bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitators and barriers to revaccination after hematopoietic stem cell transplantation among pediatric patients in Ecuador
Authors: Freire Dolores , Ladines Washington J 
Published: October 2024

Abstract

Background
Revaccination after hematopoietic stem cell transplantation (HSCT) is a challenge in areas where there is variability of access to vaccines and where special schedules are unfamiliar to physicians and primary care providers. We report the experience of re-immunization practices in pediatric patients after HSCT in Ecuador.

Methods
The database and medical charts of pediatric patients who had been in follow after HSCT from 2021 to 2023 in Solca Guayaquil was reviewed in order to assess the completeness of the revaccination schedule and to identify facilitators and barriers in implementation of the process. Patients with pediatric infectious diseases follow up where included.

Results
There were 30 patients who underwent HSCT during the reviewed period. Among them, 7 were excluded because they had not been seen by pediatric infectious diseases. Four patients who had their HSCT before the studied period were later added as they received follow-up by the specialty, therefore a total of 27 patients were included. There were 16 (59.3%) boys, mean age was 11 years (SD 3.6), and 16 (59.3%) lived outside Guayaquil. The most common diseases prompting HSCT were 14 (51.9%) lymphoblastic leukemia, 4 (14.8%) myeloid leukemia, 3 (11.1%) for Hodgkin lymphoma and 3 (11.1%) aplastic anemia. HSCT was performed outside Ecuador in 15 (55.6%) cases. Reimmunization schedule had been initiated in 21 (77.7%) of patients. Public health system was used exclusively in 11 (52.4%) cases, a combination of private and public system in 8 (38.1%) cases and exclusively private system in 2 (9.5%) cases. Among them, 9 (42.9%) had completed all recommended inactivated vaccines. Mean number of visits required for this was 5.1 (SD 1.9). After completion of inactivated vaccines, live vaccines where recommended and had been completed by 2 (9.5%) patients. The main facilitator identified was vaccine confidence and adherence to physician recommendations while the main barriers identified where health system related: a) Lack of awareness in public vaccination centers about special schedules, b) lack of availability of age licensed vaccines in public system and c) Lack of documentation of immunization administrated.

Conclusion
Health system related logistics (vaccine availability, knowledge of special schedules, coordination with immunization centers) continues to be a main barrier to complete recommended reimmunization schedule after HSCT while confidence in vaccines and adherence is the main facilitator in Ecuador. Government interventions need to be implemented in order to facilitate the process for this population of patients.

Figure 1. Revaccination after hematopoietic stem cell transplantation in Solca Guayaquil (2021 – 2023).
Stenotrophomonas maltophilia bacteremia in hemato-oncological patients
Authors: Zurita Paulina M , Villanueva G Itzel , Flores Oscar F , Ordoñez Javier , Minero Miguel A , Morayta Alfredo R 
Published: October 2024

Abstract

Background
Stenotrophomonas maltophilia is an increasingly common cause of bacteremia in immunocompromised patients, particularly those with underlying neutropenia. This study aims to characterize the clinical presentation, risk factors, and outcomes of Stenotrophomas maltophilia bacteremia in pediatric hemato-oncological patients.

Methods
We retrospectively reviewed the medical records of nine pediatric hemato-oncological patients who developed a cluster of Stenotrophomas maltophilia bacteremia at our institution from September to November in 2023. The identification and antibiotic susceptibility testing was performed by Vitek 2. Data collected included patient demographics, clinical presentation, underlying disease, treatment regimens, and outcomes.

Results
We identified nine cases of Stenotrophomas maltophilia bacteremia during the study period. The median age of the patients was 11 years (range 3-16 years), 7 were male. All patients had underlying hematologic malignancies (particularly acute lymphoblastic leukemia) and had profound neutropenia (ANC &lt;100/mm3) at the time of bacteremia. The most common clinical presentation were fever (100%) and the most frequent risk factors were having a central venous catheter (CVC) (100%) and early chemotherapy treatment prior the diagnosis, median of 9 days (range 3-14 days). All patients received intravenous antibiotics, and the most commonly used agent was trimethoprim-sulfamethoxazole (TMP-SMX), the median duration of treatment was 12 days (range 7-16 days). The overall mortality rate was 11.1% on a patient with necrotizing fasciitis.

Conclusion
Stenotrophomas maltophilia bacteremia is a severe complication in pediatric hemato-oncological patients, considering its multidrug-resistance profile. The rise in Stenotrophomonas maltophilia isolations has triggered the implementation of outbreak investigation measures and exhibits the importance of an adequate control in central line care. Early diagnosis and appropriate antimicrobial therapy are crucial for improving outcomes.
Varicella zoster infection in Pediatric oncology patients in Hue Central Hospital, Vietnam
Authors: Nguyen Thi Kim Hoa 
Published: October 2024

Abstract

Background
Varicella zoster infection in pediatric oncology patients presents a big challenge. It could lead to a severe, prolonged and disseminated infection with complications in multiple organs. This study aimed to investigate varicella zoster infection in pediatric oncology patients at Hue Central Hospital, Vietnam in order to describe demographic, epidemiological, clinical features and complications.

Methods
Varicella zoster infections among children with cancer were identified between January 8 to November 4, 2023, at Hue Central Hospital. Varicella zoster infection was diagnosed clinically based on the presence of typical skin manifestations. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA).

Results
From January 8 to November 4, 2023, a total of 20 patients with malignancies were identified as having varicella zoster, with a median age of 3.5 years (range: 1 years to 16 years). All these patients did not received varicella zoster vaccine. Almost half of the patients had solid tumor (n=11, 55.0%), and other half had leukemia (n=9, 45.0%). Some of them (n=7, 35.0%) were receiving chemotherapy, and other (n=13, 65%) just finished chemotherapy. Most children were hospitalized (n=16, 80.0%) and they were given oral acyclovir (n=18, 90.0%). Three children (15.0%) required critical care (severe infection, acute pancreatitis, and multiorgan failure (MOF)), and one (5.0%) died from disseminated and progressive varicella with MOF and suspected varicella zoster meningitis. Chemotherapy was delayed or omitted due to varicella in 70.0%. Some of the children with varicella acquired from their parents. There were 5 parents who got varicella zoster when taking care patients at the hospital. All patients were likely to expose other patients in the wards.

Conclusion
Children with cancer are at extra risk of varicella zoster infection and progression to severe disease due to their immunocompromised status. Optimizing vaccination of care providers, such as their relatives, will prevent transmitting virus to the patients.
Molecular and Seroepidemiologic Characteristics ofStaphylococcus aureus in Children with Cystic Fibrosis
Authors: Ryan Vivian G , Creech C Buddy , Soper Nicole R , Yoder Sandra M , Brady Eric , Thomsen Isaac P , Sokolow Andrew G 
Published: October 2024

Abstract

Background
Cystic fibrosis (CF), through altered sodium and chloride transport across the CF transmembrane receptor (CFTR), is associated with poor mucus clearance, bacterial colonization of the lower airway, chronic pulmonary disease punctuated by acute exacerbations, and chronic inflammation. With increased use of CFTR modulators, changes in the CF pulmonary microbiome have been observed, including decreased prevalence of Pseudomonas colonization; however, overall S. aureus prevalence remains largely unchanged. An important remaining question is whether changes in the CF pulmonary microbiome, while not affecting the overall prevalence of S. aureus colonization, has led to changes in S. aureus diversity or the strain types that are most frequently recovered from children with CF. It is also unknown whether the humoral immune response to S. aureus is altered in the presence of CFTR modulator therapy.

Methods
Genomic DNA was extracted from S. aureus isolates obtained from two cohorts: a historic cohort, comprised of children not receiving CFTR modulators, and a modern cohort, comprised of children receiving CFTR modulator therapy. Multilocus sequence typing (MLST) and whole genome sequencing (WGS) were used to identify clonotype and characterize virulence factors of interest. Serum was obtained from participants and antibody titers to the extracellular toxins LukAB and LukED were measured.

Results
One hundred participants were enrolled: 50 in cohort 1 (historic) and 50 in cohort 2 (modern). Compared to cohort 1, isolates identified in cohort 2 were less likely to contain ACME and mecA; similarly, cohort 2 isolates were more likely to contain PVL, sek, and sak. The frequency of specific clonotypes changed over time, with increased prevalence of CC8 and decreased prevalence of CC1, CC5, CC15, and CC30 in cohort 2 compared to cohort 1 (Figure 1A). Serum antibody concentrations to LukAB, a conserved toxin across S. aureus, were similar across cohorts (Figure 1B).

Conclusion
Over time, the clonotypes responsible for S. aureus colonization in patients receiving CFTR modulators have changed. Despite changes in clonotypes and receipt of CFTR modulators, serum concentrations of LukAB-specific antibodies did not differ. These data suggest that staphylococcal colonization in patients with CF is dynamic over time and may be modified based on the receipt of CFTR modulator therapy.

Figure 1. (A) S. aureus clonal complexes, over time, demonstrating a relative increase in CC8 between 2012 and 2022; (B) serum concentrations of LukAB antibodies from 2012 (historic) and 2022 (modern) cohorts. No significant difference was observed in median anti-LukAB concentrations.
New US DHHS Guidelines for Feeding of HIV Exposed Infants: Uptake, Practice Variability and Concerns
Authors: Eisenberg Ilan Rozen , Campbell Jeffrey , Clarke Diana , Cooper Ellen , Pelton Stephen , Vuppula Sharon 
Published: October 2024

Abstract

Background
Approximately 5000 infants are born to mothers living with HIV annually in the US. In the past, the Center for Disease Control (CDC), American Academy of Pediatrics (AAP), and US Department of Health and Human Services (DHHS) have recommended that people living with HIV (PWH) not breast/chest feed their infants. Recent changes published in January 2023 in the “Section on Infant Feeding for Individuals Living with HIV” in the US DHHS HIV Guidelines, now include that individuals with HIV who are on antiretroviral therapy (ART) with a sustained undetectable viral load (VL) and who choose to breastfeed should be supported in this decision. We evaluated the uptake of these guidelines, and practice variability across providers who care for such mothers and infants.

Methods
We surveyed Pediatric Infectious Diseases Society members who practice clinically in the US, via an internal email list serve. The ten-question survey assessed uptake of the updated DHHS guidelines and respondents’ clinical practice in three key areas that are subject to interpretation in the guidelines: VL control, mixed feeding, and ART prophylaxis. We used descriptive statistics to examine guideline uptake and variability in practice. We used inductive qualitative thematic analysis to identify themes in open-ended survey responses.

Results
Of 915 individuals who opened the survey, 165 responded and 129 were included in the final analysis. Respondents represented 86 US clinical centers. Uptake varied: 14 respondents (10.8%) were unaware of the new guidelines, 103 (79.8%) had implemented or were planning to implement the new guidelines, and 12 (9.3%) were not planning to implement the guidelines. The table summarizes variability in pre-delivery VL suppression and mixed feeding criteria used by 117 respondents who are either planning/already implementing guidelines or who are unaware of guidelines. Areas of concern revealed by thematic analysis included insufficient data to support guidelines and lack of specific criteria for implementation.

Conclusion
We identified substantial heterogeneity in provider uptake and comfort with new breastfeeding guidelines among US pediatric infectious diseases practitioners, and variability in assessment of safety to breastfeed. Further research is essential to explore patient preferences, define necessary follow-up, and address provider concerns regarding insufficient data to support guidelines and lack of specific criteria for implementation.
STI Rates Among High-Risk Youth Undeterred During Early COVID-19 In A HIV Care Clinic
Authors: Bittle Elspeth , Patel Nehali , Knapp Katherine , Green Amanda 
Published: October 2024

Abstract

Background
In recent years, the United States has observed increasing rates of sexually transmitted infections (STIs). Rates are highest amongst the teen and young adult age groups. In addition to the immense healthcare costs associated with STIs, long-term sequelae can be severe on the individual level. The risk of infertility is particularly high for those with repeated or prolonged infection. Upon entering the COVID-19 pandemic, it was unclear if the widespread behavioral changes and disruptions in routine care practices to minimize the further spread of COVID-19 would cause an increase or decrease in the United States’ STI rates. This study sought to determine if there was a change in the incidence of STIs during the first year of the COVID-19 pandemic compared to the year prior in a population at high risk for STIs.

Methods
A retrospective chart review was performed for 330 patients aged 12 to 41 years (mean 20.2 years, median 20 years, standard deviation 3.75 years) with human immunodeficiency virus (HIV) or on pre-exposure prophylaxis (PrEP) to prevent the acquisition of HIV, who presented for preventative and acute care appointments at a multidisciplinary pediatric and young adult HIV Clinic in the year prior to and during the first year of the COVID-19 pandemic (March 22, 2019-March 21, 2021). Utilizing telehealth, rapid COVID-19 screening, and multimodal patient communication, increased efforts were made in this clinic during the pandemic to maintain appropriate STI screening, testing, treatment, and rescheduling of routine visits when appropriate to minimize COVID-19 exposure and spread. Comparisons were made between the two time periods, which evaluated the incidences of individual and overall STIs diagnosed per person-years, STIs per total tests performed, and time to treatment initiation.

Results
Between one year prior to and the first year during the COVID-19 pandemic, this clinic experienced no statistically significant rate changes of sexually transmitted infections. A non-significant decreased incidence of chlamydia (22 cases per 100 person-years and 18 cases per 100 person-years, respectively) and unchanged rates of gonorrhea (22 cases per 100 person-years and 22 cases per 100 person-years, respectively) and syphilis (16 cases per 100 person-years and 15 cases per 100 person-years, respectively) were observed. The median times to treatment remained largely unchanged.

Conclusion
This HIV care clinic experienced a decreased chlamydia infection rate, a trend similar to the CDC United States STI data during this time period. In contrast to the nationally reported increased rates of gonorrhea and syphilis, this clinic experienced unchanged rates. The lack of change in our cohort could reflect that the benefits of a multidisciplinary HIV care model persist despite a pandemic that disrupted routine medical care and behavior practices.
Antibody responses to re-immunization in recipients of allogeneic hematopoietic cell transplantation
Authors: Hijano Diego R , Bhoopalan Senthil , Zeng Emily , Selukar Subodh , Sharma Akshay , Maron Gabriela 
Published: October 2024

Abstract

Background
Immunologic memory against vaccine-preventable diseases is often lost after an allogeneic hematopoietic cell transplant (allo-HCT), therefore recipients are required to be re-immunized after allo-HCT to regain immunity against these infections. But the response to vaccination after an allo-HCT can be highly variable and is not well understood. We performed a single center retrospective study to examine immunization practices and determine the rate of vaccine protection and seroconversion following vaccination after allo-HCT.

Methods
Electronic medical records (EMR) from patients ≤18 years of age who underwent allo-HCT at St. Jude Childrens’ Research Hospital between 2005 - 2021 were reviewed. Clinical information and serology results before and after completion of the immunizations series were extracted from the EMR. The vaccines included in this analysis were diphtheria, measles, mumps, rubella (MMR), varicella, and polio. Protection was evaluated only for infections with established immune correlates. Seroconversion was defined as 4-fold increase in titers for vaccines with quantitative antibody assays, or as a change from negative to positive IgG for vaccines with qualitative antibody tests.

Results
760 patients were included in this cohort. Demographic and clinical data are summarized in Table 1. The mean age at allo-HCT was 10.4 years, most were male (56.8%) and white (74.6%). Acute leukemia accounted for 66.4% of allo-HCT recipients. Conditioning was myeloablative for 53.45%, and reduced intensity for 37.9%. Most received transplants from mismatched-related donors, (44.9%), followed by matched unrelated donors (35.4%) and matched related donors (19.5%). The number of patients who received the full vaccination series at our institution differed by vaccine and ranged from 41-150, and the respective subsets with available pre-vaccination and post-vaccination titers ranged from 24-93. The median time from transplant to initiation of immunizations was 12 months (range: 6-58) for non-live vaccines, 25 months (range: 23, 63) for MMR vaccine, and 28 months (range: 16, 117)) for varicella vaccine. Protection post immunization varied, with less patients demonstrating protections for mumps (79%) and measles (82%) (Figure 1). Seroconversion also varied among the different vaccine components and types of vaccines.

Conclusion
Current strategies to re-immunize patients after allo-HCT do not provide protection to all patients. Understanding the factors associated with suboptimal immune responses is critical for advancing our knowledge in this area. Whether time-based approaches combined with immune reconstitution data are required to further optimize protection remains unclear. Additionally, different vaccine schedules (i.e., higher doses) may be required in these patients.

Figure 1. Protection and seroconversion rate by vaccine target.
Association Between Measurable Residual Levels and Infection Mortality in Acute Myeloid Leukemia
Authors: Gomez S , Deana A , Ruiz C , Riccheri C , Caniza M 
Published: October 2024

Abstract

Background
Acute myeloid leukemia (AML) outcomes have improved over the years. Better AML disease risk classification, achieved by measuring minimal residual disease (MRD) levels, has contributed to improved treatment and survival. Even though the role of MRD in survival is still preliminary, results are promising. However, infections are still a problem to circumvent. In our previous protocol LMA-GATLA 2007 we found a 30% incidence of sepsis related death (SRD), and they were more frequent during or after first induction. The overall survival of that study was 51.4 % (0.38). In this study, we aimed to analyze the mortality rates due to infection; and determine if there is an association of the MRD levels and infection mortality rates; also, we will analyze overall outcomes of AML.

Methods
Patients were accrued form the National Registry GATLA LMA 2021 protocol. Disease risks were classified based on cytogenetics and molecular abnormalities as standard risk (SR), high risk (HR), and very high risk (VHR). MRD determinations were performed using flow cytometry after 1st induction with mitoxantrone, anthraciclines and etoposide (MAE) protocol, at day 22 and 29 and after 2nd induction with high dose citarabine and mitoxantrone (HAM). We used descriptive statistics (analysis by frequency), compared categorical variables using chi-square or χ2 test and Fisher test, and time to event calculation techniques.

Results
95 patients have been accrued, 51.6 % were males. The median age was 9 years of age (IQR 3-13), and 31% were SR, 22% HR, and 47% VHR. MRD levels &lt; 0.1% were seen in 55.5% post first induction, 92% post intensification and 85% post consolidation. Estimated probability of overall survival was 65% (ES 0.6) at 45.7 (2.7) months, (CI 95% 40.3-51,1). 23 pts (24%) died; 11 (48 %) for progression, 7 (30%) for sepsis, for non-sepsis toxicity 3 (13%), other causes 2 pts (9%). Hazard ratio of death with MRD &gt; 0.1% was 2.35 (p=0.06, 95% CI 0.043-1.756). The incidence of SRD was 7.4%, 4 patients had sepsis with MRD &lt; 0.1% (57 %), after HAM /consolidation phase; and 3 patients with &gt; 0.1% (43%) when in relapse (p= 0.028). The SRD episodes were independent from MRD levels, however patients on remission showed SRD as late events, because no patient developed SRD during or after first induction.

Conclusion
Overall survival results have improved with current protocol. MRD seems a valuable tool to estimate response, levels &gt;0.1 % are associated with increased risk of death. However, better infection prevention and care are required to improve further the outcomes, especially those associated with higher MRD levels.