ETIDIOH - NEW

  Summary Background Post-acute sequelae of SARS-CoV-2 infection (PASC) remain a major public health challenge . Although previous studies have focused on characterising PASC in children and adolescents after an initial infection , the risks of PASC after reinfection with the omicron variant remain unclear. We aimed to assess the risk of PASC diagnosis (U09.9) and symptoms and conditions potentially related to PASC in children and adolescents after a SARS-CoV-2 reinfection during the omicron period. Methods This retrospective cohort study used data from 40 children's hospitals and health institutions in the USA participating in the Researching COVID to Enhance Recovery (RECOVER) Initiative. We included patients younger than 21 years at the time of cohort entry; with documented SARS-CoV-2 infection after Jan 1, 2022; and who had at least one health-care visit within 24 months to 7 days before the first infection. The second SARS-CoV-2 infection was confirmed by positive PCR, antigen...

  Summary -- What is already known about this topic? -  Influenza-associated encephalopathy (IAE) is a rare, severe neurologic complication of influenza. -- What is added by this report? - During the high-severity 2024–25 influenza season, 109 U.S. pediatric IAE cases were identified; 55% of affected children were previously healthy . Thirty-seven IAE cases were subcategorized as acute necrotizing encephalopathy (ANE), a severe form of IAE characterized by rapid neurologic decline and a poor prognosis . Overall, 74% of IAE patients were admitted to an intensive care unit , and 19% died ; 41% of ANE patients died. Only 16% of vaccine-eligible IAE patients had received the 2024–25 influenza vaccine. -- What are the implications for public health practice? - All children are at risk for severe neurologic complications of influenza . Annual influenza vaccination is recommended for all children aged ≥6 months to prevent influenza and associated complications, potentially including ...

  Abstract This study compares infant (0–24 months) respiratory infection presentations to a Northern Italian paediatric emergency department across two post-pandemic winters ( 2022–2023 vs 2023–2024 ). Despite an approximate 44% reduction in visits in 2023–2024 (N=176 in 2023–2024 vs N=317 in 2022–2023), infants in the 2023–2024 season experienced significantly higher proportions of ventilatory support (51.1% vs 32.8%, p<0.001) and intensive care unit admission (15.9% vs 1.9%, p<0.001) than those presenting in 2022–2023, with a non-significant trend towards higher hospitalisation (88.1% vs 81.7%, p=0.052). Respiratory syncytial virus re-emerged as the dominant pathogen (43.2% vs 27.7%, p<0.001) in 2023–2024, alongside increased human metapneumovirus and influenza A H1N1 . These findings highlight a concerning shift towards increased severity, underscoring the need for ongoing surveillance. Source: BMJ Paediatric Open,  https://bmjpaedsopen.bmj.com/content/9/1/e003695...

  Abstract Risk of death for both mother and fetus following Ebola virus infection is extremely high . In this study, healthy women in Rwanda aged ≥18 years were randomized to two-dose Ebola vaccination (Ad26.ZEBOV, MVA-BN-Filo) during pregnancy (group A) or postpartum (group B). Unvaccinated pregnant group B women served as control. This was a parallel, randomized, controlled, open-label, single-center trial to evaluate the safety (primary endpoint—outcomes of interest and serious adverse events (SAEs)) and immunogenicity (secondary endpoint) of the two-dose Ebola vaccination. Among 3,484 women screened, 2,013 were randomized, and 2,012 women and 1,945 infants born alive were descriptively analyzed . Adverse outcomes of interest occurred in women ( 5.2% in group A and 7.3% in group B ) and infants ( 26.0% in group A and 25.6% in group B ). The most common maternal outcome of interest was pathways to preterm birth (3.2% in group A and 3.4% in group B), and the most common infant ou...

  Abstract As intrinsic differences in humoral immune response to SARS-CoV-2 between children and adults remain unclear , we improved characterisation by defining the kinetics, specificity and function of antibodies to SARS-CoV-2 in children (n = 146, aged 9.4 ± 4.8 years with n = 257 samples) compared to adults (n = 85, aged 39.5 ± 15.2 years with n = 122 samples). We used plasma samples from an infection and vaccination-naive cohort study with RT-PCR confirmed ancestral B.1* SARS-CoV-2 virus infection with asymptomatic or mild disease, collected in Hong Kong between March to December 2020, from acute (0–14 days post infection) to convalescent (15–206 days) timepoints. Children had significantly lower primary antibody responses against SARS-CoV-2 proteins overall, leading to a less isotype switched response. While children had lower OC43 Spike and SARS-CoV-2 S2 IgG and avidity than adults, they exhibited higher avidities for SARS-CoV-2 whole Spike and Nucleocapsid , and higher lev...

Summary Background The Pandemic Response Repository through Microbial and Immune Surveillance and Epidemiology (PREMISE) programme was established to translate knowledge gained from global immunoepidemiological surveillance into a better understanding of population-level dynamics of emerging and re-emerging infections , as well as into the discovery and development of biomedical countermeasures against potential pandemic threats. As proof of principle for this approach, we conducted a longitudinal immunoepidemiological study in children in the USA, focusing on enterovirus D68 (EV-D68) infection dynamics but also capturing surveillance of a broad array of other endemic respiratory pathogens. Serendipitously, our sampling spanned the lifting of widespread COVID-19 non-pharmaceutical interventions (NPIs) in 2022–23, following a unique period during which virus exposure markedly diminished. Methods This prospective, multicentre, longitudinal, immunoepidemiological surveillance study enroll...

Abstract Mycoplasma pneumonia pneumonia(MPP) is a common respiratory disease that often occurs in children . The purpose of this study was to explore the clinical characteristics of children with mycoplasma pneumoniae pneumonia, the first outbreak after the prevalence of COVID-19 epidemic . Meanwhile, this study also analyzed the predictive value of serum protein indicators and coagulation parameters in the MPP group, as well as the correlation between these indicators. Children with Mycoplasma pneumoniae admitted to the pediatric ward of Chengdu Fifth People’s Hospital from May 2023 to March 2024 were selected. After screening, 411 children who met the research criteria were selected as the study subjects. All of the blood samples were tested for coagulation function , procalcitonin, serum protein and glucose among MPP group and control group. All data were processed for statistical analysis using GraphPad Prism 10.2.3. Comparison of the serum proteins and coagulation function between...

Key Points -- Question: What were the clinical characteristics, management approaches, and outcomes among children with influenza-associated acute necrotizing encephalopathy (ANE) in the US during the 2023-2024 and 2024-2025 influenza seasons? -- Findings:   In this multicenter case series of 41 children from 23 US hospitals , influenza-associated ANE carried a 27% mortality rate despite multimodal therapy. Most patients (76%) had no significant medical history , despite 15 of 32 tested (47%) having genetic risk alleles potentially related to risk of ANE identified during diagnostic evaluation. The H1 2009 influenza A strain predominated (34% of cases), and only 16% had received seasonal influenza vaccination . Among survivors, 63% had moderate to severe disability at 90-day follow-up. -- Meaning:  Influenza-associated ANE represents a rare but devastating neurologic complication primarily affecting previously healthy children. The high morbidity and mortality emphasize t...

HIGHLIGHTS •  PeV-A5 was the predominant PeV-A genotype detected from CSF/blood in 2024 at CM-KC. •  CM-KC PeV-A5 sequences resemble PeV-A5 sequences reported in Sapporo City, Japan, in 2018. •  The highest number of PeV-A5 detections within a single year in the USA. ABSTRACT Background Parechovirus-A5 (PeV-A5) blood and central nervous system (CNS) infections are rare in the United States of America (USA) and globally. We report an emergence of PeV-A5 infections among infants in Kansas City, Missouri, in 2024. Methods Cerebrospinal fluid (CSF) and blood samples from infants were tested for Parechovirus (PeV-A) in 2024 as a part of standard of care at Children's Mercy Kansas City (CM-KC). PeV-A testing included a two-step reverse transcriptase-polymerase chain reaction, and genotyping was conducted using Sanger sequencing. We analyzed the amino acid sequences and phylogeny of the 2024 PeV-A viruses and described the clinical characteristics of PeV-A infected infants. Resu...

Summary - What is already known about this topic? -- Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in school-aged children . In the United States, M. pneumoniae infection prevalence decreased during the COVID-19 pandemic and remained low through 2023. - What is added by this report? -- The number of hospital discharges of children with M. pneumoniae –associated CAP from U.S. pediatric hospitals increased sharply in 2024, accounting for approximately one half of hospitalized children with CAP. This number included children aged <5 years , a group in which M. pneumoniae infections have historically been less commonly reported. Data on length of hospitalization and intensive care unit admissions indicate that M. pneumoniae infections in 2024 were not more severe than 2018–2023 infections. - What are the implications for public health practice? -- Increased awareness among health care providers might improve diagnosis and could guide treatment of M. pneum...

Highlights •  Acute COVID-19 usually causes mild illness even in young and immunosuppressed children •  Nosocomial SARS-CoV-2 infection is associated with more severe disease •  Concurrent serious bacterial infection is rare in children admitted with acute COVID-19. ABSTRACT Background Management and outcomes of children hospitalised with acute SARS-CoV-2 infection may differ throughout the pandemic or with admission type (clinical COVID-19, incidental COVID-19 or nosocomial infection). Objectives Describe the severity, management and outcomes of hospitalised children with acute SARS-CoV-2 infection in Australia across the first 4 years of the pandemic and compare between admission types, SARS-CoV-2 variants, age groups and immune status. Study design A multi-centre prospective cohort study of 6,009 children aged 0-16 years between January 2020 to June 2023. Results Most children (84.3%) did not receive respiratory support , 33.4% received antibiotics and 8% were admitted...

Highlights •  Large study on the contribution of HCoV to childhood deaths •  Supports vigilance or further investigations into HCoV pathogenesis •  Potential information for the role Covid-19 will play during severe childhood disease •  Highlights the importance of polymicrobial infection during severe disease episodes Abstract Background Endemic human coronaviruses (HCoV-229E, HKU1, NL63, and OC43) are common causes of mild or asymptomatic respiratory infections in children but are considered rare causes of death. Methods We evaluated paediatric deaths from January 2017 through December 2022 . A panel of experts determined the cause of death (CoD) by reviewing available data, including pathological and molecular findings from minimally invasive tissue sampling (lung tissues, blood, CSF, and nasopharyngeal swabs), clinical records, and verbal autopsies. Results Endemic HCoV were detected in the respiratory samples of 3% (n=86/3357) of enrolled decedents: 1% (n=12/204...

Abstract Enterovirus D68 (EV-D68) caused large biennial cyclical outbreaks of respiratory disease and cases of acute flaccid myelitis from 2014 to 2018 in the USA . An anticipated outbreak did not occur in 2020, likely due to non-pharmaceutical interventions targeting the COVID-19 pandemic. A large respiratory disease outbreak occurred again in 2022 , but uncertainty remained regarding if circulation of EV-D68 would return to the pre-pandemic patterns. We conducted prospective active surveillance of clinical respiratory specimens from Colorado children for EV-D68 in 2023 and 2024. A subset of residual specimens positive for rhinovirus/enterovirus (RV/EV) were tested for EV-D68 via a validated in-house EV-D68 reverse transcription–PCR assay. During epi weeks 18–44 in 2023, 525 residual specimens positive for RV/EV all tested negative for EV-D68. In 2024, during epi weeks 18–44 , 10 ( 1.8% ) of the 546 RV/EV-positive specimens were EV-D68-positive . The EV-D68-positive cases were predomi...

Abstract Highly Pathogenic Avian Influenza A/H5N1 Virus has been found in multiple US states since 2024. While human infection risk is currently low, children are a high-risk group for severe infection as the virus evolves. Preventive efforts should prioritize children in vaccine and therapeutic clinical trials and vaccine implementation strategies. Source: Journal of Pediatric Infectious Diseases Society,  https://academic.oup.com/jpids/advance-article-abstract/doi/10.1093/jpids/piaf035/8120791?redirectedFrom=fulltext ____

Abstract The risk of cardiovascular outcomes following SARS-CoV-2 infection has been reported in adults , but evidence in children and adolescents is limited . This paper assessed the risk of a multitude of cardiac signs, symptoms, and conditions 28-179 days after infection , with outcomes stratified by the presence of congenital heart defects (CHDs), using electronic health records (EHR) data from 19 children’s hospitals and health institutions from the United States within the RECOVER consortium between March 2020 and September 2023. The cohort included 297,920 SARS-CoV-2-positive individuals and 915,402 SARS-CoV-2-negative controls. Every individual had at least a six-month follow-up after cohort entry. Here we show that children and adolescents with prior SARS-CoV-2 infection are at a statistically significant increased risk of various cardiovascular outcomes, including hypertension, ventricular arrhythmias , myocarditis, heart failure, cardiomyopathy, cardiac arrest, thromboemboli...

Abstract In an epidemiologic investigation of Enterovirus (EV) infections in a Verona hospital , September 2022–September 2024, we detected EV-C105 in six pediatric patients with upper respiratory symptoms between March and May 2023. The primary objective was to describe the local incidence of EV cases. The secondary objective was to perform Sanger’s genomic characterization and the whole-genome sequencing (WGS) of EV-C105. The proportion of positive EV results was calculated based on routine molecular method testing. An available cohort of 114 underwent Sanger sequencing, and the six EV-C105 were characterized with WGS. Overall, 96% EV results were from the upper respiratory tract . The total proportion of positives in children was 83%. Out of the typed 114, 90% were Rhinoviruses and 9%, EVs . Notably, six pediatric cases were EV-C105 , placing together in a unique cluster with 99% of nucleotides belonging to the European lineage with the highest Average Nucleotide Identity, including...