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.

Exploring the optimal vaccination strategy against hepatitis B virus in childhood (Review)

Vaccination against hepatitis B virus (HBV) remains the most effective strategy against HBV infection in humans. The present review summarized the optimal vaccination strategies against HBV in childhood. The following points are discussed: i) When and how the first HBV vaccines were developed; ii) the dosages, schedules and injection routes that are used for HBV vaccination; iii) the contraindications for HBV vaccination in the general paediatric population; iv) the challenges with the use of multivalent vaccines; v) the long-term immunogenicity and duration of protection against HBV; vi) the use of selective HBV vaccination and the hepatitis B immune globulin strategy in HBV-exposed infants; and vii) the effectiveness of the current HBV vaccination schemes. The present review is based on a Paediatric Virology Study Group (PVSG) webinar performed in the context of the 8th Workshop on Paediatric Virology.

Exploring medical terminology inexpediencies: Tripledemic vs. triple epidemic

Accurate and consistent medical terminology has a fundamental value in medicine. It enables medical students to understand the meaning of each term, medical physicians to communicate with each other, and it also enables science to adopt a logical language of high-level understanding and scientific regularity. Medical terminology inexpediencies caused by the adoption of etymologically illogical or linguistically false terms lead to misunderstanding and confusion among clinicians. The medical terms epidemic and pandemic are as old as Hippocrates and Sophocles, respectively. The present article evaluates the new medical terms tripledemic and triple epidemic, which were introduced during the recent COVID-19 pandemic.

Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group

Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the '8th Workshop of Paediatric Virology' organized by the Institute of Paediatric Virology based on the island of Euboea (Greece).

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.

The foundation of the Institute of Paediatric Virology on the island of Euboea, Greece (Review)

The Institute of Paediatric Virology, founded on October 2019 on the island of Euboea in Greece, introduces medical students, paediatric and neonatal trainees, postgraduate students, virologists, paediatric and allied health professionals to the bold, new, scientific field of paediatric virology. The institute is committed to medical education and is the sequel of the Paediatric Virology Study Group (PVSG), which was formed in 2007 in the United Kingdom by a group of young paediatric trainees and junior researchers. The main mission of the institute is to provide an educational e-platform on neonatal and paediatric viral infections, to facilitate scientific discussion between virologists and paediatric health professionals and to develop an international network aiming to the promotion of children's health by the prevention and treatment of viral infectious diseases. The foundation of the institute is dedicated to three children from a small fishing village at the south of the island of Euboea in Greece, who survived the 1918 Spanish flu pandemic.

The challenge of paediatric epilepsy nursing: An interview with Mrs. Jenny O'Brien, paediatric epilepsy nursing specialist at the Wirral University Teaching Hospital, UK

Epilepsy in childhood is one of the most common neurological disorders encountered in paediatric clinical practice. The current treatment of paediatric epilepsy aims to improve health outcomes, as well as to manage the educational, social and psychological issues that are involved in the quality of life of paediatric patients and their parents. In this direction, in several countries, a specialized, comprehensive, multidisciplinary service has been developed, including paediatric epilepsy nursing, which constitute a key component of this service. According to Mrs. Jennifer O'Brien, one of the pioneering paediatric epilepsy nursing specialists in the UK with a significant contribution in the care of children with epilepsy in Merseyside, the mission of paediatric epilepsy nursing is to enable children with epilepsy and their families to live as normal a life as possible, to ensure that all those who care for the child are well-educated regarding the child's epilepsy and to promote the child's safety and integration into society. She notes that in the past, epilepsy was not considered as a specialty and was looked after by all paediatricians; it is recognised now that it is an incredibly complex group of conditions, which deserves to have specialist management. She believes that although modern technology is crucial in informing and educating families, face to face education and advice is still the most important method of providing support. She highlights the recent advances in genetics of paediatric neurology along with the drive for epilepsy specialists, both nursing and medical, while she estimates that over the following years, paediatric epilepsy nursing will have progressed beyond nowadays expectations.

Retinopathy of prematurity and neonatal gut microbiome: An interview with Professor Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at The University of Chicago (USA)

Retinopathy of prematurity (ROP) is a sight-threatening disorder of the retina affecting neonates of very low birth weight and gestational age, and is characterized by the development of abnormal blood vessel growth. According to Dr Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at the University of Chicago School of Medicine in Chicago, USA, the neonatal gut microbiome may be implicated in the neoangiogenesis process in the neonatal retina and this role may be one of the missing links in the pathogenesis of ROP. The human gut microbiome consists of bacteria, viruses, protozoa and fungi, which colonize the sterile fetal intestine, and differ depending on gestational age, mode of delivery, type of neonatal feeding, the usage of antibiotics and the requirement of neonatal intensive care. To date, it has been related to multiple nutritive, metabolic and immunological functions and has been implicated in the pathogenesis of several human diseases, such as the inflammatory bowel diseases, autoimmune and neurogenerative disorders, metabolic syndrome, cardiovascular diseases and various types of malignant neoplasias. Recent research has proposed that the neonatal gut microbiome profile in high-risk neonates who develop ROP is significantly enriched with Enterobacteriacaea species several weeks prior to the diagnosis of ROP. Further research using animal models is required to prove the causative or secondary role of the microbiome composition in the development and clinical course of ROP. If this role is proven, the gut microbiome could then be a target of intervention for personalized medicine in the prevention and therapeutic management of ROP in neonates.

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.

The perspectives and the challenges of Paediatric Radiology: An interview with Dr Georgia Papaioannou, Head of the Paediatric Radiology Department at the 'Mitera' Children's Hospital in Athens, Greece

Dr Georgia Papaioannou, MD, PhD, Head of the Paediatric Radiology Department at ‘Mitera’ Children's Hospital in Athens (Greece), is one of the most talented Paediatric Radiologists in Greece. She graduated from the Medical School of Athens of the National and Kapodistrian University of Athens in 1996 and she was trained in Radiology at the 2nd Department of Radiology of the Medical School of Athens and in Paediatric Radiology in Great Ormond Street Hospital for Children (GOSH) in London (UK). Her special interests focus on foetal magnetic resonance imaging (MRI) and special applications of paediatric MRI, such as MR enterography and MR urography. According to Dr Papaioannou, medical education in Paediatric Radiology has to be of excellent quality, raising professional career and academic opportunities. Paediatric Radiology focuses on the diagnostic imaging of foetuses, neonates, infants, children and adolescents and represents the oldest subspecialty of Radiology. The advent in technology and computer science, which is strongly associated with Radiology, has launched a new era for Paediatric Radiology training and practice. Digital imaging and archiving, telemedicine, fused imaging, evolution of sonographic equipment, computed tomography (CT) and MRI scanners have opened new horizons to the understating of paediatric physiology and pathophysiology and have contributed significantly in precision Medicine and the implication of targeted therapies into clinical practice. Modern paediatric imaging focuses on radiation protection issues and launches faster sequences in all modalities, in order to reduce the number and duration of sedation. The diagnosis of neonatal and paediatric viral infections is routinely clinical and laboratory; however, Paediatric Radiology assists the diagnostic approach by excluding other entities, if that is required, i.e., in complex cases or hospitalized children, and mainly by revealing associated complications.

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'.

Clinical Virology research and medical education in Greece: An interview with Demetrios A. Spandidos, Professor of Clinical Virology at the University of Crete in Greece

Professor Demetrios A. Spandidos, Professor Emeritus of Clinical Virology at the University of Crete School of Medicine in Crete, Greece, is a pioneer in world research in Virology, Oncology and medical education. He has been the first Professor of Clinical Virology at the University of Crete School of Medicine, the only School of Medicine with a separate Department of Clinical Virology in Greece. According to Professor Spandidos, the understanding of the interactions of viruses with human host cells is what enables the development of new vaccines and new therapies against a wide range of diseases in humans, including cancer. Over the past two decades, the expansion of new knowledge, treatments, prevention and management options and the emerging needs on neonatal and paediatric viral infections have made the role of future paediatric virologists more than necessary. For this reason, he strongly believes that Paediatric Virology should be recognized as a new paediatric subspecialty. Professor Spandidos declares that medical education is a continuous sequence from undergraduate to postgraduate/specialty/subspecialty medical training and continuing learning. He also supports the concept that the future of medical education represents the future of Medicine.

The wisdom and eudaimonia of Paediatrics: An interview with Professor George P. Chrousos, Professor of Paediatrics and Endocrinology at the University of Athens, Greece

Professor George P. Chrousos, Professor Emeritus of Paediatrics and Endocrinology at the University of Athens School of Medicine, in Athens, Greece, is the most distinguished Professor of Paediatrics in the modern history of Hellenic Paediatrics and among the 100 most prominent clinical investigators worldwide. According to Professor Chrousos, viruses frequently interact with the host endocrine signaling pathways, while stress triggers acutely an early inflammatory response termed ‘neurogenic inflammation’. Soon after, however, stress suppresses innate immunity and causes a shift from T-helper 1- to T-helper 2- driven immunity. The natural history of the response to a viral infection is for immune and stress changes to take place in a highly coordinated process that results in the full return to the basal health state. He believes that over the past decades, our armamentarium against viruses has increased significantly as novel anti-viral agents, monoclonal antibodies and vaccines, have been and are continually being developed. Professor Chrousos declares that Paediatrics is a very broad scientific field, where paediatric trainees have many avenues to follow beyond clinical practice and into basic, preclinical, translational, clinical, applied, or epidemiologic research. He supports that researching and producing new knowledge to the benefit of humanity is a product of practicing Aristotle's ancient Greek virtues and a worthy cause of life's meaning. He completes our interview calling young paediatricians to ‘listen to their minds and hearts’ to select a life course that would lead them to acquire personal wisdom and eudaimonia.

Paediatric Virology and respiratory syncytial virus: An interview with Honorary Senior Lecturer in Paediatric Infectious Diseases Dr Simon B. Drysdale (St. George's, University of London, UK)

Dr Simon B. Drysdale, Consultant and Honorary Senior Lecturer in Paediatric Infectious Diseases at St. George's University Hospitals NHS Foundation Trust and St. George's, University of London, is one of the most talented early career academic specialists in Paediatric Infectious Diseases in the United Kingdom. His main research interest is respiratory syncytial virus (RSV); he is particularly interested in understanding the host susceptibility to RSV, the management of RSV infection and associated health economics and the development of treatments and immunisations/vaccines, which are currently lacking. According to Dr Drysdale, RSV is a significant cause of morbidity and mortality among young infants and older adults, particularly those with co-morbidities. While there is ample RSV epidemiological and healthcare cost data available for young infants and children, more data is required for older children and adults. There are currently several antiviral medications for the treatment of RSV infection in development; however, none have yet progressed beyond Phase 2 clinical trials. Multiple types of novel therapeutic molecules have been developed, including fusion and non-fusion inhibitors and polymerase inhibitors aimed at various RSV targets, such as the F protein and RNA polymerase. In recent years, great strides have been made with regards to an RSV vaccine or monoclonal antibody, with >40 candidates currently in development. A maternal RSV vaccine, which just completed a Phase 3 trial, was shown to have 44% efficacy against hospitalization for RSV lower respiratory tract infection in infants. A new long-acting monoclonal antibody against RSV infection, having shown excellent promise in a Phase 2 trial in infants, is about to be investigated in a Phase 3 clinical trial commencing shortly.

Advancing challenges in Paediatric Virology: An interview with Professor Barbara A. Rath, Co-founder and Chair of the Vienna Vaccine Safety Initiative

The Vienna Vaccine Safety Initiative (ViVI) is an international, scientific, non-profit, research organization, which aims to promote research, clinical practice and communication on Paediatric Infectious Diseases (PID) in a globalized healthcare setting, to facilitate the implementation of high standards in vaccine safety and efficacy and to support international and interdisciplinary scientific collaboration. Professor Barbara A. Rath, Chair and Co-founder of the Vienna Vaccine Safety Initiative, advocates for the establishment of global research networks in the field of neonatal and paediatric viral infections. Viruses do not respect borders, and large datasets are required and joint action is necessary to further strengthen efforts towards viral diseases eradication and prevention. She encourages the paediatric community to embrace the new opportunities technology offers for healthcare and medical education. To date, the Vienna Vaccine Safety Initiative has developed a number of innovative mobile applications and diagnostic tools, such as the ‘VAccApp’, which helps parents understand which vaccines were administered to their children, the ‘ViVI Disease Severity Score’, which measures clinical severity in patients with acute respiratory infections and flu-like illnesses, the ‘VACC Tool’, which assesses patient's clinical presentation to a set of diagnostic algorithms for adverse events following immunization and the ‘ViVI Health Survey’, which enables children and young adults on the move to report health needs securely and confidentially. Professor Rath agrees that during this decade there is momentum in the field of Paediatric Virology, as new antivirals and vaccines emerge and are finally becoming available to children. In the future, ‘in-house’ specialists for Paediatric Virology could be helpful to provide quality of care and reduce antimicrobial resistance by providing individual as well as hospital-wide consultations and advice. She estimates that Paediatric Virology will eventually find its place in the context of PID and Vaccinology.

Paediatric virology and human papillomaviruses: An update

Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.

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.

The philosophy of paediatric teaching: An interview with Dr Nikolaos Myriokefalitakis, former Clinical Director of the 'Penteli' Children's Hospital in Athens (Greece)

Dr Nikolaos Myriokefalitakis, one of the most experienced paediatricians in the city of Athens, Greece, has worked as a consultant paediatrician at the 'P. & A. Kyriakou' Children's Hospital for more than 25 years, while during the 2004-2011 period, he was the clinical director of the 1st Paediatric Department of the 'Penteli' Children's Hospital. Under his leadership, in 2008, his department was renovated by 'Stavros Niarchos Foundation' and was organised as one of the most modern and exemplary national paediatric departments in Greece. Having the title of the 'teacher in paediatrics' by his junior Greek colleagues, he supports that clinical experience obtained through ward-based bedside teaching is the fundamental principle of paediatric teaching. He notes that paediatric diagnosis is performed thorough medical history and detailed physical examination of the patient and it is rarely established with the help of laboratory, common or specialised, investigations. According to Dr Myriokefalitakis, a modern paediatric department cannot function 'in a vacuum', but requires technological support, adequate medical and nursing personnel and team-working between paediatricians and experts on paediatric subspecialties and other basic specialties. He accepts that the current financial crisis in Greece has clearly affected negatively the clinical practice of primary as well as hospital-based paediatric care, while he regrets to note that as the years go by, physicians become more obsessed with defense medicine and technology. He suggests that it is necessary to distinguish paediatric virology from virology and he ends up encouraging the improvement of paediatric training in Greece highlighting the basic need to 'train the trainers' in medical education.

Evaluating the proposal of paediatric virology: An interview with Professor Tina Dalianis, Professor of Tumour Virology at Karolinska Institutet

Professor Tina Dalianis, Professor of Tumour Virology at Karolinska Institutet in Stockholm, Sweden, is a well-known virologist with a strong international reputation and seminal contributions in tumour virology in the fields of human papillomaviruses (HPVs) and polyomaviruses. According to Professor Dalianis, over the past decades virology has significantly contributed to the understanding of many infectious diseases in medicine. In addition, quite a few antiviral therapies have been developed in recent years that have been very helpful, while the study of viruses has also provided valuable information about their host cells and basic cell biology. She highlights the association of HPVs with tonsillar and base of tongue cancers, as well as their epidemic rise. She also refers to additional biomarkers, which are under investigation, in order to better individualise patient care, by for example, de-escalating or targeted therapy, whenever this is possible. She clarifies that the current prophylactic vaccines against HPVs are very efficient for the types they are directed against and she hopes that boys will also soon be vaccinated against HPVs, particularly in countries where there is a low percentage of girls being vaccinated. According to Professor Dalianis, the knowledge of virology is very useful in general paediatric practice; the proposal of paediatric virology as a medical subspecialty is absolutely correct and it would be very useful, as there is much to be done. In the context of the '4th Workshop on Paediatric Virology', Professor Tina Dalianis will give the plenary lecture of this scientific event and will focus on changes in the prevalence of different HPVs in genital and oral samples in some groups of youth in Sweden during the introduction of the vaccines against HPVs.

The future of medical education in neonatology, paediatrics and paediatric virology: An interview with Professor Alan Michael Weindling, Professor of Perinatal Medicine at the University of Liverpool

Professor Alan Michael Weindling, Emeritus Professor of Perinatal Medicine at the University of Liverpool in the UK, is one of the pioneers of modern neonatal care worldwide with an enormous contribution to the care of premature babies in the city of Liverpool. During the last 3 decades, his contributions focused on the development of the clinical service, the training provided and the strong research achievements at Liverpool Women's Hospital NHS Trust, one of the most widely respected centres for neonatal medicine in western Europe. According to Professor Weindling, teaching a commitment to continuing lifelong learning as well as trying to make clinical care cost-effective is really important. He highlights the value of humility, holistic scientific approach, evidence-based medicine and multidisciplinary team working to neonatal and paediatric care. Looking back to neonatology as practiced in the 1990s, he accepts that since then, the overall standard of care has improved enormously. He supports that further neonatal care research is required for the prevention and treatment of acquired brain damage as well as on looking at ways of minimising stress for families, who have a child in an intensive care unit. He could see how for most trainees a module or series of lectures in paediatric infectious diseases would be helpful as part of their training and he estimates that in the future paediatric virology may become a specialist interest for a limited number of paediatric trainees. In the context of the ‘4th Workshop on Paediatric Virology’, which will be held in Athens, Greece, on September 22nd, 2018, Professor Weindling will receive the ‘2018 Paediatric Virology Award in Neonatology and Medical Education’.

Paediatric virology as a candidate of paediatric subspecialisation: An interview with Assistant Professor of Molecular Microbiology-Virology Angeliki Melidou

According to Professor Angeliki Melidou, Assistant Professor of Molecular Microbiology-Virology at the School of Medicine of the Aristotle University of Thessaloniki in Greece, recent advances in modern virology have important implications in the successful clinical management of neonatal and paediatric viral infections. On the other hand, preventive measures for infectious diseases and their complications, including vaccinations, proper regular examinations and early diagnosis, are equally crucial. Molecular genetics reveals a new era both in the detection of viral infections and in following up the infection and treatment, as well as identifying genetic predisposition that would affect disease course and outcome. Professor Melidou supports that paediatric virology as a candidate of paediatric subspecialisation would definitely play an important role in preparing specialised medical scientists. These scientists would be properly educated for the management of emerging and re-emerging viral infections, treatment options and schemes according to children's special needs, available prevention strategies and diagnostic capacities. In the context of the ‘4th Workshop on Paediatric Virology’, Professor Melidou's lecture will focus on the epidemiology of influenza virus types and subtypes in childhood.

Neonatology, paediatrics and paediatric virology on a British island: An interview with neonatologist Dr Prakash Thiagarajan (Isle of Man)

Dr Prakash Thiagarajan, consultant neonatologist and clinical director at Women's and Children's Division at Noble's Hospital on the Isle of Man, is one of the most talented neonatologists in the UK with a great experience in newer modes of infant ventilation and the application of technology in neonatal medicine and paediatrics. Under his leadership, the new neonatal intensive care unit (NICU) at Noble's Hospital is a state-of-the-art neonatal unit offering the very highest standards of care for critically ill babies on the island. Dr Thiagarajan highlights the re-emergence of continuous positive airway pressure (CPAP) as a key mode of ventilatory support for preterm infants and describes the current practice relating to the transport of the critically ill newborn and paediatric population. He reports the main milestones of the Isle of Man preparedness plan for influenza during the 2009 A/H1N1 influenza pandemic and he emphasises the role of immunisations and high level infection control measures in preventing future outbreaks of viral illnesses in children. He accepts that paediatric virology is an extremely important, yet underserved area of paediatrics and as with any clinical specialty, it is very important for effective two-way communications between frontline clinicians and academic researchers. He sums up suggesting the formation of the ‘European Society for Paediatric Virology’ in order to propagate knowledge and training in paediatric virology to health professionals, set standards in training, promote research and development and also raise public awareness. In the context of the ‘4th Workshop on Paediatric Virology’, which will be held in Athens, Greece, on September 22nd, 2018, Dr Thiagarajan's plenary lecture will focus on antiviral drugs in the clinical management of children with influenza.

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.

Spinal muscular atrophy type I and the dual role of viruses: An interview with Professor Basil T. Darras, Professor of Neurology (Pediatrics) at Harvard Medical School

According to Professor Basil T. Darras, Professor of Neurology (Pediatrics) at Harvard Medical School and Director of the Spinal Muscular Atrophy (SMA) Program at Boston Children's Hospital in Boston (MA, USA), the diagnosis of SMA type I is clinical and is based on detailed general physical and neurological examinations. SMA type I remains the most common genetic disease resulting in death in infancy and is really devastating for the child, the parents, as well as the medical professionals with the privilege of caring for patients with SMA and their parents. The proposed management options include: i) no respiratory support; ii) non-invasive ventilation; and iii) tracheotomy with mechanical ventilation. Deciding, which option is the best, is indeed a very personal decision. The optimal clinical care should be extremely mindful of parents' wishes and management goals with regard to the quality of life. Since the end of 2016 in the USA, and recently in Europe, there exists the possibility of accessing a novel treatment drug for SMA, namely Nusinersen. This antisense oligonucleotide is administered intrathecally and increases the production of the fully functional SMN protein, thus improving motor function, the quality of life and survival. Among the ongoing clinical trials, oral treatment with RG7916, a small molecule SMN2 splicing modifier, appears to be really promising. Gene therapy using viral vectors is expected to offer an 'one and done' therapy and possibly a cure, if administered early in life, before any symptoms appear. It is really interesting that viruses, which at the moment are the cause of death of children with SMA, if genetically modified, may be used for their treatment.

Molecular detection methods of human papillomavirus (HPV)

Human papillomavirus (HPV) testing can identify women at risk of cervical cancer. Currently, molecular detection methods are the gold standard for identification of HPV. The three categories of molecular assays that are available are based on the detection of HPV DNA and include (1) non-amplified hybridization assays, such as Southern transfer hybridization (STH), dot blot hybridization (DB) and in situ hybridization (ISH); (2) signal amplified hybridization assays, such as hybrid capture assays (HC2); (3) target amplification assays, such as polymerase chain reaction (PCR) and in situ PCR. STH requires large amounts of DNA, is laborious and not reproducible, while ISH has only moderate sensitivity for HPV. The sensitivity of the HC2 assay is similar to that of PCR-based assays, with high sensitivity being achieved by signal rather than target amplification. PCR-based detection is both highly sensitive and specific. Since PCR can be performed on very small amounts of DNA, it is ideal for use on specimens with low DNA content. In the future, with the advance of technology, viral DNA extraction and amplification systems will become more rapid, more sensitive, and more automated.

Human Papillomavirus (Hpv) Typing in Relation to ras Oncogene mRNA Expression in HPV-Associated Human Squamous Cervical Neoplasia

Objective

Human papillomavirus (HPV) has been identified as the principal etiologic agent for cervical cancer and its precursors. Different HPV types have been associated with different oncogenic potential. The purpose of this study was to evaluate the relationship between specific HPV type infection and expression pattern of the ras family oncogenes in different grades of HPV-associated human cervical neoplasia.

Methods

HPV typing was performed using polymerase chain reaction (PCR) in 31 HPV-positive human cervical specimens from patients with squamous intraepithelial lesions (SIL) or squamous cervical carcinoma (SCC). The mRNA expression levels of H-, K- and N-ras oncogenes were examined using the reverse transcriptase polymerase chain reaction (RT-PCR) technique. Statistical analyses were performed using SPSS software.

Results

Among patients with SCC, H-, K- and N-ras expression levels were higher in HPV 16/18-associated cases compared to HPV 16/18-unassociated samples (p=0.003, p=0.004 and p=0.0001, respectively). The expression levels for H-, K-and N-ras were significantly higher in SCC patients with multiple HPV infection compared with SCC patients with single HPV infection (p=0.009, p=0.01 and p=0.021, respectively). Among patients with SIL, no statistically significant relationship was found between ras expression and HPV status.

Conclusion

Our findings indicate the possible role of ras signaling interaction with “high-risk” HPV 16/18 and multiple HPV infection in cervical cancer development.

Viral infections, neonatal mortality and the mystery of the Athenian Agora: An interview with Professor of Anthropology Maria Liston

Although excavated almost 80 years ago, the infants' ‘bone well’ of the Athenian Agora in Athens, Greece and its contents were never thoroughly evaluated and published, until only recently, when a re-analysis of the whole excavation findings was performed. The well dates back to the third quarter of the 2nd century BC and contained at least 449 infants. The project, which explored the causes of neonatal mortality, found that one-third of infants' deaths were attributed to neonatal meningitis, based on the presence of bone disposition on the endocranial surface of the studied skulls. Despite the non-specific differential diagnostic approach of this pathophysiological finding in neonates, the determination of the causes of neonatal mortality in the Athenian Agora is really an impressive scientific attempt and can be a valuable lesson to all neonatal and peadiatric health professionals. According to Professor Maria Liston, Associate Professor of Anthropology at the University of Waterloo in Canada, who was the principal investigator of the skeletons from the infants' ‘bone well’ of the Athenian Agora, neonatal meningitis was the most frequently detected cause of neonatal mortality. Viral diseases unquestionably contributed to neonatal mortality, she adds and highlights that further research is required in collaboration with physicians for the better understanding and interpretation of various archaeological findings related to neonatal mortality. In the context of the 3rd Workshop on Paediatric Virology, which will be held in October 7th, 2017 in Athens, Greece, Professor Liston will reveal the role of neonatal and paediatric viral infections in the Hellenic antiquity.

George N. Papanicolaou (1883-1962), an exceptional human, scientist and academic teacher: An interview with Dr Neda Voutsa-Perdiki

Dr Neda Voutsa-Perdiki, former Director of Exfoliative Cytology at the University of Florida (Florida, USA), talks about her academic teacher Dr George N. Papanicοlaou, referred to as the 'Father of Exfoliative Cytology', and his wife Mache, known as Mary Papanicolaou. According to Dr Voutsa-Perdiki, Dr Papanicolaou was an exceptional teacher and a unique humanitarian in modern medical history. The secret of his scientific success was hard work, dedication, love of research, faith and the courage he gained from his wife and colleagues. According to Dr Voutsa-Perdiki, although Dr Papanicolaou was nominated for the Nobel Prize for at least 5 times, the reason for not receiving it remains unclear. His research was mainly clinical and not purely experimental, she adds. The official launch of her recently published book about Dr Papanicolaou entitled 'Dr George and Mache-Mary Papanicolaou - As I knew them' was held on March 1st, 2017 at the 'Benaki' Museum in Athens, Greece.

The educational challenge of Paediatric Virology: An interview with Professor of Neonatology Anne Greenough

According to Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology at the King's College London (London, UK), Paediatric Virology is indeed a rapidly increasing educational challenge. Professor Greenough, who in 1992 wrote her book on congenital, perinatal and neonatal infections, believes that during the past 3 decades, paediatric health professionals are becoming increasingly involved in specialised care and follow-up of paediatric patients with viral diseases, who require advanced medical care and innovative technological services. Moreover, she highlights the expected role of new vaccines and antiviral agents that are currently under investigation, as well as the impact of emerging viral diseases that require novel prevention strategies and therapeutic protocols. However, she notes that the number of Paediatric Virologists in any one country is likely to be small; hence, a separate paediatric subspecialty needs to be considered carefully. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor Greenough will give her plenary lecture on the impact of viral infections on the long term outcomes of prematurely born infants.

Paediatric Virology as a new educational initiative: An interview with Nobelist Professor of Virology Harald zur Hausen

Born in Gelsenkirchen-Buer in Germany on March 11th, 1936, Professor Harald zur Hausen, Emeritus Professor of Virology at the University of Freiburg and 2008 Nobel Prize Laureate in Physiology or Medicine for his discovery of human papillomavirus (HPV), which causes cervical cancer, believes that good knowledge of virological methods and diagnostic possibilities are an asset for all young paediatricians. Professor zur Hausen considers that the creation of an educational platform on Paediatric Virology is definitely very beneficial for young paediatricians, as this will greatly enhance their knowledge in the field of Virology. He very actively advocates the vaccination of boys for the eradication of HPV infection and emphasises that male HPV vaccination should be included into the current vaccination programmes. He would have certainly considered Dr George N. Papanicolaou (Kyme, Island of Euboea, Greece, 1883 - Miami, Florida, USA, 1962) as an excellent candidate for the Nobel Prize, stating that the contribution of Dr Papanicolaou did not find sufficient recognition in the past. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor zur Hausen will give his plenary lecture on 'Paediatric Virology and Oncology: Virus persistence and the important first years of life'.

The innovation of the subspecialty of Paediatric Virology: An interview with Research Professor of Molecular Virology Anna Kramvis

Professor Anna Kramvis, Research Professor of Molecular Virology at the University of the Witwatersrand in Johannesburg, South Africa, talks about direct-acting antiviral treatments against hepatitis C virus (HCV), as well as the perspective of the development of an effective vaccine against HCV. She emphasises the necessity of vaccination against hepatitis B virus (HBV), highlighting that it is very important that vaccination should be administered at birth in order to prevent mother-to-child transmission (MTCT) of HBV. Professor Kramvis states that vaccination against HBV is safe and that HBV and HCV infections are not contraindications for breastfeeding. Regarding the challenge of Paediatric Virology, she believes that it is a field that during the last years is increasing exponentially, while she concurs that Paediatric Virology subspecialty will be a popular choice for infectious diseases subspecialists. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Kramvis will give her key lecture on MTCT of HBV and HCV.

The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou

Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the 'Aghia Sophia' Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy.

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.

Paediatric Virology in the Hippocratic Corpus

Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of Paediatric Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire paediatric trainees and future Paediatric Virology subspecialists.