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2.
J Pediatric Infect Dis Soc ; 10(10): 962-966, 2021 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-34319393

RESUMEN

On May 10, 2021, the Emergency Use Authorization of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) was expanded to include adolescents (May 10, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use). We describe clinical characteristics of 8 adolescents who presented over the course of 36 days to Nicklaus Children's Hospital with perimyocarditis within 4 days of receiving a dose of BNT162b2 vaccine.


Asunto(s)
COVID-19 , Adolescente , Vacuna BNT162 , Vacunas contra la COVID-19 , Niño , Humanos , SARS-CoV-2
3.
IDCases ; 24: e01145, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34026535

RESUMEN

A 2-year-old, previously healthy, male presented with an insidious history of intermittent left knee pain and edema who had been evaluated in the emergency department on multiple occasions with unremarkable imaging and normal laboratory results. On the day of presentation, he had mild edema of the left knee and inability to bear weight. Synovial fluid analysis showed an elevated white cell count with neutrophil predominance and mildly elevated inflammatory markers, consistent with septic arthritis. He underwent knee arthrotomy with irrigation and debridement and was initiated on broad spectrum antibiotics. Cultures were negative, polymerase chain reaction for MRSA and Kingella kingae were negative. He was started on a fifth-generation cephalosporin with resolution of symptoms, marked clinical improvement and normalization of inflammatory markers. The identification of the etiologic agent was possible due to detection of bacterial 16S rRNA gene amplification by PCR for Moraxella nonliquefaciens in the synovial fluid. He completed a course of 3 weeks of parenteral antibiotics at home with full recovery.

4.
SAGE Open Med Case Rep ; 9: 2050313X21989465, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33633863

RESUMEN

In the United States, an estimated 7.3% of confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) are among persons aged less than 18 years. Data regarding clinical manifestations in this age group are still evolving. An upper airway predilection has been reported in children. We describe the case of a 15-year-old female with supraglottitis and unilateral hypomobility of vocal cord with concern for critical airway, associated with COVID-19. She was managed by a multidisciplinary team including critical care, infectious diseases, and otolaryngology. This report adds to the sparse but evolving body of literature on the clinical presentation of COVID-19 disease in children.

5.
Am J Trop Med Hyg ; 95(5): 1130-1136, 2016 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-27573631

RESUMEN

We conducted a prospective study to measure dengue virus (DENV) antibody seroconversion in travelers to dengue-endemic areas. Travelers seen in the Boston Area Travel Medicine Network planning to visit dengue-endemic countries for ≥ 2 weeks were enrolled from 2009 to 2010. Pre- and post-travel blood samples and questionnaires were collected. Post-travel sera were tested for anti-DENV IgG by indirect IgG enzyme-linked immunosorbent assay (ELISA) and anti-DENV IgM by capture IgM ELISA. Participants with positive post-travel anti-DENV IgG or IgM were tested for pre-travel anti-DENV IgG and IgM; they were excluded from the seroconversion calculation if either pre-travel anti-DENV IgG or IgM were positive. Paired sera and questionnaires were collected for 62% (589/955) of enrolled travelers. Most participants were 19-64 years of age, female, and white. The most common purposes of travel were tourism and visiting friends and relatives; most trips were to Asia or Africa. Median length of travel was 21 days. DENV antibody seroconversion by either anti-DENV IgM or IgG ELISA was 2.9-6.8%; lower range percent excluded potential false-positive anti-DENV IgG due to receipt of yellow fever or Japanese encephalitis vaccines at enrollment; upper range percent excluded proven false-positive anti-DENV IgM. Eighteen percent of those with seroconversion reported dengue-like symptoms. Seroconversion was documented for travel to Africa as well as countries and regions known to be highly dengue endemic (India, Brazil, southeast Asia). Given widespread risk of dengue, travel medicine counseling should include information on risk of dengue in endemic areas and advice on preventing insect bites and seeking prompt medical attention for febrile illness.


Asunto(s)
Virus del Dengue/inmunología , Dengue/sangre , Seroconversión , Adolescente , Adulto , África , Anciano , Anticuerpos Antivirales/sangre , Asia , Brasil , Niño , Preescolar , Dengue/inmunología , Virus del Dengue/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , India , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Encuestas y Cuestionarios , Viaje , Vacunación , Fiebre Amarilla/sangre , Fiebre Amarilla/inmunología , Vacuna contra la Fiebre Amarilla/administración & dosificación , Adulto Joven
6.
J Travel Med ; 20(6): 352-60, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24165381

RESUMEN

BACKGROUND: Dengue virus (DENV) infections may occur in travelers. OBJECTIVES: To determine prevalence of anti-DENV IgG antibody in travelers who lived in or visited dengue-endemic countries and to describe risk factors and characteristics associated with infection and subsequent anti-DENV IgG antibody presence. METHODS: Participants were enrolled from travel clinics of the Boston Area Travel Medicine Network from August 2008 through June 2009. Demographic information, trip duration, travel history, and a blood sample were collected. Serum samples were tested for anti-DENV IgG antibody by indirect IgG enzyme-linked immunosorbent assay (ELISA), and antibody-mediated virus neutralization by plaque reduction neutralization test (PRNT) for anti-DENV IgG antibody-positive and selected negative samples. Participants were stratified into group 1: born in dengue-endemic countries; group 2: born in nonendemic countries but lived continuously for ≥1 year in a dengue-endemic country; group 3: born in nonendemic countries and traveled to a dengue-endemic country for ≥2 weeks but <1 year. RESULTS: Six hundred travelers were enrolled. Anti-DENV IgG antibody was identified in 113 (19%) when tested by ELISA (51% in group 1, 40% in group 2, and 6.9% in group 3) and in 71 (12%) by PRNT (42% primary monotypic and 58% heterotypic reactive responses). Sensitivity and specificity of the ELISA based on PRNT results were 85% to 100% and 79% to 94%, assuming up to 15% misclassification of ELISA negative results. Presence of anti-DENV IgG antibody by ELISA was associated with years lived in dengue-endemic countries and birthplace in the Caribbean for group 1, receipt of Japanese encephalitis vaccine in group 3, and self-reported history of dengue in all three groups. CONCLUSIONS: Nineteen percent of participants who were born, lived in, or traveled to dengue-endemic countries had anti-DENV IgG antibody by ELISA; 12% had antibodies by PRNT, 85% of whom had no history of dengue. Presence of DENV antibodies was associated with years lived in dengue-endemic countries and self-reported history of dengue.


Asunto(s)
Anticuerpos Antivirales/análisis , Virus del Dengue/inmunología , Dengue/etnología , Enfermedades Endémicas , Inmunoglobulina G/inmunología , Viaje , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Boston/epidemiología , Región del Caribe/etnología , Niño , Dengue/virología , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto Joven
7.
J Travel Med ; 20(6): 346-51, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24165380

RESUMEN

BACKGROUND: Dengue viruses have spread widely in recent decades and cause tens of millions of infections mostly in tropical and subtropical areas. Vaccine candidates are being studied aggressively and may be ready for licensure soon. METHODS: We surveyed patients with past or upcoming travel to dengue-endemic countries to assess rates and determinants of acceptance for four hypothetical dengue vaccines with variable efficacy and adverse event (AE) profiles. Acceptance ratios were calculated for vaccines with varied efficacy and AE risk. RESULTS: Acceptance of the four hypothetical vaccines ranged from 54% for the vaccine with lower efficacy and serious AE risk to 95% for the vaccine with higher efficacy and minor AE risk. Given equal efficacy, vaccines with lower AE risk were better accepted than those with higher AE risk; given equivalent AE risk, vaccines with higher efficacy were better accepted than those with lower efficacy. History of Japanese encephalitis vaccination was associated with lower vaccine acceptance for one of the hypothetical vaccines. US-born travelers were more likely than non-US born travelers to accept a vaccine with 75% efficacy and a risk of minor AEs (p = 0.003). Compared with North American-born travelers, Asian- and African-born travelers were less likely to accept both vaccines with 75% efficacy. CONCLUSIONS: Most travelers would accept a safe and efficacious dengue vaccine if one were available. Travelers valued fewer potential AEs over increased vaccine efficacy.


Asunto(s)
Vacunas contra el Dengue/farmacología , Virus del Dengue/inmunología , Dengue/prevención & control , Brotes de Enfermedades/prevención & control , Cooperación del Paciente , Viaje , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Dengue/etnología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
8.
Clin Vaccine Immunol ; 20(3): 358-62, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23302742

RESUMEN

A commercial anti-dengue virus (anti-DENV) indirect IgG enzyme-linked immunosorbent assay (ELISA) for serological diagnosis was evaluated for its utility in determining previous DENV exposure in U.S. travelers. The Boston Area Travel Medicine Network clinics used Focus Diagnostics anti-DENV IgG ELISA to measure anti-DENV IgG antibodies in 591 pretravel specimens from U.S. residents who had traveled to countries where dengue is endemic. When using the manufacturer's index cutoff value for this ELISA, false-positive results were observed that overestimated the perceived past DENV exposure in U.S. travelers. Validation of 121 of these anti-DENV IgG results by plaque reduction neutralization test (PRNT) was used for receiver operating characteristic (ROC) curve optimization of the index cutoff value from 1 to 3.0, improving the specificity of the anti-DENV IgG ELISA from 24% to 95.7%. Additionally, previous vaccination with yellow fever virus contributed to 52.8% of the false-positive rate in the anti-DENV IgG ELISA results. Optimization of the cutoff value of the anti-DENV IgG ELISA provided better interpretation and confidence in the results and eliminated the need for confirmation by PRNT. The travel history of U.S. travelers was also useful for categorizing these travelers into groups for analysis of previous DENV exposure.


Asunto(s)
Anticuerpos Antivirales/sangre , Dengue/diagnóstico , Inmunoglobulina G/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Boston , Niño , Dengue/inmunología , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Curva ROC , Sensibilidad y Especificidad , Pruebas Serológicas/métodos , Viaje , Ensayo de Placa Viral , Adulto Joven
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