Navigating paediatric virology through the COVID‑19 era (Review)

The present review article presents the key messages of the 8th Workshop on Paediatric Virology organised virtually by the Institute of Paediatric Virology based on the island of Euboea in Greece. The major topics covered during the workshop were the following: i) New advances in antiviral agents and vaccines against cytomegalovirus; ii) hantavirus nephropathy in children; iii) human rhinovirus infections in children requiring paediatric intensive care; iv) complications and management of human adenovirus infections; v) challenges of post‑coronavirus disease 2019 (COVID‑19) syndrome in children and adolescents; and vi) foetal magnetic resonance imaging in viral infections involving the central nervous system. The COVID‑19 era requires a more intensive, strategic, global scientific effort in the clinic and in the laboratory, focusing on the diagnosis, management and prevention of viral infections in neonates and children.

Creating the 'George N. Papanicolaou Medal' by the Academy of Athens: An interview with Professor of Sculpture Theodoros Papagiannis (Athens School of Fine Arts, Athens, Greece)

The 'George N. Papanicolaou Medal' is a brass medal commissioned by the Academy of Athens on the occasion of the 100th anniversary of the birth of Dr George N. Papanicolaou in 1983. It was created by Professor Theodoros Papagiannis, Professor Emeritus of Sculpture at the Athens School of Fine Arts in Athens, Greece; the medal presents Dr George N. Papanicolaou with his microscope. According to Professor Papagiannis, the medal was requested by Professor Nikolaos Louros, Emeritus Professor of Obstetrics and Gynecology at the University of Athens School of Medicine and it was created according to the ancient Greek style. The medal was given to all honored participants of the special ceremony organized by the Academy of Athens in May 13th, 1983, in the context of the 100 years from the birth of Dr George N. Papanicolaou. The ceremony was performed at the Central Hall of the Academy of Athens in Athens under the auspices of the President of the Hellenic Democracy Constantinos Caramanlis. A copy of this medal is being exhibited at the 'Museum of Contemporary Sculpture Theodoros Papagiannis' in Elliniko at the Municipality of Katsanochoria close to Ioannina (Greece), as well as at the newly founded Institute of Paediatric Virology based on the island of Euboea, birth place of Dr George N. Papanicolaou.

Update on current views and advances on RSV infection (Review)

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood.

Mache Papanicolaou (1890-1982), the dedicated companion of the great benefactor: An interview with Dr Julie Kokkori, one of the only living relatives of Dr George N. Papanicolaou

Mache Papanicolaou (Volos, Greece, 1890 - Miami, Florida, USA, 1982) was the soul of absolute dedication to research, science and humanity of her lifelong partner, Dr George N. Papanicolaou (Kymi, Greece, 1883 - Miami Florida, USA, 1962). Her devotion to him, her endless support during their first years in the USA, as well as during the period before the approval of the Pap smear test and her selfless contribution to this revolutionary work were invaluable, indeed. In this article, which is dedicated to the memory of Mache Papanicolaou, we have the great honour to host the testimony of one of the only living relatives of Dr George N. Papanicolaou. Dr Julie Kokkori is the granddaughter of Nasos N. Papanicolaou (Kymi, Greece, 1880-Athens, Greece, 1958), the oldest brother of Dr George N. Papanicolaou, and daughter of the niece of Dr George N. Papanicolaou, Maria Kokkori (Trikala, Greece, 1918 - Athens, Greece, 2012), author of the first book in the Hellenic literature on the life of Dr George N. Papanicolaou entitled 'George N. Papanicolaou: through his life and work'.

A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak

This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits's annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island's tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.

Paediatric Virology and its interaction between basic science and clinical practice (Review)

The 3rd Workshop on Paediatric Virology, which took place on October 7th, 2017 in Athens, Greece, highlighted the role of breast feeding in the prevention of viral infections during the first years of life. Moreover, it focused on the long-term outcomes of respiratory syncytial virus and rhinovirus infections in prematurely born infants and emphasised the necessity for the development of relevant preventative strategies. Other topics that were covered included the vaccination policy in relation to the migration crisis, mother‑to‑child transmission of hepatitis B and C viruses, vaccination against human papilloma viruses in boys and advances on intranasal live‑attenuated vaccination against influenza. Emphasis was also given to the role of probiotics in the management of viral infections in childhood, the potential association between viral infections and the pathogenesis of asthma, fetal and neonatal brain imaging and the paediatric intensive care of children with central nervous system viral infections. Moreover, an interesting overview of the viral causes of perinatal mortality in ancient Greece was given, where recent archaeological findings from the Athenian Agora's bone well were presented. Finally, different continuing medical educational options in Paediatric Virology were analysed and evaluated. The present review provides an update of the key topics discussed during the workshop.

Paediatric Virology: A rapidly increasing educational challenge

The '2nd Workshop on Paediatric Virology', which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.

Vaccination against Human Papillomavirus in relation to Financial Crisis: The "Evaluation and Education of Greek Female Adolescents on Human Papillomaviruses' Prevention Strategies" ELEFTHERIA Study

STUDY OBJECTIVE

In this study we aimed to explore financial and other sociodemographic factors that affect nonvaccination against the human papillomavirus (HPV) in Greece, one of the first European Union countries to introduce the vaccination against HPV into its National Immunization Programme in 2008. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Six hundred thirty-two female adolescents (aged 11-16 years) from Greece completed a pilot cross-sectional questionnaire-based survey (ELEFTHERIA study) from 2008 to 2014.

RESULTS

Overall, only 8.9% (56 of 632) of the female adolescents reported that they had received all 3 doses of the HPV vaccination. The HPV vaccination uptake rates increased gradually from 3.2% (3 of 95) in 2008 to 17.1% (14 of 82) in 2011. However, it abruptly decreased to 2.1% (2 of 95) in 2012 and it reached 9.2% (8 of 87) in 2013 and 11.5% (11 of 96) in 2014. The most common factors for nonvaccination included fear of side effects, which decreased (Spearman ρ = -0.860; P = .024) and financial issues, which increased statistically significantly (Spearman ρ = 0.890; P = .012) during the years 2008 to 2014.

CONCLUSION

In our study we addressed the novel topic of the association of financial issues with HPV vaccination compliance and highlighted the urgent need to provide and maintain health insurance coverage to children in Greece, a country in financial crisis.

Current views and advances on Paediatric Virology: An update for paediatric trainees

Paediatric Virology is a bold new scientific field, which combines Paediatrics with Virology, Epidemiology, Molecular Medicine, Evidence-based Medicine, Clinical Governance, Quality Improvement, Pharmacology and Immunology. The Workshop on Paediatric Virology, which took place on Saturday October 10, 2015 in Athens, Greece, provided an overview of recent views and advances on viral infections occurring in neonates and children. It was included in the official programme of the 20th World Congress on Advances in Oncology and the 18th International Symposium on Molecular Medicine, which attracted over 500 delegates from the five continents. During the Workshop, the topics covered included the challenges of vaccine implementation against human papillomaviruses in countries under financial crisis, strategies for eradicating poliomyelitis and its 60th vaccine anniversary, as well as the debate on the association between autism and vaccination against measles, mumps and rubella. Among the non-vaccine related topics, emphasis was given to viral infections in prematurely born infants and their long-term outcomes, new paediatric intensive care management options for bronchiolitis related to respiratory syncytial virus, the clinical implications of hepatitis B virus and cytomegalovirus genotyping, the Ebola virus threat and preparedness in Paediatric Emergency Departments, oral, oropharynx, laryngeal, nasal and ocular viral infections and Merkel cell polyomavirus as a novel emerging virus of infancy and childhood. In this review, we provide selected presentations and reports discussed at the Workshop.

Prospective study of human norovirus infection in children with acute gastroenteritis in Greece

AIM

Noroviruses are considered as a major cause of acute gastroenteritis in childhood worldwide. This prospective study was undertaken to investigate the frequency and clinical features of norovirus infections in children aged less than 5 years with acute gastroenteritis in Greece.

METHODS

Routine stool samples were obtained from 227 children, 119 boys and 108 girls, with acute gastroenteritis, who attended a tertiary paediatric hospital in Athens during the period November 2008 - October 2009. All specimens were tested for the presence of norovirus, rotavirus and adenovirus antigens using validated enzyme-linked immunoassays.

RESULTS

Norovirus was detected in 8 (7.9%) out of 101 children during the period November 2008 to April 2009, while the respective rate during the period May 2009 to October 2009 was 1/126 (0.8%). In the total sample, rotavirus was detected in 56 (24.7%) children and adenovirus in 5 (2.2%) children. Three (1.3%) samples grew Campylobacter jejuni, while 6 (2.6%) samples grew Salmonella. In all cases, norovirus was detected as a unique viral pathogen. Among norovirus-positive children, who required hospitalization, the median duration of intravenous fluid administration was 3.5 days. The median duration of hospitalization was 4 days (range 3 days to 5 days) and did not differ from the duration of hospitalization of rotavirus-positive children.

CONCLUSION

Our results suggest norovirus as the second most common cause of community-acquired acute gastroenteritis in children in Greece, following rotavirus. We highlight the need to implement norovirus detection assays for the clinical diagnosis and the prevention of viral gastroenteritis in paediatric departments.