Severe viral infections in Severe viral infections in childhood: recent developments childhood: recent developments Brian Eley Paediatric Infectious Diseases Unit Red Cross Children’s Hospital School of Child and Adolescent Health University of Cape Town
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Severe viral infections in childhood: recent developments Brian Eley Paediatric Infectious Diseases Unit Red Cross Children’s Hospital School of Child.
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Severe viral infections in childhood: Severe viral infections in childhood: recent developmentsrecent developments
Brian Eley
Paediatric Infectious Diseases Unit
Red Cross Children’s Hospital
School of Child and Adolescent Health
University of Cape Town
OverviewOverview
• Measles
• HIV infection in young children
• Severe pneumonia in HIV-infected infants
• Viral sepsis
Measles: annual global cases & Measles: annual global cases & vaccine coverage, 1980-2008vaccine coverage, 1980-2008
1WHO. Wkly Epidemiol Rec 2009;84:349-3602Coetzee N, et al. S Afr Med J 1994;84:145-1493Corrigall J, et al. S Afr Med J 2008;98:41-45
4Gagneur A, et al. Clin Vaccine Immunol 2008;15:1845-18505R Scott, et al. Clin Infect Dis 2007;45:1417-14246 McMorrow LC, et al. S Afr Med J 2009;99:314-319
Immunisation practiceImmunisation practice
• Mass immunisation campaign– Ro = 15 – 17 in susceptible populations; vaccine
coverage ≥ 95% required to control the circulation of wild-type virus1,2
– National campaign planned for April 2010, targeting all children between 9 months and 15 years
• MV1 at 12-15 months of age
• WHO position on asymptomatic, HIV-infected children3 • 6 months, 9 months & 18 months
3WHO. Wkly Epidemiol Rec 2009;84:349-3601Tang JW, et al. J Hosp Infect 2006;64:100-1142Uzicanin A, et al. Int J Epidemiol 2002;31:968-976
Measles case managementMeasles case managementVariable Placebo
(n=97)Vitamin A
(n=92)RR (95% CI) P value
Death 10 2 0.21 (0.05-0.94) 0.046
Pneumonia duration (d) 12.4 6.5 <0.001
Diarrhoea duration (d) 8.5 5.6 <0.001
Post-measles croup 27 13 0.51 (0.28-0.92) 0.033
Adverse outcome 52 25 0.51 (0.35-0.74) <0.001
Hospital stay (d) 15.2 10.5 0.004
Vitamin A administration on two successive days
Daily dose Age categories
50,000 IU < 6 months
100,000 IU 6 – 11 months
200,000 IU ≥ 12 months
Hussey GD & Klein M. N Engl Med J 1990;323:160-164WHO. Wkly Epidemiol Rec 2009;84:349-360McMorrow LC, et al. S Afr Med J 2009;99:314-319
Cumulative mortality of HIV-infected Cumulative mortality of HIV-infected children in sub-Saharan Africachildren in sub-Saharan Africa
On World AIDS Day (1 December 2009) President Zuma announced that all children less than 12 months old with HIV infection should commence ART as soon as possible following diagnosis
• Application to fungal sepsis– Unspecific 28S rRNA gene-targeted assays2
– 18S rRNA gene-targeted PCR for Candida infections7
– Multiplex formats4,6,8
• Application to viral pathogens– Multiplex formats for common viral and bacterial pathogens9
– Real-time PCR assays for enteroviruses and parechoviruses10,11
– Real-time PCR for type-specific herpes simplex viruses12
1Wellinghausen N, et al. J Clin Microbiol 2009;47:2759-27652Zhao Y, et al. J Clin Microbiol 2009;47:2067-20783Perchorsky A, et al. J Microbiol Meth 2009;78:325-3394Lehmann LE, et al. Intensive Care Med 2010;36:49-565Bloos F, et al. Intensive Care Med 2010;36:241-2476Avolio M, et al. Shock 2010, Jan 19 [Epub ahead of print]
7Wellinghausen N, et al. Med Microbiol 2009;58(Pt 8):1106-1118 Lau A, et al. J Clin Microbiol 2009, 30 Dec [Epub ahead of print]9Kumar S, et al. J Clin Microbiol 2008;46:3063-307210Noordhoek GT, et al. J Clin Virol 2008;41:75-8011Meylan S, et al. J Clin Virol 2008;41:87-9112Benschop K, et al. J Clin Virol 2008;41:69-74
ConclusionConclusion
• To increase the effectiveness of measles immunisation the age of MV1 should be reconsidered
• The care needs of young HIV-infected children should be prioritised
• Further molecular diagnostic developments are required to advance the concept of viral sepsis, particularly in the setting of neonatology