#Fatal case of respiratory #diphtheria in an unvaccinated #child in #Italy (ECDC, August 28 '26)

 

{Excerpt from ''Weekly Communicable Disease Threats Report, Week 35, 22–28 August 2026''}

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Overview:

Summary

    ° On 20 August 2026, media sources reported a fatal case of diphtheria  in Palermo, Sicily, involving a four-year-old {girl}. According to media  reports, the case manifested initial symptoms, including fever, reduced  appetite and vomiting between 10 and 11 August. The patient's condition  deteriorated progressively, with the development of high fever and respiratory  distress on 15 August. Owing to the worsening clinical presentation, the child was  hospitalised in the intensive medical care unit.

    ° Despite receiving organ-supportive treatment and diphtheria antitoxin, the patient died on 20 August. The child had not been vaccinated against diphtheria. 

    ° Clinical specimens were submitted to Italy's National Institute of Health (Istituto Superiore di Sanità, ISS) for laboratory confirmation of suspected  diphtheria. On 25 August, the ISS confirmed the detection of  Corynebacterium diphtheriae and identified the presence of the diphtheria  toxin gene, indicating infection with a toxigenic strain capable of causing  respiratory diphtheria.

    ° A second probable case was reported in a four-year-old cousin of the  first case, who was admitted to hospital with milder symptoms. According to  media reports, the child had been previously vaccinated against diphtheria.  The patient is being managed in isolation and is reported to be in a stable clinical condition.

    ° Local health authorities have initiated an epidemiological investigation, including contact tracing and active monitoring of contacts to  identify potential additional cases and limit further transmission.

    ° Public health measures have also been implemented, including  chemoprophylaxis of contacts and vaccination of the siblings of the first case. 

    ° Media sources have reported that 10 additional family members have tested positive for C. diphtheriae. These individuals were reported to be  vaccinated and in good clinical condition.

    ° However, as of 25 August, no additional cases besides the two described  above have been reportedofficially by local health authorities.

Background

    ° Diphtheria is a vaccine-preventable bacterial disease caused by  Corynebacterium diphtheriae.

    ° Transmission can occur from person to person through respiratory  droplets, direct contact with respiratory secretions, contact with exudate from  infected skin lesions or contaminated surfaces. 

    ° Infection may present as respiratory or cutaneous diphtheria.  Asymptomatic infection is also common, particularly in highly vaccinated  populations. The pathogenicity of C. diphtheriae is primarily related to the  production of the diphtheria toxin, which can cause local tissue damage, severe  systemic complications and even death. 

    ° Diphtheria is largely preventable through vaccination, and  unvaccinated or under-vaccinated individuals are at  higher risk of severe  disease and death. 

    ° Without timely diagnosis and treatment, respiratory diphtheria  can be  life-threatening, especially in unvaccinated, young children.

    ° Diphtheria remains a relatively rare disease in the EU/EEA due to high  vaccination coverage. In 2022, a large multi-country outbreak was recorded,  primarily affecting migrants and asylum seekers, with limited evidence of spread  to the general population. Reported cases declined in subsequent years, although  sporadic cases and localised transmission continue to occur, particularly among  vulnerable populations, including migrants, people experiencing homelessness,  and unvaccinated or under-vaccinated individuals.

ECDC assessment:

    ° The probability of widespread transmission of diphtheria in the general  population in the EU/EEA is considered low, due to high levels of  population immunity achieved through routine vaccination programmes. The  impact on the general population is also assessed as low, as high vaccination coverage reduces the risk of severe disease and death. Therefore, the  overall risk to the general population in the EU/EEA is considered low.

    ° Nevertheless, sporadic cases and localised clusters may occur in  settings where vaccination coverage is suboptimal or where conditions facilitate  transmission, such as overcrowded environments and settings with poor hygiene.  Imported cases may also occur among individuals travelling from endemic  geographical areas. Severe disease is more likely among susceptible groups,  including unvaccinated or under-vaccinated individuals, young children, older  adults, and immunocompromised individuals.

    ° Achieving and sustaining high vaccination coverage in the population is  crucial to prevent serious or fatal disease. In the event of cases, rapid clinical  recognition, prompt laboratory confirmation, timely administration of appropriate  treatment, and the identification and management of close contacts are essential to reduce morbidity, mortality, and onward transmission.

Actions:

    ° ECDC continues to monitor this event through epidemic intelligence activities and is liaising with the relevant national public health authorities to  collect additional information on the case and ongoing contact tracing and contact follow-up activities.

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Source: 

Link: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-22-28-august-week-35

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#Vaccine #imprinting drives increased #SARS-CoV-2 #variant infection in #children

 

Abstract

Virus exposure history, particularly first exposure, is believed to shape vaccine efficacy and infection susceptibility; however, evidence for mechanistic links between immune responses in individuals and epidemiological outcome in populations is scarce. Recent co-circulation of SARS-CoV-2 variants XFG and BA.3.2 has revealed a striking enrichment in BA.3.2 cases among children. By combining epidemiological modeling, serology and monoclonal antibody analysis in children and adults, we show the dependence of effective variant-specific antibodies on vaccination history which may explain birth-year influence on differential susceptibility to these co-circulating variants. Ancestral cross-reactive site I antibodies frequently neutralize BA.3.2, but not XFG. By contrast, Omicron type-specific site I/III and III antibodies frequently neutralize XFG but not BA.3.2, revealing a tradeoff in the ability to neutralize these two co-circulating strains. These findings mechanistically link immune history, variant neutralization, antibody repertoire and variant infection risk, and suggest that vaccination regimens in children should prioritize neutralization breadth.

Competing Interest Statement

E.J.W. advises Arpelos Bioscience, Arsenal Biosciences, Coherus, Danger Bio, IpiNovyx, New Limit, Marengo, Pluto Immunotherapeutics Related Sciences, Santa Ana Bio, and Synthekine. E.J.W. is a founder of and holds shares of Coherus, Danger Bio, and Arsenal Biosciences. All other authors declare no competing interests.

Funder Information Declared

National Institute of Allergy and Infectious Diseases, https://ror.org/043z4tv69, 75N93021C00015, U19AI082630, AI105343, AI108545, AI155577, AI149680

National Cancer Institute, 75N91019D00024, 75N91022F00005, 75N91023F00016

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.08.12.739589v1

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Effectiveness of #Oseltamivir in Hospitalized #Children With Laboratory-Confirmed #Influenza, 2014-2023

 

Key Points

    ° Question: 

        § Does oseltamivir treatment reduce risk of intensive care unit (ICU) admission and hospital length of stay among pediatric patients hospitalized with influenza?

    ° Findings:  

        § Using a cohort study from a population-based surveillance network in 13 states across 8 influenza seasons, oseltamivir treatment was found to decrease both the likelihood of ICU admission and hospital length of stay among pediatric patients hospitalized with laboratory-confirmed influenza.

    ° Meaning:  

        § These findings support the current national recommendations from the American Academy of Pediatrics, US Centers for Disease Control and Prevention, and Infectious Diseases Society of America that recommend antiviral treatment for children hospitalized with laboratory-confirmed influenza.

Abstract

Importance  

National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission.

Objective  

To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations.

Design, Setting, and Participants  

This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026.

Exposures  

Oseltamivir receipt as a time-dependent exposure.

Main Outcome(s) and Measure(s)  

The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used.

Results  

After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity—the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21).

Conclusions and Relevance  

In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.

Source: 

Link: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2852671

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#Genomic Characterization of #SARS-CoV-2 #NB.1.8.1 and #PQ.2 from the #Infants and Young #Children with #Gastrointestinal Symptoms

 

Abstract

Purpose: 

This study investigated the viral genomic characteristics of infants and young children who presented to our hospital with gastrointestinal symptoms during a local COVID-19 epidemic and were confirmed to have SARS-CoV-2 infection.

Patients and methods: 

Between May and August 2025, pharyngeal swab samples were collected from four infants and young children who presented to the outpatient department of Meizhou People’s Hospital in Meizhou, with gastrointestinal symptoms. Nucleic acid testing and whole-genome sequencing were performed. The viral mutation profile was analyzed, and the potential impact of mutations on protein function was predicted.

Results: 

Pangolin typing identified the NB.1.8.1 variant in three patients and the PQ.2 variant in one patient. Genome sequences from three of the four viral variants displayed varying degrees of mutation. The nonsynonymous mutations for both variants were concentrated in the spike protein. A comparison with the parental XDV.1.5.1 lineage revealed 14 specific mutations, with 7 nonsynonymous sites conserved across all gene sequences. Five of these mutation sites, NSP12: D284Y, ORF3a: L46F, ORF3a: F207C, N: Q9H, and N: Q384H, were predicted to be functionally deleterious and structurally destabilizing.

Conclusion: 

SARS-CoV-2 variants from specimens obtained from four infants and young children exhibited varying degrees of mutation, providing evidence for the ongoing evolution of emerging variants in pediatric patients. However, monitoring genomic changes of circulating variants requires further clinical specimens, which contributes to understanding the dynamic changes at mutation sites, thereby supporting epidemic prevention and control.

Source: 

Link: https://www.dovepress.com/genomic-characterization-of-sars-cov-2-nb181-and-pq2-from-the-infants--peer-reviewed-fulltext-article-IDR

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Immune correlates of #risk for #SARS-CoV-2 #infection in #children: a prospective, community-based cohort study

 

Abstract

Few studies have characterized immune correlates of SARS-CoV-2 infection risk in children, particularly those with hybrid immunity from vaccination and prior infection. We conduct a prospective community-based cohort study of 1509 U.S. children (2022–2024), performing weekly SARS-CoV-2 PCR testing and measuring baseline binding and neutralizing antibody titers against multiple variants. Higher antibody levels, notably nucleocapsid-binding and Omicron-specific neutralizing antibodies, are significantly associated with reduced risk of SARS-CoV-2 infection after adjusting for age, recent infection, exposure settings, and temporal trends (adjusted hazard ratios ranging from 0.60 to 0.87 per positive unit difference in log10-fold antibody level (AU/mL)). Secondary analyses suggest these findings are robust to multiple stratifications of SARS-CoV-2 immune status, are relevant across different pediatric age groups, and appear to apply to both overall and symptomatic infection risk. Together, the results suggest that specific antibodies can predict relative infection risk in pediatric populations with diverse immune histories. Understanding these immune correlates may inform tailored vaccination strategies and risk assessments as SARS-CoV-2 continues to evolve.

Source: 

Link: https://www.nature.com/articles/s41467-026-74684-8

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#Hantavirus cardiopulmonary syndrome in #children: a systematic scoping #review of presentation, critical care management, and outcomes

 

Abstract

Background

Pediatric hantavirus cardiopulmonary syndrome/hantavirus pulmonary syndrome (HCPS/HPS) is rare but can progress rapidly from a nonspecific febrile prodrome to respiratory failure, shock, and multiorgan dysfunction. Pediatric-specific evidence is limited, and a comprehensive map of the clinical literature is lacking.

Methods

We conducted a systematic scoping review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidance (protocol registered at DOI:10.17605/OSF.IO/MZDN4). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to May 2026. Eligible reports described children or adolescents (age ≤18 years) with HCPS/HPS and extractable pediatric clinical data. Two reviewers independently screened records, assessed overlap, extracted data, and appraised reporting quality using Joanna Briggs Institute tools.

Results

Of 2208 database records, 20 reports were included in the core pediatric synthesis after removal of 976 duplicates and screening. Reports were concentrated in the Americas. Recurrent features included fever, gastrointestinal symptoms, myalgia, thrombocytopenia, hemoconcentration, pulmonary edema, respiratory failure, and shock. Severe cases required mechanical ventilation, vasoactive support, extracorporeal membrane oxygenation, and in some cases renal replacement therapy. Larger pediatric case series and surveillance-level reports reported mortality of approximately 33% to 37%. Evidence was predominantly case-based with variable reporting completeness.

Conclusions

Pediatric HCPS/HPS is rare but potentially rapidly fatal. Early suspicion in endemic regions or after rodent exposure, with prompt supportive critical care and timely consideration of advanced cardiopulmonary support, is central to management.

Source: 

Link: https://www.tandfonline.com/doi/full/10.1080/08998280.2026.2698359

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First #Ecuadorian #Pediatric Case of Multisystem and #Neurological Involvement Associated with #Influenza A #H5N1 Virus—Case Report

 

Abstract

Influenza A (H5N1) is a highly pathogenic zoonotic virus with a human fatality rate of approximately 60%. Pediatric cases and associated neurological manifestations remain poorly documented in Latin America. This report describes the first confirmed Ecuadorian pediatric case of H5N1-associated encephalitis and multisystem organ failure in a previously healthy 9-year-old female following direct contact with infected poultry. The clinical course was characterized by an atypical initial presentation of bilateral periorbital edema and headache, progressing to acute encephalitis, cerebral ischemia, flaccid tetraplegia, central diabetes insipidus, and refractory septic shock. Diagnostic confirmation was achieved via nasopharyngeal RT-PCR, with additional RT-PCR and sequencing performed on cerebrospinal fluid, which identified conserved influenza A M1/M2 gene fragments, while laboratory markers—including marked elevations in IL-6, ferritin, and CRP—indicated a severe hyperinflammatory state. Management involved an intensive multidisciplinary approach utilizing oseltamivir, intravenous immunoglobulin, modulated-dose corticosteroids, desmopressin, and mechanical ventilation. Despite a severe clinical course, the patient achieved a favorable recovery, with a Glasgow Coma Scale score of 15/15 at discharge and only partial residual paresis and left hypoacusia as sequelae. This landmark case provides rare evidence of H5N1 neuroinvasion in a pediatric patient and demonstrates that timely detection combined with aggressive immunotherapy and antiviral treatment can improve survival. Furthermore, it underscores the critical necessity for strengthened regional molecular surveillance and clinical training to recognize atypical presentations of emerging zoonoses in Latin America, especially in cases involving contact with sick poultry.

Source: 

Link: https://www.mdpi.com/1999-4915/18/7/749

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{#Canada} #Fatal #rabies in a #child (CMAJ)

 

{Summary}

Key points

    ° Rabies is a neurotropic infection that is rare in Canada and almost always fatal once symptoms develop.

    ° Rabies postexposure prophylaxis is highly effective in preventing infection in exposed humans if administered promptly and before onset of rabies symptoms.

    ° Any direct human contact with a bat is an indication for rabies postexposure prophylaxis and should be discussed with the regional public health authority.

    ° No established efficacious therapies are available for treatment of rabies once symptom onset has occurred.

An immunocompetent 11-year-old boy presented with odynophagia and emesis to an urban hospital emergency department in Ontario, Canada. Seven days before presentation, he had developed progressive right-sided facial paresthesia and numbness, followed by anorexia and right-sided facial swelling. Four days after symptom onset, he had been prescribed oral valacyclovir (1 g, 3 times daily) at a local urgent care clinic for presumed Bell palsy secondary to herpes simplex virus; however, he was unable to tolerate this because of odynophagia. He had no history of allergies, sick contacts, tick bites, or recent travel outside the country.

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Source: Canadian Medical Association Journal, https://www.cmaj.ca/

Link: https://www.cmaj.ca/content/198/25/E969

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#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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