early vaccination a provisional measure to prevent measles in infants

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Influenza vaccination in pediatric age.

Influenza is a very common disease among infants and young children, with a considerable clinical and socioeconomic impact [1]. To reduce the direct and indirect effects of pediatric influenza virus infection, influenza vaccination is recommended worldwide for children considered at risk due to a severe underlying disease. In healthy children influenza vaccination is recommended only in a small number of countries, although guidelines vary regarding the minimum age [2]. In USA universal influenza vaccination in all the age groups is recommended, including all the children until 17 years of age. In UK, influenza vaccination is recommended in the age group 4-17 years, although the program has been activated only recently. Finally, in Canada and other European countries in which health autorithies recommend the vaccine also in the healthy pediatric population, school-age children and adolescents are excluded. However, a large number of European health authorities is still reluctant to include influenza vaccination in their national vaccination programs [2]. The reasons for this reluctance include the fact that the protection offered by the currently available vaccines is considered poor, particularly in younger children. Regarding immunogenicity, younger children are quite similar to the elderly, who, because of the senescence of their immune system, respond poorly to immune stimulation [2]. In both these groups of subjects, both the innate and adaptive immune system are poorly functioning. In particular, B-cells, that are essential for antibody production and immune memory, have limited responses. To increase the immune response of children to inactivated vaccines, a number of measures that have been tested and found to be effective in adults and in the elderly have been studied [3]. The use of adjuvanted vaccines, intradermal (ID) injection, the administration of an increased dose of antigens and the live attenuated influenza vaccine (LAIV) have been evaluated in controlled clinical trials, with good results [3]. Moreover, the possibility of protecting young children through the use of a quadrivalent influenza vaccine (QIV) has been evaluated [3]. None of these measures has been definitively accepted because of the fear of an increased risk of adverse events and because in some instances data regarding immunogenicity and/or clinical efficacy are lacking or are not completely convincing. However, the preliminary data are very interesting in some cases and suggest that some of these measures must be further developed if the problem of the poor protection of young infants has to be solved

Reasons in favour of universal vaccination campaign against COVID-19 in the pediatric population

Despite the growing evidence of the extreme efficacy of COVID-19 vaccines in adults and the elderly, the administration of the same prophylactic measures to pediatric subjects is debated by some parents and by a number of researchers. The aim of this manuscript is to explain the reasons for overcoming hesitancy towards COVID-19 vaccination in children and adolescents and to highlight the importance of universal COVID-19 vaccination in the pediatric population

Effects of Coronavirus Infections in Children

These viruses should be closely monitored to prevent spread of virulent strains

use of soluble triggering receptor expressed on myeloid cells 1 midregional proadrenomedullin and midregional proatrial natriuretic peptide for identification of etiology and assessment of severity of community acquired pneumonia in children

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borrelia burgdorferi infection and lyme disease in children

Summary Lyme disease is a multisystem disease that frequently affects children. It is caused by a group of related spirochetes, Borrelia burgdorferi sensu lato, that are transmitted by ticks belonging to species of the genus Ixodes . The clinical characteristics of Lyme disease in pediatrics resemble those observed in adults, although the symptoms may last for a shorter time and the outcome may be better. However, identifying Lyme disease in children can be significantly more difficult because some of its signs and symptoms can be similar to those of other common pediatric clinical manifestations. Finally, the diagnostic and therapeutic approach to childhood Lyme disease is frequently not codified, and guidelines specifically prepared for adults are used for children without having been validated. This review of the currently available data will evaluate what may be the best approach to the diagnosis and treatment of B. burgdorferi infection and disease in the pediatric population

Advantages and Limitations of Bacteriophages for the Treatment of Bacterial Infections

Bacteriophages (BPs) are viruses that can infect and kill bacteria without any negative effect on human or animal cells. For this reason, it is supposed that they can be used, alone or in combination with antibiotics, to treat bacterial infections. In this narrative review, the advantages and limitations of BPs for use in humans will be discussed. PubMed was used to search for all of the studies published from January 2008 to December 2018 using the key words: “BPs” or “phages” and “bacterial infection” or “antibiotic” or “infectious diseases.” More than 100 articles were found, but only those published in English or providing evidence-based data were included in the evaluation. Literature review showed that the rapid rise of multi-drug-resistant bacteria worldwide coupled with a decline in the development and production of novel antibacterial agents have led scientists to consider BPs for treatment of bacterial infection. Use of BPs to overcome the problem of increasing bacterial resistance to antibiotics is attractive, and some research data seem to indicate that it might be a rational measure. However, present knowledge seems insufficient to allow the use of BPs for this purpose. To date, the problem of how to prepare the formulations for clinical use and how to avoid or limit the risk of emergence of bacterial resistance through the transmission of genetic material are not completely solved problems. Further studies specifically devoted to solve these problems are needed before BPs can be used in humans

New Approaches and Technologies to Improve Accuracy of Acute Otitis Media Diagnosis

: Several studies have shown that in recent years incidence of acute otitis media (AOM) has declined worldwide. However, related medical, social, and economic problems for patients, their families, and society remain very high. Better knowledge of potential risk factors for AOM development and more effective preventive interventions, particularly in AOM-prone children, can further reduce disease incidence. However, a more accurate AOM diagnosis seems essential to achieve this goal. Diagnostic uncertainty is common, and to avoid risks related to a disease caused mainly by bacteria, several children without AOM are treated with antibiotics and followed as true AOM cases. The main objective of this manuscript is to discuss the most common difficulties that presently limit accurate AOM diagnosis and the new approaches and technologies that have been proposed to improve disease detection. We showed that misdiagnosis can be dangerous or lead to relevant therapeutic mistakes. The need to improve AOM diagnosis has allowed the identification of a long list of technologies to visualize and evaluate the tympanic membrane and to assess middle-ear effusion. Most of the new instruments, including light field otoscopy, optical coherence tomography, low-coherence interferometry, and Raman spectroscopy, are far from being introduced in clinical practice. Video-otoscopy can be effective, especially when it is used in association with telemedicine, parents' cooperation, and artificial intelligence. Introduction of otologic telemedicine and use of artificial intelligence among pediatricians and ENT specialists must be strongly promoted in order to reduce mistakes in AOM diagnosis

Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE)

Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use

Comparison of nasopharyngeal nylon flocked swabs with universal transport medium and rayon- bud swabs with a sponge reservoir of viral transport medium in the diagnosis of paediatric influenza

This study compared a kit containing a nasopharyngeal nylon flocked swab and a tube with a liquid universal transport medium (UTM) with a kit containing a plastic-shafted rayon-budded swab with a sponge reservoir of viral transport medium for the molecular detection of influenza viruses in children. Respiratory samples were collected from 314 children aged ,5 years with influenza-like illness (186 males; mean age 2.32±2.27 years) using both swabs in a randomized sequence for each patient. The flocked swabs permitted the detection of 28 influenza A (8.9 %) and 45 influenza B (14.3 %) cases, and the rayon-bud swabs 26 influenza A (8.3 %) and 43 influenza B (13.7 %) cases, with detection rates of 23.2 and 22.0 %, respectively, and similar cycle threshold values. Paediatricians and laboratory staff were significantly more satisfied with both the simplicity (P ,0.0001) and rapidity (P ,0.0001) of the nasopharyngeal flocked swabs with UTM. These findings show that the flocked swabs with UTM and the rayon-bud swabs with a sponge transport medium are similarly efficient in preserving influenza virus nucleic acid, but that the kit containing a flocked swab with a UTM allows easier and more rapid collection and processing of specimens. INTRODUCTION Respiratory infections are the most common diseases of infants and children Antigen detection tests and PCR-based methods are both currently used to detect viruses in respiratory secretions There are various kits containing a nasopharyngeal swab and a tube with transport medium on the market, but only a few studies, mainly of adults, have compared their efficiency in collecting respiratory cells and preserving influenza virus nucleic acid Sample collection. Two samples were collected from each patient and transported by means of two kits: one containing a flexible nasopharyngeal nylon flocked swab and a mini-tube with 1 ml liquid universal transport medium (UTM; Copan Italia), and the other a rayon-budded swab with a tube containing a sponge pre-impregnated with transport medium (Virocult; Medical Wire & Equipment). Using the swabs in a randomized sequence, two nasopharyngeal samples were collected from each child (one from each nostril) by trained paediatricians (L. C., L. G. and S. B.). The distance between the patient's nares and ear lobe was measured to estimate the length of insertion, after which the swabs were gently inserted towards the pharynx until resistance was felt and then rotated three times to obtain epithelial cells. They were then withdrawn and put into the tube containing the specific transport medium. All of the specimens were kept cool and delivered to the laboratory within 3 h of collection. Sample processing. In the laboratory, each swab was processed in triplicate by three researchers (C. G. M., C. D. and A. V.) as indicated by the manufacturers: 190 ml of the liquid transport medium for the flocked swabs was used directly, whereas the rayon-budded swabs were placed in a tube containing 1 ml liquid lysis buffer (the same amount as that contained in the mini-UTM), the tube was vortexed and incubated for 10 min at room temperature, and 190 ml of the solution was used for extraction. PCR. Viral RNA was extracted from all of the samples by means of a NucliSENS EasyMAG automated extraction system (bioMeriéux), using phocine distemper virus (PDV) as an extraction/PCR inhibition control as described previously (Bosis et al., 2005; Staff satisfaction. Trained paediatricians and members of the laboratory staff were asked to record their satisfaction with the simplicity and rapidity using the swabs after the enrolment of each patient or the completion of the analysis of each pair of swabs by completing a 5-point scale (from 5 'very satisfied' to 1 'very dissatisfied'). Statistical analysis. The data relating to the paired specimens collected from 314 children (186 males, 59.2 %), with a mean age of 2.32±2.27 years, were compared using SAS version 9.1 software (SAS Institute). Continuous variables were analysed using Wilcoxon's signed rank test or rank sum test as appropriate, and the categorical variables by means of contingency tables and a x 2 or Fisher's test. RESULTS AND DISCUSSION Satisfaction was based on a 5-point scale from 5 'very satisfied' to 1 'very dissatisfied'. .20 for influenza B virus. However, the paediatricians and laboratory staff were significantly more satisfied with both the simplicity (P ,0.0001) and the rapidity (P ,0.0001) of the nasopharyngeal flocked swabs with UTM. Our study showed that the flocked swabs with UTM and the rayon-budded swabs with transport medium preimpregnated sponge were similarly efficient in preserving influenza virus nucleic acid, but that the former were considered better in terms of the simplicity and rapidity of collection and laboratory testing. Systematic evaluation of the aetiology of paediatric respiratory infections is increasingly being considered an important means of preventing their spread and rationalizing therapy Our main finding was that the paediatricians preferred the flocked swabs because they were more flexible and made it easier and quicker to collect the samples. In addition, the laboratory staff found that the kit containing a flocked swab and liquid transport medium was advantageous insofar as it allowed RNA extraction and PCR to be performed directly on the liquid without the need to add further buffer, whereas the kit containing a transport medium pre-impregnated sponge required an additional step that made the procedure more complicated, timeconsuming and at risk of contamination. One limitation of this study is represented by the fact that the interpretation of the results on simplicity and rapidity of collection and laboratory testing may be devalued by repeated scoring and clustering by the same staff members. This means that further studies that involve several swab collectors and laboratory researchers are required to confirm our results. Moreover, our aim was to compare the efficiency of the two kits in detecting influenza virus nucleic acid, but further studies are required to evaluate the sensitivity of the two transport systems with serial dilutions of positive samples of influenza A and B viruses. Finally, a complete comparison of the sensitivity and specificity of the two kits should also include detection of other respiratory viruses that are commonly found in respiratory samples (e.g. respiratory syncytial virus, adenovirus, rhinovirus), and future research should address this aim. In conclusion, both the flocked swabs with UTM and the rayon-bud swabs with a sponge reservoir of viral transport medium allow adequate collection, transport and preservation of nasal secretions for influenza detection. However, the kit containing a flocked swab with a liquid transport medium facilitated rapid specimen collection and processing. These factors should be considered together with local costs when choosing a product to use in clinical practice. ACKNOWLEDGEMENT