Alaazi
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Upton Allen
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Andre M. N. Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Ato Sekyi-Otu
- Department of Surgery, University of Toronto, Toronto, ON M5S 2J7, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada
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12
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Kitano T, Allen U. Antimicrobial stewardship in pediatric solid organ transplantation. Is it possible? Transpl Infect Dis 2022; 24:e13928. [PMID: 35980210 DOI: 10.1111/tid.13928] [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: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at increased risk of severe outcomes associated with antimicrobial resistance (AMR). Antimicrobial stewardship programs (ASP) play a vital role in mitigating the negative impacts of AMR. Pediatric evidence regarding ASP for SOT recipients is scarce, although many pediatric SOT centers have implemented different forms of ASP. METHODS This article summarized the available evidence relating to AMR among pediatric SOT recipients and discussed key strategies for the successful implementation of ASP among this population. The focus is primarily on antibacterial and secondarily on antifungal management RESULTS: The development of multi-disciplinary antimicrobial stewardship teams for pediatric SOT recipients is essential for successful stewardship implementation. Key stakeholders may include but are not limited to SOT recipients and their caregivers, primary SOT teams (transplant physicians, transplant pharmacists, transplant unit nurses, and transplant outpatient care team), transplant surgery teams, transplant infectious diseases teams, hospital AST, microbiology teams, infection prevention teams, quality improvement teams, and information technology teams. CONCLUSION As the evidence for optimal ASP in pediatric SOT is still evolving, it is important to measure the impact of implemented interventions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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13
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Kitano T, Campigotto A, Allen U. The challenge of evaluating of SARS-CoV-2 antibody responses among vaccinated transplant patients. Pediatr Transplant 2022; 26:e14319. [PMID: 35616121 PMCID: PMC9348348 DOI: 10.1111/petr.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
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14
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Dabirzadeh A, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, White M, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, Harrison J, Schiff J, Phan V, De Geest S, Allen U, Mital S, Foster BJ. Care processes and structures associated with higher medication adherence in adolescent and young adult transplant recipients. Pediatr Transplant 2021; 25:e14106. [PMID: 34339090 DOI: 10.1111/petr.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to identify care processes and structures that were independently associated with higher medication adherence among young transplant recipients. METHODS We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14-25 years old. Patients were ≥3 months post-transplant, ≥2 months post-discharge, and followed in one of 14 pediatric or 14 adult transplant programs in Canada. Patients were enrolled between June 2015 and March 2018 and followed for 6 months. Adherence was assessed at baseline, 3, and 6 months using the BAASIS© self-report tool. Patients were classified as adherent if no doses were missed in the prior 4 weeks. Transplant program directors and nurses completed questionnaires regarding care organization and processes. RESULTS Of the 270 participants, 99 were followed in pediatric programs and 171 in adult programs. Median age was 20.3 years, and median time since transplant was 5 years. At baseline, 71.5% were adherent. Multivariable mixed effects logistic regression models with program as a random effect identified two program-level factors as independently associated with better adherence: minimum number of prescribed blood draws per year for those >3 years post-transplant (per 1 additional) (OR 1.12 [95% CI 1.00, 1.26]; p = .047), and average time nurses spend with patients in clinic (per 5 additional minutes) (OR 1.15 [1.03, 1.29]; p = .017). CONCLUSION Program-level factors including protocols with a greater frequency of routine blood testing and more nurse time with patients were associated with better medication adherence. This suggests that interventions at the program level may support better adherence.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Heloise Cardinal
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Institut de Cardiologie, Université de Montréal, Montreal, QC, Canada
| | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Jennifer Harrison
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Jeffrey Schiff
- Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Veronique Phan
- CHU Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Academic Center of Nursing and Midwifery, Department of Primary Care and Public Health, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Bethany J Foster
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
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15
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Shimamoto Y, Verstegen RHJ, Mizuno T, Schechter T, Allen U, Ito S. Population pharmacokinetics of vancomycin in paediatric patients with febrile neutropenia and augmented renal clearance: development of new dosing recommendations. J Antimicrob Chemother 2021; 76:2932-2940. [PMID: 34480578 DOI: 10.1093/jac/dkab302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the influence of augmented renal clearance (ARC) on vancomycin clearance and provide dosage recommendations for paediatric patients with febrile neutropenia following HSCT. METHODS A population pharmacokinetic analysis was performed based on a two-compartment model structure using a non-linear mixed-effect modelling approach. Monte Carlo simulations were conducted as a target attainment analysis of AUC between 400 mg·h/L and 650 mg·h/L for MRSA at an MIC of 1 mg/L. RESULTS A total of 165 paediatric patients and 276 vancomycin serum concentrations were analysed in this study. Age, body weight, estimated glomerular filtration rate (eGFR) and fever (≥38.0°C) were identified as factors that significantly influenced vancomycin clearance. The median eGFR of the population was 143 mL/min/1.73 m2 and 34% of patients showed an eGFR ≥160 mL/min/1.73 m2, which may be classified as ARC. Our simulations showed that current dosing recommendations result in poor target attainment. In particular, children aged 6 months old to 6 years old with ARC require an initial vancomycin dose up to 35%-65% higher than the current dosing guidelines. CONCLUSIONS ARC is frequently observed in paediatric patients with post-HSCT febrile neutropenia, resulting in a significant increase in vancomycin clearance. We propose a vancomycin dosing strategy for children with febrile neutropenia following HSCT based on eGFR, age, weight and body temperature.
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Affiliation(s)
- Yuko Shimamoto
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Tomoyuki Mizuno
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tal Schechter
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology/BMT, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Upton Allen
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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16
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Science M, Bolotin S, Silverman M, Nadarajah J, Maguire B, Parekh RS, McGeer A, Schwartz KL, Alexander L, Allen U, Ariyarajah A, Castellani L, Cohn RD, Downing M, Katz K, Kazmi K, Leis JA, Liu D, Pernica JM, Schneiderman JE, Sumaida M, Campigotto A. SARS-CoV-2 antibodies in Ontario health care workers during and after the first wave of the pandemic: a cohort study. CMAJ Open 2021; 9:E929-E939. [PMID: 34642255 PMCID: PMC8513603 DOI: 10.9778/cmajo.20210044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Health care workers have a critical role in the pandemic response to COVID-19 and may be at increased risk of infection. The objective of this study was to assess the seroprevalence of SARS-CoV-2 immunoglobulin G (IgG) antibodies among health care workers during and after the first wave of the pandemic. METHODS We conducted a prospective multicentre cohort study involving health care workers in Ontario, Canada, to detect IgG antibodies against SARS-CoV-2. Blood samples and self-reported questionnaires were obtained at enrolment, at 6 weeks and at 12 weeks. A community hospital, tertiary care pediatric hospital and a combined adult-pediatric academic health centre enrolled participants from Apr. 1 to Nov. 13, 2020. Predictors of seropositivity were evaluated using a multivariable logistic regression, adjusted for clustering by hospital site. RESULTS Among the 1062 health care workers participating, the median age was 40 years, and 834 (78.5%) were female. Overall, 57 (5.4%) were seropositive at any time point (2.5% when participants with prior infection confirmed by polymerase chain reaction testing were excluded). Seroprevalence was higher among those who had a known unprotected exposure to a patient with COVID-19 (p < 0.001) and those who had been contacted by public health because of a nonhospital exposure (p = 0.003). Providing direct care to patients with COVID-19 or working on a unit with a COVID-19 outbreak was not associated with higher seroprevalence. In multivariable logistic regression, presence of symptomatic contacts in the household was the strongest predictor of seropositivity (adjusted odds ratio 7.15, 95% confidence interval 5.42-9.41). INTERPRETATION Health care workers exposed to household risk factors were more likely to be seropositive than those not exposed, highlighting the need to emphasize the importance of public health measures both inside and outside of the hospital.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
| | - Shelly Bolotin
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Michael Silverman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeya Nadarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Bryan Maguire
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Rulan S Parekh
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Allison McGeer
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin L Schwartz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Laura Alexander
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Upton Allen
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Archchun Ariyarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Lucas Castellani
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Ronald D Cohn
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Mark Downing
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin Katz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kescha Kazmi
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jerome A Leis
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Derek Liu
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeffrey M Pernica
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jane E Schneiderman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Maya Sumaida
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Aaron Campigotto
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
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17
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Groves H, Piché‐Renaud P, Allen U. The significance and impact of SARS-CoV-2 variants of concern in pediatric solid organ transplantation: More unknowns than knowns. Pediatr Transplant 2021; 25:e14071. [PMID: 34132451 PMCID: PMC8420296 DOI: 10.1111/petr.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Helen Groves
- Division of Infectious DiseasesDepartment of PaediatricsHospital for Sick ChildrenTorontoONCanada
| | | | - Upton Allen
- Division of Infectious DiseasesDepartment of PaediatricsHospital for Sick ChildrenTorontoONCanada,Transplant Regenerative Medicine CentreUniversity of TorontoTorontoONCanada
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18
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Kitano T, Science M, Nalli N, Timberlake K, Allen U, Teoh CW, Campigotto A. Solid organ transplant-specific antibiogram in a tertiary pediatric hospital in Canada. Pediatr Transplant 2021; 25:e13980. [PMID: 33528088 DOI: 10.1111/petr.13980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/30/2022]
Abstract
SOT recipients are more vulnerable to infections with antimicrobial-resistant organisms, and therefore, it may be useful for transplant centers to create transplant-specific antibiograms to direct empirical antimicrobial regimens and monitor trends in antimicrobial resistance. SOT-specific antibiograms were created using antimicrobial susceptibility data on isolates from 2012 to 2018 at The Hospital for Sick Children, Toronto, Ontario, Canada. The CLSI guidelines were followed to generate the antibiograms except that results from 2 years of data were pooled on a rolling basis to achieve larger sample sizes. The 3 most frequent organisms in one analysis period of the SOT antibiogram were Escherichia coli (average sample size ±standard deviation; n = 28.7 ± 3.8), Staphylococcus aureus (n = 27.8 ± 5.0), and Pseudomonas aeruginosa (non-CF) (n = 19.8 ± 8.8). For E.coli, susceptibilities in the SOT antibiogram were significantly lower than those in the hospital-wide antibiogram in 2017-2018 for ampicillin (27% vs 47%; p = .014), piperacillin/tazobactam (55% vs 88%; p < .001), cefotaxime (59% vs 89%; p < .001), ciprofloxacin (71% vs 88%; p = .007), and trimethoprim-sulfamethoxazole (41% vs 69%; p = .001), but not significantly different for aminoglycosides and meropenem. In the SOT antibiogram of E. coli, decreased susceptibility trend was confirmed in some antibiotics, including piperacillin/tazobactam (83% in 2012-2013 vs 55% in 2017-2018). At our center, the solid organ transplant-specific antibiogram revealed important differences in E. coli susceptibilities and trends in antimicrobial resistance. Developing a SOT antibiogram will assist in revising and improving empiric treatment guidelines as well as monitoring antimicrobial resistance in this population.
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Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, Department of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Science
- Division of Infectious Diseases, Department of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Nadya Nalli
- Department of Pharmacy, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Upton Allen
- Division of Infectious Diseases, Department of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Chia Wei Teoh
- Division of Nephrology, Department of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
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19
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Mehta K, Al-Yabes O, Allen A, Williams A, Petrich A, Langlois V, Hébert D, Allen U. Burden of cytomegalovirus DNAemia among pediatric renal transplant patients on antiviral prophylaxis: A hospital-based analysis. Pediatr Transplant 2020; 24:e13650. [PMID: 31891234 DOI: 10.1111/petr.13650] [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: 01/22/2019] [Revised: 11/02/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We examined the burden of CMV DNAemia and time to such events among renal transplant patients receiving CMV prophylaxis. We targeted the first year after transplantation, with the primary focus being on the first 3 months. METHODS We conducted a retrospective review of renal transplant patients (<18 years) who were transplanted and followed at our center between January 2007, and December 2017. Clinical and laboratory data were obtained from the medical records and laboratory databases. RESULTS Among 141 patients, the median age at transplant was 12.7 years (range 0.87-17.83 years). CMV DNAemia was detected in 33 of 77 patients eligible for prophylaxis (42.9%; 95% CI 31.6-54.6) during the first post-transplant year. Proportionately more D+R- patients were present among patients with DNAemia compared with those without DNAemia (15/38, 39.5% vs 16/103, 15.5%, P = .005). Median time to first positivity was 134 days (range 0-304 days). Eight patients had a positive PCR during the first 3 months (5.7% of all patients). Among those eligible for prophylaxis, 6.5% had DNAemia during the first 3 months while on prophylaxis. Among patients whose first positive PCR was after 3 months post-transplant, the median time to positivity was 52 days (range 13-214 days) after the end of prophylaxis. CONCLUSIONS Breakthrough CMV DNAemia was documented among children receiving antiviral prophylaxis. While routine monitoring while on prophylaxis might not be warranted for the majority of patients, studies are needed to determine the optimal indications for CMV PCR testing while on prophylaxis.
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Affiliation(s)
- Kayur Mehta
- Division of Infectious, Hospital for Sick Children, Toronto, ON, Canada
| | - Ohoud Al-Yabes
- Division of Infectious, Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew Allen
- Division of Infectious, Hospital for Sick Children, Toronto, ON, Canada
| | - Angela Williams
- Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.,The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Astrid Petrich
- Deaprtment of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Valerie Langlois
- Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.,The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Diane Hébert
- Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.,The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Upton Allen
- Division of Infectious, Hospital for Sick Children, Toronto, ON, Canada.,The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
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20
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Tam J, Papenburg J, Fanella S, Asner S, Barton M, Bergeron C, Desai S, Hui C, Foo C, Langley JM, Leifso K, Ma ML, Pernica J, Robinson J, Singh R, Tapiero B, Allen U. Pediatric Investigators Collaborative Network on Infections in Canada Study of Respiratory Syncytial Virus-associated Deaths in Pediatric Patients in Canada, 2003-2013. Clin Infect Dis 2020; 68:113-119. [PMID: 29788036 PMCID: PMC7108116 DOI: 10.1093/cid/ciy413] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is a major cause of pneumonia and bronchiolitis in children. Mortality rates in previously healthy children hospitalized with RSV are <0.5%, but up to 37% in patients with underlying medical conditions. The objective of this study was to characterize factors associated with deaths among children hospitalized with RSV infection in Canadian pediatric centers. Methods A retrospective case series of children aged ≤18 years with RSV-associated deaths at centers affiliated with the Pediatric Investigators Collaborative Network on Infections in Canada from 2003–2013, inclusive, was performed. Cases were identified using RSV-specific International Classification of Diseases codes to capture deaths where a diagnosis of RSV infection was present. Results Eleven centers reported 79 RSV-associated deaths. RSV was regarded as primarily responsible for death in 32 cases (40.5%). Median age at death was 11 months (range, <1 month to 16 years). Thirty-nine patients (49.4%) were male. Fourteen patients (17.7%) had no known risk factors for severe RSV infection. Healthcare-associated RSV infections (HAIs) accounted for 29 deaths (36.7%), with RSV judged to be the primary cause of death in 9 of these cases. Conclusions RSV-associated deaths were predominantly associated with chronic medical conditions and immunocompromised states among infants; however, 1 in 5 deaths occurred among patients with no known risk factors for severe RSV. Mortality associated with HAI accounted for over a third of cases. These findings highlight patient groups that should be targeted for RSV prevention strategies such as infection control practices, immunoprophylaxis, and future vaccination programs.
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Affiliation(s)
- Jennifer Tam
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario
| | - Jesse Papenburg
- Division of Infectious Diseases, Montreal Children's Hospital, Quebec
| | - Sergio Fanella
- Division of Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Sandra Asner
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario.,Unit of Pediatric Infectious Diseases and Vaccinology, Lausanne University Hospital, Switzerland
| | - Michelle Barton
- Division of Infectious Diseases, University of Western Ontario, London
| | - Cybele Bergeron
- Division of Infectious Diseases, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke Fleurimont, Sherbrooke, Quebec
| | - Shalini Desai
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Charles Hui
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa
| | - Cheryl Foo
- Division of Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Center and Nova Scotia Health Authority, Halifax
| | - Kirk Leifso
- Division of Infectious Diseases, Kingston General Hospital, Ontario
| | - My-Linh Ma
- Faculty of Medicine, McGill University, Montreal, Quebec
| | - Jeffrey Pernica
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario
| | - Joan Robinson
- Division of Infectious Diseases, Stollery Children's Hospital, Edmonton, Alberta
| | - Roopi Singh
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario
| | - Bruce Tapiero
- Division of Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine-University of Montreal, Quebec, Canada
| | - Upton Allen
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario
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21
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Penner R, Ionescu L, Mital S, Foster B, Birk P, Phan V, Blydt-Hansen T, Allen U, Hamiwka L, Morgan C, Urschel S. A Novel Tool to Quantify Immune Suppression after Pediatric Transplantation: Flow Cytometric Activation Assays. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.197] [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] [Indexed: 10/27/2022] Open
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22
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Ali S, Krueger J, Richardson SE, Sung L, Waespe N, Renzi S, Chiang K, Allen U, Ali M, Schechter T. The yield of monitoring adenovirus in pediatric hematopoietic stem cell transplant patients. Pediatr Hematol Oncol 2019; 36:161-172. [PMID: 31037986 DOI: 10.1080/08880018.2019.1607961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 02/06/2023]
Abstract
Human adenovirus (HAdV) is recognized as a serious pathogen after allogeneic hematopoietic stem cell transplantation (HSCT), causing morbidity and mortality. Currently, there is no universal agreement regarding routine HAdV surveillance after HSCT. We assessed the impact of HAdV weekly monitoring by polymerase chain reaction (PCR) on HAdV viremia rates and the risk factors that influence survival. Three-hundred and fifty-six pediatric allogeneic HSCT were done between 2007 and 2015. Until July 2011, HAdV testing was performed based on clinical suspicion (cohort 1, n = 175) and from August 2011, weekly blood-HAdV monitoring was done (cohort 2, n = 181) until day +100. Twenty-three patients (4 [2.3%] from cohort 1 and 19 [10.5%] from cohort 2, p = .001) were found with HAdV viremia and seven of them died. Both cohorts had a similar incidence of HAdV-associated mortality (3/175; 1.7% in cohort 1 and 4/181; 2.2% in cohort 2). Respiratory failure was the cause of death in all patients. Clinical symptoms appeared prior to or within 5 days of HAdV detection in cohort 2. In summary, weekly monitoring was associated with higher detection of HAdV. The study could not assess survival benefit due to small numbers of HAdV-positive cases. In many instances, symptoms occurred with the development of positive HAdV blood PCR results and hence, symptomatology could have triggered the test. Future studies are needed to provide data that help establishing a uniform approach for regular monitoring of HAdV post-transplant.
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Affiliation(s)
- Salah Ali
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Joerg Krueger
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
| | - Susan E Richardson
- b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada.,c Department of Pediatric Laboratory Medicine , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Lillian Sung
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
| | - Nicolas Waespe
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,d Swiss Childhood Cancer Registry , Institute of Social and Preventive Medicine , University of Bern , Switzerland.,e CANSEARCH Research Laboratory, Department of Pediatrics , Faculty of Medicine , University of Geneva , Switzerland
| | - Samuele Renzi
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Ky Chiang
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
| | - Upton Allen
- b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada.,f Division of Infectious Diseases, Department of Pediatrics , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Muhammad Ali
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
| | - Tal Schechter
- a Division of Hematology/Oncology/BMT , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
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Science M, Akseer N, Asner S, Allen U. Risk stratification of immunocompromised children, including pediatric transplant recipients at risk of severe respiratory syncytial virus disease. Pediatr Transplant 2019; 23:e13336. [PMID: 30604582 DOI: 10.1111/petr.13336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/13/2018] [Revised: 09/18/2018] [Accepted: 11/02/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is associated with increased morbidity and mortality in immunocompromised patients. Our goal was to develop a framework for risk stratifying immunocompromised patients, including transplant patients, for RSV prophylaxis. METHODS Risk factors for severe RSV disease in immunocompromised patients were identified in the literature and by an expert panel via survey. Experts assigned a probability of developing severe disease (0 to 100 scale) to the risk factors for each immunocompromised population. The results were validated using a clinical dataset. Linear mixed models adjusted for within-expert clustering of ranks were used to estimate average scores, and differences were tested using paired t tests. Logistic regression was utilized to identify important determinants of severe RSV disease. RESULTS The survey was emailed to twenty-seven experts and thirteen responded (48%). Across all transplant groups, age <2 years (mean 77.1, 95% CI 71.7, 82.5) and day care attendance (mean 72.8, 95% CI 67.3, 78.3) were assigned the highest risk of severe disease. The highest risk groups were lung transplant recipients (mean 73.2, 95% CI 67.6, 78.8), combined lung and heart transplant recipients (mean 75.2, 95% CI 69.6, 80.7), allogeneic stem cell transplant (mean 76.0, 95% CI 70.4, 81.6), and severe combined immunodeficiency (mean 74.7, 95% CI 69.1, 80.3). CONCLUSION The results provide a logical validity to current practice and provide guidance for prioritizing patients to receive prophylactic agents to prevent severe RSV disease. The results will facilitate the development of a risk stratification tool for RSV prophylaxis for immunocompromised patients.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nadia Akseer
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sandra Asner
- Pediatric Infectious Diseases Unit, Department of Pediatrics, University Hospital Lausanne, Lausanne, Switzerland
| | - Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Gibson TN, Beeput S, Gaspard J, George C, Gibson D, Jackson N, Leandre-Broome V, Palmer-Mitchell N, Alexis C, Bird-Compton J, Bodkyn C, Boyle R, McLean-Salmon S, Reece-Mills M, Quee-Brown CS, Allen U, Weitzman S, Blanchette V, Gupta S. Baseline characteristics and outcomes of children with cancer in the English-speaking Caribbean: A multinational retrospective cohort. Pediatr Blood Cancer 2018; 65:e27298. [PMID: 30094928 DOI: 10.1002/pbc.27298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/28/2017] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND English-speaking Caribbean (ESC) childhood cancer outcomes are unknown. PROCEDURE Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection. RESULTS A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage. CONCLUSIONS ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements.
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Affiliation(s)
- T N Gibson
- The University Hospital of the West Indies, Kingston, Jamaica
| | - S Beeput
- Bustamante Hospital for Children, Kingston, Jamaica
| | - J Gaspard
- Victoria Hospital, Castries, St. Lucia
| | - C George
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - D Gibson
- Princess Margaret Hospital, Nassau, Bahamas
| | - N Jackson
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | | | - C Alexis
- Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - C Bodkyn
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - R Boyle
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | - M Reece-Mills
- The University Hospital of the West Indies, Kingston, Jamaica
| | | | - U Allen
- The Hospital for Sick Children, Toronto, Canada
| | - S Weitzman
- The Hospital for Sick Children, Toronto, Canada
| | | | - S Gupta
- The Hospital for Sick Children, Toronto, Canada
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Abdulnoor M, Khodai-Booran N, Pietrzyk J, Paton T, Casallo G, Allen U. 657. Epstein–Barr Virus Genetic Diversity in Blood vs. Saliva Samples From Patients with Infectious Mononucleosis. Open Forum Infect Dis 2018. [PMCID: PMC6255591 DOI: 10.1093/ofid/ofy210.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The Epstein–Barr virus (EBV) is associated with several diseases, including infectious mononucleosis as well as malignant disorders. The relationship between strains of the virus and disease manifestation or illness severity is of interest. Such strains have been defined by genetic variations in the major viral genes. As a first step toward a better understanding of the relationship between strains and clinical outcomes, data are required on the patterns of genetic diversity of the virus in different populations. In this study, we examined the genetic diversity of the BZLF-1 gene, which is a major lytic gene of the virus. Methods We sequenced the BZLF-1 gene of EBV following amplification from DNA that was extracted from blood and saliva from previously healthy Canadian children and young adults with infectious mononucleosis. Sequencing was done by Sanger methodology (dideoxy DNA sequencing) and the sequences were aligned with a reference strain of EBV using Geneious software. The variant burden and types of single nucleotide variants were compared in blood and saliva samples. Results Twenty-six samples were obtained from 24 patients less than 24 years of age (16 saliva and 10 blood samples). Two subjects provided paired blood and saliva samples at the same visit. Among 36 single nucleotide variations (SNVs), 22% were common to both blood and saliva samples. There was a nonstatistically significant trend for more SNVs among blood compared with saliva samples (median 6 and 1, ranges 0–8 and 0–9, respectively). Of the 3 exons of BZLF-1, exon 1 had the greatest frequency of SNVs compared with exons 2 and 3. Among the paired samples of blood and saliva, there were different genetic variants of the BZLF-1 gene in the blood compared with the saliva samples obtained from patients with infectious mononucleosis. Conclusion Among patients with infectious mononucleosis, different genetic variants of EBV may be present in blood compared with saliva. Blood samples revealed viral strains with a tendency for more genetic diversity compared with saliva. The potential compartmentalization of strains is of relevance in sample selection for the evaluation of the potential clinical impact of the genetic diversity of EBV. In addition, the potential impact on disease pathogenesis is of interest. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Mariana Abdulnoor
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Nasser Khodai-Booran
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Jessica Pietrzyk
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Tara Paton
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Upton Allen
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
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Thom K, Hanslik A, Russell JL, Williams S, Sivaprakasam P, Allen U, Male C, Brandão LR. Incidence of infective endocarditis and its thromboembolic complications in a pediatric population over 30years. Int J Cardiol 2017; 252:74-79. [PMID: 29126655 DOI: 10.1016/j.ijcard.2017.10.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/27/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates. METHODS A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008). RESULTS The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001). CONCLUSIONS Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data.
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Affiliation(s)
- K Thom
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - A Hanslik
- Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - J L Russell
- Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - S Williams
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - P Sivaprakasam
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - U Allen
- Infectious Disease, The Hospital for Sick Children, Toronto, Canada
| | - C Male
- Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - L R Brandão
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
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27
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Allen U, Green M. Prevention and treatment of influenza illness: A seasonal challenge for transplant patients. Pediatr Transplant 2017; 21. [PMID: 28127882 DOI: 10.1111/petr.12882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Upton Allen
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Green
- Division of Infectious Diseases, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.,Department of Paediatrics, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Mehta K, Al-Yabes O, Petrich A, Williams A, Hebert D, Langlois V, Allen U. Burden of Cytomegalovirus DNAemia among Pediatric Renal Transplant Patients on Antiviral Prophylaxis: A Hospital-Based Analysis. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1926] [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] [Indexed: 11/14/2022] Open
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29
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Tam J, Papenburg J, Fanella S, Asner S, Barton M, Desai S, Foo C, Langley JM, Leifso K, Pernica J, Robinson J, Singh R, Tapiero B, Allen U, Bergeron C. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) Study of Respiratory Syncytial Virus-Associated Deaths in Pediatric Patients in Canada: A Retrospective Review From 2003 to 2013. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.01] [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)
- Jennifer Tam
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Sergio Fanella
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra Asner
- Pediatrics, Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Shalini Desai
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Foo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kirk Leifso
- Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Joan Robinson
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Roopi Singh
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bruce Tapiero
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine–University of Montreal, Montreal, Quebec, Canada
| | - Upton Allen
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cybele Bergeron
- CIUSSS de l'Estrie-CHUS Fleurimont, Sherbrooke, Quebec, Canada
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30
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McGirr AA, Schwartz KL, Allen U, Solomon M, Sander B. The cost-effectiveness of palivizumab in infants with cystic fibrosis in the Canadian setting: A decision analysis model. Hum Vaccin Immunother 2016; 13:599-606. [PMID: 27768505 DOI: 10.1080/21645515.2016.1235670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Children with cystic fibrosis (CF) are at higher risk of severe respiratory syncytial virus (RSV) infection, which can lead to a decline in lung function. A monoclonal antibody, palivizumab (PMB), effectively prevents RSV hospitalizations; however, the high cost of PMB, approximately C$10,000 per patient per RSV season, limits its widespread use. We assess the cost-effectiveness of PMB prophylaxis in CF children less than 2 y of age from the Canadian healthcare payer's perspective. METHODS In 2014, a Markov cohort model of CF disease and infant RSV infections in the Canadian setting was developed based on literature data. Infants were treated with monthly PMB injections over the 5-month RSV season. Lifetime health outcomes, quality-adjusted life years (QALYs) and 2013 $CAD costs, discounted at 5%, were estimated. Findings are summarized as incremental cost-effectiveness ratios (ICERs) and budget impact. Deterministic sensitivity analysis was conducted to assess parameter uncertainty. RESULTS Implementation of a hypothetical Canadian RSV prophylaxis program resulted in ICERs of C$652,560 (all CF infants) and C$157,332 (high-risk CF infants) per QALY gained and an annual budget impact of C$1,400,000 (all CF infants) and C$285,000 (high-risk CF infants). The analysis was highly sensitive to the probability of severe RSV, the degree of lung deterioration following infection, and the cost of PMB. CONCLUSIONS Our results suggest PMB is not cost-effective in Canada by commonly used thresholds. However, given the rarity of CF and relatively small budget impact, consideration may be given for the selective use of PMB for immunoprophylaxis of RSV in high-risk CF infants on a case-by-case scenario basis.
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Affiliation(s)
- Ashleigh A McGirr
- a Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Kevin L Schwartz
- b Division of Infectious Disease , The Hospital for Sick Children , Toronto , ON , Canada.,c Institute of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada
| | - Upton Allen
- b Division of Infectious Disease , The Hospital for Sick Children , Toronto , ON , Canada.,c Institute of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada
| | - Melinda Solomon
- d Division of Respirology , The Hospital for Sick Children , Toronto , ON , Canada
| | - Beate Sander
- c Institute of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada.,e Public Health Ontario , Toronto , ON , Canada.,f Institute for Clinical Evaluative Sciences , Toronto , ON , Canada
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Ali SS, Krueger J, Richardson S, Ali M, Courtney S, Armstrong C, Finkelstein Y, Brager R, Allen U, Schechter T. The Yield of Monitoring for Adenovirus Viremia in Pediatric Hematopoietic Stem Cell Transplant Patients. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.513] [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] [Indexed: 11/15/2022]
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Sung L, Dix D, Cellot S, Gillmeister B, Ethier MC, Roslin NM, Johnston DL, Feusner J, Mitchell D, Lewis V, Aplenc R, Yanofsky R, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Traubici J, Allen U, Beyene J, den Hollander N, Paterson AD. Single nucleotide polymorphism in IL1B is associated with infection risk in paediatric acute myeloid leukaemia. Clin Microbiol Infect 2016; 22:563.e9-563.e17. [PMID: 26932518 DOI: 10.1016/j.cmi.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
We evaluated single nucleotide polymorphisms (SNPs) associated with infection risk in children with newly diagnosed acute myeloid leukaemia (AML). We conducted a multicentre, prospective cohort study that included children aged ≤18 years with de novo AML. DNA was isolated from blood lymphocytes or buccal swabs, and candidate gene SNP analysis was conducted. Primary outcome was the occurrence of microbiologically documented sterile site infection during chemotherapy. Secondary outcomes were Gram-positive and -negative infections, viridans group streptococcal infection and proven/probable invasive fungal infection. Interpretation was guided by consistency in risk alleles and microbiologic agent with previous literature. Over the study period 254 children and adolescents with AML were enrolled. Overall, 190 (74.8%) had at least one sterile site microbiologically documented infection. Among the 172 with inferred European ancestry and DNA available, nine significant associations were observed; two were consistent with previous literature. Allele A at IL1B (rs16944) was associated with decreased microbiologically documented infection, and allele G at IL10 (rs1800896) was associated with increased risk of Gram-positive infection. We identified SNPs associated with infection risk in paediatric AML. Genotype may provide insight into mechanisms of infection risk that could be used for supportive-care novel treatments.
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Affiliation(s)
- L Sung
- Division of Haematology/Oncology, Ontario, Canada; Child Health Evaluative Sciences, Ontario, Canada.
| | - D Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - S Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, Quebec, Canada
| | | | - M C Ethier
- Child Health Evaluative Sciences, Ontario, Canada
| | - N M Roslin
- Program in Genetics and Genome Biology, Ontario, Canada
| | - D L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center, Oakland, CA, USA
| | - D Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - V Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Yanofsky
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Canada
| | - V Price
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - S Zelcer
- Hematology/Oncology, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - M Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - L Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - B Michon
- Pediatric Hematology/OncologyCentre, Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - K Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Traubici
- Department of Diagnostic Imaging, Ontario, Canada
| | - U Allen
- Division of Infectious Diseases, Ontario, Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - N den Hollander
- Histocompatibility Laboratory, University Health Network, Ontario, Canada
| | - A D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases (Science, Allen), Department of Paediatrics; Children Health Evaluative Sciences (Allen), Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - Upton Allen
- Division of Infectious Diseases (Science, Allen), Department of Paediatrics; Children Health Evaluative Sciences (Allen), Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ont.
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Patrick K, Ali M, Richardson SE, Gassas A, Egeler M, Krueger J, Lowry J, Allen U, Schechter T. The yield of monitoring for HSV and VZV viremia in pediatric hematopoietic stem cell transplant patients. Pediatr Transplant 2015; 19:640-4. [PMID: 26148054 DOI: 10.1111/petr.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 01/23/2023]
Abstract
Reactivation of HSV and VZV is common following HSCT. Consensus guidelines do not support the use of routine screening for viremia following HSCT in adults, but no such clear guidelines exist in pediatrics. In our center, routine practice was to screen patients weekly for HSV and VZV viremia until engraftment in autologous transplant patients and up to day +100 in allogeneic transplant patients. We conducted a retrospective study of over 500 patients to establish whether this screening identified any patients with HSV or VZV viremia who would not have been identified by clinical signs or symptoms. Over a 4.5-yr period, routine screening identified three cases of HSV viremia and one case of VZV viremia. Two patients had persistent, unexplained fever and two patients had skin or mucosal lesions suggestive of HSV/VZV. We conclude that routine screening for HSV and VZV viremia in pediatric HSCT patients has a very low yield and that viremia can be reliably identified by targeted testing in patients with vesicular skin lesions, oral or genital ulceration, unexplained fever, neurological symptoms, or unexplained abnormal liver transaminases.
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Affiliation(s)
- Katharine Patrick
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Muhammad Ali
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Susan E Richardson
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Gassas
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maarten Egeler
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joerg Krueger
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jane Lowry
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Upton Allen
- The Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Sullivan K, Isabel S, Edilova M, Paton T, Yeung S, Booran NK, Ng V, Allen U. 125: Genetic Diversity of Epstein-Barr Virus Latent Gene EBNA-1 Among Transplant Patients and Patients with Infectious Mononucleosis. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e79a] [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] [Indexed: 11/12/2022] Open
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Danziger-Isakov L, Allen U, Englund J, Herold B, Hoffman J, Green M, Gantt S, Kumar D, Michaels MG. Recommended Curriculum for Training in Pediatric Transplant Infectious Diseases. J Pediatric Infect Dis Soc 2015; 4:4-10. [PMID: 26407351 DOI: 10.1093/jpids/pit079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/06/2013] [Indexed: 11/14/2022]
Abstract
A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases.
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Affiliation(s)
| | - Upton Allen
- Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Janet Englund
- Seattle Children's Hospital, University of Washington
| | - Betsy Herold
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jill Hoffman
- University of Southern California, Children's Hospital Los Angeles
| | - Michael Green
- University of Pittsburgh School of Medicine, Children's Hospital Pittsburgh of UPMC, Pennsylvania
| | - Soren Gantt
- British Columbia's Children's Hospital, University of British Columbia, Vancouver
| | | | - Marian G Michaels
- University of Pittsburgh School of Medicine, Children's Hospital Pittsburgh of UPMC, Pennsylvania
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Rozenblyum EV, Levy DM, Allen U, Harvey E, Hebert D, Silverman ED. Cytomegalovirus in pediatric systemic lupus erythematosus: prevalence and clinical manifestations. Lupus 2015; 24:730-5. [PMID: 25568145 DOI: 10.1177/0961203314565443] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/25/2014] [Indexed: 12/29/2022]
Abstract
UNLABELLED Cytomegalovirus (CMV) is a beta-herpesvirus and antibodies to this virus are common in patients with systemic lupus erythematosus (SLE). However, few studies have examined the relationship between CMV infection and SLE. OBJECTIVES Our objectives were: 1) to determine the prevalence of CMV infection at the time of SLE diagnosis, and 2) to determine the risk factors for CMV infection. METHODS A database review of 670 patients with pediatric SLE (pSLE) seen over a 20-year period identified seven patients with a CMV infection detected at the time of diagnosis of SLE. CMV was diagnosed by serology, urine and bronchoalveolar lavage. Clinical manifestations, laboratory findings, virology studies and treatments were reviewed. RESULTS CMV infection was detected in seven patients at the time of SLE diagnosis (1.04% of total cohort): six were female: mean age was 13 years. Predominant features included non-Caucasian ethnicity (p < 0.01 as compared to total SLE cohort), persistent fevers on prednisone in seven and nephrotic syndrome in four. Laboratory findings included: anemia in seven, lymphopenia in five, elevated liver enzymes in four, with anti-dsDNA and anti-RNP antibodies present in six and five, respectively. Six patients received ganciclovir and CMV hyperimmune globulin (Cytogam®) with the continuation of prednisone during CMV treatment. Six of seven fully recovered without sequelae (one without treatment) but one patient died with active CMV infection. CONCLUSIONS There were 1.04% of patients with pSLE who developed CMV infection. All were of non-Caucasian ethnicity. Persistent fever despite prednisone, with concomitant anemia, may be additional clues to CMV infection in pSLE. We suggest all patients have routine testing for CMV immunity at initial presentation of pSLE.
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Affiliation(s)
| | - D M Levy
- Divisions of Rheumatology Department of Pediatrics, and the Research Institute, Hospital for Sick Children, University of Toronto, Canada
| | - U Allen
- Infectious Diseases Department of Pediatrics, and the Research Institute, Hospital for Sick Children, University of Toronto, Canada
| | | | | | - E D Silverman
- Divisions of Rheumatology Department of Pediatrics, and the Research Institute, Hospital for Sick Children, University of Toronto, Canada
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Adler E, Alexis C, Ali Z, Allen U, Bartels U, Bick C, Bird-Compton J, Bodkyn C, Boyle R, De Young S, Fleming-Carroll B, Gupta S, Ingram-Martin P, Irwin M, Kirby-Allen M, McLean-Salmon S, Mihelcic P, Richards-Dawson MA, Reece-Mills M, Shaikh F, Sinquee-Brown C, Thame M, Weitzman S, Wharfe G, Blanchette V. Bridging the Distance in the Caribbean: Telemedicine as a means to build capacity for care in paediatric cancer and blood disorders. Stud Health Technol Inform 2015; 209:1-8. [PMID: 25980698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the past 50 years, survival for children in high-income countries has increased from 30% to over 80%, compared to 10-30% in low and middle income countries (LMIC). Given this gap in survival, established paediatric cancer treatment centres, such as The Hospital for Sick Children (SickKids) are well positioned to share clinical expertise. Through the SickKids Centre for Global Child Health, the SickKids-Caribbean Initiative (SCI) was launched in March 2013 to improve the outcomes and quality of life for children with cancer and blood disorders in the Caribbean. The six participating Caribbean countries are among those defined by the United Nations as Small Island Developing States, due to their small size, remote location and limited accessibility. Telemedicine presents an opportunity to increase their accessibility to health care services and has been used by SCI to facilitate two series of interprofessional rounds. Case Consultation Review Rounds are a forum for learning about diagnostic work-up, management challenges and treatment recommendations for these diseases. To date, 54 cases have been reviewed by SickKids staff, of which 35 have been presented in monthly rounds. Patient Care Education Rounds provide nurses and other staff with the knowledge base needed to safely care for children and adolescents receiving treatment. Five of these rounds have taken place to date, with over 200 attendees. Utilized by SCI for both clinical and non-clinical meetings, telemedicine has enhanced opportunities for collaboration within the Caribbean region. By building capacity and nurturing expert knowledge through education, SCI hopes to contribute to closing the gap in childhood survival between high and low-resource settings.
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Affiliation(s)
- Ellie Adler
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Zulaika Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, UWI, St Augustine Campus, Trinidad and Tobago
| | - Upton Allen
- Department of Paediatrics, University of Toronto and Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Cassandra Bick
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Curt Bodkyn
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, UWI, St Augustine Campus, Trinidad and Tobago
| | - Rosemary Boyle
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | - Stephanie De Young
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Bonnie Fleming-Carroll
- Collaborative for Professional Practice, The Hospital for Sick Children, and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sumit Gupta
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | | | - Meredith Irwin
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Melanie Kirby-Allen
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Sharon McLean-Salmon
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Paul Mihelcic
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | | | - Furqan Shaikh
- Department of Paediatrics, University of Toronto and Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Corrine Sinquee-Brown
- University of the West Indies, School of Clinical Medicine & Research, Nassau, The Bahamas and Princess Margaret Hospital, The Bahamas
| | - Minerva Thame
- Faculty of Medical Sciences, University of the West Indies, Mona Campus, Jamaica
| | - Sheila Weitzman
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Gilian Wharfe
- University Hospital of the West Indies, Kingston, Jamaica
| | - Victor Blanchette
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Danziger-Isakov L, Evans HM, Green M, McCulloch M, Michaels MG, Posfay-Barbe KM, Verma A, Allen U. Capacity building in pediatric transplant infectious diseases: an international perspective. Pediatr Transplant 2014; 18:790-3. [PMID: 25212948 DOI: 10.1111/petr.12355] [Citation(s) in RCA: 3] [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] [Accepted: 08/04/2014] [Indexed: 11/30/2022]
Abstract
Transplant infectious diseases is a rapidly emerging subspecialty within pediatric infectious diseases reflecting the increasing volumes and complexity of this patient population. Incorporating transplant infectious diseases into the transplant process would provide an opportunity to improve clinical outcome and advocacy as well as expand research. The relationship between transplant physicians and infectious diseases (ID) specialists is one of partnership, collaboration, and mutual continuing professional education. The ID CARE Committee of the International Pediatric Transplant Association (IPTA) views the development and integration of transplant infectious diseases into pediatric transplant care as an international priority.
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Schuh S, Freedman S, Coates A, Allen U, Parkin PC, Stephens D, Ungar W, DaSilva Z, Willan AR. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA 2014; 312:712-8. [PMID: 25138332 DOI: 10.1001/jama.2014.8637] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis. OBJECTIVE To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada. Participants were 213 otherwise healthy infants aged 4 weeks to 12 months with mild to moderate bronchiolitis and true oxygen saturations of 88% or higher. INTERVENTIONS Pulse oximetry measurements with true saturation values displayed or with altered saturation values displayed that have been increased 3 percentage points above true values. MAIN OUTCOMES AND MEASURES The primary outcome was hospitalization within 72 hours, defined as inpatient admission within this interval or active hospital care for greater than 6 hours. Secondary outcomes included the use of supplemental oxygen in the emergency department, level of physician agreement with discharge from the emergency department, length of emergency department stay, and unscheduled visits for bronchiolitis within 72 hours. RESULTS Forty-four of 108 patients (41%) in the true oximetry group and 26 of 105 (25%) in the altered oximetry group were hospitalized within 72 hours (difference, 16% [95% CI for the difference, 3.6% to 28.4%]; P = .005). Using the emergency department physician as a random effect, the primary treatment effect remained significant (adjusted odds ratio, 4.0 [95% CI, 1.6 to 10.5]; P = .009). None of the secondary outcomes were significantly different between the groups. There were 23 of 108 (21.3%) subsequent unscheduled medical visits for bronchiolitis in the true oximetry group and 15 of 105 (14.3%) in the altered oximetry group (difference, 7% [95% CI, -0.3% to 0.2%]; P = .18). CONCLUSIONS AND RELEVANCE Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00673946.
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Affiliation(s)
- Suzanne Schuh
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Freedman
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Allan Coates
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek Stephens
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Ungar
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zelia DaSilva
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Hutspardol S, Schechter-Finkelstein T, Ali M, Krueger J, Egeler RM, Allen U, Richardson S, Gassas A. Significant Transplant-Related Mortality from Respiratory Virus Infections within the First 100 Days Post Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.325] [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] [Indexed: 10/25/2022]
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Al Fawaz T, Ng V, Richardson SE, Barton M, Allen U. Clinical consequences of human herpesvirus-6 DNAemia in peripheral blood in pediatric liver transplant recipients. Pediatr Transplant 2014; 18:47-51. [PMID: 24384048 DOI: 10.1111/petr.12176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Accepted: 09/16/2013] [Indexed: 01/20/2023]
Abstract
The significance of HHV6 DNAemia after solid organ transplantation has not been fully determined. Our objectives were to determine the prevalence of HHV6 DNAemia in pediatric liver transplant recipients and to describe the associated clinical characteristics and outcomes. This was a retrospective case-control study. Eligible liver transplant patients aged ≤ 18 yr with HHV6 DNAemia were matched with two subjects without HHV6 DNAemia. Matching was by age ± 6 months. Among 154 subjects, 25 patients (16%) had HHV6 DNAemia detected by PCR in whole blood or plasma (M:F ratio = 0.9:1). While 28% of subjects with DNAemia (7/25) had symptoms consistent with HHV6 infection, active infection was detected in only four subjects (2.6% of liver transplant patients). The major symptoms/signs were fever, vomiting, lethargy, splenomegaly, bone marrow suppression, and elevated transaminases. The prevalence of DNAemia due to other herpesviruses in cases vs. controls was EBV 56% vs. 60%, CMV 12% vs. 12%, HHV7 20% vs. 12%; p value is not significant for all pairwise comparisons. HHV6 DNAemia in pediatric liver transplant patients is not an uncommon entity. While the clinical relevance is still not entirely established, active HHV6 infection and attributable symptoms are relatively rare.
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Affiliation(s)
- Tariq Al Fawaz
- Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, Farmer D, Shemesh E, McDonald RA. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:798-825. [PMID: 23836431 DOI: 10.1002/lt.23697] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Deirdre A Kelly
- Liver Unit, Birmingham Children's Hospital, National Health Service Trust, Birmingham, United Kingdom.
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Ratnapalan S, Martimianakis MAT, Cohen-Silver JH, Minnes B, Macgregor D, Allen U, Richardson SE, Friedman JN, Bruce-Barrett C, Haj-Assaad L, Noordermeer J, Daneman D. Pandemic management in a pediatric hospital. Clin Pediatr (Phila) 2013; 52:322-8. [PMID: 23406719 DOI: 10.1177/0009922812474890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
OBJECTIVES To describe our experiences in the management of the second wave of influenza A H1N1 (pH1N1) pandemic in a tertiary-care children's hospital. METHODS An autoethnographic study of the pandemic planning and management committee members involved in managing the second wave of pH1N1 was conducted. RESULTS Staffing, surge capacity, communications and emergency operations planning by adding leaders of frontline workers and other key operational roles to the incident management team, and creating a tactical response team emerged as important factors in pandemic management in our hospital. The emergency department visits increased by 50%, necessitating increased staffing of the emergency department. Communications using existing chains of command had to be used to reach frontline staff during the pandemic. CONCLUSIONS Incident management teams managing pandemics and other disasters have to be dynamic and create tactical teams to ensure implementation and facilitate bidirectional communication with frontline workers.
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Affiliation(s)
- Savithiri Ratnapalan
- Division of Emergency Medicine, Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, ON, Canada.
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Dix D, Cellot S, Price V, Gillmeister B, Ethier MC, Johnston DL, Lewis V, Michon B, Mitchell D, Stobart K, Yanofsky R, Portwine C, Silva M, Bowes L, Zelcer S, Brossard J, Traubici J, Allen U, Beyene J, Sung L. Association Between Corticosteroids and Infection, Sepsis, and Infectious Death in Pediatric Acute Myeloid Leukemia (AML): Results From the Canadian Infections in AML Research Group. Clin Infect Dis 2012; 55:1608-14. [PMID: 22955431 DOI: 10.1093/cid/cis774] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Allen U, Green M. The menace of CMV disease after small bowel transplantation: bearer of bad news! Pediatr Transplant 2012; 16:545-8. [PMID: 22574878 DOI: 10.1111/j.1399-3046.2012.01715.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ali M, Asim M, Pole J, Dupuis L, Allen U, Egeler M, Al-Afghani S, Stesco N, Gassas A, Doyle J, Schechter T. Epstein-Barr Virus Associated Complications and Their Association with Antithymocyte Globulin in Pediatric Allogeneic Stem-Cell Transplantation. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.274] [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] [Indexed: 10/14/2022]
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Allen U, Nimrod C, Macdonald N, Toye B, Stephens D, Marchessault V. Relationship between antenatal group B streptococcal vaginal colonization and premature labour. Paediatr Child Health 2011; 4:465-9. [PMID: 20212961 DOI: 10.1093/pch/4.7.465] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine whether a population of pregnant women with group B streptococcal (GBS) vaginal colonization had an increased risk of specific epidemiological and intrapartum risk factors for early onset GBS disease. SETTING Tertiary university centre in Ottawa, Ontario. DESIGN Hospital-based retrospective cohort study. METHODS Pregnant women who gave birth during a four-month period in 1994 were included in the study. Potential GBS risk factors were obtained from a review of medical records. The prevalence of each risk factor in colonized and noncolonized women was examined using chi(2) or Fisher's exact test. Multiple logistic regression was performed. RESULTS A total of 986 women, including 94 (9.5%) women colonized with GBS, were studied. The proportion of women younger than 20 years of age in the colonized group was 2.1% (two of 94) versus 4.6% (41 of 891) in the noncolonized group (P=0.28). Similar rates of multiple births were observed among the colonized and noncolonized groups (2.1% [two of 94] versus 2.5% [22 of 891], respectively) (P=0.94). Likewise, there were no significant differences in either group in the prevalence of a previous pregnancy affected by GBS or diabetes mellitus (P=0.82 and P=0.79, respectively). Multivariable analyses indicated that women who were colonized with GBS were more than twice as likely to deliver prematurely (below 37 weeks' gestational age) (odds ratio [OR] 2.43, 95% CI 1.39 to 4.23). Similarly, colonized women were more likely to be febrile during labour (at least 38 degrees C) (OR 5.05, 95% CI 1.70 to 15.02). CONCLUSION GBS vaginal colonization was associated with premature labour and intrapartum pyrexia in the population studied. According to Canadian and American guidelines, women with GBS vaginal colonization qualify for intrapartum chemoprophylaxis. The study results suggest that the identification of women at risk of premature labour may be one advantage of early prenatal screening for GBS.
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Affiliation(s)
- U Allen
- Department of Pediatrics, Division of Infectious Diseases and
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Al-Mukhaizeem F, Allen U, Komar L, Naser B, Roy L, Stephens D, Read S, Kim C, Schuh S. Comparison of temporal artery, rectal and esophageal core temperatures in children: Results of a pilot study. Paediatr Child Health 2011; 9:461-5. [PMID: 19657409 DOI: 10.1093/pch/9.7.461] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rectal thermometry correlates with core temperature and represents the criterion standard of measuring temperatures in young children. However, it has numerous disadvantages, and thus, an alternative method of measuring temperature with similar agreement with the core temperature as rectal thermometry is desired. A new, noninvasive temporal artery (TA) thermometer synthesizes the skin surface and ambient temperatures to produce an arterial temperature. OBJECTIVE To examine the agreement between the TA and esophageal core thermometers, and to compare it with that between rectal and esophageal temperatures. METHODS In the present prospective, cross-sectional agreement study, intubated surgical outpatients younger than 18 years of age had temperatures measured with esophageal and rectal probes, and rectal electronic and TA thermometers. The agreement between esophageal versus rectal and TA thermometers was analyzed by intraclass correlation coefficients and by differences between esophageal versus TA and rectal temperatures with 95% CIs. The esophageal-rectal and esophageal-TA slopes were compared by Student's t test. RESULTS In 80 enrolled children, the intraclass correlation coefficients for the esophageal probe versus rectal probe, rectal electronic thermometer and TA thermometer were 0.91, 0.95 and 0.88, respectively. The mean esophageal-rectal difference was 0.00+/-0.18 degrees C and esophageal-TA difference was 0.14+/-0.20 degrees C. Linear regression analysis of the relation between esophageal probe versus rectal probe, rectal thermometer and TA thermometer yielded slopes of 0.93, 0.94 and 0.89, respectively. The slopes were neither different from each other (P=0.70) nor from the value of 1. CONCLUSION The TA and esophageal thermometers agree well, and the esophageal-TA and esophageal-rectal temperature agreements are not significantly different.
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Abstract
The most recent revision of the American Heart Association guidelines on infective endocarditis prophylaxis occurred in 2007. These revisions were based on the fact that current data have brought into question the benefit of previous recommendations for infective endocarditis prophylaxis. It was noted that the bacteremia that occurs following dental procedures represents only a fraction of the episodes of bacteremia that occur with activities of daily living (such as chewing, brushing teeth and other oral hygiene measures). The target groups and the procedures for which prophylaxis is reasonable have been significantly reduced in number. The focus is now on patients who are most likely to have adverse outcomes from infectious endocarditis. The present article is targeted at practicing Canadian physicians and provides the rationale for the current recommendations. In addition to a summary of the indications for prophylaxis, information is provided on the conditions for which prophylaxis is not recommended.
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