Leonard R. Krilov

SENTINEL1: An Observational Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis

Objective SENTINEL1 characterized U.S. preterm infants 29 to 35 weeks gestational age (wGA) < 12 months old hospitalized for laboratory‐confirmed respiratory syncytial virus (RSV) disease and not receiving RSV immunoprophylaxis during the 2014 to 2015 RSV season. Study Design This is a noninterventional, observational, cohort study. Results A total of 702 infants were hospitalized with community‐acquired RSV disease, of whom an estimated 42% were admitted to the intensive care unit (ICU) and 20% required invasive mechanical ventilation (IMV). Earlier gestational age and younger chronologic age were associated with an increased frequency of RSV‐confirmed hospitalization (RSVH), ICU admission, and IMV. Among infants 29 to 32 wGA and < 3 months of age, 68% required ICU admission and 44% required IMV. One death occurred of an infant 29 wGA. Among the 212 infants enrolled for in‐depth analysis of health care resource utilization, mean and median RSVH charges were

Palivizumab in the prevention of respiratory syncytial virus disease

55,551 and

Rapid influenza A testing for novel H1N1: point-of-care performance.

27,461, respectively, which varied by intensity of care required. Outpatient visits were common, with 63% and 62% of infants requiring visits before and within 1 month following the RSVH, respectively. Conclusion Preterm infants 29 to 35 wGA are at high risk for severe RSV disease, which imposes a substantial health burden, particularly in the first months of life.

Recent developments in the treatment and prevention of respiratory syncytial virus infection

Respiratory syncytial virus (RSV) infection is the leading cause of lower respiratory tract infection in infants and young children. Premature infants and infants with underlying lung disease are at increased risk for severe RSV infection in the first 1 – 2 years of life. Monthly prophylaxis with palivizumab (Synagis®) during RSV season has been proven safe and effective in this population and these effects have persisted over the 4 years since the drug was approved by the US FDA in 1998. Issues remain regarding the optimal candidates for palivizumab prophylaxis and whether additional groups of high-risk individuals, for example infants with congenital heart disease or cystic fibrosis, and immunocompromised hosts, might benefit from such preventive therapy. It is possible that palivizumab in combination with antiviral or anti-inflammatory agents might also prove to be beneficial in the treatment of RSV disease. Newer monoclonal antibodies to RSV in development may offer the potential for less frequent dosing, increased efficacy and a role in treatment of RSV disease, but pending further evaluation of such products palivizumab provides significant protection for high-risk infants against a major pathogen.

When Animal Viruses Attack: SARS and Avian Influenza

Abstract Objectives: The 2009 outbreak of novel influenza A H1N1 reached a pandemic status on June 11, 2009. Early detection is a key factor for management and infection-control practices. Recent studies have suggested a difference in performance of rapid influenza kits for influenza A H1N1. Our goal was to evaluate the performance of the QuickVue® influenza A+B test (Quidel Corp., San Diego, CA) in an emergency department setting and determine the most current epidemiologic trends in our community. Methods: Results from 1137 samples for influenza A collected between April 8, 2009 and June 30, 2009 were retrospectively reviewed. Results of QuickVue® influenza A+B test were compared with R-Mix viral culture and DFA results. Age distribution and hospitalization rates by age group were analyzed to further delineate the epidemiology of influenza A in a suburban hospital. Results: The sensitivity of the rapid test was 77%, the specificity was 85%, the positive predictive value was 74%, and the negative predictive value was 87%. We found a similar age distribution for positive influenza tests and admissions when compared with the national Centers for Disease Control and Prevention data. Conclusions: The QuickVue® influenza A+B test is a sensitive assay for the novel H1N1 strain of influenza. In our hospital, the group with highest risk of hospital admission was patients aged < 25 years.

Vaccine-preventable outbreaks: still with us after all these years.

Respiratory syncytial virus infection is the leading cause of lower respiratory tract infection in infants and young children. Premature infants, as well as those with underlying lung disease (chronic lung disease of infancy), congenital heart disease, neuromuscular disease or metabolic disorders, are at greater risk of severe disease when infected with RSV. Infants hospitalised by RSV infection have an increased frequency of subsequent episodes of wheezing throughout childhood. The elderly and bone marrow transplant patients have also been shown to be at risk of severe RSV disease. Treatment of RSV infection is primarily supportive care. The antiviral drug ribavirin (Virazole™ , ICN Pharm.) is the only approved agent for treating infants with severe RSV disease; however, its use has been limited by the mode of administration (prolonged aerosol), cost and limited efficacy. The humanised mAb palivizumab (Synagis™, MedImmune) is indicated for the prevention of severe RSV disease in premature infants and those with CLD but has not proven effective for treating established RSV disease. More recent antiviral compounds with anti-RSV activity in vitro are being developed. Additionally, mAbs against RSV with improved affinity and/or half-life are being developed, as are a number of approaches to developing safe and effective RSV vaccines. Finally, treatment of RSV disease may require anti-inflammatory, as well as antiviral, medications.

The 2014–2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States

SARS and avian influenza have many common features. They both arose in Asia and originated from animal viruses. They both have the potential to become pandemics because human beings lack antibodies to the animal-derived antigens present on the viral surface and rapid dissemination can occur from the relative ease and availability of high speed and far-reaching transportation methods. Pediatricians, in particular, should remain alert about the possibility of pandemic illnesses in their patients. Annual rates of influenza in children may be 1.5 to 3 times those in the adult population, and infection rates during a community epidemic may exceed 40% in preschool-aged children and 30% in school-aged children. Infected children also play a central role in disseminating influenza, as they are the major point of entry for the virus into the household, from which adults spread disease into the community. Of course, children younger than 24 months also are at high risk for complications from influenza. A 1999 Centers for Disease Control and Prevention projection of an influenza pandemic in the US paints a grim picture: 89,000 to 207,000 deaths, 314,000 to 734,000 hospitalizations, 18 million to 42 million outpatient visits, and 20 million to 47 million additional illnesses, at a cost to society of at least dollars 71.3 billion to dollars 166.5 billion. High-risk patients (15% of the population) would account for approximately 84% of all deaths. Although SARS has been kind to the pediatric population so far, there are no guarantees that future outbreaks would be as sparing. To aid readers in remaining up-to-date with SARS and avian influenza, some useful websites are listed in the Sidebar. Two masters of suspense, Alfred Hitchcock and Stephen King, may have been closer to the truth than they ever would have believed. Both birds and a super flu could bring about the end of civilization as we know it. But all is not lost--to paraphrase Thomas Jefferson, the price of health is eternal vigilance. Although we may not be able to prevent future pandemics, mankind has the ability to recognize new diseases and outbreaks as they occur, to study these infections and find ways to contain and treat them, and to implement the necessary measures to defeat them.

Health-Care Interventions with Games: A low-cost, high-impact approach.

Outbreaks of vaccine-preventable diseases continue to occur in the United States, and they have been occurring at increasing rates over the past decade. Factors contributing to these outbreaks include importation from abroad, under-vaccination of segments of the population, and incomplete protection or waning immunity with certain vaccines. This article reviews recent outbreaks of measles, mumps, and pertussis in the United States to highlight the extent to which outbreaks of these vaccine-preventable diseases are still occurring and even increasing. Appreciating the magnitude of these illnesses may help the physician in educating families who are hesitant about vaccines.

Viral Infections in the Nursery

Objective This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full‐term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks gestational age (wGA). Study Design Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infants age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. Results Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014‐2015 season relative to the 2013‐2014 season. Compared with the 2013‐2014 season, RSVH increased by 2.7‐fold (p = 0.02) and 1.4‐fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014‐2015 season with commercial and Medicaid insurance, respectively. In the 2014‐2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full‐term infants without high‐risk conditions. Conclusion Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.

Clostridium difficile Infection in Children

The increasing acceptance of the efficacy and validity of applied games, and specifically games for health, has fostered the growth of new ideas and applications. Engineers and game developers are working on a range of products that integrate new electronics that can detect physiological states with game or game-like interfaces. These devices can record and transmit physical and behavioral data as well as motivate participants to modify behavior in prosocial and prohealth ways. The U.S. and European Games for Health conferences, now held annually, are a testament to the increasing specialization in this area. Participants at the 2014 IEEE Games, Entertainment, and Media (GEM) Conference in Toronto presented papers on several health-related topics, including using games to motivate patients to do rehabilitation, training physicians to perform difficult procedures, and improving continuing education practices for health-care professionals.