Reinfection In Children Research Articles

Risk of SARS-CoV-2 Reinfection in Children Within the 12 Months Following Mild COVID-19: Insights From a Survey Study.

Understanding the correlation between immune response and protection from COVID-19 will play a pivotal role in predicting the effectiveness of vaccines in children. We studied SARS-CoV-2 reinfection risk in children 12 months post-mild COVID-19. Children under 5 years old exhibited lower reinfection risk than older infected or vaccinated siblings during 12 months postimmunization.

Respiratory Syncytial Virus Reinfections in Children in Western Australia.

Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.

2355. Incidence of Omicron Variant Reinfection and Reduction of Reinfection Risk After Coronavirus Disease 2019 Vaccination in Children

Abstract Background Reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become an important concern after the emergence of SARS-CoV-2 omicron variants (e.g., BA.1, BA.2, and BA.5). Reinfection by variants can occur in children; however, data are limited on the incidence of reinfection and the effectiveness of coronavirus disease 2019 (COVID-19) vaccines against reinfection. Methods This population-based cohort study collected clinical data for COVID-19 from children aged 15 years or younger who were diagnosed as having COVID-19 in Niigata, Japan, from January through August 2022, when omicron variants dominated. We analyzed three periods with different predominant variants (BA.1, BA.2, and BA.5). Reinfection was monitored during each period and observation was extended through November 2022. We calculated the incidence of reinfection and the hazard ratio (HR) for reinfection in relation to COVID-19 vaccination status. Results During the study period, 1338/48,099 children (2.8%) were reinfected by omicron variants; most reinfections occurred in the BA.5-predominant period (1265/1338, 94.5%). The median interval to reinfection was 169 days (interquartile range 120-207 days) (Table 1). Among children eligible for COVID-19 vaccination, the vaccine was effective in preventing reinfection: the HR for reinfection in children who completed vaccination was 0.29 (95% confidence interval, 0.20–0.40) (Figure 1).Table 1.Characteristics of children with primary coronavirus disease 2019 infection during periods of BA.1-, BA.2-, and BA.5-predominance in 2022 in Niigata, JapanFigure 1.Prevalence of pediatric COVID-19 reinfection after complete and incomplete vaccination The prevalence of reinfection by omicron was analyzed by using Kaplan–Meier analysis. Children aged 5–15 years were classified on the basis of COVID-19 vaccination history before primary infection. The hazard ratio for reinfection among children aged 5–15 years with a history of complete COVID-19 vaccination before primary infection was 0.21 (95% confidential interval 0.16-0.29), as compared with those with a history of incomplete vaccination. Conclusion Reinfection in children was frequent when omicron variant BA.5 was predominant in Japan. Children who underwent COVID-19 vaccination had a significantly lower risk of omicron reinfection, which suggests that vaccination is important in preventing reinfection by SARS-CoV-2 omicron variants and preparing for outbreaks of new variants. Disclosures All Authors: No reported disclosures

Incidence of Omicron Variant Reinfection and Reduction of Reinfection Risk After Coronavirus Disease 2019 Vaccination in Children.

Data are limited on the incidence of coronavirus disease 2019 (COVID-19) reinfection in children. This population-based cohort study in Niigata, Japan from January to November 2022 demonstrated the incidence of reinfection was 1337/48 099 (2.8%), and the hazard ratio for reinfection in vaccinated children was 0.29 (95% confidence interval, 0.20-0.40).

Post COVID-19 condition after delta infection and omicron reinfection in children and adolescents.

The burden of COVID-19 in children and adolescents has increased during the delta and omicron waves, necessitating studies of long-term symptoms such as fatigue, dyspnoea and cognitive problems. Furthermore, immune responses in relation to persisting symptoms in younger people have not been well characterised. In this cohort study, we investigated the role of antibodies, vaccination and omicron reinfection upon persisting and long-term symptoms up to 8 months post-delta infection. SARS-CoV-2 RT-PCR positive participants (n=276, aged 10-20 years) were prospectively recruited in August 2021. We recorded the major symptoms of post COVID-19 condition and collected serum samples 3- and 8-months post delta infection. Binding antibodies were measured by spike IgG ELISA, and surrogate neutralising antibodies against Wuhan and delta variants by the hemagglutination test (HAT). After delta infection, persisting symptoms at 3 months were significantly associated with higher delta antibody titres (OR 2.97, 95% CI 1.57-6.04, p=0.001). Asymptomatic acute infection compared to symptomatic infection lowered the risk of persisting (OR 0.13, 95% CI 0.02-0.55, p=0.013) and long-term (OR 0.28 95% CI 0.11-0.66, p=0.005) symptoms at 3 and 8 months, respectively. Adolescents (16-20 years) were more likely to have long-term symptoms compared to children (10-15 years) (OR 2.44, 95% CI 1.37-4.41, p=0.003). This clinical and serological study compares long-term symptoms after delta infection between children and adolescents. The association between high antibody titres and persisting symptoms suggest the involvement of an immune mechanism. Similarly to adults, the dominant long-term symptoms in children are fatigue, dyspnoea and cognitive problems. This work was funded by the Ministry of Health and Care Services, Norway, the University of Bergen, Norway and Helse Vest, Norway (F-12621).

Long-term humoral signatures following acute pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children.

Although most children experience mild symptoms during acute SARS-CoV-2 infection, some develop the severe post-COVID-19 complication, Multisystem Inflammatory Syndrome in Children (MIS-C). While acute presentations of COVID-19 and MIS-C have been well immunophenotyped, little is known about the lasting immune profile in children after acute illness. Children 2 months-20 years of age presenting with either acute COVID-19 (n = 9) or MIS-C (n = 12) were enrolled in a Pediatric COVID-19 Biorepository at a single medical center. We deeply profiled humoral immune responses and circulating cytokines following pediatric COVID-19 and MIS-C. Twenty-one children and young adults provided blood samples at both acute presentation and 6-month follow-up (mean: 6.5 months; standard deviation: 1.77 months). Pro-inflammatory cytokine elevations resolved after both acute COVID-19 and MIS-C. Humoral profiles continue to mature after acute COVID-19, displaying decreasing IgM and increasing IgG over time, as well as stronger effector functions, including antibody-dependent monocyte activation. In contrast, MIS-C immune signatures, especially anti-Spike IgG1, diminished over time. Here, we show the mature immune signature after pediatric COVID-19 and MIS-C, displaying resolving inflammation with recalibration of the humoral responses. These humoral profiles highlight immune activation and vulnerabilities over time in these pediatric post-infectious cohorts. The pediatric immune profile matures after both COVID-19 and MIS-C, suggesting a diversified anti-SARS-CoV-2 antibody response after resolution of acute illness. While pro-inflammatory cytokine responses resolve in the months following acute infection in both conditions, antibody-activated responses remain relatively heightened in convalescent COVID-19. These data may inform long-term immunoprotection from reinfection in children with past SARS-CoV-2 infections or MIS-C.

Evaluation of possible COVID-19 reinfection in children: A multicenter clinical study

BackgroundAlthough it was originally unknown whether there would be cases of reinfection of coronavirus disease 2019 (COVID-19) as seen with other coronaviruses, cases of reinfection were reported from various regions recently. However, there is little information about reinfection in children. MethodsIn this study, we aimed to investigate the incidence and clinical findings of reinfection in pediatric patients who had recovered from COVID-19. We retrospectively evaluated all patients under 18 years of age with COVID-19 infection from a total of eight healthcare facilities in Turkey, between March 2020 and July 2021. Possible reinfection was defined as a record of confirmed COVID-19 infection based on positive reverse transcription-polymerase chain reaction (RT-PCR) test results at least 3 months apart. ResultsA possible reinfection was detected in 11 out of 8840 children, which yielded an incidence of 0.12%. The median duration between two episodes of COVID-19 was 196 (92–483) days. When initial and second episodes were compared, the rates of symptomatic and asymptomatic disease were similar for both, as was the severity of the disease (p = 1.000). Also, there was no significant difference in duration of symptoms (p = 0.498) or in hospitalization rates (p = 1.000). Only one patient died 15 days after PCR positivity, which resulted in a 9.1% mortality rate for cases of reinfection in pediatric patients. ConclusionWe observed that children with COVID-19 were less likely to be exposed to reinfection when compared with adults. Although the clinical spectrum of reinfection was mostly similar to the first episode, we reported death of a healthy child during the reinfection.

Association of SARS-CoV-2 Seropositivity and Symptomatic Reinfection in Children in Nicaragua

The impact of the SARS-CoV-2 pandemic on children remains unclear. Better understanding of the burden of COVID-19 among children and their risk of reinfection is crucial, as they will be among the last groups vaccinated. To characterize the burden of COVID-19 and assess how risk of symptomatic reinfection may vary by age among children. In this prospective, community-based pediatric cohort study conducted from March 1, 2020, to October 15, 2021, 1964 nonimmunocompromised children aged 0 to 14 years were enrolled by random selection from the Nicaraguan Pediatric Influenza Cohort, a community-based cohort in District 2 of Managua, Nicaragua. Additional newborn infants aged 4 weeks or younger were randomly selected and enrolled monthly via home visits. Prior COVID-19 infection as confirmed by positive anti-SARS-CoV-2 antibodies (receptor binding domain and spike protein) or real-time reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection at least 60 days before current COVID-19 infection. Symptomatic COVID-19 cases confirmed by real-time RT-PCR and hospitalization within 28 days of symptom onset of a confirmed COVID-19 case. This cohort study assessed 1964 children (mean [SD] age, 6.9 [4.4] years; 985 [50.2%] male). Of 1824 children who were tested, 908 (49.8%; 95% CI, 47.5%-52.1%) were seropositive during the study. There were also 207 PCR-confirmed COVID-19 cases, 12 (5.8%) of which were severe enough to require hospitalization. Incidence of COVID-19 was highest among children younger than 2 years (16.1 cases per 100 person-years; 95% CI, 12.5-20.5 cases per 100 person-years), which was approximately 3 times the incidence rate in any other child age group assessed. In addition, 41 symptomatic SARS-CoV-2 episodes (19.8%; 95% CI, 14.4%-25.2%) were reinfections. In this prospective, community-based pediatric cohort study, rates of symptomatic and severe COVID-19 were highest among the youngest participants, with rates stabilizing at approximately 5 years of age. In addition, symptomatic reinfections represented a large proportion of symptomatic COVID-19 cases.

Importance of understanding the reinfection risk of COVID-19 in children

Importance of understanding the reinfection risk of COVID-19 in children

Risk of SARS-CoV-2 reinfections in children: a prospective national surveillance study between January, 2020, and July, 2021, in England

BackgroundReinfection after primary SARS-CoV-2 infection is uncommon in adults, but little is known about the risks, characteristics, severity, or outcomes of reinfection in children. We aimed to assess the risk of SARS-CoV-2 reinfection in children and compare this with the risk in adults, by analysis of national testing data for England.MethodsIn our prospective, national surveillance study to assess reinfection of SARS-CoV-2 in children in England, we used national SARS-CoV-2 testing data to estimate the risk of reinfection at least 90 days after primary infection from Jan 27, 2020, to July, 31, 2021, which encompassed the alpha (B.1.1.7) and delta (B.1.617.2) variant waves in England. Data from children up to age 16 years who met the criteria for reinfection were included. Disease severity was assessed by linking reinfection cases to national hospital admission data, intensive care admission, and death registration datasets.FindingsReinfection rates closely followed community infection rates, with a small peak during the alpha wave and a larger peak during the delta wave. In children aged 16 years and younger, 688 418 primary infections and 2343 reinfections were identified. The overall reinfection rate was 66·88 per 100 000 population, which was higher in adults (72·53 per 100 000) than children (21·53 per 100 000). The reinfection rate after primary infection was 0·68% overall, 0·73% in adults compared with 0·18% in children age younger than 5 years, 0·24% in those aged 5–11 years, and 0·49% in those aged 12–16 years. Of the 109 children admitted to hospital with reinfection, 78 (72%) had comorbidities. Hospital admission rates were similar for the first (64 [2·7%] of 2343) and second episode (57 [2·4%] of 2343) and intensive care admissions were rare (seven children for the first episode and four for reinfections). There were 44 deaths within 28 days after primary infection (0·01%) and none after reinfection.InterpretationThe risk of SARS-CoV-2 reinfection is strongly related to exposure due to community infection rates, especially during the delta variant wave. Children had a lower risk of reinfection than did adults, but reinfections were not associated with more severe disease or fatal outcomes.FundingUK Health Security Agency.

Epidemiology of intestinal helminthiases in a rural community of Ethiopia: Is it time to expand control programs to include Strongyloides stercoralis and the entire community?

BackgroundSoil transmitted helminths are highly prevalent worldwide. Globally, approximately 1.5 billion people are infected with Ascaris lumbricoides, Trichuris trichiura or hookworm. Endemic countries carry out periodic mass treatment of at-risk populations with albendazole or mebendazole as a control measure. Most prevalence studies have focused on school aged children and therefore control programs are implemented at school level, not at community level. In this study, the prevalence of intestinal helminths, including Strongyloides stercoralis, was examined using a comprehensive laboratory approach in a community in north-western Ethiopia.MethodsA cross-sectional survey was conducted on 792 individuals ≥5 years old in randomly selected houses in a rural district. Stools were examined using three techniques: a formol-ether concentration, the Baermann technique and a real time polymerase chain reaction test (these last two specific for S. stercoralis). Statistical analyses were performed between two large age groups, children (≤14 years old) and adults (≥15 years old).ResultsThe prevalence of helminths was 91.3%; (95% CI: 89.3–93.3%). Hookworm was the most prevalent, 78.7% (95% CI 75.6–81.4%), followed by S. stercoralis 55.7% (95% CI 52.2–59.1%). Co-infection with both was detected in 45.4% (95% CI 42.0–49.0%) of the participants. The mean age of hookworm-infected individuals was significantly higher than non-infected ones (p = 0.003). Also, S. stercoralis infection was significantly associated with age, being more prevalent in adults (p = 0.002).ConclusionsThis is the highest prevalence of S. stercoralis detected in Ethiopia so far. Our results highlight the need of searching specifically for infection by this parasite since it usually goes unnoticed if helminth studies rely only on conventional diagnostic techniques, i.e. Kato-Katz. Moreover, the focus of these programs on children undermines the actual prevalence of hookworm. The adult population acts as a reservoir for both hookworm and S. stercoralis and this fact may negatively impact the current control programs in Ethiopia which only target treatment of school aged children. This reservoir, together with a lack of adequate water, sanitation and hygiene, increases the probability of re-infection in children. Finally, the high prevalence of S. stercoralis found calls for a comprehensive diagnostic approach in endemic areas in addition to a revision of control measures that is, adding ivermectin to current albendazole/mebendazole, since it is the drug of choice for S. stercoralis.

Epidemiological relationship between Mycoplasma pneumoniae pneumonia and recurrent wheezing episode in children: an observational study at a single hospital in Korea

ObjectiveThis study was aimed to evaluate epidemiological and clinical relationship between Mycoplasma pneumoniae (MP) infection and childhood recurrent wheezing episode (RWE).DesignRetrospective case note review.SettingPaediatric department at a single Korean institution.ParticipantsConsecutive...

Central line replacement following infection does not improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy.

Treatment of pediatric pulmonary hypertension (PH) with IV prostanoids has greatly improved outcomes but requires a central line, posing inherent infection risk. This study examines the types of infections, infection rates, and importantly the effect of line management strategies on reinfection in children receiving IV prostanoids for PH. This study is a retrospective review of all pediatric PH patients receiving intravenous epoprostenol (EPO) or treprostinil (TRE) at one academic tertiary care center between 2000 and 2014. No patients declined participation in the study or were otherwise excluded. Infectious complications were characterized by organism(s), infection rates, time to next infection, and line management decisions (salvage vs. replace). Of the 40 patients followed, 13 sustained 38 infections involving 49 pathogens, with a predominance of gram-positive (GP) organisms (n = 35). The pooled infection rate was 1.06 per 1000 prostanoid days with no difference between EPO and TRE. No significant difference in reinfection rate was observed when comparing line salvage to replacement, regardless of organism type. Both overall and organism-type comparisons suggest longer time between line infections following line salvage compared with line replacement (732 vs. 410 days overall; 793 vs. 363 days for GP; 611 vs. 581 days for gram-negative [GN]; P > 0.05 for all comparisons). Central line replacement following blood stream infections in pediatric PH patients does not improve subsequent infection rates or time to next infection, and may lead to unnecessary risks associated with line replacement, including potential loss of vascular access. A revised approach to central line infections in pediatric PH is proposed.

Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children

Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children

Epidemiological characteristics and influential factors of hand, foot and mouth disease (HFMD) reinfection in children in Anhui province.

Hand, foot and mouth disease (HFMD) is an acute contagious condition caused by a spectrum of human enteroviruses. HFMD reinfection is common in the absence of cross-protection from other virus subtypes. This study focused on reinfection in children in Anhui province, China between 2008 and 2013 using surveillance system data. We classified 8960 cases as reinfected, corresponding to a rate of 2·02%. The reinfection rate was higher in boys than in girls [odds ratio (OR) 1·27, 95% confidence interval (CI) 1·21-1·32, P < 0·001], children aged < 3 years (OR 3·82, 95% CI 3·58-4·07, P < 0·001), and children living in rural areas (OR 1·09, 95% CI 1·04-1·14, P = 0·001). The reinfection rate in children who were originally infected with non-enterovirus A71 (non-EVA71) enteroviruses was higher than those infected with EVA71 (OR 1·36, 95% CI 1·02-1·80, P = 0·034). Influential factors of reinfection rate included annual incidence (β coefficient = 0·715, P = 0·002) and the proportion of EVA71 in patients with mild HFMD (β coefficient = -0·509, P = 0·018). These results demonstrate that boys aged <3 years, especially those in rural areas or regions with a lower EVA71 proportion are more prone to reinfection, and specific health education programmes should be developed to protect these susceptible populations.

Helicobacter pylori in Pediatrics

AbstractThis review concerned the important pediatric studies published between April 2012 and March 2013. Symptomatology in Helicobacter pylori‐positive children is nonspecific, except for those suffering from peptic ulcer diseases. Investigation of H. pylori status in children and adolescents with sideropenic anemia is recommended, and it is the aim of several studies worldwide. Associations of H. pylori with plasma ghrelin levels as well as the negative association of H. pylori with atopic disease were interesting objectives for several studies this year. Success rates of sequential therapy tended to be lower in recent studies than in previous trials, which probably reflects the increase in macrolide resistance. A beneficial effect of probiotics was reported although not all trials supported this result in children. Intrafamilial transmission and young age could be major risk factors associated with reinfection in children.

Prevalencia de protozoos intestinales en 79 niños de 2 a 5 años de edad de un hogar infantil estatal en Circasia, Quindío

IntroductionIntestinal parasites are considered a public health problem in developing countries, and they affect individuals of all ages and sexes; nevertheless they are frequent in early childhood. At present, the most reported intestinal parasite conditions in Quindío are giardiasis, caused by Giardia intestinalis (G. lamblia or G.duodenalis), and blastocystosis caused by Blastocystis sp. ObjectiveThe objective is to determine the prevalence of intestinal parasites in children 2 to 5 years old at a State nursery in Circasia, Quindio. Materials and methodsThree fecal samples per child were collected from 79 children following informed consent from their legal guardians. Microscopic and macroscopic laboratory test were made using 1% Lugol, 0,8% saline solution, saline-eosin solution and concentration techniques with formaldehyde-ether (Ritchie.) ResultsIn the three fecal samples, the pathogen parasites had the following prevalence: Blastocystis sp 49,4 %, 57 % and 64,6 % sp; Giardia lamblia 16,5 %, 22,8 % and 15,2 %; and Entamoeba histolytica/dispar 5,1 %, 5,1 % and.1,3 % respectively. ConclusionsThis study shows a high frequency of protozoa parasites, Blastocystis sp being the most prevalent. Re-infection in children was detected during the study.

The Role of Immunoprophylaxis in the Reduction of Disease Attributable to Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is an RNA virus that infects human respiratory epithelial cells and causes annual outbreaks of respiratory tract disease among infants and young children, as well as recurrent infections throughout life. Annual outbreaks of RSV disease are attributable to first-time infection in susceptible infants, reinfection in children and adults with waning or incomplete immunity, and infection by viral genotypes with sufficient antigenic variation to avoid innate and acquired immunity. In industrialized countries, few infectious diseases have a greater effect on the health of young children than does lower respiratory tract disease caused by RSV. By 2 years of age, almost all children will experience an RSV infection, and ∼50% will be infected twice.1 Results from the New Vaccine Surveillance Network (a prospective, population-based surveillance program sponsored by the Centers for Disease Control and Prevention [CDC]) define the burden of RSV disease in children younger than 5 years of age.2 An estimated 2 million children require medical care because of RSV infection, and ∼57500 children younger than 5 years are hospitalized annually. The major burden of RSV disease occurs among previously healthy infants and children whose susceptibility to severe RSV illness cannot be predicted by risk factors. Protection against RSV infection is mediated by serum antibody, secretory antibody, cytotoxic T lymphocytes, and innate immune responses. A vaccine offers the greatest promise for control of RSV disease, but vaccine development has been slowed by concerns about safety (enhancement of naturally occurring disease), the limited ability of infants to mount an immune response to RSV glycoprotein antigens, and the presence of maternal neutralizing antibody, which may attenuate an active immune response. Passive immunization with either a hyperimmune globulin or a monoclonal antibody preparation has been demonstrated in randomized, placebo-controlled trials to reduce the risk of hospitalization caused by … Address correspondence to H. Cody Meissner, MD, Tufts Medical Center, 750 Washington St, Boston, MA 02111. E-mail: cmeissner{at}tuftsmedicalcenter.org

Non‐structural protein NSP2 induces heterotypic antibody responses during primary rotavirus infection and reinfection in children

Rotaviruses are the single most important causes of severe acute diarrhoea in children worldwide. Despite success in developing vaccines, there is still a lack of knowledge about many components of the immune response, particularly those to non-structural proteins. This study established radioimmunoprecipitation (RIP) assays using labeled G1P[8], G2P[4], and G4P[6] human rotaviruses to examine the spectrum and duration of rotavirus antibodies in sera collected sequentially for 18-36 months from 27 children after hospitalization for primary rotavirus gastroenteritis. Five children experienced rotavirus re-infections. Primary responses detected to non-structural protein NSP2 declined to baseline after 100-150 days. Responses were heterotypic between NSP2 of G1P[8] and G4P[8] rotaviruses. Re-infections after 465-786 days boosted antibody levels to NSP2of both serotypes, together with the appearance of anti-NSP2 to G2P[4], even though there was no evidence of infection with this serotype. We developed an enzyme-immunoassay to measure sequential levels of anti-NSP2 IgG and IgA, using recombinant (heterotypic) NSP2 derived from SA11 (G3P[2]). Anti-NSP2 IgG and IgA were detected in sera from 23/23 (100%) and 18/24 (75%) of children after primary infection, declined to baseline after 100-150 days, were boosted after rotavirus re-infections, and again declined to baseline 150 days later. Anti-NSP2 IgA was also detected after primary infection, in duodenal juice from 14/16 (87%), and faecal extract from 11/19 (57%) of children. Sequential estimation of anti-NSP2 EIA levels in sera could be a sensitive index of rotavirus infection and re-infection. The potential of anti-NSP2 to limit viral replication after re-infection deserves further study.

Benefit of Vitamin A Supplementation on Ascaris Reinfection Is Less Evident in Stunted Children

Despite the common coexistence of vitamin A deficiency and Ascaris infection in preschool children in developing countries, and despite the widespread use of vitamin A supplements, remarkably little is understood about the impact of vitamin A supplementation on this gastrointestinal nematode. The Ministry of Health of Panama recently initiated a vitamin A supplementation program in rural indigenous populations. We took advantage of this initiative to assess the benefit of 200,000 IU (60 mg retinol) vitamin A on reinfection with Ascaris following deworming. Baseline stool exams, anthropometry, and socio-economic data were collected for 328 preschool children from 12–60 mo of age (106 supplemented within previous 3 mo and 222 unsupplemented within previous 6 mo). All children were dewormed with albendazole, and reinfection levels were monitored 3 and 5 mo later. Baseline prevalence of Ascaris was 79.5%. Stepwise regression showed that Ascaris intensity was lower in Vit A-supplemented children at baseline and 3 mo after deworming, but not after 5 mo. As 61% of the children were stunted, the impact of supplementation on Ascaris reinfection was examined separately for stunted and children of normal height. Prevalence and intensity of Ascaris at baseline and 3 mo after deworming were lower in children of normal height, but in stunted children the benefit was restricted to those who were dewormed within 6 wk of supplementation. Our study provides evidence that combined vitamin A supplementation and deworming reduces Ascaris reinfection in children living in areas of chronic parasitosis, but that the duration of the benefit is less in stunted children.