Burden Of Disease In Children Research Articles

Trends in Enterobacterales Bloodstream Infections in Children.

Enterobacterales bloodstream infections (E-BSI) cause a significant burden of disease in children and are associated with antimicrobial resistance. We assessed temporal changes in the population-based incidence of E-BSI in children in Queensland, Australia. We conducted a cohort study of incidents of E-BSI occurring in children in Queensland between 2000 and 2019, with a total population of 19.7 million child years. Infections were linked to clinical outcomes in hospital admissions and vital statistics databases. We estimated age- and sex-standardized E-BSI incidence rates over time. Secondary outcomes included the proportion of extended-spectrum β-lactamase phenotypes per year, hospital length of stay, and mortality. We identified 1980 E-BSI in 1795 children. The overall age- and sex-standardized incidence rate was 9.9 cases per 100 000 child years, which increased from 7.3 to 12.9 over the period studied, an increase of 3.9% (95% confidence interval: 3.1-4.7) per year. There were 3.6 cases of E. coli bloodstream infection per 100 000 child years, increasing annually by 4.7% (3.5-5.9). The Salmonella sp. bloodstream infection incidence was 3.0 cases per 100 000 child years, which increased from 2013 by 13.7% (3.8-24.3) per year. The proportion of extended-spectrum β-lactamase E. coli increased over time. Mortality and length of stay were higher among children with comorbidities than those without (4.0% vs 0.3%, and 14 vs 4 days, respectively, P < .001). The age- and sex-standardized incidence of E-BSI almost doubled in Queensland children over 2 decades, driven by increases in Salmonella sp. and E. coli. Increasing resistance of E. coli should prompt the inclusion of children in antimicrobial clinical trials.

Evaluation of dupilumab on the disease burden in children and adolescents with atopic dermatitis: A population-based cohort study.

Dupilumab is the first and only biologic agent approved for the treatment of atopic dermatitis (AD) in pediatric patients aged from 6 months to 17 years. The study aimed to evaluate the impact of dupilumab on the occurrence of comorbidities in pediatric patients with AD. In this population-based cohort study, we utilized electronic healthrecords from multiple healthcare organizations across the United States. Pediatric patients (<18 years of age) with a diagnosis of AD initiating dupilumab were propensity-score matched 1:1 to those initiating other systemic agents (azathioprine, cyclosporine, methotrexate, mycophenolate mofetil, or systemic corticosteroids). The primary outcomes were new-onset comorbidities emerging during the study period measured by the risk ratio (RR) and its confidence interval (CI). Subgroup analyses were stratified by age (0-5 years, 6-11 years, and 12-17 years), sex, and race. A total of 3575 pediatric patients with AD treated with dupilumab were matched to 3575 patients treated with other systemic agents. The dupilumab cohort was associated with a lowered risk of new-onset atopic comorbidities (including asthma [RR, 0.72; 95% CI, 0.59-0.89] and allergic rhinitis [RR, 0.62; 95% CI, 0.52-0.74]), infections (e.g., skin and soft tissue infection [RR, 0.70; 95% CI, 0.63-0.76] and respiratory tract infection [RR = 0.56; 95% CI, 0.51-0.61]), psychiatric disorders (e.g., mood disorder [RR, 0.52; 95% CI, 0.39-0.70] and anxiety [RR, 0.57; 95% CI, 0.46-0.70], sleep disturbance [RR, 0.60; 95% CI, 0.47-0.77]), neurologic and developmental disorders (e.g., attention deficit hyperactivity disorder [RR, 0.54; 95% CI, 0.38-0.75]). Furthermore, the positive effects are found to be more pronounced in younger children (aged 0-5 years) with AD. Treatment with dupilumab compared to systemic agents resulted in reductions in AD-related comorbidities in pediatric patients.

Changes in the epidemiological characteristics of influenza in children in Zhengzhou, China, in the post-COVID-19 era

BackgroundInfluenza is a contagious respiratory disease posing a huge burden of disease for children around the world. The purpose of this study was to investigate the epidemiologic changes in childhood influenza in Zhengzhou, China, before, during, and after the COVID-19 outbreak. The aim of this study was to determine the impact of the COVID-19 outbreak and related prevention and control policies on the children’s influenza epidemiological trend.MethodsAll influenza report card data from the Children’s Hospital Affiliated with Zhengzhou University’s Disease Surveillance Reporting Management System were collected and analyzed monthly from January 2018 to December 2023. The period of the study was divided into three phases for comparison: the pre-pandemic period, the pandemic period, and the post-pandemic period.ResultsBetween January 2018 and December 2023, a total of 82,030 children with influenza were diagnosed at our hospital, including 46,453 males and 35,577 females. A total of 11,833 of them had to be hospitalized for influenza, and 321 of them were brought to the ICU. Influenza showed low-level epidemiologic status during the COVID-19 pandemic, and there was a substantial rise in influenza and a surge in the number of cases after the COVID-19 pandemic period. The year 2023 will had the most influenza cases (40,785). The peak incidence of influenza changes in 2022, from July to October, and in 2023, from February to April and from October to December. During the post-pandemic period, the proportion of new-borns and young children among influenza patients decreased, while the proportion of school-age children increased significantly, and the proportion of influenza patients hospitalized and the proportion of ICU admissions decreased.ConclusionInfluenza showed low-level epidemiologic status during the COVID-19 pandemic. In the post-pandemic period, there is a large increase in influenza incidence, with a double peak in influenza incidence. The proportion of school-age children with influenza has also increased. As a result, we recommend that influenza vaccination for key populations, particularly school-age children, be completed by October of each year in Henan Province, and that the government and schools increase education about nonpharmacological influenza prevention approaches.

Effectiveness of nirsevimab introduction against respiratory syncytial virus in the Valencian Community: A preliminary assessment

Respiratory syncytial virus (RSV) represents a high burden of disease in children and the primary cause of hospitalization, especially in children under 1 year old. In the Valencian Community (Spain), nirsevimab, a long-acting monoclonal antibody, was introduced for the RSV 2023–2024 season as a universal pre-exposure prophylaxis for high-risk children and those under 6 months old. This study examines its impact, coverage, and effectiveness. The campaign achieved 88.5 % coverage and 73.7 % of effectiveness. Analysis of over 27,000 susceptible children (over 24,000 immunized), showed that those immunized exhibited a threefold reduction in RSV incidence compared to non-immunized ones. To prevent one case, the number needed to immunize (NNI) was 63. Hospitalizations due to acute respiratory infections were almost two times lower in immunized children compared to non-immunized ones (0.9 % vs 1.6 %, respectively). These first results showcase the preliminary positive impact of this public health intervention.

Impact of SARS-CoV-2 Pandemic on Emergency Hospitalizations for Acute Respiratory Infections: The Experience of a Paediatric Tertiary Care Hospital in Italy.

Acute respiratory infections (ARIs) are a major healthcare issue in children. The SARS-CoV-2 pandemic changed the epidemiology of ARIs; the aims of this study are to characterize the epidemiological trend of ARI emergency hospitalizations and virology results and to estimate the association of ARI emergency hospitalizations with respiratory viruses from January 2018 to June 2023. This study was carried out in an Italian tertiary care children's hospital (Bambino Gesù Children's Hospital). The demographic and clinical information of children who accessed the Emergency Department (ED) with ARI and were hospitalized were retrospectively extracted from the electronic health records. Multivariate linear regression model was used to compare the number of ARI hospital admissions with the reported temporal trends in viruses diagnosed from respiratory samples throughout the same time period. During the study period, there were 92,140 ED visits and 10,541 hospitalizations due to ARIs, reflecting an admission rate of 11.4%. The highest proportion of hospitalizations occurred in infants ≤ 1 year of age (n = 4840, 45.9% of total admissions), with a hospitalization rate of 22.6%. Emergency hospitalizations aligned closely with the predictions made by the multivariate regression model; peaks in hospitalizations reflected Respiratory Syncytial Virus (RSV) circulation. ARI hospital urgent admissions are a relevant component of ARI disease burden in children. RSV prevention and control are crucial to limit the risk of urgent hospitalizations due to ARIs.

Insurance record-based analysis of the burden of disease in children, adolescents, and adults with galactosemia in the US

Insurance record-based analysis of the burden of disease in children, adolescents, and adults with galactosemia in the US

FACTORS INFLUENCING INTEGRATED MANAGEMENT OF NEWBORN CHILDHOOD ILLNESSES (IMNCI) UPTAKE AMONG CHILDREN IN CMH GILGIT, PAKISTAN

In developing countries, about 9 million children die before reaching the age of 5 every year, with 70% of these deaths attributable to five central diseases (measles, diarrhea, pneumonia, malaria, and malnutrition). The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recognized the importance of early care-seeking and have developed the "integrated management of childhood illness" to promote proper healthcare practices within families and communities and decrease the mortality rate of children under five in developing countries. This study aimed to improve the health-seeking behaviour of mothers and reduce the burden of disease in children under five, with specific objectives to assess the factors affecting the uptake of integrated management of childhood illness (IMNCI) and the health-seeking behaviour of mothers. Using a structured questionnaire, a hospital-based cross-sectional study was conducted on 156 randomly selected parents of patients at CMH, Gilgit, from August to December 2016. The chi-square test determined associations between different factors and mothers' health-seeking behaviour. The results showed strong associations at p=0.05 and a 95% confidence interval with n=156. Strong associations were found between the first care given and the head of the family (p=0.02) and between health problems and the head of the family (p=0.01). The findings also indicated a strong relationship between the head of the family and restrictions when seeking care for a sick child (p=0.00). Maternal education positively impacts health outcomes, leading to fewer family restrictions, early identification of problems, and improved decision-making when seeking healthcare.

Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis

BackgroundEpilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems.ObjectiveThis study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa.MethodsA comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran’s Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger’s correlation and Begg’s regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals.ResultIn this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children.ConclusionNearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.

Association of Wheezing Requiring Hospitalization Before 2 Years of Age With Autoimmune Diseases During Childhood: A 15-Year Follow-up Study From Birth.

Wheezing in early life is most frequently caused by viral lower respiratory tract illnesses, constituting a significant disease burden in children. This study aimed to investigate the association of wheezing in early life with autoimmune diseases throughout childhood. A population-matched retrospective cohort study was conducted in Korea between 2002 and 2017. The cohort comprised 34,959 children admitted with viral wheezing before 2 years of age and an equal number of the matched unexposed children born in 2002 and 2003. Exposed infants were defined as those hospitalized for bronchiolitis or bronchial asthma before the age of 2. Unexposed controls were matched by sex and birth year at a 1:1 ratio, using incidence density sampling. A Cox proportional hazard model controlled for multiple risk factors was employed. The median age at hospitalization for wheeze was 9 months (interquartile range, 5-15 months), and 63% of the exposed infants were male. Over the mean 15-year follow-up period, the incidence rate of autoimmune diseases was 74.0 and 62.2 per 10,000 person-years in the exposed and matched unexposed cohorts, respectively. The adjusted hazard ratio for any autoimmune disease in the exposed cohort was 1.15 (95% confidence interval, 1.09-1.23) in comparison with the unexposed cohort. The exposed cohort revealed an augmented risk for specific autoimmune diseases, including juvenile idiopathic arthritis, Kawasaki disease, Henoch-Schönlein purpura, psoriasis, idiopathic thrombocytopenic purpura, and immunoglobulin A nephropathy. Risks were heightened for children with multiple wheezing episodes or a persistent wheezing episode after the age of 2 years. This research identifies associations between early-life wheeze and the development of autoimmune diseases in childhood. Understanding these relationships can aid in recognizing the underlying pathophysiology of early-life wheeze and childhood autoimmune diseases, contributing to management strategies for these conditions.

Assessing the disease burden of air pollution on children and adolescents in China from 1990 to 2019

&lt;p&gt;Air pollution is a pressing concern in China, particularly its adverse effects on vulnerable populations such as children and adolescents. This study aimed to elucidate the disease burden in children and adolescents attributable to air pollution in geographical areas across China from 1990 to 2019. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 methodology to estimate disease burden attributable to air pollution in 33 areas of China, including provinces, autonomous regions, municipalities, and special administrative regions. In 2019, approximately 10,511 childhood deaths and 932,095 disability-adjusted life-years (DALYs) were attributable to air pollution in China. The DALYs was higher for boys and infants &lt;1 year than it was for girls. Lower respiratory infections, neonatal preterm birth, and neonatal encephalopathy caused by birth asphyxia and trauma were the main air pollution-related diseases. The disease burden attributable to air pollution in children and adolescents decreased significantly from 1990 to 2019; with the average annual percent change (AAPC) of ?9.11% ([95%CI, ?9.61% to ?8.60%], P&lt;0.001) for death rate, and ?9.09% ([?9.59% to ?8.58%], P&lt;0.001) for DALYs rate. Disease burden attributable to air pollution in children and adolescents varied across provinces, with DALYs rate per 100,000 population ranged from 16.88 in Hong Kong to 2,152.54 in Tibet, peaking in the health area five. These findings highlight the necessity for province-specific research into the impacts of air pollution on childhood health in China, as well as improved air pollution control measures.&lt;/p&gt;

Role of Nidana Parivarjana as a Line of Management in Pureeshaja Krimiroga

Krimi is used to denote tiny organism which reside in human body. The concept of Krimi and their relation in development of disease is mentioned by Ayurveda literature. Krimi Roga, a serious morbidity, contributes significantly to disease burden in children and causes malnourishment and stunted growth in them. Aharaja and Viharaja Nidana plays an important role in growth of Krimi. Treatment modalities mentioned for Krimiroga are Apakarshana, Prakriti Vighata and Nidana Parivarjana. Concept of Nidana Parivarjana holds important role in prevention as well as treatment of disease especially in Krimiroga.

Correlation of Body Mass Index with Blood Pressure in School Going Children Aged 6 To 14 Years in Ramdhuni Municipality of Eastern Nepal

Introduction: Children of school age groups in developing countries are facing the problem of overweight and obesity. Childhood obesity continues as obesity in adulthood. The chance of high blood pressure (BP) in overweight and obese children is more than healthy weight children. However, in Nepal, data on the relationship between hypertension and obesity, and disease burden in children at the national level are limited. To overcome these diseases and to develop effective prevention strategies, knowing the prevalence of the disease is a priority. Thus, this study aims to determine the prevalence and the relationship between overweight/obesity with BP in school going children aged 6-14 years, living in Ramdhuni municipality of eastern Nepal.&#x0D; Objective: To find prevalence and the association of BMI with blood pressure in school going children aged 6 to 14 years in Ramdhuni municipality of eastern Nepal.&#x0D; Methodology: This was a school based cross-sectional prospective study conducted at various schools in Ramdhuni municipality from February -March 2022. A total of 490 apparently healthy students of age group 6-14 years of both boys and girls were enrolled. Measurement of height and weight was done by standard procedure. The data was entered into Microsoft offices excel and analyzed using a statistical package for social sciences (SPSS 20.0).&#x0D; Results: In this present study, data of 490 students aged between 6 and 14 years were evaluated. Of them, 77.8% (n=381) were normal weight, 10.6% (n=52) were overweight and 5.9% (n=29) were obese. The prevalence of hypertension and prehypertension was 0.8% (n=4) and 0.6% (n=3), respectively. The body mass index was statistically significant as an explanatory variable of hypertension for both genders.&#x0D; Conclusion: This study concludes that overweight and obese children are at a significantly higher risk for hypertension than are normal weight children. Blood pressure measurement should be routine and frequent in children, especially overweight and obese children.

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia.

The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Quantifying the environmental burden of disease for children and adolescents in Germany

Abstract Introduction Children and adolescents are more vulnerable to the impacts of environmental risk factors. They are in a sensitive stage of life, where the organ systems are still developing. Already minor interferences can have an effect on their future health. The UKAGEP-project aimed to estimate the Environmental Burden of Disease (EBD) for children and adolescents in Germany. Methods We tested the feasibility of applying the EBD-concept, developed by the World Health Organization, for 18 environmental risk factors. Where possible, data from the German Environmental Survey (GerES V) was used as the basis for the analyses. In addition, we performed systematic literature searches to identify adequate exposure-response-relationships. Results EBD quantifications were performed for 5 out of 18 environmental risk factors (PM2.5, bisphenol A, environmental noise, second-hand smoke and benzene). For the remaining risk factors, only particular steps of the EBD approach were realized. Taking two exemplary risk factors, about 28 % (170,000) of all obesity cases in the 7-17-year-olds were due to the exposure to bisphenol A and nearly 5 % (1,300) of the disability-adjusted life years for lower respiratory tract infections in 3-17-year-olds were attributable to PM2.5 in 2016. Conclusions Even though quantifications were performed for several risk factors, we had to conclude that for the remainder, availability and quality, especially of the exposure-response relationships and health data, were not sufficient to estimate burden of disease. Further, the exposure to some of these risk factors assessed in the GerES-V-study was too low to allow estimating the EBD. This does not mean that the identified concentrations were generally uncritical or that lifelong exposure could not lead to health impairments in the further life course. It only means that potential health outcomes have not occurred yet or the concentrations may lead to subclinical alterations in human body systems. Key messages • Environmental risk factors cause considerable burden in children and adolescents. • Estimating the environmental burden of disease for children and adolescents remains challenging.

Adrenergic and mesenchymal signatures are identifiable in cell-free DNA and correlate with metastatic disease burden in children with neuroblastoma.

Cell-free DNA (cfDNA) profiles of 5-hydroxymethylcytosine (5-hmC), an epigenetic marker of open chromatin and active gene expression, are correlated with metastatic disease burden in patients with neuroblastoma. Neuroblastoma tumors are comprised of adrenergic (ADRN) and mesenchymal (MES) cells, and the relative abundance of each in tumor biopsies has prognostic implications. We hypothesized that ADRN and MES-specific signatures could be quantified in cfDNA 5-hmC profiles and would augment the detection of metastatic burden in patients with neuroblastoma. We previously performed an integrative analysis to identify ADRN and MES-specific genes (n=373 and n=159, respectively). Purified DNA from cell lines was serial diluted with healthy donor cfDNA. Using Gene Set Variation Analysis (GSVA), ADRN and MES signatures were optimized. We then quantified signature scores, and our prior neuroblastoma signature, in cfDNA from 84 samples from 46 high-risk patients including 21 patients with serial samples. Samples from patients with higher metastatic burden had increased GSVA scores for both ADRN and MES gene signatures (p<.001). While ADRN and MES signature scores tracked together in serially collected samples, we identified instances of patients with increases in either MES or ADRN score at relapse. While it is feasible to identify ADRN and MES signatures using 5-hmC profiles of cfDNA from neuroblastoma patients and correlate these signatures to metastatic burden, additional data are needed to determine the optimal strategies for clinical implementation. Prospective evaluation in larger cohorts is ongoing.

Genomic, transcriptomic, and phenotypic differences among archetype Shigella flexneri strains of serotypes 2a, 3a, and 6.

Given the genomic diversity between S. flexneri serotypes and the paucity of data to support serotype-specific phenotypic differences, we applied in silico and in vitro functional analyses of archetype strains of 2457T (Sf2a), J17B (Sf3a), and CH060 (Sf6). These archetype strains represent the three leading S. flexneri serotypes recommended for inclusion in multivalent vaccines. Characterizing the genomic and phenotypic variation among these clinically prevalent serotypes is an important step toward understanding serotype-specific host-pathogen interactions to optimize the efficacy of multivalent vaccines and therapeutics. This study underpins the importance for further large-scale serotype-targeted analyses.

Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic.

Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations. To describe the epidemiology and burden of RSV-associated hospitalizations among children and adolescents in Canadian tertiary pediatric hospitals from 2017 to 2022, including changes during the COVID-19 pandemic. This cross-sectional study was conducted during 5 RSV seasons (2017-2018 to 2021-2022) at 13 pediatric tertiary care centers from the Canadian Immunization Monitoring Program Active (IMPACT) program. Hospitalized children and adolescents aged 0 to 16 years with laboratory-confirmed RSV infection were included. The proportion of all-cause admissions associated with RSV and counts and proportions of RSV hospitalizations with intensive care unit (ICU) admission, prolonged stay (≥7 days), and in-hospital mortality were calculated overall and by season, age group, and region. Seasonality was described using epidemic curves. RSV hospitalizations for 2021-2022 were compared with those in the prepandemic period of 2017-2018 through 2019-2020. Bonferroni corrections were applied to P values to adjust for multiple statistical comparisons. Among 11 014 RSV-associated hospitalizations in children and adolescents (6035 hospitalizations among male patients [54.8%]; 5488 hospitalizations among patients aged <6 months [49.8%]), 2594 hospitalizations (23.6%) had admission to the ICU, of which 1576 hospitalizations (60.8%) were among children aged less than 6 months. The median (IQR) hospital stay was 4 (2-6) days. The mean (SD) number of RSV-associated hospitalizations during prepandemic seasons was 2522 (88.8) hospitalizations. There were 58 hospitalizations reported in 2020-2021, followed by 3170 hospitalizations in 2021-2022. The proportion of all-cause hospitalizations associated with RSV increased from a mean of 3.2% (95% CI, 3.1%-3.3%) before the pandemic to 4.5% (95% CI, 4.3%-4.6%) in 2021-2022 (difference, 1.3 percentage points; 95% CI, 1.1-1.5 percentage points; corrected P < .001). A significant increase in RSV-associated hospitalizations was found in 2021-2022 for 3 provinces (difference range, 2.5 percentage points; 95% CI, 1.4-3.6 percentage points for Quebec to 2.9 percentage points; 95% CI, 1.4-3.5 percentage points for Alberta; all corrected P < .001). Age, sex, ICU admission, prolonged length of stay, and case fatality rate did not change in 2021-2022 compared with the prepandemic period. Interregional differences in RSV seasonality were accentuated in 2021-2022, with peaks for 1 province in October, 4 provinces in December, and 3 provinces in April, or May. This study found that the burden of RSV-associated hospitalizations in Canadian pediatric hospitals was substantial, particularly among infants aged less than 6 months, and RSV hospitalizations increased in 2021-2022 compared with the prepandemic period, while severity of illness remained similar. These findings suggest that RSV preventive strategies for infants aged less than 6 months would be associated with decreased RSV disease burden in children.

Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia.

The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.

Understanding the patient experience of Classic Galactosemia in pediatric and adult patients: increased disease burden, challenges with daily living, and how they evolve over time

BackgroundClassic Galactosemia (CG) is a rare, autosomal recessive condition. Newborn screening and a timely galactose-restricted diet can resolve acute symptoms and decrease fatalities, but significant chronic, progressive morbidities remain and significantly impact daily life. The objective of this study was to better understand the burden of disease in children and adults with CGs and describe how morbidities evolve over time.MethodsA total of 49 individuals with CG from the United States (US) were included in the qualitative surveys (13 adults [9 self-reported] and 36 pediatric patients). Fifteen follow-up interviews were conducted with 5 adults and 10 caregivers, discussing 17 individuals with CG overall (2 caregivers each discussed 2 children).ResultsQualitative survey and interview data demonstrated the substantial burden of CG. Difficulties in a wide range of functions were experienced, which included: speech articulation; language and communication; cognition, memory and learning; emotions; and social interactions. Most difficulties appeared in childhood and persisted or worsened with age. Most adults did not live independently. Others lived semi-independently and experienced many daily challenges and required support. Caregivers also described the burden of caring for someone with CG and spoke about the impact this has on their day-to-day life, work, and relationships.ConclusionsThese findings demonstrate the pronounced and persistent burden of disease encountered by individuals with CG, and that the condition has a significant impact on the quality of life of caregivers.

Challenges when estimating the environmental burden of disease for children in Germany

Challenges when estimating the environmental burden of disease for children in Germany