Current opportunities for vaccine prophylaxis of common infections in immunosuppressed adult patients

One of the slogans of modern clinical vaccinology is — “You have taken enough care of your children’s health, and now it is time to take care of yourselves and your parents — it is high time to think seriously about vaccinating adults!” It is indeed true that for a long time vaccinology has been confined to the paediatric service only, while general practitioners and specialists of the therapeutic branches of medicine have dealt with vaccination very rarely, and only in relation to seasonal influenza. This is often due to the fact that clinicians often have insufficient or inaccurate information regarding the need for and the effectiveness of vaccination in adult patients, including those with immunosuppression or comorbidity. In some cases, the infrastructure needed to develop a tailored vaccination schedule for adult patient groups at increased risk of developing infectious complications is lacking. This article presents current data with regard to vaccination of immunosuppressed adult patients.

Task Sharing to Support Paediatric Service Delivery in Low- and Middle-income Countries: Current Practice and a Scoping Review of Emerging Opportunities

BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. The general and skilled paediatric workforce shortage especially in low- and middle-income countries (LMICs) will impede the provision of additional paediatric services. This paper examines experiences with task sharing as part of the solution to this human resources challenge in LMICs and specifically looks beyond the provision of care for acute infectious diseases and malnutrition that are widely and historically shifted. MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritised; (2) investigated training opportunities and national policies related to task sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarised reported experience of task sharing and paediatric service delivery through a scoping review of research literature in LMICs published between 1990-2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found there is some evidence available for task sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for mid-level cadres to support safe, accessible and high-quality care.

Juvenile trabecular ossifying fibroma in association with multiple mandible deciduous teeth: an atypical case report

Ossifying fibroma is a benign fibro-osseous lesion characterized by the formation of a cellular fibrous connective tissue stroma with cementum-like material and/or osseous components. The juvenile variant is reported to be an aggressive lesion in paediatric patients. Its poor symptomatology contrasts with its highly aggressive behaviour in maxillary or mandibular region. Objective: The aim of the present study is to report a case of an atypical ossifying fibroma in association of multiple deciduous teeth. Case report: A nine years-old girl was referenced to the Oral and Maxillofacial Surgery Service at Positivo University by the Paediatric Service after radiographic confirmation of a round lesion in lower left mandible region. Imaginological examination revealed a well-defined, round, with multiple radiopaque foci associated with the roots of deciduous molars and with root of first permanent mandibular molar of the left side. Lesion embedded the root and crown of the unerupted second left premolar, suggesting that the tumour arouse from it. After incisional biopsy, histopathological analysis suggested the trabecular pattern of juvenile ossifying fibroma. Surgery was conducted through an intra-oral approach. Incision was drawn in gingiva from the left lateral inferior incisor region until the unerupted second molar region, finished with a relaxing incision. A round tumour in association with the unerupted permanent premolars, which were also extracted, was removed in its entire extent by enucleation. Histopathological analysis confirmed the previous diagnosis of juvenile trabecular ossifying fibroma. Peripheral ostectomy was conducted to diminish chances of lesion relapse. Conclusion: 16 months follow-up showed no lesion recurrence.

Female genital mutilation (FGM) in UK children: a review of a dedicated paediatric service for FGM

ObjectiveTo describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic.MethodsData collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification.ResultsBetween September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution.ConclusionsThe number of children with FGM was significantly lower than expected based on UK prevalence estimates. Most children had undergone FGM prior to UK entry, and the majority of cases were initially disclosed by the child or family themselves. These results reflect the lack of large-scale proof of the practice of FGM in the UK and are consistent with growing evidence of the abandonment of FGM among communities after migration.

P138 Are adolescents prepared for transition? A survey of practice in Northern Ireland

Background In Northern Ireland we have a single paediatric rheumatology service in which patients often stay until the end of education, before transferring to adult care. We lack a formal transition clinic or uniform process for transition. We wished to investigate whether adolescents transitioning to adult rheumatology care are sufficiently prepared for the process. Methods We surveyed the charts of patients within the paediatric rheumatology service aged over 16 years. Excluding patients who had were not under active follow up and those who had completed transition we studied 86 patients in a retrospective chart review. We studied the seven areas of readiness for transfer as recommended in the 'Ready Steady Go' programme. Results We had a population eligible for transition of 57 female and 29 male patients between the ages of 16 and 26. Around fifty percent had JIA, most commonly oligoarticular and polyarticular with other diagnoses including Raynauds, JIO, mechanical and pain conditions. Fifteen of these had been referred to the appropriate geographical area for transfer to adult service and 71 were yet to be referred. Readiness for transfer was poorly documented. Lifestyle issues (diet, exercise) and vocational (school, hobbies) were the best addressed with 41 and 56 patients respectively having at least one discussion on these aspects. Knowledge, self advocacy, ADLs, psychosocial and transition aspects were poorly documented. Conclusion We acknowledged that time pressures may have restricted what was recorded following appointments with focus on clinical information. However, we are aware of the lack of a formal transition programme within Northern Ireland and we feel this may contribute to patients spending a relatively prolonged time within the paediatric service. We have implemented quality improvement by using the 'Ready Steady Go' questionnaires within the paediatric service to improve preparedness for adult transfer and are reviewing our service of paediatric transfer. Introduction of the ‘Hello to adult services’ questionnaire by adult rheumatologists may help to achieve a more successful transition process by highlighting areas in which the young person may benefit from extra care by their adult team. Disclosures C. Masih None. D. McKenna None. M. McHenry None. M. Rooney None.