Welcome to the WSPID 2022 Virtual Congress Calendar

Background

The growth of antimicrobial resistance (AMR) worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC).

Aims

We aimed to compare paediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC, and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings.

Methods

An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020.

Results

Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76%; IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for paediatric patients, with less reliable availability of World Health Organization ‘Access’ list antibiotics. Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to paediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing, and only 25% on IPC.

Conclusions

Marked differences exist in availability of AMS and IPC resources in LMIC as compared to HIC. A collaborative international approach is urgently needed to combat AMR, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.

Background

Background:

Infections acquired during ECLS are common and can significantly increase ECLS duration and decrease survival. A review of Extracorporeal Life Support Organization (ELSO) data from 1998-2008 found that the incidence of infection increases with longer runs.

Aims

Aim:

To look at the bacteriological profiles and infections rates in our cohort.

Methods

Methods:

We collected data from year 2014 to 2018. This study involved 68 patients. In this study we did not include any background of the patients which included the ethnicity, specific age, gender, definite diagnosis, outcome and the 30-day outcome. The period of positive cultures are divided into two durations which are 1) 7 days or less (≤7 days) and 2) More than 7 days (›7 days).

Results

Results:

The maximum number of days of ECLS was 15 days with the average of 6.2 days for the post-cardiac surgery patients, 21 days for non-post cardiac patients with the average of 6.3 days.Risk of infection increased after 7 days, with the p-value of primary bloodstream infection of 0.0383 and non-bloodstream infection of 0.008. The main microorganisms identified were Coagulase Negative Staphylococcus (CONS), Candida species and Pseudomonas aeruginosa.

Conclusions

As shown in our study, the risk of infection increases with more than 7 days on ECLS, hence, it might be more advisable to do routine cultures if the patients are on ECLS for more than 7 days or when there is clinical suspicion suggestive of infection. The main microorganisms responsible for infection was Coagulase Negative Staphylococcus (CONS). A standardized prophylaxis antibiotics protocol is required.

Background

New Zealand has changed pneumococcal conjugate vaccine (PCV) several times since 2008, more recently changing PCV13 to PCV10. Globally, some regions which have made this switch have had a rise in serotype 19A IPD rates. The World Health Organisation concluded in 2019 that there is no evidence PCV10 produces indirect protection against serotype 19A (WHO Position Paper 2019).

Aims

To determine the changes in pneumococcal serogroups causing IPD in New Zealand children

Methods

IPD notification data from the Institute of Environmental Science and Research (ESR), Census data and information from the National Immunisation Register were merged to examine serotype trends over time. Antimicrobial resistance analyses were conducted at the ESR.

Results

The overall rates of IDP have reduced between 2011 and 2020. Following the change to PCV10 in 2017 incidence of serotype 19A in children <2 years increased from 0.0 to 7.3 cases per 100,000, whilst PCV10 preventable serotypes continued to decrease. In children < 5 years the proportion of vaccine-preventable cases that are serotype 19A increased from 50% (2011), to 57% (2017), to 100% (2020). Penicillin resistance of serotype 19A isolates has increased from 20% in 2010 to 65% in 2019.

Conclusions

Since the reintroduction of PCV10 serotype 19A has become the dominant vaccine-preventable serotype causing IPD in children < 5 years. This data supports the WHO position that PCV10 does not provide clinically significant cross-cover for serotype 19A. These epidemiological changes and increasing antimicrobial resistance of serotype 19A cases highlight the need to review NZ’s pneumococcal vaccine choice.

Background

Dengue is a mosquito-borne viral disease endemic in at least 128 countries and a potential threat for travelers to these countries.

Aims

Takeda’s vaccine candidate (TAK-003) is a recombinant tetravalent dengue vaccine based on a DENV-2 backbone. The clinical development program includes an ongoing long-term Phase III efficacy clinical trial in eight dengue endemic countries evaluating long-term efficacy, safety, and immunogenicity which currently has 3 years data available.

Methods

Overall, 18 clinical trials have included 28,175 participants aged 1.5-60 years in 13 endemic and non-endemic countries. In the Phase III efficacy study, healthy 4–16 year-olds (n=20,099) were randomized 2:1 to receive two doses of TAK-003 or placebo three months apart, and are under active febrile illness surveillance to detect symptomatic dengue.

Results

Safety and immunogenicity data from Phase I/II studies established the final formulation and dosing schedule. In the pivotal Phase III efficacy study the cumulative vaccine efficacy from first dose through three years after the second dose was 62.0% (95% Confidence Interval: 56.6–66.7) against virologically confirmed dengue (VCD) and 83.6% (76.8–88.4) against hospitalized VCD for safety set. Efficacy varied by serotype and some decline in efficacy was noted in a year-to-year comparison but remained robust against hospitalized VCD. Rates of serious adverse events were similar between the vaccine and placebo groups. No important safety risk was identified.

Conclusions

TAK-003 was well tolerated and protected against symptomatic dengue over three years after vaccination in both dengue-naïve and pre-exposed children in dengue endemic countries with no evidence of disease enhancement to date.

Background

Carbapenem resistance in gram negative bacteria(GNB) is major concern in the management of resistant infections. The mechanism of carbapenem resistance is primarily mediated by carbapenemases. Five most common genes (NDM , KPC , VIM , OXA , IMP) are responsible for carbapenemase production. Knowledge of these genes is important as management will vary according to the type of resistant gene.

Aims

To estimate the prevalence of different genes responsible for carbapenemase production in GNB at a tertiary health care center in South India.

Methods

In this retrospective study, samples were collected over 16 months. GNB which grew on culture, showed resistance to carbapenem (meropenem mic>8) were tested by Xpert Carba-R Assay for the detection of five important genes responsible for carbapenemase production ; NDM, KPC, VIM, OXA, and IMP.

Results

Total 184 cultures were collected which suggested carbapenem resistance GNB . 12 samples were excluded as they were repeat samples. Rest 172 samples grew Klebsiella pneumonae(152), Escherichia coli(10), acinetobacter species(6), Pseudomonas(2) and Enterobacter(2). Among them , OXA 48 and NDM are most common gene with 137 (83.5%) and 97(59.1%) respectively. 70 samples(42.6%) showed presence of both , 1 (0.6%) showed presence of OXA 48, NDM, and VIM. IMP and KPC gene were not detected.

Conclusions

In view of limited options and higher cost of antibiotics, knowledge of genes responsible for carbapenem resistance is a cost effective approach. This will helps to select appropriate antibiotics, rational use of antibiotic therapy and reduce the mortality and morbidity.

Background

Distinguishing children with SARS-CoV-2 infection compared to other acute respiratory illnesses (ARIs) would assist treatment and infection control strategies, especially where resources are limited.

Aims

The study aim was to describe the profile and outcomes of SA children with ARI with and without SARS-CoV-2 infection.

Methods

In this cross-sectional study, we evaluated routinely collected clinical data of children 0-13 years presenting with ARIs to Tygerberg Hospital, Cape Town between May 2020- November 2020. SARS-CoV-2 PCR was performed on all admitted children presenting with respiratory symptoms.

Results

Data of 178 children was included. SARS-CoV-2 positive children (40/178, 22.5%) were younger (median 6.7 vs 17 months, p=0.09), had lower weight-for-age Z-score (-0.83 vs -0.54, p=0.02) and were more likely female (55% vs 38%, p<0.01). Underlying comorbidities were similar in both groups. Multivariable logistic regression analysis showed SARS-CoV-2 positive children more frequently presented with fever (OR 3.9, 95CI 1.7-8.8), and were less likely to have cough (OR 0.3 95CI 0.1-0.6).

Oxygen supplementation (73% vs 75%, p=0.79) and respiratory support (38% vs 26%, p=0.16) were similar between groups, but SARS-CoV-2 positive children were more likely to require PICU (18% vs 7%, p=0.03) and remain on oxygen (median 6 vs 2 days, p=0.01). Readmission within 3 months for respiratory reason was similar (18% vs 15%, p=0.64).

Conclusions

Clinical presentation between children with and without SARS-CoV-2 was comparable. Children with SARS-CoV-2 infection required longer oxygen supplementation and more PICU admissions. These findings suggest a potentially differential long-term outcome in children with SARS-CoV-2 which requires further investigation.

Background

Acute encephalitis syndrome (AES) continues to be a ‘major health threat’ in India. Japanese encephalitis (JE) virus is the most commonly identified virus, but in majority of cases the etiological virus remains the mystery. Parvovirus 4 (Parv4) is a new virus but its association with any disease and its spread in the human population has not been clearly assessed.

Aims

To find any association of Parv4 in causing acute encephalitis.

Methods

CSF and serum samples of patients presenting as Acute encephalitis syndrome are routinely tested for the presence of possible etiological as part of routine viral diagnostic workup in Virology laboratory, King George’s Medical University, Lucknow, India. The cohorts of CSF samples positive for any of tested viruses (cohort 1;n=12) and CSF samples negative for tested virus (cohort 2;n=9) were further subjected to Parv4 detection by real time PCR method. PARV4 positive Samples were sequenced and phylogenetically analayzed.

Results

In cohort 1, 8/12 (66.7%) and in cohort 2, 4/9 (44.4%) were detected positive for Parv4. Two of these parv4 positive samples (one from each cohort) were sequenced by next generation sequencing. The sequences are available in GenBank under accession no. KM390024 and KM390025.

Conclusions

Present study discusses its detection in patients of acute encephalitis syndrome; however, its association as causative agent is yet to be elucidated. Whether it is just a co infecting virus (suggestive as in patient 1) or a AES causing virus (suggestive as in patient 2), is an important research question.

Background

Extensively drug-resistant (XDR) Gram-negative bacterial (GNB) sepsis is emerging as a new threat among neonates admitted in Neonatal Intensive Care Unit (NICU).

Aims

To determine the proportion of neonates, the pathogen profile and outcome of XDR-GNB neonatal sepsis, in a newly established Level III NICU in Western India.

Methods

The data of all neonates admitted in NICU from July 2016 to June 2021 was retrospectively analyzed from our database. Standard CDC definition was used to define multi-drug resistance (MDR) and XDR.

Results

Of the total of 1230 NICU admissions, 973 were inborn and 257 were outborn neonates. The incidence of total and culture positive sepsis was 31.5% (387/1230) and 11.7% (144/1230) respectively. There were a total of 194 bacterial isolates with 73.2% (142) being GNB. Out of these, 73.2% (104) were MDR and 33.8% (48) were XDR GNB isolates. Fifty eight percent of XDR GNB were isolated from outborn referred neonates. Neonates with XDR GNB sepsis accounted for one third of the total neonates with culture positive sepsis. The distribution of these XDR GNB isolates was: Klebsiella (n=21, 44%), Acinetobacter (n=18, 38%), Escherichia species (n=6, 13%), Enterobacter (n=1; 2%), Citrobacter (n=1, 2%) and Chrysobacterium (n=1, 2%). Among 142 GNB isolates, 58% of Acinetobacter, 44% of Klebsiella and 38% of Escherichia were XDR. The case fatality rate was almost double among neonates with XDR GNB sepsis as compared to non-XDR GNB sepsis (RR 1.97 [95% CI 1.11-3.51; p 0.021]).

Conclusions

XDR-GNB accounted for one-third of the total GNB isolates with almost double case fatality rate.

Background

Due to COVID-19 pandemic restrictions, health-related concerns, and lockdowns, routine adolescent immunization rates declined substantially.

Aims

We sought to assess whether online education would improve pediatricians' knowledge, competence, and confidence related to adolescent vaccinations.

Methods

Pediatricians participated in a 30-minute video lecture. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 questions assessed knowledge/competence, and 1 question rated on a Likert-type scale assessed confidence. A paired-samples t-test was conducted for significance testing on the overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (5% significance level, P <.05). Cohen’s d with correction for paired samples estimated the effect size of the education on the number of correct responses (<.20 modest, .20-.49 small, .59-.79 moderate, ≥.80 large). Data were collected from 12/11/20 to 3/1/21.

Results

Average knowledge/competence improved from 50% to 59% (N= 1,777, P<.001, Cohen’s d = 0.34) among pediatricians.

Relative improvements post-participation in specific areas were as follows (P<.001):

10% improvement among pediatricians in findings related to identifying vaccines routinely recommended by the Advisory Committee on Immunization Practices (ACIP).

28% improvement among pediatricians related to correctly identifying if a 9-year old male patient is eligible for the HPV vaccine.

35% of pediatricians had a measurable increase in confidence in their ability to collaborate with the interprofessional team to increase vaccine uptake among adolescents during the pandemic.

Conclusions

This study demonstrated the success of a 30-minute video lecture at improving pediatrician's knowledge, competence, and confidence related to recommendations for adolescent vaccines.

Background

MenB-FHbp vaccine (Trumenba^®; bivalent rLP2086; Pfizer Inc, Philadelphia, PA) is licensed to prevent meningococcal serogroup B disease in Europe (≥10 years) and the United States (10-25 years). A MenABCWY vaccine containing MenB-FHbp is being developed.

Aims

Assess immunogenicity against serogroup B and safety of MenB-FHbp (2-dose schedule) and MenABCWY.

Methods

Participants (10-25 years) received MenB-FHbp (months 0,6) and MenACWY-CRM (month 0) or MenABCWY (months 0,6). Endpoints included percentages of participants achieving ≥4-fold increase from baseline in serum bactericidal assay using human complement (hSBA) titers for 4 primary serogroup B test strains and titers ≥lower limit of quantitation (LLOQ; 1:8 or 1:16) for primary strains combined (composite response) after dose 2 of MenB-FHbp or MenABCWY; a titer ≥1:4 is the accepted correlate of protection. Safety was assessed.

Results

Percentage of participants (n=814-850) achieving ≥4-fold increases in hSBA titers against primary strains after MenB-FHbp dose 2 ranged from 67.4%-95.0%; composite response was 74.3% (Figure 1). After MenABCWY dose 2, percentage of participants (n=418-432) achieving ≥4-fold increases in hSBA titers ranged from 75.8%-94.7%; composite response was 79.9% (Figure 2). For MenB-FHbp, most reactogenicity events were mild-to-moderate in severity. Adverse events (AEs), serious AEs, medically attended AEs, and newly diagnosed chronic medical conditions were reported by 40.7%, 0.8%, 26.7%, and 0.8% of participants, respectively. Safety and tolerability of MenABCWY was similar to MenB-FHbp.

Conclusions

MenB-FHbp at 0,6 months was well-tolerated and induced protective bactericidal antibody responses, supporting the 2-dose MenB-FHbp schedule. Results also support continued evaluation of MenABCWY .

Trial Registration: ClinicalTrials.gov: NCT03135834.

Background

Children and adolescents with SARS-CoV-2 infection (COVID-19) are less likely to have severe pneumonia but may present with multisystem inflammatory syndrome (MIS-C) and both these conditions have low mortality. There are limited data on the characteristics and outcomes of children with severe COVID-19 and MIS-C requiring paediatric intensive care (PICU) from resource-limited settings.

Aims

We aim to describe the indications for admission and the outcomes of patients admitted to PICU at Tygerberg Hospital in Cape Town, South Africa.

Methods

Retrospective review of patients < 13 years admitted to PICU with COVID-19 or MIS-C from 17 April 2020 to 31 August 2021.

Results

Sixty three patients required PICU. Twenty-three (36.5%) had MIS-C, 35 (55.5%) had severe COVID-19 and in five (7.9%) children the COVID-19 was thought to be incidental. Patients with MIS-C were older (median age 84 months, IQR 48.0-108.0) than those admitted with severe COVID 19 (median age 20.5 months, IQR 7.0-57.5). Co-morbid disease was more common in children with severe COVID-19 (18/35, 51.4%), than in children with MIS-C (4/23, 17,4%). No children with MIS-C died, but 10 out of 35 children with severe COVID-19 died (28.6%). Of the children admitted to PICU with severe COVID-19 23/35 (63.8%) required invasive ventilation and 15/35 (35.7%) inotropic support. More children with MISC required inotropic support (15/23, 65%).

Conclusions

This cohort is small, but we are concerned that in this group of children with COVID-19 mortality is high once admission to PICU is required. Children with MIS-C had good outcomes.

Background

Lack of a timely receipt of vaccines causes challenges such as uncertain immune response and under-vaccination. Hence, timely vaccination is crucial to ensure an infant’s early protection.

Aims

To identify the age of presentation for the birth dose vaccination, vaccine antigens received, and determinants of timely presentation for vaccinations in Northern Nigeria.

Methods

A descriptive cross-sectional study involving 1952 mother-infant pairs enrolled from five different states in Northern Nigeria. Data collected include the socio-demographic, antenatal care (ANC) and delivery details, dates of birth, presentation for vaccination, and birth vaccine antigens received. Data analysis was done with SPSS-21.

Results

The median age of the infants at presentation for the birth dose vaccines was six (interquartile range 2-16) days. 413 (21.2%) mother-infant pairs presented on the day of birth (Day 0) or the next day (Day 1), while one-fifth (403, 20.6%) mother-infant pairs came after Day 28. The Bacille-Calmette-Guerin vaccine was most frequently received at 91.2% (1781 infants), oral polio vaccine 1703(87.2%) and hepatitis B vaccine birth dose (HBV-BD) the lowest at 75.1% (1565). The commonest reasons proffered for the delayed presentations were an ill baby (24.7%) and an ill mother, 21.9%. Determinants of presentation within 24 hours post-birth were hospital delivery (OR-1.67, 95% CI; 1.28-2.19), first child (OR-1.4; 95%CI; 1.02-1.93), Christianity (OR-2.141 95%C.I; 1.63-2.81) and mother with tertiary education (OR-1.62, 95%CI; 1.05-2.48).

Conclusions

Timely presentation for birth dose vaccines is low in Northern Nigeria. Furthermore, some babies do not get the required vaccines despite presenting for vaccination.Missed opportunities due to vaccine unavailability is a concern.