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Kociolek LK, Shane AL, Simonsen KA, Zerr DM. Infection Prevention and Control Implications of Special Pathogens in Children. Pediatr Clin North Am 2024; 71:431-454. [PMID: 38754934 DOI: 10.1016/j.pcl.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Special pathogens are broadly defined as highly transmissible organisms capable of causing severe disease in humans. Children's hospital healthcare personnel (HCP) should be prepared to identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key infection prevention, clinical, and public health stakeholders. Effective preparedness requires resources and practice with attention to education, policies and procedures, drills and training, and supplies. Successfully preparing for special pathogens is an important measure toward keeping communities, HCP, and patients and families safe in this global age that brings pathogens from across the world to our doorstep.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 20, Chicago, IL 60611, USA.
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Emory Children's Center, 2015 Uppergate Drive Northeast, Room 504A, Atlanta, GA 30322, USA
| | - Kari A Simonsen
- Department of Pediatrics, University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Mailstop MA7.226, 4800 Sand Point Way, Seattle, WA 98105, USA
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2
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Shane AL. Extremes. Clin Infect Dis 2024; 78:236-237. [PMID: 37791966 DOI: 10.1093/cid/ciad513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Andi L Shane
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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3
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Fan LK, Bai S, Du C, Bass M, Jones K, Sherry W, Morris CR, Oster ME, Shane AL, Jaggi P. Distinguishing Incomplete Kawasaki and Nonsevere Multisystem Inflammatory Syndrome in Children. Hosp Pediatr 2023; 13:e280-e284. [PMID: 37681271 DOI: 10.1542/hpeds.2022-007107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Characterizing inflammatory syndromes during the coronavirus disease 2019 pandemic was complicated by recognition of multisystem inflammatory syndrome in children (MIS-C), contemporaneous with episodes of Kawasaki disease. We hypothesized a substantial overlap between the 2 and assessed the performance of an MIS-C likelihood score in differentiating inpatients with nonsevere MIS-C from prepandemic incomplete Kawasaki disease (iKD) without coronary involvement. METHODS A retrospective review of inpatient records was conducted; the nonsevere MIS-C cohort (March 2020-February 2021) met the 2023 definition for MIS-C; the iKD cohort (January 2018-January 2019) met the American Heart Association criteria for iKD without coronary involvement. We applied the likelihood score to both cohorts. We estimated the percent of children with iKD who could have met the clinical criteria of the MIS-C, had they presented in 2023. RESULTS The 68 children in the nonsevere MIS-C cohort were older (8 vs 4 years, P < .001) than the 28 children in the iKD cohort. Those in the nonsevere MIS-C cohort had higher rates of thrombocytopenia (P < .001) and lymphopenia (P = .021); those in the iKD cohort had higher rates of pyuria (P < .001). Twenty-four (86%) children in the iKD cohort met the 2023 MIS-C definition. The scoring system correctly predicted 71% to 74% children with their respective clinical diagnoses. CONCLUSIONS Though there was considerable clinical overlap, thrombocytopenia, lymphopenia, and the absence of pyuria were the most helpful parameters to distinguish children with nonsevere MIS-C from those with iKD.
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Affiliation(s)
- Lucie K Fan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shasha Bai
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Chenxi Du
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Marissa Bass
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kaitlin Jones
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Whitney Sherry
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Claudia R Morris
- Divisions of Pediatric Emergency Medicine
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew E Oster
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Andi L Shane
- Pediatric Infectious Disease
- Division of Pediatric Infectious Disease
| | - Preeti Jaggi
- Pediatric Infectious Disease
- Division of Pediatric Infectious Disease
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Shane AL, Preidis GA. Probiotics in the Neonatal Intensive Care Unit-A Framework for Optimizing Product Standards. JAMA Pediatr 2023; 177:879-880. [PMID: 37428483 DOI: 10.1001/jamapediatrics.2023.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
This Viewpoint outlines a framework for optimizing probiotic product stringency and use in the neonatal intensive care unit.
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Affiliation(s)
- Andi L Shane
- Division of Pediatric Infectious Disease, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Geoffrey A Preidis
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston
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5
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Villacis-Nunez DS, West Z, Khan AY, Rodriguez F, Shane AL, Rytting H, Shashidharan S, Clifton MS, Woods G, Clabby M, Prahalad S. Successful Medical-Surgical Management of Intracardiac Thrombosis and Pulmonary Pseudoaneurysms in an Adolescent With Hughes-Stovin Syndrome. J Investig Med High Impact Case Rep 2023; 11:23247096231166672. [PMID: 37032536 PMCID: PMC10101212 DOI: 10.1177/23247096231166672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.
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Affiliation(s)
- D. Sofia Villacis-Nunez
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Zachary West
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Adil Y. Khan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Fred Rodriguez
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Andi L. Shane
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Heather Rytting
- Department of Pathology, Children’s
Healthcare of Atlanta, Atlanta, GA, USA
| | - Subhadra Shashidharan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Congenital Cardiac
Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S. Clifton
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Surgery, Emory University
School of Medicine, Atlanta, GA, USA
| | - Gary Woods
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Pediatrics, Emory
University School of Medicine, Atlanta, GA, USA
| | - Martha Clabby
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Sampath Prahalad
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Human Genetics, Emory
University School of Medicine, Atlanta, GA, USA
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6
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de St Maurice A, Shane AL. Sunscreen, Bug Spray, and Vaccines. J Pediatric Infect Dis Soc 2022; 11:557-558. [PMID: 36054925 DOI: 10.1093/jpids/piac090] [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: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Goggin KP, Sun E, Yun EJ, Kamel M, Perez M, Hsiao HM, Anderson EJ, Shane AL, Liverman R, George R, Rostad CA. 584. Prospective Observational Cohort Study of Serological Responses to COVID-19 Vaccines in Pediatric Kidney Transplant Recipients at a Single Institution. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Pediatric kidney transplant recipients (PKTR) are at risk of poor outcomes from COVID-19. Data on serologic responses to COVID-19 vaccines in PKTR remain sparse. We characterized the magnitude, breadth, and longevity of SARS-CoV-2 spike protein binding antibody responses in PKTR.
Methods
This single institution, prospective observational study enrolled PKTR presenting to a transplant clinic for routine care who had received or were eligible to receive a COVID-19 vaccine. Demographic data, history of prior COVID-19, and vaccination details were collected. Plasma samples obtained from standard-of-care residual specimens were analyzed for SARS-CoV-2 spike variant IgG using the MesoScale Discovery V-PLEX platform, which quantitatively measures antibodies to SARS-CoV-2 full-length spike wild-type (Wuhan-hu-1), Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), Gamma (P.1), and Omicron (B.1.1.529; BA.1) variants. Vaccine time points with > 5 samples available were analyzed. Geometric mean titers (GMTs) were calculated and log-transformed titers were compared using one-way ANOVA with Tukey’s post-hoc comparisons test.
Results
61 PKTR enrolled (Table1); 47 (77%) received at least 1 dose of COVID-19 vaccine in transplant clinic. 47 (77%) PKTR had at least one sample available for analysis, but serial specimens were lacking for many. By 6 months post-dose 2 of COVID-19 mRNA vaccination, spike (Wuhan-hu-1) IgG titers had waned to pre-vaccination levels (GMT 24 vs 47 binding antibody units (BAU)/mL, P=0.988). Administration of a 3rd dose of mRNA vaccine significantly boosted IgG antibodies (GMT 492 BAU/mL, P=0.007), and titers were maintained at 3 months (GMT 656 BAU/mL, P=0.001) but gradually waned by 6 months (GMT 223 BAU/mL, P=0.070). Administration of a 4th dose elicited a non-significant increase in titers (GMT 905 BAU/mL, P=0.870). Binding IgG antibodies to SARS-CoV-2 variant spike proteins post-vaccination were not significantly different from Wuhan spike.
Conclusion
In this cohort of PKTR, a 3rd dose of COVID-19 mRNA vaccine significantly boosted broadly cross-reactive binding IgG antibodies to SARS-CoV-2 spike variants, including Omicron. Decreasing titers at 6 months post-dose 3 raise concern for waning protective immunity and support 4th dose vaccination.
Disclosures
Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc: Data Safety Monitoring Board|MedImmune: Grant/Research Support|Medscape: Advisor/Consultant|Merck: Grant/Research Support|Micron: Grant/Research Support|NIH: Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines|PaxVax: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data Adjudication and Data Safety Monitoring Boards|WCG and ACI Clinical: Data Adjudication Board Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics (ISAPP): Honoraria Christina A. Rostad, MD, BioFire Inc, GSK, MedImmune, Micron, Merck, Novavax, PaxVax, Pfizer, Regeneron, Sanofi-Pasteur.: Grant/Research Support|Meissa Vaccines, Inc.: Co-inventor of RSV vaccine technology licensed to Meissa Vaccines, Inc.|NIH (Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines): Grant/Research Support.
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Affiliation(s)
- Kathryn P Goggin
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | - Elizabeth Sun
- Emory University School of Medicine , Atlanta , Georgia
| | - Emily J Yun
- Emory University School of Medicine , Atlanta , Georgia
| | - Margret Kamel
- Emory University School of Medicine , Atlanta , Georgia
| | - Maria Perez
- Emory University School of Medicine , Atlanta , Georgia
| | | | | | - Andi L Shane
- Emory School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | | | - Roshan George
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | - Christina A Rostad
- Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
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Leekha S, Robinson G, Jacob JT, Fridkin S, Shane AL, Sick-Samuels A, Milstone A, Nair R, Perencevich EN, Puig-Asensio M, Kobayashi T, Mayer J, Lewis J, Bleasdale SC, Wenzler E, Mena Lora AJ, Baghdadi J, Schrank GM, Nadimpalli G, Harris A. 1666. Sources and Preventability of Hospital-onset Bacteremia and Fungemia in the United States: Evaluation of a Potential Healthcare Quality Measure. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Hospital-onset bacteremia and fungemia (HOB) is being proposed as a potential healthcare quality measure due to its clinical significance, objectivity, and ease of detection. However, information is lacking on sources of HOB and the proportion and types of cases considered preventable.
Methods
We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture >= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1-6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable.
Results
We evaluated sources and potential preventability of HOB cases at 12 hospitals using retrospective chart review. HOB was defined as a positive blood culture >= day 4 (admission date=day 1) for one or more organisms. Stratified sampling of cases by commensal and noncommensal organisms was used. Infectious disease physicians determined the source of HOB and rated preventability from 1–6 (1=definitely preventable to 6=definitely not preventable) using a previously validated guide. Ratings of 1–3 were collectively considered potentially preventable and 4–6 likely not preventable.
Conclusion
Gastrointestinal and endovascular sources account for a large majority of noncommensal HOB cases. A high proportion of noncommensal HOB cases are likely not preventable. The presence of non-preventable events should be considered when using HOB as a quality measure. Approaches to identifying the subset of preventable noncommensal HOB events should be explored.
Disclosures
Scott Fridkin, MD, Pfizer: Grant/Research Support Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics (ISAPP): travel and lodging to attend international meeting to deliver a presentation, June 2022 Aaron Milstone, MD, Merck: Grant/Research Support Rajeshwari Nair, MBBS, PhD, Vertex Pharmaceuticals: Salary.
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Affiliation(s)
- Surbhi Leekha
- University of Maryland School of Medicine , Baltimore, MD
| | - Gwen Robinson
- University of Maryland , Baltimore, Baltimore, Maryland
| | - Jesse T Jacob
- Emory University School of Medicine , Atlanta, GA ; , Atlanta, GA, Atlanta , Georgia
- Georgia Emerging Infections Program , Atlanta, GA ; , Atlanta, GA, Atlanta , Georgia
| | | | - Andi L Shane
- Emory School of Medicine and Children's Healthcare of Atlanta , Atlanta , Georgia
| | | | | | | | | | | | | | | | - Julia Lewis
- Salt Lake City VA Medical Center , Salt Lake City, Utah
| | | | | | | | | | | | | | - Anthony Harris
- University of Maryland School of Medicine , Baltimore, MD
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9
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O'Boyle H, Kirpalani A, Weiss L, Hames N, Li R, Leong T, Gonzalez M, Shane AL, Charvat C. Management and Outcomes of Salmonella Gastroenteritis in the Era of Rapid Molecular Testing. Hosp Pediatr 2022; 12:1011-1019. [PMID: 36263712 DOI: 10.1542/hpeds.2021-006450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Molecular diagnostics provide a rapid and sensitive diagnosis of gastroenteritis compared with a stool culture. In this study, we seek to describe the changes in medical management and outcomes of children with Salmonella gastroenteritis as our hospital system adopted molecular diagnostics. METHODS This study is a retrospective chart review of children <18 years of age diagnosed with nontyphoidal Salmonella gastroenteritis between 2008 and 2018 at a large pediatric health care system in the southeastern United States. Those with immunocompromising conditions and hemoglobinopathies were excluded. Patients diagnosed via molecular testing were compared with those diagnosed solely by stool culture for aspects of management including admission rates, blood culture obtainment, and antibiotic administration. RESULTS Of 965 eligible patients with Salmonella gastroenteritis, 264 (27%) had a stool molecular test and 701 (73%) only had a stool culture performed. Groups were similar in age and presentation. Those diagnosed by molecular methods had higher hospitalization rates (69% vs 50%, P <.001), more blood cultures obtained (54% vs 44%, P <.01), and received more antibiotics (49% vs 34%, P <.001) despite statistically similar rates of bacteremia (11% vs 19%, P = .05). CONCLUSIONS The rapid diagnosis of Salmonella gastroenteritis by molecular methods was associated with increased hospital admission rates, blood culture obtainment, and antibiotic use. This suggests possible overmedicalization of uncomplicated Salmonella gastroenteritis, and clinicians should remain cognizant of the possibility of providing low-value care for uncomplicated disease.
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Affiliation(s)
- Hillary O'Boyle
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Affiliation has changed since this research was conducted
| | - Anjali Kirpalani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lindsay Weiss
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nicole Hames
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ruoxing Li
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | | | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Courtney Charvat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
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10
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Campbell MM, Benjamin DK, Mann TK, Fist A, Blakemore A, Diaz KS, Kim H, Edwards LJ, Rak Z, Brookhart MA, Moore Z, Tilson EC, Kalu I, Boutzoukas AE, Moorthy GS, Uthappa D, Scott Z, Weber DJ, Shane AL, Bryant KA, Zimmerman KO. Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools. Pediatrics 2022; 150:e2022058200. [PMID: 35971240 PMCID: PMC9647593 DOI: 10.1542/peds.2022-058200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. METHODS Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.
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Affiliation(s)
| | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | | | | | | | | | | | | | | | | | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Ibukun Kalu
- Duke Clinical Research Institute
- Department of Pediatrics
| | | | | | - Diya Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina
| | | | - David J. Weber
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kristina A. Bryant
- University of Louisville and Norton Children’s Hospital, Louisville, Kentucky
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
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11
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Schrank GM, Sick-Samuels A, Bleasdale SC, Jacob JT, Dantes R, Gokhale RH, Mayer J, Mehrotra P, Mehta SA, Mena Lora AJ, Ray SM, Rhee C, Salinas JL, Seo SK, Shane AL, Nadimpalli G, Milstone AM, Robinson G, Brown CH, Harris AD, Leekha S. Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia. Infect Control Hosp Epidemiol 2022; 43:1326-1332. [PMID: 35086601 PMCID: PMC9472698 DOI: 10.1017/ice.2021.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks. DESIGN HOB preventability rating guide was compared against a reference standard expert panel. PARTICIPANTS A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison. METHODS The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic. RESULTS Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64-0.88]) and 87% (κ, 0.79; 95% CI, 0.65-0.94) for the 52 scenarios with expert consensus. CONCLUSIONS Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.
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Affiliation(s)
- Gregory M Schrank
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anna Sick-Samuels
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan C Bleasdale
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jesse T Jacob
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Raymund Dantes
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Runa H Gokhale
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanmarie Mayer
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Preeti Mehrotra
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sapna A Mehta
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alfredo J Mena Lora
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Susan M Ray
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Susan K Seo
- Department of Medicine, Joan and Sanford Weil Cornell Medical College, New York, New York
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Gita Nadimpalli
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gwen Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Shane AL. Editors' Perspective. J Pediatric Infect Dis Soc 2022; 11:351. [PMID: 35686431 DOI: 10.1093/jpids/piac055] [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: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Andi L Shane
- Division of Pediatric Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA
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13
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Amin O, Rostad CA, Gonzalez M, Rostad BS, Caltharp S, Quincer E, Betke BA, Gottdenker NL, Wilson JJ, Shane AL, Elmontser M, Camacho-Gonzalez A, Senior T, Smith O, Anderson EJ, Yildirim I. CAT-SCRATCH DISEASE: 9 YEARS OF EXPERIENCE AT A PEDIATRIC CENTER. Open Forum Infect Dis 2022; 9:ofac426. [PMID: 36072697 PMCID: PMC9439574 DOI: 10.1093/ofid/ofac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
Methods
We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010, and December 31, 2018 who had serology, PCR and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia (UGA) from 2018-2020 to ascertain the burden of bartonellosis in companion animals within the state.
Results
We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41/304, 13.5%) and September (47/304, 15.5%). The median age of child cases was 8.1 years (interquartile range (IQR) 5.4-12.1]; 156 (51.3%) were female; 242/262 (92.4%) reported feline exposure, while 55/250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63/304, 20.7%). Among children with radiographic imaging, 20/55 (36.4%) had splenomegaly and 21/55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12/146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
Conclusion
Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.
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Affiliation(s)
- Omayma Amin
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mark Gonzalez
- Department of Clinical Microbiology, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Bradley S Rostad
- Division of Pediatric Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta, GA , USA
| | - Shelley Caltharp
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Pathology, Emory University School of Medicine , Atlanta, GA , USA
| | - Elizabeth Quincer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Briana A Betke
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Nicole L Gottdenker
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Jonathan J Wilson
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mohnd Elmontser
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Tal Senior
- Department of Advanced Analytics, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Oliver Smith
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA
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14
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Glover B, Charvat C, Weiss L, Kirpalani A, Shane AL, Li R, Leong T, Hames N. Intravenous Antibiotic Duration for Nontyphoidal Salmonella Bacteremia in Children. Hosp Pediatr 2022; 12:e225-e229. [PMID: 35726559 DOI: 10.1542/hpeds.2021-006387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal duration of intravenous (IV) antibiotic therapy for children with nontyphoidal Salmonella bacteremia (NTSB) is unknown. The objective of the authors of this study is to evaluate differences in outcomes among children with NTSB who received a short (≤3 days; short-duration group [SDG]) versus long (>3 days; long-duration group [LDG]) course of IV antibiotics. METHODS This is a retrospective study of children 3 months to 18 years old with NTSB admitted to a tertiary pediatric health care system in the southeastern United States between 2008 and 2018. RESULTS Among 57 patients with NTSB without focal infection, 24 (42%) were in the SDG and received IV antibiotics for a median of 3.0 days and 33 (58%) were in the LDG and received IV antibiotics for a median of 5.0 days. Demographic and clinical characteristics were similar between the SDG and LDG. The median total duration of antibiotics was 11.5 days in the SDG and 13.0 in the LDG (P = .068). The median length of stay was 3.0 days in the SDG and 4.0 in the LDG (P ≤ .001). Two children in the SDG (8%) and 1 child in the LDG (3%) returned to the emergency department for care unrelated to the duration of their IV antibiotic therapy (P = .567). None of the children were readmitted for sequelae related to salmonellosis. CONCLUSIONS The duration of IV antibiotics varied for NTSB, but the outcomes were excellent regardless of the initial IV antibiotic duration. Earlier transitions to oral antibiotics can be considered for NTSB.
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Affiliation(s)
- Brianna Glover
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Lindsay Weiss
- Division of Hospital Medicine, Department of Pediatrics, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | | | - Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ruoxing Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
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15
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Boutzoukas AE, Zimmerman KO, Inkelas M, Brookhart MA, Benjamin DK, Butteris S, Koval S, DeMuri GP, Manuel VG, Smith MJ, McGann KA, Kalu IC, Weber DJ, Falk A, Shane AL, Schuster JE, Goldman JL, Hickerson J, Benjamin V, Edwards L, Erickson TR, Benjamin DK. School Masking Policies and Secondary SARS-CoV-2 Transmission. Pediatrics 2022; 149:e2022056687. [PMID: 35260896 PMCID: PMC9647584 DOI: 10.1542/peds.2022-056687] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Accepted: 03/04/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Throughout the COVID-19 pandemic, masking has been a widely used mitigation practice in kindergarten through 12th grade (K-12) school districts to limit within-school transmission. Prior studies attempting to quantify the impact of masking have assessed total cases within schools; however, the metric that more optimally defines effectiveness of mitigation practices is within-school transmission, or secondary cases. We estimated the impact of various masking practices on secondary transmission in a cohort of K-12 schools. METHODS We performed a multistate, prospective, observational, open cohort study from July 26, 2021 to December 13, 2021. Districts reported mitigation practices and weekly infection data. Districts that were able to perform contact tracing and adjudicate primary and secondary infections were eligible for inclusion. To estimate the impact of masking on secondary transmission, we used a quasi-Poisson regression model. RESULTS A total of 1 112 899 students and 157 069 staff attended 61 K-12 districts across 9 states that met inclusion criteria. The districts reported 40 601 primary and 3085 secondary infections. Six districts had optional masking policies, 9 had partial masking policies, and 46 had universal masking. In unadjusted analysis, districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts; and for every 100 community-acquired cases, universally masked districts had 7.3 predicted secondary infections, whereas optionally masked districts had 26.4. CONCLUSIONS Secondary transmission across the cohort was modest (<10% of total infections) and universal masking was associated with reduced secondary transmission compared with optional masking.
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Affiliation(s)
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | - Moira Inkelas
- Fielding School of Public Health
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
| | - M. Alan Brookhart
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Sabrina Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Shawn Koval
- University of Wisconsin Health, Healthy Kids Collaborative, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Vladimir G. Manuel
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
- University of California David Geffen School of Medicine, Los Angeles, California
| | | | | | | | - David J. Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Falk
- Department of Pediatrics, Aspirus Doctors Clinic, Wisconsin Rapids, Wisconsin
| | - Andi L. Shane
- Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | | | | | | | | | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
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16
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Campbell MM, Benjamin DK, Mann T, Fist A, Kim H, Edwards L, Rak Z, Brookhart MA, Anstrom K, Moore Z, Tilson EC, Kalu IC, Boutzoukas AE, Moorthy GS, Uthappa D, Scott Z, Weber DJ, Shane AL, Bryant KA, Zimmerman KO. Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools. Pediatrics 2022; 149:e2021056045. [PMID: 35437593 PMCID: PMC10084405 DOI: 10.1542/peds.2021-056045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants. METHODS Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment. RESULTS We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed. CONCLUSION After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.
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Affiliation(s)
| | - Daniel K Benjamin
- Duke Clinical Research Institute
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | | | | | | | | | | | | | | | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | | | | | | | - Diya Uthappa
- Duke University School of Medicine, Durham, North Carolina
| | | | - David J Weber
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andi L Shane
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kristina A Bryant
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Kentucky
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
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17
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Shane AL, Hansen NI, Moallem M, Wyckoff MH, Sánchez PJ, Stoll BJ. Surgery-Associated Infections among Infants Born Extremely Preterm. J Pediatr 2022; 240:58-65.e6. [PMID: 34461060 PMCID: PMC8712381 DOI: 10.1016/j.jpeds.2021.08.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/18/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the burden of invasive infection following surgery (surgery-associated infections [SAI]) among infants born extremely premature. STUDY DESIGN This was an observational, prospective study of infants born at gestational age 22-28 weeks hospitalized for >3 days, between April 1, 2011, to March 31, 2015, in academic centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. SAI was defined by culture-confirmed bacteremia, fungemia, or meningitis ≤14 days following a surgical procedure. RESULTS Of 6573 infants, 1154 (18%) who underwent surgery were of lower gestational age (mean [SD]: 25.5 [1.6] vs 26.2 [1.6], P < .001), lower birth weight (803 [220] vs 886 [244], P < .001), and more likely to have a major birth defect (10% vs 3%, P < .001); 64% had 1 surgery (range 1-10 per infant). Most underwent gastrointestinal procedures (873, 76%) followed by central nervous system procedures (150, 13%). Eighty-five (7%) infants had 90 SAIs (78 bacteremia, 5 fungemia, 1 bacteremia and meningitis, 6 meningitis alone). Coagulase-negative staphylococci were isolated in 36 (40%) SAI and were isolated with another organism in 5 episodes. Risk of SAI or death ≤14 days after surgery was greater after gastrointestinal compared with central nervous system procedures (16% vs 7%, adjusted relative risk [95% CI]: 1.95 [1.15-3.29], P = .01). Death ≤14 days after surgery occurred in 141 of the 1154 infants; 128 deaths occurred after gastrointestinal surgeries. CONCLUSIONS Surgical procedures were associated with bacteremia, fungemia, or meningitis in 7% of infants. The epidemiology of invasive postoperative infections as described in this report may inform the selection of empiric antimicrobial therapy and postoperative preventive care.
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Affiliation(s)
- Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Nellie I Hansen
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, United States
| | - Mohannad Moallem
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, GA, United States,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
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18
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Linam WM, Shane AL. A Vexing Problem: When Visitors Become Vectors of Viruses. J Pediatric Infect Dis Soc 2021; 10:889-890. [PMID: 34173657 DOI: 10.1093/jpids/piab053] [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: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022]
Affiliation(s)
- William Matthew Linam
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andi L Shane
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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19
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Green M, Adler-Shohet FC, Blyth CC, Chiotos K, Gerber JS, Jhaveri R, Kociolek L, Martin-Blais R, Palazzi D, Shane AL, Schuster JE, Shulman ST, Storch GA, Weinberg GA, Zaoutis T. COVID-19-Related Submission Priorities From the Journal of the Pediatric Infectious Diseases Society. J Pediatric Infect Dis Soc 2021; 11:1-2. [PMID: 34608936 PMCID: PMC8500135 DOI: 10.1093/jpids/piab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Green
- Department of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA,Corresponding Author: Michael Green, MD, MPH, Department of Pediatrics and Surgery, Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA 15224, USA. E-mail:
| | - Felice C Adler-Shohet
- Division of Infectious Diseases, Children’s Hospital of Orange County, Orange, California, USA,Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Larry Kociolek
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel Martin-Blais
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Debra Palazzi
- Department of Pediatrics, Infectious Diseases Section, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Andi L Shane
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer E Schuster
- Department of Pediatrics, Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Stanford T Shulman
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Geoffrey A Weinberg
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Theoklis Zaoutis
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Professor of Pediatrics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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20
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Reisner A, Blackwell LS, Sayeed I, Myers HE, Wali B, Heilman S, Figueroa J, Lu A, Hussaini L, Anderson EJ, Shane AL, Rostad CA. Osteopontin as a biomarker for COVID-19 severity and multisystem inflammatory syndrome in children: A pilot study. Exp Biol Med (Maywood) 2021; 247:145-151. [PMID: 34565198 DOI: 10.1177/15353702211046835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study sought to evaluate the candidacy of plasma osteopontin (OPN) as a biomarker of COVID-19 severity and multisystem inflammatory condition in children (MIS-C) in children. A retrospective analysis of 26 children (0-21 years of age) admitted to Children's Healthcare of Atlanta with a diagnosis of COVID-19 between March 17 and May 26, 2020 was undertaken. The patients were classified into three categories based on COVID-19 severity levels: asymptomatic or minimally symptomatic (control population, admitted for other non-COVID-19 conditions), mild/moderate, and severe COVID-19. A fourth category of children met the Centers for Disease Control and Prevention's case definition for MIS-C. Residual blood samples were analyzed for OPN, a marker of inflammation using commercial ELISA kits (R&D), and results were correlated with clinical data. This study demonstrates that OPN levels are significantly elevated in children hospitalized with moderate and severe COVID-19 and MIS-C compared to OPN levels in mild/asymptomatic children. Further, OPN differentiated among clinical levels of severity in COVID-19, while other inflammatory markers including maximum erythrocyte sedimentation rate, C-reactive protein and ferritin, minimum lymphocyte and platelet counts, soluble interleukin-2R, and interleukin-6 did not. We conclude OPN is a potential biomarker of COVID-19 severity and MIS-C in children that may have future clinical utility. The specificity and positive predictive value of this marker for COVID-19 and MIS-C are areas for future larger prospective research studies.
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Affiliation(s)
- Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Laura S Blackwell
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Iqbal Sayeed
- Department of Emergency Medicine, Brain Research Laboratory, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hannah E Myers
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Bushra Wali
- Department of Emergency Medicine, Brain Research Laboratory, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Stacy Heilman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Austin Lu
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Laila Hussaini
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Evan J Anderson
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Medicine, 12239Emory University School of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Christina A Rostad
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
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21
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Teherani M, Banskota S, Camacho-Gonzalez A, Smith AGC, Anderson EJ, Kao CM, Crepy D’Orleans C, Shane AL, Lu A, Jaggi P. Intent to Vaccinate SARS-CoV-2 Infected Children in US Households: A Survey. Vaccines (Basel) 2021; 9:1049. [PMID: 34579286 PMCID: PMC8473386 DOI: 10.3390/vaccines9091049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
A paucity of data exists evaluating a guardian's intent to vaccinate their child against COVID-19 in the United States. We administered 102 first (April-November 2020) and 45 second (December-January 2020-2021) surveys to guardians of children (<18 years) who had a laboratory-confirmed diagnosis of COVID-19 and assessed their intent to give a COVID-19 vaccine to their child, when one becomes available. The first and second surveys of the same cohort of guardians were conducted before and following the press releases detailing the adult Pfizer-BioNTech and Moderna Phase 3 results. Both surveys included an intent-to-vaccinate question using the subjective language of "if a safe and effective vaccine" became available, and a second question was added to second surveys using the objective language of "would prevent 19 of 20 people from getting disease". When using subjective language, 24 of 45 (53%) guardians endorsed vaccine administration for their children in the first survey, which decreased to 21 (46%) in the second survey. When adding objective language, acceptance of vaccination increased to 31 (69%, p = 0.03). Common reasons for declining vaccination were concerns about adverse effects and/or vaccine safety. Providing additional facts on vaccine efficacy increased vaccine acceptance. Evidence-based strategies are needed to increase pediatric COVID-19 vaccine uptake.
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Affiliation(s)
- Mehgan Teherani
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Samridhi Banskota
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Alison G. C. Smith
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | | | - Andi L. Shane
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Austin Lu
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
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22
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Bharath A, Sathian U, Zmitrovich A, Shane AL, Escoffery C, Kelleman MS, Gandrakota N, Aguilera-Navarro C, Jaggi P. Pediatric Caregiver Behaviors Related to Oral Antibiotic Use. J Pediatric Infect Dis Soc 2021:piab020. [PMID: 34363082 DOI: 10.1093/jpids/piab020] [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: 10/04/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022]
Abstract
In a survey of 396 caregivers of children, 119 (30%) reported requesting antibiotics from clinicians and 65 (16%) had stored antibiotics at home. In addition, 47 (12%) reported past or intended nonprescription antibiotic administration; this finding was associated with household income of ≥$75 000 annually (odds ratio 2.042, 95% confidence interval 1.01-4.14, P = .048).
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Affiliation(s)
- Anita Bharath
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Usha Sathian
- Division of Pediatric Urgent Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - April Zmitrovich
- Division of Pediatric Urgent Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andi L Shane
- Division Pediatric Infectious Disease, Department of Pediatrics, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael S Kelleman
- Research Biostatistics Core, Emory+Children's Pediatric Institute, Atlanta, Georgia, USA
| | - Nikhila Gandrakota
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Preeti Jaggi
- Division Pediatric Infectious Disease, Department of Pediatrics, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
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23
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Jhaveri R, Adler-Shohet FC, Blyth CC, Chiotos K, Gerber JS, Green M, Kociolek L, Martin-Blais R, Palazzi D, Shane AL, Schuster JE, Shulman ST, Storch GA, Weinberg GA, Zaoutis T. Weighing the Risks of Perimyocarditis With the Benefits of SARS-CoV-2 mRNA Vaccination in Adolescents. J Pediatric Infect Dis Soc 2021; 10:937-939. [PMID: 34270752 PMCID: PMC8344506 DOI: 10.1093/jpids/piab061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Corresponding Author: Ravi Jhaveri MD, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 20, Chicago, IL 60611-2991, USA. E-mail:
| | - Felice C Adler-Shohet
- Division of Infectious Diseases, Children’s Hospital of Orange County, Orange, California, USA,Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael Green
- Department of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Larry Kociolek
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel Martin-Blais
- Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Debra Palazzi
- Department of Pediatrics, Infectious Diseases Section, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Andi L Shane
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer E Schuster
- Department of Pediatrics, Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Stanford T Shulman
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Geoffrey A Weinberg
- Department of Pediatrics, Division of Infectious Diseases, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Theoklis Zaoutis
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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24
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Orenstein EW, ElSayed-Ali O, Kandaswamy S, Masterson E, Blanco R, Shah P, Lantis P, Kolwaite A, Dawson TE, Ray E, Bryant C, Iyer S, Shane AL, Jernigan S. Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge. JAMA Netw Open 2021; 4:e2117809. [PMID: 34292335 PMCID: PMC8299313 DOI: 10.1001/jamanetworkopen.2021.17809] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Hospitalized children are at increased risk of influenza-related complications, yet influenza vaccine coverage remains low among this group. Evidence-based strategies about vaccination of vulnerable children during all health care visits are especially important during the COVID-19 pandemic. OBJECTIVE To design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted among children eligible for the seasonal influenza vaccine who were hospitalized in a tertiary pediatric health system providing care to more than half a million patients annually in 3 hospitals. The study used a sequential crossover design from control to intervention and compared hospitalizations in the intervention group (2019-2020 season with the use of an intervention order set) with concurrent controls (2019-2020 season without use of an intervention order set) and historical controls (2018-2019 season with use of an order set that underwent intervention during the 2019-2020 season). INTERVENTIONS A CDS intervention was developed through a user-centered design process, including (1) placing a default influenza vaccine order into admission order sets for eligible patients, (2) a script to offer the vaccine using a presumptive strategy, and (3) just-in-time education for clinicians addressing vaccine eligibility in the influenza order group with links to further reference material. The intervention was rolled out in a stepwise fashion during the 2019-2020 influenza season. MAIN OUTCOMES AND MEASURES Proportion of eligible hospitalizations in which 1 or more influenza vaccines were administered prior to discharge. RESULTS Among 17 740 hospitalizations (9295 boys [52%]), the mean (SD) age was 8.0 (6.0) years, and the patients were predominantly Black (n = 8943 [50%]) or White (n = 7559 [43%]) and mostly had public insurance (n = 11 274 [64%]). There were 10 997 hospitalizations eligible for the influenza vaccine in the 2019-2020 season. Of these, 5449 (50%) were in the intervention group, and 5548 (50%) were concurrent controls. There were 6743 eligible hospitalizations in 2018-2019 that served as historical controls. Vaccine administration rates were 31% (n = 1676) in the intervention group, 19% (n = 1051) in concurrent controls, and 14% (n = 912) in historical controls (P < .001). In adjusted analyses, the odds of receiving the influenza vaccine were 3.25 (95% CI, 2.94-3.59) times higher in the intervention group and 1.28 (95% CI, 1.15-1.42) times higher in concurrent controls than in historical controls. CONCLUSIONS AND RELEVANCE This quality improvement study suggests that user-centered CDS may be associated with significantly improved influenza vaccination rates among hospitalized children. Stepwise implementation of CDS interventions was a practical method that was used to increase quality improvement rigor through comparison with historical and concurrent controls.
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Affiliation(s)
- Evan W. Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Information Services and Technology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Omar ElSayed-Ali
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | | | - Erin Masterson
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Reena Blanco
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Pareen Shah
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Patricia Lantis
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Amy Kolwaite
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Thomas E. Dawson
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Edwin Ray
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christy Bryant
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Srikant Iyer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Andi L. Shane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Infectious Diseases, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Stephanie Jernigan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Division of Nephrology, Children’s Healthcare of Atlanta, Atlanta, Georgia
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25
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Shane AL, Weinberg GA. Can We Further Increase Protection Against Rotavirus by Reducing 2 Barriers to Immunization, Inpatient Hospitalization and Older Age? J Pediatric Infect Dis Soc 2021; 10:68-70. [PMID: 31318433 DOI: 10.1093/jpids/piz046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/06/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York
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26
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Abebe W, Bacha T, Shane AL, Berkowitz T. Triage guideline for immunocompromised children with fever in an emergency centre in Ethiopia. Afr J Emerg Med 2021; 11:20-25. [PMID: 33312850 PMCID: PMC7721625 DOI: 10.1016/j.afjem.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 11/26/2022] Open
Abstract
Fever in children with neutropenia often portends life-threatening bacteremia that may be ameliorated with early recognition and the rapid administration of antimicrobial therapy. Studies demonstrating this effect have been done in resource-endowed countries, but not in resource-limited settings. We attempted to decrease the time to antibiotics in patients with fever and neutropenia presenting to a paediatric emergency centre at a tertiary care referral hospital in Ethiopia. In 3 phases we performed baseline data collection, instituted triaging and treatment guidelines, and provided antibiotics. We tracked a variety of outcomes, most importantly time from arrival to initiation of antibiotics. While this time was reduced during the guideline institution phase of our intervention, time reductions were inconsistent and not sustained. This was likely due to competing clinical priorities among providers caring for a high volume of ill children. While in the U.S., fever and neutropenia is easy to prioritise within the paediatric emergency centre, future quality improvement measures in this setting may have a greater benefit on critical presentations such as shock or respiratory failure. Alternative strategies geared towards general efficiency improvement and teamwork, rather than focusing on one patient group may be a higher yield approach for improving care in this paediatric emergency centre.
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27
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Shane AL, Sato AI, Kao C, Adler-Shohet FC, Vora SB, Auletta JJ, Nachman S, Raabe VN, Inagaki K, Akinboyo IC, Woods C, Alsulami AO, Kainth MK, Santos RP, Espinosa CM, Burns JE, Cunningham CK, Dominguez SR, Martinez BL, Zhu F, Crews J, Kitano T, Saiman L, Kotloff K. A Pediatric Infectious Diseases Perspective of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Novel Coronavirus Disease 2019 (COVID-19) in Children. J Pediatric Infect Dis Soc 2020; 9:596-608. [PMID: 32840614 PMCID: PMC7499621 DOI: 10.1093/jpids/piaa099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2, responsible for coronavirus disease 2019 (COVID-19) infections, is emerging. While the severe manifestations and acute clinical burden of COVID-19 have largely spared children compared with adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities and the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Here, we summarize the current knowledge, identify resources, and outline research opportunities. Pediatric infectious diseases clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment, and prevention studies to optimize their care as well as to represent children in the development of guidance and policy during pandemic response.
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MESH Headings
- Asymptomatic Diseases
- Betacoronavirus
- COVID-19
- COVID-19 Testing
- Child
- Child Health Services
- Clinical Laboratory Techniques
- Coronavirus Infections/diagnosis
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/prevention & control
- Infectious Disease Transmission, Vertical
- Pandemics/prevention & control
- Pediatrics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Practice Guidelines as Topic
- Pregnancy
- Pregnancy Complications, Infectious
- SARS-CoV-2
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Affiliation(s)
- Andi L Shane
- Division of Pediatric Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Alice I Sato
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha, Nebraska, USA
| | - Carol Kao
- Division of Pediatric Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Felice C Adler-Shohet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital of Orange County, Orange, California, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington, USA
| | - Jeffery J Auletta
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Sharon Nachman
- Department of Pediatrics, Stony Brook Children’s, Stony Brook, New York, USA
| | - Vanessa N Raabe
- Division of Infectious Disease, Department of Medicine and Pediatrics, New York University Langone Grossman School of Medicine, New York, New York, USA
| | - Kengo Inagaki
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ibukunoluwa C Akinboyo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Charles Woods
- Department of Pediatrics, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA
| | - Abdulsalam O Alsulami
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mundeep K Kainth
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Roberto Parulan Santos
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, University Hospital, Jackson, Mississippi, USA
| | - Claudia M Espinosa
- Division of Pediatric Infectious Disease, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Julianne E Burns
- Division of Hospital Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Coleen K Cunningham
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Samuel R Dominguez
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Beatriz Larru Martinez
- Division of Paediatric Infectious Diseases & Immunology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Frank Zhu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan Crews
- Division of Pediatric Infectious Diseases, Baylor College of Medicine, Children’s Hospital of San Antonio, San Antonio, Texas, USA
| | - Taito Kitano
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children’s Hospital, New York, New York, USA
| | - Karen Kotloff
- Division of Pediatric Infectious Diseases and Tropical Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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28
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King S, Tancredi D, Lenoir-Wijnkoop I, Gould K, Vann H, Connors G, Sanders ME, Linder JA, Shane AL, Merenstein D. Does probiotic consumption reduce antibiotic utilization for common acute infections? A systematic review and meta-analysis. Eur J Public Health 2020; 29:494-499. [PMID: 30219897 PMCID: PMC6532828 DOI: 10.1093/eurpub/cky185] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overall reduction of antibiotic use is a widely adopted public health goal. Given evidence that consuming probiotics reduce the incidence, duration and/or severity of certain types of common acute infections, we hypothesized that probiotics are associated with reduced antibiotic use. This systematic review of randomized controlled trials (RCTs) assessed the impact of probiotic supplementation (any strain, dose or duration), compared to placebo, on antibiotic utilization for common, acute infections in otherwise healthy people of all ages. METHODS We searched 13 electronic databases including MEDLINE, Embase and CENTRAL from inception to 17th January 2017. Backward and forward citation searches were also conducted. Two reviewers independently selected studies for inclusion and extracted study data. We assessed risk of bias for individual studies using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model. RESULTS We screened 1533 citations, and of these, 17 RCTs met our predefined inclusion criteria. All 17 were conducted in infants and/or children with a primary aim of preventing acute respiratory tract infections, acute lower digestive tract infections or acute otitis media. Included studies used 13 probiotic formulations, all comprising single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Trial quality was variable. Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a lower risk of being prescribed antibiotics, relative to those who received placebo (Pooled Relative Risk = 0.71, 95% CI: 0.54-0.94). When restricted to five studies with a low risk of bias, the pooled relative risk was 0.46 (95% CI: 0.23-0.97). Significant statistical heterogeneity was present in effect size estimates, which appeared to be due to one trial which could partly be considered as an outlier. CONCLUSIONS Probiotics, provided to reduce the risk for common acute infections, may be associated with reduced antibiotic use in infants and children. Additional well-designed studies are needed to substantiate these findings in children and explore similar findings in other population groups.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey A Linder
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andi L Shane
- Emory University School of Medicine, Atlanta, GA, USA
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29
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Wong MF, Matić Z, Campiglia GC, Zimring CM, Mumma JM, Kraft CS, Casanova LM, Durso FT, Walsh VL, Shah PY, Shane AL, Jacob JT, Dubose JR. Design Strategies for Biocontainment Units to Reduce Risk During Doffing of High-level Personal Protective Equipment. Clin Infect Dis 2020; 69:S241-S247. [PMID: 31517982 PMCID: PMC6743504 DOI: 10.1093/cid/ciz617] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). Methods In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. Results The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P = .004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P = .04), and participants reported a similar workload in the redesigned doffing layout (P = .43). Conclusions Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE.
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Affiliation(s)
- Maria F Wong
- SimTigrate Design Lab, Georgia State University, and College of Design
| | - Zorana Matić
- SimTigrate Design Lab, Georgia State University, and College of Design
| | | | - Craig M Zimring
- SimTigrate Design Lab, Georgia State University, and College of Design
| | - Joel M Mumma
- School of Psychology, Georgia State University, and Georgia Institute of Technology
| | - Colleen S Kraft
- Division of Infectious Diseases, Georgia State University, and Department of Medicine.,Department of Pathology and Laboratory Medicine, Georgia State University, and Emory University School of Medicine
| | | | - Francis T Durso
- School of Psychology, Georgia State University, and Georgia Institute of Technology
| | - Victoria L Walsh
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Puja Y Shah
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Andi L Shane
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Georgia
| | - Jesse T Jacob
- Division of Infectious Diseases, Georgia State University, and Department of Medicine
| | - Jennifer R Dubose
- SimTigrate Design Lab, Georgia State University, and College of Design
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30
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Mumma JM, Durso FT, Casanova LM, Erukunuakpor K, Kraft CS, Ray SM, Shane AL, Walsh VL, Shah PY, Zimring C, DuBose J, Jacob JT. Variability in the Duration and Thoroughness of Hand Hygiene. Clin Infect Dis 2020; 69:S221-S223. [PMID: 31517981 PMCID: PMC6743505 DOI: 10.1093/cid/ciz612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We observed 354 hand hygiene instances across 41 healthcare workers doffing personal protective equipment at 4 hospital-based biocontainment units. We measured the duration and thoroughness of each hand hygiene instance. Both parameters varied substantially, with systematic differences between hospitals and differences between healthcare workers accounting for much of the variance.
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Affiliation(s)
- Joel M Mumma
- School of Psychology, Georgia Institute of Technology, Atlanta
| | - Francis T Durso
- School of Psychology, Georgia Institute of Technology, Atlanta
| | | | | | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta
| | - Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta
| | - Victoria L Walsh
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta
| | - Puja Y Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta
| | - Craig Zimring
- School of Architecture, Georgia Institute of Technology, Atlanta
| | - Jennifer DuBose
- School of Architecture, Georgia Institute of Technology, Atlanta
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta
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Mumma JM, Durso FT, Casanova LM, Erukunuakpor K, Kraft CS, Ray SM, Shane AL, Walsh VL, Shah PY, Zimring C, DuBose J, Jacob JT. Common Behaviors and Faults When Doffing Personal Protective Equipment for Patients With Serious Communicable Diseases. Clin Infect Dis 2020; 69:S214-S220. [PMID: 31517977 PMCID: PMC6743503 DOI: 10.1093/cid/ciz614] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The safe removal of personal protective equipment (PPE) can limit transmission of serious communicable diseases, but this process poses challenges to healthcare workers (HCWs). Methods We observed 41 HCWs across 4 Ebola treatment centers in Georgia doffing PPE for simulated patients with serious communicable diseases. Using human factors methodologies, we obtained the details, sequences, and durations of doffing steps; identified the ways each step can fail (failure modes [FMs]); quantified the riskiness of FMs; and characterized the workload of doffing steps. Results Eight doffing steps were common to all hospitals—removal of boot covers, gloves (outer and inner pairs), the outermost garment, the powered air purifying respirator (PAPR) hood, and the PAPR helmet assembly; repeated hand hygiene (eg, with hand sanitizer); and a final handwashing with soap and water. Across hospitals, we identified 256 FMs during the common doffing steps, 61 of which comprised 19 common FMs. Most of these common FMs were above average in their riskiness at each hospital. At all hospitals, hand hygiene, removal of the outermost garment, and removal of boot covers were above average in their overall riskiness. Measurements of workload revealed that doffing steps were often mentally demanding, and this facet of workload correlated most strongly with the effortfulness of a doffing step. Conclusions We systematically identified common points of concern in protocols for doffing high-level PPE. Addressing FMs related to hand hygiene and the removal of the outermost garment, boot covers, and PAPR hood could improve HCW safety when doffing high-level PPE. We identified ways that doffing protocols for high-level personal protective equipment may fail to protect healthcare workers. Hand hygiene, removing the outermost garment, boot covers, and respirator hood harbored the greatest risk and failed in similar ways across different hospitals.
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Affiliation(s)
- Joel M Mumma
- School of Psychology, Georgia Institute of Technology, Atlanta
| | - Francis T Durso
- School of Psychology, Georgia Institute of Technology, Atlanta
| | | | | | - Colleen S Kraft
- Division of Infectious Diseases, Atlanta Department of Medicine.,Department of Pathology and Laboratory Medicine, Atlanta Emory University School of Medicine
| | - Susan M Ray
- Division of Infectious Diseases, Atlanta Department of Medicine
| | - Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta
| | | | - Puja Y Shah
- Division of Infectious Diseases, Atlanta Department of Medicine
| | - Craig Zimring
- School of Architecture, Georgia Institute of Technology, Atlanta
| | - Jennifer DuBose
- School of Architecture, Georgia Institute of Technology, Atlanta
| | - Jesse T Jacob
- Division of Infectious Diseases, Atlanta Department of Medicine
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Teherani MF, Kao CM, Camacho-Gonzalez A, Banskota S, Shane AL, Linam WM, Jaggi P. Burden of Illness in Households With Severe Acute Respiratory Syndrome Coronavirus 2-Infected Children. J Pediatric Infect Dis Soc 2020; 9:613-616. [PMID: 32780809 PMCID: PMC7454727 DOI: 10.1093/jpids/piaa097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/12/2022]
Abstract
We investigated of illness among household members of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children receiving medical care (n = 32). We identified 144 household contacts (HCs): 58 children and 86 adults. Forty-six percent of HCs developed symptoms consistent with coronavirus disease. Child-to-adult transmission was suspected in 7 cases.
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Affiliation(s)
- Mehgan F Teherani
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
- Alternate corresponding authors: Mehgan Teherani, MD, MS. , Carol Kao, MD.
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Alternate corresponding authors: Mehgan Teherani, MD, MS. , Carol Kao, MD.
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | | | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | - William M Linam
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
- Corresponding Author: Preeti Jaggi, MD. 2015 Uppergate Drive NE, Atlanta, GA 30322. Phone: 404-727-4807. Fax: 404-727-9098.
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Shi P, Yan J, Keskinocak P, Shane AL, Swann JL. The impact of opening dedicated clinics on disease transmission during an influenza pandemic. PLoS One 2020; 15:e0236455. [PMID: 32760086 PMCID: PMC7410326 DOI: 10.1371/journal.pone.0236455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/05/2020] [Indexed: 11/19/2022] Open
Abstract
Dedicated clinics can be established in an influenza pandemic to isolate people and potentially reduce opportunities for influenza transmission. However, their operation requires resources and their existence may attract the worried-well. In this study, we quantify the impact of opening dedicated influenza clinics during a pandemic based on an agent-based simulation model across a time-varying social network of households, workplaces, schools, community locations, and health facilities in the state of Georgia. We calculate performance measures, including peak prevalence and total attack rate, while accounting for clinic operations, including timing and location. We find that opening clinics can reduce disease spread and hospitalizations even when visited by the worried-well, open for limited weeks, or open in limited locations, and especially when the clinics are in operation during times of highest prevalence. Specifically, peak prevalence, total attack rate, and hospitalization reduced 0.07–0.32%, 0.40–1.51%, 0.02–0.09%, respectively, by operating clinics for the pandemic duration.
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Affiliation(s)
- Pengyi Shi
- Krannert School of Management, Purdue University, West Lafayette, Indiana, United States of America
| | - Jia Yan
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Pinar Keskinocak
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Andi L. Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - Julie L. Swann
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, United States of America
- * E-mail:
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Gattis S, Yildirim I, Shane AL, Serluco S, McCracken C, Liverman R. Impact of Pharmacy-Initiated Interventions on Influenza Vaccination Rates in Pediatric Solid Organ Transplant Recipients. J Pediatric Infect Dis Soc 2019; 8:525-530. [PMID: 30307524 DOI: 10.1093/jpids/piy095] [Citation(s) in RCA: 4] [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] [Received: 01/22/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In solid organ transplant (SOT) recipients, influenza infection can lead to subsequent graft dysfunction and death. Vaccination is the most effective approach to preventing influenza infection; however, vaccination rates are low, and interventions to optimize vaccine coverage are needed. The purpose of this study was to evaluate if pharmacy-initiated screening and recommendations for influenza immunization improve the rate of vaccination in pediatric SOT recipients. METHODS We performed a retrospective pre-post chart review of all kidney, liver, and heart transplant recipients followed by Children's Healthcare of Atlanta/Emory University transplant services between September 1, 2011, and February 16, 2017. Influenza vaccination coverage and influenza rates before (2011-2013) and after (2014-2016) the implementation of pharmacy-driven vaccination in SOT recipients were assessed. RESULTS A total of 822 patients were included; 101 (13%) of these patients were diagnosed with influenza, and 40 (5%) were hospitalized secondarily during the study period. Vaccination coverage increased over time (144 [36%] patients vaccinated in 2011 vs 430 [74%] in 2016; P < .001). Influenza diagnosis rates decreased between the 2 eras (P = .006). The median time in which 50% of the population was vaccinated decreased over time from 163 days in 2012 to 94 days in 2016 (P < .001). CONCLUSION Within the constraints of the pre-post study design, we observed a significant increase in influenza vaccination rates after implementation of a transplant pharmacy-initiated screening and vaccination program. The number of patients diagnosed with influenza and the time to vaccination decreased after our pharmacy intervention. All efforts should be made to increase compliance with influenza vaccination; pharmacy-initiated interventions can improve protection against influenza infection in pediatric SOT recipients.
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Affiliation(s)
- Sara Gattis
- Department of Pharmacy, Children's Healthcare of Atlanta, Georgia
| | - Inci Yildirim
- Department of Infectious Disease, Children's Healthcare of Atlanta, Georgia.,Department of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Andi L Shane
- Department of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Staci Serluco
- Department of Pharmacy, Children's Healthcare of Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Anderson EJ, Lopman B, Yi J, Libster R, Creech CB, El-Khorazaty J, Baqar S, Yildirim I, Kao C, Rouphael N, Shane AL, Edwards K. Effect of Concomitant Antibiotic and Vaccine Administration on Serologic Responses to Rotavirus Vaccine. J Pediatric Infect Dis Soc 2019; 9:479-482. [PMID: 31237948 PMCID: PMC7495907 DOI: 10.1093/jpids/piz044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/07/2018] [Accepted: 05/28/2019] [Indexed: 11/14/2022]
Abstract
Data from 1174 infants enrolled in a previous rotavirus vaccine study were analyzed to determine the effect of antibiotic exposure (from 14 days before to 7 days after vaccination) on rotavirus serum immunoglobulin A (IgA) responses. Serum IgA responses 1 month after the completion of vaccination were similar among antibiotic-exposed and nonexposed infants.
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Affiliation(s)
- Evan J Anderson
- Departments of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Departments of Medicine, Emory University School of Medicine, Atlanta, Georgia,Correspondence: E. J. Anderson, MD, Emory Children’s Center, Division of Infectious Diseases, 2015 Uppergate Dr, Atlanta, GA 30322 ()
| | - Benjamin Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jumi Yi
- Departments of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Romina Libster
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee,Fundacion INFANT/National Technical and Scientific Research Council, Buenos Aires, Argentina
| | - C Buddy Creech
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Shahida Baqar
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - Inci Yildirim
- Departments of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carol Kao
- Departments of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nadine Rouphael
- Departments of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Andi L Shane
- Departments of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kathryn Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Cieslak TJ, Evans L, Kortepeter MG, Grindle A, Aigbivbalu L, Boulter K, Carroll RW, Cumplido S, Danforth AG, Fry C, Gaensbauer J, Hume JR, Husain A, Kelleher A, Kratochvil CJ, Kunrath C, Morgan JS, Schwedhelm MM, Shane AL, Tennill P, Yager PH, Davies HD. Perspectives on the Management of Children in a Biocontainment Unit: Report of the NETEC Pediatric Workgroup. Health Secur 2019; 17:11-17. [PMID: 30779612 DOI: 10.1089/hs.2018.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
During the outbreak of Ebola virus disease that struck West Africa during 2014-2016, a small handful of expatriate patients were evacuated to specialized high-level containment care units, or biocontainment units, in the United States and Western Europe. Given the lower mortality rate (18% versus 40% for those treated in Africa) among these patients, it is likely that high-level containment care will be used in the future with increasing frequency. It is also likely that children infected with Ebola and other highly hazardous communicable diseases will someday require such care. The National Ebola Training and Education Center convened a pediatric workgroup to consider the unique and problematic issues posed by these potential child patients. We report here the results of those discussions.
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Affiliation(s)
- Theodore J Cieslak
- Theodore J. Cieslak, MD, MPH, is Medical Co-Director, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha NE
| | - Laura Evans
- Laura Evans, MD, MSc, is Medical Director of Critical Care and Special Pathogens Program, Bellevue Hospital, New York University School of Medicine, New York, NY
| | - Mark G Kortepeter
- Mark G. Kortepeter, MD, MPH, is Professor of Epidemiology, University of Nebraska College of Public Health, Omaha, NE
| | - Amanda Grindle
- Amanda Grindle, MSN, Clinical Program Manager, with the Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Lemuel Aigbivbalu
- Lemuel Aigbivbalu, MD, is in the Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Kate Boulter
- Kate Boulter, RN, MPH, is Nurse Manager, Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha NE
| | - Ryan W Carroll
- Ryan W. Carroll, MD, MPH, is with Pediatric Critical Care Medicine, Massachusetts General Hospital for Children, Boston, MA
| | - Sylvia Cumplido
- Sylvia Cumplido, MSN, is a Nurse Epidemiologist, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alison G Danforth
- Alison G. Danforth, BSN, RN, with the Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Cecilia Fry
- Cecilia Fry is a Pediatric Intensivist, Special Pathogens Unit, Providence Sacred Heart Medical Center, Spokane, WA
| | - James Gaensbauer
- James Gaensbauer, MD, is an Assistant Professor, University of Colorado School of Medicine, Denver, CO
| | - Janet R Hume
- Janet R. Hume, MD, PhD, is an Assistant Professor, Department of Pediatrics, Division of Critical Care Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Amyna Husain
- Amyna Husain, DO, is a Clinical Instructor, Pediatric Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Arlene Kelleher
- Arlene Kelleher, MS, RN, is Nurse Director, Pediatric Intensive Care Unit, Massachusetts General Hospital for Children, Boston, MA
| | - Christopher J Kratochvil
- Christopher J. Kratochvil, MD, is Associate Vice Chancellor for Clinical Research, University of Nebraska Medical Center, Omaha NE
| | - Claudia Kunrath
- Claudia Kunrath, MD, is Medical Director, Pediatric Critical Care, Denver Health Medical Center, Denver, CO
| | - Jill S Morgan
- Jill S. Morgan, RN, is Lead Nurse for Education, Serious Communicable Disease Unit, Emory University Hospital, Atlanta, GA
| | - Michelle M Schwedhelm
- Michelle M. Schwedhelm, MSN, is Executive Director, Emergency Management and Biopreparedness, Nebraska Medicine, Omaha, NE
| | - Andi L Shane
- Andi L. Shane, MD, is Associate Professor of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Patricia Tennill
- Patricia Tennill, RN, is Associate Director of Nursing, Special Pathogens Program, Bellevue Hospital, New York, NY
| | - Phoebe H Yager
- Phoebe H. Yager, MD, is Chief, Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - H Dele Davies
- H. Dele Davies, MD, is Professor of Pediatric Infectious Diseases and Public Health, Department of Pediatrics, University of Nebraska Medical Center, Omaha NE
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Haston JC, Rostad CA, Jerris RC, Milla SS, McCracken C, Pratt C, Wiley M, Prieto K, Palacios G, Shane AL, McElroy AK. Prospective Cohort Study of Next-Generation Sequencing as a Diagnostic Modality for Unexplained Encephalitis in Children. J Pediatric Infect Dis Soc 2019; 9:326-333. [PMID: 31107955 PMCID: PMC7457329 DOI: 10.1093/jpids/piz032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Encephalitis is an inflammatory condition of the brain associated with long-term neurologic sequelae and even death in children. Although viruses are often implicated, an etiology is not identified in the majority of cases. Metagenomics-based next-generation sequencing (mNGS) is a high-throughput sequencing technique that can enhance the detection of novel or low-frequency pathogens. METHODS Hospitalized immunocompetent children aged 6 months to 18 years with encephalitis of unidentified etiology were eligible for enrollment. Demographic, historical, and clinical information was obtained, and residual blood and cerebrospinal fluid (CSF) samples were subjected to mNGS. Pathogens were identified by querying the sequence data against the NCBI GenBank database. RESULTS Twenty children were enrolled prospectively between 2013 and 2017. mNGS of CSF identified 7 nonhuman nucleic acid sequences of significant frequency in 6 patients, including that of Mycoplasma bovis, parvovirus B19, Neisseria meningitidis, and Balamuthia mandrillaris. mNGS also detected Cladophialophora species, tobacco mosaic virus, and human bocavirus, which were presumed to be contaminants or nonpathogenic organisms. One patient was found to have positive serology results for California encephalitis virus, but mNGS did not detect it. Patients for whom mNGS identified a diagnosis had a significantly higher CSF white blood cell count, a higher CSF protein concentration, and a lower CSF glucose level than patients for whom mNGS did not identify a diagnosis. CONCLUSION We describe here the results of a prospective cohort analysis to evaluate mNGS as a diagnostic tool for children with unexplained encephalitis. Although mNGS detected multiple nonpathogenic organisms, it also identified multiple pathogens successfully and was most useful in patients with a CSF abnormality.
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Affiliation(s)
- Julia C Haston
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | | | - Sarah S Milla
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Catherine Pratt
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Michael Wiley
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Karla Prieto
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Gustavo Palacios
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Anita K McElroy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia,Department of Pediatrics, University of Pittsburgh, Pennsylvania,Correspondence: A. K. McElroy, MD, PhD, University of Pittsburgh, Department of Pediatrics, 3501 Fifth Ave, Pittsburgh, PA 15261 ()
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Chan KN, Silverstein A, Bryan LN, McCracken CE, Little WK, Shane AL. Comparison of a Smartphone Otoscope and Conventional Otoscope in the Diagnosis and Management of Acute Otitis Media. Clin Pediatr (Phila) 2019; 58:302-306. [PMID: 30463434 DOI: 10.1177/0009922818812480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute otitis media (AOM) is a leading cause of health encounters and antimicrobial prescriptions in children worldwide. We assessed (1) the rates of antimicrobial prescribing by pediatric emergency department clinicians using a smartphone otoscope device as compared with a conventional otoscope and (2) clinician acceptability of the smartphone device. We conducted a randomized control study in children's hospital emergency departments over 6 months. More than 1500 encounters were analyzed. The odds of prescribing antibiotics after being given a diagnosis of AOM by clinicians assigned to the smartphone group was 11% higher than the conventional group (18.8% vs 18.0%, odds ratio = 1.106, P = .600). Eight (73%) of the 11 physicians in the smartphone group preferred the smartphone device over the conventional otoscope. Use of a smartphone otoscope for detection of AOM in a pediatric emergency department setting did not lead to an increased likelihood of AOM diagnosis.
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Affiliation(s)
- K Ning Chan
- Emory University, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | | | - Wendalyn K Little
- Emory University, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andi L Shane
- Emory University, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
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Anderson EJ, Lopman B, Yi J, Yildirim I, Creech CB, El-Khorazaty J, Shane AL, Edwards K. 2280. Antibiotic Exposure Does Not Impact Serological Responses to Rotavirus Vaccination. Open Forum Infect Dis 2018. [PMCID: PMC6255677 DOI: 10.1093/ofid/ofy210.1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Antibiotic exposure around the time of rotavirus (RV) immunization has been suggested to diminish immune responses, but data are sparse. Methods We retrospectively analyzed data from a randomized RV vaccine study (NCT01266850) outlined in the Table. Concomitant antibiotic use, defined as receipt of an antibiotic 14 days before or 7 days after RV immunization, was recorded. The primary outcome was RV-specific IgA seroresponse (IgA ≥20 U/mL) by ELISA obtained 1 month after the last dose of RV vaccine and geometric mean titer (GMT) to strain WC3 (RV5 backbone) or strain 89–12 (RV1 backbone). Only subjects who received all scheduled vaccine doses and phlebotomy were included. Data were assessed for homogeneity across vaccine schedule groups, stratified by antibiotic exposure. We examined differences in seroresponse adjusting for treatment group, gender, race, ethnicity, and study site using logistic regression models. Results Of the 1384 immunized children, 1174 (85%) met inclusion criteria. Nearly 10% (n = 114) of participants were antibiotic exposed; group 4 had the least antibiotic exposure (P = 0.05). No differences in GMT or seroresponses were observed to either WC3 or 89–12 (figure) by antibiotic exposure. In the multivariable logistic regression model, there were no significant differences for gender, race, ethnicity, site, or antibiotic exposure (P-value ≥0.5 for IgA seroresponse). The only observed difference in seroresponses was by RV vaccine group (P < 0.0001). Conclusion Antibiotic administration around the time of RV vaccine did not diminish RV-specific IgA seroresponses observed 1 month after the last RV vaccine dose. Disclosures E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support. C. B. Creech, Pfizer: Grant Investigator, Research grant. Novartis: Grant Investigator, Research grant. A. L. Shane, International Scientific Association of Probiotics and Prebiotics: Member, Reimbursement of travel and lodging for attendance and presentations at international scientific meetings 2016 and prior and support for attendance at meeting at FDA in 2017 to discuss probiotic and prebiotic research. K. Edwards, Novartis: Grant Investigator, Research grant. Novartis: Scientific Advisor, Consulting fee.
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Affiliation(s)
- Evan J Anderson
- Departments of Medicine and Pediatrics, Divisions of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jumi Yi
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Inci Yildirim
- Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - C Buddy Creech
- Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Andi L Shane
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kathryn Edwards
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
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Bell CE, Shane AL, Pickering LK. Corrigendum to ‘Discrepancies Between US Food and Drug Administration Vaccine Licensure Indications and Advisory Committee on Immunization Practices Recommendations: Provider Knowledge and Attitudes’ [Clinical Therapeutics 40 (2018) 1308–1319]. Clin Ther 2018; 40:1619. [DOI: 10.1016/j.clinthera.2018.08.020] [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: 10/28/2022]
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Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2018; 65:1963-1973. [PMID: 29194529 DOI: 10.1093/cid/cix959] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Georgia
| | - Rajal K Mody
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Washington University in St. Louis School of Medicine, Missouri
| | - Theodore S Steiner
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Joanne M Langley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Wanke
- Division of Nutrition and Infection, Tufts University, Boston, Massachusetts
| | - Cirle Alcantara Warren
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Cantey
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston
| | - Larry K Pickering
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
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42
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Brady RC, Jackson LA, Frey SE, Shane AL, Walter EB, Swamy GK, Schlaudecker EP, Szefer E, Wolff M, McNeal MM, Bernstein DI, Steinhoff MC. Randomized trial comparing the safety and antibody responses to live attenuated versus inactivated influenza vaccine when administered to breastfeeding women. Vaccine 2018; 36:4663-4671. [PMID: 29961606 PMCID: PMC8785652 DOI: 10.1016/j.vaccine.2018.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) are both licensed for administration to nursing mothers. Little is known about the potential for transmission of LAIV viruses from the mother to the infant and the comparative breast milk antibody responses to LAIV and IIV. METHODS We performed a randomized, double-blind study comparing the immunogenicity of LAIV to IIV when administered to nursing mothers. The safety of LAIV to IIV in women and their infants was also compared. Women received LAIV + intramuscular placebo, or IIV + intranasal placebo on Day 0. Breast milk and nasal swabs (from women and infants) were collected on Days 0, 2, and 8 for detection of LAIV. Breast milk and serum antibody responses were measured at Days 0 and 28. The primary hypothesis was that LAIV would provide superior induction of breast milk IgA responses to influenza as compared to IIV when administered to nursing mothers. RESULTS Breast milk IgG, breast milk IgA (H1N1 only), serum hemagglutination inhibition (HAI), and serum IgG responses were significantly higher following administration of IIV compared to LAIV. Receipt of either LAIV or IIV was safe in women and their infants. One (1%) LAIV recipient transmitted vaccine virus to her infant who remained well. No influenza virus was detected in breast milk. CONCLUSIONS Breast milk and serum antibody responses were higher for IIV compared to LAIV. LAIV and IIV were safe for nursing women but there was one (1%) possible transmission of LAIV to an infant. This study suggests that IIV may be the preferred vaccine for nursing mothers.
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MESH Headings
- Administration, Intranasal
- Adolescent
- Adult
- Antibodies, Viral/analysis
- Antibodies, Viral/blood
- Antibody Formation
- Breast Feeding
- Double-Blind Method
- Female
- Humans
- Immunoglobulin A/analysis
- Immunoglobulin G/analysis
- Immunoglobulin G/blood
- Infant
- Infant, Newborn
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza Vaccines/immunology
- Injections, Intramuscular
- Male
- Middle Aged
- Milk, Human/immunology
- Orthomyxoviridae/immunology
- Placebos/administration & dosage
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/immunology
- Young Adult
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Affiliation(s)
- Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | | | | | | | | | | | | | - Mark Wolff
- The EMMES Corporation, Rockville, MD, USA
| | | | | | - Mark C Steinhoff
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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43
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Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017; 65:e45-e80. [PMID: 29053792 PMCID: PMC5850553 DOI: 10.1093/cid/cix669] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022] Open
Abstract
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Rajal K Mody
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Theodore S Steiner
- Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO; 5Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | | | - Christine Wanke
- Division of Nutrition and Infection, Tufts University, Boston, Massachusetts,Cirle Alcantara Warren, MD
| | - Cirle Alcantara Warren
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Cantey
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Larry K Pickering
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
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44
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Abstract
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure, inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents. This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Pablo J Sánchez
- Divisions of Neonatology and Infectious Disease, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara J Stoll
- University of Texas, Health McGovern Medical School, Houston, TX, USA
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45
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Hatzenbuehler LA, Tobin-D'Angelo M, Drenzek C, Peralta G, Cranmer LC, Anderson EJ, Milla SS, Abramowicz S, Yi J, Hilinski J, Rajan R, Whitley MK, Gower V, Berkowitz F, Shapiro CA, Williams JK, Harmon P, Shane AL. Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infection. J Pediatric Infect Dis Soc 2017; 6:e116-e122. [PMID: 28903524 DOI: 10.1093/jpids/pix065] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mycobacterium abscessus is an uncommon cause of invasive odontogenic infection. METHODS M abscessus-associated odontogenic infections occurred in a group of children after they each underwent a pulpotomy. A probable case-child was defined as a child with facial or neck swelling and biopsy-confirmed granulomatous inflammation after a pulpotomy between October 1, 2013, and September 30, 2015. M abscessus was isolated by culture in confirmed case-children. Clinical presentation, management, and outcomes were determined by medical record abstraction. RESULTS Among 24 children, 14 (58%) were confirmed case-children. Their median age was 7.3 years (interquartile range, 5.8-8.2 years), and the median time from pulpotomy to symptom onset was 74 days (range, 14-262 days). Clinical diagnoses included cervical lymphadenitis (24 [100%] of 24), mandibular or maxillary osteomyelitis (11 [48%] of 23), and pulmonary nodules (7 [37%] of 19). Each child had ≥1 hospitalization and a median of 2 surgeries (range, 1-6). Of the 24 children, 12 (50%) had surgery alone and 11 (46%) received intravenous (IV) antibiotics. Nineteen of the 24 (79%) children experienced complications, including vascular access malfunction (7 [64%] of 11), high-frequency hearing loss (5 [56%] of 9), permanent tooth loss (11 [48%] of 23), facial nerve palsy (7 [29%] of 24), urticarial rash (3 [25%] of 12), elevated liver enzyme levels (1 [20%] of 5), acute kidney injury (2 [18%] of 11), incision dehiscence/fibrosis (3 [13%] of 24), and neutropenia (1 [9%] of 11). CONCLUSIONS M abscessus infection was associated with significant medical morbidity and treatment complications. Unique manifestations included extranodal mandibular or maxillary osteomyelitis and pulmonary nodules. Challenges in the identification of case-children resulted from an extended incubation period and various clinical manifestations. Clinicians should consider the association between M abscessus infection and pulpotomy in children who present with subacute cervical lymphadenitis. The use of treated/sterile water during pulpotomy might prevent further outbreaks.
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Affiliation(s)
- Lindsay A Hatzenbuehler
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Baylor College of Medicine, Houston, Texas
| | | | | | | | - Lisa C Cranmer
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Evan J Anderson
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Division of Infectious Diseases.,Department of Medicine
| | - Sarah S Milla
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Radiology
| | - Shelly Abramowicz
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Oral and Maxillofacial Surgery
| | - Jumi Yi
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph Hilinski
- Department of Pediatrics.,St. Luke's Children's Hospital, Boise, Idaho
| | - Roy Rajan
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Otolaryngology-Head & Neck Surgery
| | - Matthew K Whitley
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Verlia Gower
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Frank Berkowitz
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Craig A Shapiro
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph K Williams
- Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Plastic and Reconstructive Surgery
| | - Paula Harmon
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Andi L Shane
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
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46
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Woodhall DM, Garcia AP, Shapiro CA, Wray SL, Shane AL, Mani CS, Stimpert KK, Fox LM, Montgomery SP. Assessment of U.S. Pediatrician Knowledge of Toxocariasis. Am J Trop Med Hyg 2017; 97:1243-1246. [PMID: 28820703 DOI: 10.4269/ajtmh.17-0232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Toxocariasis, one of a group of parasitic diseases known as neglected parasitic infections, is a disease caused by the larvae of two species of Toxocara roundworms, Toxocara canis, from dogs, and less commonly Toxocara cati, from cats. Although most infected individuals are asymptomatic, clinical manifestations may include fever, fatigue, coughing, wheezing, or abdominal pain (visceral toxocariasis) or vision loss, retina damage, or eye inflammation (ocular toxocariasis). To assess U.S. pediatrician knowledge of toxocariasis, we conducted an electronic survey of American Academy of Pediatrics members. Of the 2,684 respondents, 1,120 (47%) pediatricians correctly selected toxocariasis as the diagnosis in an unknown case presentation with findings typical for toxocariasis; overall 1,695 (85%) stated they were not confident that their knowledge of toxocariasis was current. This knowledge gap suggests a need for improved toxocariasis awareness and education for U.S. pediatricians, especially those caring for children at risk for infection.
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Affiliation(s)
- Dana M Woodhall
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda P Garcia
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig A Shapiro
- Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, Georgia.,Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Shequenta L Wray
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andi L Shane
- Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, Georgia.,Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | - Kelly K Stimpert
- IHRC Inc., Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LeAnne M Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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47
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Hatzenbuehler L, Drenzek C, Tobin-D'Angelo M, Peralta G, Anderson EJ, Yi J, Shapiro C, Abramowicz S, Cranmer L, Shore S, Statham M, Hilinski J, Harmon P, Baktha S, Williams J, Berkowitz F, Milla S, Gower V, Whitley M, Shane AL. Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Cherie Drenzek
- Georgia Department of Community Health, Atlanta, Georgia
| | | | - Gianna Peralta
- Georgia Department of Community Health, Atlanta, Georgia
| | - Evan J. Anderson
- Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jumi Yi
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Craig Shapiro
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lisa Cranmer
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Steve Shore
- Pediatric Infectious Disease, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Melissa Statham
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joseph Hilinski
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Paula Harmon
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Sivi Baktha
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joseph Williams
- Plastic and Craniofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Frank Berkowitz
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Milla
- Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Verlia Gower
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew Whitley
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Andi L. Shane
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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48
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Yi J, Sederdahl BK, Wahl K, Jerris RR, Kraft CS, McCracken C, Gillespie S, Kirby AE, Shane AL, Moe CL, Anderson EJ. Rotavirus and Norovirus in Pediatric Healthcare-Associated Gastroenteritis. Open Forum Infect Dis 2016; 3:ofw181. [PMID: 27807589 PMCID: PMC5088695 DOI: 10.1093/ofid/ofw181] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/23/2016] [Indexed: 12/30/2022] Open
Abstract
Rotavirus and norovirus are important etiologies of gastroenteritis among hospitalized children. During 2012–2013, we tested 207 residual stool specimens from children with healthcare-associated vomiting and/or diarrhea for rotavirus and norovirus. Twenty (10%) were rotavirus positive, and 3 (3%) were norovirus positive, stressing the importance of these pathogens in hospitalized children.
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Affiliation(s)
- Jumi Yi
- Department of Pediatrics , Emory University School of Medicine
| | - Bethany K Sederdahl
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University
| | - Kelly Wahl
- Rollins School of Public Health , Emory University
| | - Robert R Jerris
- Children's Healthcare of Atlanta; Department of Pathology and Laboratory Medicine
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Scott Gillespie
- Department of Pediatrics , Emory University School of Medicine
| | - Amy E Kirby
- Rollins School of Public Health , Emory University
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University; Children's Healthcare of Atlanta
| | | | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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49
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Rappaport KM, McCracken CC, Beniflah J, Little WK, Fletcher DA, Lam WA, Shane AL. Assessment of a Smartphone Otoscope Device for the Diagnosis and Management of Otitis Media. Clin Pediatr (Phila) 2016; 55:800-10. [PMID: 26156976 DOI: 10.1177/0009922815593909] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Jacob Beniflah
- Emory University School of Medicine, Atlanta, GA, USA Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Wendalyn K Little
- Emory University School of Medicine, Atlanta, GA, USA Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Wilbur A Lam
- Emory University School of Medicine, Atlanta, GA, USA Children's Healthcare of Atlanta, Atlanta, GA, USA Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Andi L Shane
- Emory University School of Medicine, Atlanta, GA, USA Children's Healthcare of Atlanta, Atlanta, GA, USA
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50
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Abstract
This is a summary from a workshop convened as part of the 13(th) annual meeting of the International Scientific Association for Probiotics and Prebiotics. A group of 24 stakeholders, including clinical experts, researchers, federal government officials, funding agencies, lawyers and industry experts met to review the challenges of the current regulatory approach to human research on probiotics in the USA and to discuss ways to move research forward. There was agreement that some of the current regulatory requirements imposed on probiotic research in the United States hindered research progress and increased cost without improving study subject safety. Many situations were outlined by clinical investigators demonstrating the impact of regulatory delays on research progress. Additionally, research is compromised when study designs and outcomes require manipulation so as to invoke less burdensome regulatory requirements. These responses by investigators to regulatory requirements have placed United States' researchers at a disadvantage. The public ultimately suffer when research to clarify the role of these products on health is stalled. Workshop participants concurred that regulatory oversight should balance study subject vulnerability with documented safety for the intended use for the probiotic strain, and that human research on foods and supplements should not be be regulated as drug research. Challenges and potential improvement strategies are discussed.
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Affiliation(s)
- Mary Ellen Sanders
- International Scientific Association for Probiotics and Prebiotics, Centennial, CO, USA
| | - Andi L. Shane
- Emory University School of Medicine, Atlanta, GA, USA
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