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Abstract Body

Background:

Direct Provision (DP) in Ireland provides basic needs of food and shelter to asylum seekers while their refugee status is processed. As of October 2018, 6,405 people were living in DP, including 1,778 children. Communicable disease screening upon entry to Ireland is voluntary, many relocated prior to completion.

Methods:

We report on contact tracing for 90 children exposed to pulmonary tuberculosis at an Irish DP centre. Identified high-risk cases assessed for latent tuberculosis infection(LTBI). This included clinical assessment, initial tuberculin skin test(TST) and repeat at 6 weeks where indicated, quantiferon release assay(IGRA) and chest radiograph. TST defined as positive if >5mm.

Results:

Ninety children reside in the DP center; contact tracing identified 22 children aged 11 months to 10 years referred for assessment.

1.Repeat TST carried out if initial TST <5mm

2.Eight children awaiting IGRA testing

3.Two children not started on treatment, DNA appointments

Fifteen (16.6%) paediatric DP residents treated for LTBI. Compliance good, follow up ongoing, to date treatment well tolerated. All CXRs without evidence of active TB disease.

Conclusions:

Residence in DP places vulnerable populations at risk, especially children. Initial migrant screening at entry point is indicated in addition to limited duration spent by families with young children in this environment.

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Background

Mother-to-child transmission is the principal way of acquisition of HIV infection by children. We aimed to describe the impact of perinatal preventive HIV transmission measures in neonatal outcome.

Methods

Retrospective descriptive study of offspring of HIV-infected mothers, born at Hospital Beatriz Ângelo, from January/2012 to December/2019. Obstetric and perinatal data, antiretroviral therapy (ART) and laboratory history were collected.

Results

From a total of 92 HIV infected women (93 newborns), median age 32,5 years, 81%(75) were emigrants, mostly of African origin (69;75%). 93%(86) were HIV1, 92%(85) acquired through heterosexual contact and 11%(10) with hepatitis coinfection.

HIV infection was diagnosed before pregnancy in 57%(52), although 35%(18) were not on ART. 41%(38) diagnosed during pregnancy. Most pregnancies (57;62%) required triple ART and 28%(26) needed 4 drug regimen.

In the third trimester median CD4 cell count was 422/mm³(11; 921), HIV viral load (VL) was undetectable in 57%(52) and under 1000cp/ml in 29%(27). All women with a VL above 1000cp/ml underwent a caesarean section, except one that had home delivery.

Median weight of the offspring was 3032g, 84%(78) at term. All newborns received prophylactic ART on the first 12 hours: 72%(67) AZT and 28%(26) AZT/3TC+NVP at least during four weeks. Only one newborn was breastfed before screening in labour. Infant PCR HIV was examined on 6 and 18 weeks and none of the children were infected.

Conclusions

Pre-conception and prenatal follow-up should be reinforced to ensure an earlier diagnosis. The implementation of several risk reduction measures prevented mother-to-child transmission in all cases.

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Background: Rapid nucleic acid tests (RNATs) for Group A Streptococcus (GAS) seem more sensitive than rapid antigen detection tests (RADTs). A systematic review of their accuracy is lacking.

Aims: We aimed to: (1) evaluate the accuracy of RNATs for detecting GAS in patients with pharyngitis, (2) explore test- and study-level factors that could explain variations in accuracy, (3) compare the accuracy of RNATs with that of RADTs.

Methods: We searched MEDLINE, Embase, and Web of Science (1990-2020) for studies evaluating RNATs for GAS, compared to throat culture. We assessed risk of bias and applicability concerns using QUADAS-2. Summary estimates of sensitivity and specificity were obtained by bivariate meta-analysis. Heterogeneity was explored by subgroup analyses and meta-regression. We compared the accuracy of RADTs and RNATs using direct comparisons.

Results: We included 33 studies (23/33 included children), encompassing 16,051 test results. RNATs were most often performed in a laboratory. The overall methodological quality was uncertain because of incomplete reporting. RNATs had a summary sensitivity of 97.5% (95% CI: 96.0-98.5) and specificity of 95.8% (94.4-96.9). Variability in sensitivity was explained by test type and GAS prevalence (p<0.05 for both). Estimates were robust in low risk of bias studies. RNATs were more sensitive than RADTs (10 studies; 97.2% vs. 79.7%, p=0.007).

Conclusions: The high diagnostic accuracy of RNATs may allow their use as stand-alone tests. However, further studies should evaluate them in point-of-care settings and assess other outcomes, such as their impact on antibiotic prescription rates and cost-effectiveness.

Registration number: CRD42020157289 (Prospero).

Funding: None.

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Introduction:

Community acquired pneumonia (CAP) is a leading cause of childhood morbidity and mortality globally. Our aim was to determine common viruses associated with (CAP) in hospitalized children with risk factors for pediatric intensive care unit (PICU) admission

Method:

A cross-sectional single institutional retrospective descriptive study performed at Hamad Medical Corporation in Qatar for children admitted with CAP from Dec 2017- Dec 2019 included details of demographics and respiratory viruses detected by PCR nasal swab

Result:

260 hospitalized children with CAP between 3 months-14 years with mean age of 4 years included. 234 had PCR nasal swab that tested positive in 198(81.5%); single virus isolated in 137 case and multiple viruses in 61 case. The commonest was Rhinovirus 78(28%).

Fever was the commonest symptom in 193(97%) followed by cough 190(95%). Most common finding in Chest x ray (done in 98%) was infiltrates 92(39%) then consolidation 82(35%) Figure (1).

Out of 96(48%) who needed Respiratory support; nasal cannula was used most in 68(70%). Antibiotics were used in 188(94%) with median hospital stay 7.7 days.

The commonest virus in PICU admissions (49 (20%) of 234 nasal swabbed children) was H1N1 influenza (figure 2) particularly in children with cerebral palsy, history of prematurity and asthma. Out of 198 admitted patients only 6 received flu vaccine

Conclusion:

Our study revealed that Rhinovirus was the most common causative agent in hospitalized children with CAP. H1N1 influenza virus plays a major role in PICU admission, adherence to annual influenza vaccine may reduce CAP complications and morbidity.

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Background and aims: LUS is an useful tool to monitor patients with respiratory symptoms. The aim was to describe LUS patterns in children with COVID-19 infection and respiratory symptoms, and in children with COVID-19 infection with non-respiratory symptoms.

Methods: prospective, observational study, performed in a tertiary Paediatric Hospital. Patients <18 years old admitted to the hospital with positive COVID19 test were included. Lung aeration and consolidation pattern were analysed. LUS results were defined in 3 grades depending on aeration loss: low, moderate, and severe; and in three patterns: viral pneumonia, bacterial pneumonia and atelectasis.

Results: Sixteen patients were recruited. The median age was 11 years (IQR 2.8-12), 11 (68.8%) were males. Six patients (37.5%) presented respiratory symptoms (RS). In all those patients (100%), LUS showed moderate-severe aeration loss; viral pneumonia pattern in 4 cases (66.6%), and atelectasis in one case (16.7%). Ten patients (62.5%) presented with non-respiratory symptoms (n-RS). In n-RS patients, LUS showed moderate-severe aeration loss in 9/10 (90%); two viral pneumonias (20%) and 1 bacterial pneumonia (10%). From n-RS cases, three patients were diagnosed of multi-systemic inflammatory syndrome (MIS-C). All of them presented severe aeration loss and bilateral pleural effusion in LUS. From all sample, four children required PICU admission, two due to respiratory failure, and two due to hemodynamic failure.

Conclusions and Relevance: COVID-19 paediatric patients with respiratory symptoms mostly showed viral pneumonia pattern with moderate-severe aeration loss in LUS. Patients with non-respiratory symptoms also have altered LUS.

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Objectives: Antibiotics administrated in the first week of life can disrupt the gut microbiome and thus the development of the gastrointestinal immune system. Therefore, we studied the association between atopic disorders at 4-6 years of age and antibiotic treatment in the first week of life in term born infants.

Methods: A prospective observational birth cohort of 436 term born infants with 151 receiving broad-spectrum antibiotics for suspected infection (AB+)[AB for 2-3 days (AB2) n=42, AB for 7 days (AB7) n=109], and 285 healthy controls (AB-) was followed-up at the age of 4-6 years. An online questionnaire was sent to 418 parents which were available for follow-up about asthma, eczema, rhinitis, allergies (food, drug, insect venom, inhalation or contact allergy). We used multiple logistic regression analyses to assess the risk for allergic diseases after antibiotic treatment. Additionally we investigated whether treatment duration was associated.

Results: In total, 341/418 (82%) parents responded (114 AB+[AB2 32, AB7 82], 227 AB-). Parental reported allergy was significantly higher in AB+ compared to AB- (23% vs 11% p=0.003, aOR 2.40 [95%CI 1.22-4.72, P=0.01], corrected for sex, age, day care attendance and household education. After adding duration of antibiotics to the model, only AB7 was associated with higher risk of parental reported allergy (aOR2.85 [95%CI 1.37-5.91, P=0.005]). No differences were found between AB+ and AB- for asthma, eczema and rhinitis.

Conclusion: Antibiotic treatment for 7-days in the first week of life, is significantly associated with an increased risk of allergy in children at 4-6 years of age.

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Background & aims: Influenza virus is a major respiratory pathogen transmitted via respiratory droplets, specifically types A and B which cause seasonal epidemics. Vaccination is the main method of prophylaxis. This study aims to explore if the seasonal flu vaccine should be routinely provided to the whole paediatric population.

Methods: A systematic review of all the literature was performed on PubMed. English language studies about the vaccine regarding children aged 6 months-18 years were included. Meanwhile, studies focusing on target groups included in HSE’s vaccination recommendation, and the vaccine during the H1N1 pandemic were excluded.

Results: The search yielded 238 relevant studies. A recurring theme of this systematic review was the significant disease burden of influenza, especially in children between six months and five years. The vaccine is efficacious in reducing influenza related hospitalisation by 25%, mortality by 2.5%, and incidence/morbidity by 40-60%. Studies showed that the vaccine’s effectiveness on the 6 months- 8 years cohort has been increasing yearly. Also, it is cost-effective when considering reduced health care and societal burdens, and has an economically feasible method of administration through school-based vaccination campaigns. Furthermore, the reported adverse effects of vaccines are at acceptably low rates. WHO recommends everybody over 6 months be administered the vaccine seasonally.

Conclusion: A universal seasonal influenza vaccination policy should be implemented due to the high disease burden of influenza, and high impact of vaccination. The evidence from this study illustrates that the advantages of influenza vaccine administration to healthy children far outweigh the disadvantages.