COVID infection severity in children under 5 years old before and after Omicron emergence in the US

Importance Pediatric SARS-CoV-2 infections and hospitalizations are rising in the US and other countries after the emergence of Omicron variant. However data on disease severity from Omicron compared with Delta in children under 5 in the US is lacking. Objectives To compare severity of clinic outcomes in children under 5 who contracted COVID infection for the first time before and after the emergence of Omicron in the US. Design, Setting, and Participants This is a retrospective cohort study of electronic health record (EHR) data of 79,592 children under 5 who contracted SARS-CoV-2 infection for the first time, including 7,201 infected when the Omicron predominated (Omicron cohort), 63,203 infected when the Omicron predominated (Delta cohort), and another 9,188 infected when the Omicron predominated but immediately before the Omicron variant was detected in the US (Delta-2 cohort). Exposures First time infection of SARS-CoV-2. Main Outcomes and Measures After propensity-score matching, severity of COVID infections including emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and mechanical ventilation use in the 3-day time-window following SARS-CoV-2 infection were compared between Omicron and Delta cohorts, and between Delta-2 and Delta cohorts. Risk ratios, and 95% confidence intervals (CI) were calculated. Results Among 7,201 infected children in the Omicron cohort (average age of 1.49 years), 47.4% were female, 2.4% Asian, 26.1% Black, 13.7% Hispanic, and 44.0% White. Before propensity score matching, the Omicron cohort were younger than the Delta cohort (average age 1.49 vs 1.73 years), comprised of more Black children, and had fewer comorbidities. After propensity-score matching for demographics, socio-economic determinants of health, comorbidities and medications, risks for severe clinical outcomes in the Omicron cohort were significantly lower than those in the Delta cohort: ED visits: 18.83% vs. 26.67% (risk ratio or RR: 0.71 [0.66-0.75]); hospitalizations: 1.04% vs. 3.14% (RR: 0.33 [0.26-0.43]); ICU admissions: 0.14% vs. 0.43% (RR: 0.32 [0.16-0.66]); mechanical ventilation: 0.33% vs. 1.15% (RR: 0.29 [0.18-0.46]). Control studies comparing Delta-2 to Delta cohorts show no difference. Conclusions and Relevance For children under age 5, first time SARS-CoV-2 infections occurring when the Omicron predominated (prevalence >92%) was associated with significantly less severe outcomes than first-time infections in similar children when the Delta variant predominated.

Determinants affecting utilisation of health services and treatment for children under-5 in rural Nepali health centres: a retrospective cohort study

Background: Large inequalities in child health remain in Nepal, with caste, ethnicity and sex being major determinants of deprivation and negative outcomes. The purpose of this study was to explore whether key demographics on under 5s were associated with health seeking behaviours, utilisation of health care, and treatment received.Methods: Data came from Integrated Management of Neonatal & Childhood Illness (IMNCI) records of 23 health centres across five districts. After digitising the paper records, district, ethnicity, sex, age and temperature of the child were used to predict the number of days taken to seek medical care for Acute Respiratory Infection (ARI), diarrhoea and fever. In addition to this, correct diagnosis and subsequent treatment of pneumonia was assessed against IMNCI guidelines, again using the demographic factors of interest to predict these outcomes.Results: From 116 register books spanning 23 health centres, 33,860 child patient records were considered for analysis. The median age of attendance was 16 months (Inter-Quartile Range= 9, 30), while there were more male children that attended (55.8% vs. 44.2% for females). There were statistically significant differences for the time taken to attend a health centre between different districts for ARI, diarrhoea and fever, with children in the remote Humla and Mugu districts taking significantly longer to present at a health facility after the onset of symptoms (all p<0.012). Children from underprivileged ethnic groups, Madhesi and Dalit, were less likely to be given a correct diagnosis of pneumonia (p=0.001), while males were more likely to receive a correct diagnosis than females (73% vs. 67%, p=0.001). This sex difference remained in the adjusted regression models for diagnosis of pneumonia (p=0.011) but not for treatment of pneumonia (p=0.202).Conclusions: Significant demographic differences were found based on ethnicity, sex, and district when examining health seeking behaviours for ARI, diarrhoea, and fever. Significant associations were seen for these same factors when exploring accuracy of diagnoses of pneumonia, but not for treatment. This study has emphasised the importance of a digitalised healthcare system, where inequalities can be identified without the reliance on anecdotal evidence.

Prevalence of Human Bocavirus in Children Under 5 Years with Upper and Lower Respiratory Infections in Southeastern Iran

Background: Human Bocavirus (HBoV) is a parvovirus associated with mild to severe upper and lower respiratory tract infections in children. Objectives: This study aimed to detect the virus in the nasopharynx of children under 5-year-old with respiratory infection by polymerase chain reaction (PCR). Methods: Two hundred samples were taken from children referred to pediatric clinics in Kerman, southeastern Iran, with respiratory infections and were positive for virus by PCR. Next, the positive samples were genotyped by real-time PCR. Results: Out of 200 samples, 13 (6.5%) were positive for the Bocavirus gene, and all positive samples were infected by HBoV-1. We observed that 116 patients were male, and there was no difference in the prevalence of the virus based on gender (P = 0.345). The prevalence was significantly higher in infants under 10 months old (P = 0.049). Infection by Bucavirus virus was significantly correlated with symptoms, such as fever (P = 0.035, r = 0.7), otitis media (P = 0.013, r = 0.8), diarrhea, nausea, and vomiting (P = 0.001, r = 0.4). Conclusions: According to our findings, HBoV could be one of the causes of infections in the respiratory system of children, and the only type in the studied region is HBoV-1.

Optimising Malaria Control Interventions in Mali Based on Epidemiological Surveillance and Rainfall Data

Background In malaria endemic countries, control interventions are performed during the high malaria transmission season using epidemiological surveillance data. One such intervention, seasonal chemoprevention (SMC), consists of the monthly administration of antimalarial drugs to children under 5 years. This study proposes an anticipating approach for adapting the timing of SMC interventions in Mali and the number of rounds. Our primary objective was to select the best approach for anticipating the onset of the high transmission season in the different health districts of Mali based on epidemiological surveillance and rainfall data. Our secondary objective was to evaluate the number of malaria cases, hospitalisations, and deaths in children under 5 years that could be prevented in Mali using the selected approach and the additional cost associated.Method Confirmed malaria cases and weekly rainfall data were collected for the 75 health districts of Mali for the 2014-2019 period. The onset of the rainy season, the onset of the high transmission season, the lag between these two events and the duration of the high transmission season were determined for each health district. Two approaches for anticipating the onset of the high transmission season in 2019 were evaluated. Results In 2014-2019, the onset of the rainy season ranged from W17 April to W34 August and that of the high transmission season from W25 June to W40 September. The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best approach anticipated the onset of the high transmission season 2019 in June in 2 districts, July in 46 districts, August in 21 districts and September in 6 districts. Using this approach over the 2014-2019 period would have led to changing the timing of SMC interventions in 36 health districts and would have prevented 43,819 cases, 1,943 hospitalisations and 70 deaths in children under 5 years. The additional cost of using our proposed approach is less than 5% of the current approach. Conclusion Adapting the timing of SMC interventions using our proposed approach would improve the prevention of malaria cases, hospitalisations, and deaths for a reasonable additional cost.

Sexual Reproductive Health: Improving Child Survival Initiatives in Botswana

Improving maternal and child survival it’s an important integral part of health care. A large number of deaths in Africa emanate from preventable diseases and largely in the first month of life. Majority of deaths were from preventable causes such as pneumonia, diarrhea and malaria and all accounting to 14.9%, 9.2% and 7.3% respectively. In an endeavour to the prevent and promote healthcare system, the government of Botswana came up with a special programme geared toward protecting the locals against common diseases. The government of Botswana, through the Ministry of Health (MoH), introduced the Accelerated Child Survival and Development (ACSD) strategic plan intervention with a specific focus on reducing the ‘under five mortality rate’ (U5MR). One of the high-impact interventions for reducing the U5MR is the Integrated Management of Childhood Illness (IMCI) strategy. The strategic goal of IMCI is to reduce death, illness, and disability and to promote improved growth and development among children under 5 years of age. Child welfare clinic and Nutrition has been discovered as one of the strategy to promote child’s growth and development. This strategy can be effective if it is implemented with IMCI and Immunisation.

Structural activity relationship of metallo-aminoquines as a next generation antimalarials

Apicomplexian parasite of the genus Plasmodium is the causative agent of malaria, one of the most devastating, furious and common infectious disease throughout the world. According to the latest World malaria report, there were 229 million cases of malaria in 2019 majorly consisting of children under 5 years of age. Some of known analogues viz. quinine, quinoline-containing compounds have been used for last century in the clinical treatment of malaria. Past few decades have witnessed the emergence of multi-drug resistance (MDR) strains of Plasmodium species to existing antimalarials pressing the need for new drug candidates. For the past few decades bioorganometallic approach to malaria therapy has been introduced which led to the discovery of noval metalcontaining aminoquinolines analogues viz. ferroquine (FQ or 1), Ruthenoquine (RQ or 2) and other related potent metal-analogues. It observed that some metal containing analogues (Fe-, Rh-, Ru-, Re-, Au-, Zn-, Cr-, Pd-, Sn-, Cd-, Ir-, Co-, Cu-, and Mn-aminoquines) were more potent; however, some were equally potent as Chloroquine (CQ) and 1. This is probably due to the intertion of metals in the CQ via various approaches, which might be a very attractive strategy to develop a SAR of novel metal containing antimalarials. Thus, this review aims to summarize the SAR of metal containing aminoquines towards the discovery of potent antimalarial hybrids to provide an insight for rational designs of more effective and less toxic metal containing amoniquines.

The availability of priority medicines for children under 5 years in eThekwini, South Africa

Background Globally, an estimated 8.1 million children under 5 years die annually in developing countries. Ensuring essential medicines are accessible and affordable to the population is key to saving lives. This study investigated accessibility, availability and affordability of a basket of priority medicines for children under 5 years in public and private healthcare sector pharmacies in the eThekwini Metropolitan area in Durban, South Africa. Methods The WHO/HAI survey tool for assessing medicine prices, availability and affordability was adapted and employed for a basket of WHO Priority life-saving medicines for children under 5 years. Six district hospitals in the north, south and central eThekwini Metropolitan were selected as major facility reference points and for data collection and pharmacies within a 5 km radius from each major facility were also invited to participate in the study, as outlined in the WHO/HAI tool methodology. Of the 58 pharmacies selected, a total of 27 pharmacies from both private and public healthcare sectors agreed to participate and were surveyed, representing a 47% response rate. Data was analysed using Microsoft excel. Results All participating pharmacies (and hence the selected basket of priority medicines at these facilities) were deemed accessible. Overall the public sector had more medicines available on the shelf (averaging 64%) than the private sector (48%) which had more medicines available on order (84%). At least one medicine for each of the eight (8) conditions was available at both sectors which meant patients could be treated for these conditions. Medicines for priority conditions (except HIV, which was a 28-day course) were deemed affordable as these regimens were obtainable within a day’s wage for the lowest paid unskilled worker. Priority medicines for children under 5 years were more available and more affordable in the public sector. Conclusion The basket of WHO essential medicines for priority conditions for children under 5 years were accessible, available and affordable in the eThekwini Metropolitan areas. This was the first study in eThekwini to determine access to the WHO basket of priority medicines for children and can be scaled-up to a national study to provide a holistic comparison of these medicines in the country, and also for global comparison.

Burden of SARS-CoV-2 and protection from symptomatic second infection in children

ImportanceThe impact of the SARS-CoV-2 pandemic on children remains unclear. Better understanding of the burden of COVID-19 among children and their protection against re-infection is crucial as they will be among the last groups vaccinated.ObjectiveTo characterize the burden of COVID-19 and assess how protection from symptomatic re-infection among children may vary by age.DesignA prospective, community-based pediatric cohort study conducted from March 1, 2020 through October 15, 2021.SettingThe Nicaraguan Pediatric Influenza Cohort is a community-based cohort in District 2 of Managua, Nicaragua.ParticipantsA total of 1964 children aged 0-14 years participated in the cohort. Non-immunocompromised children were enrolled by random selection from a previous pediatric influenza cohort. Additional newborn infants aged ≤4 weeks were randomly selected and enrolled monthly, via home visits.ExposuresPrior COVID-19 infection as confirmed by positive anti SARS-CoV-2 antibodies (receptor binding domain [RBD] and spike protein) or real time RT-PCR confirmed COVID-19 infection ≥60 days prior to current COVID-19.Main Outcomes and MeasuresSymptomatic COVID-19 cases confirmed by real time RT-PCR and hospitalization within 28 days of symptom onset of confirmed COVID-19 case.ResultsOverall, 49.8% of children tested were seropositive over the course of the study. There were also 207 PCR-confirmed COVID-19 cases, 12 (6.4%) of which were severe enough to require hospitalization. Incidence of COVID-19 was highest among children aged <2 years—16.1 per 100 person-years (95% Confidence Interval [CI]: 12.5, 20.5)—approximately three times that of children in any other age group assessed. Additionally, 41 (19.8%) symptomatic SARS-CoV-2 episodes were re-infections, with younger children slightly more protected against symptomatic reinfection. Among children aged 6-59 months, protection was 61% (Rate Ratio [RR]:0.39, 95% CI:0.2,0.8), while protection among children aged 5-9 and 10-14 years was 64% (RR:0.36,0.2,0.7), and 49% (RR:0.51,0.3-0.9), respectively.Conclusions and RelevanceIn this prospective community-based pediatric cohort rates of symptomatic and severe COVID-19 were highest among the youngest participants, with rates stabilizing around age 5. Reinfections represent a large proportion of PCR-positive cases, with children <10 years displaying greater protection from symptomatic reinfection. A vaccine for children <5 years is urgently needed.Key PointsQuestionWhat is the burden of COVID-19 among young children and how does protection from re-infection vary with age?FindingsIn this study of 1964 children aged 0-14 years children <5 years had the highest rates of symptomatic and severe COVID-19 while also displaying greater protection against re-infection compared to children ≥10 years.MeaningGiven their greater risk of infection and severe disease compared to older children, effective vaccines against COVID-19 are urgently needed for children under 5.

Anaemia prevalence and its associated factors in children under 5 years in Western China: a systematic review

BackgroundIron-deficiency anaemia disproportionately affects children in low-income and middle-income areas; Western China is a prime example. Given the health risks associated with childhood anaemia and the large heterogeneity of published studies on this subject, we conducted a systematic review of the evidence regarding anaemia prevalence and associated factors in children under 5 years in Western China.MethodsWe searched for all relevant studies on the prevalence of iron deficiency anaemia in children under 5 years in Western China, obtaining research between 1 January 2011 and 30 June 2021, in English and Chinese from Medline, Embase, PubMed, Web of Science, CNKI, WanFang Data and VIP. Two reviewers independently screened titles and abstracts; three reviewed full texts of relevant articles for data extraction and performed quality assessments. The median prevalence was calculated on unweighted pooling, stratified by region, sex, age and ethnic group. Associated factors and a linear trend chart were conducted to identify trends and research highlights.ResultsAmong the 55 articles included, most were cross-sectional studies (39, 70.91%). The prevalence of anaemia in children under 5 years in Western China ranged from 3.69% to 75.74% (median 42.54% (IQR 25.62%–52.56%)); the highest levels were in Qinghai province: 59.10%–75.74% (median 67.80% (IQR 64.70%–72.75%)); the highest levels were reported in the subgroup of children aged 6–12 months (median 50.09% (IQR 34.35%–59.04%)). Regional contexts, individual sociodemographic characteristics and feeding behaviours, and nutritional programme interventions were factors associated with anaemia prevalence.ConclusionThe prevalence of anaemia in children under 5 years in Western China is concerningly high. For this multiethnic and economically underdeveloped region, more high-quality and prospective studies are needed to inform evidence based and targeted preventive strategies to decrease the high prevalence of anaemia among young children.