Varicella paediatric hospitalisations in Belgium : a 1-year national survey

Background: Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods: Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results: Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact among those 0-4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had >= 1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/ 552) received acyclovir. Incidence of complicated hospitalised cases was 19/10(5) person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions: Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium

Pandemic A/H1N1v influenza 2009 in hospitalized children: a multicenter Belgian survey

<p>Abstract</p> <p>Background</p> <p>During the 2009 influenza A/H1N1v pandemic, children were identified as a specific "at risk" group. We conducted a multicentric study to describe pattern of influenza A/H1N1v infection among hospitalized children in Brussels, Belgium.</p> <p>Methods</p> <p>From July 1, 2009, to January 31, 2010, we collected epidemiological and clinical data of all proven (positive H1N1v PCR) and probable (positive influenza A antigen or culture) pediatric cases of influenza A/H1N1v infections, hospitalized in four tertiary centers.</p> <p>Results</p> <p>During the epidemic period, an excess of 18% of pediatric outpatients and emergency department visits was registered. 215 children were hospitalized with proven/probable influenza A/H1N1v infection. Median age was 31 months. 47% had ≥ 1 comorbid conditions. Febrile respiratory illness was the most common presentation. 36% presented with initial gastrointestinal symptoms and 10% with neurological manifestations. 34% had pneumonia. Only 24% of the patients received oseltamivir but 57% received antibiotics. 10% of children were admitted to PICU, seven of whom with ARDS. Case fatality-rate was 5/215 (2%), concerning only children suffering from chronic neurological disorders. Children over 2 years of age showed a higher propensity to be admitted to PICU (16% vs 1%, p = 0.002) and a higher mortality rate (4% vs 0%, p = 0.06). Infants less than 3 months old showed a milder course of infection, with few respiratory and neurological complications.</p> <p>Conclusion</p> <p>Although influenza A/H1N1v infections were generally self-limited, pediatric burden of disease was significant. Compared to other countries experiencing different health care systems, our Belgian cohort was younger and received less frequently antiviral therapy; disease course and mortality were however similar.</p

Integrative approach to reduce Streptococcus pneumoniae burden of disease. From understanding host-pathogen interactions to optimizing vaccine strategies.

Le Streptococcus pneumoniae est une bactérie pathogène pouvant causer chez les êtres humains une pléiade d’infections des plus communes aux plus sévères. Malgré les nombreux progrès faits au cours de ces dernières années notamment grâce à l’avènement de la vaccination, l’impact de cet agent infectieux reste très élevé de par le monde puisqu’on estime qu’il est responsable chaque année de 14,5 millions d’infections et de plus de 800.000 décès d’enfants de moins de 5ans. Le S. pneumoniae est la première cause de pneumonie (communautaire ou hospitalière), de méningite non-épidémique et d’otite moyenne aigüe et également une cause fréquente de sepsis, l’ensemble étant associé à une mortalité et morbidité significatives surtout chez les jeunes enfants et les personnes âgées. Paradoxalement, cet agent microbien est également une bactérie commensale, cohabitant au sein du nasopharynx humain avec de multiples autres espèces au sein de structures complexes. Si le portage nasopharyngé a clairement été identifié comme la première étape indispensable au développement de l’infection invasive, beaucoup de points restent encore à élucider quant aux facteurs conditionnant in-vivo la transition du portage vers la maladie et l’invasivité bactérienne, l’ensemble résultant d’interactions complexes entre la bactérie, le système immunitaire de l’hôte, les autres agents microbiens présents et l’environnement. Avec 61% des décès pédiatriques liés au pneumocoque concentrés sur seulement 10 pays d’Afrique et d’Asie, de nombreuses inégalités géographiques persistent malheureusement en termes d’impact de ce pathogène. Dans la région appelée ceinture méningée africaine, une prévalence accrue de méningites pneumococciques est observée, conjointement aux méningites à méningocoque et survenant selon le même mode saisonnier que celles-ci mais grevées d’un taux de léthalité plus élevé. Ces méningites sont majoritairement attribuables au seul sérotype 1 (Sp1), dont le tropisme pour le système nerveux central ainsi que le caractère pathogène affectant l’ensemble des tranches d’âge contrastent avec ce qui est observé dans les pays industrialisés. Heureusement, les actions de soutien de la Global Vaccine Alliance (GAVI) et de l’organisation mondiale de la santé (OMS) ont permis à la majeure partie des pays de cette région d’introduire depuis quelques années les vaccins conjugués (PCVs) 10/13-valents au sein de leur schéma d’immunisation infantile. La vaccination globale est en effet devenue la stratégie de choix dans la lutte contre le pneumocoque et le déploiement dans de nombreux pays des PCVs chez les enfants et adultes à risque a permis de réduire de façon conséquente la morbi-mortalité liée aux infections invasives pneumococciques, en particulier celles causées par les sérotypes inclus dans les vaccins. Néanmoins, l’émergence de sérotypes non-vaccinaux (phénomène de remplacement) combinée à la circulation continue de lignées plus virulentes, à l’accroissement de l’antibiorésistance, à la couverture épidémiologique variable d’un pays à l’autre et à l’existence de moindres répondeurs parmi les vaccinés ont tempéré les bénéfices attendus, et ce également dans la ceinture méningée où l’impact sur le Sp1 reste marginal.Avec l’objectif ultime d’améliorer la prévention offerte par la vaccination contre un tel pathogène ubiquitaire, nous avons réalisé un projet triangulaire s’articulant autour des trois domaines de l’immunologie, de la microbiologie et de l’épidémiologie et comportant plusieurs collaborations internationales afin de mieux comprendre d’une part les facteurs hôte/pathogène impliqués dans la survenue des infections invasives et d’autre part de proposer des idées d’amélioration des stratégies vaccinales présentes et futures tant dans les pays industrialisés que dans ceux en voie de développement. Grâce à l’analyse d’échantillons collectés dans des populations Africaines et Européennes, nous avons pu explorer en profondeur les réponses immunitaires humorales engendrées naturellement après un contact avec le S. pneumoniae, démontrant leur moindre amplitude comparée aux réponses vaccinales, et parallèlement décrire le taux de portage d’un vaste ensemble de gènes réputés associés à la virulence au sein des souches invasives circulant dans ces populations. Nous avons ainsi pu démontrer que ni la présence des facteurs de virulence étudiés, ni une plus grande susceptibilité immunitaire humorale des individus, n’étaient responsables de l’endémie caractéristique de méningites à Sp1 observée dans la ceinture méningée africaine. Toujours dans le même but d’optimiser la prévention, nous avons ensuite proposé une approche dans laquelle la surveillance accrue et continue de l’épidémiologie post-vaccinale occuperait une place de choix pour guider la stratégie mise en place, et ce, compte tenu de la plasticité génétique extraordinaire dont est doté le S. pneumoniae. Cette plasticité génétique, qui représente un avantage évolutif certain lui permettant de s’adapter constamment aux pressions environnementales, se reflète dans les changements épidémiologiques notoires survenus dans notre pays à la suite de modifications du schéma vaccinal comme discuté dans notre troisième étude. Les limitations des vaccins liés aux sérotypes capsulaires apparaissant inéluctables avec le temps, le développement de nouvelles plateformes vaccinales s’est imposé depuis quelques années, plateformes dont nous discutons les avantages et inconvénients potentiels à la lumière de nos résultats en gardant en mémoire le caractère commensal du S. pneumoniae. Entre autres, nous avons montré que la prévalence de certaines protéines de surfaces investiguées comme principales cibles dans les nouveaux modèles vaccinaux souffrait comme pour les antigènes capsulaires d’une grande variabilité géographique, rendant les bénéfices attendus d’un modèle vaccinal non automatiquement transposables d’un pays à l’autre. Nous insistons également sur le bon usage des techniques récentes de laboratoire en soulignant les multiples perspectives que celles-ci peuvent offrir, tant dans l’évaluation de l’efficacité vaccinale que dans la compréhension des interactions hôte/pathogène et de la virulence bactérienne.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe

Specialty grand challenge in pediatric infectious diseases

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Challenges and Issues of Anti-SARS-CoV-2 Vaccines

International audienceAt the beginning of 2021, anti-SARS-CoV-2 vaccination campaigns had been launched in almost 60 countries with more than 500 million doses having been distributed. In addition to the few vaccines already in use, many other candidates are in preclinical phases or experimental stages in humans. Despite the fact that the availability of anti-SARS-CoV-2 vaccine constitutes a major advance and appear to be the only way to control the pandemic, some investigation remains to be carried out, and this is notably concerning the impact on transmissibility, the duration of the conferred protection in the mid- and long term, the effectiveness against present and future viral mutants, or the ideal schedule that should be applied. In this paper, we review the circumstances that facilitated such a rapid development of anti-SARS-CoV-2 vaccines and summarize the different vaccine platforms under investigation as well as their present results and perspectives in different settings. We also discuss the indications of vaccination under special conditions, such as a history of previous COVID-19 infection or belonging to extreme age categories like children and elderly. Overall, this review highlights the multiple challenges to face if aiming to find a global solution to the pandemic through high vaccination coverage all over the world

Faut-il vacciner contre la varicelle?

Varicella is a frequent viral disease, with a substantial medical and societal impact. For many years, various industrialized countries have adopted an universal mass vaccination against varicella, using a one-dose schedule. In these countries, the global incidence of varicella has decreased by about 90 %. A significant reduction in hospitalizations, outpatient visits and medical costs due to varicella has also been observed. Recently, a 2-dose schedule has demonstrated an efficacy of about 98 %, as well as herd immunity.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Management of varicella in neonates and infants

In countries where vaccination is not implemented, varicella is a common ubiquitous disease offering a broad range of clinical presentations. Whereas mother-to-child perinatal transmission of varicella zoster virus (VZV) can lead to disseminated life-threatening diseases in unimmunised newborns, postnatal acquisition will be generally a source of milder infections. The pattern and severity of the disease are known to be partly determined by the timing of VZV acquisition during pregnancy with the highest risk period located around delivery. Management of youngest children after contact with a varicella case remains difficult for clinicians not only because of unawareness of varicella natural history and risks factors for serious complications, but also because of the lack of consensus from experts available in the literature. This state of uncertainty often leads to overconsumption of healthcare resources with systematic hospitalisation and unjustified antiviral intravenous therapies. After a concise literature review, this article proposes pragmatic recommendations considering newborns in various scenarios following a contact with VZV, taking into account the timing and mode of virus transmission, the maternal immunological status, the baby's gestational age and the presence of other underlying conditions.SCOPUS: re.jinfo:eu-repo/semantics/publishe

The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children

Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Varicella paediatric hospitalisations in Belgium: a 1-year national survey.

BACKGROUND: Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. METHODS: Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. RESULTS: Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/10(5) person-years, with the highest impact among those 0-4 years old (global incidence and odds of hospitalisation: 79/10(5) person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had >/=1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/10(5) person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/10(6) and fatality ratio 0.2% among our cohort. CONCLUSIONS: Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium

Underlying factors in paediatric invasive pneumococcal disease in Belgium – Authors' reply

SCOPUS: le.jinfo:eu-repo/semantics/publishe