WHO Case Definition Research Articles

Infectious aetiologies of neonatal illness in south Asia classified using WHO definitions: a primary analysis of the ANISA study

SummaryBackgroundGlobally, neonatal mortality accounts for almost half of all deaths in children younger than 5 years. Aetiological agents of neonatal infection are difficult to identify because the clinical signs are non-specific. Using data from the Aetiology of Neonatal Infections in south Asia (ANISA) cohort, we aimed to describe the spectrum of infectious aetiologies of acute neonatal illness categorised post-hoc using the 2015 WHO case definitions of critical illness, clinical severe infection, and fast breathing only.MethodsEligible infants were aged 0–59 days with possible serious bacterial infection and healthy infants enrolled in the ANISA study in Bangladesh, India, and Pakistan. We applied a partial latent class Bayesian model to estimate the prevalence of 27 pathogens detectable on PCR, pathogens detected by blood culture only, and illness not attributed to any infectious aetiology. Infants with at least one clinical specimen available were included in the analysis. We assessed the prevalence of these aetiologies according to WHO's case definitions of critically ill, clinical severe infection, and infants with late onset, isolated fast breathing. For the clinical severe definition, we compared the prevalence of signs by bacterial versus viral aetiology.FindingsThere were 934 infants (992 episodes) in the critically ill category, 3769 (4000 episodes) in the clinical severe infection category, and 738 (771 episodes) in the late-onset isolated fast breathing category. We estimated the proportion of illness attributable to bacterial infection was 32·7% in infants in the critically ill group, 15·6% in the clinical severe infection group, and 8·8% among infants with late-onset isolated fast breathing group. An infectious aetiology was not identified in 58–82% of infants in these categories. Among 4000 episodes of clinical severe infection, those with bacterial versus viral attribution had higher proportions of hypothermia, movement only when stimulated, convulsions, and poor feeding.InterpretationOur modelled results generally support the revised WHO case definitions, although a revision of the most severe case definition could be considered. Clinical criteria do not clearly differentiate between young infants with and without infectious aetiologies. Our results highlight the need for improved point-of-care diagnostics, and further study into neonatal deaths and episodes with no identified aetiology, to ensure antibiotic stewardship and targeted interventions.FundingThe Bill and Melinda Gates Foundation.

Does knowing the influenza epidemic threshold has been reached influence the performance of influenza case definitions?

BackgroundDisease surveillance using adequate case definitions is very important. The objective of the study was to compare the performance of influenza case definitions and influenza symptoms in the first two epidemic weeks with respect to other epidemic weeks.MethodsWe analysed cases of acute respiratory infection detected by the network of sentinel primary care physicians of Catalonia for 10 seasons. We calculated the diagnostic odds ratio (DOR) and 95% confidence intervals (CI) for the first two epidemic weeks and for other epidemic weeks.ResultsA total of 4,338 samples were collected in the epidemic weeks, of which 2,446 (56.4%) were positive for influenza. The most predictive case definition for laboratory-confirmed influenza was the WHO case definition for influenza-like illness (ILI) in the first two epidemic weeks (DOR 2.10; 95% CI 1.57–2.81) and in other epidemic weeks (DOR 2.31; 95% CI 1.96–2.72). The most predictive symptom was fever. After knowing that epidemic threshold had been reached, the DOR of the ILI WHO case definition in children aged <5 years and cough and fever in this group increased (190%, 170% and 213%, respectively).ConclusionsDuring influenza epidemics, differences in the performance of the case definition and the discriminative ability of symptoms were found according to whether it was known that the epidemic threshold had been reached or not. This suggests that sentinel physicians are stricter in selecting samples to send to the laboratory from patients who present symptoms more specific to influenza after rather than before an influenza epidemic has been declared.

Differentiation of hepatic alveolar echinococcosis with a hemangioma-like pattern compared to typical liver hemangioma using contrast-enhanced ultrasound: a pilot study

PurposeEchinococcus multilocularis infects humans as a false intermediate host, primarily with intrahepatic manifestation. Incorrect diagnostic interpretation of these liver tumors, especially the hemangioma-like pattern, can lead to progressive disease. The aim of the study was to investigate the differentiation of typical hemangioma and a hemangioma-like pattern of E. multilocularis using contrast-enhanced ultrasound (CEUS).MethodsThis prospective clinical pilot study comprised patients with hemangioma (n = 14) and patients with alveolar echinococcosis (AE) and hemangioma-like pattern (n = 7). Inclusion criteria were the detection of a liver lesion according to a hemangioma-like pattern on E. multilocularis Ulm classification—ultrasound (EMUC-US) and “confirmed” or “probable” AE according to WHO case definition. The comparison group had hepatic hemangioma with typical B-scan sonographic morphology. All participants underwent conventional and contrast-enhanced ultrasonography.ResultsThe patient group comprised five men (71.4%) and two women (28.6%) with a mean average age of 64.1 ± 11.2 years. The patient group with hemangioma comprised nine female subjects (64.3%) and five male subjects (35.7%) with a mean average age of 56.1 ± 12.0 years. Early arterial bulbous ring enhancement (p < 0.0001) and iris diaphragm phenomenon could only be visualized in the patients with hemangioma (p < 0.0001). Furthermore, the patients with hemangioma exhibited hyperenhancement in the late phase (p = 0.0003). In contrast, the patients exhibited typical early arterial rim enhancement (p < 0.0001) and, in the portal venous and late phase, complete or incomplete non-enhancement (black hole sign; p = 0.0004).ConslusionThe behavior of hemangioma-like AE lesions and typical liver hemangiomas is significantly different on CEUS. AE should be considered as a possible differential diagnosis, especially in high-endemic areas.

Difficult questions about long COVID in children

Difficult questions about long COVID in children

Correlation between CK-MB, TSH, LDL, HDL, Troponin T, Troponin I and myocardial infarction

Introduction: The assessment of patients with acute chest pain of possible cardiac cause continues to be a challenge and positive diagnosis has psychological, social and legal implications. The presence of ST segment elevation in the ECG is highly specific (but only about 50% sensitive) for acute myocardial infarction (MI). However, many patients presenting to coronary care units has chest pain without ST elevation in the ECG. The diagnostic possibilities in these cases include: acute coronary syndrome in evolution, or ‘non-ischaemic’ chest pain. The World Health Organization defines for diagnosing AMI, the presence of two of the three enlisted features namely, symptoms of myocardial ischemia, elevated levels of cardiac marker (protein or enzyme) concentrations in the blood, and a typical electrocardiographic pattern involving the development of Q waves or persistent T wave changes. Methods: In this Prospective study, the data of the registry maintained in the Department of biochemistry, Tertiary care Teaching Hospital were analysed. The WHO case definition was used to assign a diagnosis in 430 patients presenting to the emergency department with symptoms of cardiac ischemia.

Changing epidemiology of human enteroviruses (HEV) in a hand, foot and mouth disease outbreak in Vellore, south India

PurposeHand Foot and mouth disease (HFMD) is a major childhood exanthematous disease causing outbreaks that have become a major public health threat in recent years. In Vellore district of Tamil Nadu, south India, occasional outbreaks are common among the paediatric age group, most commonly in those under 5years of age (U5s). CoxsackieA6, A4, A5, A9, A10, B2 and B5 are the common serotypes causing outbreaks. This study aimed to identify the molecular serotype of the causative agent, co-circulating in this region. MethodsAdapting the WHO case definition, cases during an HFMD outbreak between October and December 2017, were identified by a clinical criterion of fever, mouth ulcers and rash in the extremities. Vesicle fluid from these lesions were collected in viral transport medium and transported cold to the Clinical Virology laboratory of a tertiary care hospital in Vellore. Identification of the causative agent was undertaken by two real time PCRs (EV1 and EV2) followed by sequencing the VP1–2C region and constructing a phylogenetic tree. ResultsAmong the 31 HFMD patients included in this study, 23 (74.2%) were U5s, 3 (9.7%) were between 6 and 15 years and the remaining 5 (16.1%) were adolescents (>15 ​yrs). The outbreak ran a mild clinical course, with 22(71%) patients having fever as a prodromal symptom. Papulovesicular lesions characteristic of HFMD were present on all 31 (100%) patients’ palms and soles, buttocks of 19 (61.3%), oral mucosa of 12 (38.7%), and all over the body in 4 (12.9%) patients. Coxsackie A6(75%) and Coxsackie A16(25%) were the pathogens associated with this outbreak. ConclusionsChanging epidemiology of HFMD was seen in this outbreak since; other serotypes apart from the classical Coxsackievirus serotypes causing HFMD outbreak were also found co-circulating. EV1 PCR was a better screening assay than EV2 PCR in this region. Continued surveillance and molecular serotyping are necessary for HFMD outbreaks in any region.

To study the clinical profile of acute encephalitic syndrome in children aged 3 months to 12 years

Background: Acute encephalitic syndrome (AES) poses challenges to physicians owing to acute presentation, often rapid deterioration with various causes including infective inflammatory conditions of central nervous system. Thus, the aim of our study was to assess clinical profile of AES and to assess the outcome of management of AES in children. Materials and Methods: For this hospital-based observational prospective study, 32 clinically diagnosed hospitalized AES children, as per WHO case definition over a period of 2 years consecutively were enrolled. Cerebrospinal fluid(CSF) samples were tested for viral PCR and MRI was performed in all cases. Results: Major clinical manifestations were seizures 24 (75%), vomiting (40.6%) and abnormal gait (31.2%) were noted. Dengue infection was most common etiology for AES followed by Covid-19 infection and Tubercular meningitis. Rabies encephalitis, Autoimmune encephalitis, HSV encephalitis and Pneumococcal meningitis were also found among the study samples. Conclusion: The most common causes found in our study were Dengue fever and Covid-19 infection, therefore, one should be aware of common etiological agents causing AES as well as newer etiological agents like Covid-19 which might come in the future.

Diphtheria resurgence in Sada'a-Yemen, 2017\u20132020

BackgroundDiphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children.MethodsA study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors.Results747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05).ConclusionsThe findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.

Post- COVID-19 multisystem inflammatory syndrome in children

COVID-19 is a severe acute respiratory infection affecting worldwide population. There are many cases of complications after the COVID exposure occurring nowadays. One among is Post-COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C). As per CDC report till March 1, 2021, 2617 cases of MIS-C were meeting the definite case criteria and among 33 death cases were reported. Here we report a case of COVID-19 associated Multi-system inflammatory syndrome in a child (MIS-C) interpreted with WHO case definition criteria. The patient was a 7-year-old boy, with initial presentation of moderate fever, non-itchy red blanching rashes, breathlessness, later progressed to cardiogenic shock accompanied by positive SARS-CoV-2 antigen result. The emergency cardiogenic shock treatment protocol was followed with initial stabilization and resuscitation strategy. He was successfully managed by three days of IV Immunoglobulin 2g/kgand Methylprednisolone 2mg/kg/day therapy along with other supportive treatments. The patient was discharged after 20 days of hospital stay with improved health condition. Our case report will strengthen the exposure-outcome relations between the coronavirus infection and MIS-C, moreover the strategies carried out in our case will be a future direction for the effective management of MIS-C.

Occurrence of Dengue Virus Infection with Multiple Serotypes in Central Karnataka, India.

Objective To find the incidence of concurrent infection of dengue and correlate the difference in clinical features, laboratory diagnoses, and outcomes between dengue and dengue-like illnesses. Methodology A total of 2,256 patients with suspected dengue fever during the period of July 2014 to June 2020 as per the WHO case definition for dengue fever were enrolled in the study. All patients admitted with a suspected dengue fever were studied in detail in terms of demographic features, clinical features, and laboratory profiles. Two blood samples were collected from each patient with a history of fever for 5 to 7 days. Investigation consisted of CBC, Widal test, malarial card test, Weil Felix test, Scrub typhus test, chikungunya, dengue parameters such as dengue NS1, IgM, and IgG, and real-time PCR for dengue serotypes were performed for each sample. Results A total of 1,412 males (62.6%) and 844 females (37.4%) of age 2 to 44 years were hospitalized. Out of 2,256 clinically suspected dengue cases, 1,306 cases were positive and 950 were negative by RT-PCR test. Fever was the most common clinical features among the RT-PCR-positive cases, followed by retroorbital pain (85.9%), flushing in 77.5%, and rashes in 84.8% of patients. ARDS was seen in 9.7% and splenomegaly in 27.5% patients. A platelet count of less than 100,000 was observed in 1,838 (81.5%) patients, and a platelet count of less than 20,000 was observed in 147 (6.5%) patients. Of 2,256 samples, 1,306 (57.9%) tested positive for dengue viral RNA by RT-PCR. Also, 798 cases were infected with a single DENV serotype, and 608 had a concurrent infection. Of the 798 single DENV serotype infection cases, 392 (54.2%) were typed as DENV-2 and 218 (29.2%) as DENV-3. Coinfection with serotypes DENV-2 and DENV-3 was found to account for 67.8% of all concurrent infections.Conclusion The study showed that dengue fever with concurrent infection with multiple serotypes is on the rise, and an occurrence of recombination may lead to the emergence of more virulent strains showing varied clinical presentations.

Dietary Supplementation with Biobran/MGN-3 Increases Innate Resistance and Reduces the Incidence of Influenza-like Illnesses in Elderly Subjects: A Randomized, Double-Blind, Placebo-Controlled Pilot Clinical Trial.

Influenza-like illness (ILI) remains a major cause of severe mortality and morbidity in the elderly. Aging is associated with a decreased ability to sense pathogens and mount effective innate and adaptive immune responses, thus mandating the development of protective nutraceuticals. Biobran/MGN-3, an arabinoxylan from rice bran, has potent anti-aging and immunomodulatory effects, suggesting that it may be effective against ILI. The objective of the current study was to investigate the effect of Biobran/MGN-3 on ILI incidence, natural killer (NK) cell activity, and the expressions of RIG-1 (retinoic acid-inducible gene 1), MDA5 (melanoma differentiation-associated protein 5), and their downstream signaling genes ISG-15 (interferon-stimulated genes 15) and MX1 (myxovirus (influenza) resistance 1, interferon-inducible). A double-blind, placebo-controlled clinical trial included eighty healthy older adults over 55 years old, 40 males and 40 females, who received either a placebo or Biobran/MGN-3 (500 mg/day) for 3 months during known ILI seasonality (peak incidence) in Egypt. The incidence of ILI was confirmed clinically according to the WHO case definition criteria. Hematological, hepatic, and renal parameters were assessed in all subjects, while the activity of NK and NKT (natural killer T) cells was assessed in six randomly chosen subjects in each group by the degranulation assay. The effect of Biobran/MGN-3 on RIG-1 and MDA5, as well as downstream ISG15 and MX1, was assessed in BEAS-2B pulmonary epithelial cells using flow cytometry. The incidence rate and incidence density of ILI in the Biobran/MGN-3 group were 5.0% and 0.57 cases per 1000 person-days, respectively, compared to 22.5% and 2.95 cases per 1000 person-days in the placebo group. Furthermore, Biobran/MGN-3 ingestion significantly enhanced NK activity compared to the basal levels and to the placebo group. In addition, Biobran/MGN-3 significantly upregulated the expression levels of RIG-1, MDA5, ISG15, and MX1 in the human pulmonary epithelial BEAS-2B cell lines. No side effects were observed. Taken together, Biobran/MGN-3 supplementation enhanced the innate immune response of elderly subjects by upregulating the NK activity associated with reduction of ILI incidence. It also upregulated the intracellular RIG-1, MDA5, ISG15, and MX1 expression in pulmonary epithelial tissue cultures. Biobran/MGN-3 could be a novel agent with prophylactic effects against a wide spectrum of respiratory viral infections that warrants further investigation.

Risk of Hospitalization in Under-five Children With Community-Acquired Pneumonia: A Multicentric Prospective Cohort Study

To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP). Prospective cohort study. Multi-site hospital based study. A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2-59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day). Risk factors for hospitalization among pneumonia patients. A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multi-variate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, P=0.01), procalcitonin level >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95% CI: 0.6, 0.9, P=0.02). Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.

Clinical and virological characteristics of patients during the outbreak of chikungunya in Thiruvananthapuram, Kerala, India, 2019–2020

BackgroundAfter the 2007 epidemic, a major outbreak of chikungunya was reported from Thiruvananthapuram, Kerala, India during 2019–2020. Study designA cross sectional survey was conducted during the period to elucidate the clinical profile of patients and the genotype of CHIKV involved in the infections in one of the worst affected villages. Patients (n = 148) meeting WHO case definition were recruited both prospectively and retrospectively. All the samples were subjected to either RT-PCR or IgM ELISA based on the duration of symptoms. The CHIKV envelope gene sequences amplified among the positives were analyzed. Data on socio-demographic details, mosquito control practices, clinical features, details of hospitalization and treatment were collected. ResultsAmong the CHIKV suspected cases, 38 were recruited prospectively and 110 retrospectively. Among the former group 92% tested positive for CHIKV infection by either PCR or ELISA. Fever (51.4%) and joint pain (20.0%) were the presenting symptoms. More than 45% of the subjects had involvement of the knee joints. CHIKV Envelope gene sequence analysis indicated that all the cases belonged to the genetic lineage similar to 2006 outbreak CHIKV in Kerala. In addition, two novel non-synonymous mutations, K211E and I317V was recorded. ConclusionsThe clinical presentation of Chikungunya has shown some changes compared to previous epidemic. Fever was reported to be the initial symptom of the clinical profile. Implication of the two additional mutations found in the envelope gene of the virus needs further exploration towards recent increasing trend of CHIKV infection in the state.

1373Severe acute respiratory infection with high mortality rate in Sana'a city, 2018-2019 Yemen

Abstract Background The burden of influenza and severe acute respiratory infection (SARI) in conflict countries such as Yemen is exacerbated due to limited resources and the collapse of the health system. The aims are to describe epidemiology of SARI, determine influenza detection and case fatality rates among SARI patients. Methods We used a descriptive analytical study design. All SARI patients who meet WHO case definition during 2018-2019 from Sana'a city were included. Nasopharyngeal samples were examined by polymerase chain reaction. A soft copy of data that collected by surveillance staff was obtained from the National Influenza Control Program (NICP). Case fatality rate and detection rate were calculated and P value &amp;lt; 0.05 used for statistical significant. Results 1447 SARI patients were reported: 73% males, 54% aged 15- &amp;lt; 50 years. Comorbidity was among 27% (387) of them: (57% cardio-vascular diseases and 50% diabetes). Samples of 934 (64%) SARI patients were tested and influenza viruses were detected in 141 (15%) patients (13% type A and 2% type B). Higher influenza viruses were detected in winter months (November – February) (17% vs 9%, P &amp;lt; 0.001). Overall SARI fatality rate was 19% (276), significantly higher among patients with comorbidity (26% vs 16%, P &amp;lt; 0.001) confirmed influenza (30% Vs 15%, P value &amp;lt; 0.001) and not receiving antiviral (51% vs 17%, P &amp;lt; 0.001) than relevant groups. Conclusions SARI patients in Yemen had a high case-fatality rate particularly SARI patients with confirmed influenza. Introduce influenza vaccination for the risk group should be considered. Key messages Influenza and SARI cases are high in Yemen and progress to death.

Comparison of clinical and laboratory profile of survivors and non-survivors of SARS-CoV-2-related multisystem inflammatory syndrome of childhood in India: An observational study.

The SARS-CoV-2 pandemic is characterised by multiple reports of paediatric multisystem inflammatory disease or multisystem inflammatory syndrome in children (MIS-C) with Kawasaki disease-like features often complicated by myocarditis, shock and macrophage activation syndrome. Certain clinical and laboratory markers may be used to identify high risk cases. All sequentially admitted patients hospitalised between April 2020 and October 2020, who met the WHO case definition for MIS-C were included. Data included patient demographic information, presenting symptoms, organ dysfunction and laboratory parameters. SARS-CoV-2 infection was diagnosed by nasopharyngeal swab real-time reverse transcription-polymerase chain reaction and/or rapid antibody test for SARS-CoV-2 as recommended. The clinical and laboratory criteria were compared in the survival and non-survival groups. A total of 29 patients with MIS-C were treated during the study period. There were 21 survivors and 8 non-survivors. The non-survivors had more neurocognitive and respiratory symptoms along with increased incidence of myocarditis compared with survivors. The serum levels of CPK-MB, D-dimer, ferritin and triglyceride were significantly raised in non-survivors as compared to survivors. The non-survivor group had higher CPK and greater proportion of children with troponin-T elevation indicating higher incidence of myocardial injury and necrosis. The D-dimer, ferritin and triglyceride were also higher in the mortality group, indicating the greater extent of inflammatory damage in this group.

#42: COVID-19 in Pediatric Hemato-Oncology Patients from Three Hispaniola Hospitals

Abstract Background In late 2019, a novel coronavirus, SARS-CoV-2, was reported in China, which rapidly spread across the globe. The WHO declared a pandemic of coronavirus disease (COVID-19) in early 2020. In March, both the Dominican Republic and Haiti reported their first cases. The three pediatric oncology units (POUs) that make up the St. Jude Global Infectious Diseases Hispaniola Project began to see COVID-19 among patients in Santo Domingo in March and in both Santiago and Port-au-Prince in June. We report the experience of managing pediatric hemato-oncology patients with COVID-19 in these three POUs. Methods We added COVID-19 data to our ongoing healthcare-associated infection surveillance in the POUs of the Hispaniola Project. The population studied included all patients tested for SARS-CoV-2 by PCR and/or serological methods. Patient data was recorded on a basic line listing. Cases were categorized using a published clinical symptom severity scale and case definition criteria from the WHO and the US Centers for Disease Control and Prevention (CDC). Results In total, 31 pediatric oncology patients met either the WHO and/or CDC case definition for COVID-19. The average age was 8 years (range: 5 months to 15 years). Just over half (17, 55%) of cases were female. The most common oncology diagnosis was acute lymphoblastic leukemia in 17 of the cases, followed by acute myeloid leukemia (5) and solid tumor (4). Five (16%) cases were in the consolidation phase, 7 (23%) in induction, and 11 (35%) in maintenance. Using the symptom severity scale, 13 (32%) cases were asymptomatic; symptoms were considered mild in 14 (45%) cases, moderate in 3 (10%), severe in 0 (0%), and critical in 1 (3%). Three deaths were attributed to COVID-19. Eighteen cases met the WHO criteria, 13 (72%) of which were confirmed, 1 probable, and 4 suspected. Twenty-six cases met the CDC criteria, 13 (50%) of which were confirmed and 13 (50%) were suspected; there were 0 probable cases. Conclusions Our findings about COVID-19 in pediatric oncology patients are consistent with data reported globally that disease presentation is mostly asymptomatic or mild but with increased mortality. The high contagiousness and unpredictable clinical response of children with cancer call for rigorous measures to prevent infections in this population. In low resource settings, the scarcity of antiviral, immunologic, and supportive medications further underscores this need. Additionally, we observed differences in our data depending on which COVID-19 case criteria were used (WHO versus CDC); this highlights the importance of standardized definitions that can be used at all resource levels to promote reliable measurement of disease burden.

Accuracy and agreement of the Tuberculin Skin Test (TST) and the QuantiFERON-TB Gold In-tube test (QFT) in the diagnosis of tuberculosis in Indian children

PurposeAccurate diagnosis of TB in children is hampered by poor specificity of symptoms in endemic countries and the paucibacillary nature of childhood TB. This study was done to compare the accuracy and agreement of the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-tube test (QFT) in diagnosing tuberculosis (TB) in a predominantly BCG-vaccinated population of children. MethodsThis retrospective cohort study enrolled all children aged 1–15 years who underwent TST and QFT testing as part of screening for TB. Children were classified according to the 2014 WHO case definition of TB, and statistical analysis was done to generate data on concordance between the TST and the QFT as well as sensitivity and specificity within WHO-defined groups. ResultsTST and QFT concordance was 83.9% overall (kappa 0.51), 79% in those with WHO-defined TB and 89% in those without TB. TST+/QFT-discordance was commoner than QFT+/TST- discordance across groups. The sensitivity of the TST vs. the QFT was 70.8% vs. 50% for WHO-defined TB, with comparable specificity at 89% vs. 90% respectively. ConclusionsThe higher sensitivity of the cheaper and simpler TST supports its use for TB diagnosis in a normally nourished population of BCG-vaccinated children.

COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

BackgroundMultisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar.MethodsClinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed.ResultsThe mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70–100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors.ConclusionsOur report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

First COVID-19 cases with high secondary infection among health workers, Sana’a capital, April 2020: Lessons learned and future opportunities

ObjectivesConfirm existence of COVID-19 outbreak, conduct contact tracing, and recommend control measures. MethodsTwo COVID-19 cases in Sana’a Capital met the WHO case definition. Data were collected from cases and contacts who were followed for 14 days. Nasopharyngeal swabs were taken for confirmation by Polymerase Chain Reaction (PCR). ResultsTwo confirmed Yemeni male patients aged 20 and 40 years who had no travel history were admitted to hospital on 24 April 2020. Regarding the first patient, symptoms started on April 18th, 2020 then the patient improved and was discharged on May 5th, while the second patient’s symptoms started on April 22nd but the patient died on April 29th, 2020. Both patients had 54 contacts, 17 (32%) were health workers (HWs). Four contacts (7%) were confirmed, two of them were HWs that needed hospitalization. The secondary attack rate (sAR) was 12% among HWs compared to 5% among other contacts. ConclusionsFirst COVID-19 outbreak was confirmed among Yemeni citizens with a high sAR among HWs. Strict infection control among HWs should be ensured. Physical distancing and mask-wearing with appropriate disinfecting measures should be promoted especially among contacts. There is a need to strengthen national capacities to assess, detect, and respond to public health emergencies.

Trends in Lassa Fever Outbreak in Plateau State Nigeria

Background: Since the first case of Lassa fever was reported in Plateau State, Nigeria in 1969, several outbreaks have occurred, and many more cases are being reported every year. This study aimed to describe the trends in Lassa fever outbreak in Plateau State, Nigeria from 2015 to the first half of 2019.&#x0D; Methodology: A time series study was carried out employing a retrospective analysis of records of Lassa fever cases (from January 2015 – June 2019) obtained from Plateau State Epidemiological Unit. Cases were identified using the WHO case definition. Age-adjusted cumulative incidence, case positivity and case fatality rates were calculated for each year to study the trends. Data were retrieved and analyzed using Microsoft Excel.&#x0D; Results: Cases were mainly of the younger age group and were more concentrated in the Northern senatorial zone. Despite the increasing trend in incident cases from 5 in 2015 to 126 in 2019, and age-adjusted cumulative incidence from 1 case per 10,000 population in 2015 to 348 per 10,000 population in 2019, case fatality rate showed a downward trend from 29.6% in 2016 to 12.9% in 2019. Case positivity rates varied from 27.3% to 34.1% to 19.4% and back to 27.3% from 2016 to 2019, and the cumulative Case Positivity Rate was 25.7%.&#x0D; Conclusion: The incidence of Lassa fever in Plateau State showed an increasing trend while that of mortality was on a downward trend. More efforts should be put in place by the State government and other stakeholders to reduce the burden of this disease.