Journal of the Pediatric Infectious Diseases Society最新文献

Background: While clinical risk factors for respiratory syncytial virus (RSV) bronchiolitis are well established, data on socioeconomic risk factors is lacking. We explored the association of parental education, income, and employment status on an infant's risk of hospitalization for RSV bronchiolitis.

Methods: This population-based retrospective case-control study covered all RSV-related hospital admissions of under 1-year-old children in Finland between 2004 and 2018. Controls were matched by month and year of birth, sex, province of residence, and family size. Registry data were linked using unique personal identity codes. Cases and controls were compared using adjusted odds ratios (aOR) calculated for socioeconomic outcomes including maternal and paternal education, household income, and parental employment.

Results: A total of 10 767 infants and 50 054 controls were included in the study. Lower parental education significantly raised the risk for RSV hospital admission in infants, the risk growing with decreasing education levels; aOR 1.03 (0.96-1.09) with post-secondary education, 1.12 (1.05-1.2) with secondary education, and 1.33 (1.2-1.47) with primary education. Combined parental income was not significant: aOR 0.97 (confidence interval [CI] 0.91-1.05), 1.02 (CI 0.95-1.1), 1 (CI 0.92-1.08), and 0.94 (CI 0.85-1.04), respectively with decreasing income level. Unemployment of both parents seemed to be a risk factor for the child's RSV hospital admission, aOR 1.24 (1.12-1.38).

Conclusions: Lower parental socioeconomic status may increase the risk of an infant's RSV hospitalization. Socioeconomic risk factors should be considered when designing RSV infection primary prevention strategies.

2.5 × 1010 vp Ad26.COV2.S elicited robust SARS-CoV-2-specific antibody responses in adolescents through 6 months, with acceptable safety and reactogenicity profiles. Compared with adults immunized with 5 × 1010 vp Ad26.COV2.S, adolescents had higher antibody levels, despite being vaccinated with a lower dose.

To determine if healthcare-associated (HA)-respiratory syncytial virus (RSV) is associated with worse outcomes, this multicenter cohort study studied 26 children with HA-RSV and 78 matched non-HA-RSV patients of whom 58% and 55%, respectively, had ≥2 comorbidities. Overall, 39% of HA-RSV versus 18% of non-HA-RSV patients required respiratory support escalation (adjusted odds ratio (aOR) 5.1, CI95 1.4, 19.1).

In the United States, the burden of hepatitis C virus (HCV) infection is disproportionately high among young adults including pregnant persons, resulting in increased infections among children as perinatal transmission remains the main route of HCV infection in children. Hence, in 2020, the Centers for Disease Control and Prevention (CDC) recommended universal HCV screening during each pregnancy. HCV infection in infancy is usually asymptomatic, so the diagnosis entirely relies on testing of perinatally exposed infants which, historically, included anti-HCV antibody testing at ≥18 months of age. However, nation-wide perinatal HCV testing rates have been suboptimal with significant loss to follow-up. To address this problem, in 2023, the CDC introduced early single HCV RNA testing at 2-6 months of age with an alternative for HCV RNA testing up to 17 months of age if not previously tested. The high sensitivity and specificity of the HCV real-time PCR laid the grounds for this policy shift. In this review, we highlight how these new CDC recommendations will enhance testing of infants and children and ultimately contribute to overall HCV elimination efforts. We also emphasize the role of all pediatric providers and obstetricians in implementing these new guidelines. Additionally, we offer our perspective and practical advice for testing of perinatally exposed infants and children. Currently, curative oral antivirals for HCV-infection treatment are approved for children ≥3 years of age. As pediatricians, advocating for children's wellness, it is our utmost duty to ensure that every child exposed to perinatal hepatitis C has been tested, diagnosed, linked to care, treated, and achieved cure.

Background: Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early ribonucleic acid (RNA) testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and the type of testing completed are lacking.

Methods: In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born between 2010 and 2020 captured in the electronic health record-based TriNetX Research Network. We analyzed factors associated with appropriate HCV testing completion (negative or positive HCV RNA testing or negative HCV antibody testing at any age through study end in 2022) and with RNA compared with antibody testing using univariable and multivariable logistic regression with clustered standard errors by healthcare organization.

Results: Of 8516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). A total of 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.26-0.55), Asian/Pacific Islander (OR: 0.06, 95% CI: 0.03-0.11), and Hispanic/Latinx (OR: 0.56, 95% CI: 0.36-0.88) children had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children.

Conclusions: Fewer than half of HCV-exposed children in this national sample were tested for HCV, with lower testing odds among Black, Asian/Pacific Islander, and Hispanic/Latinx children. Substantial work to increase testing and treatment and decrease disparities in testing among HCV-exposed children is needed to help reach US HCV elimination goals.

Objective: The rising prevalence of hepatitis C infections among individuals of reproductive age further emphasizes the importance of evidence-based management of hepatitis C virus (HCV) during pregnancy to minimize perinatal transmission and to optimize maternal and fetal outcomes. In this review, we discuss the most recent recommendations on the management of HCV in pregnancy, including recommendations for screening and treatment during pregnancy and the postpartum period, as well as infant management to reduce perinatal transmission of HCV.

Recent findings: Current guidelines recommend universal HCV screening during each pregnancy. With varying guidance regarding the use of direct-acting antivirals (DAAs) during pregnancy, recent studies have focused on the safety and efficacy of DAA initiation during pregnancy. Additionally, there has been an increased focus on improving treatment rates in the postpartum period through innovative linkage to care efforts, telemedicine, and additional efforts reducing barriers to care for patients.

The management of hepatitis B virus (HBV) in pediatrics presents many challenges, given the potential sequelae of untreated infection including hepatic fibrosis, cirrhosis, and malignancy, and a lack of clear guidance on the timing of treatment initiation. The goal of this review is to feature common clinical scenarios that occur in the evaluation and treatment of HBV infection in children. Each vignette presents an opportunity to discuss guidelines and evidence-based practices as well as review landmark studies and evolving practices.