Incomplete Vaccination Status Research Articles

Etiologies of Mild and Moderate Diarrheal Illness among Children in Consuelo, Dominican Republic.

Since the rotavirus vaccine was included in the Dominican Republic's national immunization schedule in 2012, the microbiologic etiologies of acute gastroenteritis have not been described. This study aimed to determine the contribution of rotavirus as an etiology of acute gastroenteritis over a 12-month period in children under 5 years of age in both an inpatient and an outpatient setting in Consuelo, Dominican Republic. All children who were seen at Niños Primeros en Salud clinic or admitted to Hospital Municipal Dr. Angel Ponce Pinedo for acute gastroenteritis during January 2021-April 2022 were enrolled in the study. Stools were evaluated for rotavirus, enteric parasites, and pathogenic bacteria. Pathogen detection was compared between outpatients and inpatients and on the basis of child's vaccination status. From 181 children enrolled, 170 stool samples were collected, 28 (16.5%) from inpatients and 142 (83.5%) from outpatients. Rotavirus was the most commonly detected pathogen and was proportionately more common among hospitalized children, with nine (32.1%) cases among hospitalized children and 16 (11.3%) among outpatient children. (Pearson χ2 = 8.1, P = 0.004). Among patients with a positive rotavirus result, vaccination rate was lower among moderate (hospitalized) (three of six; 50%) compared with mild (outpatient) diarrhea patients (12 of 15; 80%). Giardia lamblia (10%) was the next most prevalent pathogen detected in both inpatients and outpatients using standard laboratory measures. Despite the availability of rotavirus vaccination, rotavirus remains a common cause of gastrointestinal illness among children under 5 years of age in our cohort. Incomplete vaccination status was associated with hospitalization for gastrointestinal illness.

Assessing vaccine-induced immunity against pneumococcus, hepatitis A and B over a 9-year follow-up in pediatric liver transplant recipients: A nationwide retrospective study

Pediatric liver transplant recipients are particularly at risk of infections. The most cost-effective way to prevent infectious complications is through vaccination, which can potentially prevent infections due to hepatitis B (HBV) virus, hepatitis A virus (HAV), and invasive pneumococcal diseases. Here, we performed a retrospective analysis of HBV, HAV, and pneumococcal immunity in pediatric liver transplant recipients between January 1, 2009, and December 31, 2020, to collect data on immunization and vaccine serology. A total of 94% (48/62) patients had available vaccination records. At transplant, 90% (45/50) were seroprotected against HBV, 63% (19/30) against HAV, and 78% (18/23) had pneumococcal immunity, but immunity against these 3 pathogens remained suboptimal during the 9-year follow-up. A booster vaccine was administered to only 20% to 40% of patients. Children who had received >4 doses of HBV vaccine and > 2 doses of HAV vaccine pretransplant displayed a higher overall seroprotection over time post-solid organ transplant. Our findings suggest that a serology-based approach should be accompanied by a more systematic follow-up of vaccination, with special attention paid to patients with an incomplete vaccination status at time of transplant.

The relationship between COVID-19 vaccination status in pregnancy and birthweight

Despite findings that maternal COVID-19 infection in pregnancy is associated with low birth weight (LBW; weight < 2,500 grams), previous studies demonstrate no difference in LBW risk between COVID-19 vaccinated and unvaccinated pregnant persons. Few studies, however, have examined the association of unvaccinated, incomplete, and complete vaccination on LBW, and they have been limited by small sample sizes and lack of adjustment for covariates. We sought to address key limitations of prior work and evaluate this association between unvaccinated, incomplete, and complete COVID-19 vaccination status in pregnancy and LBW. We predicted a protective association of vaccination on LBW that varies by number of doses received. We performed a population-based retrospective study using the Vizient® clinical database, which included data from 192 hospitals in the United States. Our sample included pregnant persons who delivered between January 2021 and April 2022 at hospitals that reported maternal vaccination data and birth weight at delivery. Pregnant persons were categorized into three groups: unvaccinated; incompletely vaccinated (one dose of Pfizer or Moderna); or completely vaccinated (one dose of Johnson & Johnson or ≥ two doses of Moderna or Pfizer). Demographics and outcomes were analyzed using standard statistical tests. We performed multivariable logistic regression to account for potential confounders between vaccination status and LBW in the original cohort. Propensity score matching was used to reduce bias related to likelihood of vaccination, and the multivariable logistic regression model was then applied to the propensity score matched cohort. Stratification analysis was performed for gestational age and race/ethnicity. Of the 377,995 participants, 31,155 (8.2%) had LBW, and these participants were more likely to be unvaccinated than those without LBW (98.8% versus 98.5%, p < 0.001). Incompletely vaccinated pregnant persons were 13% less likely to have LBW neonates compared to unvaccinated persons (odds ratio 0.87, 95% confidence interval 0.73-1.04), and completely vaccinated persons were 21% less likely to have LBW neonates (odds ratio 0.79, 95% confidence interval 0.79-0.89). After controlling for maternal age, race/ethnicity, hypertension, diabetes, lupus, tobacco use, multifetal gestation, obesity, use of assisted reproductive technology, and maternal/neonatal COVID-19 infections in the original cohort, these associations remained significant for only complete vaccination (adjusted odds ratio 0.80, 95% confidence interval 0.70-0.91) and not incomplete vaccination (adjusted odds ratio 0.87, 95% confidence interval 0.71-1.04). In the propensity score matched cohort, pregnant persons who were completely vaccinated against COVID-19 were 22% less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals (aOR 0.78, 95% CI 0.76-0.79). Pregnant persons who were completely vaccinated against COVID-19 were less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals. This novel association was observed among a large population after adjusting for confounders of LBW and factors influencing the likelihood of receiving the COVID-19 vaccine.

Association of Educational Status of Mothers and Incomplete Immunization in Children

Objective: To determine the association of educational status of mothers and incomplete immunization in children presented at Tertiary Care Hospital, Karachi. Methods: This Case-control study was conducted at Pediatric department, Abbasi Shaheed Hospital, Karachi; from July 2018 to January 2019. The data were prospectively collected from 434 subjects with consent out of which 217 had an incomplete vaccination status and 217 had completed vaccination status. Case group included unvaccinated children whose mothers were uneducated (mothers were labeled un-educated who were never enrolled in school, madrasa and received primary education), whereas control group included vaccinated children whose mothers were educated (mothers were labeled educated who were enrolled in school, madrasa and received primary education).Quantitative data were presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Chi-square test was applied to compare both groups and the odds ratio was calculated. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Using post-stratification chi-square test, a p-value of ?0.05 was considered as significant. Results: A total of 434 (217 cases and 217 controls) were included in this study. The mean age was 3.27±1.79 years (case) and 3.49±1.40 years (controls). Educational status of mothers was assessed verbally. Uneducated mothers are defined as those who did not receive formal education of any level, while educated mothers are defined as those who were enrolled in school or madarsa and received primary education or more. On the basis of which the uneducated mothers in case group were 144 (66.4%) while in control group was 52 (24%).Children with incomplete immunization were 6.25 times more likely to have uneducated mothers than those with complete immunization, after controlling for the other factors. Conclusion: This study has strengthened the value of maternal education in context of complete childhood immunization because acquisition of literacy and health-seeking behavior enhance vaccine uptake for their children.

Zero-Dose, Under-Immunized, and Dropout Children in Nigeria: The Trend and Its Contributing Factors over Time

This study analyzes the trend of prevalence of, and factors contributing to, children with incomplete vaccination status, namely zero-dose, under-immunized, and dropout children, over time from 2003 to 2018 in Nigeria, one of the countries with the highest number of children with incomplete vaccination. Nigeria Demographic and Health Survey data from 2003 to 2018 were analyzed to calculate the prevalence of children with incomplete vaccination status by geographical zone over time and to investigate the factors contributing to the change in the prevalence of such children over time based on the Blinder-Oaxaca decomposition analysis. The prevalence of children with incomplete vaccination status substantially decreased from 2003 to 2018 in most of zones in Nigeria. Rural areas and the northern zones had consistently higher prevalence of children with incomplete vaccination status than urban areas and the southern zones. It was identified that mothers' education and the household wealth level explained the reduction in the prevalence of zero-dose and under-immunized children, but the degree of contribution of each factor varied by zone and place of residence, i.e., urban or rural. Both the mother's education and household wealth level only weakly contributed to the reduction in the number of dropout children. Future studies should explore further how to improve the vaccination coverage in Nigeria over time. Examples of topics for future study include other contributing factors beyond education and wealth level, differential factors influencing the reduction in the number of children with incomplete vaccination status by area of residence (urban vs. rural), why the reduction in the number of dropout children is not explained by either education or wealth, and the significant contributors to the reduction in the number of such children.

Clinical and paraclinical features of the course of infection caused by SARS-CoV-2 in primary school-age children depending on gender

The COVID-19 pandemic has been going on for 2.5 years, which is a serious challenge for the health care systems of most countries of the world. The high frequency of mutations of the SARS-CoV-2 changes the epidemiological characteristics, clinical manifestations of the disease, as well as consequences after infection.Aim of the study. To conduct an analysis of the clinical and paraclinical features of the course of COVID-19 in primary school-age children, taking into account gender, to improve the prognosis of the severity and duration of the disease, to optimize the tactics of managing patients.Materials and methods. 55 clinical cases of COVID-19 in primary school-age patients were analyzed. The gender of the patients was considered a group-forming feature. The obtained results were analyzed by methods of descriptive statistics biostatistics, and clinical epidemiology.Results. It was established that half of the male patients and 44.4% of the girls had registered complications of the main disease, mainly in the form of acute respiratory failure. The onset of the disease was characterized by general weakness and fever. Cough was more likely to be noted among boys, while in girls, there was a tendency to increase the frequency of complaints of nasal congestion. In the hospital, during the physical examination, the pathological sounds under the lungs during auscultation were registered significantly more common in male patients (75.0±8.2 versus 48.1±9.6%, Рφ &lt; 0,05). Male gender, residence in the cities, violation in vaccination schedule, dyspnea, the level of blood oxygen saturation below 95% during hospitalization are characterized with a high predictive value of a longer hospitalization period.Conclusion. The course of COVID-19 in primary school-aged children was not dependent on gender and was multisymptomatic, however, the average duration of hospitalization was significantly higher among male patients. Incomplete vaccination status increased the attributive relative risks of more bed days in the hospital with an odds ratio of 6.7:1.

Exploring barriers to vaccine delivery in adult migrants: a qualitative study in primary care

Abstract Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; 18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally; 1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff; unclear or incomplete vaccine records; and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages

Real-life vaccination coverage in Slovak children with rheumatic diseases.

BackgroundEvidence-based recommendations for vaccination of patients with pediatric rheumatic diseases (PRDs) are available, their implementation in practice is unknown.ObjectivesTo analyze real-life vaccination coverage in children with PRDs and identify reasons for incomplete vaccination.MethodsUp-to-date information on vaccination status of Slovak children followed at a tertiary pediatric rheumatology center was retrieved from pediatricians over an 18-month period and compared to the standard Slovak Immunization Schedule. Reasons for missed vaccinations were analyzed retrospectively.ResultsVaccination records of 156 patients (median age 10 years, 2–18) with PRDs (JIA n = 108, systemic diseases n = 21, autoinflammatory diseases n = 16, uveitis n = 9, others n = 2) were available for analysis. 117 (75.0%) were completely vaccinated, 2 (1.3%) had not received any vaccine due to reasons unrelated to PRD. 37 (23.7%) remaining patients missed altogether 48 mandatory vaccinations. In 58.3% (n = 28, in 24 patients) no PRD related reasons for missing vaccinations were identified. Only 20 vaccinations (18 live-attenuated and 2 non-live in 19 patients) were missed due to ongoing immunosuppressive treatment or PRD activity. Patients aged 11–14 years were more likely to be incompletely vaccinated than other age groups (48.8% vs. 15.9%, p < 0.001), mainly due to missed MMR booster. Systemic immunosuppressive treatment was a significant predictor for incomplete vaccination status (OR 5.03, 95% CI 1.13–22.31, p = 0.03).ConclusionFull vaccination is possible in a high proportion of PRD patients. In addition to immunosuppressive therapy, reasons unrelated to PRDs are a frequent and possibly inadequate cause of missed vaccinations. Periodic vaccination status assessments are needed in pediatric rheumatology care.

Exclusive circulation of canine parvovirus type 2c in the Guadalajara metropolitan area in western Mexico: a five-year study.

Canine parvovirus type 2 (CPV-2) infection in dogs is associated with severe gastroenteritis, bloody diarrhea, and vomiting, resulting in high rates of death, especially in unvaccinated puppies within the first months of age. There are three variants, called CPV-2a, CPV-2b, and CPV-2c, co-circulating worldwide. Our group previously reported that the only circulating CPV-2 variant in the Guadalajara metropolitan area in western Mexico was type 2c. Now, a five-year study was performed in order to investigate the possible dominance of CPV-2c in our region. Rectal swabs were collected from 146 dogs with clinical gastroenteritis from May 2014 to August 2019 at the Veterinary Hospital of the University of Guadalajara. Of these, 90 dogs tested positive for canine parvovirus by PCR. Most of the infected dogs with CPV-2 had a partial or incomplete vaccination status (n = 88, 97.8%). Approximately 65% (n = 59) of them were mixed-breed dogs, 77.8% (n = 70) were under 6 months of age, and 37.8% (n = 34) of them died from clinical complications. RFLP analysis of amplicons derived from the vp2 gene showed that all 90 DNA samples corresponded to CPV-2c, with no evidence of the presence of CPV-2a or CPV-2b variants. Twenty-nine of the 90 DNA samples were selected for amplification of a portion of the vp2 gene, and sequencing of these amplicons showed that all of them had the sequence GAA at codon 426, encoding the amino acid glutamic acid, which is characteristic of CPV-2c. Phylogenetic analysis showed that the CPV-2c sequences were related to those of viruses from Europe and South America. The present study indicates that CPV-2c is still the only variant circulating in the dog population of the Guadalajara metropolitan area.

General vaccination willingness and current vaccination status in relation to clinical and psychological variables in patients with multiple sclerosis

BackgroundInfections can have a significant impact on morbidity and mortality in multiple sclerosis (MS) patients. Therefore, vaccinations are of immense importance. If vaccination willingness is to be increased, possible influencing factors should be identified. The aim of the present study was to investigate the status of active immunisation in MS patients in association with sociodemographic, clinical-neurological, psychopathological and personality variables using the NEO-Five Factor Inventory, the Temperament and Character Inventory-Revised and the Hospital Anxiety and Depression Scale. MethodFour hundred and four MS patients from two German neurological hospitals were examined for their vaccination attitudes, in detail, the general willingness to vaccinate and the current vaccination status of mumps, measles and rubella (MMR) as well as tetanus and influenza. We also looked at the current level of disability in relation to the current vaccination status, as well as possible associated personality and psychopathological variables. ResultsPatients with a complete MMR vaccination status were significantly younger and those with a complete influenza vaccination status were significantly older than those with related incomplete vaccination status. Tetanus vaccination status completeness did not differ depending on age and did not show substantial association with personality scores. However, influenza vaccination completeness was associated with differences in personality and psychopathological variables; extraversion, openness, novelty seeking, harm avoidance and anxiety. A reported general vaccination willingness was significantly correlated with the current completeness of tetanus and influenza vaccinations. Novelty seeking, persistence, extraversion, agreeableness, conscientiousness and neuroticism were found associated with an increased vaccination willingness. Anxiety and depression were not related to general vaccination willingness. ConclusionsNo specific personality trait could be defined on its own in relation to general vaccination willingness or complete vaccination status. Younger patients should be made more aware of influenza vaccination. Reasons for rather low vaccination rates need to be further investigated.

Insights into Predictors of Vaccine Hesitancy and Promoting Factors in Childhood Immunization Programs-A Cross-Sectional Survey in Cameroon.

Background: Vaccination is claimed to be a key intervention against the COVID-19 pandemic. A major challenge today is to increase vaccine acceptance as vaccine hesitancy has delayed the eradication of polio. This study aimed to identify predictors associated with vaccine acceptance in the context of the Expanded Program on Immunization among parents of children between the ages of 12 to 23 months in the Foumbot district, Cameroon. Methods: The design of this study is a cross-sectional survey. A total of 160 mothers of children between the ages of 12 to 23 months were selected using a simple random sampling technique. A pre-tested structured questionnaire was used for data collection. Incomplete vaccination status was considered “vaccine hesitancy”. Data was analyzed along with 95% confidence intervals and the p-value < 0.05. The results showed 60% vaccine acceptance and 40% vaccine hesitancy. Factors such as age-appropriate vaccination, knowledge of vaccine-preventable diseases (VPD), and religion were associated with vaccine acceptance. Conclusion: Poor knowledge of VPDs is a matter of concern as it contributes to vaccine hesitancy. The study findings provide the basis to heighten health education, the public perceived threat of the VPDs, and the consequences if no measures are taken to ensure health.

Stratification for Risk Factors and Its Correlation to Outcome in Children with Malnutrition of Age 6 Months to 5 Years

Background: Wide range of illness is covered under malnutrition including under nutrition, specific nutrient deficiencies and over nutrition. There is heavy cost burden on Pakistani economy due to high prevalent condition. Children are affected in several ways and exposed to infectious diseases, psychosocial mal-development and cognitive deficiencies.&#x0D; Objectives: Objectives of this study are to determine the risk factors of malnutrition in children of age 6 months to 5 years and to determine the correlation between risk factors of malnutrition and outcome in children of age 6 months to 5 years.&#x0D; Methodology: A prospective observational study was conducted at Paediatric Medicine Department, PUMHS (Nawabshah). 138 patients were recruited using the non-probability consecutive sampling technique. Informed consent was taken from study participants before enrolment into the study. Children admitted to peadiatric medicine ward were explored for malnutrition risk factors. A pre-designed proforma was used for data collection. Data was analyzed using SPSS version 21.&#x0D; Results: Out of 138 children, 78 (56.5) were males and 60 (43.5) were females. Average age of patients was 27.49 ± 13.32. Using criteria of MUAC, 97 (70.28%) were severely malnourished and 41 (29.71%) were moderately malnourished. By criteria of weight-to-height z-score, 116 (84.05%) were severe malnourished and 22 (15.94%) were moderately malnourished. Among child factors, the highest prevalent risk factor was bottle and mixed feeding practice (122, 88.40%). Child related factors were significantly associated with patients’ outcome. Among parental risk factors, the highest prevalent risk factor was unemployment (96, 69.57%) fathers of patients were unemployed. Among environmental factors, the most prevalent risk factor was use of inappropriate water source (102, 73.91%). 31 (22.46%) children expired at the end of the study. Environmental factors were also found to be associated with patients’ outcome.&#x0D; Conclusion: Lack of breast feeding, unemployment and inappropriate source of water were most prevalent factors. Furthermore, illiteracy and incomplete vaccination status were also prevalent. Therefore, interventions are needed in order to overcome these problems. Parental education should be done and high authorities should make efforts to provide clean and safe water in rural area as well.

Psychological Distress in Patients with Coronary Artery Disease During the COVID-19 Pandemic and its Association with Coping Mechanisms.

Coronary artery disease (CAD) has been associated with increased stress both etiologically and as a consequence. The current pandemic of COVID-19 infection has impacted the personal, social, and occupational spheres of people's lives and has negatively affected mental health. People with existing chronic medical illnesses may be more vulnerable to the stressful effects of the ongoing pandemic.This study was conducted on patients with CAD during the COVID-19 pandemic to estimate the prevalence of psychological distress, the factors associated with distress, and their coping mechanisms. A cross-sectional study was conducted at a tertiary care teaching hospital in Kerala in the cardiology department. After informed consent was obtained from the patients with CAD, sociodemographic details were collected, Kessler Psychological Distress Scale (K-10 scale) was administered to assess psychological distress and the Brief COPE scale was administered to assess their coping mechanisms. Among 50 patients who participated, the prevalence of psychological distress was 50%. The factors associated with distress were female gender, semiskilled occupation, incomplete COVID-19 vaccination status, exposure of family to COVID-19, experiencing financial difficulties, and experiencing difficulty acquiring medications prescribed for CAD. Religion and acceptance were the most common coping strategies applied by the patients and acceptance was found to be a better coping strategy than religion. There is a high prevalence of psychological distress among patients with CAD during the pandemic, owing to the emotional, financial, and familial instability faced during the pandemic.

Profound Sensorineural Hearing Loss Following Adjuvant Steroid Delay in Pediatric Bacterial Meningitis

Streptococcus pneumonia is a gram positive, polysaccharide-encapsulated diplococcus associated with various pulmonary and extra-pulmonary clinical presentations including invasive diseases such as acute meningitis. It can be associated with high rates of morbidity and mortality in both the pediatric and the adult populations. The introduction of the pneumococcal conjugate vaccine which expanded to cover 13 strains allowed remarkable protection against these invasive infections. In addition, the use of adjuvant corticosteroid therapy in the last few years; in particular dexamethasone, for the management of acute bacterial meningitis reduced the incidence of severe hearing loss in both Hib and other bacterial meningitis. The IDS guidelines recommend administering the first dose of steroids just before or with the start of antibiotics due to its decreased effectiveness with the late presentations of meningitis. We present the case of a 14-year-old female adolescent refugee, with incomplete vaccination status prior to relocating to Lebanon presenting with pneumococcal meningitis. Her hospitalization was complicated by bilateral profound sensorineural hearing loss (SNHL) following a delay in steroid administration. The aim of this article is to highlight the role of vaccines in decreasing morbidity of vaccine-preventable illnesses, and the importance of early administration of steroids as adjuvant to therapy for prevention of neurologic sequeleae.

COVID-19 vaccination timing and kidney transplant waitlist management: An international perspective.

BackgroundThe coronavirus disease 2019 (COVID‐19) pandemic has created unprecedented challenges for solid organ transplant programs worldwide. The aim of this study is to assess an international perspective on challenges faced by kidney transplant programs.MethodsWe administered an electronic survey instrument from January 3, 2021 to June 8, 2021 to staff at transplant programs outside the United States that comprised of 10 questions addressing the management of kidney transplant candidates with asymptomatic COVID‐19 infection or unvaccinated who receive an organ offer.ResultsRespondents (n = 62) represented 19 countries in five continents. Overall, 90.3% of respondents encourage vaccination on the waiting list and prior to planned living donor transplant. Twelve percent of respondents reported that they have decided to inactivate unsensitized candidates (calculated panel reactive antibody, cPRA <80%) until they received the two doses of vaccination, and 7% report inactivating candidates who have received their first vaccine dose pending receipt of their second dose. The majority (88.5%) of international respondents declined organs for asymptomatic, nucleic acid testing (NAT)+ patients during admission without documented prior infection. However, 22.9% of international respondents proceeded with kidney transplant in NAT+ patients who were at least 30 days from initial diagnosis with negative chest imaging.ConclusionsPractitioners in some countries are less willing to accept deceased donor organs for waitlist candidates with incomplete COVID‐19 vaccination status and to wait longer before scheduling living donor transplant, compared to United States practices. Access to vaccinations and other resources may contribute to these differences. More research is needed to guide the optimal approach to vaccination before and after transplant.

Role of Multistrain Probiotic as Supportive Therapy in Reducing the Frequency and Severity of Respiratory Infections in Children

Background: Respiratory tract infection is a disease that can result in high mortality and morbidity. Factors related with severe respiratory infections in children comprise the age of young children, male sex, malnutrition, incomplete vaccination status and breastfeeding only children. This analysis targets the Role of multi-strain probiotics as supportive therapy in reducing the frequency and severity of respiratory infections among children. Place and Duration: In the Pediatric Medicine department of Abbasi Shaheed Hospital, Karachi for six months duration from January 2021 to June 2021. Methods: This was a randomized controlled study in 74 children aged 2 months to 5 years with respiratory infections receiving standard therapy and multi strains probiotics versus standard therapy and placebo. The assessment regarding treatment was done in both groups. Results following 7 days of adjuvant treatment alienated into group I (n = 37) (standard therapy and multi strains probiotics) and II Group (n = 37) (placebo and standard therapy). The factors evaluated in this analysis included subject characteristics, duration of stay, duration of fever, dyspnea, withdrawal, C-reactive protein, rales, breast history and probiotics use. The analysis of data was accomplished using SPSS version 20.0. Results: The males were 51.4% and females were 49.6%), breastfeeding (83.8% in Group-I vs 67.6% in Group-II), children who were not malnourished (81.1% in Group-I vs 86.5% in Group-II), and children who completed vaccination history (91.9% in Group-I versus 78.4% in Group-II). As shown in Table 1 in groups I and II, correspondingly, the mean concentration of CRP in subjects diagnosed with respiratory infections was not statistically significant in 1st group (30.10 (20.01-44.60 mg / l), relative to Group II (28.23 (19.20-46.12 mg / l), respectively (P = 0.39).Multivariate analysis with Ancova showed that probiotics can significantly decrease the time of Rale by 5.84 hours (p = 0.021, CI 95% -10.90 - (- 0.87). Conclusions: In this study, it was found that multi strains probiotic therapy significantly reduced the duration of Rale among children with infections of the upper respiratory tract. Keywords: Respiratory tract infections, children, multi strain probiotics, efficiency.

The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p<0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality. Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico. For the Portuguese translation of the abstract see Supplementary Materials section.

Prevalence and Factors Associated with Deficiency Malnutrition in the Health District of Guédiawaye, Senegal

Introduction: Deficiency malnutrition poses a real public health problem, especially in developing countries. The objective of this study is to assess: (a) the prevalence of deficiency malnutrition in its various forms in children aged 6 - 59 months living in Guédiawaye and (b) its determinants. Materials and Methods: This descriptive and analytical cross-sectional study took place from September 1 to October 30, 2020 throughout the district of Guédiawaye in community. The study population consisted of children aged 6 - 59 months. Sampling with no survey was carried out and the total sample consisted of 603 subjects. Results: Twenty-nine point three percent (29.3%) of the children were acutely malnourished, 20.4% chronically malnourished, and 25.5% were underweight. Early breastfeeding was performed in 62.7% of children and 97.1% had received exclusive breastfeeding for up to 6 months. The factors associated with acute malnutrition were: the number of children ≥3 (pvalue = 0.001), non-consumption of vegetables (pvalue = 0.020), non-consumption of meat / offal / poultry (pvalue = 0.032), consumption of condiments / spices (pvalue = 0.000), presence of fever during the last weeks preceding the survey (pvalue = 0.010), non-washing of hands when leaving the toilet (pvalue = 0.010) and incomplete immunization status ( Pvalue = 0.00). The factors associated with chronic malnutrition were female sex (pvalue = 0.003), non-consumption of meat / offal / poultry (pvalue = 0.001), presence of diarrhoea during the last two weeks preceding the survey (pvalue = 0.021) and incomplete vaccination status (Pvalue = 0.000). The factors associated with underweight were: uneducated father (pvalue = 0.005), number of children ≥ 1 (pvalue = 0.028), lack of dietary diversification at 6 months (pvalu = 0.042), non-consumption of meat / offal / poultry (pvalue = 0.000), the presence of diarrhoea during the last weeks preceding the survey (pvalue = 0.001), and incomplete vaccination status (Pvalue = 0.000). Conclusion: The prevalence of deficiency malnutrition, whatever its form, remains high among children in Guédiawaye. Promoting good dietary practices, improving hygiene conditions and monitoring nutritional status in immunization units could help fight malnutrition.

O027 / #587: THE EPIDEMIOLOGY OF PEDIATRIC SEPSIS IN BRAZILIAN INTENSIVE CARE UNITS (THE SEPSIS PREVALENCE ASSESSMENT DATABASE IN PEDIATRIC POPULATION, SPREAD-PED): AN OBSERVATIONAL STUDY

Aims & Objectives: To evaluate the prevalence of severe sepsis and septic shock in pediatric intensive care units (PICUs) in Brazil, in-hospital mortality and its associated factors and to estimate national incidence of pediatric ICU-treated sepsis. Methods: We did a point-prevalence study with follow-up of patients with sepsis in a nationally-representative random sample of PICU stratified by geographical region and hospital main source of income. We followed patients until hospital discharge censored at 60 days. We assessed mortality prognostic factors using random-effects regression models. Results: On study day, 144 (39.5%) of 365 randomly selected PICUs provided data on 1,120 patients, of whom 280 had severe sepsis or septic shock (prevalence: 25.0 septic patients per 100 ICU beds [95% confidence interval (CI): 21.6 – 28.8]. The PICU sepsis incidence was 2.85 per 100 patient-days, mortality was 19.6%. Age≤2 years-old, incomplete vaccination status, PELOD-2 score at sepsis diagnosis and healthcare-associated infection were independently associated with higher mortality. The projected incidence of ICU-treated severe sepsis per year is 67.9 per 100,000 population (95%CI: 55.9 – 82.4), which yields about 38,552 cases annually, of whom 7,556 die in hospital. Conclusions: In a representative sample of pediatric Brazilian ICUs, sepsis prevalence, population-based incidence of pediatric ICU treated-sepsis and in-hospital mortality were high. The major factors associated with a higher hospital mortality were younger age, inadequate vaccination status, presence of healthcare-associated infection and severity of illness.

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

According to a recent World Health Organization estimate, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which originated in China in 2019, has spread globally, infecting nearly 100 million people worldwide by January 2021. Patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation, and immunosuppressed individuals after liver transplantation appear to be at increased risk of infections in general, which in turn translates into increased mortality. This is also the case for SARS-CoV-2 infection, where patients with cirrhosis, in particular, are at high risk of a severe COVID-19 course. Therefore, vaccination against various pathogens including SARS-CoV-2, administered as early as possible in patients with CLD, is an important protective measure. However, due to impaired immune responses in these patients, the immediate and long-term protective response through immunisation may be incomplete. The current SARS-CoV-2 pandemic has led to the exceptionally fast development of several vaccine candidates. A small number of these SARS-CoV-2 vaccine candidates have already undergone phase III, placebo-controlled, clinical trials in healthy individuals with proof of short-term safety, immunogenicity and efficacy. However, although regulatory agencies in the US and Europe have already approved some of these vaccines for clinical use, information on immunogenicity, duration of protection and long-term safety in patients with CLD, cirrhosis, hepatobiliary cancer and liver transplant recipients has yet to be generated. This review summarises the data on vaccine safety, immunogenicity, and efficacy in this patient population in general and discusses the implications of this knowledge on the introduction of the new SARS-CoV-2 vaccines.