Ongoing Exposure of U.K. Infants to Vaccine Serotype Pneumococci

by Mary Slack, FRCPATH; Andrew Vyse, PhD; Harish Madhava, MD; Ralf-Rene Reinert, MD; Gillian Ellsbury, MD; Carole Czudek, PhD; Bradford Gessner, MD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002184  "To the editors: 

We read with interest the article by Makwana et al. The authors note that most childhood invasive pneumococcal disease (IPD) cases are now due to non-13 valent pneumococcal conjugate vaccine (PCV13) serotypes though PCV13 serotypes remain in circulation with serotypes 3 and 19A listed among the top 10 that caused IPD in children in 2015/16. Of the 25 cases with PCV13-type IPD in 2015/16, 11 (44%) were due to serotype 19A.

 

Key insight is given into the IPD burden in infants 3–11 months of age, which over the 6-year study period accounted for a substantial proportion (508/1255, 40%) of the total in children <5 years of age. Additionally, meningitis was most prevalent in infants (209/456 cases, 45.8%) and was associated with the highest case fatality (9.6%). The most recent data from 2015/16 showed 103/271 (38%) of IPD cases occurred in infants 3–11 months of age, with 5 (4.8%) attributed to PCV13 serotypes. This reflects an increase in infant IPD compared with 2014/15 and slightly exceeds the number of cases in this age group in 2010/11 when PCV13 was first introduced illustrating a continuing and substantial burden of infant IPD. ..."

 

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Integrated Safety Profile of a New Approved, Fully Liquid DTaP5-HB-IPV-Hib Vaccine

by Jin Xu, PhD; Jon E. Stek, MS; Eddy Ziani, MD; G. Frank Liu, PhD; Andrew W. Lee, MD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002257

 

 

DTaP5-HB-IPV-Hib is a fully liquid, hexavalent vaccine containing a 5-antigen pertussis component, approved since 2016 in Europe [Vaxelis; DTaP5-HB-IPV-Hib vaccine: Diphtheria, tetanus, pertussis (5 acellular components: pertussis toxoid [PT], filamentous haemagglutinin [FHA], pertactin (PRN), and fimbriae Types 2 and 3 [FIM]), hepatitis B (recombinant DNA: rDNA), poliomyelitis (inactivated) and Haemophilus influenzae type b conjugate vaccine (adsorbed); MCM Vaccine B.V., The Netherlands] for primary and booster vaccination in infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and invasive diseases caused by Haemophilus influenzae type b. The comparator vaccine (control) was INFANRIX hexa (GlaxoSmithKline Biologics S.A., Rixensart, Belgium) (DTaP3-IPV-HepB/Hib) in European studies and PENTACEL (DTaP5-IPV/Hib) (Sanofi Pasteur, Swiftwater, PA) in US studies.

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Invasive Pneumococcal Disease in Neonates Prior to Pneumococcal Conjugate Vaccine Use in South Africa 2003–2008

by Krishnee Moodley, MBChB, FCPath, MMed; Yacoob Mahomed Coovadia, MBChB, FCPathSA; Cheryl Cohen, MBChB, PhD; Susan Meiring, MBChB, DTM&H; Sarona Lengana, MBChB, DipHIVManSA; Linda De Gouveia, NDMed Tech; Claire von Mollendorf, MBChB, MSc, PhD; Penny Crowther-Gibson, MSc, MSc; Vanessa Quan, MBChB, MPH; Brian Eley, MBChB; Gary Reubenson, MBBCh, FCPaed; Trusha Nana, MBChB, FCPath, MMed; Anne von Gottberg, MBChB, PhD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002096

 

 

Neonatal invasive pneumococcal disease (IPD) in developing countries is poorly described. Researchers provide a baseline description of neonatal IPD in South Africa, before implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009.

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Optimizing Gentamicin Dosing in Pediatrics Using Monte Carlo Simulations

by Abdullah Alsultan, PhD; Manal Abouelkheir, PharmD; Yasmine Elsharawy, PharmD; Aljawharah Alkoraishi, BPharm; Reem Osman, PharmD; Michael N. Neely, MD; Wael Mansy, MD; Saeed Algahtani, PhD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002120

 

 

Gentamicin is known to have concentration-dependent bactericidal activity, and its nephrotoxic effect is well described. Researchers developed a population pharmacokinetic/pharmacodynamic model to optimize gentamicin dosing in pediatrics. Data were retrospectively collected for pediatric patients 1 month to 12 years of age, admitted to general pediatric wards or intensive care units and received gentamicin for suspected or proven Gram-negative infections at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 306 gentamicin peak and trough concentrations sets from 107 patients were analyzed with mean (±standard deviation) patient age and weight of 4.5 ± 3.5 years and 16.7 ± 10.8 kg, respectively. Gentamicin pharmacokinetics were adequately described with a one compartment system (R 2 = 0.82, bias = 1.75% and precision = 88% for population predictions and R 2 = 0.94, bias = 5% and precision = 29% for individual predictions). The gentamicin pharmacokinetic parameters were as follows: volume of distribution = 8.9 L, total body clearance = 2.8 L/h for a 20-kg patient. Monte Carlo simulations showed that doses of 5–6 mg/kg/dose once daily are adequate only to treat infections with Gram-negative organisms having minimal inhibitory concentration less than 1 µg/mL. While, at minimal inhibitory concentration of 1 µg/mL, higher doses (7–8 mg/kg/dose once daily) are needed to maximize the efficacy of gentamicin. However, at minimal inhibitory concentration of 2 µg/mL, even a 10 mg/kg dose showed poor target attainment (52%). The finding of this study highlights the need to reevaluate the current breakpoints of gentamicin and also to assess the safety of higher doses of gentamicin in pediatrics.

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Transient Tachypnea of the Newborn Is Associated With an Increased Risk of Hospitalization Due to Respiratory Syncytial Virus Bronchiolitis

by Santtu Heinonen, MD, PhD; Liina Süvari, MD; Mika Gissler; Olli Pitkänen, MD, PhD; Sture Andersson, MD, PhD; Otto Helve, MD, PhD

Published in The Pediatric Infectious Disease Journal, April 2019.doi: 10.1097/INF.0000000000002057

 

 

Transient tachypnea of the newborn (TTN) is a self-limiting respiratory disorder, resulting from a failure to clear the lungs of perinatal fluid. As similar pathophysiologic features are present in children with respiratory syncytial virus (RSV) bronchiolitis, researchers hypothesized that these two conditions may be connected.

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Bordetella pertussis Infection in Infants and Young Children in Shanghai, China, 2016–2017: Clinical Features, Genotype Variations of Antigenic Genes and Macrolides Resistance

by Pan Fu, MS; Chuanqing Wang, MD, PhD; He Tian, MS; Zhihua Kang, PhD; Mei Zeng, MD, PhD

Published inThe Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002160

 

 

The global resurgence of pertussis in countries with high vaccination coverage has been a concern of public health.

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Characteristics and Outcomes of Young Children Hospitalized With Laboratory-confirmed Influenza or Respiratory Syncytial Virus in Ontario, Canada, 2009–2014

by Sarah A. Buchan, PhD; Hannah Chung, MPH; Timothy Karnauchow, PhD; J. Dayre McNally, MD, PhD; Michael A. Campitelli, MPH; Jonathan B. Gubbay, MD; Kevin Katz, MD; Allison J. McGeer,  MD; David C. Richardson, MD; Susan E. Richardson, MD; Andrew Simor, MD; Marek Smieja, MD, PhD; George Zahariadis, MD; Dat Tran, MD; Natasha S. Crowcroft, MD (Cantab); Laura C. Rosella, PhD, MHSc; Jeffrey C. Kwong, MD, MSc.

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002164

 

 

Respiratory illnesses are a major contributor to pediatric hospitalizations, with influenza and respiratory syncytial virus (RSV) causing substantial morbidity and cost each season. Researchers compared the characteristics and outcomes of children 0–59 months of age who were hospitalized with laboratory-confirmed influenza or RSV between 2009 and 2014 in Ontario, Canada.

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The Risk of Serious Bacterial Infection in Febrile Infants 0–90 Days of Life With a Respiratory Viral Infection

by Erin G. Nicholson, MD; Vasanthi Avadhanula, PhD; Laura Ferlic-Stark, MS; Kirtida Patel, BS; Karen E. Gincoo, BS; Pedro A. Piedra, MD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002165

 

 

Molecular diagnostic methods enhance the sensitivity and broaden the spectrum of detectable respiratory viruses in febrile infants ≤90 days of life. Researchers describe the occurrence of respiratory viruses in this population, as well as the rates of serious bacterial infection (SBI) and respiratory viral coinfection with regard to viral characteristics.

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Culture-confirmed Tuberculosis in South African Infants Younger Than 3 Months of Age: Clinical Presentation and Management of Respiratory Complications

by Lisa Frigati, MMED; Adrie Bekker, PhD; Silvia Stroebele, MMED; Pierre Goussard, PhD; H. Simon Schaaf, PhD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002163

 

 

Little is known about the course and management of perinatal tuberculosis (TB). This publication describes the presentation, medical and surgical management of culture-confirmed TB in infants younger than 3 months of age.

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Respiratory syncytial virus (RSV) and child pneumonia

RSV-and-child-pneumonia-webinar-cover-im_20190314-164122_1

Above, photo submitted by Keith Klugman, The Bill & Melinda Gates Foundation

 

Talks by:

 

Ting Shi, University of Edinburgh: ”Global disease burden estimate of RSV in young children”

 

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Engaging communities in collecting and using results from verbal autopsies for child deaths: an example from urban slums in Freetown, Sierra Leone

by Hutain J, Perry HB, Koffi AK, Christensen M, Cummings O'Connor E, Jabbi SB, Samba TT, and Kaiser R

Scheduled for release in The Journal of Global Health, June 2019. 

 

 

Verbal autopsies (VAs) can provide important epidemiological information about the causes of child deaths. Though studies have been conducted to assess the validity of various types of VAs, the programmatic experience of engaging local communities in collecting and using VA has received little attention in the published literature. Concern Worldwide, an international non-governmental organization (NGO), in collaboration with the Ministry of Health and Sanitation (MOHS), has implemented a VA protocol in five urban slums of Freetown, Sierra Leone. This paper provides VA results and describes lessons learned from the VA process.

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An Outpatient Clinic as a Potential Site of Transmission for an Outbreak of New Delhi Metallo-β-Lactamase–producing Klebsiella pneumoniae Sequence Type 716: A Study Using Whole-genome Sequencing

by Amélie Heinrichs, Maria Angeles Argudín, Ricardo De Mendonça, Ariane Deplano, Sandrine Roisin, Magali Dodémont, Julien Coussement, Lorenzo Filippin, Jill Dombrecht, Katrien De Bruyne, Te-Din Huang, Philip Supply, Baudouin Byl, Youri Glupczynski, and Olivier Denis

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy581

 

 

The incidence of nosocomial infections due to carbapenem-resistant Klebsiella pneumoniae is increasing worldwide. Whole-genome sequencing (WGS) can help elucidate the transmission route of nosocomial pathogens.

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Immune Responses to Middle East Respiratory Syndrome Coronavirus During the Acute and Convalescent Phases of Human Infection

by Hyoung-Shik Shin, Yeonjae Kim, Gayeon Kim, Ji Yeon Lee, Ina Jeong, Joon-Sung Joh, Hana Kim, Eunjin Chang, Soo Yeon Sim, Jun-Sun Park, and Dong-Gyun Lim

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy595

 

 

An understanding of immune responses against the Middle East respiratory syndrome (MERS) is important for the development of treatments and preventive measures. Researchers investigated the spectrum of immune responses occurring in patients with MERS during the early period of infection.

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Disparities by sex in care-seeking behaviors and treatment outcomes for pneumonia among children admitted to hospitals in Bangladesh

by Naheed A, Breiman RF, Islam MS, Saha SK, and Tabassum Naved R

Published in PLoS One, 7 March 2019. doi: 10.1371/journal.pone.0213238

 

 

Incidence of community acquired pneumonia is high globally. In Bangladesh, more male children than female children are brought to hospitals for pneumonia. Researchers examined if there was disparities in the severity of illness and outcome by sex among children who were admitted with pneumonia to hospitals in Bangladesh.

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Bioaerosol Sampling to Detect Avian Influenza Virus in Hanoi’s Largest Live Poultry Market

by Vuong N Bui, Tham T Nguyen, Hung Nguyen-Viet, Anh N Bui, Katie A McCallion, Hu Suk Lee, Son T Than, Kristen K Coleman, and Gregory C Gray

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy583

 

 

Newly emergent and virulent strains of H7N9 avian influenza virus are rapidly spreading in China and threaten to invade Vietnam. Researchers sought to introduce aerosol sampling for avian influenza viruses in Vietnam.

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Influenza Epidemiology, Vaccine Coverage and Vaccine Effectiveness in Children Admitted to Sentinel Australian Hospitals in 2017: Results from the PAEDS-FluCAN Collaboration

by Christopher C Blyth, Kristine K Macartney, Jocelynne McRae, Julia E Clark, Helen S Marshall, Jim Buttery, Joshua R Francis, Tom Kotsimbos, Paul M Kelly, and Allen C Cheng

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy597

 

 

In 2017, Australia experienced record influenza notifications. Two surveillance programs combined to summarize the epidemiology of hospitalized influenza in children and report on vaccine effectiveness (VE) in the context of a limited nationally funded vaccination program.

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Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza

by Timothy M Uyeki, Henry H Bernstein, John S Bradley, Janet A Englund, Thomas M File, Alicia M Fry, Stefan Gravenstein, Frederick G Hayden, Scott A Harper, Jon Mark Hirshon, Michael G Ison, B Lynn Johnston, Shandra L Knight, Allison McGeer, Laura E Riley, Cameron R Wolfe, Paul E Alexander, and Andrew T Pavia

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy874

 

 

Seasonal influenza A and B virus epidemics are associated with significant morbidity and mortality each year in the United States and worldwide. One study estimated that during 2010–2016, the seasonal incidence of symptomatic influenza among all ages in the United States was approximately 8% and varied from 3% to 11%. Most people recover from uncomplicated influenza, but influenza can cause complications that result in severe illness and death, particularly among very young children, older adults, pregnant and postpartum women within 2 weeks of delivery, people with neurologic disorders, and people with certain chronic medical conditions including chronic pulmonary, cardiac, and metabolic disease, and those who are immunocompromised. During 2010–2018, seasonal influenza epidemics were associated with an estimated 4.3–23 million medical visits, 140 000–960 000 hospitalizations, and 12 000–79 000 respiratory and circulatory deaths each year in the United States. A recent modeling study estimated that 291,243–645,832 seasonal influenza–associated respiratory deaths occur annually worldwide.

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New antibiotics for community-acquired pneumonia

by Marin H. Kollef and Kevin D. Betthauser

Published in Current Opinion in Infectious Diseases, scheduled for release April 2019. doi: 10.1097/QCO.0000000000000526

 

 

This review provides the rationale for the development of new antibiotics to treat community-acquired pneumonia (CAP). It also provides an overview of the new antibiotics targeting CAP that have recently received approval by the regulatory agencies, and those antibiotics that are in the development pipeline.

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The evolving burden of viruses in pneumonia

by Nicole R. Brenner and Andrew F. Short

Published in Current Opinion in Infectious Diseases, scheduled for release April 2019. doi: 10.1097/QCO.0000000000000536

 

 

Researchers aimed to describe the evolving microbiology of various forms of pneumonia and the importance of viruses as etiologic causes of pneumonia.

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Procalcitonin to guide antibiotic decision making

by Angela Branche, Olivia Neeser, Beat Mueller, and Philipp Schuetz

Published in Current Opinion in Infectious Diseases, scheduled for release April 2019. doi: 10.1097/QCO.0000000000000522

 

 

There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Researchers aimed to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data.

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