Infectious Disease Experts Research Articles

Lessons Learned From Clinical Trials of Immunotherapeutics for COVID-19.

The COVID-19 pandemic caused by the SARS-CoV-2 virus was arguably one of the worst public health disasters of the last 100 years. As many infectious disease experts were focused on influenza, MERS, ZIKA, or Ebola as potential pandemic-causing agents, SARS-CoV-2 appeared to come from nowhere and spread rapidly. As with any zoonotic agent, the initial pathogen was able to transmit to a new host (humans), but it was poorly adapted to the immune environment of the new host and resulted in a maladapted immune response. As the host-pathogen interaction evolved, subsequent variants of SARS-CoV-2 became less pathogenic and acquired immunity in the host provided protection, at least partial protection, to new variants. As the host-pathogen interaction has changed since the beginning of the pandemic, it is possible the clinical results discussed here may not be applicable today as they were at the start of the pandemic. With this caveat in mind, we present an overview of the immune response of severe COVID-19 from a clinical research perspective and examine clinical trials utilizing immunomodulating agents to further elucidate the importance of hyperinflammation as a factor contributing to severe COVID-19 disease.

Remote Practice of Infectious Diseases Through Telemedicine: Improving Access for Patients and Appeal for Physicians

Abstract The specialty of Infectious Diseases (ID) is facing headwinds in attracting new physicians into training and clinical practice, leading to workforce shortage and rising burnout among existing ID physicians. The distribution of ID physicians across the country is skewed and many Americans do not have access to ID expertise. Novel care models are needed to ensure the longevity of the ID specialty and patient access to ID care. ID telemedicine provides a new opportunity for ID physicians with the benefits of residing in one’s preferred geographic location, eliminating the need to commute, and structuring the workday to improve work-life balance. This viewpoint, which includes personal experiences in transitioning from in-person to remote ID practice, describes the extent of challenges facing the ID specialty, and how telemedicine can reduce burnout among ID physicians, attract more physicians into the specialty, and improve access to ID care.

Healthcare workers’ knowledge and preparedness for unprecedented foodborne botulism outbreak in Saudi Arabia

BackgroundThe recent unprecedented foodborne botulism outbreak in Saudi Arabia necessitated an assessment of healthcare workers' (HCWs) knowledge, attitudes, and practices (KAP). This study assessed healthcare workers' knowledge regarding the transmission, contagiousness, presentation, and diagnosis of foodborne botulism, as well as their management practices, including contacting public health authorities, administering antitoxin, preparedness to respond to botulism cases and consulting generative Artificial Intelligent (AI)-chatbots, like ChatGPT. MethodsA cross-sectional online survey targeting Saudi HCWs was conducted from May 6–19, 2024, following the first foodborne botulism outbreak. The survey, developed by infectious disease and public health experts according to the Saudi Public Health Authority (SPHA) botulism guidelines, covered several sections: demographics, knowledge about foodborne botulism, attitudes and perceptions, intended practices, and worry level. Statistical analysis included descriptive statistics, multivariable linear regression to assess factors influencing knowledge, and multivariable logistic binary regression to evaluate factors affecting confidence in handling botulism. ResultsAmong the 1058 participants, the knowledge score was 9.69/20 (48.4 % correct ± 18 %), with higher scores among HCWs working in tertiary centers, older than 34 years, reading SPHA botulism protocol, and using scientific journals as main information sources. HCWs consulting ChatGPT had significantly lower knowledge scores (p-value < 0.001). HCWs displayed highly intended practices in managing botulism, with a mean score of 4.10/5. The self-rated management confidence was moderate (2.84 ± 1.05 out of 5-points). Multivariable logistic binary regression showed that previous experience with botulism and reading SPHA protocol were the most significant factors associated with a higher management confidence. ConclusionsThis study highlights significant HCWs’ knowledge gaps during unprecedented foodborne botulism outbreak. Previous experience with botulism cases and reading recent guidelines were associated with higher knowledge and confidence, while reliance on ChatGPT was linked to lower scores. This study emphasizes the importance of timely publishing local guidelines to favorably affect both knowledge and confidence to deal with infectious outbreaks. Future research should evaluate long-term effectiveness of educational interventions.

Practice guideline of influenza vaccination and antiviral drugs use in children(2024 editon)

Influenza is the most common acute respiratory infectious diseases among children in China. The annual seasonal influenza outbreak has a significant impact on children's health, poses a significant disease and socioeconomic burden, and arouses a wide public concern. In recent years, a number of new influenza vaccines and influenza antivirals have been approved for use in children, expanding the choices for prevention and treatment of influenza. Pediatric Infection Group, Chinese Society of Infectious Diseases of Chinese Medical Association and Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, and China Clinical Practice Guidelines Alliance Methodology Committee organized a multidisciplinary guideline development group (GDG) consisting of experts in pediatrics, infectious diseases,epidemiologists,health policy,and guideline methodology proposed eight key issues concerning influenza vaccination and antiviral use from a practice perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated. This guideline is intended to provide guidance for pediatricians at different facility levels and healthcare providers engaged in vaccination services,and institutional professionals dealing with prevention and control of infectious diseases.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (&amp;gt;300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

The coming microbial crisis: Our antibiotic bubble is about to burst

This month, the United Nations (UN) General Assembly will convene its second High-Level Meeting on antimicrobial resistance , urging UN member states to take decisive action against this growing threat. The US Centers for Disease Control and Prevention (CDC) has released a list of the drug-resistant bacterial and fungal infections that pose the greatest concern to public health. Yet, despite increasing warnings from infectious disease experts, the public remains largely unaware of the true scale of the problem. In a world where antibiotics still protect us from bacterial infections, we are shielded from experiencing antimicrobial resistance as an immediate threat to our daily lives.

Knowledge, attitudes, and practices on leprosy among dermatology residents in the Philippines

Introduction: leprosy is a chronic bacterial infection caused by Mycobacterium leprae and Mycobacterium lepromatosis, primarily affecting the skin and peripheral nerves. Dermatologists play an important role in diagnosing and treating patients affected with leprosy and are equipped with adequate knowledge about the clinical presentation and management of patients with leprosy. Methods: a cross-sectional study was conducted on the knowledge, attitudes, and practices of leprosy among dermatology residents in the Philippines using a selfadministered online questionnaire. The study was conducted in two phases: Phase I was the development of the questionnaire, and Phase II was the survey proper, where the questionnaire was administered to dermatology residents in the Philippines via convenience sampling. Descriptive statistics appropriate for the study variables were used. Results: in Phase I of the study, a questionnaire was validated by three leprosy and infectious disease experts and pilot-tested on ten dermatology graduates in the year 2022, showing that items had high scores for validity and reliability. Phase II involved administering the survey to dermatology residents. Data showed that overall, 46 of 118 participants (38.98%) obtained a satisfactory score of 80% and higher on knowledge, 101 of 118 (85.59%) exhibited a positive attitude, and 116 of 118 (98.31%) had adequate practices. Moreover, first-year residents exhibit lower attitude scores than those in higher years, and no significant differences in knowledge and practices were found based on the practice setting. Conclusion: results of the study show that less than half of the included resident dermatologists had satisfactory knowledge of leprosy. However, we identified gaps in these physician’s knowledge, mainly in peripheral assessment nerve function, doses, and duration of treatment for leprosy peoples. On the other hand, participants were noted to have an overall positive attitude towards leprosy and adequate practices.

Budget Impact Analysis for the Spread and Financial Sustainability of Videoconference Antimicrobial Stewardship Programs

Background: In rural areas, antimicrobial stewardship programs often have limited access to infectious disease (ID) expertise. Videoconference Antimicrobial Stewardship Teams (VASTs) pair rural Veterans Affairs (VA) medical centers with an ID expert to discuss treatment of patients with concerns for infection. In a pilot study, VASTs were effective at improving antimicrobial use. Here, we evaluated 12-month operating costs for staffing for 3 VASTs. Methods: We used the following data to describe 12 months of clinical encounters for 3 VASTs operating from January 2022 – March 2023: the number of VAST sessions completed and clinical encounters; Current Procedural Terminology (CPT) codes associated with clinical encounters; session attendees (by role) and the time spent (percent effort) on VAST-related activities. The annual operating cost was based on the annual salaries and percent effort of VAST attendees. We used these characteristics combined with private-sector and Medicare reimbursements to evaluate the cost of implementation and number of clinical encounters needed to offset those costs (breakeven) for each site. Results: Three VASTs recorded 229 clinical encounters during 117 sessions (Table 1). Based on CPT codes, the approximate revenue per patient was $516.46. Site A, the only site to break even, had the most sessions and clinical encounters as well as the lowest operating costs. For Site B, a slight increase in the clinical encounters, which might be achieved by 3 additional VAST sessions, would help achieve breakeven. For Site C, increasing the number of clinical encounters to 3-4 per session would have helped their VAST break even without requiring a decrease in operating costs. Conclusions: The frequency of VAST sessions, volume of clinical encounters, and low operating costs all contributed the VAST at Site A achieving a financial break-even point within 12 months. Consideration of the potential number of clinical encounters and sessions will help other VASTs achieve financial sustainment, independent of cost-savings related to potential decreases in expenditures for antibiotics and antibiotic-related adverse events. These results also provide insight into possible adoption and diffusion of VAST-like programs in the Medicare hospital setting.

Exploring the Singapore general population's trust in COVID-19 information from different sources and its association with perceived risk of infection during the pandemic.

The degree of public trust in the government's competence is crucial in preventing the spread of misinformation and reducing psychological distress during a pandemic. The study aimed to (i) explore the trust in COVID-19 information from different sources and trust in the ability of the World Health Organization (WHO), government departments and related institutions in handling the epidemic in Singapore and (ii) its association with perceived risk of infection among Singapore residents. A total of 1,129 participants (aged 21 and above) were recruited from a cross-sectional study examining the well-being and resilience of Singapore's population between May 2020 to June 2021. Trust in COVID-19 information from different sources was measured on a 10-point scale and an ordinal 7-point scale was used for perceived risk of infection. Descriptive statistics and multivariate logistic regression model were conducted. 85.5% reported high trust in COVID-19 information from the government and their ability in handling the pandemic. Participants also reported high trust in COVID-19 information from local public health or infectious disease experts (84.4%) and traditional media (77.2%). Low trust in the ability of government departments and related institutions was associated with higher future (1 month) perceived risk of infection (OR: 5.7, 95% CI 1.02-32.45) and low trust in social media was associated with higher current perceived risk of infection (OR: 2.4, 95% CI 1.09-5.24). The present study provided insight on the level of trust on COVID-19 information from different sources and its associated perceived risks of infection. Future qualitative studies are recommended to facilitate better understanding of public trust and identify strategies for how it can be effectively addressed to support future public health responses.

Towards XAI agnostic explainability to assess differential diagnosis for Meningitis diseases

Meningitis, characterized by meninges and cerebrospinal fluid inflammation, poses diagnostic challenges due to diverse clinical manifestations. This work introduces an explainable AI automatic medical decision methodology that determines critical features and their relevant values for the differential diagnosis of various meningitis cases. We proceed with knowledge acquisition to define the rules for this research. Currently, we have established the etiological diagnosis of Meningococcaemia, Meningococcal Meningitis, Tuberculous Meningitis, Aseptic Meningitis, Haemophilus influenzae Meningitis, and Pneumococcal Meningitis. The data preprocessing was conducted after collecting data from samples with meningitis diseases at Setif Hospital in Algeria. Tree-based ensemble methods were then applied to assess the model’s performance. Finally, we implement an XAI agnostic explainability approach based on the SHapley Additive exPlanations technique to attribute each feature’s contribution to the model’s output. Experiments were conducted on the collected dataset and the SINAN database, obtained from the Brazilian Government’s Health Information System on Notifiable Diseases, which comprises 6729 patients aged over 18 years. The Extreme Gradient Boosting model was chosen for its superior performance metrics (Accuracy: 0.90, AUROC: 0.94, and F1-score: 0.98). Setif’s hospital data revealed notable performance metrics (Accuracy: 0.7143, F1-Score: 0.7857). This study’s findings showcase each feature’s contribution to the model’s predictions and diagnosis. It also reveals critical biomarker ranges associated with distinct types of Meningitis. Significant diagnostic effect was found for Meningococcal Meningitis with elevated neutrophil levels ( > 40%) and balanced lymphocyte levels (40%–60%). Tuberculous Meningitis demonstrated low neutrophil levels ( < 60%) and elevated lymphocyte levels ( > 60%). H. influenzae meningitis exhibited a predominance of neutrophils ( > 80%), while Aseptic meningitis showed lower neutrophil levels ( < 40%) and lymphocyte levels within the range of 50%–60%. The majority of the AI automatic medical decision results are twinned with validation by our team of infectious disease experts, confirming the alignment of algorithmic diagnoses with clinical practices.

Development of a Biosafety Level 1 Cellular Assay for Identifying Small-Molecule Antivirals Targeting the Main Protease of SARS-CoV-2: Evaluation of Cellular Activity of GC376, Boceprevir, Carmofur, Ebselen, and Selenoneine.

While research has identified several inhibitors of the main protease (Mpro) of SARS-CoV-2, a significant portion of these compounds exhibit reduced activity in the presence of reducing agents, raising concerns about their effectiveness in vivo. Furthermore, the conventional biosafety level 3 (BSL-3) for cellular assays using viral particles poses a limitation for the widespread evaluation of Mpro inhibitor efficacy in a cell-based assay. Here, we established a BSL-1 compatible cellular assay to evaluate the in vivo potential of Mpro inhibitors. This assay utilizes mammalian cells expressing a tagged Mpro construct containing N-terminal glutathione S-transferase (GST) and C-terminal hemagglutinin (HA) tags and monitors Mpro autodigestion. Using this method, GC376 and boceprevir effectively inhibited Mpro autodigestion, suggesting their potential in vivo activity. Conversely, carmofur and ebselen did not exhibit significant inhibitory effects in this assay. We further investigated the inhibitory potential of selenoneine on Mpro using this approach. Computational analyses of binding energies suggest that noncovalent interactions play a critical role in facilitating the covalent modification of the C145 residue, leading to Mpro inhibition. Our method is straightforward, cost-effective, and readily applicable in standard laboratories, making it accessible to researchers with varying levels of expertise in infectious diseases.

Alasdair Geddes: infectious disease expert and bioterrorism adviser who diagnosed the world’s last reported case of smallpox

Alasdair Geddes: infectious disease expert and bioterrorism adviser who diagnosed the world’s last reported case of smallpox

Guidelines for diagnosis and management and prevention of pertussis of China (2024 edition)

Pertussis re-emergence is a global public health concern. The reported incidence of pertussis in China from 2018 to 2022 was comparable to that in the late 1980s. In fact, the incidence of pertussis is still significantly underestimated in China, owing to a lack of comprehensive active pertussis surveillance, missed diagnosis of atypical pertussis cases, and the fact that many medical institutions do not perform pertussis laboratory diagnosis. Meanwhile, China is also faced with the clinical issue that Bordetella pertussis is highly resistant to first-line macrolide treatment. To better guide and standardize the clinical diagnosis, treatment, monitoring, prevention and control of pertussis cases in China, a multidisciplinary guideline development group comprised of experts in infectious diseases, epidemiology, immunization planning and guideline methodology proposed 12 clinical issues related to the diagnosis, treatment and prevention, especially vaccine immunization strategies from a practical perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated to provide references for clinical physicians engaged in the diagnosis and management of pertussis, microbiological laboratory professionals, hospital infection control professionals, and public health professionals involved in infectious disease prevention, control and immunization planning.

유치원 교사의 유아 감염병 예방교육 현황과 보건교사 방문교육에 대한 요구

The purpose of this study is to obtain implications for kindergarten health education by grasping the current status of kindergarten's infectious disease prevention education and the demand for health teachers' visiting education. The subjects of this study were 151 teachers currently working in kindergarten in ‘S’ city, who participated in an online survey. Findings revealed that most of them had experience in early childhood infectious disease prevention education, and most of the instructors were themselves. Their difficulties were the lack of expertise in infectious diseases and the lack of activities and play support materials. They responded that ‘methods and activities of infection prevention’ are the most necessary educational content. ‘Infection prevention methods and activities’ and ‘the importance of preventing infectious diseases’ is suitable from the age of 3, In addition, home support activities are required, and Home letters, card news, and expert lectures are preferred. Mostly, they need early childhood infectious disease prevention education visited by health teachers, and they are willing to participate in projects. They responded that group activity for visiting health teachers is preferably around 30 minutes, and related activities and plays are required along with the class. The results of this study are expected to be used as basic data for early childhood infectious disease prevention education projects visited by health teachers

Infectious Diseases - a new specialty for postgraduate training in Germany

Medicine in Germany is currently facing major structural and economic challenges. Infectious Diseases, with the recent introduction of a new specialty in "Internal Medicine and Infectious Diseases" and with the existing additional training for almost all specializations, will make an important contribution to overcoming these challenges. Expertise in infectious diseases has to be very broad and requires high interdisciplinarity, which makes infectious diseases an attractive and demanding specialty. The complex fundamentals of infectious diseases must now be quickly conveyed to as many physicians as possible in a short period of time, as part of their specialization or as additional training. Until this is achieved, transitional solutions will be necessary for some time. The adaptation of the current billing and reimbursement system for infectious diseases services and improved intersectoral cooperation are of the utmost importance for the further development of the specialty.

Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing.

The role of serologic testing for SARS-CoV-2 has evolved during the pandemic as seroprevalence in global populations has increased. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct updated best practice guidance related to SARS-CoV-2 serologic testing. This guideline is an update to the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. To develop evidence-based recommendations and identify unmet research needs pertaining to the use of anti-SARS-CoV-2 antibody tests for diagnosis, decisions related to vaccination and administration of monoclonal antibodies or convalescent plasma in immunocompromised patients, and identification of a serologic correlate of immunity. A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature reviewed, identified, and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel recommends against serologic testing to diagnose SARS-CoV-2 infection in the first two weeks after symptom onset (strong recommendations, low certainty of evidence). Serologic testing should not be used to provide evidence of COVID-19 in symptomatic patients with a high clinical suspicion and repeatedly negative nucleic acid amplification test results (strong recommendation, very low certainty of evidence). Serologic testing may assist with the diagnosis of multisystem inflammatory syndrome in children (strong recommendation, very low certainty of evidence). To seek evidence for prior SARS-CoV-2 infection, the panel suggests testing for IgG, IgG/IgM, or total antibodies to nucleocapsid protein three to five weeks after symptom onset (conditional recommendation, low certainty of evidence). In individuals with previous SARS-CoV-2 infection or vaccination, we suggest against routine serologic testing given no demonstrated benefit to improving patient outcomes (conditional recommendation, very low certainty of evidence.) The panel acknowledges further that a negative spike antibody test may be a useful metric to identify immunocompromised patients who are candidates for immune therapy. The high seroprevalence of antibodies against SARS-CoV-2 worldwide limits the utility of detecting anti-SARS CoV-2 antibody. The certainty of available evidence supporting the use of serology for diagnosis was graded as very low to low. Future studies should use serologic assays calibrated to a common reference standard.

Gaining Consensus Around Patient Risk Groups and Prognostic Profiles to Guide CMV Management Among Patients With Allogeneic Hematopoietic Stem Cell Transplant: Insights From a Delphi Panel With Hematopoietic Stem Cell Transplant Experts

This study aimed to characterize patient risk groups and prognostic profiles to optimize clinical decision-making and guide appropriate medical cytomegalovirus (CMV) management among patients with allogeneic hematopoietic stem cell transplant (HSCT). Between 8/2021 and 2/2022, a 3-round modified Delphi study was conducted to generate consensus among 10 international experts in HSCT and infectious diseases. Experts were asked about treatment and prognoses for patients in 7 distinct clinical scenarios. Furthermore, experts were asked to risk-stratify patients by pre-/post-transplant characteristics. Consensus around opting for/against a treatment was observed if ≥75% or <25% of experts reported ≥50% likelihood to recommend or if treatments were ranked inside/outside the top 2 options and ≥75% of experts were within 1 SD of mean ranks. Experts agreed on several unmet needs in CMV disease management post-HSCT, particularly avoidance of treatment-limiting toxicities with conventional CMV therapy and the emergence of both refractory and drug-resistant treatment failures. Experts considered CMV viral load, resistance profile, and route of administration as critical to treatment selection. For newer CMV therapeutic options, experts listed a lack of long-term use data, concerns over potential resistance, high cost, and limited availability as challenges restricting adoption and successful patient management. Experts achieved consensus around patient risk stratifications and factors influencing therapeutic options. Recommendations emerging from this Delphi study may support practicing physicians when confronted with challenging CMV scenarios in patients with HSCT.

Guidance for prevention and management of COVID-19 in children and adolescents: A consensus statement from the Pediatric Infectious Diseases Society Pediatric COVID-19 Therapies Taskforce.

Since November 2019, the SARS-CoV-2 pandemic has created challenges for preventing and managing COVID-19 in children and adolescents. Most research to develop new therapeutic interventions or to repurpose existing ones has been undertaken in adults, and although most cases of infection in pediatric populations are mild, there have been many cases of critical and fatal infection. Understanding the risk factors for severe illness and the evidence for safety, efficacy, and effectiveness of therapies for COVID-19 in children is necessary to optimize therapy. A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacology, and pediatric intensive care medicine from 21 geographically diverse North American institutions was re-convened. Through a series of teleconferences and web-based surveys and a systematic review with meta-analysis of data for risk factors, a guidance statement comprising a series of recommendations for risk stratification, treatment, and prevention of COVID-19 was developed and refined based on expert consensus. There are identifiable clinical characteristics that enable risk stratification for patients at risk for severe COVID-19. These risk factors can be used to guide the treatment of hospitalized and non-hospitalized children and adolescents with COVID-19 and to guide preventative therapy where options remain available.

Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies.

Urinary tract infections (UTIs) pose a significant challenge in the care of renal transplant recipients. This comprehensive review explores this population's multifaceted landscape of UTIs, emphasizing the importance of early diagnosis and tailored management strategies. Renal transplant recipients face an elevated risk of UTIs due to immunosuppression, altered urinary tract anatomy, and complex comorbidities. Complications of UTIs can lead to graft dysfunction and systemic illness, underscoring the need for effective management. The emergence of multidrug-resistant uropathogens adds complexity to treatment, highlighting the importance of targeted antibiotic therapy. Antibiotics are the most commonly prescribed drugs for UTIs, with nitrofurantoin, fosfomycin, amoxicillin, and amoxicillin-clavulanate potassium being some of the commonly used antibiotics. However, the emergence of multidrug-resistant uropathogens has led to the exploration of alternative treatments, such as bacteriophage therapy, as a potential alternative against multidrug-resistant uropathogenic bacteria. Analgesics such as phenazopyridine can be prescribed to relieve discomfort associated with UTIs. Estrogen therapy has also been suggested as a potential treatment option for UTIs, particularly in postmenopausal women. Trimethoprim-sulfamethoxazole or trimethoprim is recommended as first-line therapy for uncomplicated UTIs. The choice of drug and therapy for UTIs depends on the severity of the infection, the causative organism, and the presence of antibiotic resistance.Preventive measures encompass pre-transplant evaluation, perioperative strategies, post-transplant follow-up, and vaccination. A multidisciplinary approach involving transplant specialists, infectious disease experts, pharmacists, and patient engagement is vital for successful care. The future of UTI management lies in ongoing research, exploring personalized medicine, novel therapies, and innovative prevention strategies. By implementing these strategies and advancing research, healthcare providers can improve graft and patient survival, enhancing the quality of care for renal transplant recipients.

Vaccination recommendations for adults receiving biologics and oral therapies for psoriasis and psoriatic arthritis: Delphi consensus from the medical board of the National Psoriasis Foundation

For psoriatic patients who need to receive nonlive or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving nonlive or live vaccines. Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. Key recommendations include continuing most oral and biologic therapies without modification for patients receiving nonlive vaccines; consider interruption of methotrexate for nonlive vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of livevaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4weeks after live vaccination. Studies regarding infection rates after vaccination are lacking. Interruption of antipsoriatic oral and biologic therapies is generally not necessary forpatients receiving nonlive vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases.