Epidemiological and clinical characteristics of children with confirmed COVID-19 infection in a tertiary referral hospital in Manila, Philippines.

BACKGROUND: COVID-19 has challenged the under-resourced health systems of low- and middle-income countries, significantly affecting child health. Available published data on Filipino children with COVID-19 infection are limited. This study aims to describe the epidemiological and clinical characteristics of pediatric patients with confirmed COVID-19 in an infectious disease hospital in Manila, Philippines. MAIN TEXT: This cross-sectional study reviewed data on patients ages 0 to 18 years with confirmed COVID-19 infection, admitted to San Lazaro Hospital from January 25, 2020 to January 25, 2022. Demographic data and clinical characteristics obtained from COVID-19 case investigation forms were summarized and compared between severe and non-severe cases. Risk factors for disease severity and mortality were analyzed. Of 115 patients, 64% were males. There were 87 patients (75.7%) with asymptomatic, mild, or moderate disease, and 28 cases (24.3%) with severe or critical illness. The median age of all patients was 10 years (interquartile range: 4-15 years). The majority of patients (40.9%) were adolescents ages 13 to 18 years. Predominant symptoms were fever (73.9%) and cough (55.7%). Patients with severe or critical illness were more likely to experience difficulty of breathing (55.2% vs 44.8%, p < 0.001), and have a longer hospital stay (11 days vs 8 days, p = 0.043). Among all patients, 48.7% had at least one underlying disease; and common infectious co-morbidities were tuberculosis (17.4%), dengue (12.2%), and HIV (4.3%). Having tuberculosis (p = 0.008) or at least one co-morbidity (p < 0.001) was associated with disease severity. Ten patients (8.7%) died; and mortality was higher among those with severe or critical illness (80% vs 20%, p < 0.001). Sepsis (p = 0.020) or having at least one co-morbidity (p = 0.007) was associated with death. CONCLUSION: Children of all ages remain susceptible to COVID-19 infection, and usually present with mild or moderate symptoms. In this study, many adolescents are affected, highlighting the value of COVID-19 vaccination in this age group. Understanding the clinical features of COVID-19 in Filipino children is essential to identifying and optimally managing those at highest risk of severe disease.

Safety and Immunogenicity of a New Inactivated Polio Vaccine Made From Sabin Strains: A Randomized, Double-Blind, Active-Controlled, Phase 2/3 Seamless Study.

BACKGROUND: A new inactivated polio vaccine made from Sabin strains (sIPV) was developed as part of the global polio eradication initiative. METHODS: This randomized, double-blind, active-controlled, phase 2/3 seamless study was conducted in 2 stages. Healthy infants aged 6 weeks were randomly assigned to receive 3 doses of 1 of 4 study vaccines at 6, 10, and 14 weeks of age (336 received low-, middle-, or high-dose sIPV, or conventional IPV [cIPV] in stage I, and 1086 received lot A, B, or C of the selected sIPV dose, or cIPV in stage II). The primary outcome was the seroconversion rate 4 weeks after the third vaccination. RESULTS: In stage I, low-dose sIPV was selected as the optimal dose. In stage II, consistency among the 3 manufacturing lots of sIPV was demonstrated. The seroconversion rates for Sabin and wild strains of the 3 serotypes after the 3-dose primary series were 95.8% to 99.2% in the lot-combined sIPV group and 94.8% to 100% in the cIPV group, proving the noninferiority of sIPV compared to cIPV. No notable safety risks associated with sIPV were observed. CONCLUSIONS: Low-dose sIPV administered as a 3-dose vaccination was safe and immunogenic compared to cIPV. CLINICAL TRIALS REGISTRATION: NCT03169725.

Clinical profile and outcome of children with parapneumonic effusion

@#Parapneumonic effusions frequently occur as complications of pneumonia. Data from developing countries is limited. The purpose of this paper is to review the epidemiological and clinical profile of parapneumonic effusions among children admitted in a tertiary government hospital. Methodology: Medical records of 72 children diagnosed with parapneumonic effusions from 2005-to-2009 were obtained. Demography, clinical presentations, diagnostics, treatment modalities, outcomes, etiology and antibiotic susceptibilities were analyzed using descriptive statistics. Comparison of purulent effusion and empyema was done using parametric or non-parametric statistics, accordingly. Results: There were 106 children discharged with a diagnosis of parapneumonic effusion. Of the 96 medical records available, 72 patients fulfilled the criteria for parapneumonic effusions. Only 53 patients submitted pleural fluid for analysis: 29 cases were empyema, while 24 cases were purulent effusion; mean age was 9.66 years. Fever (90.28%), cough (69.44%), and dyspnea (66.67%) were the most common clinical presentations. Forty-four patients underwent thoracentesis while 37 children had closed-tube thoracostomy. Methicillin-resistant Staphylococcus aureus(MRSA) was the most commonly isolated organism from the pleural fluid cultures (9.26%) and blood cultures (6.25%). Patients with purulent effusion were treated with a combination of antibiotics and anti-TB meds (75%).Majority of patients with empyema were treated with antibiotics alone (79.31%). Earlier improvement and shorter hospital stay were observed among patients with purulent effusion. Conclusion: Parapneumonic effusions occurred in 6.80% of hospitalized children with pneumonia; 54.72% of which were empyema and 45.28% were purulent effusion. MRSA was the most commonly isolated organism. Chest imaging, pleural fluid analysis and cultures, and blood cultures were important diagnostic procedures. The mainstays of treatment were medical, surgical or both, depending on the severity of effusion. Prompt diagnosis and management could account for favorable clinical outcomes.