COVID-19 vaccination in children: a public health priority

Abstract Objective: Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group. Sources of data: The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics. Summary of findings: Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety. Conclusions: Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.

COVID-19 in a child with down syndrome and extensive pulmonary tuberculosis: a case report / COVID-19 em criança com síndrome de down e tuberculose pulmonar extensa: relato de caso

Abstract Introduction: although pediatric patients have comparatively fewer cases of COVID-19, children with Down Syndrome exhibit comorbidities such as immunodeficiency, diabetes and, in this perspective, are considered a population at risk for severe COVID-19. In addition, the literature also points to an unfavorable perspective on co-infection with Mycobacterium tuberculosis, considered an important comorbidity and a predictor of a worse clinical outcome. Description: female child, nine years old, with Down Syndrome, congenital heart disease and prematurity, with significant weight loss and intermittent fever for six months. A week ago, she had an intensification of fever, productive cough and mild respiratory distress. RT-PCR for SARS-CoV-2 detectable in nasopharynx swab, chest X-ray with diffuse alveolar infiltrate, chest CT with consolidations, excavation, solid micronodules in a sprouting tree pattern mainly in the right upper and lower lobes. Molecular rapid test for Mycobacterium tuberculosis detectable in gastric lavage. After specific treatment, the patient progressed well and was discharged from the hospital after 72 hours without fever and improvement in her breathing pattern. Discussion: despite the extensive pulmonary involvement, the patient did not require invasive ventilatory support and presented a satisfactory short-term outcome. Therefore, the relevance of the association of Tuberculosis and COVID-19 and other comorbidities in the pediatric age group still remains uncertain.

Resumo Introdução: apesar dos pacientes pediátricos apresentarem, comparativamente, menos casos da COVID-19, crianças com Síndrome de Down manifestam comorbidades como imunodeficiência, diabetes e, nessa perspectiva, são apontadas como população de risco para COVID-19 grave. Ademais, a literatura também sinaliza para um cenário desfavorável na coinfecção com Mycobacterium tuberculosis, considerada comorbidade importante e preditora para pior desfecho clínico. Descrição: criança de nove anos, sexo feminino, com Síndrome de Down, cardiopatia congênita e prematuridade, história de perda ponderal significativa e febre intermitente vespertina há seis meses. Há uma semana, apresentou intensificação da febre, tosse produtiva e desconforto respiratório leve. RT-PCR para SARS-CoV-2 em swab de nasofaringe detectável, radiografia de tórax com infiltrado alveolar difuso, tomografia de tórax com consolidações, focos de escavação, micronódulos sólidos em padrão de árvore em brotamento principalmente em lobos superior e inferior direitos. Teste rápido molecular para Mycobacterium tuberculosis detectável em lavado gástrico. Após início de tratamento específico, a paciente exibiu melhora clínica e de padrão respiratório e recebeu alta hospitalar após 72 horas afebril. Discussão: apesar do extenso comprometimento pulmonar, a paciente não necessitou de suporte ventilatório invasivo e apresentou um desfecho satisfatório em curto prazo. Portanto, a relevância da associação de tuberculose e COVID-19 e outras comorbidades na faixa etária pediátrica ainda permanecem incertas.

Systemic inflammatory syndrome in children during COVID-19 pandemic in Ceará state, northeastern Brazil: an observational study

Abstract In this study, we report the occurrence of multisystemic inflammatory syndrome among 64 children (2 deaths) with recent severe acute respiratory syndrome-related coronavirus 2 (SARS-COV-2) infections in the northeast region of Brazil. The major clinical symptoms and signs reported were exanthema (60.9%), abdominal pain (56.3%), nausea and vomiting (46.9%), diarrhea (37.5%), and dyspnea (37.5%). Laboratory findings revealed that the levels of C-reactive protein (75.0%), hemoglobin (51.6%), D-dimer (48.4%), lymphocytes (43.8%), LDH (45.3%), AST (42.2%), ALT (51.6%), and ferritin (48.4%) were above the reference values for a given age and gender. The clinical findings were similar to those observed in Kawasaki disease, although it represents a separate entity, emphasizing the need for proactive surveillance and early treatment.

Vesiculobullous exanthema in a 3-month-old child with probable acute chikungunya infection / Exantema vesiculobolhoso em criança de 3 meses com provável infecção aguda por chikungunya

Objective: to report a rare case of a 3-month-old child with acute chikungunya infection presenting as vesiculobullous rash. Case description: herein we report a case of a 3-month-old infant which developed a diffuse erythematous rash involving the trunk and limbs within two days after sudden acute fever, and also presented striking irritability with inconsolable crying, hyporexia, cough, and coryza. Hematological and biochemical investigations were undertaken and were found to be normal. Serum samples were tested for Chikungunya revealing positive IgM. He was treated with supportive therapy, mainly with antipyretics, venous hydration and rest evolving with entirely resolution of the symptoms after four days. Comments: Chikungunya fever is a disease caused by the Chikungunya virus which can be found in endemic areas such as Brazil. Atypical manifestations can affect various systems including the skin and may be more frequent in children. The role of dermatological manifestations related to Chikungunya infection is not completely understood. The reported case is an unusual case of Chikungunya infection which highlights the importance of to know and to be aware of this manifestation in children mainly in new endemic areas such as Brazil.

Objetivo: relatar o caso raro de uma criança de 3 meses de idade com infecção aguda por chikungunya apresentando-se como erupção vesiculobolhosa. Descrição do caso: aqui relatamos o caso de uma criança de 3 meses que evoluiu com erupção eritematosa difusa envolvendo tronco e membros dois dias após febre aguda repentina, além de apresentar irritabilidade marcante com choro inconsolável, hiporexia, tosse e coriza. Investigações hematológicas e bioquímicas foram realizadas e foram normais. Amostras de soro foram testadas para Chikungunya revelando IgM positiva. Ele foi tratado com terapia de suporte, principalmente com antipiréticos, hidratação venosa e descanso evoluindo com resolução completa dos sintomas após quatro dias. Comentários: a febre Chikungunya é uma doença causada pelo vírus Chikungunya, que pode ser encontrada em áreas endêmicas como o Brasil. Manifestações atípicas podem afetar vários sistemas, incluindo a pele, e podem ser mais frequentes em crianças. O papel das manifestações dermatológicas relacionadas à infecção por Chikungunya não é completamente compreendido. O caso relatado é um caso incomum de infecção por Chikungunya, que destaca a importância de conhecer e ter consciência dessa manifestação em crianças, principalmente em novas áreas endêmicas como o Brasil.

Disseminated cutaneous larva migrans in a 7-year-old patient

Introduction: Cutaneous larva migrans is a cutaneous infestation caused by zoonotic nematode larvae commonly due to hookworms such as the Ancylostoma braziliense. Case report: Herein we report a case of a 7-year-old child to the Emergency Department complaining of erythematous papular itching lesions on his right elbow, wrist and knee. He had no previous history of contact with sand or animals. The lesions in his right elbow presented impetiginization. Ivermectin 200mcg/kg/day treatment was initiated and oxacillin associated. On the third day of treatment, the patient was discharged with complete resolution of the lesions. Coclusion: The reported case assumes importance because it is a common and benign disease, but due to an unusual presentation was not diagnosed early. The disseminated form commonly may require hospitalization and prolonged treatment as presented

Introdução: A larva migrans cutânea é uma infestação cutânea causada por larvas de nematoides zoonóticos comumente causadas por ancilostomídeos como o Ancylostoma braziliense. Relato de caso: Aqui, relatamos o caso de uma criança de 7 anos de idade levada ao Departamento de Emergência, queixando-se de lesões eritematosas de prurido no cotovelo, punho e joelho direitos. Negava história prévia de contato com areia ou animais. As lesões no cotovelo direito apresentavam impetiginização. Ivermectina 200mcg/kg/dia foi iniciada e oxacilina associada. No terceiro dia de tratamento, o paciente recebeu alta com resolução completa das lesões. Conclusão: O caso relatado assume importância por ser uma doença comum e benigna, mas devido a uma apresentação incomum não foi diagnosticada precocemente. A forma disseminada comumente pode requerer hospitalização e tratamento.

Clinical and laboratory profiles of children with severe chikungunya infection

Abstract INTRODUCTION: Chikungunya infection presents with distinct clinical features depending on the patient age group. METHODS: Medical records of children with positive IgM for the chikungunya virus who were hospitalized in a pediatric ward in Fortaleza, Ceará, Brazil were analyzed. RESULTS: Fourteen children with a median age of 4 months (36 days to 15 years) were included. All patients presented with fever persisting for an average of 5 days. The joints were involved in 6 (42.8%) children, and 8 (57.1%) children presented with bullous rash. CONCLUSIONS: Systemic involvement and atypical clinical manifestations characterize severe forms of chikungunya infection in children.

Visceral Leishmaniasis hospitalizations and seasonality in Fortaleza, Ceará, Northeast Brazil between 2003 ­ 2012 / Hospitalização por leishmaniose visceral e sazonalidade em Fortaleza, Ceará, Nordeste do Brasil entre 2003 e 2012

Introduction: The knowledge of the relationship between Visceral Leishmaniosis and climatic aspects is already well established in the literature of other countries, but lack data of this relationship in Brazil. Objective: This study aimed to describe the seasonal distribution of hospitalizations for Visceral Leishmaniosis (VL) in a referral hospital for infectious diseases located in an endemic area of the semiarid in the Northeast of Brazil. Methods: The number of monthly hospitalizations between 2003 and 2012 was recorded retrospectively and was correlated with climate variables. Results: During this period 1,302 patients were hospitalized. We observed an inverse relationship with the monthly amount of precipitation (r = - 0.725; p = 0.008), the number of days per month with precipitation (r = - 0.683; p = 0.0144) and relative humidity (r = - 0.746; p = 0.005) when compared with the monthly number of hospitalizations due to VL. Inversely, there was a direct relationship with the maximum monthly mean temperature and the number of hospitalizations due to VL (r = 0.643; p = 0.024). Conclusions: The rainy season, characterized by more rainfall and higher humidity, was correlated with fewer hospitalizations for VL. Conversely, in months with higher temperatures the number of hospitalizations for VL was higher.

IMPROVEMENT OF INTESTINAL PERMEABILITY WITH ALANYL-GLUTAMINE IN HIV PATIENTS: a randomized, double blinded, placebo-controlled clinical trial

Context Glutamine is the main source of energy of the enterocyte and diarrhea and weight loss are frequent in HIV infected patients. Objective To determine the effect of alanyl-glutamine supplementation on intestinal permeability and absorption in these patients. Methods Randomized double-blinded, placebo-controlled study using isonitrogenous doses of alanyl-glutamine (24 g/day) and placebo (glycine, 25 g/day) during 10 days. Before and after this nutritional supplementation lactulose and mannitol urinary excretion were determined by high performance liquid chromatography. Results Forty six patients with HIV/AIDS, 36 of whom were male, with 37.28 ± 3 (mean ± standard error) years were enrolled. Twenty two and 24 subjects were treated with alanyl-glutamine and with glycine respectively. In nine patients among all in the study protocol that reported diarrhea in the 14 days preceding the beginning of the study, mannitol urinary excretion was significantly lower than patients who did not report this symptom [median (range): 10.51 (3.01–19.75) vs. 15.37 (3.93–46.73); P = 0.0281] and lactulose/mannitol ratio was significantly higher [median (range): 0.04 (0.00–2.89) vs. 0.02 (0.00–0.19); P = 0.0317]. There was also a significant increase in mannitol urinary excretion in the group treated with alanyl-glutamine [median (range): 14.38 (8.25–23.98) before vs 21.24 (6.27–32.99) after treatment; n = 14, P = 0.0382]. Conclusion Our results suggest that the integrity and intestinal absorption are more intensely affected in patients with HIV/AIDS who recently have had diarrhea. Additionally, nutritional supplementation with alanyl-glutamine was associated with an improvement in intestinal absorption. .

Contexto A glutamina é a principal fonte de energia do enterócito e diarreia e perda de peso são frequentes em pacientes infectados pelo HIV. Objetivo Determinar o efeito da alanil-glutamina sobre a permeabilidade e a absorção intestinais nesses pacientes. Métodos Estudo duplo-cego, randomizado, controlado por placebo, utilizando doses isonitrogênicas de alanil-glutamina (24 g/dia) e de placebo (glicina, 25 g/dia) durante 10 dias. Antes e depois dessa suplementação nutricional a excreção urinária de lactulose e manitol foi determinada por cromatografia líquida de alta performance. Resultados Quarenta e seis pacientes com HIV/AIDS, sendo 36 do sexo masculino, com 37,28 ± 3 anos (média ± erro padrão) foram incluídos. Vinte e dois e 24 indivíduos foram tratados com alanil-glutamina e com glicina, respectivamente. Nos nove pacientes que relataram ter apresentado diarreia nos 14 dias anteriores ao início do estudo, a excreção urinária de manitol foi significativamente menor do que nos pacientes que não referiram essa queixa [mediana (intervalo): 10,51 (3,01-19,75) vs 15,37 (3,93-46,73), P = 0,0281] e a razão lactulose/manitol foi significativamente mais elevada [mediana (intervalo): 0,04 (0,00-2,89) vs 0,02 (0,00-0,19), P = 0,0317]. Constatou-se também aumento significativo na excreção urinária de manitol no grupo tratado com alanil-glutamina [mediana (intervalo): 14,38 (8,25-23,98), antes vs 21,24 (6,27-32,99) após o tratamento, n = 14, P = 0,0382]. Conclusão Os resultados do presente estudo sugerem que a integridade e a absorção intestinais são mais intensamente afetadas em pacientes com HIV/AIDS que tiveram diarreia recentemente. Adicionalmente, a suplementação ...

Refractory Congenital Chylous Ascites.

Refractory congenital chylous ascites (CCA) is an uncommon clinical condition. Few cases have been described and no gold standard treatment has been defined so far. This report describes a case of refractory CCA in a newborn child which was treated by surgery. Preoperative lower-limb lymphoscintigraphy associated with intraoperative patent blue testing and fibrin glue application were useful in order to provide a successful outcome.

Condições sociodemográficas de crianças de zero a dois anos filhas de mães com HIV/Aids, Fortaleza, CE, Brasil / The socio-demographic conditions of children aged 0 to 2 years born to mothers with HIV/AIDS, in the city of Fortaleza, in the Brazilian State of Ceará

OBJETIVOS: identificar as condições sociodemográficas das crianças de 0 a 2 anos de idade nascidas de mães HIV + / AIDS em Fortaleza, Ceará, Nordeste do Brasil. MÉTODOS: estudo transversal utilizando um questionário semiestruturado com cuidadores (63 mães e 5 avós) de crianças no ambulatório de um hospital estadual, entre Dezembro de 2005 e Abril de 2006. RESULTADOS: a idade média das mães foi de 26 anos de idade. Aproximadamente 16 por cento eram analfabetas, 57,3 por cento eram casadas e 5,9 por cento viúvas. Mais de dois terços (79,4 por cento) das mulheres participantes do estudo tornou-se ciente de seu status de HIV + no último parto e 51,5 por cento relataram não receber qualquer tipo de assistência social do governo. A idade média das crianças foi de 15,6 meses e 13 por cento não tiveram um teste de HIV. A maioria delas era proveniente de áreas rurais (60,3 por cento), com renda familiar média mensal de R$ 446,32. Verificou-se que 57,9 por cento das crianças viviam em uma casa com cinco ou mais pessoas, e 31 por cento relataram ter quatro ou mais crianças morando na mesma casa. CONCLUSÕES: há necessidade de estratégias de prevenção e promoção à saúde, levando em consideração o contexto social das famílias que vivem com HIV/AIDS.

OBJECTIVES: to ascertain the socio-demographic conditions of children aged between 0 and 2 years born to mothers testing positive for HIV / AIDS in the city of Fortaleza, in the Northeastern Brazilian State of Ceará. METHODS: a cross-sectional study was conducted involving the application of a semi-structured questionnaire to women caring for children (63 mothers and 5 grandmothers) at a State hospital outpatient clinic, between December 2005 and April 2006. RESULTS: the mean age of the mothers was 26 years. Approximately 16 percent were illiterate; 57.3 percent were married and 5.9 percent widows. More than two thirds (79.4 percent) of the women taking part in the study first became aware of their HIV status during their last delivery. 51.5 percent reported not having received any kind of social assistance from the government. The mean age of children was 15.6 months and 13 percent had not been tested for HIV. Most women came from rural communities (60.3 percent), and had a mean household income of R$ 446.32. 57.9 percent of the children lived in a household of five individuals or more and 31 percent reported having four or more children living in the same residence. CONCLUSIONS: there is a need for health promotion and disease prevention strategies to be implemented that take into account the social context of families living with HIV/AIDS.

Acesso e utilização de fórmula infantil e alimentos entre crianças nascidas de mulheres com HIV/AIDS / Access and use of infant formula and other foods among children born to HIV positive mothers / Acceso y utilización de fórmula infantil y alimentos entre niños nacidos de mujeres con VIH/SIDA

O objetivo deste estudo foi conhecer as práticas alimentares de crianças de 0-2 anos, filhas de mães portadores de HIV e foi fundamentado na metodologia qualitativa. Para a coleta de dados utilizaram-se entrevistas com 15 mulheres soropositivas acompanhadas no ambulatório de pediatria de um Hospital de Doenças Infecciosas em Fortaleza, Ceará, de março a junho de 2005, cujas análises apontaram duas categorias temáticas: 1. recebendo o leite artificial - experiência das mulheres soropositivas e 2. os alimentos oferecidos às crianças. Apreendeu-se que existem dificuldades para receber o leite doado a seus filhos, bem como na preparação dos alimentos. Há falta de rotina na distribuição da fórmula infantil nas Unidades de Saúde, demonstrando a complexidade do acompanhamento desse tipo de demanda. As práticas alimentares inadequadas utilizadas pelas mães foram: diluições incorretas, adição de complementos energéticos e introdução precoce de alimentos não lácteos. Conclui-se que há necessidade de equipe capacitada para melhorar a organização e distribuição da fórmula infantil e, principalmente, na orientação e preparo dos alimentos, garantindo a segurança alimentar deste grupo vulnerável.

The aim of this qualitative study was to: examine child feeding practices of children 0-2 years of age born to HIV+ mothers and, identify factors related to the distribution and receipt of infant formula at government health units. Fifteen in-depth interviews were conducted with women who had children between 0 and 2 years of age and who were receiving health services at the referral Hospital for Infectious Diseases in Brazil by trained interviewers using a semi-structured questionnaire including open-ended questions. Two main themes were identified: 1. issues related to access and receipt of infant formula by HIV+ mothers; 2. child feeding practices. Study results showed that HIV+ mothers face several barriers to access and receive infant formulas for their children and that they also have difficulties with daily child feeding practices. The lack of preparedness of the health units to address the needs of HIV+ mothers with infants was revealed by this study, indicating the complexity of rendering services to this population group by current existing health services. In addition, study results showed that the diet of the children is rich in carbohydrates and dairy, with early introduction of "table food" and processed foods. Findings suggest the need for multidisciplinary teams adequately trained to follow up the growth and development of these children in order to guarantee the food security of this high-risk group.

El estudio tuvo como objetivo conocer las prácticas alimentares de madres, portadoras de VIH positivo, con sus hijos nacidos después del diagnostico de la infección. Estudio seccional exploratorio, fundamentado en la metodología cualitativa. Para la colecta de datos se utilizaron entrevistas individuales con 15 mujeres seropositivas seguidas en el ambulatorio de pediatría de un Hospital de Enfermedades Infecciosas en Fortaleza, Ceará, de marzo a junio de 2005, cuyos análisis indicaron dos categorías temáticas: recibiendo la leche artificial- experiencia de las mujeres seropositivas; alimentos ofrecidos a los niños. Se observó que existen dificultades para recibir la leche donada a sus hijos, así como en la preparación de los alimentos. Hay una falta de rutina en la distribución de la fórmula infantil en las Unidades de Salud, demostrando la complejidad del seguimiento de este tipo de demanda. Las prácticas alimentarias inadecuadas utilizadas por las madres fueron: dilución incorrecta, adición de complementos energéticos e introducción precoz de alimentos no lácteos. Se concluye que hay necesidad de un equipo capacitado para mejorar la organización y la distribución de la fórmula infantil y principalmente para la orientación y preparación de los alimentos, garantizando la seguridad alimentaría de este grupo vulnerable.

C-reactive protein follow-up of children with acute bacterial meningitis

Twenty-two children with bacterial meningitis were prospectively studied to follow serum levels of C-reactive protein (CRP) at admission, and the 2nd, 5th and 7th days of treatment, and in the cerebrospinal fluid (CSF) at admission, to investigate whether there is any relationship of its levels with the clinical evolution. CRP was measured by latex agglutination and/or ELISA techniques with detection limits of 0.15mg/L and 0.9mg/L, respectively. Patients were classified according to clinical evolution in two groups: uneventful recovery (n=12) and complicated evolution (n=10). Clinical complications observed were: relapse of fever (8), persistent fever (4), arthritis (4), ventricle enlargement (2), subdural effusion (1), subdural empyema (1), ataxia (1), cervical hypotonia (1), deafness (1), endophthalmitis (1), accute otitis media (1), secondary skin infection (1) and treatment change due to poor clinical response (1). A significant decrease in CRP levels was observed among the uneventful recovery group after admission. In contrast, in the group with complicated evolution, CRP levels showed either secondary elevation or remained high continously. Mean serum CRP levels were significantly lower in the uneventful recovery group than in the complicated evolution group on the 5th and 7th days. CRP levels below 20mg/L on the 5th and 7th days were associated with an uneventful recovery, and CRP levels higher than 20mg/L on those same days were associated with a complicated clinical evolution (p=0.01* and p=0.0015*, respectively). We conclude that serumm CRP level monitoring in children with bacterial meningitis provides useful and objective information about their clinical evolution. This procedure is inexpensive and suitable for use in endemic areas lacking sophisticated laboratories.