Hepatitis B Transmission: Is Vertical Transmission the Major Route in Intermediate Endemic Areas? A Proof-of-Concept Study Based on Mother–Child Genotypes

The route of hepatitis B transmission is believed to be horizontal in India, though pediatric studies showed mother as source in the majority of chronic HBV (CHB) cases. We aimed at establishing the fact that mother–child transmission is the main route of acquisition by documenting genotypically identical viruses in mother–child pairs. Blood samples of consecutive children (≤18 years) with CHB and high DNA (>10,000 IU/mL) and their positive mother were collected from January 2013 to December 2015. Polymerase chain reaction (PCR) products of HBV-DNA were amplified and sequenced by using BigDye Terminator Cycle Sequencing Kit v3.1 and aligned with previously described sequences in the region of interest for genotypes A to G by using BioEdit software. Phylogenetic tree was generated using p-distance algorithm in MEGA software version 6. Genotyping of 59 (33 children and 26 mothers) subjects include genotype A in 24 (40.7%) and genotype D in 35 (59.3%). Both mother–child pair genotyping was possible in 25. The median age of 25 children (20 males) was 9 (interquartile range, IQR: 4–11). The distribution of genotypes among mother–child pairs was similar. The concordance between children and their mothers was 24 of 25 (96%). Evolutionary analyses showed significant similarities between mother and child sequences for both genotype A and D, suggesting thereby the same virus. In conclusion, mother–baby transmission seems to be the major route of acquisition of HBV in children in India and near-complete homology in genetic sequences between mother–child pairs is definite proof for that. However, a larger epidemiological study is required to substantiate our findings.

Public Views of Dairy Calf Welfare and Dairy Consumption Habits of American Youth and Adults

The primary objective of this study was to explore views of dairy calf welfare and dairy product consumption habits among youth and adults. The secondary objective was to explore views of dairy calf welfare and dairy product consumption habits among a subset of parent-child pairs. Participants 5–17 years of age (n = 463) and 18 years old or greater (n = 1,310) completed an in-person survey at the Minnesota State Fair (St. Paul, MN, USA) in summer 2018. A subset of these data was comprised of parent-child pairs (n = 188). The survey was administered via Qualtrics using iPads and included multiple-choice questions about demographics and calf welfare, an open-ended question on “what dairy calves need to have a good life,” and multiple-choice questions about participants' consumption of dairy products and nondairy alternative products. Content analysis was used for responses to the open-ended question, and concepts to describe dairy calf welfare views were identified. Fisher's exact test and Cohen's Kappa were used to investigate the relationships between parent-child pair responses about dairy calf welfare. In addition to these methods, prevalence-adjusted and bias-adjusted kappa (PABAK) were used to investigate the relationships between parent-child pair responses about consumption habits. The median age of all youth participants was 11 years and 61% were female, 82% were urban residents, and 63% did not have prior experience handling agricultural animals but 83% had visited a farm in the past. Most youth participants (94.4%) indicated that they consumed dairy products, while 47.1% consumed nondairy alternatives products. Median age range of all adult participants was 45–54 years, 65% were female, 82% urban residents, and 81% did not have prior experience handling agricultural animals but 63% had visited a farm in the past. Most adult participants (94%) indicated that they consumed dairy products and 47% indicated that they consumed nondairy alternative products. In response to “what dairy calves need to have a good life,” youth and adults most commonly focused on issues related to biological functioning (82 and 70% of youth and adults mentioning this concept, respectively), followed by natural living (44 and 50%, respectively), humane care (30 and 20%, respectively), and affective states (5% of both youth and adults). For the natural living concept of animal welfare, parent and child responses were slightly associated (Kappa = 0.19; P = 0.01; overall agreement = 61%). Almost all participants reported consuming dairy products, therefore, the agreement is high between parents and children because in most households (90%), both parents and children consume dairy products. However, child consumption was observed to be lower (75%, 9/12) when parents do not consume dairy than when parents do consume dairy (95%, 167/176), leading to a Kappa of 0.20 (P = 0.006, PABAK = 0.81) and a slight association between parents and children. The results suggest that biological functioning is highly valued by the public and views of parents and their children related to natural living in dairy calves are slightly associated.

Maternal pesticide exposure and child neuro-development among smallholder tomato farmers in the southern corridor of Tanzania

Background Exposure to pesticides with its associated effects prenatally and in early childhood has not received much attention. There is little scientific data on this aspect in Tanzania therefore this study was meant to contribute to the deficit in the subject. Method A cross-sectional study was conducted to a sample of 286 participants of mother to child pair, whereby 172 and 114 were exposed and non-exposed respectively. Mothers who had been working in tomato sprayed farms were exposed and mothers who had not been working in the tomato sprayed farms were un-exposed. Child aged 0–6 years was chosen from each mother sampled but only one child found to be the youngest with the classified age was enrolled. Malawi child development Tool (M-DAT) was employed to assess the child level of development, height, and weight of the children were collected and analyzed by the WHO anthropometric calculator. A checklist and questionnaire were used to observe and assess maternal exposure. Bivariate and Multivariate analysis were conducted to assess the relationship between various factors of exposure. Results Overall 15% of the children examined were not well developed and the most used pesticides were those posing neuro-development effects. On the bivariate analysis model, mothers who worked while pregnant were more likely to have a child with neuro-developmental effect OR=5.8(1.29–26.3). On multivariate analyses adjusted for age of the mother, variables which remain in the model were a distance from home [AOR=9.4(4.2–20.5)], and working while pregnancy [AOR=5.8(1.29–26.3)] other were removed due to collinearity effect. None of confounders had a potential significant effect but only nutrition seems to be the effect modifier [AOR=7.8(1.29–36.3)] when analyzed with working while pregnancy. Conclusions The findings from this study have indicated that maternal pesticide exposure among farmworker residents in the SAGCOT area has a potential association with child developmental effect.

A scoping review of mother–child separation in clinical paediatric settings

There is increasing evidence to suggest that autonomic regulation of hospitalised infants is affected by separation from their mother. This review explored the extent of the evidence relating to the impact of separation on infants and children and aimed to identify suitable measures of the impact of mother–child separation. We conducted a scoping review of seven databases using the main search terms ‘physiological’, ‘psychological’, ‘infant/child’, ‘maternal separation’ and ‘hospital’. Thirty-four articles containing data relevant to the effects of mother–child separation on either member of the pair were included. Findings highlight the central importance of the mother’s presence in mediating the stressful effects of hospitalisation on her child. The majority of articles reported on psychological effects of separation on mothers of infants or on younger children. We identified no articles reporting on physiological effects on the older child or mothers of older children or psychological effects on mothers of older children. Only nine articles used validated tools to measure the effects of separation. There is a need for more evidence, based on validated measurement, about the psychological effects of separation on the child, particularly the older child, and on the physiological effects of separation on the mother–child pair during hospitalisation.

Clinical Outcomes of a Zika Virus Mother–Child Pair Cohort in Spain

Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4–6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4–39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.

PLACENTAL DYSFUNCTION: HEALTH STATUS, NUTRITIONAL STATUS AND MINERAL PROFILE OF A MOTHER-CHILD PAIR

The aim: the analysis of the PD, pregnancy, the labor, the research on peculiarities of the development and health status of breast-fed children, who are born to mothers with PD, by means of analyzing the mother-child pair’s nutritional status and mineral homeostasis. Materials and methods: At the 1 stage, an analysis of the PD frequency, the pregnancy, the labor was conducted during 5 years. At the 2 stage, 188 mother-child pairs were examined: 84.04% women had PD and 15.96% didn’t have it. The research included the analysis of the anamnestic data, maternal nutritional status, general clinical study, assessment of the physical, psychomotor level of the child’s development, study of the elemental profile. Results: High frequency of complications in pregnancy and labor was observed in cases when women had PD, due to the imbalance in the “mother-placenta-fetus” system. The results’ analysis showed an increased level of Zn (1.437%), K (10.147%), and Ca (83.900%) in hair; an increased level of K (82.818%), Cr (0.274%), and Na (3.611%) in breast milk of women with PD. Children born to mothers with PD had a significantly increased level of Cr (0.92%), S (0.578%) and P (0.169%), Na (0.107%), Ca (56.041%), and Zn (7.149%). Conclusions: PD has a negative impact on the pregnancy and labor and may be one of the factors causing the mineral imbalance of breast-fed infant.

Effect of Mobile Phone Reminders and Recalls on Missed Immunisations among Infants in Two Health Facilities in Abakaliki, Nigeria

Background: Missed immunisation (MI) may contribute to low immunisation coverage in diverse settings, especially developing countries. Receipt of vaccines at the recommended ages and intervals will ensure that children are adequately protected from target diseases at all times. Immunisation reminder and recall (RR) systems are cost-effective methods of improving adherence to recommended immunisation schedules. This study, therefore, determined the effect of immunisation reminders and recalls on reducing missed immunisations in Abakaliki. Materials and Methods: This is a quasi-experimental study conducted among caregivers of infants in rural health facilities in Abakaliki. Mile-Four and St. Vincent hospitals located in Ebonyi and Izzi Local Government Areas (LGA) respectively in Ebonyi State were selected purposively. Mile-Four was assigned intervention group and St. Vincent as control group. The sample size was determined using the formula for comparing two proportions. Caregiver-child pair was recruited during the infants’ BCG or Pentavalent vaccines 1 immunisation visit and followed till the final scheduled immunisation visit for each child. Data was collected using a questionnaire, proforma and checklist. Statistical Package for Social Science (SPSS) version 22.0 was used for analysis. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA). Results: A greater proportion of respondents in the intervention group (8.3%) missed vaccination at the 6th and 10th weeks when compared with the 4.1% and 6.9% for the above mentioned weeks respectively in the control group. In the control group, a greater proportion (22.1%) missed vaccination than the intervention group (8.9%) at the 14th week, a difference in the proportion that was significant (p=0.04). Relative to female caregivers, male caregivers are 6.2 times more likely to miss immunisation in the intervention group. They are 2.3 times more likely to miss immunisation than the female ones in the control group. Those at older age (≥30 years) are 1.2 times more likely to miss immunisation than those of younger age group. Conclusion: Mobile phone reminders and recall has proven effective in reducing childhood missed immunisations and non-compliance in Abakaliki. Implementation of immunisation reminders and recall systems is therefore recommended in immunisation clinics in developing countries especially in Nigeria for immunisation timeliness and completion.

Awareness, Perception to Immunisation Reminders and Recall among Caregivers of Infants in Abakaliki, Southeast Nigeria

Background: Effective vaccination communication with parents is critical in efforts to overcome barriers to childhood vaccination, tackle vaccine hesitancy and improve vaccination coverage. Health workers should be able to provide information to caregivers and support them in decision making about vaccinating their children. Limited information exists regarding the awareness, perceptions to childhood immunisation reminders and recall system in Abakaliki. This study, therefore, assessed the awareness, perceptions of caregivers to childhood immunisation reminders and recall system in improving immunisation coverage in Abakaliki. Materials and Methods: A descriptive analytical study design comparing two large health facilities (Mile-Four and St.Vincent Hospitals in Ebonyi and Izzi Local Government Areas respectively) in Ebonyi State was used for the survey. The study duration was three months. Sample size was determined using the formula for comparing two proportions. Data were collected using semi-structured interviewer administered questionnaire from 145 caregiver-child pair from each group. Statistical Package for Social Science (SPSS) version 22 was used for analysis. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA), Nigeria. Results: The mean age of respondents in Mile-Four and St.Vincent hospitals were 26.6 ±4.9 years and 27.1±4.2 years respectively. Higher proportion of caregivers in Mile-Four group (18.6%) than in St.Vincent group (14.5%) had ever heard of immunisation reminders and recalls prior to this study. Similarly, only 8.3% of caregivers in Mile-Four and 4.8% in St.Vincent had ever been reminded and/or recalled on the course of their children’s immunisation uptake. A comparable proportion of respondents in Mile-Four (93.1%) and St.Vincent (94.5%) perceived reminders and recalls very important. There was a significant relationship between respondent's marital and educational status and positive perception about immunisation reminders and recalls in Mile-Four and respondent’s age and marital status and positive perception about immunisation reminders and recalls in St.Vincent (p<0.05). Conclusion: Respondents’ awareness was low but positive perception to reminders and recall was found. It is pertinent for health policy makers and programme managers to understand these factors when implementing immunisation communication system.

HIV-1 Subtype C-Infected Children with Exceptional Neutralization Breadth Exhibit Polyclonal Responses Targeting Known Epitopes

ABSTRACT We have previously shown that HIV-1-infected children develop broader and more potent neutralizing antibody responses than adults. This study aimed to determine the antibody specificities in 16 HIV-1 subtype C-infected children who displayed exceptional neutralization breadth on a 22-multisubtype virus panel. All children were antiretroviral treatment (ART) naive with normal CD4 counts despite being infected for a median of 10.1 years with high viral loads. The specificity of broadly neutralizing antibodies (bNAbs) was determined using epitope-ablating mutants, chimeric constructs, and depletion or inhibition of activity with peptides and glycoproteins. We found that bNAbs in children largely targeted previously defined epitopes, including the V2-glycan, V3-glycan, CD4bs, and gp120-gp41 interface. Remarkably, 63% of children had antibodies targeting 2 or 3 and, in one case, 4 of these bNAb epitopes. Longitudinal analysis of plasma from a mother-child pair over 9 years showed that while they both had similar neutralization profiles, the antibody specificities differed. The mother developed antibodies targeting the V2-glycan and CD4bs, whereas bNAb specificities in the child could not be mapped until 6 years, when a minor V2-glycan response appeared. The child also developed high-titer membrane-proximal external region (MPER) binding antibodies not seen in the mother, although these were not a major bNAb specificity. Overall, exceptional neutralization breadth in this group of children may be the result of extended exposure to high antigenic load in the context of an intact immune system, which allowed for the activation of multiple B cell lineages and the generation of polyclonal responses targeting several bNAb epitopes. IMPORTANCE An HIV vaccine is likely to require bNAbs, which have been shown to prevent HIV acquisition in nonhuman primates. Recent evidence suggests that HIV-infected children are inherently better at generating bNAbs than adults. Here, we show that exceptional neutralization breadth in a group of viremic HIV-1 subtype C-infected children was due to the presence of polyclonal bNAb responses. These bNAbs targeted multiple epitopes on the HIV envelope glycoprotein previously defined in adult infection, suggesting that the immature immune system recognizes HIV antigens similarly. Since elicitation of a polyclonal bNAb response is the basis of next-generation HIV envelope vaccines, further studies of how bNAb lineages are stimulated in children is warranted. Furthermore, our findings suggest that children may respond particularly well to vaccines designed to elicit antibodies to multiple bNAb epitopes.