Prospective Research of #Human #Parechovirus and #Cytokines in #CSF of Young #Children Less than One Year with #Sepsis-like Illness: Comparison with #Enterovirus (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 15 August 2019 / In Press, Journal Pre-proof

Prospective Research of Human Parechovirus and Cytokines in Cerebrospinal Fluid of Young Children Less than One Year with Sepsis-like Illness: Comparison with Enterovirus

Su Eun Park ab1, Duyeal Song c1, Kyunghwa Shin c, Sang Ook Nam ab, Ara Ko ab, Ju Hyun Kong ab, Young Mi Kim d, Gyu Min Yeon e, Yun-Jin Lee ab

{a} Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {b} Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {c} Department of Laboratory Medicine, Pusan National University Yangsan Hospital – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {d} Department of Pediatrics, Pusan National University Hospital – 179, Gudeok-ro, 49241, Busan, South Korea; {e} Department of Pediatrics, Kosin University Gospel Hospital, Kosin University – 262, Gamcheon-ro, 49267, Busan, South Korea

Received 26 December 2018, Revised 12 March 2019, Accepted 14 August 2019, Available online 15 August 2019. DOI:



  • HPeV meningitis was found in 11.1% of sepsis-like children less than 12 months.
  • CSF findings were significantly different between HPeV and enteroviral meningitis.
  • CSF cytokine profiles noticeably differed between HPeV and enteroviral meningitis.


{1} Su Eun Park and Duyeal Song were equally responsible for the work described in this paper.

© 2019 Elsevier B.V. All rights reserved.

Keywords: Parechovirus; Enterovirus; Sepsis; Pediatrics.



#Safety and #Immunogenicity of a #RSV Fusion (F) Protein #Nanoparticle #Vaccine in Healthy Third-Trimester #Pregnant Women and Their #Infants (J Infect Dis., abstract)

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

Safety and Immunogenicity of a Respiratory Syncytial Virus Fusion (F) Protein Nanoparticle Vaccine in Healthy Third-Trimester Pregnant Women and Their Infants

Flor M Muňoz, Geeta K Swamy, Somia P Hickman, Sapeckshita Agrawal, Pedro A Piedra,Gregory M Glenn, Nita Patel, Allison M August, Iksung Cho, Louis Fries

The Journal of Infectious Diseases, jiz390,

Published: 12 August 2019




Respiratory syncytial virus (RSV) is the leading cause of infant lower respiratory tract disease and hospitalization worldwide.


Safety and immunogenicity of RSV fusion (F) protein nanoparticle vaccine or placebo were evaluated in 50 healthy third-trimester pregnant women. Assessments included vaccine tolerability and safety in women and infants, and RSV-specific antibody measures in women before and after vaccination, at delivery and postpartum.


The vaccine was well tolerated; no meaningful differences in pregnancy or infant outcomes were observed between study groups. RSV-specific antibody levels increased significantly among vaccine recipients, including responses competitive with well-described monoclonal antibodies specific for multiple RSV neutralizing epitopes. No significant antibody increase was seen among placebo-recipients, although a shallow upward trend across the RSV season was noted. Transplacental antibody transfer ranged between 90%–120% across assays for infants of vaccinated women. Women with an interval of ≥30 days between vaccination and delivery demonstrated higher placental antibody transfer rates than women with an interval <30 days. Half-lives of RSV-specific antibodies in infants approximated 40 days. There was no evidence of severe RSV disease in infants of vaccinated mothers.


Data from this phase 2 study support a maternal immunization strategy to protect infants from RSV disease.

Vaccine, maternal immunization, pregnancy, infant, respiratory syncytial virus (RSV)

Issue Section: Major Article

This content is only available as a PDF.

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

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: RSV; Pregnancy; Pediatrics; Vaccines.


#Community-acquired #UTIs in #children: #Resistance patterns of #uropathogens in a tertiary care center in #Saudi Arabia (Int J Pediatr Adolesc Med., abstract)

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

Int J Pediatr Adolesc Med. 2019 Jun;6(2):51-54. doi: 10.1016/j.ijpam.2019.02.010. Epub 2019 Mar 8.

Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia.

Hameed T1,2,3, Al Nafeesah A4, Chishti S1,3, Al Shaalan M1,2,3, Al Fakeeh K1,2,3.

Author information: 1 Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City – Central Region, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3 King Abdullah International Medical Research Center, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 4 Unaizah College of Medicine and Medical Sciences, Al-Qassim University, Unaizah, Saudi Arabia.




The aim of the present study was to investigate the bacterial pathogens and their resistance patterns in children presenting with their first admission for a urinary tract infection (UTI) in a large tertiary care center in Riyadh, Saudi Arabia.


A retrospective chart review was conducted of pediatric patients 0-14 years of age who were admitted for their first community-acquired UTI in a large tertiary care center in Riyadh, Saudi Arabia. The review covered a 6-year period (2006-2012).


Data were obtained from 202 children, of which 162 (80.2%) were female. The most frequently isolated uropathogens were Escherichia coli (75.7%), followed by Klebsiella pneumoniae (9.4%), Pseudomonas aeruginosa (5.9%) and Enterococcus species (3.5%). Sixteen (7.9%) isolates were ESBLs. Among all uropathogens, 68% were resistant to ampicillin, 54% resistant to co-trimoxazole, and 30% resistant/intermediate sensitivity to amoxicillin/clavulinic acid. Overall, there was a low resistance rate to cefotaxime (4.4%).


E. coli is the predominant uropathogen causing UTIs in children, yet there is a high rate of multidrug-resistant organisms. For children admitted for a community-acquired UTI, a third-generation cephalosporin remains an appropriate empiric antibiotic. Our study and the work of others emphasize the importance of choosing empiric antibiotics for pediatric UTIs based on local resistance patterns.

PMID: 31388546 PMCID: PMC6676371 DOI: 10.1016/j.ijpam.2019.02.010

Keywords: Antibiotics; Drugs Resistance; UTI; Pediatrics; Saudi Arabia.


Detection of human #Metapneumovirus #infection in #children under 18 years old hospitalized in Lima – #Peru (PeerJ., abstract)

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

PeerJ. 2019 Jul 25;7:e7266. doi: 10.7717/peerj.7266. eCollection 2019.

Detection of human Metapneumovirus infection in children under 18 years old hospitalized in Lima-Peru.

Del Valle-Mendoza J#1,2, Orellana-Peralta F#1, Del Valle LJ3, Verne E4,5, Ugarte C4,5, Weilg C1, Silva-Caso W1,2, Valverde-Ezeta J1, Carrillo-Ng H2,4, Peña-Tuesta I1, Palomares-Reyes C1, Cornejo-Tapia A1, Aguilar-Luis MA1,2.

Author information: 1 School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences., Universidad Peruana de Ciencias Aplicadas, Lima, Peru. 2 Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional (IIN), Lima, Peru. 3 Barcelona Research Center for Multiscale Science and Engineering, Departament d’Enginyeria Química, EEBE, Universitat Politecnica de Catalunya (UPC), Barcelona Tech, Barcelona, Spain. 4 Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru. 5 Servicio de Pediatria, Hospital Nacional Cayetano Heredia, Lima, Peru. #Contributed equally




Human Metapneumovirus (hMPV) is a negative single-stranded RNA virus. Infection by hMPV mainly affects the pediatric population and can cause upper or lower respiratory tract pathologies which can develop life threating complications. This study was carried out between 2009 and 2010 in a high complexity national hospital in Lima, Peru. The time frame corresponds to the pandemic of influenza A H1N1.


A prospective study was performed between September 2009 and September 2010. Patients with a clinical diagnosis suggestive of an acute respiratory infection were included. RT-PCR was utilized to attain the amplification and identification of the hMPV.


A total of 539 samples were analyzed from patients with a clinical context suggestive of an acute respiratory tract infection. Of these samples 73, (13.54%) were positive for hMPV. Out of the positive cases, 63% were under one year old, and increased to nearly 80% when considering children younger than two years old. Cough was the most frequent symptom presented by our population with a number of 62 cases (84.93%). Viral seasonality was also established, noting its predominance during the months of summer in the southern hemisphere. The infection by hMPV has an important prevalence in Peru. It mainly affects children under one year old and should be considered an important differential diagnosis in a patient with an acute respiratory infection.

KEYWORDS: Acute obstructive bronchitis; Acute respiratory tract infection; Human metapneumovirus; Pediatrics; Peru; Polymerase chain reaction

PMID: 31380147 PMCID: PMC6661132 DOI: 10.7717/peerj.7266

Keywords: Metapneumovirus; Pediatrics; Peru.


Safety and immunogenicity of unadjuvanted subvirion #monovalent inactivated #influenza #H3N2 variant (#H3N2v) #vaccine in #children and #adolescents (Vaccine, abstract)

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

Vaccine. 2019 Jul 30. pii: S0264-410X(19)31006-0. doi: 10.1016/j.vaccine.2019.07.085. [Epub ahead of print]

Safety and immunogenicity of unadjuvanted subvirion monovalent inactivated influenza H3N2 variant (H3N2v) vaccine in children and adolescents.

Munoz FM1, Anderson EJ2, Bernstein DI3, Harrison CJ4, Pahud B4, Anderson E5, Creech CB6, Berry AA7, Kotloff KL7, Walter EB8, Atmar RL9, Bellamy AR10, Chang S11, Keitel WA9.

Author information: 1 Departments of Pediatrics, Baylor College of Medicine, Houston, TX, United States; Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States. Electronic address: 2 Department of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, United States. 3 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States. 4 Department of Pediatrics, Children’s Mercy Hospital Kansas City, Kansas City, MO, United States. 5 Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, United States. 6 Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States. 7 Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States. 8 Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States. 9 Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States; Medicine, Baylor College of Medicine, Houston, TX, United States. 10 The Emmes Corporation, Rockville, MD, United States. 11 National Institute of Allergy and Infectious Diseases, Rockville, MD, United States.




In response to the emergence of influenza viruses with pandemic potential, we evaluated a swine-origin influenza A/H3N2 variant (H3N2v) vaccine in children.


This multicenter phase II open-label study assessed the safety and immunogenicity of two doses, 21 days apart, of investigational unadjuvanted subvirion monovalent inactivated H3N2v vaccine administered via intramuscular injection. Children 6-35 months of age received 7.5mcg or 15mcg of hemagglutinin (HA)/dose; children 3-17 years of age received 15mcg HA/dose. Safety and reactogenicity were assessed by measuring the occurrence of solicited injection site and systemic reactions in the 7 days after each vaccination; adverse events were assessed for 42 days and serious adverse events for 7 months after the first vaccination. Immunogenicity was evaluated by measuring hemagglutination inhibition (HAI) and neutralizing (Neut) antibodies to H3N2v prior to and 21 days after each vaccination. Cross-reactivity against seasonal H3N2 strains was evaluated.


The H3N2v vaccine was well tolerated. Transient mild to moderate injection site tenderness, pain and erythema was observed, with the most commonly reported systemic reactogenicity being irritability in children 6-35 months, and headache and fatigue in children 9-17 years old. Children 6-35 months old, whether they received 7.5mcg or 15mcg/dose, had low HAI and Neut antibody responses after two doses compared to older children. Children under 9 years of age required two doses of vaccine to demonstrate a response, while 9-17 year olds responded well after one dose. Previous influenza vaccination and older age were associated with higher immune responses to H3N2v vaccine. Children 9-17 years of age also developed cross-reactive antibodies against recent seasonal H3N2 influenza viruses.


The H3N2v vaccine was safe and immunogenic in children and adolescents. Age-related increases in immunogenicity against H3N2v and seasonal H3N2 viruses were observed, suggesting prior priming via infection and/or immunization. Clinical trial registry: The trial is registered with NCT02100436.

Copyright © 2019 Elsevier Ltd. All rights reserved.

KEYWORDS: Adolescents; Children; Cross-reactive antibodies; H3N2 variant; Immunogenicity; Influenza; Safety

PMID: 31375440 DOI: 10.1016/j.vaccine.2019.07.085

Keywords: Swine Influenza; Influenza A; Seasonal Influenza; Pandemic Influenza; H3N2v; Pediatrics; Vaccines.


Early Results of #Nerve #Transfers for Restoring Function in #Severe Cases of Acute Flaccid #Myelitis [#AFM] (Ann Neurol., abstract)

[Source: Annals of Neurology, full page: (LINK). Abstract, edited.]

Early Results of Nerve Transfers for Restoring Function in Severe Cases of Acute Flaccid Myelitis

Paula A. Pino MD,  Jessica Intravia,  Scott H. Kozin MD,  Dan A. Zlotolow MD

First published: 29 July 2019 / DOI:

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.25558.




To describe early functional outcomes of nerve transfer surgery in a relatively large cohort of patients with Acute Flaccid Myelitis (AFM).


Retrospective case analysis of patients with AFM treated with nerve transfer surgery between 2007 and 2018. Surgical criteria were persistent motor deficits after 6 months from onset and available donor nerves. Thirty‐two patients with AFM were evaluated, 16 underwent nerve transfer surgeries. Motor function was evaluated by a licensed occupational therapist using the Active Movement Scale (AMS) preoperatively and during follow‐up examinations. Patients with 6 or more months of follow‐up were included in the analysis. Patients with procedures other than nerve transfers were excluded.


Sixteen patients with AFM had nerve transfers, with a male predominance (75%) and median age of 2.5 years (range 4 months‐12 years). Eleven patients had a minimum 6 months follow‐up. Nerve transfers to restore elbow function had 87% excellent recovery for elbow flexion and 67% for elbow extension. Finger and thumb extension were full against gravity in one patient (100%). Shoulder external rotation was excellent in 50% of patients and shoulder abduction in only 20%. Nine out of 10 patients (90%) had resolution of shoulder pseudosubluxation following nerve transfer to the suprascapular nerve.


Patients with AFM with persistent motor deficits after 6 to 9 months after onset benefit from nerve transfer surgery. Restoration of elbow function was more reliable than restoration of shoulder function. We recommend early referral of patients with incomplete recovery to an experienced center in nerve transfers for timely evaluation and treatment.

This article is protected by copyright. All rights reserved.

Keywords: AFM; Neurology; Neurosurgery; Pediatrics.


Acute flaccid #myelitis and #EVD68: lessons from the past and present (Eur J Pediatr., abstract)

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

Eur J Pediatr. 2019 Jul 23. doi: 10.1007/s00431-019-03435-3. [Epub ahead of print]

Acute flaccid myelitis and enterovirus D68: lessons from the past and present.

Helfferich J1, Knoester M2, Van Leer-Buter CC2, Neuteboom RF3, Meiners LC4, Niesters HG2, Brouwer OF5.

Author information: 1 Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands. 2 Department of Medical Microbiology and Infection Prevention, Division of Clinical Virology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3 Department of Pediatric Neurology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. 4 Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 5 Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands.



Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus.


This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease.

What is Known:

  • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI
  • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68.

What is New:

  • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians.
  • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.

KEYWORDS: Acute flaccid myelitis; Acute flaccid paralysis; Enterovirus; Enterovirus D68; Poliomyelitis; Poliovirus

PMID: 31338675 DOI: 10.1007/s00431-019-03435-3

Keywords: Pediatrics; AFM; AFP; EV-D68.