scholarly journals 2621. Influence of HIV Exposure Status on Carriage Rates and Density of Streptococcus Pneumoniae and Pneumocystis Jirovecii in Zambian Children

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S912-S913
Author(s):  
ingrid Y Camelo ◽  
Christopher Gill ◽  
Donald M Thea ◽  
John Weinstein
Keyword(s):  
Streptococcus Pneumoniae ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Severe Pneumonia ◽  
Infected Group ◽  
Pneumocystis Jirovecii ◽  
World Health ◽  
Mortality And Morbidity ◽  
Hiv Exposure ◽  
Hiv Exposed

Abstract Background Low rates of mother to child HIV transmission in Zambia, translates into a high number of children who are HIV exposed but uninfected (HEU) who have increased mortality and morbidity when compared with children HIV unexposed and uninfected (HUU). We performed a secondary analysis on The Pneumonia Etiology Research in Child Health (PERCH), a case–control study focused on identifying the etiologies of pediatric pneumonia including two pathogens, Streptococcus pneumoniae and Pneumocystis jirovecii in Zambian children to evaluate if HIV exposure status influences carriage rates and density for these pathogens. Methods Children ages 1–59 months were enrolled as cases if they met the World Health Organization (WHO) definition of severe or very severe pneumonia. Controls did not have a diagnosis of pneumonia and were matched by age and HIV status to cases. Each case and control had a nasopharyngeal (NP) swab and an oropharyngeal (OP) swab specimen. A multiplex real-time polymerase chain reaction (PCR) assay was used to test the NP/OP specimens for S. pneumoniae and P. jirovecii. A density of log10 copies/mL in microbiology confirmed cases compared with controls was used to define positive infection with S. pneumoniae and P. jirovecii. Results The highest S. pneumoniae carrier rates were seen in HIV unexposed controls and the lowest carrier rates seen in HIV-infected controls. HIV-infected children who were S. pneumoniae carriers and were classified as controls had the highest S. pneumoniae density of all groups. Overall, the HIV-infected group had the highest S. pneumoniae density rates. There was minimal variation in the S. pneumoniae density of those in the HIV exposed and HIV unexposed. P. jirovecii was present only in 31% of HIV-infected cases and 7% of the same group controls. HIV exposed cases had half the carrier rates of their counterparts in the HIV-infected group, but the P. jirovecii carriage rates were the same as the carriage rates in HIV-infected controls. The P. jirovecii carriage density in HIV-infected and HIV-exposed cases was similar. Conclusion HIV exposure status in children can be a predictor factor in S. pneumoniae and P. jirovecii carriage and density. The results of our analysis could potentially explain the high rates of pneumonia in children exposed to HIV but uninfected. Our findings open the door to more in-depth studies about the immunological status in children exposed to HIV but uninfected. Disclosures All authors: No reported disclosures.

#33: A Tale of Two Pneumos: the Impact of HIV Exposure or Infection Status on Pediatric Carriage of Streptococcus pneumoniae and Pneumocystis jirovecii, a Nested Case–control Analysis from the Pneumonia Etiology Research in Child Health (PERCH) study in Zambia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S18-S18
Author(s):  
I Camelo ◽  
L M Mwananyanda ◽  
D M Thea ◽  
P Seidenberg ◽  
C J Gill ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Regression Models ◽  
Pediatric Hiv ◽  
Pneumocystis Jirovecii ◽  
Control Analysis ◽  
Linear Regression Models ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
And Control ◽  
The Impact

Abstract Background Most pediatric HIV cases in Africa reflect maternal to child transmission (MTCT). The persistently high seroprevalence of HIV in pregnant women (16.6%) and the low rates of mother to child HIV transmission (~2%) have resulted in a high number of children who are HIV exposed but uninfected (HEU). HIV exposed but uninfected (HEU) children have increased rates of morbidity and mortality vs. HIV unexposed and uninfected (HUU). Methods To explore the mechanisms behind this phenomenon, each case and control was sampled using a nasopharyngeal NP swab and an oropharyngeal (OP). A multiplex real-time polymerase chain reaction (PCR) assay was used to determine the presence of Streptococcus pneumoniae and Pneumocystis jirovecii in the NP/OP specimens. We compared nasopharyngeal carriage rates of S. pneumoniae and P. jirovecii between HIV-infected, HEU, or HUU case (pneumonia) and control (without pneumonia) children. In bivariate analyses, using carriage as a dichotomous outcome, proportions we compared using chi-square or odds ratios with 95% confidence intervals. In multivariate models, we created logistic and linear regression models adjusting for nutritional status as possible mediators of carriage status. Results SP carriage rates were similar between cases and controls. However, density was increased among HIV-infected children vs. HEU or HUU children (15.8 vs. 4.7 vs. 3.6 × 105 copies/mL, respectively). Among cases, PJ carriage among HIV positive, HEU and HUU children was 31%, 15% and 10%,, respectively, (P < 0.05) and carriage density was 63.9, 20.9, and 4.8 × 103 copies/mL, respectively (P < 0.05). In adjusted logistic regression models, HIV-infected cases were slightly more likely to be an S. pneumoniae carrier compared with HUU cases (aOR = 1.1; 95% CI: 0.57–2.14). In contrast, all other case/exposure combinations were less likely to be S. pneumoniae carriers with the lowest adjusted odds among HIV-infected controls children (aOR = 0.34; 95% CI: 0.17–0.71). The odds of being a PJ carrier was almost 6 times higher in HIV-infected cases than in HIV unexposed cases (aOR = 6.63; 95% CI: 3.24–13.54). Conclusions We demonstrate that HIV infection and HIV exposure without infection each have an impact on carriage rates and density for S. pneumoniae and P. jirovecii, though the magnitude and nature of these effects differs substantially between the two pathogens. This may be explained in part by differences in immune responses to these two different pathogens. Our analysis provides further evidence of fundamental differences in immune function among HIV exposed but uninfected infants compared with HIV unexposed, uninfected infants.

scholarly journals An audit of mother to child HIV transmission rates and neonatal outcomes at a tertiary hospital in South Africa

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Ghad Benali ◽  
Tanusha Ramdin ◽  
Daynia Ballot
Keyword(s):  
South Africa ◽  
Birth Weight ◽  
Hiv Transmission ◽  
Tertiary Hospital ◽  
Academic Hospital ◽  
Child Transmission ◽  
Transmission Rates ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Mother To Child

Abstract Objective The aim of this study was to explore the prevalence of congenital HIV infection of neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 2015 and 2017, as well as compare the HIV PCR positive and HIV PCR negative neonates. Results A total number of 1443 HIV exposed neonates was examined for the study period out of a total of 5029 admissions (HIV exposure 28.6%) The study found that the rate of HIV transmission at birth was 2.52%. The majority of infants had low birth weight and were also born prematurely. These results show that, despite the introduction of the extended mother to child transmission programme, HIV transmission is high.

scholarly journals Similar HIV protection from four weeks of zidovudine versus nevirapine prophylaxis among formula-fed infants in Botswana

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Kathleen M. Powis ◽  
Shahin Lockman ◽  
Gbolahan Ajibola ◽  
Michael D. Hughes ◽  
Kara Bennett ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Full Term ◽  
World Health ◽  
Comparative Efficacy ◽  
Term Infants ◽  
Once Daily ◽  
Grade 3 ◽  
Using Data ◽  
Hiv Exposed ◽  
Health Organization

Background: The World Health Organization HIV guidelines recommend either infant zidovudine (ZDV) or nevirapine (NVP) prophylaxis for the prevention of intrapartum motherto-child HIV transmission (MTCT) among formula-fed infants. No study has evaluated the comparative efficacy of infant prophylaxis with twice daily ZDV versus once daily NVP in exclusively formula-fed HIV-exposed infants.  Methods: Using data from the Mpepu Study, a Botswana-based clinical trial investigating whether prophylactic co-trimoxazole could improve infant survival, retrospective analyses of MTCT events and Division of AIDS (DAIDS) Grade 3 or Grade 4 occurrences of anaemia or neutropenia were performed among infants born full-term (≥ 37 weeks gestation), with a birth weight ≥ 2500 g and who were formula-fed from birth. ZDV infant prophylaxis was used from Mpepu Study inception. A protocol modification mid-way through the study led to the subsequent use of NVP infant prophylaxis. Results: Among infants qualifying for this secondary retrospective analysis, a total of 695 (52%) infants received ZDV, while 646 (48%) received NVP from birth for at least 25 days but no more than 35 days. Confirmed intrapartum HIV infection occurred in two (0.29%) ZDV recipients and three (0.46%) NVP recipients (p = 0.68). Anaemia occurred in 19 (2.7%) ZDV versus 12 (1.9%) NVP (p = 0.36) recipients. Neutropenia occurred in 28 (4.0%) ZDV versus 21 (3.3%) NVP recipients (p = 0.47). Conclusions: Both ZDV and NVP resulted in low intrapartum transmission rates and no significant differences in severe infant haematologic toxicity (DAIDS Grade 3 or Grade 4) among formula-fed full-term infants with a birthweight ≥ 2500 g.

scholarly journals The utility of a modified W.H.O. TB screening tool among children at a Botswana child welfare clinic

2021 ◽  
Vol 21 (1) ◽  
pp. 64-71
Author(s):  
Wame Dikobe ◽  
Mooketsi Molefi ◽  
Bornapate Nkomo ◽  
Botshelo Kgwaadira ◽  
Boingotlo Gasenelwe ◽  
...  
Keyword(s):  
Screening Tool ◽  
World Health ◽  
Resource Limited ◽  
Increased Risk ◽  
Child Welfare Clinic ◽  
Childhood Tb ◽  
History Of ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Health Organization

Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening; HIV Exposure screening; TB/HIV integration.

scholarly journals Chest radiography in children aged 2–59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Tisungane Mvalo ◽  
Eric D. McCollum ◽  
Elizabeth Fitzgerald ◽  
Portia Kamthunzi ◽  
Robert H. Schmicker ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Chest Radiography ◽  
Secondary Analysis ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
World Health ◽  
Middle Income ◽  
Radiographic Findings ◽  
Link Type ◽  
Significant Pathology

Abstract Background Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes. Methods When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes. Results Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was “other infiltrates only” in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was “primary endpoint pneumonia”(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58). Conclusions In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with “primary endpoint pneumonia” was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs. Trial registration ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov (NCT02760420, NCT02678195, and NCT02960919, respectively).

scholarly journals 2529. Child HIV Exposure and CMV Seroprevalence in Botswana: No Associations with 24-Month Growth and Neurodevelopment

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S879-S879
Author(s):  
Natasha Onalenna Moraka ◽  
Sikhulile Moyo ◽  
Maryanne Ibrahim ◽  
Gloria Mayondi ◽  
Jean Leidner ◽  
...  
Keyword(s):  
Child Growth ◽  
World Health ◽  
Neurodevelopmental Outcomes ◽  
Women Living With Hiv ◽  
Increased Risk ◽  
Z Scores ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Living With Hiv ◽  
Cmv Status

Abstract Background HIV-exposed but uninfected (HEU) children are at increased risk for poorer growth outcomes compared with HIV-unexposed/uninfected (HUU) children. Mechanisms underlying the poorer growth and delays in development of HEU children compared HUU children are not fully understood. We sought to define the relationship between child CMV status and HIV− exposure status and determine if a correlation existed between CMV status and growth (and neurodevelopmental) outcomes by 24 months of age in Botswana. Methods We used existing data and samples from the observational Botswana Tshipidi study, pregnant women living with HIV (WLHIV) and those without HIV, as well as their infants were enrolled and followed prospectively through 2 years postpartum. We tested 18-month child plasma samples from all available children for anti-HCMV IgG. We evaluated the association between positive (vs. negative) child CMV status at 18 months, and child growth, using the World Health Organization’s Growth Standard adjusted for age and sex and neurodevelopment at 24 months of age, using the Bayley Scales of Child Development (BSID) III. Results Of 317 children tested for CMV IgG at 18 months, 215 (67.8%) tested positive. Significantly higher proportions of HUU children had positive CMV serology (82.6%) compared with HEU children (47.4%, P < 0.01); 96.7% of HUU vs. 10.5% of HEU children breastfed. Child CMV infection was not associated with head circumference, weight-for-age, weight-for-height, nor height-for-age z-scores at 24 months. BSID III scores in receptive and expressive language, fine and gross motor, and cognitive domains at 24 months of age also did not differ by child CMV status. Conclusion We observed high rates of CMV seropositivity in 18-month-old children in Botswana with significantly higher CMV seropositivity among HUU children likely owing to breastfeeding. Positive CMV serostatus was not associated with child growth or neurodevelopmental outcomes at 24 months. Disclosures All authors: No reported disclosures.

scholarly journals The utility of a modified W.H.O. TB screening tool among children at a Botswana child welfare clinic

2021 ◽  
Vol 21 ◽  
pp. 64-71
Author(s):  
Wame Dikobe ◽  
Mooketsi Molefi ◽  
Bornapate Nkomo ◽  
Botshelo Kgwaadira ◽  
Boingotlo Gasenelwe ◽  
...  
Keyword(s):  
Screening Tool ◽  
World Health ◽  
Resource Limited ◽  
Increased Risk ◽  
Child Welfare Clinic ◽  
Childhood Tb ◽  
History Of ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Health Organization

Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening; HIV Exposure screening; TB/HIV integration.

DIAGNOSTICS OF THE CURRENT STATE OF HEALTHCARE IN RUSSIA

2020 ◽  
Vol 15 (5) ◽  
pp. 35-55
Author(s):  
N.P. STARYKH ◽  
◽  
A.V. EGOROVA ◽  
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Statistical Data ◽  
Secondary Analysis ◽  
World Health ◽  
Healthy Life Expectancy ◽  
Federal State ◽  
Sociological Research ◽  
Healthy Life ◽  
Current State

The purpose of the article is to analyze the current state of healthcare in Russia. Scientific novelty of the study: the authors suggest that the efficiency of the health care system depends on the state of such indicators of public health as life expectancy and healthy life expectancy. Life expectancy is an integrated demographic indicator that characterizes the number of years that a person would live on average, provided that the age-specific mortality rate of a generation would be at the level for which the indicator was calculated throughout life. The indicator ‘healthy life expectancy’ is formed by subtracting the number of years of unhealthy life (due to chronic diseases, disabilities, mental and behavioral disorders, etc.) from the life expectancy indicator. Results: the article presents an analysis of the current state of Russian healthcare based on statistical data provided by the Federal State Statistics Service, the World Health Organization, and world rankings. Attention is focused on the perceptions of Russians about the quality of medical services and Russian healthcare. Conclusions about the current state of health care in Russia are formulated by the authors, based on a secondary analysis of statistical data, as well as data from sociological research presented by leading Russian sociological centers.

scholarly journals Newborns at risk of Covid-19 ― lessons from the last year

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Malika D. Shah ◽  
Ola Didrik Saugstad
Keyword(s):  
Horizontal Transmission ◽  
Mode Of Delivery ◽  
Newborn Infants ◽  
World Health ◽  
Premature Delivery ◽  
Mortality And Morbidity ◽  
Skin Contact ◽  
Cord Clamping ◽  
Increased Risk ◽  
Health Organization

Abstract After more than 1 year of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)’s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother’s SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.

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