#Progress towards the #WHO Global Initiative for #Childhood #Cancer target of 60% 5-year survival for all childhood cancers combined, 1990–2019 (CONCORD-4): ...

 

Summary

Background

CONCORD is a global public health programme for long-term surveillance of population-based cancer survival. The first three cycles of this programme focused primarily on adults. In CONCORD-4, for the first time, we also included all cancers in children. The WHO Global Initiative for Childhood Cancer (GICC), published in 2018, set a target for 5-year survival for all childhood cancers combined, worldwide, to reach 60% by 2030. We designed the protocol for CONCORD-4 to assess progress towards this target in as many countries as possible.

Methods

We identified population-based cancer registries from the members of the International Association of Cancer Registries and other sources. We invited 513 registries in 101 countries to submit anonymised individual records for all children (aged 0–14 years) living in their territory who were diagnosed with any form of cancer during the 30-year period 1990–2019, or later years. The data included demographic variables, the morphological type and anatomical location of the tumour, and the follow-up for the vital status of each child. We used the data for 2010–19 to construct a set of weights that reflect the global frequency distribution of childhood cancers, by age, sex, and subtype, both for the 12 major groups in the third edition of the International Classification of Childhood Cancer (ICCC-3) and for the six WHO tracer cancers prioritised in the GICC. We estimated 5-year net survival for children diagnosed during 1990–2019 by age, sex, and type of cancer, using the Pohar Perme estimator. We then used the weights to construct a Cancer Survival Index (CSI) as a weighted average of these survival estimates, for each country and each 5-year period during 1990–2019 for the 12 ICCC-3 groups and separately for the six WHO tracer cancers.

Findings

We received 679 776 individual records for children diagnosed with cancer during 1990–2022 from 307 population-based cancer registries in 68 countries and territories, 52 with 100% national coverage. We produced two sets of weights, by age, sex, and type of cancer, reflecting the global distribution of cancer in children, both for all childhood cancers and for the six WHO tracer cancers. We restricted survival analyses to 613 021 children diagnosed during 1990–2019. The 5-year CSI for all childhood cancers combined increased in most countries between 1990 and 2019. For children diagnosed during 2015–19, the CSI was more than 80% in most high-income countries, in the range 60–80% in most upper-middle-income countries, and in the range 50–60% in the five participating lower-middle-income countries.

Interpretation

The new CSI enables quantitative international comparison of trends in survival for all childhood cancers combined and for the six WHO tracer cancers, through a simple three-way standardisation by age, sex and subtype. The CSI should be a useful tool to monitor future trends. In most high-income, upper-middle-income, and lower-middle-income countries participating in CONCORD-4, the all-cancers CSI was either close to or had already passed the GICC target to reach 60% 5-year survival for all childhood cancers combined, worldwide, by 2030. The GICC target therefore may not be ambitious enough.

Funding

Cancer Research UK, Institut National du Cancer (France), St Jude Children's Research Hospital (USA), US National Cancer Institute, and Dell Technologies.

Research in context

Evidence before this study

Survival differs widely between the various types of cancer in children, and between countries defined by their World Bank national income group. In 2018, WHO published the Global Initiative for Childhood Cancer (GICC), with the central target of reaching 60% survival (presumed to be 5 years) for all childhood cancers combined, worldwide, by 2030. 

No single metric exists to enable monitoring of progress towards this target. We searched PubMed for articles published in English, without date limits, using the following search string: “Population-based cancer regist*”[tiab] OR population-based registr* OR “population-based study”[tiab:~0] OR “EUROCARE”[tiab] AND “case-mix-standardised survival”[tiab:~0] OR “all cancers combined survival”[tiab:~0] OR “case-mix by cancer “[tiab:~0] OR “cancer survival index”[tiab:~0] OR “one-number index”[tiab:~0] OR “all cancers survival”[tiab:~0] OR “patient survival for all cancers combined”[ti:~0]”. 

At present, the only attempt to evaluate progress towards the GICC target is derived from simulation-based model estimates of net survival for 197 countries. In most of these countries, real-world data from population-based cancer registries are not available. The estimates include all types of cancer combined in the age range 0–14 years in a single pool, despite the well known differences in survival by age, sex, and type of cancer. Some large comparisons of survival for all cancers combined were produced by the EUROCARE project, in Europe, or by NORDCAN, in northern Europe only, or in single countries (Canada, China, Denmark, and the USA). 

In these studies, an estimate of survival for all cancers combined, in adults or in children, was based on a double standardisation, starting from the usual standardisation by age, followed by a further standardisation by case-mix or cancer type, and sex. This approach implies the use of two sets of weights, one for age-standardisation and another to reflect the cancer type and sex distribution of the patients included in each study. These distributions are not representative of the global population of cancer patients—in this context, children. The cancer survival indices derived for all these studies are not directly comparable either between countries or over time.

Added value of this study

The current cycle of the CONCORD programme for global surveillance of trends in population-based cancer survival (CONCORD-4) has extended coverage to include data for adults diagnosed with one of 22 malignancies, and for the first time, also includes data on all children diagnosed with a cancer during 1990–2022. 

CONCORD-4 provides the largest global real-world database on childhood cancer, including data from 307 population-based cancer registries in 68 countries, 52 with 100% national coverage. We created two sets of weights that reflect the global frequency distribution of childhood cancers by age, sex, and subtype: one set for the 12 major groups defined in the 3rd edition of the International Classification of Childhood Cancer, and another for the six tracer cancers prioritised by WHO in 2021. 

For each country and 5-year calendar period during the three decades 1990–2019, we then constructed a Cancer Survival Index (CSI), which enables quantitative comparisons of net survival for all childhood cancers combined, between countries and over time. Both sets of weights, which allow for a simple three-way standardisation by age, sex, and subtype, are now available for national and international research on childhood cancer survival. 30-year trends in the CSI offer a robust, long-term baseline against which to evaluate progress towards the GICC 2030 target.

Implications of all the available evidence

The CSI will facilitate monitoring of real-world progress towards the GICC target for childhood cancer survival. The CSI that includes all childhood cancers is a better indicator than the CSI based on the six WHO tracer cancers, especially for lower-middle-income countries, where diagnostic facilities are often inadequate, and the need to improve survival is even more urgent. WHO should devote even greater efforts to increase the coverage of population-based cancer registries worldwide and to facilitate data sharing for international research. In most high-income and upper-middle-income countries, impressive trends in survival for all childhood cancers combined since 1990 have already exceeded the GICC target for 2030, suggesting that a more ambitious target could be set. In low-income countries and lower-middle-income countries, where 60% of the world's children live, late presentation, abandonment of treatment, and suboptimal health-care systems are major contributors to poor survival.

Source: 

Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00189-3/fulltext?rss=yes

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Mild #SARS-CoV-2 #maternal #infection in mice induces transient offspring #neurodevelopmental aberrance

 

Significance

The rising global numbers of SARS-CoV-2 infections highlight the need to assess potential neurodevelopmental and psychiatric impact in children born to infected mothers. Human cohorts have provided conflicting conclusions, while mouse studies have focused on moderate-to-severe infection despite most infections in pregnant women being mild or asymptomatic. Our study shows that mild, respiratory tract–restricted SARS-CoV-2 infection in pregnant mice was sufficient to cause placental inflammation and transient changes in offspring brain gene expression, without altering gross brain structure or behavior under our experimental conditions. These findings suggest that soluble factors induced by maternal respiratory infection mediate placental inflammation and changes in offspring brain gene expression during the fetal and neonatal periods, which resolve in later childhood.

Abstract

Maternal viral infection during pregnancy has been identified as a risk factor for psychiatric disorders and neurodevelopmental abnormalities in offspring. With cumulative SARS-CoV-2 infections now numbering in the hundreds of millions globally, there is a need to evaluate the effects of maternal SARS-CoV-2 infection on offspring brain development and behavior. We developed a mouse model of mild COVID-19 during pregnancy in which SARS-CoV-2 infection is restricted to the respiratory tract. Infected mothers did not show weight loss or changes in litter size, but did exhibit detectable local and systemic immune responses, including placental inflammation. Characterization of the offspring’s cerebral cortex revealed transcriptomic changes in the fetus at E15 and on postnatal day 5 (P5), but no gross alterations in cytoarchitecture, synaptic density, or microglial abundance. We did not detect any significant changes in open-field or novel object recognition tests in P50 offspring born to SARS-CoV-2-infected dams. These findings suggest that mild maternal respiratory SARS-CoV-2 infection induces soluble factors that mediate placental inflammation and transient cerebral cortex alterations in offspring that resolve by later childhood.

Source: 

Link: https://www.pnas.org/doi/abs/10.1073/pnas.2518294123?af=R

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#International #food safety event: #Infant #formula and products containing arachidonic acid oil contaminated with #cereulide #toxin - Multi-country (#WHO, March 13 '26)

 

Situation at a glance

Multi-country recalls of infant formula and other products have been initiated after cereulide toxin, was detected in batches of multiple internationally distributed brands. 

Investigations have identified arachidonic acid (ARA) oil, used as an ingredient in the implicated products, as the source of contamination. 

However, the full root cause analysis and complete traceability of all affected batches remains under investigation. 

Contaminated formulae, nutritional products, and oil mixes have been distributed to 99 countries and territories across six WHO Regions, with the first product recalls initiated on 10 December 2025. 

Between 1 January and 25 February 2026, 144 suspected and confirmed cases were reported across ten countries in three WHO Regions, with investigations ongoing. 

Based on the available information, WHO assesses the overall public health risk as moderate due to the vulnerability of the affected population (infants), the ongoing uncertainty regarding the full extent of distribution and exposure, and remaining gaps in case detection and root cause information.

Description of the situation

Since 10 December 2025, and as of 25 February 2026, 99 countries and territories have been identified as having received batches of infant formula products subject to recall due to contamination with cereulide toxin. 

During this period, 144 suspected and confirmed cases were reported across 10 countries. The epidemiological investigations and product‑traceback activities remain ongoing in many countries.

The case definitions in use by the International Food Safety Authorities Network (INFOSAN) are currently:

-- Suspect case: 

- A person presenting symptoms of cereulide intoxication with a history of consumption of the recalled product, without laboratory confirmation in a clinical sample.

-- Confirmed case: 

- A person presenting symptoms of cereulide intoxication with a history of consumption of recalled product, with laboratory confirmation in a clinical sample.

Health authorities are actively searching for cases and conducting laboratory testing of human specimens and infant formula products. 

However, case definitions used may differ from those established by INFOSAN, such as those established by the European Centre for Disease Prevention and Control, creating challenges with comparability of reported case numbers.

Since this is not a routinely tested contaminant or condition, diagnostic challenges and limited surveillance capacity are hindering Member States’ ability to identify confirmed cases. One country has laboratory confirmed cases linked to the contaminated products (Belgium).

The limited case numbers appearing in multiple, geographically separated areas is consistent with sporadic exposures to contaminated products that were widely distributed.

​Precautionary recalls have been issued across all countries and territories where products were distributed. 

These measures aim to prevent further exposures, although the speed and completeness of product recall and withdrawal vary by location according to various factors including inspection and enforcement capacities. 

Epidemiology

Cereulide is a heat-stable toxin produced by certain strains of Bacillus cereus, a Gram-positive, spore-forming bacterium ubiquitous in soil, dust, and food production environments. 

The primary hazard in this event is suspected to have occurred during the production of ARA oils used in infant formula, although a root cause analysis has not yet been provided to WHO. 

Cereulide is not contagious; illness occurs only when a person ingests the toxin, such as through consumption of contaminated products. 

The toxin withstands cooking temperatures (stable up to 121°C) and common pasteurization, persisting in finished products. 

Symptoms manifest rapidly, typically within 0.5–6 hours post-ingestion, and usually present as acute gastrointestinal symptoms (nausea, vomiting, abdominal pain) with risk of rapid dehydration and electrolyte imbalance which can be particularly severe in infants due to their physiological vulnerability and limited reserves. 

The toxin has a very low symptomatic dose threshold and remains fully active despite gastric conditions, contributing to its clinical potency. 

For babies who rely entirely on formula, repeated feedings can increase the amount of toxin consumed, and using contaminated formula for rehydration can worsen illness.

The absence of specific antidotes or targeted therapies places greater emphasis on supportive clinical care, effective risk communication to caregivers and health workers, and robust coordination between food safety and public health authorities. 

Where there is limited access to health care and where there may be delays in care seeking, rapid dehydration and electrolyte imbalance in infants may be fatal.

As of 25 February 2026, the following countries have notified suspected cases: 

1) Austria (9), 

2) Brazil (5),  

3) China, Hong Kong SAR, (1), 

4) Czechia (4), 

5) France (11), 

6) Italy (1), 

7) Singapore (3), 

8) Spain (41), and 

9) the United Kingdom of Great Britain and Northern Ireland (61).  

In other countries, including Denmark (32) and the Netherlands (221) the number of suspected cases is based on self-reporting and is therefore not comparable with the INFOSAN case definition.  

To date, Belgium is the only country with laboratory‑confirmed cases, reporting eight confirmed intoxications linked to the implicated products.

Public health response

WHO Response: 

Since 7 January 2026, when distribution of the products was confirmed to extend beyond the European Union, WHO, through the INFOSAN Secretariat, has been contacting INFOSAN Emergency Contact Points in the countries and territories identified as affected to notify them of recalled products exported to their markets and to support information exchange and coordinated response. 

Communication within the European Union has been managed through the European Rapid Alert System for Food and Feed (RASFF), with close coordination between INFOSAN and RASFF.

Response measures in affected countries and territories:

Recalls and communication campaigns have been carried out in many countries and territories where contaminated products were distributed, preventing further exposures despite variable implementation of recall and withdrawal measures. 

Active case-finding and laboratory confirmation efforts are ongoing in affected countries and territories, with most countries and territories reporting no linked illnesses to date.

WHO risk assessment

WHO assesses the overall public health risk associated with this event to be Moderate. 

This assessment is based on the information currently available and reflects the wide international distribution of contaminated products, ongoing uncertainties regarding the full extent of contaminated product distribution, case detection, and root cause of contamination, and the vulnerability of infants and young children to dehydration and electrolyte imbalance from with vomiting illness associated with cereulide toxin ingestion.

Several considerations contribute to this assessment:

-- Cereulide is a thermostable emetic toxin that can cause acute vomiting and rapid dehydration particularly in very young infants which can have severe consequences if untreated; mild or self-limiting cases are likely to go unreported, especially in settings with limited healthcare access or diagnostic capacities.

-- The extent of the contaminated ARA oil distribution remains uncertain, as complete traceability from the original implicated manufacturer has not been provided to WHO. 

-- Secondary distribution through commercial supply chains has further complicated efforts to identify all affected products. Additional investigation is required to determine the source and extent of the cereulide contamination. 

-- The international spread of contaminated products has already disrupted trade and supply chains across at least 99 countries and territories, with the possibility of further recalls if additional affected batches or product categories are identified. These recalls, while essential for public health protection, have created a risk of localized shortage of infant formula, particularly in settings where reliance on specific products is high, despite manufacturers’ efforts to increase production of unaffected products. A residual risk of exposure persists while investigations and traceability efforts continue, as competent authorities manage evolving distribution information and update risk communication measures. 

-- Mild clinical presentations can resemble common childhood illnesses, laboratory capacity for cereulide testing in contaminated products or human samples varies widely, and variations in case definitions across countries complicate consistent reporting and may delay detection. 

-- Although limited numbers of suspected and confirmed cases have been reported to date, without continued investment in surveillance for toxin‑related events, strengthened laboratory networks, training of health‑care providers, and clear communication on recalls and safe alternatives, delays in detection and response could lead to preventable morbidity in infants.

WHO advice

Based on the information available, WHO recommends Member States to maintain epidemiological surveillance, enhance readiness of laboratory capacity for cereulide testing of suspected contaminated products and in clinical samples of suspected cases, and facilitate effective implementation of recalls and withdrawals, as needed.

WHO advises Member States to:  

-- Identify, trace, and withdraw all affected products from the market.

-- Verify the effectiveness of recalls at retail and distribution levels and ensure that affected products are not available for sale, including online sales.

-- Conduct sampling and laboratory testing of suspect products and human specimens.

-- Strengthen requirements for traceability across the supply chain and food recalls.

-- Enhance inspection and oversight of facilities producing or handling ingredients used in infant nutrition.

-- Share relevant information through established international information-sharing mechanisms, including INFOSAN.

-- Issue targeted alerts to consumers, caregivers, health workers, and retailers, while providing clear guidance on identifying and disposing of affected products.

-- Promote breastfeeding and address barriers to accessing safe alternative nutrition.

-- Encourage early presentation to health facilities for infants with sudden vomiting.

-- Reinforce guidance on dehydration management and red-flag symptoms, while supporting availability of tools for safe clinical management of affected infants.

WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.  

Further information

-- European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA). Multi-country foodborne event caused by cereulide in infant formula products. 19 February 2026. Available from: https://www.ecdc.europa.eu/en/publications-data/multi-country-foodborne-event-caused-cereulide-infant-formula-products  

-- European Food Safety Authority (EFSA). EFSA provides rapid risk assessment on cereulide in infant formula. EFSA; 1 February 2026. https://www.efsa.europa.eu/en/news/efsa-provides-rapid-risk-assessment-cereulide-infant-formula

-- European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 31 January–6 February 2026 (Week 6). ECDC; 12 February 2026. https://www.ecdc.europa.eu/sites/default/files/documents/Communicable-disease-threats-report-week-6-2026.pdf  

-- European Food Safety Authority (EFSA). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. EFSA; 27 January 2026. https://www.efsa.europa.eu/en/news/precautionary-global-recall-infant-nutrition-products-following-detection-bacillus-cereus  

-- European Centre for Disease Prevention and Control (ECDC). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. ECDC; 27 January 2026.  https://www.ecdc.europa.eu/en/news-events/precautionary-global-recall-infant-nutrition-products-following-detection-bacillus  

-- European Centre for Disease Prevention and Control. European outbreak case definition: cereulide contamination of infant formula products (EpiPulse event 2025-FWD-00107). Stockholm: ECDC; 2026. https://www.ecdc.europa.eu/sites/default/files/documents/Case%20definition%20cereulide%20event.pdf

-- World Health Organization. Strengthening surveillance of and response to foodborne diseases. WHO; 11 December 2025. https://www.who.int/publications/i/item/9789240118188  

-- Austrian Agency for Health and Food Safety (AGES). Update: Information on cereulide in infant formula. AGES; 1 February 2026. https://www.ages.at/en/news/detail/update-information-zu-cereulid-in-saeuglingsnahrung  

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Citable reference: World Health Organization (13 March 2026). Disease Outbreak News;  Recall of internationally distributed infant formula and products containing ARA oil due to contamination with cereulide toxin. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596 

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596

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Life-Threatening #SARS-CoV-2–Associated #Encephalopathy and Multiorgan Failure in #Children, #Asia and #Oceania, 2022–2024

 

Abstract

SARS-CoV-2 infections in children occasionally manifest with severe neurologic signs. We report a case series of life-threatening encephalopathy associated with SARS-CoV-2 in 25 children in Australia, Japan, Singapore, and Taiwan during February 2022–January 2024. All children had severe encephalopathy develop, characterized by rapidly progressive cerebral edema, conditions known as acute shock with encephalopathy and multiorgan failure or acute fulminant cerebral edema. Among the 25 patients, 22 (88%) eventually died; 11 (44%) children died within 24 hours of hospitalization. In addition, 18 (72%) had illness manifest with shock, and 14 (56%) had multiorgan failure develop within 6 hours of neurologic onset. Serum concentrations of cytokines/chemokines including interleukin 6 and tumor necrosis factor-α were significantly higher within 24 hours of onset than for controls. SARS-CoV-2–associated encephalopathy cases such as those described here represent an emerging neurologic crisis with high mortality rate resulting from rapidly progressive brain edema and multiorgan failure.

Source: 

Link: https://wwwnc.cdc.gov/eid/article/32/2/25-0549_article

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Detection of #LaCrosse Virus #RNA in Clinical #Specimens Obtained from #Children with La Crosse Infection

 

Highlights

• Viremia in children with La Crosse Virus infection is transient; viral RNA was detected in only 3.2% of sera

• Detection of La Crosse Virus RNA in respiratory samples is slightly higher at 21.7% and may reflect the temporal distribution of the virus after infection

• NAAT has limited utility in routine diagnosis of La Crosse Virus encephalitis in children but may still be useful in cases with delayed seroconversion

Abstract

Background

La Crosse virus (LACV), a member of family Peribunyaviridae, genus Orthobunyavirus, is the leading cause of neuroinvasive arboviral infection in children in the United States. Diagnosis relies on detecting specific antibodies (IgG or IgM), a 4-fold titer rise or seroconversion, in patients with compatible presentations. NAAT used for LACV detection has largely been limited to mosquito, animal models or postmortem brain tissue. There is a lack of data on the performance of NAATs in clinical specimens from living patients.

Methods

Children who had positive arbovirus serology tests and a diagnosis of LACV encephalitis were identified. Remnant specimens including plasma, serum, CSF, throat swab (THT) or nasopharyngeal sample (NP) submitted to the laboratory for other diagnostic testing were retrieved and tested with LACV-PCR. Medical records were reviewed for demographics, presenting symptoms and test results.

Results

From June 2015 to October 2021, 61 patients had remnant specimens available for LACV-PCR and were included in this study. A total of 179 clinical specimens from these patients were tested, including 64 sera, 31 plasma, 33 CSF, 23 THT and 28 NP. Ten (5.3%) samples collected from 8 (13.1%) unique patients were positive for LACV RNA. The positive rates were 3.2%, 0, 6.5%, 3.5% and 21.7% for sera, plasma, CSF, NP and THT respectively.

Conclusion

There is limited utility of NAATs for diagnosis of LACV infection. NAATs may be useful in cases with delayed seroconversion or in immunocompromised individuals.

Source: 

Link: https://www.sciencedirect.com/science/article/abs/pii/S1386653226000120?dgcid=rss_sd_all

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#Milk as a #Transmission Vehicle for Highly Pathogenic Avian #Influenza #H5N1

Abstract

Highly pathogenic avian influenza A (H5N1) (H5N1 hereafter) is an emerging pathogen in mammals. The recent recognition of H5N1 in dairy cattle increases opportunities for human exposure and infection and may accelerate a trajectory toward sustained human-to-human transmission. Furthermore, the presence of virus at high concentration in unpasteurized milk raises new risks for humans, especially infants and children. Milk has been identified as a vehicle for viral transmission in and between mammalian species, including humans. Sialic acids (SAs) found on cell surfaces are important mediators of species susceptibility to specific influenza strains and play an important role in viral tropism. New data demonstrate that SA receptors with α2,3 linkages capable of binding avian influenza strains are present in human mammary tissue. The presence of SA receptors that can bind avian influenza and a comparative analysis of viral transmission risk of raw and pasteurized milk in several mammalian species have implications for human milk feeding. During this period of sporadic human infections with H5N1, further research and collaboration is warranted to address the potential risk of human milk contamination. Infants and children are particularly vulnerable to emerging infections during pandemics and have unique needs that may be overlooked. Pandemic preparedness must address the needs of all populations at all life stages, including pregnancy and infancy, and must include support for the safety of human milk.

Source: 

Link: https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2025-072525/206156/Milk-as-a-Transmission-Vehicle-for-Highly?redirectedFrom=fulltext

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#Management of #critical illness in an #adolescent caused by highly pathogenic avian #influenza #H5N1 virus infection in #BC, #Canada

 

Summary

Highly pathogenic avian influenza A(H5N1) viruses have been circulating among wild birds and are enzootic in poultry in some areas of the world with spillover to a wide range of terrestrial and marine mammals. Since 1997, sporadic animal to human, primarily poultry to human, transmission of highly pathogenic avian influenza A(H5N1) viruses has been reported in 25 countries. More recently there have been locally acquired infections in the Americas due to the 2.3.4.4b clade of the virus. Most of the recently detected human infections in the USA have been relatively mild but there have been cases of critical illness reported in several countries. In this Grand Round we present the first locally acquired highly pathogenic avian influenza A(H5N1) virus infection in Canada, which was in a 13-year-old female, who developed severe disease requiring prolonged critical care. She was infected with a clade 2.3.4.4b, genotype D1.1 virus and developed evidence of cytokine storm and received several modalities of care including combination antiviral therapy, renal replacement therapy, therapeutic plasma exchange, and invasive mechanical ventilation support with veno-venous extracorporeal life support. She recovered and was discharged home without requirement for additional support. This Grand Round describes important clinical and management considerations for critically ill patients infected with highly pathogenic avian influenza A(H5N1) virus.

Source: Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00773-X/abstract?rss=yes

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Comprehensive evaluation of #therapeutic #effectiveness and #safety profiles of #baloxavir marboxil for managing #influenza virus infection in #pediatric populations: a systematic #review with pooled meta-analytic data

 

Abstract

Objective: 

This systematic review aimed to assess the clinical effectiveness and safety profile of baloxavir marboxil for managing influenza in pediatric populations.

Methods: 

This review has been registered on the INPLASY platform (INPLASY2025110063). Designed in accordance with the PRISMA 2020 guidelines, we searched four major biomedical databases (PubMed, Embase, Web of Science, Cochrane Library) covering publications from January 1, 2015, to January 30, 2025. Eligibility criteria encompassed both randomized controlled trials and observational cohort studies evaluating this antiviral agent in children with laboratory-confirmed influenza. Methodological rigor was appraised using the Cochrane Collaboration's risk of bias instrument for randomized controlled trials (RCTs) and the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Statistical synthesis was conducted using RevMan 5.3 software (Version 5.3.5) with metafor package implementation.

Results: 

Our analysis incorporated 12 clinical investigations involving a total of 4,586 patients. A random-effects model meta-analysis demonstrated that, compared to neuraminidase inhibitors (oseltamivir, zanamivir, peramivir, laninamivir), baloxavir marboxil achieved accelerated resolution of febrile symptoms (MD = −13.16 h, 95% CI: −19.16 to −7.15, P < 0.0001). Subgroup analyses stratified by viral subtype demonstrated consistent therapeutic advantages in influenza A infections (random-effects model, MD = −9.40 h, 95% CI: −18.31 to −0.49, P = 0.04), particularly regarding time to symptom alleviation (fixed-effect model, MD = −8.50 hours, 95% CI: −13.14 to −3.86, P = 0.0003). Safety assessments indicated a 59% reduction in drug-related adverse events relative to oseltamivir (fixed-effect model, OR 0.41, 95% CI 0.31–0.56; P < 0.001), while total adverse event rates showed comparable incidence between treatment arms (fixed-effect model, OR = 0.85, 95% CI: 0.69–1.05, P = 0.14).

Conclusion: 

These findings suggest baloxavir marboxil demonstrates faster fever resolution and a favorable safety profile in pediatric influenza management. However, continuous monitoring for baloxavir-resistant mutations (such as PA/I38T) in the pediatric population is warranted. Furthermore, confirmation through large-scale multicenter trials with extended follow-up periods remains warranted.

Source: Frontiers in Pediatrics, https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2025.1733111/full

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#Pathogenesis and #Research #Models of Acute #Influenza-Associated #Encephalitis / #Encephalopathy: An Update

 

Abstract

Influenza-associated encephalitis/encephalopathy (IAE) is a severe neurological complication characterized by central nervous system dysfunction and structural damage following influenza virus infection. Predominantly affecting infants and young children, IAE exhibits its highest incidence in those under five years of age. Key clinical manifestations of IAE include acute seizures, sudden high fever, and impaired consciousness, frequently progressing to coma. Neuroimaging, particularly magnetic resonance imaging (MRI), often reveals multifocal brain lesions involving multiple brain regions, including the cerebellum, brainstem, and corpus callosum. The prognosis of IAE is poor, with a mortality rate reaching 30%. Current diagnosis relies heavily on clinical presentation and characteristic neuroimaging findings, as the precise pathogenesis of IAE remains elusive. While various research models, including cell lines, brain organoids, and animal models, have been developed to recapitulate IAE features, significant limitations persist in modeling the core clinical pathophysiology observed in pediatric patients, necessitating further model refinement. This review synthesizes the clinical spectrum of IAE, summarizes progress in understanding its pathogenesis, and critically evaluates existing research models. We aim to provide a foundation for utilizing experimental approaches to elucidate IAE mechanisms and identify potential therapeutic strategies.

Source: 

Link: https://www.mdpi.com/1999-4915/18/1/95

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#Global burden of lower respiratory #infections and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

 

Summary

Background

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years.

Methods

Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years.

Findings

In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24–2·81) deaths and 98·7 million (87·7–112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4–47·4) since 2010, with a global mortality rate of 94·8 (75·6–116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000–721 000] deaths or 25·3% [24·5–26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000–298 000] deaths or 10·9% [10·3–11·3]), and Klebsiella pneumoniae (228 000 [204 000–261 000] deaths or 9·1% [8·8–9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000–201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900–75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths.

Interpretation

This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies—including newer interventions such as respiratory syncytial virus monoclonal antibodies—and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies.

Funding

Gates Foundation.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00689-9/abstract?rss=yes

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Invasive #Pneumococcal Diseases Before and After the #COVID19 #Pandemic in #Italy (2018–2023)

 

Abstract

This study assessed the epidemiological and microbiological invasive pneumococcal disease (IPD) changes that occurred before and after the emergence of COVID-19 in Italy. All IPD cases reported through the nationwide surveillance system during 2018–2023 were included. IPD incidence and serotype distributions were analyzed by age group. IPD incidence in 2020–2021 declined in all age groups compared with 2018–2019, especially in children less than 2 years of age and elderly people aged > 64 years. A resurgence of IPD cases was observed from late 2022 onwards, with values in children exceeding those seen before the pandemic. The post COVID-19 increase in children was mainly driven by some PCV13 serotypes, such as 3, 19A, and 19F, but also non-vaccine serotypes, including 10A, 8, and 24F, while in the elderly population, a predominance of serotypes 3 and 8 was observed. In conclusion, a steep drop in IPD incidence was observed during the peak of the COVID-19 pandemic, followed by a subsequent upsurge of cases, especially in children. Continuous national surveillance is necessary to monitor the dynamics and evolution of IPD and the impact of new higher-valency vaccines in Italy over the next few years.

Source: 

Link: https://www.mdpi.com/2076-2607/13/12/2734

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Post #COVID19 #resurgence of #Mycoplasma pneumoniae infections in French #children (ORIGAMI): a retrospective and prospective multicentre cohort study

 

Summary

Background

Following a decline during the COVID-19 pandemic, Mycoplasma pneumoniae infections resurged in several countries. We aimed to characterise the clinical presentation of paediatric patients admitted to hospital for M pneumoniae during 2023 and 2024 in France.

Methods

We conducted a nationwide, multicentre, retrospective, and prospective observational study across 37 French paediatric hospitals (September, 2023–September, 2024). Children younger than 18 years who were hospitalised with laboratory-confirmed M pneumoniae infection (PCR or serology) were included. Demographics (excluding race), clinical features, laboratory and radiological findings, management, and outcomes data were described and analysed. Logistic regression was used to identify factors associated with paediatric intensive care unit (PICU) admission. The trial was registered at ClinicalTrials.gov (NCT06260371) and is complete.

Findings

We included 969 children and adolescents with M pneumoniae infection (7·3 years [SD 4·5], 426 [44%] of 966 patients were female and 540 [56%] of 966 were male). 936 (97%) of all patients were positive by PCR for M pneumoniae. Pneumonia was diagnosed in 628 (87%) of the 726 patients with respiratory involvement, and cutaneous manifestations were reported in 132 (14%) of 969 patients, including 56 (42%) of 132 who had erythema multiforme. Macrolides were prescribed in 884 (95%) of the 931 patients who were prescribed antibiotics, primarily azithromycin (563 [64%] of 884). Macrolide resistance was detected in one (5%) of the 21 tested samples. In total, 57 (6%) of 969 patients required PICU admission and four (<1%) died. Factors significantly associated with PICU admission included being older than 11 years (adjusted odds ratio 2·0 [95% CI 1·1–3·6]; p=0·023), asthma (2·2 [1·2–4·0]; p=0·0072), other underlying conditions (2·1 [1·2–3·7]; p=0·013), and erythema multiforme (3·7 [1·6–8·8]; 0·0025).

Interpretation

The 2023–2024 M pneumoniae epidemic in France resulted in a substantial paediatric hospitalisation burden. Although severe cases were uncommon, children older than 11 years, those with asthma, other comorbidities, and erythema multiforme were at increased risk of PICU admission. Ongoing surveillance and targeted management strategies are warranted for future epidemics.

Funding

Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV).

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00598-5/abstract?rss=yes

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Updated #Evidence for #Covid19, #RSV, and #Influenza #Vaccines for 2025–2026

 

Abstract

Background

Changes in the vaccine advisory process in the United States have disrupted immunization guidance, which reinforces the need for independent evidence review to inform decisions regarding immunization for respiratory viruses during the 2025–2026 season.

Methods

We conducted a systematic review of U.S.-licensed immunizations against coronavirus disease 2019 (Covid-19), respiratory syncytial virus (RSV), and influenza. We searched databases on PubMed/MEDLINE, Embase, and Web of Science for updates of the most recent review by the Advisory Committee on Immunization Practices (ACIP) Evidence-to-Recommendations for each disease, which was performed during the 2023–2024 period. Outcomes included vaccine efficacy and effectiveness against hospitalization, other clinical end points, and safety.

Results

Of 17,263 identified references, 511 studies met the inclusion criteria. Covid-19 mRNA vaccines against the XBB.1.5 subvariant had pooled vaccine effectiveness against hospitalization of 46% (95% confidence interval [CI], 34 to 55; from cohort studies) and 50% (95% CI, 43 to 57; from case–control studies) among adults and 37% (95% CI, 29 to 44) among immunocompromised adults. In a case–control study, vaccines against the KP.2 subvariant showed an effectiveness of 68% (95% CI, 42 to 82). Maternal RSV vaccination (for infant protection), nirsevimab for infants, and RSV vaccines in adults who were 60 years of age or older showed vaccine effectiveness of 68% or more against hospitalization. Influenza vaccination had a pooled vaccine effectiveness of 48% (95% CI, 39 to 55) in adults between the ages of 18 and 64 years and 67% (95% CI, 58 to 75) in children against hospitalization. Safety profiles were consistent with previous evaluations. The diagnosis of myocarditis associated with Covid-19 vaccines occurred at rates of 1.3 to 3.1 per 100,000 doses in male adolescents, with lower risk associated with longer dosing intervals. The RSVpreF vaccine was associated with 18.2 excess cases of Guillain–Barré syndrome per million doses in older adults; a significant association with preterm birth was not observed when the vaccine was administered at 32 to 36 weeks’ gestation.

Conclusions

Ongoing peer-reviewed evidence supports the safety and effectiveness of immunizations against Covid-19, RSV, and influenza during the 2025–2026 season. (Funded by the Center for Infectious Disease Research and Policy and the Alumbra Innovations Foundation.)

Source: The New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/NEJMsa2514268?query=TOC

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#Assessment of #malnutrition in preschool-aged #children by mid-upper arm circumference in the #Gaza Strip (January, 2024–August, 2025): a longitudinal, cross-sectional, surveillance study

 

Summary

Background

Since October, 2023, Palestinian children in the Gaza Strip have suffered war-induced displacement, food insecurity, malnutrition, and elevated risks of famine and mortality. In this study, we aimed to document the extent of, and patterns in, wasting malnutrition in children aged 6–59 months across the Gaza Strip between January, 2024, and August, 2025.

Methods

This longitudinal, cross-sectional, surveillance study was conducted across a total of 16 UN Relief and Works Agency for Palestine Refugees in the Near East health centres and 78 medical points established within school shelters and tent encampments across the five governorates of Gaza. Children aged 6–59 months were screened for wasting malnutrition by mid-upper arm circumference (MUAC) measurement. Children with a MUAC of less than 125 mm were enrolled into therapeutic feeding regimens. MUAC Z scores were derived from published WHO age-specific and sex-specific arm circumferential growth curves. Monthly prevalence of acute wasting (MUAC Z scores less than –2) and severe wasting (MUAC Z scores less than –3) were described by age, sex, type of screening facility, and governorate.

Findings

Between Jan 1, 2024, and Aug 15, 2025, 265 974 measurements were obtained from 219 783 uniquely identified children, with two-thirds of children screened in Khan Younis and Middle Governorates. The monthly prevalence of acute wasting ranged from 5% (34 of 722 children) to 7% (794 of 10 907) between January and June, 2024. After approximately 4 months of severe aid restrictions between September, 2024, and mid-January, 2025, the prevalence of wasting increased from 8·8% (1601 of 18 225 children) to 14·3% (1661 of 11 619), with the highest prevalence observed in Rafah (32·2%; 95 of 295) and among children aged 24–59 months (21·0%; 1366 of 6518). After a 6-week ceasefire, marked by a substantial increase in the number of aid trucks entering through territory borders, by March, 2025, the prevalence of wasting had declined to 5·5% (831 of 15 165). However, after an 11-week blockade from March to May, 2025, and continued severely restricted entry of food, water, medicines, fuel, and other essentials thereafter, by early August, 2025, 15·8% (1213 of 7668) of screened children were acutely wasted, including 3·7% (280 of 7668) severely wasted, equating to more than 54 600 children in need of therapeutic care.

Interpretation

After nearly 2 years of war and severe restrictions in humanitarian aid, tens of thousands of preschool-aged children in the Gaza Strip are suffering from preventable acute malnutrition and facing an increased risk of mortality.

Funding

UN Relief and Works Agency for Palestine Refugees in the Near East.

Source: The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01820-3/abstract?rss=yes

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#Clinical Characteristics of #Paediatric #RSV, #Influenza, and #SARS-CoV-2 Infections: Insights from Three Consecutive Seasons

 

Abstract

Background: 

The purpose of this study was to retrospectively analyse the clinical presentation of RSV, Influenza, and SARS-CoV-2 infections in children across three consecutive seasons (2022/2023; 2023/2024; and 2024/2025). 

Methods: 

Of the 321 hospitalised patients, 129 (36%) tested positive for RSV, 110 (38%) for Influenza, and 82 (26%) for SARS-CoV-2. Children were aged ≤ 17 years (median: 15 months). The data were statistically analysed using the χ2 test, multinomial multivariable logistic regression, OR (odds ratio), and 95% CI (confidence interval). 

Results: 

Significant independent predictors of RSV infection were auscultatory abnormalities (OR: 15.9 [1.49–169]) and hospital admission ≥ 4 days after symptom onset (OR: 32.5 [1.19–907]). Among RSV-positive patients, compared with those aged < 6 months, those aged 7–24 months were more likely to present with higher CRP levels (OR 1.06 [1.003–1.13]), reduced appetite (OR 6.7 [1.62–27.67]), and longer duration of fever (OR 7.22 [1.47–35.59]), while in children > 24 months, only a longer duration of fever remained significant (OR 16.82 [2.14–162.4]). In Influenza, reduced appetite was the only characteristic feature in the 7–24-month age group (OR 13.55 [1.79–102.81]). In COVID-19, children aged 7–24 months more frequently had higher CRP levels (OR 1.108 [1.001–1.226]) and chronic diseases (OR 7.59 [1.115–51.64]), whereas in those >24 months, only CRP was significant (OR 1.16 [1.047–1.31]). 

Conclusions: 

RSV was associated with severe respiratory manifestations and later hospital admission, whereas Influenza and SARS-CoV-2 were characterised by milder courses with predominant upper respiratory symptoms. Observed age- and virus-specific patterns highlight the importance of continued surveillance and comparative research on major respiratory viruses in children.

Source: WOAH, https://www.mdpi.com/1999-4915/17/11/1403

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#LongCOVID associated with #SARS-CoV-2 #reinfection among #children and adolescents in the #omicron era (RECOVER-EHR): a retrospective cohort study

 

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 tests, or a diagnosis of COVID-19 that occurred at least 60 days after the first infection. The primary endpoint was a clinician-documented diagnosis of PASC (U09.9). Secondary endpoints were 24 symptoms and conditions previously identified as being potentially related to PASC. We used the modified Poisson regression model to estimate the relative risk (RR) between the second and first infection episodes, adjusted for demographic, clinical, and health-care utilisation factors using exact and propensity-score matching.

Findings

We identified 407 300 (87·5%) of 465 717 eligible children and adolescents with a first infection episode and 58 417 (12·5%) with a second infection episode from Jan 1, 2022, to Oct 13, 2023, in the RECOVER database. 233 842 (50·2%) patients were male and 231 875 (49·8%) were female. The mean age was 8·17 years (SD 6·58). The incident rate of PASC diagnosis (U09.9) per million people per 6 months was 903·7 (95% CI 780·9–1026·5) in the first infection group and 1883·7 (1565·1–2202·3) in the second infection group. Reinfection was associated with a significantly increased risk of an overall PASC diagnosis (U09.9) (RR 2·08 [1·68–2·59]) and a range of symptoms and conditions potentially related to PASC (RR range 1·15–3·60), including myocarditis, changes in taste and smell, thrombophlebitis and thromboembolism, heart disease, acute kidney injury, fluid and electrolyte disturbance, generalised pain, arrhythmias, abnormal liver enzymes, chest pain, fatigue and malaise, headache, musculoskeletal pain, abdominal pain, mental ill health, POTS or dysautonomia, cognitive impairment, skin conditions, fever and chills, respiratory signs and symptoms, and cardiovascular signs and symptoms.

Interpretation

Children and adolescents face a significantly higher risk of various PASC outcomes after reinfection with SARS-CoV-2. These findings add to previous evidence linking paediatric long COVID to multisystem effects and highlight the need to promote vaccination in younger populations and support ongoing research to better understand PASC, identify high-risk subgroups, and improve prevention and care strategies.

Funding

National Institutes of Health.

Source: The Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00476-1/fulltext?rss=yes

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#Pediatric #Influenza-Associated #Encephalopathy and Acute Necrotizing Encephalopathy — #USA, 2024–25 Influenza Season (#CDC MMWR)

 

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 IAE.

Abstract

In January 2025, CDC received several reports of deaths among children aged <18 years with a severe form of influenza-associated encephalopathy (IAE) termed acute necrotizing encephalopathy (ANE). Because no national surveillance for IAE currently exists, CDC requested notification of U.S. pediatric IAE cases from clinicians and health departments during the 2024–25 influenza season, a high-severity season with a record number of pediatric influenza-associated deaths. Among 192 reports of suspected IAE submitted to CDC, 109 (57%) were categorized as IAE, 37 (34%) of which were subcategorized as ANE, and 72 (66%) as other IAE; 82 reports did not meet IAE criteria and were categorized as other influenza-associated neurologic disease. The median age of children with IAE was 5 years and 55% were previously healthy, 74% were admitted to an intensive care unit, and 19% died; 41% of children with ANE died. Only 16% of children with IAE who were vaccination-eligible had received the 2024–25 influenza vaccine. Health care providers should consider IAE in children with encephalopathy or altered level of consciousness and a recent or current febrile illness when influenza viruses are circulating. Annual influenza vaccination is recommended for all children aged ≥6 months to prevent influenza and associated complications, potentially including severe neurologic disease such as IAE and ANE.

Source: US Centers for Disease Control and Prevention, https://www.cdc.gov/mmwr/volumes/74/wr/mm7436a1.htm?s_cid=OS_mm7436a1_w

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Shifting tides: increased #severity despite fewer visits for #infant respiratory #infections across two consecutive post-pandemic winters in Northern #Italy

 

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

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