Trends in Mortality in Children Hospitalized with Meningococcal Infections in Albania from 2006 to 2014

Background: Lack of vaccination and modern health care facilities in many countries including Albania let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. Patients expected to develop life-threatening complications in acute meningococcal infections require early recognition and appropriate monitoring. Different prognostic scoring systems have been developed. Aim: The aim of this study was to evaluate mortality in children hospitalized with meningococcal infections in Albania, including scoring systems in prognosticating mortality rate. Materials and Methods: This was a retrospective descriptive study, performed on 40 patients with definite diagnosis of meningococcal infection admitted to PICU in UHC “Mother Teresa”, Tirana, Albania, between 2006 and 2014. There were 40 patients, 22(55%) males, and 18(45%) females, from 2 months to 10 years old. We evaluated all the patients based on Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score. Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. Results: Overall mortality was 42%. According to the GMSPS(3) prognostic score of meningococcemia: 28 (70%) patients had a score <8 points and were recorded four deaths representing a mortality rate of 14.2%; the mortality rate of 12(45%) patients with a score ≥8 points resulted in 100% mortality. The sensitivity was 100%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 100% for a GMSPS score ≥8. According to the Stiehm and Damrosch criteria (2): 22(55%) patients had two or fewer factors present and was recorded three deaths representing a mortality rate of 13.6%; the mortality rate of 18(45%) patients with three or more factors present the mortality rate was 72.2%. The sensitivity was 90%, specificity was 80%, the positive predictive value was 75% and negative predictive value was 92.3% for the criterion ≥3 of the Stiehm and Damrosch criteria. Conclusions: Meningococci are still killers, they affect men more than women. The Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score can rapidly identify children with the fulminant meningococcal disease and poor prognosis and help us starting prompt administration of suitable antibiotics, critical care, and special therapeutic measures.Keywords: Meningococcal disease, meningococcemia, meningitis, children, scoring system

Influenza and respiratory syncytial virus in infants study (IRIS) of hospitalized and non-ill infants aged <1 year in four countries: study design and methods

Abstract Background This multi-country prospective study of infants aged <1 year aims to assess the frequency of influenza virus and respiratory syncytial virus (RSV) infections associated with hospitalizations, to describe clinical features and antibody response to infection, and to examine predictors of very severe disease requiring intensive care. Methods/Design We are enrolling a hospital-based cohort and a sample of non-ill infants in four countries (Albania, Jordan, Nicaragua, and the Philippines) using a common protocol. We are currently starting year 2 of a 2- to 3-year study and will enroll approximately 3,000 infants hospitalized for any acute illness (respiratory or non-respiratory) during periods of local influenza and/or RSV circulation. After informed consent and within 24 h of admission, we collect blood and respiratory specimens and conduct an interview to assess socio-demographic characteristics, medical history, and symptoms of acute illness (onset ≤10 days). Vital signs, interventions, and medications are documented daily through medical record abstraction. A follow-up health assessment and collection of convalescent blood occurs 3-5 weeks after enrollment. Influenza and RSV infection is confirmed by singleplex real time reverse transcriptase polymerase chain reaction (rRT-PCR) assays. Serologic conversion will be assessed comparing acute and convalescent sera using hemagglutination inhibition assay for influenza antibodies and enzyme-linked immunosorbent assay (ELISA) for RSV. Concurrent with hospital-based enrollment, respiratory specimens are also being collected (and tested by rRT-PCR) from approximately 1,400 non-ill infants aged <1 year during routine medical or preventive care. Discussion The Influenza and RSV in Infants Study (IRIS) promises to expand our knowledge of the frequency, clinical features, and antibody profiles of serious influenza and RSV disease among infants aged <1 year, quantify the proportion of infections that may be missed by traditional surveillance, and inform decisions about the potential value of existing and new vaccines and other prevention and treatment strategies.https://deepblue.lib.umich.edu/bitstream/2027.42/136185/1/12879_2017_Article_2299.pd