RESUMO
BACKGROUND: While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. METHODS: The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. RESULTS: We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. CONCLUSION: In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Gravidez , Adulto , Lactente , Feminino , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Canadá/epidemiologia , Antirretrovirais/uso terapêutico , Mães , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologiaRESUMO
PURPOSE: Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada. METHODS: We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP). RESULTS: In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children. CONCLUSION: Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.
Assuntos
Tosse/etiologia , Febre/etiologia , Hemoptise/etiologia , Testes de Liberação de Interferon-gama/estatística & dados numéricos , Teste Tuberculínico/estatística & dados numéricos , Tuberculose/epidemiologia , Canadá/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Morbidade , Estudos Prospectivos , Redução de PesoRESUMO
BACKGROUND: Infants HIV-exposed and uninfected (IHEU) who are born to women living with HIV are at an increased risk of preterm birth (PTB). Antenatal exposure to certain maternal antiretroviral therapy (ART) regimens has been associated with PTB, although existing studies in this domain are limited and report discordant findings. We determined odds of PTB among IHEU by antenatal ART regimens and timing of exposure, adjusting for maternal risk factors. METHODS: We retrospectively studied IHEU born in British Columbia (BC), Canada between 1990 and 2012 utilizing provincial health administrative databases. We included data from a control group of infants HIV-unexposed and uninfected (IHUU) matched ~3:1 for each IHEU on age, sex and geocode. RESULTS: A total of 411 IHEU and 1224 IHUU were included in univariable analysis. PTB was more frequent among IHEU (20%) compared with IHUU (7%). IHEU were more often antenatally exposed to alcohol, tobacco, as well as prescription, nonprescription, and illicit drugs (IHEU: 36%, 8% and 35%; vs. IHUU: 3%, 1% and 9%, respectively). After adjusting for maternal substance use and smoking exposure, IHEU remained at increased odds of PTB [adjusted odds ratio (aOR) (95% CI): 2.66; (1.73, 4.08)] compared with matched IHUU controls. ART-exposed IHEU (excluding those with NRTIs only ART) had lower adjusted odds of PTB compared with IHEU with no maternal ART exposure, regardless of regimen [aOR range: 0.16-0.29 (0.02-0.95)]. Odds of PTB between IHEU exposed to ART from conception compared with IHEU exposed to ART postconception did not differ [aOR: 0.91 (0.47, 1.76)]; however, both groups experienced lower odds of PTB compared with IHEU with no maternal ART [preconception: aOR: 0.28 (0.08, 0.89); postconception: aOR 0.30 (0.11, 0.83)]. CONCLUSIONS: BC IHEU were over twice as likely to be born preterm compared with demographically matched controls. Maternal substance use in pregnancy modulated this risk; however, we found no adverse associations of PTB with exposure to antenatal ART.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro , Adulto , Colúmbia Britânica , Feminino , Infecções por HIV/virologia , Humanos , Lactente , Masculino , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature. METHODS: PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1st to October 5th, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes were included. RESULTS: 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51; I2 = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I2 = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07; I2 = 36%). CONCLUSIONS: Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.
Assuntos
COVID-19/etiologia , SARS-CoV-2 , Criança , Comorbidade , Humanos , RiscoAssuntos
Hepatite C Crônica/diagnóstico , Hepatite C Crônica/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Canadá , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/transmissão , Humanos , Programas de Rastreamento , Cuidado Pós-Natal , Guias de Prática Clínica como Assunto , Cuidado Pré-Concepcional , Diagnóstico Pré-NatalRESUMO
OBJECTIVES: To assess and compare neurodevelopmental disorders in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children in British Columbia, Canada. To determine associations between these outcomes and in-utero exposure to antiretroviral drugs. DESIGN: Retrospective controlled cohort study. METHODS: Data were collected on 446 HEU children and 1323 HUU children (matched â¼1â:â3 for age, sex, and geocode) born between 1990 and 2012. Multivariable logistic regressions determined odds ratios of neurodevelopmental disorder diagnoses. RESULTS: HEUs had three times higher odds of being born preterm (Pâ<â0.0001), and a more than two-fold increase in odds for autism, disturbance of emotions, hyperkinetic syndrome, and developmental delay compared with matched HUUs (Pâ<â0.02) in unadjusted analysis. This association was reduced [adjusted neurodevelopmental disorder odds ratio (AOR)â=â1.67; 95% confidence interval: 1.12-2.48; Pâ=â0.011] after adjusting for maternal substance use and/or smoking (children born after April 2000). Regardless of antiretroviral exposure type (i.e. none, treatment with one or multiple drug classes), HEUs had higher odds of any neurodevelopmental disorders compared with matched HUUs; however, there was no evidence suggesting any specific classes of antiretroviral drugs or exposure durations increased their likelihood of neurodevelopmental disorders. CONCLUSION: The results suggest no adverse associations between antiretroviral drugs and neurodevelopmental disorders within antiretroviral-exposed HEU children in our cohort. Prevalence of neurodevelopmental disorders is higher in HEUs; however, maternal substance use plays a role, as could other environmental factors not captured. These findings highlight a need for holistic support for pregnant women as well as careful developmental monitoring of HEUs past infancy, and access to early interventions, particularly among those born preterm and those exposed to addictive substances.
Assuntos
Antirretrovirais/administração & dosagem , Desenvolvimento Infantil/efeitos dos fármacos , Troca Materno-Fetal , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Vertical HIV transmission has declined in Canada, but missed opportunities for prevention continue to occur. We sought to determine the adequacy, and changes over time in adequacy, of uptake of maternal and neonatal antiretroviral therapy for the prevention of vertical HIV transmission, and to determine the vertical transmission rate over time and according to adequacy of antenatal antiretroviral therapy during the combination antiretroviral therapy era in Canada. METHODS: The Canadian Perinatal HIV Surveillance Program collects data annually through retrospective chart review concerning HIV-infected women and their infants. We determined receipt of adequate antiretroviral treatment (antenatal combination antiretroviral treatment for ≥ 4 wk, intrapartum intravenous zidovudine treatment and 4-6 wk of infant oral zidovudine treatment) and predictors of inadequate antenatal combination antiretroviral therapy (none or < 4 wk) in Canada in 1997-2016. RESULTS: We identified 3785 mother-infant pairs. Uptake of 4 weeks or more of antenatal combination antiretroviral therapy increased over time across all provinces/territories and regardless of maternal race/ethnicity or risk category (p < 0.001). During 2011-2016, 92 women (6.5%) received no or less than 4 weeks of antenatal combination antiretroviral therapy, 146 women (10.7%) received no intrapartum zidovudine treatment, and 43 infants (3.1%) received less than 4 weeks of zidovudine treatment. In multivariate analysis restricted to 2011-2016, higher uptake of adequate antenatal combination antiretroviral therapy was seen among black women than among Indigenous (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.23-7.26) or white (OR 1.87, 95% CI 0.99-1.27) women and in British Columbia/Yukon Territory than in Alberta (OR 3.31, 95% CI 1.06-10.32), Ontario (OR 3.16, 95% CI 1.08-9.26) or Quebec (OR 3.44, 95% CI 1.09-10.84). Among the 14 vertical HIV transmission events during 2011-2016 (vertical transmission rate 1.0%), maternal HIV infection was diagnosed before the onset of labour in 5 cases, and only 2 women received adequate antenatal combination antiretroviral therapy. INTERPRETATION: Efforts to improve timely access to care, HIV screening and treatment for all women, combined with enhanced resources targeting populations at increased risk for HIV infection, will be needed if vertical HIV transmission is to be eliminated in Canada.
RESUMO
We undertook a 28-year review of enteric fever at a large tertiary care pediatric center. Most cases occurred in children who visited friends and relatives in the Indian subcontinent, and there was significant antibiotic resistance. Documented vaccination rates were low, and many cases also had evidence of delays in diagnosis and treatment.
Assuntos
Diversidade Cultural , Países em Desenvolvimento , Emigrantes e Imigrantes , Hospitais Pediátricos , Salmonella paratyphi A , Salmonella typhi , Centros de Atenção Terciária , Doença Relacionada a Viagens , Febre Tifoide/transmissão , Antibacterianos/uso terapêutico , Bangladesh/etnologia , Canadá , Criança , Diagnóstico Tardio , Farmacorresistência Bacteriana , Humanos , Índia/etnologia , Testes de Sensibilidade Microbiana , Paquistão/etnologia , Recidiva , Estudos Retrospectivos , Febre Tifoide/diagnóstico , Febre Tifoide/tratamento farmacológico , Febre Tifoide/microbiologiaRESUMO
OBJECTIVES: To determine if a standardized global child health (GCH) modular course for pediatric residents leads to satisfaction, learning, and behavior change. METHODS: Four 1-hour interactive GCH modules were developed addressing priority GCH topics. "Site champions" from 4 Canadian institutions delivered modules to pediatric residents from their respective programs during academic half-days. A pre-post, mixed methods evaluation incorporated satisfaction surveys, multiple-choice knowledge tests, and focus group discussions involving residents and satisfaction surveys from program directors. RESULTS: A total of 125 trainees participated in ≥1 module. Satisfaction levels were high. Focus group participants reported high satisfaction with the concepts taught and the dynamic, participatory approach used, which incorporated multimedia resources. Mean scores on knowledge tests increased significantly postintervention for 3 of the 4 modules (P < .001), and residents cited increases in their practical knowledge, global health awareness, and motivation to learn about global health. Program directors unanimously agreed that the modules were relevant, interesting, and could be integrated within existing formal training time. CONCLUSIONS: A relatively short, participatory, foundational GCH modular curriculum facilitated knowledge acquisition and attitude change. It could be scaled up and serve as a model for other standardized North American curricula.
Assuntos
Instrução por Computador/métodos , Saúde Global/educação , Internato e Residência/métodos , Pediatria/educação , Desenvolvimento de Programas , Atitude do Pessoal de Saúde , Canadá , Competência Clínica , Grupos Focais , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
A total of 324 pandemic H1N1 cases were reported to the Immunization Monitoring Program, Active from May 1, 2009 to August 31, 2009. As of August 31, 2009, case details were available for 73% (n=235) of these cases. The median age was 4.8 years and 69% of children were older than 2 years of age. In total, 95 (40%) of children were previously healthy. The proportion with an underlying health condition increased with age. Close to 50% of children received antiviral medication. Two children died from the infection. The pediatric risk groups affected and course of disease caused by pandemic H1N1 appear similar to seasonal influenza.
Assuntos
Surtos de Doenças , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/virologia , Adolescente , Fatores Etários , Canadá/epidemiologia , Criança , Pré-Escolar , Comorbidade , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/mortalidade , Influenza Humana/patologia , MasculinoRESUMO
Active surveillance data from 12 Canadian tertiary-care hospitals on children hospitalized with postvaccination thrombocytopenia were analyzed. Since 1992, there have been 107 cases reported; while 96% of the children were symptomatic, only 2 had severe bleeding. With treatment, 28 children (26%) had normal platelet counts on discharge from hospital and 93% had documented recovery within 3 months.
Assuntos
Púrpura Trombocitopênica Idiopática/epidemiologia , Vacinação/efeitos adversos , Canadá/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Esquemas de Imunização , Lactente , Masculino , Púrpura Trombocitopênica Idiopática/etiologia , Garantia da Qualidade dos Cuidados de Saúde , Vacinas/administração & dosagem , Vacinas/efeitos adversosRESUMO
We reviewed the antibiotic susceptibility patterns of all isolates of Salmonella typhi in Ontario, Canada from January 2002 to December 2007. We identified a total of 381 unique cases over the 5-year period (50-73 cases per year). Of the 381 cases, 171 were female, 164 were male, and no gender was identified for 33 cases. Age of the patients ranged from less than 1 to 102 years of age (median age of 20 years). Although resistance patterns for ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins (cefotaxime until May 2005 and ceftriaxone from June 2005 to present), and chloramphenicol remained stable, nalidixic acid resistance rose sharply between 2003 and 2005 and has remained at approximately 80% of isolates since 2005. The significant and sustained increase in nalidixic acid-resistant S. typhi suggests that ciprofloxacin should no longer be used as the drug of choice for the empiric treatment of typhoid fever in Ontario.