Pediatric Infectious Disease Journal最新文献

We characterized the clinical characteristics of invasive group A streptococcal (iGAS) cases among Los Angeles County residents <18 years of age during July 2023-June 2024. Among 53 iGAS cases, 47% had potentially delayed diagnoses and 10% died. Providers should maintain elevated levels of suspicion for iGAS in children with repeat clinical presentations or risk factors such as recent viral infections.

Background: Respiratory syncytial virus (RSV) is the major pathogen of lower respiratory tract infection in infants and young children. Molecular epidemiology studies allow the surveillance of circulating RSV genotypes worldwide. However, comprehensive data about the genetic variability of RSV strains within an individual host is lacking. The objective of this study was to investigate the genetic within-host variability of RSV strains in pediatric patients in Heidelberg, Germany.

Methods: Nasopharyngeal swabs (NPS) were prospectively screened for RSV from children admitted with acute respiratory tract infection to the Heidelberg University Hospital during the winter seasons 2012-2016. RSV-positive samples with detection of RSV-A genotype ON1 were selected for deep sequencing by next-generation sequencing.

Results: In a total of 121 RSV-A genotype ON1 (GA 2.3.5)-positive samples, the second hypervariable region of the G gene was successfully deep sequenced via next-generation sequencing. The dominant RSV within-host variants all belonged to genotype ON1 (GA 2.3.5) and could be divided into 9 different lineages. Deep sequencing revealed that 67.7 % (n = 82/121) of all samples comprised at least 2 different viral strains of RSV that represented at least 1% of within-host variants. The majority of these samples (67.1%; n = 55/82) contained RSV-A variants that had lost 72-nt-duplication characteristic for genotype ON, representing 1%-3% of within-host variants.

Conclusions: Deep sequencing revealed a substantial genetic within-host variability of RSV in hospitalized children, and we first described the loss of the characteristic ON1 72-nt-duplication in children.

Objective: In the context of varicella outbreaks occurring in schools, this study focused on the efficacy of the varicella vaccine and the severity of the illness.

Methods: Our study conducted from 2017 to 2023 in 11 schools collected data using questionnaires on student demographics, clinical presentation, varicella history and immunization status completed by parents or teachers. Students with varicella were in the case group, whereas healthy classmates comprised the control. Conditional logistic regression analysis was utilized to determine vaccine effectiveness (VE).

Results: Of the 1947 students, 23.5% were unvaccinated, 53.4% had received 1 dose of the vaccine, and 23.1% had received 2 doses. A total of 123 varicella cases were reported, and 71 were breakthrough cases. The median interval since last vaccination was 9 years after 1 dose and 4 years after 2. The adjusted VEs of 1 and 2 doses in the outbreak case-control study were 67% and 74%. The VE difference between 1 and 2 doses was not significant (P = 0.376). The number of rashes differed by vaccine status (P < 0.001), and the minority breakthrough cases had >50 rashes. The fever duration was significantly lower in breakthrough cases than in unvaccinated cases (P < 0.05). For other clinical manifestations, varicella cases who received a single dose versus those who received 2 doses did not exhibit any difference.

Conclusions: Varicella outbreaks were still recorded in Qingdao because of insufficient immunization rates. The vaccination coverage may be expanded to enhance VE.

Background: Bloodstream infections (BSI) are an important cause of neonatal deaths in low- and middle-income countries.

Methods: We conducted a cross-sectional study of culture-confirmed BSI in neonates aged <28 days at 6 lower-tier South African hospitals (October 2019 to September 2020), comparing maternal-infant characteristics between preterm and term babies.

Results: Of 907 BSI episodes, clinical data were available for 676 neonates. Median gestational age was 33 weeks [interquartile ranges (IQR), 29-37 weeks], with 70% (472/676) of neonates born preterm. Preterm neonates had longer median hospital stays than term neonates [19 days (IQR, 9-36) vs. 11 days (IQR, 6-17), P < 0.001], more BSI episodes during days 3-27 of life [72% (343/472) vs. 57% (119/204); P < 0.001] and higher maternal HIV prevalence [38% (177/463) vs. 24% (49/200); P = 0.001]. Fewer mothers of preterm versus term neonates attended antenatal clinic appointments [86% (367/426) vs. 94% (166/176); P = 0.004]. Crude mortality was higher among preterm versus term neonates [31% (146/472) vs. 8.3% (17/204); P < 0.001], with a higher BSI-attributable mortality (defined as death within 3 days of a BSI) [21% (97/472) vs. 5.4% (11/204); P < 0.001]. Preterm neonates had 3.7 times higher adjusted odds of death (1·71-8·14; P = 0.001) than term neonates.

Conclusions: Preterm neonates with a BSI were more likely to die than those who were term. Neonatal units should implement interventions to prevent horizontal transmission of infections among these small, sick neonates. Targeted antenatal and intrapartum interventions are needed to prevent preterm births as a root cause.

Background: Virologic failure (VF) in children living with HIV (CLHIV) remains challenging in sub-Saharan Africa, reaching alarming rates in Cameroon. We sought to evaluate predictors of virologic response and HIV drug resistance (HIVDR) among CLHIV in Cameroon during the introduction of pediatric dolutegravir (pDTG)-based antiretroviral therapy (ART).

Methods: We conducted a facility-based longitudinal study from November 2022 through April 2023 among CLHIV (age 0-10 years) attending the Chantal BIYA Foundation's Mother and Child Centre in Yaoundé-Cameroon. Plasma viral load (PVL) and HIVDR were evaluated, with VF defined as 2 consecutive PVL ≥1000copies/mL under active adherence counseling/support.

Results: Overall, the 318 enrolled participants had a median (interquartile range) age of 8 (6-9) years and 162/318 (50.9%) girls. Most (299/318, 94.03%) received pDTG-based ART and mean ART duration was 5.6 ± 2.6 years. At enrollment, 37 (11.6%) children were virally unsuppressed (PVL≥1000copies/mL), with higher odds among children from rural areas (P = 0.018) and among those reporting poor adherence (P < 0.001). After active adherence counseling and support, 30/37 (81.1%) children were resampled after 1 month and 3 remained unsuppressed, indicating <1% (3/311) with VF overall. Among those experiencing VF, HIVDR mutations were found in <1% (2/311) children [L74V(1/3), K103N(1/3), M184V(2/3), P225H(1/3)].

Conclusions: Virologic response among children receiving pDTG-containing ART was strong in Cameroon. Combining robust ART regimens with active adherence support can advance sustained progress towards HIV elimination in children by 2030 in sub-Saharan Africa.

Background: Nirsevimab is approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants. Although nucleic acid detection by polymerase chain reaction is primarily utilized for the clinical diagnosis of RSV, antigen detection is still routinely used and primarily relies on direct interaction with the RSV F protein in patient nasal samples. While expected monoclonal antibody (mAb) levels in nasal samples are typically <1 μg/mL following administration, some mAbs targeting the RSV F protein, such as palivizumab, have been shown to interfere with antigen detection. We assessed whether the presence of nirsevimab in nasal samples may interfere with RSV detection by antigen tests.

Methods: RSV detection was evaluated in 6 antigen detection tests utilizing contrived samples containing RSV A or B, and nirsevimab at 2 concentrations (1 or 10 µg/mL) chosen to estimate and exceed physiologically relevant concentrations. To better simulate real-world diagnostic specimens, RSV-positive nasal samples were pooled and assessed in the presence of nirsevimab in 2 frequently utilized detection tests.

Results: RSV was detected in contrived samples by all diagnostic kits evaluated in the presence of nirsevimab at both concentrations. Furthermore, RSV was detected in all nasal specimen pools by both diagnostic tests and remained detectable in the presence of nirsevimab at both concentrations tested, displaying 100% agreement with nonspiked pools.

Conclusions: Nirsevimab did not interfere with RSV detection with any of the antigen tests evaluated, suggesting patients who receive nirsevimab are unlikely to require alternative assays for clinical RSV diagnosis.