Digital Commons Network^™

Infants Admitted To Us Intensive Care Units For Rsv Infection During The 2022 Seasonal Peak., Natasha Halasa, Laura D. Zambrano, Justin Z. Amarin, Laura S. Stewart, Margaret M. Newhams, Emily R. Levy, Steven L. Shein, Christopher L. Carroll, Julie C. Fitzgerald, Marian G. Michaels, Katherine Bline, Melissa L. Cullimore, Laura Loftis, Vicki L. Montgomery, Asumthia S. Jeyapalan, Pia S. Pannaraj, Adam J. Schwarz, Natalie Z. Cvijanovich, Matt S. Zinter, Aline B. Maddux, Melania M. Bembea, Katherine Irby, Danielle M. Zerr, Joseph D. Kuebler, Christopher J. Babbitt, Mary Glas Gaspers, Ryan A. Nofziger, Michele Kong, Bria M. Coates, Jennifer E. Schuster, Shira J. Gertz, Elizabeth H. Mack, Benjamin R. White, Helen Harvey, Charlotte V. Hobbs, Heda Dapul, Andrew D. Butler, Tamara T. Bradford, Courtney M. Rowan, Kari Wellnitz, Mary Allen Staat, Cassyanne L. Aguiar, Saul R. Hymes, Adrienne G. Randolph, Angela P. Campbell, Rsv-Pic Investigators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.

OBJECTIVE: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection.

EXPOSURE: Respiratory syncytial virus.

MAIN OUTCOMES AND MEASURES: Data were captured on demographics, …

Notes From The Field: Multipathogen Respiratory Virus Testing Among Primary And Secondary School Students And Staff Members In A Large Metropolitan School District - Missouri, November 2, 2022-April 19, 2023., Jennifer Goldman, Brian R. Lee, Janelle Porter, Anila Deliu, Shannon Tilsworth, Olivia M. Almendares, Sadia Sleweon, Hannah L. Kirking, Rangaraj Selvarangan, Jennifer E. Schuster

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Treatment Of Covid-19 Symptoms With Over The Counter (Otc) Medicines Used For Treatment Of Common Cold And Flu., Ronald Eccles, Guy Boivin, Benjamin J. Cowling, Andrew Pavia, Rangaraj Selvarangan

Manuscripts, Articles, Book Chapters and Other Papers

Persons suffering from acute upper respiratory tract viral infections (URTI) commonly use over the counter (OTC) medicines to relieve symptoms such as fever, muscle aches, cough, runny nose, sore throat and nasal congestion. At present OTC medicines are only licensed for treatment of common cold and flu symptoms and not for treatment of the same symptoms associated with COVID-19. The innate immune response responsible for the mechanisms of the symptoms of URTI is the same for all respiratory viruses including SARS-CoV-2 and these symptoms can be relieved by treatment with the same OTC medicines as available for treatment of colds …

Pharmacogenomic Variation In The Malagasy Population: Implications For The Antimalarial Drug Primaquine Metabolism., Estee Y. Cramer, Jacquelaine Bartlett, Ernest R. Chan, Andrea Gaedigk, Arsene C. Ratsimbasoa, Rajeev K. Mehlotra, Scott M. Williams, Peter A. Zimmerman

Manuscripts, Articles, Book Chapters and Other Papers

Aim: Antimalarial primaquine (PQ) eliminates liver hypnozoites of Plasmodium vivax. CYP2D6 gene variation contributes to PQ therapeutic failure. Additional gene variation may contribute to PQ efficacy. Information on pharmacogenomic variation in Madagascar, with vivax malaria and a unique population admixture, is scanty. Methods: The authors performed genome-wide genotyping of 55 Malagasy samples and analyzed data with a focus on a set of 28 pharmacogenes most relevant to PQ. Results: Mainly, the study identified 110 coding or splicing variants, including those that, based on previous studies in other populations, may be implicated in PQ response and copy number variation, specifically in …

Evolutionary And Functional History Of The Escherichia Coli K1 Capsule., Sergio Arredondo-Alonso, George Blundell-Hunter, Zuyi Fu, Rebecca A. Gladstone, Alfred Fillol-Salom, Jessica Loraine, Elaine Cloutman-Green, Pål J. Johnsen, Ørjan Samuelsen, Anna K. Pöntinen, François Cléon, Susana Chavez-Bueno, Miguel A. De La Cruz, Miguel A. Ares, Manivanh Vongsouvath, Agnieszka Chmielarczyk, Carolyne Horner, Nigel Klein, Alan Mcnally, Joice N. Reis, José R. Penadés, Nicholas R. Thomson, Jukka Corander, Peter W. Taylor, Alex J. Mccarthy

Manuscripts, Articles, Book Chapters and Other Papers

Escherichia coli is a leading cause of invasive bacterial infections in humans. Capsule polysaccharide has an important role in bacterial pathogenesis, and the K1 capsule has been firmly established as one of the most potent capsule types in E. coli through its association with severe infections. However, little is known about its distribution, evolution and functions across the E. coli phylogeny, which is fundamental to elucidating its role in the expansion of successful lineages. Using systematic surveys of invasive E. coli isolates, we show that the K1-cps locus is present in a quarter of bloodstream infection isolates and has emerged …

Congenital Malformations And Preeclampsia Associated With Integrase Inhibitor Use In Pregnancy: A Single-Center Analysis., Christiana Smith, Angela J. Fought, Joyce F. Sung, Jennifer R. Mckinney, Torri D. Metz, Kirk B. Fetters, Sarah Lazarus, Shannon Capraro, Emily Barr, Carrie Glenny, Jenna Buehler, Adriana Weinberg, Chip Perinatal Medical Team

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Antiretroviral therapy (ART) decreases perinatal HIV transmission, but concerns exist regarding maternal and infant safety. We compared the incidence of congenital malformations and other adverse outcomes in pregnancies exposed to integrase inhibitor (INSTI) versus non-INSTI ART.

SETTING: Single-site review of all pregnancies among women living with HIV between 2008 and 2018.

METHODS: We used binomial family generalized estimating equations to model the relationship of congenital anomalies and pregnancy outcomes with exposure to INSTI or dolutegravir (DTG) versus non-INSTI ART.

RESULTS: Among 257 pregnancies, 77 women received ≥1 INSTI (54 DTG, 14 elvitegravir, 15 raltegravir), 167 received non-INSTI, and 3 …

The Detrimental Effects Of Peripartum Antibiotics On Gut Proliferation And Formula Feeding Injury In Neonatal Mice Are Alleviated With Lactobacillus Rhamnosus Gg, Alain Cuna, Marianne N. Nsumu, Heather Menden, Susana Chavez-Bueno, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

Peripartum antibiotics can negatively impact the developing gut microbiome and are associated with necrotizing enterocolitis (NEC). The mechanisms by which peripartum antibiotics increase the risk of NEC and strategies that can help mitigate this risk remain poorly understood. In this study, we determined mechanisms by which peripartum antibiotics increase neonatal gut injury and evaluated whether probiotics protect against gut injury potentiated by peripartum antibiotics. To accomplish this objective, we administered broad-spectrum antibiotics or sterile water to pregnant C57BL6 mice and induced neonatal gut injury to their pups with formula feeding. We found that pups exposed to antibiotics had reduced villus …

Irf7 And Unc93b1 Variants In An Infant With Recurrent Herpes Simplex Virus Infection., Megan H. Tucker, Wei Yu, Heather Menden, Sheng Xia, Carl F. Schreck, Margaret Gibson, Daniel A. Louiselle, T Pastinen, Nikita Raje, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

Neonatal herpes simplex virus (HSV) infection is a devastating disease with substantial morbidity and mortality. The genetic basis of susceptibility to HSV in neonates remains undefined. We evaluated a male infant with neonatal skin/eye/mouth (SEM) HSV-1 disease, who had complete recovery after acyclovir but developed HSV-1 encephalitis at 1 year of age. An immune workup showed an anergic PBMC cytokine response to TLR3 stimulation but no other TLRs. Exome sequencing identified rare missense variants in IFN-regulatory factor 7 (IRF7) and UNC-93 homolog B1 (UNC93B1). PBMC single-cell RNA-Seq done during childhood revealed decreased expression of several innate immune genes and a …

The Leaky Pipeline In Academia., Mary Anne Jackson

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Community-Onset Bacterial Coinfection In Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection., Kristin L. Moffitt, Mari M. Nakamura, Cameron C. Young, Margaret M. Newhams, Natasha B. Halasa, J Nelson Reed, Julie C. Fitzgerald, Philip C. Spinella, Vijaya L. Soma, Tracie C. Walker, Laura L. Loftis, Aline B. Maddux, Michele Kong, Courtney M. Rowan, Charlotte V. Hobbs, Jennifer E. Schuster, Becky J. Riggs, Gwenn E. Mclaughlin, Kelly N. Michelson, Mark W. Hall, Christopher J. Babbitt, Natalie Z. Cvijanovich, Matt S. Zinter, Mia Maamari, Adam J. Schwarz, Aalok R. Singh, Heidi R. Flori, Shira J. Gertz, Mary A. Staat, John S. Giuliano, Saul R. Hymes, Katharine N. Clouser, John Mcguire, Christopher L. Carroll, Neal J. Thomas, Emily R. Levy, Adrienne G. Randolph

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.

METHODS: We evaluated children and adolescents agedadmission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.

RESULTS: Of the 532 patients, 63.3% received empiric antibiotics, but …

Sars-Cov-2 Screening Testing Programs For Safe In-Person Learning In K-12 Schools., Ibukunoluwa C. Kalu, Kanecia O. Zimmerman, Jennifer Goldman, Dana Keener Mast, Ashley M. Blakemore, Ganga Moorthy, Angelique E. Boutzoukas, Melissa M. Campbell, Diya Uthappa, Jesse Delarosa, Jessica M. Potts, Laura J. Edwards, Rangaraj Selvarangan, Daniel K. Benjamin, Tara K. Mann, Jennifer E. Schuster

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening testing is a recommended mitigation strategy for schools, although few descriptions of program implementation are available.

METHODS: Kindergarten through 12th grade (K-12) students and staff practicing universal masking during the delta and omicron variant waves from five schools in Durham, North Carolina and eight schools in Kansas City, Missouri participated; Durham's program was structured as a public health initiative facilitated by school staff, and Kansas City's as a research study facilitated by a research team. Tests included school-based rapid antigen or polymerase chain reaction testing, at-home rapid antigen testing, and off-site …

Disseminated Juvenile Xanthogranuloma With A Novel Myh9-Flt3 Fusion Presenting As A Blueberry Muffin Rash In A Neonate., Emily E. Clark, Mollie Walton, Lionel M L Chow, J Todd Boyd, M David Yohannan, Shreyas Arya

Manuscripts, Articles, Book Chapters and Other Papers

Juvenile xanthogranuloma (JXG) is a benign proliferative histiocytic disorder of the dendritic cell phenotype. It mostly presents in the pediatric age group as a solitary skin lesion. We describe a rare case of an infant born with disseminated JXG who presented with a blueberry muffin rash at birth. A term infant was noted to have multiple petechiae, purple nodules, and macules (1 mm-2 cm in diameter) and hepatosplenomegaly, at the time of birth. Further investigations revealed thrombocytopenia and direct hyperbilirubinemia and a magnetic resonance imaging showed scattered tiny foci of restricted diffusion in multiple areas of the brain. Patient received …

Pediatric Covid-19 Involving Complicated Sinusitis With Intracranial Extension And Lemierre Syndrome: A Case Report., Rohit Nallani, Michael E. Price, Srivats S. Narayanan, Meghan Tracy, Jill M. Arganbright

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Pediatric coronavirus disease 2019 (COVID-19) has been associated with various complications including chronic respiratory disease and multisystem inflammatory syndrome. There are a few reported cases of complicated sinusitis following pediatric COVID-19 infection. We present a patient with recent COVID-19 who developed complicated sinusitis with intracranial extension and Lemierre syndrome. A 16-year-old female with a history of COVID-19 diagnosis 17 days prior presented with worsening head and neck symptoms. Physical examination demonstrated left proptosis, cranial nerve (CN) VI palsy, and limited neck range of motion. Imaging demonstrated bilateral sinus disease, a 3.3 × 2 × 3-centimeter sellar/clival abscess, bilateral cavernous sinus …

Bnt162b2 Mrna Vaccination Against Coronavirus Disease 2019 Is Associated With A Decreased Likelihood Of Multisystem Inflammatory Syndrome In Children Aged 5-18 Years-United States, July 2021 - April 2022., Laura D. Zambrano, Margaret M. Newhams, Samantha M. Olson, Natasha B. Halasa, Ashley M. Price, Amber O. Orzel, Cameron C. Young, Julie A. Boom, Leila C. Sahni, Aline B. Maddux, Katherine E. Bline, Satoshi Kamidani, Keiko M. Tarquinio, Kathleen Chiotos, Jennifer E. Schuster, Melissa L. Cullimore, Sabrina M. Heidemann, Charlotte V. Hobbs, Ryan A. Nofziger, Pia S. Pannaraj, Melissa A. Cameron, Tracie C. Walker, Stephanie P. Schwartz, Kelly N. Michelson, Bria M. Coates, Heidi R. Flori, Elizabeth H. Mack, Laura Smallcomb, Shira J. Gertz, Samina S. Bhumbra, Tamara T. Bradford, Emily R. Levy, Michele Kong, Katherine Irby, Natalie Z. Cvijanovich, Matt S. Zinter, Cindy Bowens, Hillary Crandall, Janet R. Hume, Manish M. Patel, Angela P. Campbell, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood.

METHODS: In a multicenter, case-control, public health investigation of children ages 5-18 years hospitalized from 1 July 2021 to 7 April 2022, we compared the odds of being fully vaccinated (2 doses of BNT162b2 vaccine ≥28 days before hospital admission) between MIS-C case-patients and hospital-based controls who tested negative for SARS-CoV-2. These associations were examined by age group, timing of vaccination, …

Bacterial Infections And Cancer: Exploring This Association And Its Implications For Cancer Patients., Kafayat Yusuf, Venkatesh Sampath, Shahid Umar

Manuscripts, Articles, Book Chapters and Other Papers

Bacterial infections are common in the etiology of human diseases owing to the ubiquity of bacteria. Such infections promote the development of periodontal disease, bacterial pneumonia, typhoid, acute gastroenteritis, and diarrhea in susceptible hosts. These diseases may be resolved using antibiotics/antimicrobial therapy in some hosts. However, other hosts may be unable to eliminate the bacteria, allowing them to persist for long durations and significantly increasing the carrier's risk of developing cancer over time. Indeed, infectious pathogens are modifiable cancer risk factors, and through this comprehensive review, we highlight the complex relationship between bacterial infections and the development of several cancer …

Comprehensive Smn1 And Smn2 Profiling For Spinal Muscular Atrophy Analysis Using Long-Read Pacbio Hifi Sequencing., Xiao Chen, John Harting, Emily G. Farrow, Isabelle Thiffault, Dalia Kasperaviciute, Genomics England Research Consortium, Alexander Hoischen, Christian Gilissen, T Pastinen, Michael A. Eberle

Manuscripts, Articles, Book Chapters and Other Papers

Spinal muscular atrophy, a leading cause of early infant death, is caused by bi-allelic mutations of SMN1. Sequence analysis of SMN1 is challenging due to high sequence similarity with its paralog SMN2. Both genes have variable copy numbers across populations. Furthermore, without pedigree information, it is currently not possible to identify silent carriers (2+0) with two copies of SMN1 on one chromosome and zero copies on the other. We developed Paraphase, an informatics method that identifies full-length SMN1 and SMN2 haplotypes, determines the gene copy numbers, and calls phased variants using long-read PacBio HiFi data. The SMN1 and SMN2 copy-number …

Circulation Of Rhinoviruses And/Or Enteroviruses In Pediatric Patients With Acute Respiratory Illness Before And During The Covid-19 Pandemic In The Us., Danielle A. Rankin, Andrew J. Spieker, Ariana Perez, Anna L. Stahl, Herdi K. Rahman, Laura S. Stewart, Jennifer E. Schuster, Joana Y. Lively, Zaid Haddadin, Varvara Probst, Marian G. Michaels, John V. Williams, Julie A. Boom, Leila C. Sahni, Mary A. Staat, Elizabeth P. Schlaudecker, Monica M. Mcneal, Christopher J. Harrison, Geoffrey A. Weinberg, Peter G. Szilagyi, Janet A. Englund, Eileen J. Klein, Susan I. Gerber, Meredith Mcmorrow, Brian Rha, James D. Chappell, Rangaraj Selvarangan, Claire M. Midgley, Natasha B. Halasa, Nvsn Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting.

OBJECTIVE: To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought …

Increasing Cefazolin Use For Surgical Prophylaxis In Penicillin-Allergy-Labeled Patients., Kathryn A. Vandervelde, Sarah Suppes, Kate Gibbs, Kevin Latz, Angela C. Vanderpool, Rana El Feghaly, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Objective: Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.

Design: Quality improvement initiative.

Setting: Children's Mercy Kansas City (CMKC), a freestanding children's hospital.

Patients: Children scheduled for an orthopedic surgery (excluding spinal surgery) at CMKC who had a PCN allergy label and received a perioperative antibiotic.

Methods: No standardized process existed to identify and clarify PCN-allergic-labeled patients preoperatively. We developed a process for patient identification combined with a pharmacist phone interview for PCN allergy clarification. In …

Variation In Antibiotic Resistance Patterns For Children And Adults Treated At 166 Non-Affiliated Us Facilities Using Ehr Data., Shivani Sivasankar, Jennifer Goldman, Mark A. Hoffman

Manuscripts, Articles, Book Chapters and Other Papers

Background: Antibiotic resistance (AR) is a global public health threat. Surveillance of baseline AR and trends and emerging resistance among priority bacterial isolates with respect to the age of the patients and the type of healthcare setting are required due to differences in antimicrobial need and use in these populations.

Methods: We performed a retrospective study using deidentified electronic health record (EHR) data in the Cerner Health Facts™ data warehouse. Antibiotic susceptibility data were extracted for all bacterial isolates of interest at 166 non-affiliated healthcare facilities reporting microbiology susceptibility results of the FDA recommended antibiotics between the years 2012 to …

Defining Genetic Diversity Of Rhesus Macaque Fcγ Receptors With Long-Read Rna Sequencing., Haleigh E. Conley, Max M. He, David Easterhoff, Hélène Fradin Kirshner, Sarah L. Cocklin, Jacob Meyer, Taylor Hoxie, Madison Berry, Todd Bradley, William D. Tolbert, Marzena Pazgier, Georgia D. Tomaras, Joern E. Schmitz, Michael Anthony Moody, Kevin Wiehe, Justin Pollara

Manuscripts, Articles, Book Chapters and Other Papers

Fcγ receptors (FcγRs) are membrane-bound glycoproteins that bind to the fragment crystallizable (Fc) constant regions of IgG antibodies. Interactions between IgG immune complexes and FcγRs can initiate signal transduction that mediates important components of the immune response including activation of immune cells for clearance of opsonized pathogens or infected host cells. In humans, many studies have identified associations between FcγR gene polymorphisms and risk of infection, or progression of disease, suggesting a gene-level impact on FcγR-dependent immune responses. Rhesus macaques are an important translational model for most human health interventions, yet little is known about the breadth of rhesus macaque …

Changes In Distribution Of Severe Neurologic Involvement In Us Pediatric Inpatients With Covid-19 Or Multisystem Inflammatory Syndrome In Children In 2021 Vs 2020., Kerri L. Larovere, Tina Y. Poussaint, Cameron C. Young, Margaret M. Newhams, Suden Kucukak, Katherine Irby, Michele Kong, Stephanie P. Schwartz, Tracie C. Walker, Melania M. Bembea, Kari Wellnitz, Kevin M. Havlin, Natalie Z. Cvijanovich, Mark W. Hall, Julie C. Fitzgerald, Jennifer E. Schuster, Charlotte V. Hobbs, Natasha B. Halasa, Aalok R. Singh, Elizabeth H. Mack, Tamara T. Bradford, Shira J. Gertz, Adam J. Schwarz, Katri V. Typpo, Laura L. Loftis, John S. Giuliano, Steven M. Horwitz, Katherine V. Biagas, Katharine N. Clouser, Courtney M. Rowan, Aline B. Maddux, Vijaya L. Soma, Christopher J. Babbitt, Cassyanne L. Aguiar, Amanda R. Kolmar, Sabrina M. Heidemann, Helen Harvey, Laura D. Zambrano, Angela P. Campbell, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.

OBJECTIVE: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021.

DESIGN, SETTING, AND PARTICIPANTS: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having …

A Pilot Intervention Combining Assessment And Feedback With Communication Training And Behavioral Nudges To Increase Hpv Vaccine Uptake., Andrea Bradley-Ewing, Brian R. Lee, Jason N. Doctor, Georgann Meredith, Kathy Goggin, Angela Myers

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Human papillomavirus (HPV) causes >40,000 cancer diagnoses each year, yet vaccination rates remain low because widespread implementation of strategies to increase vaccinations has not occurred. Behavioral nudges have demonstrated efficacy in improving uptake of desired behaviors in health care settings but have not been tested for increasing HPV vaccinations. We assessed the impact of an intervention combining behavioral nudges with other proven strategies (i.e., assessment and feedback, provider communication training) on HPV vaccination rates and parental satisfaction in four Midwestern pediatric, outpatient practices. Practices were randomly assigned to receive either assessment and feedback or assessment and feedback combined with vaccine …

Characteristics Of Antifungal Utilization For Hospitalized Children In The United States., Lourdes Eguiguren, Brian R. Lee, Jason G. Newland, Matthew P. Kronman, Adam L. Hersh, Jeffrey S. Gerber, Grace M. Lee, Hayden T. Schwenk

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To characterize antifungal prescribing patterns, including the indication for antifungal use, in hospitalized children across the United States.

Design: We analyzed antifungal prescribing data from 32 hospitals that participated in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study, a cross-sectional point-prevalence survey conducted between June 2016 and December 2017.

Methods: Inpatients aged < 18 years with an active systemic antifungal order were included in the analysis. We classified antifungal prescribing by indication (ie, prophylaxis, empiric, targeted), and we compared the proportion of patients in each category based on patient and antifungal characteristics.

Results: Among 34,927 surveyed patients, 2,095 (6%) received at least 1 systemic antifungal and there were 2,207 antifungal prescriptions. Most patients had an underlying oncology or bone marrow transplant diagnosis (57%) or were premature (13%). The most prescribed antifungal was fluconazole (48%) and the …

Let's Talk About Antibiotics: A Randomised Trial Of Two Interventions To Reduce Antibiotic Misuse., Kathy Goggin, Emily A. Hurley, Brian R. Lee, Andrea Bradley-Ewing, Carey Bickford, Kimberly Pina, Evelyn Donis De Miranda, David Yu, Kirsten Weltmer, Sebastian Linnemayr, Christopher C. Butler, Jason G. Newland, Angela Myers

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent-clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical.

OBJECTIVES: Compare two feasible (higher vs lower intensity) interventions for enhancing parent-clinician communication on the rate of inappropriate antibiotic prescribing.

DESIGN: Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019.

SETTING: Academic and private practice outpatient clinics.

PARTICIPANTS: Clinicians (n=41, 85% of eligible approached) and 1599 parent-child dyads (ages 1-5 years with ARTI symptoms, 71% of eligible approached). …

Frosted Branch Angiitis Presenting After A Sars-Cov-2 Infection., Akhila Alapati, Nathaniel Cameron, Sean Gratton, Erin Stahl, Mary Champion

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: To report a case of frosted branch angiitis presenting in a pediatric patient with unremarkable laboratory work-up apart from SARS-CoV-2 IgG antibodies.

OBSERVATIONS: Less than four weeks after a SARS-CoV-2 infection, a 10 year-old female presented to the emergency department with severe headache and intermittent fevers. During her hospital admission, the ophthalmology service was consulted for blurry vision. Subsequent eye examination revealed frosted branch angiitis. The patient initially received intravenous corticosteroids but was escalated to plasmapheresis to achieve resolution of her symptoms. Outpatient maintenance therapy consisted of an oral Prednisone taper and Infliximab infusion.

CONCLUSION AND IMPORTANCE: This case …

Current Practices In Delaying Testing For Ige-Mediated Food Allergy After Anaphylaxis, Jordan Pitt, Cody Shopper, Paul Dowling, Christopher Miller, Ashley K. Sherman, Salman Aljubran

Manuscripts, Articles, Book Chapters and Other Papers

Background

Objective

Methods

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome In Children After Sars-Cov-2 Infection., Laura D. Zambrano, Kathleen N. Ly, Ruth Link-Gelles, Margaret M. Newhams, Manzilat Akande, Michael J. Wu, Leora R. Feldstein, Keiko M. Tarquinio, Leila C. Sahni, Becky J. Riggs, Aalok R. Singh, Julie C. Fitzgerald, Jennifer E. Schuster, John S. Giuliano, Janet A. Englund, Janet R. Hume, Mark W. Hall, Christina M. Osborne, Sule Doymaz, Courtney M. Rowan, Christopher J. Babbitt, Katharine N. Clouser, Steven M. Horwitz, Janet Chou, Manish M. Patel, Charlotte Hobbs, Adrienne G. Randolph, Angela P. Campbell, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities.

METHODS: This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk …

Respiratory Virus Surveillance Among Children With Acute Respiratory Illnesses - New Vaccine Surveillance Network, United States, 2016-2021., Ariana Perez, Joana Y. Lively, Aaron Curns, Geoffrey A. Weinberg, Natasha B. Halasa, Mary Allen Staat, Peter G. Szilagyi, Laura S. Stewart, Monica M. Mcneal, Benjamin Clopper, Yingtao Zhou, Brett L. Whitaker, Elizabeth Lemasters, Elizabeth Harker, Janet A. Englund, Eileen J. Klein, Rangaraj Selvarangan, Christopher J. Harrison, Julie A. Boom, Leila C. Sahni, Marian G. Michaels, John V. Williams, Gayle E. Langley, Susan I. Gerber, Angela Campbell, Aron J. Hall, Brian Rha, Meredith Mcmorrow, New Vaccine Surveillance Network Collaborators

Manuscripts, Articles, Book Chapters and Other Papers

The New Vaccine Surveillance Network (NVSN) is a prospective, active, population-based surveillance platform that enrolls children with acute respiratory illnesses (ARIs) at seven pediatric medical centers. ARIs are caused by respiratory viruses including influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and most recently SARS-CoV-2 (the virus that causes COVID-19), which result in morbidity among infants and young children (1-6). NVSN estimates the incidence of pathogen-specific pediatric ARIs and collects clinical data (e.g., underlying medical conditions and vaccination status) to assess risk factors for severe disease and calculate influenza and COVID-19 vaccine effectiveness. Current NVSN …

Piloting A Systems Level Intervention To Improve Cervical Cancer Screening, Treatment And Follow Up In Kenya., Natabhona M. Mabachi, Catherine Wexler, Harshdeep Acharya, May Maloba, Kevin Oyowe, Kathy Goggin, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

Although preventable, Cervical Cancer (CC) is the leading cause of cancer deaths among women in Sub-Saharan Africa with the highest incidence in East Africa. Kenyan guidelines recommend an immediate screen and treat approach using either Pap smear or visual screening methods. However, system (e.g., inadequate infrastructure, weak treatment, referral and tracking systems) and patient (e.g., stigma, limited accessibility, finance) barriers to comprehensive country wide screening continue to exist creating gaps in the pathways of care. These gaps result in low rates of eligible women being screened for CC and a high loss to follow up rate for treatment. The long-term …

Rotavirus Strain Trends In United States, 2009-2016: Results From The National Rotavirus Strain Surveillance System (Nrsss)., Slavica Mijatovic-Rustempasic, Jose Jaimes, Charity Perkins, M Leanne Ward, Mathew D. Esona, Rashi Gautam, Jamie Lewis, Michele Sturgeon, Junaid Panjwani, Gail A. Bloom, Steve Miller, Erik Reisdorf, Ann Marie Riley, Morgan A. Pence, James Dunn, Rangaraj Selvarangan, Robert C. Jerris, Dona Degroat, Umesh D. Parashar, Margaret M. Cortese, Michael D. Bowen

Manuscripts, Articles, Book Chapters and Other Papers

Before the introduction of vaccines, group A rotaviruses (RVA) were the leading cause of acute gastroenteritis in children worldwide. The National Rotavirus Strain Surveillance System (NRSSS) was established in 1996 by the Centers for Disease Control and Prevention (CDC) to perform passive RVA surveillance in the USA. We report the distribution of RVA genotypes collected through NRSSS during the 2009-2016 RVA seasons and retrospectively examine the genotypes detected through the NRSSS since 1996. During the 2009-2016 RVA seasons, 2134 RVA-positive fecal specimens were sent to the CDC for analysis of the VP7 and VP4 genes by RT-PCR genotyping assays and …