Diagnosis,treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children:experts'consensus statement updatedforthe Omicron variant

It has been more than 3 years since the novel coronavirus(SARS-CoV-2)pandemic raged globally.The coronavirus disease 2019(COVID-19)has greatly influenced human society.According to data from the World Health Organization(WHO),there were over 656 million confirmed cases of COVID-19 in the world as of January 1,2023,including over 6.6 million deaths[1].

Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Background Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treat-ments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed. Methods National Health Commission of China assembled an expert committee for a revision of the guidelines. The com-mittee included 33 members who are specialized in diagnosis and treatment of HFMD. Results Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia;(2) involvement of nervous system;(3) worsening respiratory rate and rhythm;(4) circulatory dysfunction;(5) elevated peripheral WBC count;(6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases. Conclusion The guidelines can provide systematic guidance on the diagnosis and management of HFMD.

Diagnosis and treatment of herpangina:Chinese expert consensus

Background Herpangina is a common infectious disease in childhood caused by an enterovirus.This consensus is aiming to standardize and improve herpangina prevention and clinical diagnosis.Methods The Subspecialty Group of Infectious Diseases,the Society of Pediatric,Chinese Medical Association and Nation Medical Quality Control Center for Infectious Diseases gathered 20 experts to develop the consensus,who are specialized in diagnosis and treatment of herpangina.Results The main pathogenic serotypes of herpangina include Coxsackievirus-A,Enterovirus-A and Echovirus.Its diagnosis can be rendered on the basis of history of epidemiology,typical symptoms,characteristic pharyngeal damage and virological tests.The treatment is mainly symptomatic,and incorporates topical oral spray with antiviral drugs.The course of herpangina generally lasts 4-6 days with a good prognosis.Conclusion The consensus could provide advices and references for the diagnosis,treatment and management of herpangina in children.

Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

In the early February,2020,we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis,treatment and prevention of coronavirus disease 2019 (COVID-19) in children,which has been published in this journal.With accumulated experiences in the diagnosis and treatment of COVID-19 in children,we have updated the consensus statement and released the second edition recently.The current version in English is a condensed version of the second edition of consensus statement on diagnosis,treatment and prevention of COVID-19 in children.In the current version,diagnosis and treatement criteria have been optimized,and early identification of severe and critical cases is highlighted.The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice.This version of experts consensus will be valuable for better prevention,diagnosis and treatment of COVID-19 in children worldwide.

Clinical features of pediatric patients with COVID-19: a report of two family cluster cases

Background Coronovirus disease 2019 (COVID-19) has spread rapidly across the globe.People of all ages are susceptible to COVID-19.However,literature reports on pediatric patients are limited.Methods To improve the recognition of COVID-19 infection in children,we retrospectively reviewed two confirmed pediatric cases from two family clusters.Both clinical features and laboratory examination results of the children and their family members were described.Results The two confirmed children only presented with mild respiratory or gastrointestinal symptoms.Both of them had normal chest CT images.After general and symptomatic treatments,both children recovered quickly.Both families had travel histories to Hubei Province.Conclusions Pediatric patients with COVID-19 are mostly owing to family cluster or with a close contact history.Infected children have relatively milder clinical symptoms than infected adults.We should attach importance to early recognition,early diagnosis,and early treatment of infected children.

Soluble IL-2Rα correlates with imbalances of Th1/Th2 and Tc1/Tc2 cells in patients with acute brucellosis

Background Previous studies showed that soluble IL-2Rαis an important marker of cellular immune activation and might be a marker of treatment efficacy for children with brucellosis.However,data regarding adult patients with brucellosis were unknown.The aim of study was to explore the potential role of serum sIL-2Rαevaluating treatment responses in adult patients with brucellosis,and T cell immune status was also examined.Methods During January 2016–April 2017,30 patients with acute brucellosis from the Third People’s Hospital of Linfen in Shanxi Province and Beijing Di Tan Hospital,and 28 healthy controls were included in this study.Peripheral blood samples were collected before and after six weeks of antibiotic treatment.Serum sIL-2Rαlevels were measured by enzyme-linked immunosorbent assay,and the percentage of Th1,Th2,Tc1,Tc2,and Tregs was detected by flow cytometry after intracellular staining for cytokines(interferon-γand interleukin-4)and Foxp3 in T lymphocytes from peripheral blood.The obtained data were analyzed with Wilcoxon ranked sum tests for paired values,Mann-Whitney U-tests for comparisons between patients and healthy controls,and Spearman rank tests for correlation analyses.Results Serum sIL-2Rαlevels were significantly higher in patients than in controls(P=0.001).A significant decline was observed in patients after the cessation of treatment(P<0.001)and return to normal(P>0.05).Th1,Tc1,Th2,and Tc2 cell frequencies were higher in patients than in healthy subjects(P<0.05),while the Th1/Th2 and Tc1/Tc2 ratios were significantly lower(P=0.0305 and 0.0005,respectively)and returned to normal levels after treatment.In patients with acute brucellosis,serum sIL-2Rαlevels were negatively correlated with the Th1/Th2 ratio(r=−0.478,P=0.028),Tc1/Tc2 ratio(r=−0.677,P=0.001),and Tc1 percentage(r=−0.516,P=0.017).Serum sIL-2Rαand Tc2 percentages were positively correlated(r=0.442,P=0.045).Conclusions Based on the correlations with Th1/Th2 and Tc1/Tc2 ratios,serum sIL-2Rαlevels may reflect the immune response status.sIL-2Rαmay be a marker for therapeutic efficacy in acute brucellosis.

Diagnosis,treatment,and prevention of monkeypox in children:an experts'consensus statement

Monkeypox is a zoonotic disease.Since the first human monkeypox case was detected in 1970,it has been prevalent in some countries in central and western Africa.Since May 2022,monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide.As of September 14,2022,there have been more than 58,200 human monkeypox cases,and there is community transmission.The cessation of smallpox vaccination in 1980,which had some cross-protection with monkeypox,resulted in a general lack of immunity to monkeypox,which caused global concern and vigilance.As of Sep-tember 14,2022,there are four monkeypox cases in China,including three in Taiwan province and one in Hong Kong city.Previous foreign studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians'understanding of monkeypox and achieve early detection,early diagno-sis,early treatment,and early disposal,we have organized national authoritative experts in pediatric infection,respiratory,dermatology,critical care medicine,infectious diseases,and public health and others to formulate this expert consensus,on the basis of the latest"Clinical management and infection prevention and control for monkeypox"released by The World Health Organization,the"guidelines for diagnosis and treatment of monkeypox(version 2022)"issued by National Health Commission of the People's Republic of China and other relevant documents.During the development of this consensus,multidisciplinary experts have repeatedly demonstrated the etiology,epidemiology,transmission,clinical manifestations,laboratory examinations,diagnosis,differential diagnosis,treatment,discharge criteria,prevention,disposal process,and key points of prevention and control of suspected and confirmed cases.

A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014–2015

Background:The Ebola virus disease spread rapidly in West Africa in 2014,leading to the loss of thousands of lives.Community engagement was one of the key strategies to interrupt Ebola transmission,and practical community level measures needed to be explored in the field and tailored to the specific context of communities.Methods:First,community-level education on Ebola virus disease(EVD)prevention was launched for the community’s social mobilizers in six districts in Sierra Leone beginning in November 2014.Then,from January to May of 2015,in three pilot communities,local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures,by involving them in alert case report,contact tracing,and social mobilization.The epidemiological indicators of transmission interruption in three study communities were evaluated.Results:A total of 6016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts,and EVD message reached an estimated 631680 residents.In three pilot communities,72 EVD alert cases were reported,with 70.8%of them detected by trained local community members,and 14 EVD cases were finally identified.Contact tracing detected 64.3%of EVD cases.The median duration of community infectivity for the cases was 1 day.The secondary attack rate was 4.2%,and no third generation of infection was triggered.No health worker was infected,and no unsafe burial and noncompliance to EVD control measures were recorded.The community-based measures were modeled to reduce 77 EVD cases,and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.Conclusions: The community-based strategy of social mobilization and community engagement was effective in casedetection and reducing the extent of Ebola transmission in a country with weak health system. The successfullypractical experience to reduce the risk of Ebola transmission in the community with poor resources would potentiallybe helpful for the global community to fight against the EVD and the other diseases in the future.

Expert consensus on COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)is a public health disaster that has not been encountered for a hundred years.On January 12,2020,the World Health Organization(WHO)confirmed and named the coronavirus which caused unexplained pneumonia as 2019 novel coronavirus(2019-nCoV).Since then,the disease caused by this virus had been named as coronavirus disease 2019(COVID-19).On February 11,2020,the International Committee on Taxonomy of Viruses announced that the English name of the novel coronavirus was severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)[1].At present,SARS-CoV-2 infection is still rampant worldwide.As of September 10,2021,there were about 222 million confirmed cases of COVID-19 and more than 4.5 million deaths worldwide[2].According to the American Centers for Disease Control and Prevention,by July 29,2021,4.19 million pediatric COVID-19 cases had been reported in the United States。

Global Pediatric Pulmonology Alliance(GPPA)proposal for COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)remains a global epidemic.As of August 18,2021,the number of reported cases has exceeded 207 million globally,with more than 4.3 million deaths.COVID-19 has brought devastating losses to human society.The overall crude mortality rate is 1-3%.Although pediatric deaths from COVID-19 are rare,they do occur,as over 9,000 children have died from COVID-19 globally to date[1].With the gradual and broad application of COVID-19 vaccines around the world,the rising proportion of cases among children and unvaccinated young adults demands attention.According to World Health Organization surveillance data.