Publications

The HIV-1 antibody response: a footprint of the viral reservoir in children vertically infected with HIV

2020

Authors: Palma P, McManus M, Cotugno N, Rocca S, Rossi P, Luzuriaga K

Published in: Lancet HIV. 2020;7(5):e359-e365

Clinical outcomes of a Zika virus mother–child pair cohort in Spain

2020

Authors: Soriano-Arandes A, Frick MA, García López-Hortelano M, et al.

Published in: Pathogens 2020;9(5):E352

Differences in inducibility of the latent HIV reservoir in perinatal and adult infection

2020

Authors: Dhummakupt A, Rubens JH, Andeson T, et al.

Published in: JCI Insight. 2020;5(4)

Characterization of drug resistance and the defective HIV reservoir in virally suppressed vertically infected children in Mali

2020

Authors: Brice J, Sylla M, Desire N, Sayon S, Telly F, Bocar-Fofana D, Murphy R, Peytavin G, Diallo S, Nastouli E, Calvez V, Marcelin AG, Maiga AI, Lambert-Niclot S

Published in: The Journal of antimicrobial chemotherapy

A comparison of five paediatric dosing guidelines for antibiotics

2020

Authors: Mathur S, Jackson C, Urus H, Ziarko I, Goodbun M, Hsia Y, Ellis S, Sharland M.

Published in: Bulletin of the World Health Organization, April 2020

Interim pharmacokinetic analysis of a multi-centre randomised open label phase IIb study in neonates to validate the meta-analysis population pharmacokinetic model used to simulate an optimised dosing regimen in neonates and infants aged < 90 days: the NeoVanc trial

2020

Authors: L. Hill, E. Jacqz-Aigrain, V. Elie, W. Zhao, M. Clements, M. Turner, I. Lutsar, P. Heath, E. Roilides, S. Walker, M. Sharland

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

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An optimised dosing regimen vs. a standard dosing regimen of vancomycin for the treatment of late onset sepsis due to Gram-positive microorganisms in infants less than 90 days: the NeoVanc trial

2020

Authors: L. Hill, M. Clements, M. Turner, I. Lutsar, E. Jacqz-Aigrain, P. Heath, E. Roilides, S. Walker, M. Sharland

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Respiratory pathogens detected in children with community-acquired sepsis-like syndrome in 6 European countries

2020

Authors: V. Matheeussen, K. Loens, K. Jacobs, P. Horby, H. Goossens, M. Kohns Vasconcelos, M. Sharland, M. De Jong, M. P. G. Koopmans, P. Fraaij, M. Ieven

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Aetiology and outcome of children hospitalised for acute respiratory tract infections in Europe: findings from a multi-country combined case-control and cohort study

2020

Authors: M. Kohns Vasconcelos; on behalf of the PED-MERMAIDS Study Group

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Application of WISCA (Weighted Incidence Syndromic Combination Antibiogram) to guide empiric therapy in oncological paediatric patients with febrile neutropenia

2020

Authors: E. Barbieri, D. Bottigliengo, P. Costenaro, A. Marzollo, M. Petris, M. Pierobon, G. Biddeci, C. Giaquinto, A. Biffi, D. Donà

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Antibiotic treatment for paediatric outpatients with community-acquired pneumonia: findings from 10 years of prescribing habits in Italy

2020

Authors: P. Costenaro, A. Cantarutti, E. Barbieri, A. Scamarcia, A. Oletto, P. Sacerdoti, R. Lundin, L. Cantarutti, C. Giaquinto, D. Dona’

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

An optimised dosing regimen versus a standard dosing regimen of vancomycin for the treatment of late onset sepsis due to Gram-positive microorganisms in neonates and infants aged less than 90 days (NeoVanc): study protocol for a randomised controlled trial

2020

Authors: Hill LF, Turner MA, Lutsar I, et al; NeoVanc Consortium.

Published in: Trials. 2020;21(1):329

Genomic and epidemiological surveillance of Zika virus in the Amazon region

2020

Authors: Giovanetti M, Faria NR, Lourenco J, et al.

Published in:  Cell Rep. 2020;30(7):2275-2283

Differences in inducibility of the latent HIV reservoir in perinatal and adult infection

2020

Time to viral suppression in perinatally HIV-infected infants depends on the viral load and CD4 T-cell percentage at the start of treatment

2020

Authors: Schröter J, Anelone A,  Yates A, de Boer RJ;  on behalf of the EPIICAL Consortium

Published in: J Acquir Immune Defic Syndr. 2020;83(5):522-529

 

Background Interventions aiming for an HIV cure would benefit from rapid elimination of virus after the onset of antiretroviral therapy (ART), by keeping the latent HIV reservoir small.

Setting We investigated HIV suppression in 312 perinatally infected infants starting ART within 6 months after birth from the EPPICC (European Pregnancy and Paediatric HIV Cohort Collaboration).

Methods To better understand kinetic differences in HIV suppression among infants, we investigated their individual viral load (VL) decay dynamics. We identified VL decay patterns and determined times to viral suppression (TTS). For infants with strictly declining VLs (n = 188), we used parameter fitting methods to estimate baseline VLs, decay rates, and TTS. We subsequently identified the parameters determining TTS by linear modeling.

Results The majority of infants suppress HIV VL after the onset of ART. Some children experienced a long TTS due to an “erratic” VL decay pattern. We cannot exclude that this is partly due to treatment complications and subsequent treatment changes, but these children were characterized by significantly lower CD4 percentages (CD4%) at start of treatment compared with those with a “clean” VL decline. Focusing on this “clean” subset, the TTS could be predicted by mathematical modeling, and we identified baseline VL and CD4% as the major factors determining the TTS.

Conclusions As VL steeply increases and CD4% constantly decreases in untreated HIV-infected infants, the progression of an HIV infection is largely determined by these 2 factors. To prevent a further disease progression, treatment should be initiated early after contracting HIV, which consequently shortens TTS.

Mothers’ adherence helps in identifying more infants in need of extended prophylaxis

2020

Authors: Dominguez-Rodriguez S, Rojo P, Lain MG,  Barnabas S, Lopez-Varela E, Otwombe K, Danaviah S, Nastouli E, Serna-Pasqual M, Gianuzzi V, Giaquointo C, Kuhn L, Tagarro A on behalf of the EPIICAL Consortium

Published in: 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Timing of HIV diagnosis in HIV-positive pregnant women giving birth in a high prevalence Russian region

2020

Authors: Sconza R, Plotnikova Y, Plynsky A, Rozenberg V, Thorne C

Published in: 10th International Workshop on HIV & Women, 6th – 7 th March 2020, Boston, MA

Global variations in pubertal growth in adolescents living with perinatal HIV

2020

Authors: Crichton S, Jesson J, Aké-Assi MH, Belfrage E, Davies MA, Pinto J, Teasdale C, Van Lam N, Vreeman R, Wanless S, Williams P, Yotebieng M, Leroy V, Goodall R on behalf of the CIPHER Global Cohort Collaboration

Published in: 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

NK Cells are preserved by early ART in HIV-infected children with lower reservoir

2020

Authors: Zicari S, Doria M, Domínguez-Rodríguez S, Cotugno N, Tagarro A, Rojo P, Nastouli E, Gartner K, Klein N, Foster C, Pahwa S, De Rossi A, Giaquinto C, Rossi P,  Palma P, for the EPIICAL consortium

Published in: 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Poor outcome in early treated HIV perinatally infected infants in Africa

2020

Authors: Tagarro A, Domínguez-Rodríguez S, Violari A, Cotton M, Mhampossa T, Klein N, Ramsagar N, Van Rensburg AJ, Behuhuma O, Vaz P,  Oletto A, Palma P, Rossi P, Rojo P, on behalf of the EPIICAL Consortium

Published in27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Assessment of HIV-1 DNA by single-genome sequencing in children on suppressive ART

2020

Authors: Gärtner K, Gkouleli T, Byott M, Heaney J, Spyer MJ, DeRossi A, Persaud D, Palma P, Giaquinto C, Rojo P, Foster C, Marcelin AG, Rossi P, Nastouli E, for the EPIICAL consortium

Published in27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Cell-associated HIV-1 DNA/RNA in children: performance of real-time and digital PCR

2020

Authors: Gärtner K, Gkouleli T, Heaney J, Grant P, Dominguez-Rodriguez S, Busby E, O’Sullivan D, Spyer MJ, Foster C, Rojo P, Persaud D, DeRossi A, Huggett J, Nastouli E, for the EPIICAL consortium

Published in27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Adeqaute dolutegravir exposure dosed BID with rifampicin in children 6 to < 18 years

2020

Authors: Waalewijn H, Mujuru HA, Amuge P, Cotton M, Bollen P, Chan M, Ali S, Variavan E, Makumbi S, Colbers A, Gibb D, Ford D, Burger D, Turkova A, and the ODYSSEY-trial team

Published in27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Adeqaute dolutegravir exposure dosed BID with rifampicin in children 6 to < 18 years

2020

Authors: Waalewijn H, Mujuru HA, Amuge P, Cotton M, Bollen P, Chan M, Ali S, Variavan E,Makumbi S, Colbers A, Gibb D, Ford D, Burger D, Turkova A, and the ODYSSEY-trial team

Published in: Oral presentation at 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Abacavir dosing, effectiveness, and safety in young infants living with HIV in Europe

2020

Authors: Crichton S , Collins  IJ, Turkova A, Ene L, Galli L, Marczynska M, Navarro M, Naver L, Noguera-Julian A, Plotnikova Y, Scherpbier H, Volokha A, Voronin E, Judd A; on behalf of the European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)

Published in: 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Abstract

Background: The World Health Organization (WHO) recommends abacavir as the preferred/alternative backbone for 1st line regimens in children with HIV from age 28 days. There are limited data available on safety and tolerability of abacavir in young infants aged <3 months.

Methods: We describe infant and regimen characteristics at the start of abacavir (including drug combinations and dosing) and outcomes up to 12 months after first use of abacavir. Outcomes include:

  • drug discontinuations (defined as interruption of abacavir for >30 days),
  • clinical adverse events (AE, reported from start of abacavir, and up to 30 days after discontinuation of abacavir) and
  • viral load at 6 and 12 (±3) months after start of abacavir

Conclusions: Across children initiating abacavir in early life in Europe, it was safe and well tolerated, and discontinuations for safety concerns were rare. • Viral suppression was below the UN-AIDS 90% target which may reflect challenges of treatment in infancy.

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Outcomes following prenatal exposure to dolutegravir: the Dolomite-EPPICC study

2020

Authors: Thorne C, Rasi V, Aebi-Popp K, Ene L, Floridia M, Mendoza-Palomar N, Prieto L, Ragone L, Sconza R, CGiaquinto C, Vannappagari V; for the Dolomite-EPPICC study group

Published in: Oral presentation at 27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

 

Abstract

BACKGROUND • In 2018, the Tsepamo Study, Botswana reported significant increased risk of NTD in women conceiving on DTG (0.94%) 1 leading to a safety alert • Updated analysis of NTD prevalence (08/2014 – 03/2019)2 • 5 NTDs/1,683 deliveries in women on DTG at conception (0.30%, 95% CI 0.13-0.69 vs 0.10%, 95% CI 0.06-0.17 for non-DTG ART at conception • The Antiretroviral Pregnancy Registry recently reported 1 NTD in 312 periconception DTG exposures (0.3%) 3 • The Dolomite Study was set up in 2017 to address use & safety of DTG in pregnancy and exposed infants in Europe and Canada; conducted within the NEAT-ID network and EPPICC (the European Pregnancy and Paediatric Infections Cohort Collaboration)

Aim: To assess pregnancy and neonatal outcomes following DTG use during pregnancy in real-world European settings • Objectives were to describe: • characteristics of pregnant women receiving DTG-based regimens • frequency of adverse pregnancy and birth outcomes, by earliest timing of DTG exposure

Method: Dolomite-EPPICC involves pooled analyses of prospectively collected individual patient data on DTG-exposed pregnancies from participating studies • Data specification based on a modified HIV Data Exchange Protocol (www.hicdep.org) • Data merger included • All pregnancies with any prenatal DTG exposure • With birth outcomes reported by Feb 2019 • Periconception DTG exposure was defined as initial exposure at ≤6 weeks of estimated gestational age (EGA)

Results: 453 pregnancies in 428 women included (Figure) • Pregnancies reported from six countries • 347 (76.6%) UK and Ireland, 45 (9.9%) Spain, 29 (6.4%) Switzerland, 29 (6.4%) Italy, 3 (0.7%) Romania

 

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Long-term non-progression in children with perinatally acquired HIV

2020

Authors: Jackson C, Bamford A, Crichton S, Goodall R,Goulder P, Klein N, Marques L, Paioni P, Riordan A, Spoulou V, Vieira VA, Collins IJ. On behalf of The European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC) study group

Published in:  27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Markers of HIV reservoir size in infected children on long-term viral control

2020

Authors: Rinaldi S, Pallikkuth S, de Armas L, Pahwa R, Dominguez S, Cotugno N, Rojo Conejo P, Nastouli E, Gartner K, Klein N, Foster C, De Rossi A, Carlo Giaquinto C, Rossi P, Palma P, Pahwa S and EPIICAL Consortium

Published in:  27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

Viral response in HIV infected infants starting ART at 1 month in Southern Mozambique

2020

Authors: Lain MG, Vaz P, Ismael N,  Cantarutti A, Porcu G, Palma P, Cotugno N, Bila D, Rinaldi S,  Pallikkuth S, Pahwa R, Taibo E, Esmeralda Karajeanes E, Giaquinto C, Pahwa S.

Published in:  27th Conference on Retroviruses and Opportunistic Infections, March 8th –11th, 2020 – Boston.

ushr: Understanding suppression of HIV in R

2020

Authors: Morris SE, Dziobek-Garrett L, Yates AJ and the EPIICAL consortium

Published in: BMC Bioinformatics 2020;21(1):52

Background HIV/AIDS is responsible for the deaths of one million people every year. Although mathematical modeling has provided many insights into the dynamics of HIV infection, there is still a lack of accessible tools for researchers unfamiliar with modeling techniques to apply them to their own clinical data.

Researching Zika in pregnancy: lessons for global preparedness

2020

Authors: Ades AE, Thorne C, Soriano-Arandes A, et al.

Published in: Lancet Infect Dis. 2020 Feb 18

Abstract: Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015–16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.

Overview and preliminary results of the ZIKAction vertical transmission study in Jamaica

2020

Authors: Celia C.

Published in: Oral presentation at 3rd international Conference on Zika Virus and aedes related infections, February 13th – 16th, 2020– Washington DC, USA.

Trends in Dengue – The Jamaican experience

2020

Authors: Webster-Kerr K.

Published in: Oral presentation at 3rd international Conference on Zika Virus and aedes related infections, February 13th – 16th, 2020– Washington DC, USA.

Severity and outcomes of Dengue in hospitalized children from five hospitals in Jamaica during the 2018-2019 epidemic: is this due to antibody dependent immune enhancement from ZIKA virus exposure?

2020

Authors: Lue A.

Published in: Oral presentation at 3rd international Conference on Zika Virus and aedes related infections, February 13th – 16th, 2020– Washington DC, USA.

Early ART-treated perinatally HIV-infected seronegative children demonstrate distinct long-term persistence of HIV-specific T and B cell memory

2020

Authors: Cotugno N, Morrocchi E, Rinaldi S, et al; EPIICAL Consortium.

Published in: AIDS. 2020 Feb 3.

Objective To investigate long-term persistence of HIV-specific lymphocyte immunity in perinatally HIV-infected children treated within the first year of life.

Design Twenty perinatally HIV-infected children who received ART therapy within the first year of life (early treated) and with stable viral control (>5 years) were grouped according to their serological response to HIV.

Methods Western blot analysis and ELISA defined 14 HIV-seropositive and 6 seronegative patients. Frequencies of gp140-specific T-cell and B-cell, and T-cell cytokine production were quantified by flow cytometry in both seronegatives and seropositives. Transcriptional signatures in purified gp140-specific B-cell subsets, in response to in-vitro stimulation with HIV peptides was evaluated by multiplex RT-PCR.

Impact of early antiretroviral therapy initiation on HIV-specific CD4 and CD8 T cell function in perinatally infected children

2020

Authors: Rinaldi S, Pallikkuth S, Cameron M, et al.

Published in: J Immunol. 2020 Feb 1;204:540-549

Abstract Early initiation of antiretroviral therapy (ART) in vertically HIV-infected children limits the size of the virus reservoir, but whether the time of treatment initiation (TI) can durably impact host immune responses associated with HIV infection is still unknown. This study was conducted in PBMC of 20 HIV-infected virally suppressed children on ART (mean age 9.4 y), classified as early treated (ET; age at ART initiation ≤0.5 y, n = 14) or late treated (LT; age at ART initiation 1–10 y, n = 6). Frequencies and functions of Ag-specific CD4 (CD40L+) and CD8 (CD69+) T cells were evaluated by intracellular IL-2, IFN-γ, and TNF-α production with IL-21 in CD4 or CD107a, granzyme B and perforin in CD8 T cells following stimulation with HIV gp140 protein (ENV) or GAG peptides by multiparameter flow cytometry. ET showed a higher proportion of cytokine-producing ENV- and GAG-specific CD4 and CD8 T cells compared with LT. In particular, ET were enriched in polyfunctional T cells. RNA sequencing analysis showed upregulation of immune activation pathways in LT compared with ET. Our results suggest that timing of TI in HIV-infected children has a long-term and measurable impact on the quality of the HIV-specific T cell immune responses and transcriptional profiles of PBMC, reinforcing the importance of early TI.

Etiology and outcome of Candidemia in neonates and children in Europe: an 11-year multinational retrospective study

2020

Authors: Warris A, Pana ZD, Oletto A, et al. EUROCANDY study group.

Published in: Pediatr Infect Dis J. 2020;39(2):114-120

Background Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia.

Materials and methods All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients’ demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality.

Results One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed.

Conclusions This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship.

Return of the founder Chikungunya virus to its place of introduction into Brazil is revealed by genomic characterization of exanthematic disease cases

2020

Authors: Pereira Gusmão Maia Z, Mota Pereira F, do Carmo Said RF, et al.

Published in: Emerg Microbes Infect. 2020;9(1):53-57

Abstract Between June 2017 and August 2018, several municipalities located in Bahia state (Brazil) reported a large increase in the number of patients presenting with febrile illness similar to that of arboviral infections. Using a combination of portable whole genome sequencing, molecular clock and epidemiological analyses, we revealed the return of the CHIKV-ECSA genotype into Bahia. Our results show local persistence of lineages in some municipalities and the re-introduction of new epidemiological strains from different Brazilian regions, highlighting a complex dynamic of transmission between epidemic seasons and sampled locations. Estimated climate-driven transmission potential of CHIKV remained at similar levels throughout the years, such that large reductions in the total number of confirmed cases suggests a slow, but gradual accumulation of herd-immunity over the 4 years of the epidemic in Bahia after its introduction in 2014. Bahia remains a reservoir of the genetic diversity of CHIKV in the Americas, and genomic surveillance strategies are essential to assist in monitoring and understanding arboviral transmission and persistence both locally and over large distances.

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

2020

Authors: Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M

Published in: Antimicrob Resist Infect Control.2020;9:3

Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally.

Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data.

Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides.

Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

PD-1+ CD4 T cells are associated with HIV reservoir size and impaired function of T follicular helper cells in children and young adults on long-term viral control

2019

Authors: S. Rinaldi, V. Dinh, S. Pallikkuth, L. De Armas, R. Pahwa, N. Cotugno, E. Nastouli, C. Foster, P. Palma, S. Pahwa

Published in: Poster presented at 9th International Workshop on HIV Persistence during Therapy; December, 2019; Miami, FL

Background: Curative strategies for HIV will need to eliminate the replication competent latent reservoir. CD4 T cells expressing Immune Checkpoint molecules (ICP) have been shown to preferentially harbor latent, replication-competent HIV. T follicular helper (Tfh) cell subset of CD4 T cells are critical for B cell differentiation. Here a cohort of HIV vertically infected children and young adults under durable viral control (PHIV) were investigated for CD4 ICP, immune activation (IA) markers and function in relation to HIV reservoir size.

Methods: 40 PHIV (4-19yrs age) who started ART <2 years of life and had undetectable viremia (<50 HIV copies/ml) for the past 5 years, were enrolled in 7 European research centers. HIV-DNA copies per million peripheral blood mononuclear cells (PBMC) were measured by real-time PCR. Flow cytometry was used to investigate CD4 T cells for 1) co-expression of PD1 with IA (ICOS, CD38, Ki67 and HLA-DR) or ICP (TIGIT, LAG3, TIM3 and CTLA4) and 2) intracellular cytokine production (IL2, IFNg, TNFα, IL21) after stimulation with ENV peptides. Pearson correlations and 2 group comparisons were performed using the Mann-Whitney T Test. P value<0.05 was considered significant.

Results: Total PD1+ CD4 T cells positively correlated with HIV-DNA (r=0.46) as did CD4 T cells co-expressing PD1 with other ICP or IA (table 1 below). We then divided our cohort based on HIV-DNA distribution into those with high (4th quartile) and low (1st quartile) HIV-DNA. We found that PD1+ CD4 T cells co-expressing IA or ICP were higher in participants with high HIV-DNA (table 1). PD1+ CD4 T cells also showed negative correlation with ENV antigen activated Tfh expressing CD40L (r=-0.41, p<0.05) with selective induction of IL2 (r=0.47, p<0.05), a cytokine that is inhibitory for Tfh.

Conclusions: This study suggests that PD-1 expression on CD4 T cells is associated with dysfunctional T:B cell interaction in response to HIV antigens, and supports the association of PD1 expression on CD4 T cells with size of viral reservoirs in vertically HIV infected children and young adults under long-term viral control.

Standardising neonatal and pediatric anitibiotic clinical trial design and conduct: the PENTA-ID network review

2019

Authors: Folgori L, Lutsar I, Standing JF, et al.

Published in: BMJ Open. 2019; 9:e032592

Abstract: Antimicrobial development for children remains challenging due to multiple barriers to conducting randomised clinical trials (CTs). There is currently considerable heterogeneity in the design and conduct of paediatric antibiotic studies, hampering comparison and meta-analytic approaches. The board of the European networks for paediatric research at the European Medicines Agency (EMA), in collaboration with the Paediatric European Network for Treatments of AIDS-Infectious Diseases network (www.penta-id.org), recently developed a Working Group on paediatric antibiotic CT design, involving academic, regulatory and industry representatives. The evidence base for any specific criteria for the design and conduct of efficacy and safety antibiotic trials for children is very limited and will evolve over time as further studies are conducted. The suggestions being put forward here are based on the adult EMA guidance, adapted for neonates and children. In particular, this document provides suggested guidance on the general principles of harmonisation between regulatory and strategic trials, including (1) standardised key inclusion/exclusion criteria and widely applicable outcome measures for specific clinical infectious syndromes (CIS) to be used in CTs on efficacy of antibiotic in children; (2) key components of safety that should be reported in paediatric antibiotic CTs; (3) standardised sample sizes for safety studies. Summarising views from a range of key stakeholders, specific criteria for the design and conduct of efficacy and safety antibiotic trials in specific CIS for children have been suggested. The recommended criteria are intended to be applicable to both regulatory and clinical investigator-led strategic trials and could be the basis for harmonisation in the design and conduct of CTs on antibiotics in children. The next step is further discussion internationally with investigators, paediatric CTs networks and regulators.

Role of Magnetic Resonance Imaging and cranial ultrasonography in congenital Cytomegalovirus infection

2019

Authors: Blazquez-Gamero D, Soriano-Ramos M, Martinez de Aragon A, et al.

Published in: Pediatr Infect Dis J. 2019;38(11):1131-1137

Modulated Zika virus NS1 conjugate offers advantages for accurate detection of Zika virus specific antibody in double antigen binding and Ig capture enzyme immunoassays

2019

Authors: Tedder RS, Dicks S, Ijaz S, et al.

Published in: PLoS One. 2019;14(8):e0215708

Abstract: The accurate diagnosis and seroprevalence investigations of Zika virus (ZKV) infections remain complex due to cross reactivity with other flaviviruses. Two assay formats, both using labelled Zika virus NS1 antigen as a revealing agent (a double antigen binding assay, DABA, and an immunoglobulin Ig capture assay, G capture) were initially developed and compared with the indirect EuroimmunZ assay for the detection of anti-Zika antibody. Of 147 pre-Zika period serum samples, 39 (27%) were reactive in the EuroimmunZ or the DABA assays, 28 sera concordantly so. Such false reactivity was influenced by the serotype of Dengue virus (DV) to which individuals had been exposed to. Thus, of sera from patients undergoing secondary Dengue virus infection of known serotype, 91%, 45% and 28% of Dengue virus serotype 2, 3 and 4 respectively were reactive in one or more of the three assays. A novel method of quenching false sero-reactivity was therefore developed for the DABA and G capture assays. Initial addition of a single homologous Dengue virus serotype 3 NS1Ag quench significantly ablated false reactivities in the pre-Zika period sera. An equipotent quadrivalent quench comprising homologous Dengue virus serotypes 1 to 4 NS1Ag was shown to be optimum yet retained sensitivity for the detection of specific anti-Zika antibody. Comparing DABA and G capture assays using quenched and unquenched conjugates in comparison with EuroimmunZ early in the course of PCR-confirmed infection indicated that a significant component of the apparent early anti-ZIKA antibody response is likely to be due to a Zika virus-driven anamnestic anti-Dengue virus response. The increased specificity provided by homologous antigen quenching is likely to provide a significant improvement in sero-diagnostics and to be of clinical value.

 

Analysing small groups within clinical trials, while borrowing information from larger groups

2019

Authors: Turner B, Ford D, Moore C, Gibb D, Turkova A,  White I, and ODYSSEY trial team

Published in: Oral Presentation atInternational Society for Clinical Biostatics; July 16th 2019

Yellow Fever virus reemergence and spread in southeast Brazil, 2016-2019

2019

Authors: Giovannetti M, de Mendonca MCL, Fonseca V, et al.

Published in: J Virol. 2019;94(1). pii: e01623-19

Abstract The recent reemergence of yellow fever virus (YFV) in Brazil has raised serious concerns due to the rapid dissemination of the virus in the southeastern region. To better understand YFV genetic diversity and dynamics during the recent outbreak in southeastern Brazil, we generated 18 complete and nearly complete genomes from the peak of the epidemic curve from nonhuman primates (NHPs) and human infected cases across the Espírito Santo and Rio de Janeiro states. Genomic sequencing of 18 YFV genomes revealed the estimated timing, source, and likely routes of yellow fever virus transmission and dispersion during one of the largest outbreaks ever registered in Brazil. We showed that during the recent epidemic, YFV was reintroduced from Minas Gerais to the Espírito Santo and Rio de Janeiro states multiple times between 2016 and 2019. The analysis of data from portable sequencing could identify the corridor of spread of YFV. These findings reinforce the idea that continued genomic surveillance strategies can provide information on virus genetic diversity and transmission dynamics that might assist in understanding arbovirus epidemics.

Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986–2012)

2019

Authors: Goncalves BS, Nogueira RMR, Bispo de Filippis AM, Horta MAP

Published in: Trans R Soc Trop Med Hyg. 2019;113(11):670-677

Background Since 1981, >12 million cases of dengue have been reported in Brazil. Early prediction of severe dengue with no warning signs is crucial to avoid progression to severe dengue. Here we aimed to identify early markers of dengue severity and characterize dengue infection in patients in Rio de Janeiro.
Methods We evaluated early severity markers, serotypes, infection status, number of days of illness and viral loads associated with dengue fever in patients from Rio de Janeiro, Brazil through an observational retrospective study (1986–2012). We compared dengue without warning signs and dengue with warning signs/severe dengue (DWWS/SD). Infection status was classified by enzyme-linked immunosorbent assay and viraemia was quantified by quantitative real-time reverse transcription polymerase chain reaction.
Results The presence of DWWS/ SD was significantly associated with younger age; patients 13–19 y of age had a significantly greater chance of presenting warning signs. Dengue virus type 3 (DENV3) was more likely to induce DWWS/SD, which was more frequent on days 4–5 of illness.
Conclusions DENV3, 4–5 d of illness and 13–19 y of age were early biomarkers of dengue severity. To our knowledge, this was the first study to analyse the characteristics of dengue severity in the state of Rio de Janeiro over 27 y of epidemics since the introduction of DENV.

Reduced time to suppression among neonates with HIV initiating antiretroviral therapy within 7 days of age

2019

Authors: Domínguez-Rodríguez S, Tagarro A. Palma P, et al.

Published in: JAIDS 2019;82(5):483-490

Abstract There are limited data on infants with HIV starting antiretroviral therapy (ART) in the neonatal period. We investigated the association between the timing of ART initiation and time-to-suppression among infants who tested HIV-positive and initiated ART within the first 28 days of life. The effect was estimated using cumulative probability flexible parametric spline models and a multivariable generalized additive mixed model was performed to test nonlinear associations. Forty-four neonates were included. Nineteen (43.2%) initiated ART within 7 days of life and 25 (56.8%) from 8 to 28 days. Infants treated within 7 days were 4-fold more likely to suppress earlier than those treated after 7 days [Hazard ratio (HR) 4.01 (1.7–9.5)]. For each week the ART initiation was delayed, the probability of suppression decreased by 35% (HR 0.65 [0.46–0.92]). Age at ART start was linearly associated with time-to-suppression. However, a linear association with normally distributed residuals was not found between baseline viral load and time-to-suppression, with no association found when baseline viral loads were ≤5 log(10) copies/mL, but with exponential increase in time-to-suppression with > log5 copies/mL at baseline. Starting ART within 7 days of life led to 4-fold faster time to viral suppression, in comparison to initiation from 8 to 28 days.

Time to HIV suppression in perinatally infected infants depends on the viral load and CD4 T-cell percentage at the start of treatment

2019

Authors: Schröter J.

Published in: Poster presented at 4th Workshop on Virus Dynamics, October 21st-23rd, 2019 -Paris, FR

Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network

2019

Authors: Li G, Bielicki JA, Ahmed ASMNU, et al.

Published in: Arch Dis Child.2091;0:1-6

Objective To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middleincome country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR).Design A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns.Setting 39 NNUs from 12 countries.Patients Any neonate admitted to one of the participating NNUs.

Interventions This was an observational cohort study.

Results The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List ’Access’ antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%.

Conclusion AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally

Differential susceptibility of Staphylococcus epidermidis biofilms to vancomycin, daptomycin and linezolid between clinical Isolates from neonates and adults

2019

Authors:Simitsopoulou M, Kadiltzoglou P, Kyrpitzi D, Roilides E.

Published in: Int J Biol Med Res.2019;10(1):6591-6596

Abstract This study aimed to compare the effects of vancomycin, linezolid and daptomycin against planktonic cells and biofilms of 32 bloodstream isolates derived from neonates and adults of three hospitals. Staphylococcus epidermidis biofilm formation was spectrophotometrically assessed following safranin staining. Susceptibility testing of planktonic and biofilm cells was performed by XTT reduction assay. MICs of vancomycin and daptomycin were 1mg/L and that of linezolid 0.5 mg/L. At concentrations >0.5 mg/L, complete eradication of planktonic cells was effected by all three antibiotics. The biofilm MICs for the three antibiotics were 3-7 twofold dilutions higher than the corresponding planktonic MICs (P<0.05). Vancomycin and linezolid exhibited similar median MICs against biofilms of neonatal isolates ranging from 16 to 32mg/L with comparable damage (44%-84% for vancomycin vs 56%-77% for linezolid). Their MICs against biofilms of isolates from adults were 128 mg/L and 4 mg/L, respectively (P<0.001). Vancomycin showed lower MIC than daptomycin against biofilms of neonatal isolates (16 mg/L vs 64 mg/L, respectively; P<0.05). Biofilm MIC of linezolid was lower than the corresponding daptomycin MIC for both age groups (neonatal isolates: 16 mg/L vs 64 mg/L; adult isolates: 4 mg/L vs 64 mg/L, P<0.05). Vancomycin and linezolid are equally effective against biofilms of neonatal blood isolates and both exhibit superior activity to daptomycin. In the adult group, linezolid is more efficacious than both vancomycin and daptomycin against biofilms, while vancomycin and daptomycin exhibit similar anti-biofilm activities. Our results suggest that vancomycin and linezolid show better anti-biofilm activity than daptomycin against biofilms of neonates and linezolid have increased activity against biofilms of adults.

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