Early childhood infections and body mass index in adolescence

BACKGROUND: The incidence of childhood overweight and obesity is rising. It is hypothesized that infections in early childhood are associated with being overweight. This study investigated the association between the number of symptomatic infections or antibiotic prescriptions in the first 3 years of life and body mass index (BMI) in adolescence. SUBJECTS: The current study is part of the Prevention and Incidence of Asthma and Mite Allergy population-based birth cohort study. Weight and height were measured by trained research staff at ages 12 and 16 years. The 3015 active participants at age 18 years were asked for informed consent for general practitioner (GP) data collection and 1519 gave written informed consent. Studied exposures include (1) GP-diagnosed infections, (2) antibiotic prescriptions, and (3) parent-reported infections in the first 3 years of life. Generalized estimating equation analysis was used to determine the association between each of these exposures and BMI z-score. RESULTS: Exposure data and BMI measurement in adolescence were available for 622 participants. The frequencies of GP-diagnosed infections and antibiotic prescriptions were not associated with BMI z-score in adolescence with estimates being 0.14 (95% CI -0.09-0.37) and 0.10 (95% CI -0.14-0.34) for the highest exposure categories, respectively. Having ≥6 parent-reported infections up to age 3 years was associated with a 0.23 (95% CI 0.01-0.44) higher BMI z-score compared to <2 parent-reported infections. CONCLUSIONS: For all infectious disease measures an increase in BMI z-score for the highest childhood exposure to infectious disease was observed, although only statistically significant for parent-reported infections. These results do not show an evident link with infection severity, but suggest a possible cumulative effect of repeated symptomatic infections on overweight development

Real-world comparison of the effects of etanercept and adalimumab on well-being in non-systemic juvenile idiopathic arthritis: a propensity score matched cohort study

Background: Etanercept (ETN) and adalimumab (ADA) are considered equally efective biologicals in the treat‑ ment of arthritis in juvenile idiopathic arthritis (JIA) but no studies have compared their impact on patient-reported well-being. The objective of this study was to determine whether ETN and ADA have a diferential efect on patientreported well-being in non-systemic JIA using real-world data. Methods: Biological-naive patients without a history of uveitis were selected from the international Pharmachild registry. Patients starting ETN were matched to patients starting ADA based on propensity score and outcomes were collected at time of therapy initiation and 3–12 months afterwards. Primary outcome at follow-up was the improve‑ ment in Juvenile Arthritis Multidimensional Assessment Report (JAMAR) visual analogue scale (VAS) well-being score from baseline. Secondary outcomes at follow-up were decrease in active joint count, adverse events and uveitis events. Outcomes were analyzed using linear and logistic mixed efects models. Results: Out of 158 eligible patients, 45 ETN starters and 45 ADA starters could be propensity score matched result‑ ing in similar VAS well-being scores at baseline. At follow-up, the median improvement in VAS well-being was 2 (inter‑ quartile range (IQR): 0.0 – 4.0) and scores were signifcantly better (P=0.01) for ETN starters (median 0.0, IQR: 0.0 – 1.0) compared to ADA starters (median 1.0, IQR: 0.0 – 3.5). The estimated mean diference in VAS well-being improvement from baseline for ETN versus ADA was 0.89 (95% CI: -0.01 – 1.78; P=0.06). The estimated mean diference in active joint count decrease was -0.36 (95% CI: -1.02 – 0.30; P=0.28) and odds ratio for adverse events was 0.48 (95% CI: 0.16 –1.44; P=0.19). One uveitis event was observed in the ETN group. Conclusions: Both ETN and ADA improve well-being in non-systemic JIA. Our data might indicate a trend towards a slightly stronger efect for ETN, but larger studies are needed to confrm this given the lack of statistical signifcance

SARS-CoV-2 outbreaks in secondary school settings in the Netherlands during fall 2020: silent circulation

BACKGROUND: In fall 2020 when schools in the Netherlands operated under a limited set of COVID-19 measures, we conducted outbreaks studies in four secondary schools to gain insight in the level of school transmission and the role of SARS-CoV-2 transmission via air and surfaces. METHODS: Outbreak studies were performed between 11 November and 15 December 2020 when the wild-type variant of SARS-CoV-2 was dominant. Clusters of SARS-CoV-2 infections within schools were identified through a prospective school surveillance study. All school contacts of cluster cases, irrespective of symptoms, were invited for PCR testing twice within 48 h and 4-7 days later. Combined NTS and saliva samples were collected at each time point along with data on recent exposure and symptoms. Surface and active air samples were collected in the school environment. All samples were PCR-tested and sequenced when possible. RESULTS: Out of 263 sampled school contacts, 24 tested SARS-CoV-2 positive (secondary attack rate 9.1%), of which 62% remained asymptomatic and 42% had a weakly positive test result. Phylogenetic analysis on 12 subjects from 2 schools indicated a cluster of 8 and 2 secondary cases, respectively, but also other distinct strains within outbreaks. Of 51 collected air and 53 surface samples, none were SARS-CoV-2 positive. CONCLUSION: Our study confirmed within school SARS-CoV-2 transmission and substantial silent circulation, but also multiple introductions in some cases. Absence of air or surface contamination suggests environmental contamination is not widespread during school outbreaks

Rotavirusvaccinatie voor alle jonge kinderen

Rotavirus-gastro-enteritis is een ernstige ziekte, waardoor in Nederland jaarlijks circa 2700 kinderen < 5 jaar in het ziekenhuis terechtkomen en 5-7 komen te overlijden. Er zijn effectieve en veilige vaccins tegen het rotavirus. In 2017 oordeelde de Gezondheidsraad positief over rotavirusvaccinatie van alle kinderen en adviseerde om in ieder geval kinderen in risicogroepen te vaccineren, omdat in die groepen de ziektelast het hoogst is. Algemene vaccinatie zou naar het oordeel van de raad niet kosteneffectief zijn. Inmiddels heeft de ZonMw/RIVAR-studie laten zien dat rotavirusvaccinatie van risicogroepen minder effectief is dan eerder gedacht. Daarom adviseerde de Gezondheidsraad medio 2021 om toch álle kinderen rotavirusvaccinatie aan te bieden. Algemene vaccinatie binnen het Rijksvaccinatieprogramma leidt, behalve tot directe bescherming, naar verwachting tevens tot groepsimmuniteit, waardoor ook kwetsbare kinderen in risicogroepen beschermd worden. Helaas heeft staatssecretaris Blokhuis besluitvorming over implementatie van rotavirusvaccinatie doorgeschoven naar het nieuwe kabinet. Hopelijk hakt de nieuwe staatssecretaris deze knoop nu snel door

Rotavirus vaccination for all Dutch infants

Rotavirus-gastro-enteritis is een ernstige ziekte, waardoor in Nederland jaarlijks circa 2700 kinderen &lt; 5 jaar in het ziekenhuis terechtkomen en 5-7 komen te overlijden. Er zijn effectieve en veilige vaccins tegen het rotavirus. In 2017 oordeelde de Gezondheidsraad positief over rotavirusvaccinatie van alle kinderen en adviseerde om in ieder geval kinderen in risicogroepen te vaccineren, omdat in die groepen de ziektelast het hoogst is. Algemene vaccinatie zou naar het oordeel van de raad niet kosteneffectief zijn. Inmiddels heeft de ZonMw/RIVAR-studie laten zien dat rotavirusvaccinatie van risicogroepen minder effectief is dan eerder gedacht. Daarom adviseerde de Gezondheidsraad medio 2021 om toch álle kinderen rotavirusvaccinatie aan te bieden. Algemene vaccinatie binnen het Rijksvaccinatieprogramma leidt, behalve tot directe bescherming, naar verwachting tevens tot groepsimmuniteit, waardoor ook kwetsbare kinderen in risicogroepen beschermd worden. Helaas heeft staatssecretaris Blokhuis besluitvorming over implementatie van rotavirusvaccinatie doorgeschoven naar het nieuwe kabinet. Hopelijk hakt de nieuwe staatssecretaris deze knoop nu snel door.Recently, the Netherlands Health Council (HC) issued an updated advice on rotavirus vaccination. Rotavirus gastro-enteritis primarily affects young children, of whom, in the Netherlands, annually ~2700 end up in the hospital and 5-7 die. In 2017, the HC judged positively on rotavirus vaccination of young children, but also concluded that the cost-effectiveness of general vaccination was unfavorable. Yet, the HC recommended to at least vaccinate vulnerable children in specific risk-groups. Because of the corona crisis, this, however, has not materialized. Meanwhile, the Dutch Risk-group Infant Vaccination Against Rotavirus study has demonstrated that rotavirus vaccination of children in risk-groups is less effective than previously thought. Therefore, the HC now recommends rotavirus vaccination of all children. General vaccination within the Dutch NIP is expected to result in herd-immunity, such that all children, including those in risk-groups, are protected. Nonetheless, the Dutch Ministry of Health has decided to postpone implementation of rotavirus vaccination.</p

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 - 2019).

We performed a cross-sectional study using routine healthcare data in a Dutch tertiary hospital between January 1st 2015 and August 1st 2019. MDRO risk assessment upon hospitalization included assessment of: known MDRO carriage, previous hospitalization in another Dutch hospital during an outbreak or a foreign hospital, living in an asylum centre, exposure to livestock farming and household membership of a methicillin-resistant Staphylococcus aureus carrier