A Study to assess the breast feeding self-efficacy among postnatal mothers at NRI General Hospital Guntur Dist., Andhra Pradesh.

Background: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. The importance of exclusive breastfeeding and the immunological and nutritional values of breast milk has been demonstrated. Materials and Methods: A quantitative approach and non-experimental descriptive design was adopted. The study was conducted on 60 postnatal mothers admitted at NRI General Hospital using convenient sampling technique. Data were collected structured knowledge questionnaire and obtained data were analysed by descriptive and inferential statistics. Results: Regarding the breastfeeding self-efficacy among post-natal mothers, 23.3% mothers had low confidence, 33.3% mothers had moderate confidence, 43.3% mothers had high confidence. Conclusion: The findings revealed that the improve the breast feeding self-efficacy of postnatal Mother’s.

Effectiveness of palivizumab immunoprophylaxis in infants with respiratory syncytial virus disease in Colombia

Introduction: Respiratory syncytial virus (RSV) is one of the most important childhood infections. Objective: To evaluate the effectiveness and safety of palivizumab immunoprophylaxis in preterm infants at a high risk of severe respiratory syncytial virus infection during the RSV season in Colombia. Methodology: A prospective observational non-comparative multicenter study in six Colombian cities. At the beginning of the RSV infection season, palivizumab prophylaxis, up to five doses, was administered to infants born at ≤32 weeks of gestation, infants younger than six months, infants under one year of age with bronchopulmonary dysplasia (BPD), infants one year or less of age with hemodynamically significant acyanotic and non-acyanotic congenital heart disease (CHD), and with follow-up during the immunoprophylaxis until one month after the last dose. Results: The study enrolled 600 patients, 91.8% of which were born at ≤ 32 weeks of gestation. BPD was observed in 54.9% of infants. 49% were born at < 32 weeks gestation and presented BPD. 6.9% had hemodynamically significant acyanotic and non-acyanotic CHD 53.3% received three or more doses of palivizumab. The mean interval between doses was 39.6 days. 1.8% of patients were hospitalized due to a confirmed RSV infection. Overall mortality was 1.2%, whereas the mortality by RSV in infants undergoing prophylaxis was 0.2%. Conclusions: Palivizumab was a clinically effective, well-tolerated treatment in the Colombian population. The safety profile of palivizumab reflects the findings from previous studies in developed countries.

Decreased IL-10 accelerates B-cell leukemia/lymphoma in a mouse model of pediatric lymphoid leukemia

Exposures to a wide repertoire of common childhood infections and strong inflammatory responses to those infections are associated with risk of pediatric B-cell acute lymphoblastic leukemia (B-ALL) in opposing directions. Neonatal inflammatory markers are also related to risk by unknown mechanism(s). Here, we demonstrate that IL-10 deficiency, which is associated with childhood B-ALL, indirectly impairs B lymphopoiesis and increases B-cell DNA damage in association with a module of 6 proinflammatory/myeloid-associated cytokines (IL-1α, IL-6, IL-12p40, IL-13, MIP-1β/CCL4, and G-CSF). Importantly, antibiotics attenuated inflammation and B-cell defects in preleukemic Cdkn2a-/-Il10-/- mice. In an ETV6-RUNX1+ (E6R1+) Cdkn2a-/- mouse model of B-ALL, decreased levels of IL-10 accelerated B cell neoplasms in a dose dependent manner, and altered the mutational profile of these neoplasms. Our results illuminate a mechanism through which a low level of IL-10 can create risk of leukemic transformation and support developing evidence that microbial dysbiosis contributes to pediatric B-ALL.

Past Emerging Viruses

This chapter focuses on past emerging viruses. For our ancestors, it was their change in lifestyle from hunter-gatherer to farmer some 10,000 years ago that triggered an onslaught of new, emerging infectious diseases. The switch from the nomadic life to living in fixed communities, along with the change from hunting animals to their domestication, encouraged spillover of new viruses as well as other types of microbes. As such, the early farmers’ emerging viruses jumped from the animals they domesticated, while the cramped conditions of life in villages, and later towns, gave these viruses the opportunity to thrive in their new human host. This was the beginning of many of our acute childhood infections, so-called crowd diseases. The chapter looks at how these ancient afflictions have evolved over the intervening 10,000 years with a view to understanding how diseases like COVID-19 might evolve over time. It considers smallpox and measles, which are both highly infectious, lethal, airborne viruses, as well as polio, which is spread by faecal–oral contamination.

Turning The Tables

This chapter outlines the different ways of combatting viruses. Smallpox was the most lethal of the recurrent childhood infections, and, until the late eighteenth century, had it all its own way. But in 1715, when smallpox virus infected Lady Mary Wortley Montagu, the fightback began. This turn of events gave Lady Mary a keen interest in smallpox that led, a few years later, to the first successful prevention of the disease in Europe. However, inoculation was obviously not entirely safe and was not universally accepted. Despite this, it continued to be popular until 1798, when Edward Jenner published the details of a safer alternative: vaccination. Following smallpox, rabies virus was the next to be prevented by a vaccine, this time produced by microbiologist Louis Pasteur working in Paris in the mid 1800s. From the mid 1950s onwards, a surge in production saw vaccines against common viruses like polio, measles, rubella, and mumps, as well as common bacterial infections like diphtheria, pertussis, and tetanus, being rolled out to all children in western countries. The chapter then looks at how these vaccines were prepared and the recent advances in vaccinology spurred on by the COVID-19 pandemic. It also considers flu vaccines, subunit vaccines, and microbial treatments.

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

Background Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. Methods We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. Results Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. Conclusion Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.

The seasonality of three childhood infections in a pre-industrial society without schools

Background: The burden of many infectious diseases varies seasonally and a better understanding of the drivers of infectious disease seasonality would help to improve public health interventions. For directly transmitted highly-immunizing childhood infections, the leading hypothesis is that seasonality is strongly driven by social gatherings imposed by schools, with maxima and minima during school terms and holidays respectively. However, we currently have a poor understanding of the seasonality of childhood infections in societies without schools and whether these are driven by human social gatherings. Here, we used unique nationwide data consisting of >40 epidemics over 100 years in 18th and 19th century Finland, an agricultural pre-health care society without schools, to (i) quantify the seasonality of three easily identifiable childhood infections, smallpox, pertussis and measles and (ii) test the extent to which seasonality of these diseases is driven by seasonal social gatherings. Methods: We quantified the seasonality of transmission using time series Suscpetibel-Infected-Recovery models, wavelet analyses and general additive mixed models.Results: We found that all three infections were seasonal and the seasonality patterns differed from those in industrialized societies with schools. Smallpox and measles showed high transmission in the first half of the year, but we could not associate this with seasonal human gatherings events. For pertussis, however, transmission was higher during social gathering events such as New Year and Easter.Conclusions: Our results show that the seasonality of childhood infections is more variable than previously described in other populations and indicate a pathogen-specific role of human social aggregation in driving the infectious disease dynamics.Funding: Academy of Finland (278751, 292368), Nordforsk (104910), the Ehrnrooth Foundation, the Finnish Cultural Foundation, the University of Turku Foundation and the Doctoral Programme in Biology, Geography and Geology, University of Turku.

Is annual vaccination best? A modelling study of influenza vaccination strategies in children

Introduction: Annual vaccination of children against influenza is a key component of vaccination programs in many countries. However, past infection and vaccination may affect an individual's susceptibility to infection. Little research has evaluated whether annual vaccination is the best strategy. Using the United Kingdom as our motivating example, we assess the impact of different childhood vaccination strategies, specifically annual and biennial (every other year), on attack rate and expected number of infections. Methods and Findings: We present a multi-annual, individual-based, stochastic, force of infection model that accounts for individual exposure histories and disease/vaccine dynamics influencing susceptibility. We simulate birth cohorts that experience yearly influenza epidemics and follow them until age 18 to determine attack rates and the number of childhood infections. We perform simulations under baseline conditions, with an assumed vaccination coverage of 44\%, to compare annual vaccination to no and biennial vaccination. We relax our baseline assumptions to explore how our model assumptions impact vaccination program performance. At baseline, we observed more than a 50% reduction in the number of infections between the ages 2 and 10 under annual vaccination in children who had been vaccinated at least half the time compared to no vaccination. When averaged over all ages 0-18, the number of infections under annual vaccination was 2.07 (2.06, 2.08) compared to 2.63 (2.62, 2.64) under no vaccination, and 2.38 (2.37, 2.40) under biennial vaccination. When we introduced a penalty for repeated exposures, we observed a decrease in the difference in infections between the vaccination strategies. Specifically, the difference in childhood infections under biennial compared to annual vaccination decreased from 0.31 to 0.04 as exposure penalty increased. Conclusion: Our results indicate that while annual vaccination averts more childhood infections than biennial vaccination, this difference is small. Our work confirms the value of annual vaccination in children, even with modest vaccination coverage, but also shows that similar benefits of vaccination can be obtained by implementing a biennial vaccination program.