Welcome to the WSPID 2022 Virtual Congress Calendar

Background

Pneumococcal conjugate vaccines (PCVs) have reduced the proportion of vaccine-types isolates and resistance to antibiotics. In 2011, Colombia introduced PCV10 in routine childhood immunization program.

Aims

To determine pneumococcal lineages and antimicrobial resistance (AMR) genes in post-vaccine childhood using WGS.

Methods

Hundred and ten Streptococcus pneumoniae isolates recovered from children under 5 years old by passive laboratory surveillance during 2015-2018 were analyzed. Isolates were serotyped by Quellung and antimicrobial susceptibility was determined by broth micro-dilution. All isolates had resistance to one or more antibiotics. WGS was performed by Illumina in Sanger Institute. Global Pneumococcal Sequencing Cluster (GPSC) and penicillin-binding protein (PBPs) variants were assigned using Pathogenwatch. AMR genes were determined using GHRU-AMR pipelines protocols. Data was visualized on Microreact.

Results

Isolates were collected from patients with pneumonia (36.4%), sepsis (18.2%) and meningitis (10.9%). Eighteen lineages were identified. GPSC1 was the most abundant (n=66; 60%), composed by multidrug-resistant serotype 19A-ST320 (n=57), 19A-ST1451 (n=5) and 19A-ST13455 (n=3), which predominantly contained PBP1a, PBP2b, and PBP2x profile 13-11-16 with penicillin MIC >4ug/ml and AMR genes ermB-mefA-msr, tetM, and folP were found. GPSC10 included 19A-ST276 (n=10) and 24-ST230 (n=2), 75% with PBP profile 17-39-18 and penicillin MIC of 2-4ug/ml and carried ermB and tetM genes. GPSC5 and GPSC48 contained non-PVC10 isolates exhibited different PBP profiles and two had mefA-msrD and tetM genes.

Conclusions

WGS is a tool useful for surveillance and understanding the genetic composition of GPSCs associated with resistance that could be used to predict the impact of the vaccine and to design strategies for pneumococcal disease control.

Background

One explanation to why children are infected less frequently and severely than adults is that cross-reactive human common cold coronavirus (HCoV) immunity, could confer some protection. In addition, it has been reported that children have lower levels of spike protein antibodies than adults, and their accumulative humoral response is more expanded to “accessory proteins” like nsp1. Nsp1 plays a critical role in coronaviruses replication and virulence.

Aims

The aims were to predict B and T cell epitopes that could be recognized in human and to assess the epitope conservancy across different coronavirus species.

Methods

Nsp1 protein sequences of SARS CoV-2, HCoV.229E, HCoV NL63, HCoV OC43 and HCoV HKU1 were obtained from GenBank. MAFFT tool was used for multiple sequence alignment. BepiPred-2.0 and NetMHCpan EL 4.1 prediction methods were used to identify sequential B cells and MHC-I restricted T cell epitopes, respectively, and epitope conservancy was determined.

Results

B epitopes GQEWH67-71, and LHSLGGF109-115 in nsp1 of HCoV HKU1; EAASNGFR33-40 and KFSDRPF77-83 in nsp1 of HCoV 229E, and PLGMSLEAC108-116, and PVQSR135-143 in nsp1 of HCoV OC43 showed levels of epitope conservancy in nsp1 of SARS CoV-2 higher than 30%. PVQSR and its counterpart in nsp1 of SARS CoV-2 (GEIPVAY112-118) contain or are flanked by amino acids conserved in alpha and beta-coronavirus. MHC class I restricted T cell epitopes with levels of conservancy higher than 30% were found. Their counterparts in SARS CoV-2 protein also showed high prediction scores for some HLA molecules.

Conclusions

Cross-reactive immunity could explain aspects of differential clinical outcome in children and adults

Background

Vaccine hesitancy contributes significantly to suboptimal vaccination of infants from low wealth quintile families in Nigeria and the different strategies that have been employed to address it are yet to yield satisfactory outcomes. Older women infant caregivers are unrecognized stakeholders in infant care despite their cultural and strategic relevance in infant care. Exploring their views about vaccine hesitancy may offer better understanding of the phenomenon within the local context and guide the design of appropriate interventions.

Aims

To explore the views of older women caregivers regarding vaccine hesitancy and describe their experiences and handling of the same in seven urban slum communities of Ibadan, Nigeria.

Methods

Exploratory qualitative study design was used, and data was obtained using 22 focus group discussions among older women (≥35 years). Data was transcribed, and thematic analysis was used to analyze the data.

Results

The older women described vaccine hesitancy as complete avoidance of vaccine, but many did not view delayed or incomplete infant vaccination as vaccine hesitancy. They had all witnessed or experienced vaccine hesitancy in the past and believed it was due to ignorance, misinformation, and lack of trust in government policies. Vaccine hesitancy have been handled by reporting offending parents to community health committees, threatening and educating such parents by the older women.

Conclusions

Older women infant caregivers studied did not recognize the full spectrum of vaccine hesitancy and were handling it using ineffective means. Training these older women about vaccine hesitancy may improve infant vaccination in Nigerian slum communities.

Background

SARS-CoV-2 infection became a public health emergency around the world. Although infection in adults has been described as more severe when compared with children, the real burden of disease in vulnerable population such as neonates is still not well understood.

Aims

We sought to describe the clinical characteristics of patients younger than 90 days of age infected with SARS-CoV-2 in the only tertiary hospital in Costa Rica.

Methods

We collected the clinical information of patients diagnosed with Covid-19 using PCR between August 2020 to July 2021. After discharge, patients were contacted once by phone for follow-up. Clinical presentation, laboratory findings, and outcomes were analyzed for this report.

Results

Between August 2020-July 2021, 72 patients younger than 90 days of age were included. Median age was 36 days [24.5-56.8], with most patients having adequate prenatal care (86%), complete vaccination schedules, (97%), and being breastfed (97%). Fever (58%), rhinorrhea (43%), increase work of breathing (40%), and cough (38%) were the most common clinical findings at admission. Most patients were admitted (79%), with 33 (46%) requiring oxygen and 8 (11%) needing PICU admission. Outpatients were older (54 [48-60] vs. 32 [24-51] days of age, p=0.027), and presented most commonly with rhinorrhea (80% vs. 33%, p=0.002) and lower lymphocytes counts (2.1 [1.8-3] vs. 4.1 [2.5-6], p=0.04). No patients died during the study period.

Conclusions

SARS-CoV-2 infection in young infants is still not well understood, and clinical presentation varies among this population. Understanding the clinical presentation could help us predict possible outcomes in this vulnerable group.

Background

Lactating women can produce protective antibodies in their milk after vaccination, which has informed antenatal vaccination programs for diseases such as influenza and pertussis. However, whether SARS-CoV-2-specific antibodies are produced in human milk as a result of COVID-19 vaccination is still unclear.

Aims

Our aims are (1) to longitudinally quantify SARS-CoV-2-specific IgA and IgG in human milk of lactating women who received COVID-19 mRNA vaccine, with reference to a cohort convalescent from antenatal COVID-19 as well as a control cohort of healthy lactating women, and (2) to detect and quantify vaccine mRNA in human milk after vaccination.

Methods

Prospective cohort study of a convenience sample of lactating healthcare workers living in Singapore, who were due to receive two doses of the BNT162b2 (Pfizer/BioNtech) vaccine/ We collected milk samples at 5 time points.

Results

Lactating mothers who received the BNT162b2 vaccine secreted SARS-CoV-2-specific IgA and IgG antibodies into milk, with the most significant increase at 3–7 days post-dose 2. Virus-specific IgG titers were stable out to 4–6 weeks after dose 2. In contrast, SARS-CoV-2-specific IgA levels showed substantial decay. Vaccine mRNA was detected in few milk samples (maximum of 2 ng/ml), indicative of minimal transfer. Infants who consumed post-vaccination human milk had no reported adverse effects up to 28 days post-ingestion.

Conclusions

Our results define the safety and efficacy profiles of the vaccine in this demographic and provide initial evidence for protective immunity conferred by milk-borne SARS-CoV-2-specific antibodies. Taken together, our study supports recommendations for uninterrupted breastfeeding subsequent to mRNA vaccination against COVID-19.

Background

Misdiagnosis of Malaria could result in significant morbidity and mortality. Rapid, accurate and accessible detection of falciparum and non-falciparum malaria parasites through the use of local combined HRP2/pLDH (Pan) Rapid Detection Test (RDT) with a paired blood film has an important role in addressing this. However, there are known limitations to the efficacy of RDTs such us its lack of validation for the recognition of Knowlesi malaria, currently prevalent in some countries of Southeast Asia.

Aims

To establish the local diagnostic accuracy of the use of a single paired RDT and blood film to rule out Malaria disease in well children.

Methods

Methods

Retrospective study of 198 presumed cases of imported Malaria seen at SCH between 2014 and 2019. All of them had at least one RDT, blood film and Full blood count to exclude disease. Hospital numbers were facilitated by our local Haematology lab. The data was collected from local electronic records. Data analysed using Microsoft Excel and MedCalc software.

Results

Results

Overall, a single RDT was diagnostically accurate in all 17 cases of confirmed Malaria (100.00%; 95% CI 98.15%-100.00%) of which 15 had a positive paired blood film (98.99%; 95% CI 96.40%-99.88%). All confirmed cases seen at SCH travelled from African countries and presented with symptoms and abnormal FBC.

Conclusions

Conclusion

The use of a single paired RDT and blood film could be enough to rule out Malaria disease in well children, with normal FBC results, who travel from low-risk areas for Knowlesi malaria.

Background

Non-tuberculous mycobacteria (NTM) lymphadenitis in children is increasingly recognised, and poses diagnostic and therapeutic challenges.

Aims

To describe the epidemiology and clinical features of NTM lymphadenitis, determine sampling diagnostic yield, and review management and outcomes.

Methods

We performed a 10 year retrospective review (2011-2021) of children aged 0-16 years with NTM lymphadenitis. Diagnosis was based on typical clinical features in the presence of positive histological finding of granulomatous inflammation, culture, or direct polymerase chain reaction testing. Data collection included demographics, risk factors, clinical features, investigations, treatment, complications and outcomes.

Results

Forty-five children had 48 episodes of NTM lymphadenitis; 62.2% female, mean age 80 months (range 12-166 months). 43.7% presented with unilateral single node, most commonly parotid (39.6%), and submandibular (29.2%). 20.8% had reported fever. Three patients with disseminated NTM infection had pre-existing (n=2) or newly diagnosed (n=1) immunodeficiency. Sixty-seven sampling procedures were performed; NTM was identified in 23/64 (35.9%) specimens sent, from culture (n=16) or sequencing (n=7). NTM was identified in 22/48 episodes (45.8%). Mycobacterium abscessus was most common (11/23, 47.8%), followed by Mycobacterium haemophilum (6/23, 26.1%). Surgery was performed in 45/48 episodes (98.3%). 38 children (79.2%) received antibiotics; mean duration 4.96 months (range 0.75-19 months). Outcomes for 43 episodes showed 69.8% fully resolved, 27.9% relapsed at a new site, 2.3% recurred. 10/45 (22.2%) had post-surgical complications and 11/38 (28.9%) developed adverse drug reactions.

Conclusions

Mycobacterium abscessus lymphadenitis was most commonly identified. Culture yield was low but molecular sequencing improved diagnosis. About 1/3 had relapse or recurrence, and 1/4 had treatment complications..

Background

Reports of pediatric COVID-19 cases in Asia are limited. In Thailand, the third outbreak has been resurged in April 2021 coincided with an increasing proportion of the Delta variant.

Aims

To describe the clinical characteristics and outcomes of pediatric COVID-19 in Thailand where favipiravir is the mainstay for antiviral treatment.

Methods

An observational cohort study, hospital-based of COVID-19 among children was conducted at tertiary care center in Bangkok, Thailand. The study included children age younger than 15 years with confirmed positive RT-PCR for SARS-CoV-2 from nasopharyngeal swab.

Results

From April to July 2021, 416 cases with median (IQR) age of 7.1 (2.7-11.6) years were included. Ninety one percent contacted from household members. The spectrum of diseases included 82 (20%) asymptomatic, 232 (56%) mild, and 102 (24%) pneumonia. Abnormal chest x-ray findings included ground glass opacities (46%), focal infiltrations (27%), perihilar opacities (19%), reticular infiltrations (15%), and other non-specific findings (4%). Only 12 children (3%) required oxygen support. Favipiravir was prescribed to 129 children (31%); 102 patients with pneumonia and 27 patients at risk for disease progression. Pneumonia was more common in age less than 3 years when compared to those aged 3-<12 years (aOR 0.30, 95%CI 0.17-0.52), and 12-15 years (aOR 0.40, 95%CI 0.21-0.77), and in patients with comorbidities (aOR 2.36, 95%CI 1.09-5.12). Rates of pneumonia significantly increased from April to Jul 2021 (p=0.008).

Conclusions

One-fourth of pediatric COVID had pneumonia, but only few required oxygen support. Favipiravir has been reported as an off-label uses in pediatric COVID-19 in recent outbreak in Bangkok.

Background

Self-medication with antibiotics is frequent and it comes to 35% in low-income countries with limited resources and thus represents a public health problem.

Aims

The objective was to measure the factors associated with antibiotic self-medication as well as the knowledge and attitudes of caregivers in pediatric emergency department.

Methods

Case-control study of patients with a infectious diagnosis who came to emergency room in two hospitals in Bogota, Colombia. A case was a patient that reported self-medication who was matched to 3 controls who went to the emergency room at the same time and didn't report this behavior on a survey. The results were compared using logistic regression analysis with an odds ratio(OR) and 95% confidence intervals.

Results

A total of 729 patients, 182 cases, and 547 controls were included. If the mother OR=0.56[0.40-0.79] and father OR=0.62[0.43-0.89] have a high level of education, the probability of self-medication is lower. Requesting antibiotics from the physician OR=3.92[1.59-9.66], buying antibiotics without a prescription OR=23.66[11.76-47.59], and recommending antibiotics among family members OR=2.90[1.75-4.82] resulted in an increased likelihood of self-medication. There was a higher probability of self-medication among older children OR=1.13[1.09-1.17] and those with a greater number of siblings OR=1.25[1.09-1.43]. Having received antibiotics within the last 3 months increased the probability of self-medication OR=6.27[4.35-9.04].

Conclusions

An increase in self-medication was identified as connected to an older age in years, previous use of antibiotics, presence of siblings, and parents with lower levels of education. The attitudes and knowledge of the caregivers suggested improper use of antibiotics on the Colombian pediatric population.

Background

SARS-CoV-2 affects children as coronavirus infectious disease (COVID-19) or multisystem inflammatory syndrome (MIS-C). COVID-19 results in mild to moderate symptoms in children; MIS-C can present with features of Kawasaki disease and cardiovascular compromise.

Aims

Pediatric COVID-19 and MIS-C have overlapping features, despite different pathophysiologies. We present a comparison between the clinico-pathological features, clinical course and outcomes of pediatric COVID-19 and MIS-C, to aid in early diagnosis and appropriate management.

Methods

We reviewed the medical records of children ≤16 years with the diagnosis of COVID-19 versus MIS-C presenting to two centers in the Islamabad-Rawalpindi metropolitan area, the fourth-largest of Pakistan, between March-December 2020. Demographics, clinical presentation, investigations, management and outcomes were compared. Descriptive analysis was performed; statistical association was determined between independent variables by calculating adjusted odds ratio using logistic regression. P<0·05 was considered statistically significant.

Results

Of 60 children included, 37 children had COVID-19 and 23 children had MIS-C. More children with COVID-19 had underlying illnesses while children with MIS-C were previously healthy. All children with MIS-C were symptomatic; 65% of children had symptomatic COVID-19. Features of Kawasaki disease were only seen in MIS-C. More children with MIS-C had cardiovascular involvement [signs of shock: COVID-19 n=5 (13·5%), MIS-C n=9 (39·1%), OR 5.30, 95% CI (0·95, 29·77), p=0.04; abnormal echocardiogram: COVID-19 n=0, MIS-C n=4 (17·4%), OR 8.36, 95%CI (1·43, 33·47), p=0·002; thus, being sicker, their hospitalization rates were higher. Outcomes were similar for both.

Conclusions

Compared to COVID-19, MIS-C occurs in healthy children but with more severe presentation, frequent cardiovascular involvement, worse laboratory findings, and higher hospitalization rates.

Background

BackgroundBackground
In low- and middle-income countries, infection is a major contributor to neonatal mortality, and aetiological data from non-central hospitals are scarce.

Aims

We conducted enhanced laboratory surveillance for culture-confirmed bloodstream infections and meningitis among neonates aged <28days at six non-tertiary level neonatal units in South Africa

Methods

From October 2019 through September 2020, clinical data and isolate(s) were collected. Healthcare-associated-infections (HAI) were those diagnosed in a neonate aged ≥3days and hospitalised for ≥48hours prior to specimen collection.

Results

Of 933 episodes of neonatal infection, clinical data were available for 812. Of these 30% (243/812) were early-onset sepsis (EOS: aged <3days), 14% (111/812) were community-associated infections (CAI: aged >3days and hospitalised <48hours) and 56% (n=458/812) were HAI. Day 28 mortality was 21% amongst EOS, 20% amongst CAI and 29% amongst HAI (p=0.01).
259/458 (57%) HAI cases had isolates available for characterisation. Of these, 79% (205) were Gram-negative bacteria (GN), 15% (39) Gram-positive bacteria (GP) and 6% (15) fungal isolates. The top four aetiologies were Klebsiella pneumoniae (102, 39%), Acinetobacter baumannii (58, 22%), Enterobacter cloacae (19, 7%) and Staphylococcus aureus (18, 7%),
Amongst HAIs, 48% (93/195) GN and 65% (24/37) GP were susceptible to at least one first-line antibiotic (ampicillin and gentamicin). Eight-five percent (162/191) GN and 89% (32/36) of GP were susceptible to at least one second-line antibiotic (piperacillin-tazobactam and amikacin). Fifty percent (98/196) GN and 78% (28/36) GP were susceptible to meropenem.

Conclusions

Neonatal HAI was associated with a high mortality, with high prevalence of GN infections and substantial resistance to WHO-recommended antibiotic therapy.

Background

Selection for antibiotic resistance remains a concern with long-term azithromycin (AZM) use in chronic lung diseases (CLD).

Aims

We investigated the impact of 48 weeks of AZM on the carriage and antibiotic resistance of common respiratory bacteria among children with HIV-associated CLD.

Methods

Nasopharyngeal (NP) swabs and sputa were collected at baseline, 48 and 72 weeks from participants with HIV-associated CLD randomised to receive weekly AZM or placebo for 48 weeks and followed post-intervention until 72 weeks. The primary outcomes were prevalence and antibiotic resistance of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) at these timepoints. Mixed-effects logistic regression and Fisher's exact test were used to compare carriage and resistance respectively.

Results

Of 347 (174 AZM, 173 placebo) participants (median age 15 years [IQR =13–18], females 49%),NP carriage was significantly lower in the AZM (n=159) compared to placebo (n=153) arm for SP (18% vs 41%, p<0.001), HI (7% vs 16%, p=0.01), and MC (4% vs 11%, p=0.02); SP resistance to AZM (62% [18/29] vs 13%[8/63], p<0.0001) or tetracycline (60%[18/29] vs 21%[13/63], p<0.0001) were higher in the AZM arm. Carriage of SA resistant to AZM (91% [31/34] vs 3% [1/31], p<0.0001), tetracycline (35% [12/34] vs 13% [4/31], p= 0.05) and clindamycin (79% [27/34] vs 3% [1/31], p<0.0001) was also significantly higher in the AZM arm and persisted at 72 weeks. Similar findings were observed for sputa.

Conclusions

The risk of drug resistance should be considered during long-term AZM use. The clinical significance of antibiotic resistance needs investigation.