#Mapping 123 million #neonatal, #infant and #child #deaths between 2000 and 2017 (Nature, abstract)

[Source: Nature, full page: (LINK). Abstract, edited.]

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Roy Burstein, Nathaniel J. Henry,  […] Simon I. Hay

Nature, volume 574, pages353–358 (2019)



Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Keywords: Society; Poverty; Pediatrics; Global Health.



#Nasopharyngeal #carriage of invasive #pneumococcal serotypes during #childhood #community-acquired alveolar #pneumonia is associated with specific clinical presentation (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Nasopharyngeal carriage of invasive pneumococcal serotypes during childhood community-acquired alveolar pneumonia is associated with specific clinical presentation

Yaniv Faingelernt, Ron Dagan, Noga Givon-Lavi, Shalom Ben-Shimol, Jacob Bar-Ziv, David Greenberg

The Journal of Infectious Diseases, jiz513, https://doi.org/10.1093/infdis/jiz513

Published: 05 October 2019




Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying common recognized invasive pneumococcal serotypes (1, 5, 7F, 14 and 19A; PnIST) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg).


Children <5 years visiting the only regional Pediatric Emergency Room, with radiologically-proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical/demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel.


A total of 1,423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality and previous antibiotics, the following variables were positively associated with PnISRT carriage compared to both groups: temperature ≥39°C, peripheral WBC ≥20,000/mm3, C-reactive protein ≥70.0 mg/L and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection and comorbidities were negatively associated with Pn-IST carriage (odds ratios <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or non-significant.


Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia and viral detection, and had more intense systemic inflammatory response than those carrying non-PnISR or not carrying Pnc.

community-acquired alveolar pneumonia, children, pneumococcal serotypes, clinical signs, laboratory characteristics

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© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Streptococcus pneumoniae; Invasive pneumococcal disease; Pediatrics.


#Challenges in the #diagnosis of #paediatric #pneumonia in intervention field trials: #recommendations from a pneumonia field trial working group (Lancet Resp Med., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

Dina Goodman, MSPH, Mary E Crocker, MD, Farhan Pervaiz, MD, Eric D McCollum, MD, Prof Kyle Steenland, PhD, Suzanne M Simkovich, MD, Catherine H Miele, MD, Laura L Hammitt, MD, Phabiola Herrera, MD, Prof Heather J Zar, MBBCh, Prof Harry Campbell, MD, Prof Claudio F Lanata, MD, John P McCracken, ScD, Lisa M Thompson, PhD, Ghislaine Rosa, PhD, Miles A Kirby, PhD, Sarada Garg, DNB, Gurusamy Thangavel, MSc, Prof Vijayalakshmi Thanasekaraan, MD, Prof Kalpana Balakrishnan, PhD, Carina King, PhD, Prof Thomas Clasen, PhD, William Checkley, MD for theHAPIN Investigators †

Published: October 04, 2019 / DOI: https://doi.org/10.1016/S2213-2600(19)30249-8



Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

Keywords: Pneumonia; Pediatrics.


#Congenital #Zika Syndrome in a #Brazil – #Paraguay – #Bolivia #border region: #Clinical features of cases diagnosed between 2015 and 2018 (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Congenital Zika Syndrome in a Brazil-Paraguay-Bolivia border region: Clinical features of cases diagnosed between 2015 and 2018

Fabio Antonio Venancio  , Maria Eulina Quilião Bernal , Maria da Conceição de Barros Vieira Ramos, Neuma Rocha Chaves, Marcos Vinicius Hendges, Mattheus Marques Rodrigues de Souza, Márcio José de Medeiros , Cláudia Du Bocage Santos Pinto , Everton Falcão de Oliveira

Published: October 4, 2019 / DOI: https://doi.org/10.1371/journal.pone.0223408



Congenital Zika Syndrome (CZS) is a unique pattern of congenital abnormalities found in fetuses and neonates infected with the Zika virus (ZIKV). Here, we clinically identify and characterize infants with CZS between 2015 and 2018 in Mato Grosso do Sul, Brazil—a border area with Paraguay and Bolivia. This cross-sectional study, based on primary and secondary data, tracks the cases registered in the Brazilian Public Health Reporting System through the following stages: (1) preliminary data analysis, (2) identification of the congenital syndrome cases, (3) etiologic classification of the cases, (4) active search, and (5) clinical assessment. Of the 72 investigated cases, 16 were probable cases of CZS. Of these, it was only possible to clinically assess 11 infants. Considering the 16 probable cases of CZS, nine were classified as confirmed cases, and five as potential cases of the syndrome. Regarding clinical features, brain palsy was identified in all analyzed infants. Moreover, microcephaly and pseudobulbar syndrome were found in eight infants, and hydrocephalus was found in three individuals. In addition to these conditions, seven children were malnourished. Our study may provide significant insights for other researches that aim to elucidate CZS and its clinical and populational consequences.


Citation: Venancio FA, Bernal MEQ, Ramos MdCdBV, Chaves NR, Hendges MV, Souza MMRd, et al. (2019) Congenital Zika Syndrome in a Brazil-Paraguay-Bolivia border region: Clinical features of cases diagnosed between 2015 and 2018. PLoS ONE 14(10): e0223408. https://doi.org/10.1371/journal.pone.0223408

Editor: Angela Lupattelli, University of Oslo, NORWAY

Received: July 16, 2019; Accepted: September 21, 2019; Published: October 4, 2019

Copyright: © 2019 Venancio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Zika Virus; Zika Congenital Syndrome; Microcephaly; Brazil; Paraguay; Bolivia; Neurology; Pediatrics.


Viral #Kinetics and #Resistance Development in #Children Treated with #Neuraminidase #Inhibitors: The Influenza Resistance Information Study (IRIS) (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Sep 27. pii: ciz939. doi: 10.1093/cid/ciz939. [Epub ahead of print]

Viral Kinetics and Resistance Development in Children Treated with Neuraminidase Inhibitors: The Influenza Resistance Information Study (IRIS).

Roosenhoff R1, Reed V2, Kenwright A3, Schutten M4, Boucher CA1, Monto A5, Clinch B3, Kumar D6, Whitley R7, Nguyen-Van-Tam JS8, Osterhaus ADME9,10, Fouchier RAM1, Fraaij PLA1,11.

Author information: 1 Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands. 2 Micron Research Ltd, Ely, UK. 3 Roche Products Ltd, Welwyn Garden City, UK. 4 Clinical Virology and Diagnostics, Alkmaar, The Netherlands. 5 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA. 6 University Health Network, Toronto, ON, Canada. 7 Department of Pediatrics, Microbiology, Medicine and Neurosurgery, The University of Alabama at Birmingham, Birmingham, AL, USA. 8 School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. 9 Research Institute for Infectious Diseases and Zoonosis, University of Veterinary Medicine, Hannover, Germany. 10 Artemis One Health Foundation, Utrecht, The Netherlands. 11 Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus Medical Center – Sophia, Rotterdam, The Netherlands.




The effect of age, baseline viral load, vaccination status, antiviral therapy and emergence of drug resistance on viral shedding in children infected with influenza A or B virus was studied.


Samples from children (aged ≤13 years) enrolled during the 7 years of the prospective Influenza Resistance Information Study (IRIS; NCT00884117) were analyzed by polymerase chain reaction to determine the influenza virus(sub-)type, viral load and resistance mutations. Disease severity was assessed; clinical symptoms were recorded. The association of age with viral load and viral clearance was examined by determining the area under the curve for viral RNA shedding using logistic regression and Kaplan-Meier analyses.


A total of 2131 children infected with influenza (683 A/H1N1pdm09; 825 A/H3N2; 623 influenza B) were investigated. Age did not affect the mean baseline viral load. Children aged 1>5 years, infected with A/H1N1pdm09, A/H3N2 or influenza B virus had prolonged viral RNA shedding (±1-2 days) compared with older children (aged >5 years) and up to 1.2-fold higher total viral burden. Besides older age (odds ratio [OR] 1.08; confidence interval [CI]: 1.05-1.12), prior vaccination status (OR 1.72; CI: 1.22-2.43) and antiviral treatment (OR 1.74; CI: 1.43-2.12) increased the rate of viral clearance. Resistance mutations were detected in 49 children infected with influenza A virus (34 A/H1N1pdm09; 15 A/H3N2) treated with oseltamivir, most of whom were aged <5 years (n = 39).


Children aged 1>5 years had a higher total viral burden with prolonged virus shedding and had an increased risk of acquiring resistance mutations following antiviral treatment.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

KEYWORDS: Influenza; Influenza Resistance Information Study; pediatrics; resistance mutations; viral load

PMID: 31560055 DOI: 10.1093/cid/ciz939

Keywords: Seasonal Influenza; H1N1pdm09; H3N2; Antivirals; Drugs Resistance; Oseltamivir; Pediatrics.


A ten-year review of #ESBL and non-ESBL #Escherichia coli #bloodstream #infections among #children at a tertiary referral #hospital in South Africa [#ZA] (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Oliver Ombeva Malande , James Nuttall, Vashini Pillay, Colleen Bamford, Brian Eley

Published: September 24, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222675




There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.


In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.


There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.


These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.


Citation: Malande OO, Nuttall J, Pillay V, Bamford C, Eley B (2019) A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS ONE 14(9): e0222675. https://doi.org/10.1371/journal.pone.0222675

Editor: Surbhi Leekha, University of Maryland School of Medicine, UNITED STATES

Received: April 30, 2019; Accepted: September 3, 2019; Published: September 24, 2019

Copyright: © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: There was no special funding for this work, except patient folders and clinical records and staff input from the Red Cross Hospital Children’s Hospital – Paediatric infectious Diseases unit and University of Cape Town.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Carbapenem; Colistin; Beta-lactams; Bacteremia; Pediatrics; South Africa.


#Effect of #measles #vaccination in #infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis

Laura M Nic Lochlainn, PhD, Brechje de Gier, PhD, Nicoline van der Maas, PhD, Rob van Binnendijk, PhD, Peter M Strebel, MBChB, Tracey Goodman, MA, Hester E de Melker, PhD, Prof William J Moss, MD, Susan J M Hahné, PhD

Open Access / Published: September 20, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30396-2




Vaccinating infants with a first dose of measles-containing vaccine (MCV1) before 9 months of age in high-risk settings has the potential to reduce measles-related morbidity and mortality. However, there is concern that early vaccination might blunt the immune response to subsequent measles vaccine doses. We systematically reviewed the available evidence on the effect of MCV1 administration to infants younger than 9 months on their immune responses to subsequent MCV doses.


For this systematic review and meta-analysis, we searched for randomised and quasi-randomised controlled trials, outbreak investigations, and cohort and case-control studies without restriction on publication dates, in which MCV1 was administered to infants younger than 9 months. We did the literature search on June 2, 2015, and updated it on Jan 14, 2019. We included studies reporting data on strength or duration of humoral and cellular immune responses, and on vaccine efficacy or vaccine effectiveness after two-dose or three-dose MCV schedules. Our outcome measures were proportion of seropositive infants, geometric mean titre, vaccine efficacy, vaccine effectiveness, antibody avidity index, and T-cell stimulation index. We used random-effects meta-analysis to derive pooled estimates of the outcomes, where appropriate. We assessed the methodological quality of included studies using Grading of Recommendation Assessment, Development and Evaluation (GRADE) guidelines.


Our search retrieved 1156 records and 85 were excluded due to duplication. 1071 records were screened for eligibility, of which 351 were eligible for full-text screening and 21 were eligible for inclusion in the review. From 13 studies, the pooled proportion of infants seropositive after two MCV doses, with MCV1 administered before 9 months of age, was 98% (95% CI 96–99; I2=79·8%, p<0·0001), which was not significantly different from seropositivity after a two-dose MCV schedule starting later (p=0·087). Only one of four studies found geometric mean titres after MCV2 administration to be significantly lower when MCV1 was administered before 9 months of age than at 9 months of age or later. There was insufficient evidence to determine an effect of age at MCV1 administration on antibody avidity. The pooled vaccine effectiveness estimate derived from two studies of a two-dose MCV schedule with MCV1 vaccination before 9 months of age was 95% (95% CI 89–100; I2=12·6%, p=0·29). Seven studies reporting on measles virus-specific cellular immune responses found that T-cell responses and T-cell memory were sustained, irrespective of the age of MCV1 administration. Overall, the quality of evidence was moderate to very low.


Our findings suggest that administering MCV1 to infants younger than 9 months followed by additional MCV doses results in high seropositivity, vaccine effectiveness, and T-cell responses, which are independent of the age at MCV1, supporting the vaccination of very young infants in high-risk settings. However, we also found some evidence that MCV1 administered to infants younger than 9 months resulted in lower antibody titres after one or two subsequent doses of MCV than when measles vaccination is started at age 9 months or older. The clinical and public-health relevance of this immunity blunting effect are uncertain.



Keywords: Measles; Vaccines; Pediatrics.