Increasing incidence of life-threatening pertussis: A retrospective cohort study in New Zealand.

Background Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in preschool children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. Methods We investigated an established cohort of 6846 NZ children, born in 2009-10, with linkage to a national dataset of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. Results In the whole cohort, factors associated with ID hospitalisation were Māori (OR=1.49, 95%CI 1.17-1.89) or Pacific (2.51, 2.00-3.15) vs. European maternal ethnicity, male gender (1.32, 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for &lt;4 months (1.22, 1.04-1.43), maternal experience of healthcare racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households [1.50, 1.12-2.02]), day-care attendance (1.43, 1.12-1.81), and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were: high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants: delayed immunization (1.72, 1.23-2.38), maternal experience of healthcare racism (2.20, 1.29-3.70), and maternal smoking (1.59, 1.10-2.29). Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.</p

Increasing incidence of life-threatening pertussis: A retrospective cohort study in New Zealand.

Background Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in preschool children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. Methods We investigated an established cohort of 6846 NZ children, born in 2009-10, with linkage to a national dataset of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. Results In the whole cohort, factors associated with ID hospitalisation were Māori (OR=1.49, 95%CI 1.17-1.89) or Pacific (2.51, 2.00-3.15) vs. European maternal ethnicity, male gender (1.32, 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for Factors associated with ID hospitalisation for Māori infants were: high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants: delayed immunization (1.72, 1.23-2.38), maternal experience of healthcare racism (2.20, 1.29-3.70), and maternal smoking (1.59, 1.10-2.29). Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.</p

CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

Purpose: Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. Methods: A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed. Enrolled cases met criteria for influenza-associated encephalopathy or had status epilepticus. Functional outcome at discharge was compared between groups using the Modified Rankin Scale (mRS). Results: There were 22 children with influenza studied of whom 11/22 had encephalopathy and 11/22 had status epilepticus. Only one child had a documented influenza immunization. The biomarker CSF neopterin was tested in 10/11 children with encephalopathy and was elevated in 8/10. MRI was performed in all children with encephalopathy and was abnormal in 8 (73%). Treatment of children with encephalopathy was with corticosteroids or intravenous immunoglobulin in 9/11 (82%). In all cases oseltamivir use was low (59%) while admission to the intensive care unit was frequent (14/22, 66%). Clinical outcome at discharge was moderate to severe disability (mRS score > 2) in the majority of children with encephalopathy (7/11, 64%), including one child who died. Children with status epilepticus recovered to near-baseline function in all cases. Conclusion: Raised CSF neopterin was present in most cases of encephalopathy, and along with diffusion restriction on MRI, is a useful diagnostic biomarker. Lack of seasonal influenza vaccination represents a missed opportunity to prevent illness in children, including severe neurological disease