Antibiotic use for upper respiratory tract infections in children: A cross-sectional survey of knowledge, attitudes, and practices (KAP) of parents in Greece

<p>Abstract</p> <p>Background</p> <p>Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to document and analyse parental beliefs on antibiotic use for children with URTIs in Greece, a country with high levels of antibiotic use and antibiotic resistance.</p> <p>Methods</p> <p>A knowledge-attitude-practice questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. The sample of the study contained parents from all geographic areas of Greece.</p> <p>Results</p> <p>The majority of Greek parents (80%) believed that UTRIs are mostly self-limited, although 74% of them expected to receive antibiotics when such a diagnosis was given. Earache was the most common reason for which parents expected antibiotics (45%). Greek parents rarely gave antibiotics to their children without medical advice (10%) and most (88%) believed that unnecessary antibiotic use drives antibiotic resistance and they were happy to receive symptomatic therapy if instructed by their physician. Almost 70% of parents confused antibiotics with other medicines used for symptomatic therapy for a child with URTI.</p> <p>Conclusion</p> <p>Greek parents have a trusted relationship with their paediatrician and rarely give antibiotics without medical advice, indicating that parents contribute less than expected to antibiotic misuse. Parents also appreciate the benign course of most URTIs and the fact that unnecessary antibiotic use is harmful. More time needs to be invested in educating mostly physicians on the potential benefit from reducing antibiotic prescribing for children with URTI.</p

Surveillance study of vector species on board passenger ships, Risk factors related to infestations

<p>Abstract</p> <p>Background</p> <p>Passenger ships provide conditions suitable for the survival and growth of pest populations. Arthropods and rodents can gain access directly from the ships' open spaces, can be carried in shiploads, or can be found on humans or animals as ectoparasites. Vectors on board ships may contaminate stored foods, transmit illness on board, or, introduce diseases in new areas. Pest species, ship areas facilitating infestations, and different risk factors related to infestations were identified in 21 ferries.</p> <p>Methods</p> <p>486 traps for insects and rodents were placed in 21 ferries. Archives of Public Health Authorities were reviewed to identify complaints regarding the presence of pest species on board ferries from 1994 to 2004. A detail questionnaire was used to collect data on ship characteristics and pest control practices.</p> <p>Results</p> <p>Eighteen ferries were infested with flies (85.7%), 11 with cockroaches (52.3%), three with bedbugs, and one with fleas. Other species had been found on board were ants, spiders, butterflies, beetles, and a lizard. A total of 431 <it>Blattella germanica </it>species were captured in 28 (9.96%) traps, and 84.2% of them were nymphs. One ship was highly infested. Cockroach infestation was negatively associated with ferries in which Hazard Analysis Critical Control Point system was applied to ensure food safety on board (Relative Risk, RR = 0.23, <it>p </it>= 0.03), and positively associated with ferries in which cockroaches were observed by crew (RR = 4.09, <it>p </it>= 0.007), no cockroach monitoring log was kept (RR = 5.00, <it>p </it>= 0.02), and pesticide sprays for domestic use were applied by crew (RR = 4.00, <it>p </it>= 0.05). Cockroach infested ships had higher age (<it>p </it>= 0.03). Neither rats nor mice were found on any ship, but three ferries had been infested with a rodent in the past.</p> <p>Conclusion</p> <p>Integrated pest control programs should include continuing monitoring for a variety of pest species in different ship locations; pest control measures should be more persistent in older ships. HACCP system aids in the prevention of cockroach infestations on board.</p

Prognostic factors related to sequelae in childhood bacterial meningitis: Data from a Greek meningitis registry

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae.</p> <p>Methods</p> <p>A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model.</p> <p>Results</p> <p>The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3).</p> <p>Conclusions</p> <p>A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.</p

Does tourism affect the long term course of COVID-19 pandemic in a country of destination? Evidence from a popular Greek island in 2020 where control measures were implemented

Greece opened its points of entry on July 1, 2020, with specific guidelines for travellers arriving by sea, air or land. The aim of this article is to examine the effect of tourism on the long term course of the Coronavirus Disease 2019 (COVID-19) pandemic during the pre-vaccination era (June to December 2020) on the popular Greek island of Crete. To achieve this, a cross-sectional serosurvey, repeated at monthly intervals, was conducted to compare the seroprevalence in Crete with seroprevalence in the mainland of Greece. Crete welcomed nearly 2,000,000 travellers during the 2020 summer season. Left-over serum samples were collected and obtained from public and private laboratories located in Greece, including the island of Crete. These samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies. A total of 55,938 samples were collected, 3,785 of which originated from Crete. In Crete, the seroprevalence ranged between 0% (June 2020) and 2.58% (December 2020), while the corresponding seroprevalence in Greece was 0.19% and 10.75%, respectively. We identified 4.16 times lower seropositivity in Crete (2.58%) in comparison with the mainland of Greece (10.75%) during December 2020. Moreover, the monthly infection fatality rate (IFR) in Crete was calculated at 0.09%, compared with 0.21% in mainland Greece for December 2020. The island of Crete presented more than four times lower seroprevalence than the mainland of Greece, despite being a highly attractive tourist destination. This evidence supports the idea that tourism may not have affected the long term course of the COVID-19 pandemic in Greece. However, due to contradicting results from previous studies, further investigation is needed

Longitudinal study of HIV infection in children and adolescents in Greece

The present study includes a:Η. A retrospective part with data of the pediatric AIDS unit of Aghia Sophia Childrens Hospital from the period 1985 – 2011 andΗΗ. A prospective part aiming to investigate the non-traditional adipokines which are involved in lipodystrophy an important adverse effect of antiretroviral treatment of HIV infected patients.Η. RETROSPECTIVE PARTΗa. This part includes data from multitransfused children and adolescents (Haemoglobinopathies, Haemophiliacs) who were infected with HIV before 1985, Total No 43.Ηb. Data of vertically infected children or infected from unknown source, Total No 62.Ηc. Data of babies of HIV (+) mothers from 1985 – 2011, Total No 163.a) Patients of the first group did not have the chance of antiretroviral treatment and the majority have succumbed while few were followed up in adults AIDS units.b) Patients of the second group had received antiretroviral treatment in various stages of their disease. The majority of patients are alive with a good quality of life. The main concerns are the immediate and future adverse effects of the antiretroviral treatment.c) Babies of this group were born from HIV (+) mothers (1985 – 2011). As it is well known from 1994 the recommended chemoprophylaxis with AZT during pregnancy, labor and to the newborn has reduced the risk of mother to child transmission (MTCT) of HIV from 25% to 8%.A number of 163 babies were followed up. It is worth noticing that only during the last 3 years the chemoprophylaxis is satisfactory implemented, but still there is much to be done for the effective prevention.II. PROSPECTIVE STUDYBackground. Lipodystrophy characterized by adipose tissue redistribution and lipid and glucose metabolism abnormalities, is common among HIV-infected adults and children on highly-active-antiretroviral-therapy (HAART). In a previous study of HIV-infected children, we did not detect insulin resistance, despite a high percentage of body fat redistribution abnormalities.Aim of the study. To investigate the non-traditional adipokines Retinol-binding-Protein-4 (RBP4), neutrophil-gelatinase-associated-lipocalin (NGAL), YKL-40 and a-FABP and evaluate their possible association to lipodystrophic changes or insulin resistance.Methods. Seventeen vertically HIV-infected children (mean age: 12.5 years, mean duration of HAART: 5.2 years) and 20 age and BMI-matched controls were recruited. The HIV-children were re-evaluated after 12 months. RBP4, NGAL, a-FABP and YKL-40 were assessed at study entry and 12 months later and were correlated to body fat content and insulin resistance.Results. RBP4 values were similar at study entry and 12 months later in HIV-children and controls and showed no correlation to body fat or insulin resistance. NGAL was lower in HIV children at study entry but normalized after 12 months with no positive correlation to insulin resistance. a-FABP was positively correlated to body fat content, especially to trunk fat, both at initial evaluation and at follow-up in HIV children and, after prolonged highly-active-antiretroviral-therapy, it was also positively correlated to insulin resistance.Conclusions. This study is the first one to demonstrate that a-FABP could be a useful marker in unraveling central fat accumulation in HIV-infected children on highly-active-antiretroviral-therapy. Extended prospective studies are needed to confirm these results.Η παρούσα διατριβή περιλαμβάνει:Ι.Αναδρομική μελέτη με τα πεπραγμένα της μονάδας του «Παιδικού AIDS» του Νοσοκομείου Παίδων «Η ΑΓΙΑ ΣΟΦΙΑ» 1985 – 2011.ΙΙ. Προοπτική μελέτη με αναζήτηση βιολογικών δεικτών παρακολούθησης της λιποδυστροφίας, ανεπιθύμητης ενέργειας της αντιρετροϊκής αγωγής που συνδέεται με κίνδυνο ανάπτυξης καρδιαγγειακής νόσου. ΥΛΙΚΟ. Ελέγχθηκαν 17 παιδιά με κάθετη μετάδοση του ιού (μέση ηλικία 12.5 χρόνια και μέση διάρκεια αντιρετροϊκής θεραπείας HAART 5.2 χρόνια) και 20 παιδιά μάρτυρες συμβατοί ως προς την ηλικία και τον δείκτη βάρους σώματος ΒΜΙ. Τα HIV παιδιά επανεξετάσθηκαν με προσδιορισμό των δεικτών RBP4, NGAL, a-FABP & YKL-40 μετά 12 μήνες. Οι δείκτες συσχετίσθηκαν με το λίπος σώματος και την αντίσταση στην ινσουλίνη. ΑΠΟΤΕΛΕΣΜΑΤΑ. Τα επίπεδα της RBP4 βρέθηκαν παρόμοια στην έναρξη της μελέτης και μετά 12 μήνες στα HIV παιδιά και τους μάρτυρες. Δεν διαπιστώθηκε συσχέτιση με το λίπος σώματος και την αντίσταση στην ινσουλίνη.RBP4 (mg/L)•Μάρτυρες: 22.0 ± 0.8•Ασθενείς (έναρξη): 21.1 ± 2•Ασθενείς με HAART 1 χρόνο μετά: 21.3 ±6Τα επίπεδα της NGAL ήταν χαμηλότερα στα HIV παιδιά στην έναρξη της μελέτης αλλά αποκαταστάθηκαν στο φυσιολογικό μετά 12 μήνες χωρίς να διαπιστωθεί θετική συσχέτιση με την αντίσταση στην ινσουλίνη.NGAL (μg/L)•Μάρτυρες: 67.5 ± 55 (33.5 – 136.1)•Ασθενείς (έναρξη): 18.8 ± 4.6 (4.4 – 81.7) p<0.001•Ασθενείς με HAART 1 χρόνο μετά: 68.2 ± 22.3 (6.1 – 377.9) p<0.001a-FABPΤα επίπεδα είχαν σημαντική θετική συσχέτιση με το λίπος του σώματος, ειδικά του κορμού τόσο κατά την αρχική αξιολόγηση όσο και μετά από 12 μήνες υπό HAART παρακολούθηση. Θετική βρέθηκε επίσης μετά από 12 μήνες η συσχέτιση με την αντίσταση στην ινσουλίνη.•Μάρτυρες: 39.5 ± 3.9 (18.6 – 74.5)•Ασθενείς (έναρξη): 19.0 ± 3.0 (5.4 – 54.8) p<0.001•Ασθενείς με HAART 1 χρόνο μετά: 16.8 ± 2.9 (4.0 – 49.5) p<0.001YKL-40. Τα επίπεδα της YKL-40 σε HIV παιδιά στην έναρξη της μελέτης δεν διέφεραν από τους μάρτυρες μετά από 12 μήνες υπό HAART. Τα επίπεδα της YKL-40 ήταν παρόμοια με εκείνα της έναρξης της μελέτης αλλά σημαντικά υψηλότερα από εκείνα των μαρτύρων. •Μάρτυρες: 38.3 ± 2.7 (17.6 – 57.9)•Ασθενείς (έναρξη): 48.0 ± 4.5 (19.4 – 87.7)•Ασθενείς με HAART 1 χρόνο μετά: 59.7 ± 6.9 (18.5 – 110.9) p=0.003 Συμπέρασμα. Από τη μελέτη διαπιστώνεται για πρώτη φορά ότι ο προσδιορισμός της a-FABP μιας νέας λιποκίνης θα μπορούσε να αποτελέσει δείκτη αξιολόγησης της λιποδυστροφίας σε HIV παιδιά υπό αγωγή με υψηλής δραστικότητας αντιρετροϊκή αγωγή (HAART). Προοπτικές μελέτες με μεγάλο αριθμό ασθενών απαιτούνται για επιβεβαίωση των ευρημάτων της παρούσης μελέτης

Vaccination of healthcare workers: is mandatory vaccination needed?

Introduction: Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational acquisition of vaccine-preventable diseases (VPDs) and to indirectly protect their patients and the essential healthcare infrastructure. However, outbreaks due to VPDs continue to challenge healthcare facilities and HCWs are frequently traced as sources of VPDs to vulnerable patients. In addition, HCWs were disproportionately affected during the current measles outbreak in Europe. Areas covered: We reviewed the recent published information about HCWs vaccinations with a focus on mandatory vaccination policies. Expert commentary: Although many countries have vaccination programs specifically for HCWs, their vaccination coverage remains suboptimal and a significant proportion of them remains susceptible to VPDs. The increasing vaccination hesitancy among HCWs is of concern, given their role as trusted sources of information about vaccines. Mandatory vaccinations for HCWs are implemented for specific VPDs in few countries. Mandatory influenza vaccination of HCWs was introduced in the United States a decade ago with excellent results. Mandatory vaccinations for VPDs that may cause significant morbidity and mortality should be considered. Issues of mistrust and misconceptions about vaccinations should also be addressed

Pertussis Epidemiology in Greece and Emerging Risk Groups during the Vaccination Era (1980–2008)

To study the epidemiology of pertussis in Greece and epidemiologic changes throughout a period of twenty-nine years, we conducted a retrospective analysis of available data of pertussis cases for the past twenty-nine years (1980–2008) and a prospective analysis of hospitalized pertussis cases from a children’s hospital in Athens for eight years (2001–2008). From 1980 through 2008, the incidence of pertussis in Greece declined from 11.2 to 0.05 cases per 100,000. Epidemic cycles occurring every 3 to 5 years were observed. Since pertussis circulation cannot be fully controlled by present immunization programs, efforts should be made to vaccinate infants at the recommended age, early diagnose, treatment as well as contact tracing of pertussis cases. Control of pertussis in social susceptible populations is necessary. A national program with adolescent and adult booster could decrease the circulation of B. pertussis. Despite an overall decrease for pertussis cases, pertussis is still a present and future challenge of public health service in Greece

Vaccinations and Malaria Chemoprophylaxis of Adolescents Traveling From Greece to International Destinations A Nine-Year Prospective Study

Background: There are few publications focusing on vaccination and malaria chemoprophylaxis in adolescent travelers. We assessed pretravel vaccinations and malaria chemoprophylaxis of adolescents 12-18 years old traveling from Greece to international destinations. Methods: We prospectively studied 239 adolescents 12-18 years old during 2008-2016. A standard questionnaire was used to collect data. Results: Adolescents sought pretravel services at a mean of 24.1 days before departure. Their main destinations were sub-Saharan Africa (79 adolescents; 33.1%), Latin America (56; 23.5%) and North America (26; 10.9%). Almost half (46.1%) of them planned to stay abroad for at least 3 months. Sixteen (7.4%) adolescents planned to visit friends and relatives. The yellow fever vaccine and the typhoid vaccine were the most frequently administered vaccines (74.1% and 20.5%, respectively), while the hepatitis A vaccine and the tetanus-diphtheria vaccine accounted for most routine vaccinations (18% and 14.2%, respectively). The rabies and the typhoid fever vaccines were administered inadequately to adolescents traveling to endemic areas. Malaria chemoprophylaxis should have been prescribed in many cases traveling to sub-Saharan Africa and the Indian subcontinent. Conclusions: Only a small number of adolescents from Greece traveling abroad seek pretravel counseling. We found significant gaps in typhoid fever and rabies vaccinations of adolescents traveling to endemic areas. We also found gaps in prescription of malaria chemoprophylaxis for those traveling to high-risk areas. There is a need to develop communication strategies to access adolescent travelers and improve appropriate vaccination and use of malaria chemoprophylaxis

A Case-Control Study on the Risk Factors for Meningococcal Disease among Children in Greece.

The aim of this study was to identify environmental or genetic risk factors that are associated with invasive meningococcal disease (IMD) in children in Greece.A case-control study was performed in 133 children (44 cases and 89 controls) aged between 0-14 years, who were hospitalized in a children's hospital in Athens. Demographics and possible risk factors were collected by the use of a structured questionnaire. To investigate the association of mannose binding lectin (MBL) with IMD, a frequency analysis of the haplotypes of the MBL2 gene and quantitative measurement of MBL serum protein levels were performed using Nanogen NanoChipR 400 technology and immuno-enzyme techniques, respectively.The multivariate analysis revealed that changes in a child's life setting (relocation or vacation, OR = 7.16), paternal smoking (OR = 4.51), upper respiratory tract infection within the previous month (OR = 3.04) and the density of people in the house/100m2 (OR = 3.16), were independent risk factors associated with IMD. Overall 18.8% of patients had a MBL2 genotype with low functionality compared to 10.1% of healthy controls, but this was not statistically significant (p = 0.189).Prevention strategies aimed at reducing parental smoking and other risk factors identified in this study could decrease the risk of IMD among children in Greece

Comparison of microbial colonization rates between central venous catheters and peripherally inserted central catheters

Abstract Background Central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), have been widely used as intravascular devices in critically ill patients. However, they might evoke complications, such as catheter colonization that has been considered as predisposing factor for central line-associated bloodstream infections (CLABSIs). Although numerous studies have compared the risk of bloodstream infections between PICCs and CVCs, comparative studies on their colonization rates are limited. Objectives The episodes of catheter colonization in critically ill patients with CVCs or PICCs were retrospectively analysed during a two-year period in a Greek tertiary care hospital and colonization rates, microbial profiles and antimicrobial susceptibility patterns were compared. Methods Clinical and laboratory data of consecutive hospitalized critically-ill patients who underwent PICC and CVC placement between May 2017–May 2019 were analysed. All catheters were examined by the semiquantitative culture technique for bacterial pathogens, either as a routine process after catheter removal or after suspicion of infection. Species identification and antimicrobial resistance patterns were determined by the Vitek2 automated system. Results During the survey period a total of 122/1187 (10.28%) catheter colonization cases were identified among CVCs and 19/639 (2.97%) cases among PICCs (p = 0.001). The colonization rate was 12.48/1000 catheter-days for the CVC group and 1.71/1000 catheter-days for the PICC group (p < 0.001). The colonization rate per 1000 catheter-days due to multidrug-resistant organisms (MDROs) was 3.85 in all study cases, 7.26 (71/122) in the CVC group and 0.63 (7/19) in the PICC group (p < 0.001). Within the CVC group, the most common microorganism isolated was MDR Acinetobacter baumannii (n = 38, 31.1%) followed by MDR Klebsiella pneumoniae (n = 20, 16.4%). In the PICC group, the predominant microorganism isolated was Candida spp. (n = 5, 23.8%) followed by MDR K. pneumoniae and MDR A. baumannii in equal numbers (n = 3, 14.2%). Conclusion PICC lines were associated with significantly lower colonization rates comparing to the CVC ones. In addition, patterns of microbial colonization revealed a trend over the predominance of MDR gram-negatives in CVCs suggesting that PICCs might be a safer alternative for prolonged inpatient intravascular access. Prevention programs directed by local microbial ecology may diminish catheter colonization rates and CLABSIs