Recommendations for respiratory syncytial virus surveillance at national level

Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants aged <6 months. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among older adults. The development of new candidate vaccines and monoclonal antibodies highlights the need for reliable surveillance of RSV. In the European Union (EU), no up-to-date general recommendations on RSV surveillance are currently available. Based on outcomes of a workshop with 29 European experts in the field of RSV virology, epidemiology and public health, we provide recommendations for developing a feasible and sustainable national surveillance strategy for RSV that will enable harmonisation and data comparison at the European level. We discuss three surveillance components: active sentinel community surveillance, active sentinel hospital surveillance and passive laboratory surveillance, using the EU acute respiratory infection and World Health Organization (WHO) extended severe acute respiratory infection case definitions. Furthermore, we recommend the use of quantitative reverse transcriptase PCR-based assays as the standard detection method for RSV and virus genetic characterisation, if possible, to monitor genetic evolution. These guidelines provide a basis for good quality, feasible and affordable surveillance of RSV. Harmonisation of surveillance standards at the European and global level will contribute to the wider availability of national level RSV surveillance data for regional and global analysis, and for estimation of RSV burden and the impact of future immunisation programmes

Modeling geographic vaccination strategies for COVID-19 in Norway.

Vaccination was a key intervention in controlling the COVID-19 pandemic globally. In early 2021, Norway faced significant regional variations in COVID-19 incidence and prevalence, with large differences in population density, necessitating efficient vaccine allocation to reduce infections and severe outcomes. This study explored alternative vaccination strategies to minimize health outcomes (infections, hospitalizations, ICU admissions, deaths) by varying regions prioritized, extra doses prioritized, and implementation start time. Using two models (individual-based and meta-population), we simulated COVID-19 transmission during the primary vaccination period in Norway, covering the first 7 months of 2021. We investigated alternative strategies to allocate more vaccine doses to regions with a higher force of infection. We also examined the robustness of our results and highlighted potential structural differences between the two models. Our findings suggest that early vaccine prioritization could reduce COVID-19 related health outcomes by 8% to 20% compared to a baseline strategy without geographic prioritization. For minimizing infections, hospitalizations, or ICU admissions, the best strategy was to initially allocate all available vaccine doses to fewer high-risk municipalities, comprising approximately one-fourth of the population. For minimizing deaths, a moderate level of geographic prioritization, with approximately one-third of the population receiving doubled doses, gave the best outcomes by balancing the trade-off between vaccinating younger people in high-risk areas and older people in low-risk areas. The actual strategy implemented in Norway was a two-step moderate level aimed at maintaining the balance and ensuring ethical considerations and public trust. However, it did not offer significant advantages over the baseline strategy without geographic prioritization. Earlier implementation of geographic prioritization could have more effectively addressed the main wave of infections, substantially reducing the national burden of the pandemic

Assessing severity in pediatric pneumonia. Predictors of the need for major medical interventions

Objective: The aim of this study was to determine potential predictors of the need for major medical interventions in the context of assessing severity in pediatric pneumonia. Methods: This was a prospective, cohort study of previously healthy children and adolescents younger than 18 years presenting to the pediatric emergency room with clinically suspected pneumonia and examining both the full cohort and those with radiologically confirmed pneumonia. The presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific tachypnea, high temperature (≥38.5°C), chest retraction score, modified Pediatric Early Warning Score, age, C-reactive protein, white blood cell (WBC) count, and chest radiograph findings at first assessment were analyzed by univariate and multivariate analyses to examine their predictive ability for the need for major medical interventions: supplemental oxygen, supplemental fluid, respiratory support, intensive care, or treatment for complications during admission. Results: Fifty percent of the 394 cases of suspected pneumonia and 60% of the 265 cases of proven pneumonia were in need of 1 or more medical interventions. In multivariate logistic regression, only the presence of hypoxemia (odds ratios, 3.66 and 3.83 in suspected and proven pneumonia, respectively) and chest retraction score (odds ratios, 1.21 and 1.31, respectively for each 1-point increase in the score) significantly predicted the need for major medical interventions in both suspected and proven pneumonia. Specificity of 94% or greater, positive likelihood ratio of 6.4 or greater, and sensitivity of less than 40% were found for both hypoxemia and chest retraction score in predicting major medical interventions. C-reactive protein and white blood cell count were not associated with the need for these interventions, whereas multifocal radiographic changes were. Conclusions: Hypoxemia and an assessment of chest retractions were the predictors significantly able to rule in more severe pneumonia, but with a limited clinical utility given their poor ability to rule out the need for major medical interventions. Future validation of these findings is needed. Key Words: pneumonia, sensitivity and specificity, severity predictors (Pediatr Emer Care 2017;00: 00–00

Assessing Severity in Pediatric Pneumonia: Predictors of the Need for Major Medical Interventions

Objective: The aim of this study was to determine potential predictors of the need for major medical interventions in the context of assessing severity in pediatric pneumonia. Methods: This was a prospective, cohort study of previously healthy children and adolescents younger than 18 years presenting to the pediatric emergency room with clinically suspected pneumonia and examining both the full cohort and those with radiologically confirmed pneumonia. The presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific tachypnea, high temperature (≥38.5°C), chest retraction score, modified Pediatric Early Warning Score, age, C-reactive protein, white blood cell (WBC) count, and chest radiograph findings at first assessment were analyzed by univariate and multivariate analyses to examine their predictive ability for the need for major medical interventions: supplemental oxygen, supplemental fluid, respiratory support, intensive care, or treatment for complications during admission. Results: Fifty percent of the 394 cases of suspected pneumonia and 60% of the 265 cases of proven pneumonia were in need of 1 or more medical interventions. In multivariate logistic regression, only the presence of hypoxemia (odds ratios, 3.66 and 3.83 in suspected and proven pneumonia, respectively) and chest retraction score (odds ratios, 1.21 and 1.31, respectively for each 1-point increase in the score) significantly predicted the need for major medical interventions in both suspected and proven pneumonia. Specificity of 94% or greater, positive likelihood ratio of 6.4 or greater, and sensitivity of less than 40% were found for both hypoxemia and chest retraction score in predicting major medical interventions. C-reactive protein and white blood cell count were not associated with the need for these interventions, whereas multifocal radiographic changes were. Conclusions: Hypoxemia and an assessment of chest retractions were the predictors significantly able to rule in more severe pneumonia, but with a limited clinical utility given their poor ability to rule out the need for major medical interventions. Future validation of these findings is needed

Urbanization and preparedness for outbreaks with high-impact respiratory pathogens

Source at https://www.fhi.no/

Barnevaksinasjonsprogrammet i Norge. Rapport for 2021

Barnevaksinasjonsprogrammet 2021 Barnevaksinasjonsprogrammet omfatter en rekke ulike vaksiner som helsemyndighetene anbefaler til barn og unge, og tilbys alle barn og unge som oppholder seg i Norge. I 2021 ble vaksiner mot 12 sykdommer tilbudt alle barn: Rotavirussykdom, difteri, stivkrampe, kikhoste, poliomyelitt, Haemophilus influenzae type b (Hib)-infeksjon, hepatitt B, pneumokokksykdom, meslinger, kusma, røde hunder og humant papillomavirus (HPV). Barn i definerte risikogrupper ble i tillegg tilbudt vaksine mot tuberkulose (BCG), og barn født før svangerskapsuke 32 fikk tilbud om en ekstra dose seksvalent vaksine0F0F[1] ved alder 6-8 uker for å redusere risiko for alvorlig forløp av kikhoste. Det er en høy og stabil oppslutning om vaksinene i barnevaksinasjonsprogrammet i Norge til tross for at koronapandemien har vært svært ressurskrevende. Det viser at programmet og systemet for å gi barnevaksiner er robust, og at det er høy tillit til rådene om vaksinering av barn. Mens WHO har varslet om at pandemien har utfordret mulighet til å gjennomføre barnevaksinasjoner i mange land og områder, hadde Norge en like høy vaksinasjonsdekning som tidligere år. Det er generelt lav forekomst av sykdommene vi vaksinerer mot. Det viser effekten av et vaksinasjonsprogram med høy oppslutning. Det er en nedgang i antall meldte bivirkninger i 2021. Meldte mistenkte bivirkninger gir ikke grunn til å endre gjeldende anbefalinger for vaksiner som benyttes i barnevaksinasjonsprogrammet. Påvirkning av koronapandemien Smittevernrestriksjonene under koronapandemien har ført til en reduksjon i alle smittsomme sykdommer det vaksineres mot i barnevaksinasjonsprogrammet, i tillegg til nedgang også av andre vanlige infeksjoner som barn får. Konsekvensene av mindre smitte blant barn er lite naturlig boostring og ujevn fordeling av infeksjoner, med risiko for mer infeksjoner blant barn ved gjenåpning av samfunnet. Det ble sett tydelig i Norge for respiratorisk syncytialvirus (RSV) høsten 2021 da sesongutbruddet av RSV kom uvanlig tidlig og ble vesentlig større enn tidligere toppår. For 2022 kan det sannsynligvis bli lignende situasjoner for andre infeksjoner som for eksempel influensa. Med lavere vaksinasjonsdekning hos barn i mange land under koronapandemien, i tillegg til nedskalert overvåking av barneinfeksjoner på grunn av covid-19, er systemene for å hindre og tidlig oppdage utbrudd med meslinger svekket. Meslinger vil sannsynligvis være den første vaksineforebyggbare infeksjonen som vil øke i 20221F1F[2]. Det antas at det vil bli flere tilfeller av meslinger også i Norge på grunn av import og økt reiseaktivitet, men med en stabilt høy vaksinasjonsdekning her i landet, vil store utbrudd være usannsynlig. Det kan også bli økning i kikhoste, som siden mars 2020 har vært på historisk lavt nivå. I 2021 ble det kun meldt om 39 tilfeller av kikhoste, mot 2534 tilfeller i 2019. I motsetning til meslingevaksinen, som gir svært høy og langvarig beskyttelse allerede fra første dose, gir fullvaksinering med tre doser kikhostevaksine kun beskyttelse i noen år (4-12 år). I tillegg er det barna i alder før første vaksinedose (3-månedersalder) som er mest utsatt for alvorlig sykdom. De kan få passiv beskyttelse ved maternell vaksinasjon - at den gravide kvinnen vaksineres i svangerskapet, og overfører antistoffer til barnet før fødsel. Det er vist at maternell vaksinasjon mot kikhoste beskytter spedbarn mot alvorlig infeksjon de første tre levemåneder. Land som ikke har tilbud om slik vaksinasjon, vurderer nå å innføre dette for å være i forkant av en eventuell infeksjonsbølge. Norge utredet maternell vaksinasjon mot kikhoste i 2019, og på det tidspunktet var det ikke aktuelt å innføre på bakgrunn av den epidemiologiske situasjonen. Hvis forekomsten av kikhoste hos større barn og voksne øker i 2022 og 2023, kan imidlertid dette endres, og vi må på nytt vurdere om slik vaksinasjon bør inkluderes som en utvidet del av barnevaksinasjonsprogrammet. [1] Seksvalent vaksine = kombinasjonsvaksine mot difteri, stivkrampe, kikhoste, polio, hepatitt B og Hib. [2] WHO news release, 27.april 2022, Unicef and WHO warn of perfect storm of conditions for measles outbreaks affecting childre