Treatment outcomes and their predictors in children hospitalized with varicella complicated by bacterial superinfections after pandemic of COVID-19 - a retrospective multicenter analysis of real-life data in Poland.

PURPOSE: The aim of this study was to analyze treatment outcomes and their predictors in children hospitalized due to varicella complicated by bacterial superinfections after pandemic of COVID-19. METHODS: This retrospective study analyzed data collected in a multicenter, nationwide, observational database dedicated for children aged 0-17 years hospitalized due to bacterial complications of varicella in 9 Polish tertiary healthcare inpatient centers. The primary endpoint of this study was the treatment outcome established after the end of hospital management assessed at a 4-point scale. The secondary endpoint was defined as the necessity of surgical intervention. RESULTS: There were 458 patients with a median age of 4 (IQR 2-6) years. After the completed treatment, 319 (69%) participants were found fully recovered; 132 (29%) had transient complications; 2 (0.5%) had persistent complications; and 1 child (0.5%) died. Multivariate analysis revealed that implementation of ibuprofen in pre-treatment management of a child with varicella was associated with a 4.07-fold (2.50-6.60) increase in risk of complications after the treatment and it was associated with 2.87 times (1.39-5.89) higher risk of surgical intervention necessity. For other pre-hospital interventions (implementation of acyclovir, antibiotics or antihistaminics) no significant impact was observed. GAS infection increased the necessity of surgical intervention by 7.51 (3.64-15.49) times. CONCLUSIONS: One-third of patients treated for bacterial complications of varicella have post-treatment complications, most of them transient. GAS infection increases the need for surgical intervention. The use of ibuprofen in the treatment of varicella significantly increases the risk of complications and the need for surgical intervention.

Differences in Clinical Presentation of COVID-19 in Children Hospitalized During Domination of Early (BA.1, BA.2) and Late (BA.5, BA.2.75, BQ.1 and XBB.1.5) SARS-CoV-2 Omicron Subvariants.

This study analyzed data for 1098 children: 575 diagnosed with COVID-19 between January and June 2022 (early Omicron) and 523 hospitalized from July 2022 to April 2023 (late Omicron). New Omicron subvariants lead to similar recovery rates without deaths and acute respiratory distress syndrome in children as BA.1 and BA.2, however, they more often cause fever and croup. Children suffering from comorbidities, presenting with pulmonary lesions and older, may be prone to a more severe consequences of COVID-19 in terms of the currently dominating Omicron subvariants.

Multifunctional Composite Materials Based on Anion Exchangers Modified with Copper Compounds-A Review of Their Synthesis Methods, Characteristics and Applications.

As copper and its compounds are of fundamental importance for the development of innovative materials, the synthesis of composites intended for water purification was undertaken in which submicron copper containing particles were dispersed within the matrix of a strongly basic anion exchanger, with a macroporous and gel-like structure. Due to their trimethylammonium functional groups, the host materials alone exhibited an affinity to anionic water contaminants and antimicrobial properties. The introduction of such particles as CuO, Cu2O, metallic Cu, CuO/FeO(OH), Cu4O3, Cu(OH)2, Cu4(OH)6SO4, Cu2(OH)3Cl increased these properties and demonstrated new properties. The composites were obtained unconventionally, in ambient conditions, using eco-friendly reagents. Alternative synthesis methods were compared and optimized, as a result of which a new group of hybrid ion exchangers was created (HIXs) containing 3.5-12.5 wt% of Cu. As the arrangement of the inorganic phase in the resin matrix was atypical, i.e., close to the surface of the beads, the obtained HIXs exhibited excellent kinetic properties in the process of oxidation and adsorption of As(III), as well as catalytic properties for the synthesis of triazoles via click reaction, and also antimicrobial properties in relation to Gram-positive Enterococcus faecalis and Gram-negative Pseudomonas aeruginosa and Escherichia coli, preventing biofilm formation. Using thermogravimetry, the effect of the inorganic phase on decomposition of the polymeric phase was evaluated for the first time and comprehensively, confirming the relationship and finding numerous regularities. It was also found that, depending on the oxidation state (CuO, Cu2O, Cu), copper-containing particles affected the textural properties of the polymeric phase endowing a tighter structure, limiting the porosity and reducing the affinity for water.

Biocidal activity of multifunctional cuprite-doped anion exchanger - Influence of bacteria type and medium composition.

The study presents unconventional, bifunctional, heterogeneous antimicrobial agents - Cu2O-loaded anion exchangers. The synergetic effect of a cuprous oxide deposit and polymeric support with trimethyl ammonium groups was studied against the reference strains of Enterococcus faecalis ATCC 29212 and Pseudomonas aeruginosa ATCC 27853. Biological testing (minimum bactericidal concentration, MBC), time- and dose-dependent bactericidal effect (under different conditions - medium composition and static/dynamic culture) demonstrated promising antimicrobial activity and confirmed its multimode character. The standard values of MBC, for all studied hybrid polymers and bacteria, were similar (64-128 mg/mL). However, depending on the medium conditions, due to the copper release into the bulk solution, bacteria were actively killed even at much lower doses of the hybrid polymer (25 mg/mL) and low Cu(II) concentrations in solution (0.01 mg/L). Simultaneously, confocal microscopic studies confirmed the effective inhibition of bacterial adhesion and biofilm formation on their surface. The studies conducted under different conditions showed also the influence of the structure and physical properties of studied materials on the biocidal efficacy and an antimicrobial action mechanism was proposed that could be significantly affected by electrostatic interactions and copper release to the solution. Although the antibacterial activity was also dependent on various strategies of bacterial cell resistance to heavy metals present in the aqueous medium, the studied hybrid polymers are versatile and efficient biocidal agents against bacteria of both types, Gram-positive and Gram-negative. Therefore, they can be a convenient alternative for point-of-use water disinfection systems providing water quality in medical devices such as dental units, spa equipment, and aesthetic devices used in the cosmetic sector.

Clinical Course and Severity of COVID-19 in 940 Infants with and without Comorbidities Hospitalized in 2020 and 2021: The Results of the National Multicenter Database SARSTer-PED.

This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant (III-IV vs. I-II waves of the pandemic, respectively). In addition, the influence of the presence of comorbidities on the clinical course of COVID-19 in infants was studied. This multicenter study, based on the pediatric part of the national SARSTer database (SARSTer-PED), included 940 infants with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 13 Polish inpatient centers. An electronic questionnaire, which addressed epidemiological and clinical data, was used. The number of hospitalized infants was significantly higher in 2021 than in 2020 (651 vs. 289, respectively). The analysis showed similar lengths of infant hospitalization in 2020 and 2021, but significantly more children were hospitalized for more than 7 days in 2020 (p < 0.009). In both analyzed periods, the most common route of infection for infants was household contact. There was an increase in the percentage of comorbidities, especially prematurity, in children hospitalized in 2021 compared to 2020. Among the clinical manifestations, fever was predominant among children hospitalized in 2021 and 2020. Cough, runny nose, and loss of appetite were significantly more frequently observed in 2021 (p < 0.0001). Severe and critical conditions were significantly more common among children with comorbidities. More infants were hospitalized during the period of VOCs dominance, especially the delta variant, compared to the period of wild strain dominance, even though indications for hospitalization did not include asymptomatic patients during that period. The course of COVID-19 was mostly mild, characterized mainly by fever and respiratory symptoms. Comorbidities, particularly from the cardiovascular system and prematurity, were associated with a more severe course of the disease in infants.

The Influence of SARS-CoV-2 Variants B.1.1.7 and B.1.617.2 on a Different Clinical Course and Severity of COVID-19 in Children Hospitalized in 2021 Compared With 2020.

BACKGROUND: This study aimed to analyze the differences in the epidemiologic and clinical characteristics of coronavirus disease 2019 (COVID-19) in children hospitalized in 2021, when the severe acute respiratory syndrome coronavirus 2 variants B.1.1.7 (alpha) and B.1.617.2 (delta) dominated, compared with 2020. METHODS: In this multicenter study based on the pediatric part of the national SARSTer register (SARSTer-PED), we included 2771 children (0-18 years) with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 14 Polish inpatient centers. An electronic questionnaire, which addressed epidemiologic and clinical data, was used. RESULTS: Children hospitalized in 2021 were younger compared with those reported in 2020 (mean 4.1 vs. 6.8 years, P = 0 .01). Underlying comorbidities were reported in 22% of the patients. The clinical course was usually mild (70%). A significant difference in the clinical course assessment between 2020 and 2021 was found, with more asymptomatic patients in 2020 and more severely ill children in 2021. In total, 5% of patients were severely or critically ill, including <3% of the participants in 2020 and 7% in 2021. The calculated mortality rate was 0.1% in general and 0.2% in 2021. CONCLUSION: Infections with severe acute respiratory syndrome coronavirus 2 variants alpha and delta lead to a more severe course of COVID-19 with more pronounced clinical presentation and higher fatality rates than infection with an original strain. Most of the children requiring hospitalization due to COVID-19 do not have underlying comorbidities.

Elbasvir/grazoprevir in children aged 3-18 years with chronic HCV genotype 1 or 4 infection: a pharmacokinetic modeling study.

BACKGROUND: Approximately 3.5 million children and adolescents worldwide are chronically infected with HCV. This study uses pharmacokinetic modeling to identify pediatric doses of elbasvir/grazoprevir (EBR/GZR) that achieve plasma concentrations similar to those seen in adults receiving the approved fixed-dose combination regimen of EBR/GZR. PATIENTS AND METHODS: We conducted a nonrandomized, single-arm, multicenter, open-label phase 2b trial in children and adolescents aged 3 to <18 years with chronic HCV genotype 1 or 4 infection (NCT03379506). Pharmacokinetic data were used to bridge efficacy and safety data from adults to children in a stepwise (oldest to youngest) manner. A total of 57 participants were enrolled: cohort 1 (aged 12 to <18 y), n=22; cohort 2 (aged 7 to <12 y), n=17; and cohort 3 (aged 3 to <7 y), n=18. RESULTS: Steady-state plasma exposures were achieved by week 4 for EBR and GZR in all cohorts and daily dosing achieved geometric mean steady-state area under the concentration-time curve at 0-24 hours that fell within comparability bounds established for adults. All participants achieved sustained virologic response 12 weeks after completing treatment (ie, undetectable HCV RNA 12 wk following completion of treatment). Headache (n=4), fatigue (n=4), and nausea (n=2) were the most common treatment-related adverse events (all mild or moderate); no participant discontinued because of an adverse event. CONCLUSIONS: Pediatric EBR/GZR pharmacokinetic models were successfully developed based on complex adult population pharmacokinetic models. At appropriate age-related doses, EBR/GZR is safe and effective in pediatric and adolescent participants with HCV infection.

Pneumonia, gastrointestinal symptoms, comorbidities, and coinfections as factors related to a lengthier hospital stay in children with COVID-19-analysis of a paediatric part of Polish register SARSTer.

BACKGROUND: Although COVID-19 is associated with a mild course in children, a certain proportion requires admission to hospital due to SARS-CoV-2 infection and coexisting diseases. The prospective multicenter study aimed to analyze clinical factors influencing the length of the hospital stay (LoHS) in children with COVID-19. METHODS: The study included 1283 children from 14 paediatric infectious diseases departments with diagnosed SARS-CoV-2 infection. Children were assessed in respective centres regarding indications for admission to hospital and clinical condition. History data, clinical findings, laboratory parameters, treatment, and outcome, were collected in the paediatric SARSTer register. The group of children with a hospital stays longer than seven days was compared to the remaining patients. Parameters with a statistically significant difference were included in further logistic regression analysis. RESULTS: One thousand one hundred and ten children were admitted to the hospital, 763 children were hospitalized >24 h and 173 children >7 days. 268 children had comorbidities. Two hundred and eleven children had an additional diagnosis with coinfections present in 135 children (11%). Factors increasing the risk of higher LoHS included pneumonia [odds ratio-OR 3.028; 95% confidence interval-CI (1.878-4.884)], gastrointestinal symptoms [OR = 1.556; 95%CI (1.049-2.322)], or rash [OR = 2.318; 95%CI (1.216-4.418)] in initial clinical findings. Comorbidities [OR = 2.433; 95%CI (1.662-3.563)], an additional diagnosis [OR = 2.594; 95%CI (1.679-4.007)] and the necessity of the empirical antibiotic treatment [OR = 2.834; 95%CI (2.834-6.713)] were further factors related to higher LoHS. CONCLUSIONS: The clinical course of COVID-19 was mild to moderate in most children. Factors increasing the risk of higher LoHS included pneumonia, gastrointestinal symptoms, comorbidities, an additional diagnosis, and the empirical antibiotic treatment.

Clinical and Epidemiological Characteristics of 1283 Pediatric Patients with Coronavirus Disease 2019 during the First and Second Waves of the Pandemic-Results of the Pediatric Part of a Multicenter Polish Register SARSTer.

This prospective multicenter cohort study aimed to analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in children. The study, based on the pediatric part of the Polish SARSTer register, included 1283 children (0 to 18 years) who were diagnosed with COVID-19 between 1 March 2020 and 31 December 2020. Household contact was reported in 56% of cases, more frequently in younger children. Fever was the most common symptom (46%). The youngest children (0-5 years) more frequently presented with fever, rhinitis and diarrhea. Teenagers more often complained of headache, sore throat, anosmia/ageusia and weakness. One fifth of patients were reported to be asymptomatic. Pneumonia was diagnosed in 12% of patients, more frequently in younger children. During the second wave patients were younger than during the first wave (median age 53 vs. 102 months, p < 0.0001) and required longer hospitalization (p < 0.0001). Significantly fewer asymptomatic patients were noted and pneumonia as well as gastrointestinal symptoms were more common. The epidemiological characteristics of pediatric patients and the clinical presentation of COVID-19 are age-related. Younger children were more frequently infected by close relatives, more often suffered from pneumonia and gastrointestinal symptoms and required hospitalization. Clinical courses differed significantly during the first two waves of the pandemic.

Copper Rich Composite Materials Based on Carboxylic Cation Exchangers and Their Thermal Transformation.

The effect of a cupric deposit (Cu2+, CuO) on the thermal decomposition of carboxylic cation exchangers (CCEs) is not known, and such studies may have practical significance. CCEs have a very high ion exchange capacity, so an exceptionally large amount of CuO (which is a catalyst) can be precipitated inside them. Two CCEs, macroreticular (Amberlite IRC50) and gel-like (Amberlite IRC86), served as a polymeric support to obtain copper-rich hybrid ion exchangers. Composites with CuO particles inside a polyacrylic matrix (up to 35.0 wt% Cu) were obtained. Thermal analyses under air and under N2 were performed for CCEs in the H+ and Cu2+ form with and without a CuO deposit. The results of sixteen experiments are discussed based on the TG/DTG curves and XRD patterns of the solid residues. Under air, the cupric deposit shifted the particular transformations and the ultimate polymeric matter decomposition (combustion) toward lower temperatures (even about 100-150 °C). Under N2, the reduction of the cupric deposit to metallic copper took place. Unique composite materials enriched in carbonaceous matter were obtained, as the products of polymeric matrix decomposition (free radicals and hydrogen) created an additional amount of carbon char due to the utilization of a certain amount of hydrogen to reduce Cu (II) to Cu0.

Immunogenicity and safety of different schedules of the meningococcal ABCWY vaccine, with assessment of long-term antibody persistence and booster responses - results from two phase 2b randomized trials in adolescents.

The meningococcal serogroup B (MenB) protein vaccine, 4CMenB, combined with MenA, MenC, MenW and MenY polysaccharide-protein conjugates for a pentavalent MenABCWY vaccine, can potentially protect against most causative agents of invasive meningococcal disease worldwide. Two phase 2b, randomized, multicenter studies were conducted (NCT02212457, NCT02946385) to assess the immunogenicity and safety of the MenABCWY vaccine as well as antibody persistence and response to a booster dose 2 years after the last vaccination, compared to 4CMenB vaccination. Participants (10 - 18 years), randomized (3:3:2:2:2:2), received the 4-component 4CMenB vaccine according to a 0-2 month (M) schedule or MenABCWY according to a 0-2, 0-6, 0-2-6, 0-1, or 0-11 M schedule. All participants received 5 injections (at M0, M1, M2, M6 and M12) with either the study vaccines or placebo/hepatitis A vaccine. Follow-on participants (4CMenB-0-2, MenABCWY-0-2, MenABCWY-0-6 and MenABCWY-0-2-6 groups) received one dose of either 4CMenB (4CMenB-0-2 group) or MenABCWY and newly enrolled, age-matched, meningococcal vaccine-naïve adolescents (randomized 1:1) received 2 doses (0-2 M) of either 4CMenB or MenABCWY. MenABCWY vaccination was immunogenic against MenB test strains. Non-inferiority for all 4 components of the 4CMenB vaccine could not be demonstrated for the 0-2 M schedule. Antibodies persisted up to 2 years post-MenABCWY vaccination and a booster dose induced an anamnestic response as higher titers were observed in follow-on participants compared to the first-dose response in vaccine-naïve participants. MenABCWY had a clinically-acceptable safety profile, not different from that of 4CMenB.

Weakly Hydrated Anion Exchangers Doped with Cu2O and Cu0 Particles-Thermogravimetric Studies.

Hybrid ion exchangers (HIXs) containing fine Cu2O and Cu0 particles were subjected to thermal analysis in order to determine their hygroscopic water content (with regard to their anomalously low porosity) and to determine the effect of the oxidation state of the copper atom in the deposit on the thermal properties of composite materials. Commercially available anion exchangers, Amberlite IRA 900Cl (macroreticular, M) and Amberlite IRA 402OH (gel-like, G), were used as supporting materials. M/Cu2O, G/Cu2O, M/Cu and G/Cu, containing 4.3-8.4 wt% Cu, were subjected to thermal analysis under respectively air and N2. TG/DTG curves revealed that dry M/Cu and G/Cu contained as little as 7.2% and 4.3% hygroscopic water, while M/Cu2O and G/Cu2O contained respectively 10.6% and 9.4% (Cu0 was a stronger water repellent than Cu2O). The oxidation state of the copper atom in the deposit was found to affect the amount of the forming char, and also Cu0 was found to contribute to the formation of more char than in the pyrolysis of the pure resin (the anion exchanger with no copper deposit). Under air the two kinds of particles transformed into CuO, while under N2 metallic copper and char (from the resin phase) made up the solid residue. This means that in the pyrolysis of the HIXs the inorganic phase participated in char formation and it also transformed itself (undergoing reduction when possible). The above findings provide a basis for in-depth research aimed at the innovative use of copper-containing HIXs and at obtaining usable composite materials with a designed (organic-inorganic) composition.

Size-Controlled Transformation of Cu2O into Zero Valent Copper within the Matrix of Anion Exchangers via Green Chemical Reduction.

Composite materials containing zero valent copper (ZVC) dispersed in the matrix of two commercially available strongly basic anion exchangers with a macroreticular (Amberlite IRA 900Cl) and gel-like (Amberlite IRA 402OH) structure were obtained. Cu0 particles appeared in the resin phase as the product of the reduction of the precursor, i.e., copper oxide(I) particles previously deposited in the two supporting materials. As a result of a one-step transformation of preformed Cu2O particles as templates conducted using green reductant ascorbic acid and under mild conditions, macroporous and gel-type hybrid products containing ZVC were obtained with a total copper content of 7.7 and 5.3 wt%, respectively. X-ray diffraction and FTIR spectroscopy confirmed the successful transformation of the starting oxide particles into a metallic deposit. A scanning electron microscopy study showed that the morphology of the deposit is mainly influenced by the type of matrix exchanger. In turn, the drying steps were crucial to its porosity and mechanical resistance. Because both the shape and size of copper particles and the internal structure of the supporting solid materials can have a decisive impact on the potential applications of the obtained materials, the results presented here reveal a great possibility for the design and synthesis of functional nanocrystalline solids.

Cu(II)-Fe(III) oxide doped anion exchangers - Multifunctional composites for arsenite removal from water via As(III) adsorption and oxidation.

The aim of the present study was to investigate As(III) oxidation and adsorption on the surface of hybrid anion exchangers containing Cu(II)-Fe(III) binary oxide deposited in their porous structure with the same Cu:Fe ratio of 1:2 but with different amounts and distribution of inorganic deposit within polymeric beads. The equilibrium studies confirmed high adsorption capacity of the best hybrid polymer: 94.4 mg As/g. Moreover, the adsorption was effective over a wide pH range, selective in the presence of interfering ions, and the material was effectively regenerated. The performance of the hybrid polymer was also confirmed in the column process which enabled both As(III) and As(V) concentrations to be lowered from 500 µg/L to below 10.0 µg/L in a solution with a composition similar to natural groundwater. The breakthrough point of the bed was reached after the solution amounting to 1833 bed volumes passed through the column. Desorbed As speciation, FTIR and XPS studies showed that As(III) was mainly adsorbed on the surface of Cu-Fe oxides followed by its oxidation to As(V). In the oxidation reaction metal oxides acted as catalysts and adsorbents, while the oxidant was probably oxygen dissolved in solution.

Evaluation of hybrid anion exchanger containing cupric oxide for As(III) removal from water.

The aim of this study was investigate of arsenite adsorption on a hybrid polymer based on a polystyrene/divinylbenzene macroporous anion exchanger containing cupric oxide deposited within its porous structure. The study included batch kinetic and equilibrium experiments, and investigation of influence of the pH, regeneration of spent adsorbent and the column process on arsenic(III) adsorption. The experimental data were evaluated using kinetic, isotherm and fixed-bed column models. The adsorption capacity calculated from the Langmuir model was 6.61 mg As(III) g-1. The adsorption rate was controlled by both chemisorption of arsenic on the adsorbent surface and external diffusion, and at a higher initial As(III) concentration also by intraparticle diffusion. The spent adsorbent was easily regenerated with 1.0 M NaOH solution. Based on batch adsorption studies and X-ray photoelectron spectroscopic analyses a mechanism of As(III) adsorption was proposed. Arsenite removal proceeded in two stages: oxidation to arsenate on the CuO surface, followed by an ion exchange reaction. The studied hybrid polymer also showed very good adsorption characteristics under the dynamic regime. The S-shape of breakthrough curves and insignificant influence of bed height, initial concentration and flow rate on the adsorption capacity confirmed its applicability in water treatment.

A randomized study of fever prophylaxis and the immunogenicity of routine pediatric vaccinations.

OBJECTIVE: Prophylactic antipyretic use during pediatric vaccination is common. This study assessed whether paracetamol or ibuprofen prophylaxis interfere with immune responses to the 13-valent pneumococcal conjugate vaccine (PCV13) given concomitantly with the combined DTaP/HBV/IPV/Hib vaccine. METHODS: Subjects received prophylactic paracetamol or ibuprofen at 0, 6-8, and 12-16 h after vaccination, or 6-8 and 12-16 h after vaccination at 2, 3, 4, and 12months of age. At 5 and 13months, immune responses were evaluated versus responses in controls who received no prophylaxis. RESULTS: After the infant series, paracetamol recipients had lower levels of circulating serotype-specific pneumococcal anticapsular immunoglobulin G than controls, reaching significance (P<0.0125) for 5 serotypes (serotypes 3, 4, 5, 6B, and 23F) when paracetamol was started at vaccination. Opsonophagocytic activity assay (OPA) results were similar between groups. Ibuprofen did not affect pneumococcal responses, but significantly (P<0.0125) reduced antibody responses to pertussis filamentous hemagglutinin and tetanus antigens after the infant series when started at vaccination. No differences were observed for any group after the toddler dose. CONCLUSIONS: Prophylactic antipyretics affect immune responses to vaccines; these effects vary depending on the vaccine, antipyretic agent, and time of administration. In infants, paracetamol may interfere with immune responses to pneumococcal antigens, and ibuprofen may reduce responses to pertussis and tetanus antigens. The use of antipyretics for fever prophylaxis during infant vaccination merits careful consideration. ClinicalTrials.gov identifier: NCT01392378https://clinicaltrials.gov/ct2/show/NCT01392378?term=NCT01392378&rank=1.

Circulating Antibody 1 and 2 Years After Vaccination With the 13-Valent Pneumococcal Conjugate Vaccine in Preterm Compared With Term Infants.

BACKGROUND: Premature infants have lower short-term immune responses to vaccination than term infants, but patterns of antibody persistence in preterm infants over longer periods are not well established. This study assessed the persistence of antibody response to the 13-valent pneumococcal conjugate vaccine (PCV13) in formerly preterm versus term infants. METHODS: In total, 100 preterm and 100 term infants received PCV13 with routine vaccines at ages 2, 3, 4 and 12 months. Serotype-specific anticapsular immunoglobulin G (IgG)-binding antibodies and opsonophagocytic activity were determined 1 and 2 years after the last PCV13 dose. RESULTS: At 1 and 2 years after the last vaccination (toddler dose), IgG geometric mean concentrations (GMCs) for all serotypes had declined from levels measured 1 month after the toddler dose but remained above pretoddler dose levels. IgG GMCs were significantly lower in preterm than term subjects for a majority of serotypes at both follow-up time points. IgG GMCs increased in both groups for some serotypes from the 1-year to 2-year follow-up, whereas others declined. Opsonophagocytic activity results supported the IgG results. CONCLUSIONS: The routine (3 + 1) vaccination schedule is likely to offer long-term protection against invasive pneumococcal disease in preterm infants and should be initiated regardless of gestational age or weight at birth, without delay of the toddler dose.

Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.

Predominance of genotype P[9]G3 in rotavirus gastroenteritis in Polish children.

INTRODUCTION: Rotavirus (RV) infection is the most common cause of gastroenteritis in children. This paper identifies the most common genotypes of rotaviruses isolated from children hospitalized with gastroenteritis and attempts to determine any relationship between infection with a certain rotavirus genotype. MATERIAL AND METHODS: The investigated group consisted of 68 consecutive children with rotavirus gastroenteritis (confirmed by an agglutination test). Rotavirus genotype was determined in stool samples obtained from each child. RESULTS: The P[9]VP4 genotype was observed in 41/61 positive samples (over 67.2%) that were permanently associated with the G3 VP7 genotype. Moreover, G3 was determined as the most commonly isolated G type (77.94%). As well as the P[9]G3 type, G3 was also found in the P[4] type (5 cases). Twenty-six out of 61 (42.6%) children in whom rotavirus genotype was determined were co-infected with pathogenic bacteria. No statistical correlation was observed between rotavirus P[9]G3 gastroenteritis and digestive tract co-infection with pathogenic bacteria (p > 0.05). Elevated ALT activity was found in 34/59 (57.6%) cases of rotavirus gastroenteritis. Elevated ALT serum level was found to correlate with P[9]G3 rotavirus genotype but concomitant infections did not. CONCLUSIONS: The most common genotype of rotaviruses observed in our group of children, P[9]G3, has rarely been described. Co-infection of the digestive tract with pathogenic bacteria and elevated serum ALT concentrations were found to be the most frequent phenomena. A correlation between P[9]G3 rotavirus genotype and elevated serum ALT level was found, but no significant relationship was identified between concomitant infections and P[9]G3 genotype.