scholarly journals Risk of Hospitalization, severe disease, and mortality due to COVID-19 and PIMS-TS in children with SARS-CoV-2 infection in Germany

2021 ◽  
Author(s):  
Anna-Lisa Sorg ◽  
Markus Hufnagel ◽  
Maren Doenhardt ◽  
Natalie Diffloth ◽  
Horst Schroten ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Absolute Risk ◽  
Severe Disease ◽  
Age Groups ◽  
Case Fatality ◽  
Admission Rate ◽  
High Rate ◽  
Disease Course ◽  
Notification System ◽  
Icu Admission

Background: Although children and adolescents have a lower burden of SARS-CoV-2-associated disease as compared to adults, assessing absolute risk among children remains difficult due to a high rate of undetected cases. However, without more accurate case numbers, reliable risk analyses are impossible. Methods: We combine data from three sources - a national seroprevalence study (the SARS-CoV-2 KIDS study), the German statutory notification system and a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or Pediatric Inflammatory Multisystem Syndrome (PIMS-TS) - in order to provide reliable estimates on childrens hospitalization, intensive care admission and death due to COVID-19 and PIMS-TS. Results: While the overall hospitalization rate associated with SARS-CoV-2 infection was 35.9 per 10,000 children, ICU admission rate was 1.7 per 10,000 and case fatality was 0.09 per 10,000. Children without comorbidities were found to be significantly less likely to suffer from a severe or fatal disease course. The lowest risk was observed in children aged 5-11 without comorbidities. In this group, the ICU admission rate was 0.2 per 10,000 and case fatality could not be calculated, due to an absence of cases. The overall PIMS-TS rate was 1 per 4,000 SARS-CoV-2 infections, the majority being children without comorbidities. Conclusion: Overall, the SARS-CoV-2-associated burden of a severe disease course or death in children and adolescents is low. This seems particularly the case for 5-11-year-old children without comorbidities. By contrast, PIMS-TS plays a major role in overall disease burden among all pediatric age groups.

Bipolar Type I Disorder in Children

2020 ◽  
Vol 1 (1) ◽  
pp. 11-14
Author(s):  
Syaiful Fadilah ◽  
Fatimah Haniman
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Severe Disease ◽  
Large Population ◽  
Type I ◽  
Disease Course ◽  
Clinical Area ◽  
Clinical Disorder ◽  
Bipolar Type ◽  
Dsm Iv

Bipolar disorder in children and adolescents is a clinical disorder that causes publicmental health problems that need attention. In the last decade, bipolar disorder in children andadolescents has become a trendy field, both in the clinical area and in research, especially interms of diagnosis, which is still controversial. The controversy that remains is whether it ispossible to diagnose bipolar disorder in prepubertal children. Based on the DSM-IV-TRdiagnostic criteria, the prevalence of the bipolar disorder in children scarce rare.Epidemiological studies report the lifetime prevalence of bipolar I and II disorders in lateadolescence is about 1 per cent. Various studies in a large population have shown aprevalence rate of 0.1% -2%. The onset of bipolar disorder in children and adolescents is oftenaccompanied by a more severe disease course, compared to bipolar disorder with onset inadulthood. This case report presents a case of bipolar 1 in children accompanied bycomprehensive management.

scholarly journals Risk-benefit analysis of the AstraZeneca COVID-19 vaccine in Australia using a Bayesian network modelling framework

2021 ◽  
Author(s):  
Colleen L Lau ◽  
Helen J Mayfield ◽  
Jane E Sinclair ◽  
Sam J Brown ◽  
Michael Waller ◽  
...  
Keyword(s):  
Bayesian Network ◽  
Sinus Thrombosis ◽  
Severe Disease ◽  
Age Groups ◽  
Case Fatality ◽  
Benefit Analysis ◽  
Network Modelling ◽  
High Transmission ◽  
Blood Clots ◽  
Risk Benefit Analysis

Thrombosis and Thromobocytopenia Syndrome (TTS) has been associated with the AstraZencea (AZ) COVID-19 vaccine. Australia has reported low TTS incidence of <3/100,000 after the first dose, with case fatality rate (CFR) of 5-6%. Risk-benefit analysis of vaccination has been challenging because of rapidly evolving data, changing levels of transmission, and age-specific variation in rates of TTS, COVID-19, and CFR. We aim to optimise risk-benefit analysis by developing a model that enables inputs to be updated rapidly as evidence evolves. A Bayesian network was used to integrate local and international data, government reports, published literature and expert opinion. The model estimates probabilities of outcomes under different scenarios of age, sex, low/medium/high transmission (0.05%/0.45%/5.76% of population infected over 6 months), SARS-CoV-2 variant, vaccine doses, and vaccine effectiveness. We used the model to compare estimated deaths from vaccine-associated TTS with i) COVID-19 deaths prevented under different scenarios, and ii) deaths from COVID-19 related atypical severe blood clots (cerebral venous sinus thrombosis & portal vein thrombosis). For a million people aged >70 years where 70% received first dose and 35% received two doses, our model estimated <1 death from TTS, 25 deaths prevented under low transmission, and >3000 deaths prevented under high transmission. Risks versus benefits varied significantly between age groups and transmission levels. Under high transmission, deaths prevented by AZ vaccine far exceed deaths from TTS (by 8 to >4500 times depending on age). Probability of dying from COVID-related atypical severe blood clots was 58-126 times higher (depending on age and sex) than dying from TTS. To our knowledge, this is the first example of the use of Bayesian networks for risk-benefit analysis for a COVID-19 vaccine. The model can be rapidly updated to incorporate new data, adapted for other countries, extended to other outcomes (e.g., severe disease), or used for other vaccines.

scholarly journals Metabolic syndrome and associated factors in Iranian children and adolescents: the CASPIAN-V study

2018 ◽  
Vol 10 (4) ◽  
pp. 214-220 ◽  
Author(s):  
Ramin Heshmat ◽  
Zeinab Hemati ◽  
Mostafa Qorbani ◽  
Laleh Nabizadeh Asl ◽  
Mohammad Esmaeil Motlagh ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Children And Adolescents ◽  
Rural Areas ◽  
Associated Factors ◽  
Age Groups ◽  
High Rate ◽  
P Value ◽  
Surveillance Program ◽  
Pediatric Age ◽  
Increased Risk

Introduction: Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups. Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests. Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63). Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.

scholarly journals Severe Acute Respiratory Infections With Influenza and Noninfluenza Respiratory Viruses: Yemen, 2011-2016

2019 ◽  
Vol 56 ◽  
pp. 004695801985073
Author(s):  
Mohammad Abdullah Al Amad ◽  
Ali Ali Al Mahaqri ◽  
Abdulwahed Abdulgabar Al Serouri ◽  
Yousef S. Khader
Keyword(s):  
Chronic Diseases ◽  
Respiratory Infections ◽  
Case Fatality ◽  
Admission Rate ◽  
Type A ◽  
Influenza Viruses ◽  
Acute Respiratory Infections ◽  
Fatality Rate ◽  
Icu Admission ◽  
Severe Acute Respiratory Infections

In 2010, Yemen started the surveillance for severe acute respiratory infections (SARIs) by establishing 2 sentinel sites in Sana’a and Aden city. This study aims to determine the proportions of influenza and noninfluenza viruses among SARI patients and to determine the severity of SARI and its associated factors. The data of SARI patients who were admitted to SARI surveillance sites at Al Johory hospital in Sana’a and Al Wahdah hospital in Aden city during the period 2011-2016 were analyzed. The proportions of positive influenza viruses (type A, B) and noninfluenza viruses (respiratory syncytial, adenovirus, human parainfluenza, and human metapneumovirus), intensive care unit (ICU) admission rate, and fatality rate among SARI patients were calculated. A total of 1811 of SARI patients were admitted during 2011-2016. Of those, 78% were <15 years old. A total of 89 (5%) patients had influenza viruses and 655 (36%) had noninfluenza viruses. The overall ICU admission rate was 40% and the case-fatality rate was 8%. Infection by influenza type (A, B) and mixed (adenovirus, human parainfluenza) was significantly associated with lower ICU admission. Age <15 years old, infection with influenza B, pre-existence of chronic diseases, and admission to Aden site were significantly associated with higher fatality rate among patients. In conclusion; SARI patients in Yemen had a high ICU admission and case-fatality rates. Influenza type B, chronic diseases, and admission to Aden site are associated with higher fatality rate. Expanding surveillance sites and panel of laboratory tests to involve other pathogens will help to provide accurate diagnosis for SARI etiology and give more comprehensive picture. Training staff for SARI case management will help to reduce severe outcomes.

scholarly journals How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

2021 ◽  
Vol 8 ◽  
Author(s):  
Masoumeh Azimirad ◽  
Maryam Noori ◽  
Hamideh Raeisi ◽  
Abbas Yadegar ◽  
Shabnam Shahrokh ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Elderly Patients ◽  
Bacterial Infections ◽  
Severe Disease ◽  
Age Groups ◽  
Gastrointestinal Symptoms ◽  
Healthcare Setting ◽  
High Rate ◽  
Opportunistic Pathogens ◽  
Clostridioides Difficile

Coronavirus disease 2019 (COVID-19) has rapidly spread all over the world with a very high rate of mortality. Different symptoms developed by COVID-19 infection and its impacts on various organs of the human body have highlighted the importance of both coinfections and superinfections with other pathogens. The gastrointestinal (GI) tract is vulnerable to infection with COVID-19 and can be exploited as an alternative transmission route and target for virus entry and pathogenesis. The GI manifestations of COVID-19 disease are associated with severe disease outcomes and death in all age groups, in particular, elderly patients. Empiric antibiotic treatments for microbial infections in hospitalized patients with COVID-19 in addition to experimental antiviral and immunomodulatory drugs may increase the risk of antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI). Alterations of gut microbiota are associated with depletion of beneficial commensals and enrichment of opportunistic pathogens such as C. difficile. Hence, the main purpose of this review is to explain the likely risk factors contributing to higher incidence of CDI in patients with COVID-19. In addition to lung involvement, common symptoms observed in COVID-19 and CDI such as diarrhea, highlight the significance of bacterial infections in COVID-19 patients. In particular, hospitalized elderly patients who are receiving antibiotics might be more prone to CDI. Indeed, widespread use of broad-spectrum antibiotics such as clindamycin, cephalosporins, penicillin, and fluoroquinolones can affect the composition and function of the gut microbiota of patients with COVID-19, leading to reduced colonization resistance capacity against opportunistic pathogens such as C. difficile, and subsequently develop CDI. Moreover, patients with CDI possibly may have facilitated the persistence of SARS-CoV-2 viral particles in their feces for approximately one month, even though the nasopharyngeal test turned negative. This coinfection may increase the potential transmissibility of both SARS-CoV-2 and C. difficile by fecal materials. Also, CDI can complicate the outcome of COVID-19 patients, especially in the presence of comorbidities or for those patients with prior exposure to the healthcare setting. Finally, physicians should remain vigilant for possible SARS-CoV-2 and CDI coinfection during the ongoing COVID-19 pandemic and the excessive use of antimicrobials and biocides.

Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children

2010 ◽  
Vol 17 (4) ◽  
pp. 441-448 ◽  
Author(s):  
IA Ketelslegers ◽  
IER Visser ◽  
RF Neuteboom ◽  
M Boon ◽  
CE Catsman-Berrevoets ◽  
...  
Keyword(s):  
Age Groups ◽  
White Matter Lesions ◽  
Acute Disseminated Encephalomyelitis ◽  
Clinical Event ◽  
Disease Course ◽  
Large White ◽  
Icu Admission ◽  
Presenting Symptoms ◽  
Duration Of Hospitalization ◽  
Periventricular Lesions

Background: Acute disseminated encephalomyelitis (ADEM) affects children more frequently than adults. Current studies investigating ADEM in different age groups are difficult to compare. Objective: To investigate whether the clinical presentation, outcome and disease course of ADEM differ between adults and children. Methods: Disease characteristics of 25 adults and 92 children suffering from ADEM between 1988 and 2008 were compared. Results: The most common presenting symptoms of ADEM in both groups were pyramidal signs and encephalopathy. Ataxia occurred more frequently in children ( p = 0.002). In general, MRI showed ill-defined and large white matter lesions in both groups, whereas periventricular lesions were more prevalent in adults ( p = 0.001). In adults, duration of hospitalization was longer ( p = 0.002) and intensive care unit (ICU) admission was more frequently required ( p = 0.043). Three adults (12%) and one child (1%) died ( p = 0.030). Fewer adults had complete motor recovery after their first clinical event ( p < 0.001). In 73 patients follow-up time was ≥ 2 years and most of these patients remained monophasic. Although relapses after ADEM can occur, only one adult (5%) and five children (6%) converted to MS. Conclusions: The clinical presentations in children and adults share similarities, but the disease course and outcome of ADEM is more severe in adults with respect to hospitalization, ICU admission, recovery and mortality.

scholarly journals 2631. Influenza-Associated Intensive Care Unit Hospitalizations and Deaths in Children, During 2010–2019 in Greece

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S918-S918
Author(s):  
Ioanna Magaziotou ◽  
Sotirios Tsiodras ◽  
Anastasia Andreopoulou ◽  
Elisavet Mouratidou ◽  
Alexandra Vernardaki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Influenza A ◽  
Severe Disease ◽  
Case Fatality ◽  
Influenza B ◽  
Notification System ◽  
Co Morbidity ◽  
Common Diagnosis ◽  
Epidemiological Characteristics

Abstract Background The clinico-epidemiological characteristics of children with severe influenza-related intensive care unit (ICU) admissions in Greece during 2010–2019 are described. Methods All laboratory-confirmed influenza cases (real-time PCR), in children 0–16 years old, admitted to Pediatric ICUs throughout the country, are reported using a mandatory notification system to the National Public Health Organization of Greece. Case fatality rates (CFR) were analyzed according to age and presence of comorbidities. Results From October 2010 to April 2019, 131 influenza cases [7.2/100,000 children, 65 (49.6%) girls] with PICUs admissions were recorded. The majority of cases (n = 78; 60%) occurred in the age group 0–4 years-old [31 (24%) children were < 12 months-old]. Sixty-five (49.6%) children had underlying comorbidities (22 neurological disease, 12 congenital syndromes, 7 cancer, 5 chronic respiratory, 19 other). The most common diagnosis was febrile ARDS and 67 (51.14%) had severe pneumonia (40% viral, 7% bacterial). Seventy-five (57.2%) children required invasive ventilation. Influenza A accounted for 102 (77.86%) of cases; out of 86 (84.31%) subtyped, 68 (79%) were AH1N1pdm09, and 18 (21%) were AH3N2. Influenza B accounted for 29 (22.13%) of cases. All children received oseltamivir. Median length of stay was 10 days (range 1–90). A total of 32 deaths was recorded (CFR 24.4%, total rate: 1.76/100,000 children); 13 (40.1%) deaths occurred in children with no known co-morbidity. Mortality rates were higher in children aged > 4 years (18/53, 33.9% vs. 14/78, 17.9%, P = 0.04) while there was a trend for children with comorbidities (19/65, 29.2% vs. 13/66, 19.69%, P = 0.1). Only 4% of children were previously immunized against influenza. Conclusion AH1N1pdm09 accounted for the vast majority of severe cases and influenza associated deaths in children in Greece over the last 10 years. Severe disease occurred also in children with no comorbitidies. Longitudinal clinico-epidemiological data should be considered in shaping the national immunization program. Disclosures All authors: No reported disclosures.

scholarly journals Lessons From COVID-19 in Children: Key Hypotheses to Guide Preventative and Therapeutic Strategies

2020 ◽  
Vol 71 (8) ◽  
pp. 2006-2013 ◽  
Author(s):  
Tulika Singh ◽  
Sarah M Heston ◽  
Stephanie N Langel ◽  
Maria Blasi ◽  
Jillian H Hurst ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Current Knowledge ◽  
Severe Disease ◽  
Age Groups ◽  
Case Fatality ◽  
Opportunity To Learn ◽  
Therapeutic Strategies ◽  
Future Research ◽  
Epidemiologic Evidence ◽  
Lower Case

Abstract The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), reveals a peculiar trend of milder disease and lower case fatality in children compared with adults. Consistent epidemiologic evidence of reduced severity of infection in children across different populations and countries suggests there are underlying biological differences between children and adults that mediate differential disease pathogenesis. This presents a unique opportunity to learn about disease-modifying host factors from pediatric populations. Our review summarizes the current knowledge of pediatric clinical disease, role in transmission, risks for severe disease, protective immunity, as well as novel therapies and vaccine trials for children. We then define key hypotheses and areas for future research that can use the pediatric model of disease, transmission, and immunity to develop preventive and therapeutic strategies for people of all age groups.

scholarly journals Epidemiology and Trends of Pertussis among Infants: United States, 2000–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S5-S5 ◽  
Author(s):  
Catherine Bozio ◽  
Tami Skoff ◽  
Tracy Pondo ◽  
Jennifer Liang
Keyword(s):  
Negative Binomial ◽  
Severe Disease ◽  
Age Distribution ◽  
Age Groups ◽  
Case Fatality ◽  
Annual Average ◽  
Young Infants ◽  
Hospitalization Rates ◽  
The Impact ◽  
Over Time

Abstract Background Pertussis, a cyclic respiratory disease, causes the greatest morbidity and mortality among infants, particularly those too young to be vaccinated. Following a resurgence of pertussis in the 1990s, a recommendation was made in 2012 to vaccinate during every pregnancy in order to prevent infant disease. We describe pertussis trends from 2000–2015 among U.S. infants aged &lt;1 year. Methods We analyzed infant pertussis cases reported through the National Notifiable Diseases Surveillance System from 2000 to 2015. Incidence rates (cases per 100,000 population) among various age groups (&lt;2, 2– &lt;4, 4– &lt;6, and 6–&lt;12 months) were calculated using National Center for Health Statistics population estimates as denominators. Negative binomial regression was used to estimate the annual average percent change with a linear trend; P &lt; 0.05 was significant. Results From 2000 to 2015, 48,909 infant pertussis cases and 255 deaths were reported; infants aged &lt;2 months accounted for 38.7% of cases. The age distribution of infant cases was stable from 2000 to 2009 but changed from 2010 to 2015 (Fig. 1), as the proportion of cases aged 4–&lt;12 months increased annually on average by 4.7% (P &lt; 0.001). Annual incidence was highest among &lt;2 month olds; however, rates increased among older infants (Fig. 2): 7% average annual increase among infants aged 4–&lt;6 months and 11% among infants aged 6–&lt;12 months (P &lt; 0.001 for each). The proportion of infants hospitalized decreased over time in each age group (P &lt; 0.001 for all) with the largest annual average declines among 4–&lt;6 (−5.1%) and 6–&lt;12 month (−5.9%) olds. For all age groups, hospitalization rates were relatively stable, but non-hospitalization rates increased (P &lt; 0.05 for all). The case–fatality ratio (CFR) was highest among &lt;2 month olds (1.6%); CFRs decreased over time among &lt;2 and 2–&lt; 4 month olds (P &lt; 0.05 for each). Conclusion Pertussis incidence remains highest among infants aged &lt;4 months, although the age distribution appears to be changing. Decreasing proportions of infants hospitalized may suggest a true decline in disease severity or an increase in reporting of less severe disease. Ongoing monitoring of infant pertussis is needed to better understand the impact of vaccinating pregnant women to prevent pertussis in young infants. Disclosures All authors: No reported disclosures.

scholarly journals Serotype Replacement After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine in Ontario, Canada, 2007-2018

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Allison H Yeung ◽  
Shinthuja Wijayasri ◽  
Sarah E Wilson ◽  
Tara M Harris ◽  
Sarah A Buchan ◽  
...  
Keyword(s):  
Public Health ◽  
Severe Disease ◽  
Age Groups ◽  
Pneumococcal Vaccination ◽  
Case Fatality ◽  
Vaccination Programs ◽  
Hospitalization Rates ◽  
Age Related ◽  
Serotype Replacement ◽  
Vaccine Type

Introduction: Invasive pneumococcal disease (IPD) is a disease of public health significance in Ontario, Canada, where publicly funded pneumococcal vaccination programs target children, older adults, and people at high risk of disease. Since the implementation of pneumococcal conjugate vaccines (PCV), serotype replacement has been documented, where non-PCV serotypes replace the niche created by the reduction in vaccine-preventable serotypes. Our objective was to determine whether there has been serotype replacement or a change in IPD severity in Ontario since implementation of the childhood 13-valent (PCV13) program by assessing IPD burden over a 12-year period (2007-2018). Methods: We included all confirmed IPD cases reported in Ontario’s integrated Public Health Information System (iPHIS) and defined the pre-PCV13 era (January 2007-December 2010) and post-PCV13 era (January 2011-December 2018). We grouped IPD serotypes according to associated vaccine type: PCV13; 23-valent polysaccharide vaccine (unique PPV23); and non-vaccine-preventable (NVP). We used population data to calculate incidence and hospitalization rates (per 100,000 population) by age group, vaccine type, and era. Results: In the post-PCV13 era, PCV13-specific incidence and hospitalization rates decreased, while the incidence and hospitalizations due to unique PPV23 and NVP serotypes increased; this was consistent across all age groups. The greatest decrease in incidence (RR=0.4) and hospitalizations (RR=0.4) was observed in children <5 years with PCV13 serotypes. There were no distinct age-related trends observed for case fatality ratios; the highest CFR was observed in adults ≥65 years. Conclusion: A shift in serotype distribution was seen across all age groups; IPD incidence and hospitalization rates due to PCV13 serotypes decreased after PCV13 implementation, but this reduction was offset by the increasing burden and severity of unique PPV23 and NVP serotypes. As IPD continues to be a severe disease, continued surveillance is required to better understand the growing burden of these serotypes and emergence of non-vaccine-preventable serotypes.

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