Paediatric Virology Research Articles

Exploring the optimal vaccination strategy against hepatitis B virus in childhood (Review).

Vaccination against hepatitis B virus (HBV) remains the most effective strategy against HBV infection in humans. The present review summarized the optimal vaccination strategies against HBV in childhood. The following points are discussed: i) When and how the first HBV vaccines were developed; ii) the dosages, schedules and injection routes that are used for HBV vaccination; iii) the contraindications for HBV vaccination in the general paediatric population; iv) the challenges with the use of multivalent vaccines; v) the long-term immunogenicity and duration of protection against HBV; vi) the use of selective HBV vaccination and the hepatitis B immune globulin strategy in HBV-exposed infants; and vii) the effectiveness of the current HBV vaccination schemes. The present review is based on a Paediatric Virology Study Group (PVSG) webinar performed in the context of the 8th Workshop on Paediatric Virology.

Challenges and perspectives of palliative medicine: Awebinar by the Paediatric Virology Study Group.

Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the '8th Workshop of Paediatric Virology' organized by the Institute of Paediatric Virology based on the island of Euboea (Greece).

Insights in paediatric virology during the COVID-19 era (Review).

The present article provides an overview of the key messages of the topics discussed at the '7th Workshop on Paediatric Virology', which was organised virtually on December 20, 2021 by the Institute of Paediatric Virology, located on the Island of Euboea in Greece. The workshop's plenary lectures were on: i) viral pandemics and epidemics in the ancient Mediterranean; ii) the impact of obesity on the outcome of viral infections in children and adolescents; and iii) COVID-19 and artificial intelligence. Despite the scarcity of evidence from fossils and remnants, viruses have been recognised as significant causes of several epidemics in the ancient Mediterranean. Paediatric obesity, a modifiable critical health risk factor, has been shown to impact on the development, progression and severity of viral infections. Thus, the prevention of paediatric obesity should be included in formulating public health policies and decision-making strategies against emerging global viral threats. During the current COVID-19 pandemic, artificial intelligence has been used to facilitate the identification, monitoring and prevention of SARS-CoV-2. In the future, it will play a fundamental role in the surveillance of epidemic-prone infectious diseases, in the repurposing of older therapies and in the design of novel therapeutic agents against viral infections. The collaboration between different medical specialties and other diverse scientific fields, including archaeology, history, epidemiology, nutritional technologies, mathematics, computer technology, engineering, medical law and ethics is essential for the successful management of paediatric viral infections. The current COVID-19 pandemic has underscored this need, which should be further encouraged in modern medical education.

Neuroblastoma in childhood and its potential viral involvement: A webinar by the Paediatric Virology Study Group

Neuroblastoma represents the most common and lethal solid tumour of early childhood. In view of variations in genetic elements, MYCN amplification is certainly the most prominent genetic factor occurring in 1/4 or 1/5 of children with neuroblastoma; however, overall, the pathogenesis of neuroblastoma remains to be resolved. Rare, sporadic infections with Epstein‑Barr, hepatis C virus and varicella‑zoster virus have been detected in children with neuroblastoma, while the presence of BK virus was initially claimed, but later falsified as a triggering factor for the development of high‑risk neuroblastoma. The proposed model by Professor Ugo Rovigatti, Professor of Molecular Biology at the University of Florence in Italy, is based upon infection with micro‑foci inducing virus and its potential tumorigenic role as trigger of i) high and persistent inflammation; ii) chromothripsis and genetic instability; and iii) <em>in vitro</em> cell transformation and <em>in vivo</em> carcinogenesis. Modelling is still under‑utilized and under-developed in clinical virology and cancer research; however, it is expected to play a significant role in the future, aiming to elucidate the cancer enigma. This article is based on a webinar on neuroblastoma in children, which was organised virtually on December 12, 2020, by the Institute of Paediatric Virology.

SARS‑CoV‑2 infection and children: Insights from the 6th Workshop on Paediatric Virology (Review)

The present article provides an overview of the key messages of the plenary lectures on severe acute respiratory syndrome coronavirus type 2 (SARS‑CoV‑2) infection in children, which were presented at the ‘6th Workshop on Paediatric Virology’ organised by the Institute of Paediatric Virology on October 24, 2020. SARS‑CoV‑2 is a novel human coronavirus with a positive‑sense, monopartite mRNA genome, 26‑32 kilobases in length, causing mild to severe respiratory infection in humans, including children. The spike (S) protein of SARS‑CoV‑2 is the key determinant of host/cell tropism and capacity for transmission, mediating receptor binding and membrane fusion. SARS‑CoV‑2 is predominately transmitted via the respiratory route. The effects of SARS‑CoV‑2 infection occurring early during pregnancy remain unknown. Newborns rarely experience significant morbidity and mortality. In children, SARS‑CoV‑2 severe symptomatic respiratory infection has been reported much less frequently than in adults. In addition, there have been rare cases of the newly reported multisystemic inflammatory syndrome in children (MIS‑C), which has similarities with Kawasaki disease. Several therapeutic agents have been evaluated for the treatment of SARS‑CoV‑2 infection; however, few have been shown to be truly efficacious. On the whole, further research, both basic and clinical, on SARS‑CoV‑2 is essential, as without a thorough knowledge of the molecular virology of SARS‑CoV‑2, effective preventive and treatment modalities, which are so urgently required, cannot be designed and implemented.

COVID-19 threat and frontline paediatric care professionals.

COVID-19 threat and frontline paediatric care professionals.

Training in paediatric virology in the UK: A brief overview (Review).

Paediatric virology is a bold, new scientific field, where paediatrics focuses on the newly acquired knowledge from clinical virology, enriched with current advances in epidemiology, molecular medicine, evidence-based medicine, clinical governance, quality improvement, pharmacology and immunology. Although there are several methods with which to obtain training in paediatric viral infections in the UK, paediatric virology does not currently exist as a specific subspecialty. The aim of the present article was to present the existing educational platforms and training options in paediatric virology in the UK available to trainees wanting to pursue a clinical and/or academic career in paediatric virology.

Paediatric virology and medical terminology.

Paediatric virology and medical terminology.

Viruses, vaccinations and RSV: Exploring terminology in paediatric virology.

Viruses, vaccinations and RSV: Exploring terminology in paediatric virology.

The foundation of the Institute of Paediatric Virology on the island of Euboea, Greece (Review).

The Institute of Paediatric Virology, founded on October 2019 on the island of Euboea in Greece, introduces medical students, paediatric and neonatal trainees, postgraduate students, virologists, paediatric and allied health professionals to the bold, new, scientific field of paediatric virology. The institute is committed to medical education and is the sequel of the Paediatric Virology Study Group (PVSG), which was formed in 2007 in the United Kingdom by a group of young paediatric trainees and junior researchers. The main mission of the institute is to provide an educational e-platform on neonatal and paediatric viral infections, to facilitate scientific discussion between virologists and paediatric health professionals and to develop an international network aiming to the promotion of children's health by the prevention and treatment of viral infectious diseases. The foundation of the institute is dedicated to three children from a small fishing village at the south of the island of Euboea in Greece, who survived the 1918 Spanish flu pandemic.

Update on COVID-19: A teleconference with the Paediatric Virology Study Group (Review).

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans mainly via contact and droplet transmission and its entry into cells is mediated by the efficient binding of the spike (S) viral protein with the angiotensin converting enzyme-2 (ACE2) receptors. Although acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 fulfills the criteria of the Berlin definition, in a considerable proportion of patients with COVID-19, there is a dissociation between their relatively well-preserved lung mechanics and the severity of hypoxaemia. The extent of pneumococcal related morbidity and mortality is largely unknown. Respiratory comorbidities that increase the risk of severe disease and mortality due to SARS-CoV-2 include chronic obstructive pulmonary disease, asthma, bronchiectasis and fibrotic interstitial lung diseases, regardless of aetiology. Pneumococcal and seasonal influenza vaccinations are useful in preventing a substantial burden of mortality in high-risk populations, while general quarantine and social distancing can reduce the infiltration of the virus within the community. To date, several therapeutic agents have been studied or are currently examined, such as hydroxychloroquine, chloroquine, ritonavir/lopinavir, remdesivir, colchicines and interleukin-6 inhibitors. However, the usage of most of these into clinical practice was not based on randomised clinical trials and their results should be viewed with extreme caution; remdesivir seems to be the more promising option. Rigorous efforts are under way for the development of a safe and successful vaccine against SARS-CoV-2.

COVID-19 threat and the 1918 Spanish flu outbreak: The following day.

COVID-19 threat and the 1918 Spanish flu outbreak: The following day.

Creating the 'George N. Papanicolaou Medal' by the Academy of Athens: An interview with Professor of Sculpture Theodoros Papagiannis (Athens School of Fine Arts, Athens, Greece).

The ‘George N. Papanicolaou Medal’ is a brass medal commissioned by the Academy of Athens on the occasion of the 100th anniversary of the birth of Dr George N. Papanicolaou in 1983. It was created by Professor Theodoros Papagiannis, Professor Emeritus of Sculpture at the Athens School of Fine Arts in Athens, Greece; the medal presents Dr George N. Papanicolaou with his microscope. According to Professor Papagiannis, the medal was requested by Professor Nikolaos Louros, Emeritus Professor of Obstetrics and Gynecology at the University of Athens School of Medicine and it was created according to the ancient Greek style. The medal was given to all honored participants of the special ceremony organized by the Academy of Athens in May 13th, 1983, in the context of the 100 years from the birth of Dr George N. Papanicolaou. The ceremony was performed at the Central Hall of the Academy of Athens in Athens under the auspices of the President of the Hellenic Democracy Constantinos Caramanlis. A copy of this medal is being exhibited at the ‘Museum of Contemporary Sculpture Theodoros Papagiannis’ in Elliniko at the Municipality of Katsanochoria close to Ioannina (Greece), as well as at the newly founded Institute of Paediatric Virology based on the island of Euboea, birth place of Dr George N. Papanicolaou.

Update on current views and advances on RSV infection (Review).

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood.

Paediatric Virology and innovation in medical education: An interview with Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea (Greece) and Coordinator of the Paediatric Virology Study Group.

Born in Chalkida in Greece, Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea, studied Medicine at the University of Crete School of Medicine, where he received his MD in 2002 and his PhD in Clinical Virology in 2006. He was trained in Paediatrics and Neonatology in Merseyside (UK), attending the ‘Alder Hey’ Children's Hospital's specialty training (ST) rotation programme and in Athens (Greece) at the ‘Penteli’ Children's Hospital and the ‘MAKKA’ Paediatric Infectious Diseases (PID) Unit of the ‘Aghia Sophia’ Children's Hospital. On October 10th, 2015, he presented the Paediatric Virology subspecialty's proposal, which up-to-date has attracted the critical interest of several international experts in the scientific fields of Neonatology, Paediatrics, PID and Virology and has been evaluated as a unique project of innovation in medical education. According to Dr Mammas, Paediatrics is the specialty, which daily provides the opportunity to support with responsibility the children's smile, the hope of life and future. He highlights the significant role of the Paediatric Virology Study Group (PVSG), a paediatric think tank, which was established by a group of paediatric trainees and young paediatricians in 2007 and since then has been involved with enthusiasm in the perspectives of Paediatric Virology in medical education. Dr Mammas strongly believes that in the future, Paediatric Virology subspecialists will have a strategically principal role, both clinical and academic, at the fight against viral infections in childhood. This aim will be supported by the newly founded Institute of Paediatric Virology (IPV), the first scientific initiative in the world committed to medical education on neonatal and paediatric viral infections.

Advancing challenges in Paediatric Virology: An interview with Professor Barbara A. Rath, Co-founder and Chair of the Vienna Vaccine Safety Initiative.

The Vienna Vaccine Safety Initiative (ViVI) is an international, scientific, non-profit, research organization, which aims to promote research, clinical practice and communication on Paediatric Infectious Diseases (PID) in a globalized healthcare setting, to facilitate the implementation of high standards in vaccine safety and efficacy and to support international and interdisciplinary scientific collaboration. Professor Barbara A. Rath, Chair and Co-founder of the Vienna Vaccine Safety Initiative, advocates for the establishment of global research networks in the field of neonatal and paediatric viral infections. Viruses do not respect borders, and large datasets are required and joint action is necessary to further strengthen efforts towards viral diseases eradication and prevention. She encourages the paediatric community to embrace the new opportunities technology offers for healthcare and medical education. To date, the Vienna Vaccine Safety Initiative has developed a number of innovative mobile applications and diagnostic tools, such as the ‘VAccApp’, which helps parents understand which vaccines were administered to their children, the ‘ViVI Disease Severity Score’, which measures clinical severity in patients with acute respiratory infections and flu-like illnesses, the ‘VACC Tool’, which assesses patient's clinical presentation to a set of diagnostic algorithms for adverse events following immunization and the ‘ViVI Health Survey’, which enables children and young adults on the move to report health needs securely and confidentially. Professor Rath agrees that during this decade there is momentum in the field of Paediatric Virology, as new antivirals and vaccines emerge and are finally becoming available to children. In the future, ‘in-house’ specialists for Paediatric Virology could be helpful to provide quality of care and reduce antimicrobial resistance by providing individual as well as hospital-wide consultations and advice. She estimates that Paediatric Virology will eventually find its place in the context of PID and Vaccinology.

Practicing humility and medical education: Lessons learnt interviewing experts on Paediatric Virology.

Practicing humility and medical education: Lessons learnt interviewing experts on Paediatric Virology.

Educational pathways in Paediatric Virology: Pros and cons.

Educational pathways in Paediatric Virology: Pros and cons.

Clinical Virology research and medical education in Greece: An interview with Demetrios A. Spandidos, Professor of Clinical Virology at the University of Crete in Greece.

Professor Demetrios A. Spandidos, Professor Emeritus of Clinical Virology at the University of Crete School of Medicine in Crete, Greece, is a pioneer in world research in Virology, Oncology and medical education. He has been the first Professor of Clinical Virology at the University of Crete School of Medicine, the only School of Medicine with a separate Department of Clinical Virology in Greece. According to Professor Spandidos, the understanding of the interactions of viruses with human host cells is what enables the development of new vaccines and new therapies against a wide range of diseases in humans, including cancer. Over the past two decades, the expansion of new knowledge, treatments, prevention and management options and the emerging needs on neonatal and paediatric viral infections have made the role of future paediatric virologists more than necessary. For this reason, he strongly believes that Paediatric Virology should be recognized as a new paediatric subspecialty. Professor Spandidos declares that medical education is a continuous sequence from undergraduate to postgraduate/specialty/subspecialty medical training and continuing learning. He also supports the concept that the future of medical education represents the future of Medicine.

Paediatric Virology and respiratory syncytial virus: An interview with Honorary Senior Lecturer in Paediatric Infectious Diseases Dr Simon B. Drysdale (St. George's, University of London, UK).

Dr Simon B. Drysdale, Consultant and Honorary Senior Lecturer in Paediatric Infectious Diseases at St. George's University Hospitals NHS Foundation Trust and St. George's, University of London, is one of the most talented early career academic specialists in Paediatric Infectious Diseases in the United Kingdom. His main research interest is respiratory syncytial virus (RSV); he is particularly interested in understanding the host susceptibility to RSV, the management of RSV infection and associated health economics and the development of treatments and immunisations/vaccines, which are currently lacking. According to Dr Drysdale, RSV is a significant cause of morbidity and mortality among young infants and older adults, particularly those with co-morbidities. While there is ample RSV epidemiological and healthcare cost data available for young infants and children, more data is required for older children and adults. There are currently several antiviral medications for the treatment of RSV infection in development; however, none have yet progressed beyond Phase 2 clinical trials. Multiple types of novel therapeutic molecules have been developed, including fusion and non-fusion inhibitors and polymerase inhibitors aimed at various RSV targets, such as the F protein and RNA polymerase. In recent years, great strides have been made with regards to an RSV vaccine or monoclonal antibody, with >40 candidates currently in development. A maternal RSV vaccine, which just completed a Phase 3 trial, was shown to have 44% efficacy against hospitalization for RSV lower respiratory tract infection in infants. A new long-acting monoclonal antibody against RSV infection, having shown excellent promise in a Phase 2 trial in infants, is about to be investigated in a Phase 3 clinical trial commencing shortly.