Expert consensus on the diagnosis, treatment, and prevention of respiratory syncytial virus infections in children

Background Respiratory syncytial virus(RSV)is the leading global cause of respiratory infections and is responsible for about 3 million hospitalizations and more than 100,000 deaths annually in children younger than 5 years,representing a major global healthcare burden.There is a great unmet need for new agents and universal strategies to prevent RSV infections in early life.A multidisciplinary consensus development group comprising experts in epidemiology,infectious diseases,respiratory medicine,and methodology aims to develop the current consensus to address clinical issues of RSV infections in children.Data sources The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Library,using variations in terms for"respiratory syncytial virus","RSV","lower respiratory tract infection","bronchiolitis","acute","viral pneumonia","neonatal","infant""children",and"pediatric".Results Evidence-based recommendations regarding diagnosis,treatment,and prevention were proposed with a high degree of consensus.Although supportive care remains the cornerstone for the management of RSV infections,new monoclonal antibodies,vaccines,drug therapies,and viral surveillance techniques are being rolled out.Conclusions This consensus,based on international and national scientific evidence,reinforces the current recommendations and integrates the recent advances for optimal care and prevention of RSV infections.Further improvements in the management of RSV infections will require generating the highest quality of evidence through rigorously designed studies that possess little bias and sufficient capacity to identify clinically meaningful end points.

Safety and clinical efficacy of linezolid in children:a systematic review and meta-analysis

Background We aimed to evaluate the tolerability and efficacy of linezolid in children for treating suspected and diagnosed Gram-positive bacterial infections.Methods A systematic literature search was conducted up to April 23,2021,using linezolid and its synonyms as search terms.Two reviewers independently identified and extracted relevant randomized controlled trials and prospective cohort studies.The extracted studies were included in a single-rate meta-analysis of adverse events and clinical outcomes using random-effects models.Results A total of 1082 articles were identified,and nine studies involving 758 children were included in the meta-analysis.The overall proportion of adverse events was 8.91%[95%confidence interval(CI)=1.64%–36.52%],with diarrhea(2.24%),vomiting(2.05%),and rash(1.72%)being the most common.The incidences of thrombocytopenia and anemia were 0.68%and 0.16%,respectively.Some specific adverse events,including rash and gastrointestinal events,were more frequent in the oral administration subgroup.In terms of efficacy,the overall proportion of clinical improvement was 88.80%(95%CI=81.31%–93.52%).Children with a history of specific bacteriological diagnosis or concomitant antibiotic therapy had a 1.13-fold higher clinical improvement than children without such histories.The proportion of microbial eradication was 92.68%(95%CI=84.66%–96.68%).The proportion of all-cause mortality was 0.16%(95%CI=0.00%–7.75%).Conclusions Linezolid was well-tolerated in pediatric patients and was associated with a low frequency of adverse events,such as anemia,thrombocytopenia,and neutropenia.Moreover,linezolid was effective in children with diagnosed and suspected Gram-positive infections.

Acute Hepatitis of Unknown Origin in Children: Early Observations from the 2022 Outbreak

Recent reports of acute hepatitis of unknown origin in previously healthy children have been increasing worldwide.The main characteristics of the affected children were jaundice and gastrointestinal symptoms.Their serum aminotransaminase levels were above 500 IU/L,with negative tests for hepatitis viruses A–E.By 31 May 2022,the outbreak had affected over 800 children under the age of 16 years in more than 40 countries,resulting in acute liver failure in approximately 10%,including at least 21 deaths and 38 patients requiring liver transplantation.There was still no confirmed cause or causes,although there were several different working hypotheses,such as severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),adenovirus serotype 41,or SARS-CoV-2 superantigen-mediated immune cell activation.Here,we review early observations of the 2022 outbreak which may inform diagnosis,treatment,and prevention in the context of an overlapping COVID-19 pandemic.

Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in China in 2014

Background To quantify the associations between the under-five mortality rate(U5MR)and measures of pediatric human resources,including pediatricians per thousand children(PPTC)and the geographical distribution of pediatricians.Methods We analyzed data from a national survey in 2015-2016 in 2636 counties,accounting for 31 mainland provinces of China.We evaluated the associations between measures of pediatric human resources and the risk of a high U5MR(>18 deaths per 1000 live births)using logistic regression and restricted cubic spline regression models with adjustments for potential confounders.PPTC and pediatricians per 10,000 km^(2) were categorized into quartiles.The highest quartiles were used as reference.Results The median values of PPTC and pediatricians per 10,000 km^(2) were 0.35(0.20-0.70)and 150(50-500),respectively.Compared to the counties with the highest PPTC(≥0.7),those with the lowest PPTC(<0.2)had a 52% higher risk of a high U5MR,with an L-shaped relationship.An inverted J-shaped relationship was found that the risk of a high U5MR was 3.74[95%confidence interval(CI)2.55-5.48],3.07(95% CI 2.11-4.47),and 2.25 times(95% CI 1.52-3.31)higher in counties with<50,50-149,and 150-499 pediatricians per 10,000 km^(2),respectively,than in counties with≥500 physicians per 10,000 km^(2).The joint association analyses show a stronger association with the risk of a high U5MR in geographical pediatrician density than PPTC.Conclusion Both population and geographical pediatrician density should be considered when planning child health care services,even in areas with high numbers of PPTC.