Vaccinating children: The pros and cons

Vaccinating children against Covid raised a debate, due to generally mild clinical presentation. The decision to vaccinate teenagers was motivated by the global public health need: to decrease transmission to other age groups. Among adolescents, the efficacy (better immunity than in young adults) and safety of vaccines was clearly demonstrated. Among 5-to-12-year-olds, due to lower contamination the collective benefit is less clear, and when the m-RNA vaccines were available for this age group, the Omicron variant was predominant and their effect on non-severe infections and transmission had yet to be determined. Individual benefit is based both on somatic criteria and on the child's schooling and mental health. Children under 5 years of age received a 3lg dose of vaccine, which is one tenth of the adult dose, resulting in immunogenicity similar to that of 16-to-25-year-olds.

Using Telehealth through the Mobile Channel to Reduce Health Inequality and Disparity: A Real-World Study Examining Patients with Type 2 Diabetes Mellitus

Background and Aims: COVID-19 led to digital acceleration, raising alarms that minorities (Black/Hispanic) would be left further behind. Did patients with type 2 diabetes (PwT2D) who rely on routine care change their use of health IT resources? Methods: Using longitudinal patient portal usage data of 55,548 PwT2Dfroman urban hospital in the U.S.,we examinedmobile-vsdesktop internet access before-and-after COVID-19. We constructed threemodels using the panel dataset: pooled Ordinary Least Squares (OLS), random effect (RE), and fixed effect (FE). Result(s): The interaction of COVID-PeriodxMinority across the three models (OLS/RE/FE) was significant and showed racial disparity is increasing for desktop use (beta= -0.052/-0.053/-0.054) and decreasing for mobile use (beta = 0.026/0.025/0.025). COVID- 19 has reduced the gap by 34% (0.025/0.073) according to the RE model. Table 1 shows that racial disparity shrinkage is largely driven by the use of mobile communication. Conclusion(s): COVID-19 is a natural experiment providing the opportunity to investigate whether accelerated digitization impacted health inequality and disparity among PwT2D. The effect is mostly driven by mobile device access and cannot be explained by pre-COVID-19 trends. First, COVID-19 has been cited as a ''great magnifier'' of pre-existing racial inequality in health;however, telehealth can become a ''great equalizer'' for reducing inequity. Second, in the U.S., much effort in combating the digital divide has focused on the broadband connectivity gap;the transformative potential of mobile health is overlooked. Third, the lack of access to patient portals has disadvantaged PwT2D minorities;so long as they have access, they can ''catch up.'' NIH Award 5UL1TR001425-03.

Vaccinating children: the pros and cons. (Special Issue: The SARS-CoV-2 vaccines: retrospective and perspectives.)

Vaccinating children against Covid raised a debate, due to generally mild clinical presentation. The decision to vaccinate teenagers was motivated by the global public health need: to decrease transmission to other age groups. Among adolescents, the efficacy (better immunity than in young adults) and safety of vaccines was clearly demonstrated. Among 5-to-12-year-olds, due to lower contamination the collective benefit is less clear, and when the m-RNA vaccines were available for this age group, the Omicron variant was predominant and their effect on non-severe infections and transmission had yet to be determined. Individual benefit is based both on somatic criteria and on the child's schooling and mental health. Children under 5 years of age received a 3 micro g dose of vaccine, which is one tenth of the adult dose, resulting in immunogenicity similar to that of 16-to-25-year-olds.

Dietary preparation for bariatric surgery via video conferencing during the COVID-19 health crisis and perspectives

Introduction: The health crisis linked to COVID-19 led to the containment of the general population in order to limit the spread of the virus. With the emergence of this new disease, it was necessary to mobilise in order to limit the transmission of the virus to our obese population, at risk of developing a severe form of COVID-19. To do this, we proposed to carry out our TPE workshops by videoconference to all patients included in the TPE "bariatric surgery"programme. Objectives: The aim of this study is to identify the benefits and drawbacks of this group distance TVE format, their efficiency in terms of learning and behavioural changes, and the different resources of the programme that facilitate their learning for the pre- and post-surgery course. Methods: This is a two-phase mixed-methods study. The first phase of the study consisted of an exploratory qualitative study using semi-directive interviews with 18 patients who had followed the distance TPE from March 2020 to May 2020, to explore their experiences of the different educational sessions. In a second phase, the exploratory study made it possible to draw up a questionnaire to gather the views of all the patients educated from March 2020 to May 2021. The analysis of the answers mobilised the theory of capabilities to identify the positive or negative conversion factors of the programme for the patients'learning. Results: Of the 70 patients included, 43 responded to the questionnaire. This video conferencing TPE enabled the scheduling of surgical procedures to be maintained. Patients reported time savings due to the absence of travel. Patients with low digital literacy were able to access this programme. Participants stressed the importance of continuity of connection with caregivers. Patients reported self-care skills acquired through this distance learning and an average weight loss of 7 kg. Both positive and negative learning factors were identified. Discussion: The results of this study demonstrate the interest in developing e-TPE programmes for several reasons: the difficulties in bringing these patients to the hospital, the geographical inequalities in access to TPE, the absence of reimbursement for transport tickets and the lack of dedicated spaces available. It therefore seems important to train professionals and patients in the digital tool. Conclusion: This study of a population of obese patients who participated in a TVE programme by videoconference during a pandemic and a period of confinement shows the perceived quality of this distance education. In view of the different programmes transposed into distance format, it would be interesting to promote research crossing the experiences of patients and professionals to propose the best educational format to the health authorities. © 2023 SETE. Introduction : La crise sanitaire liée au Covid-19 a engendré un confinement de la population générale afin de limiter la propagation du virus. Dans l'émergence de cette nouvelle maladie, il a fallu se mobiliser afin de limiter la transmission du virus auprès de notre population d'obèses, à risque de développer une forme grave au Covid-19. Pour cela, nous avons propos de réaliser nos ateliers ETP par visioconférence à l'ensemble des patients inclus dans le programme ETP « chirurgie bariatrique ». Objectifs : L'objectif de cette étude est de dégager les bénéfices et inconvénients de ce format d'ETP distanciel en collectif, leur efficience au regard des apprentissages et des changements de comportement, et les différentes ressources du programme facilitant leurs apprentissages pour le parcours pré et post chirurgie. Méthodes : Il s'agit d'une étude mixte en deux phases. La première phase de l'étude consiste en une étude qualitative exploratoire par entretiens semi-directifs auprès de 18 patients ayant suivi l'ETP en distanciel de mars 2020 à mai 2020, pour explorer leur vécu des différentes sessions éducatives. L'étude exploratoire a permis d'élaborer dans une deuxième phase un questionnaire pour recueillir le point de vue de l'ensemble des patients éduqués de mars 2020 à mai 2021. L'analyse des réponses a mobilisé la théorie des capabilités pour identifier les facteurs de conversion positifs ou négatifs du programme pour les apprentissages des patients. Résultats : Sur l'ensemble des 70 patients inclus quarante-trois personnes ont répondu au questionnaire... Cette ETP en visioconférence a permis de maintenir la programmation des interventions chirurgicales. Les patients ont rapporté un gain de temps lié à l'absence de déplacement. Des patients avec une faible littératie numérique ont pu accéder à ce programme. Les participants ont souligné l'importance de la continuité du lien avec les soignants. Les patients ont rapporté des compétences d'auto-soins acquises à travers cette ETP à distance ainsi qu'une perte de poids de 7 kg en moyenne. Des facteurs positifs et négatifs au regard des apprentissages ont été mis en évidence. Discussion : Les résultats de cette étude démontrent l'intérêt de développer des programmes e-ETP pour plusieurs raisons : les difficultés à faire venir ces patients à l'hôpital, les inégalités géographiques d'accès à l'ETP, l'absence de remboursement des titres de transport et d'espaces disponibles dédiés. Il parait donc important de former les professionnels et les patients à l'outil numérique. Conclusion : Cette étude auprès de la population de patients obèses ayant participé à un programme d'ETP par visioconférence en période de pandémie et de confinement témoigne de la qualité perçue de cette éducation en distanciel. Au regard des différents programmes transposés sous format distanciel, il serait intéressant de promouvoir des recherches croisant les expériences des patients et des professionnels pour proposer aux autorités de santé le meilleur format éducatif. © 2022 EDP Sciences. All rights reserved.

Nirsevimab binding-site conservation in respiratory syncytial virus fusion glycoprotein worldwide between 1956 and 2021: an analysis of observational study sequencing data

BACKGROUND: Nirsevimab is an extended half-life monoclonal antibody to the respiratory syncytial virus (RSV) fusion protein that has been developed to protect infants for an entire RSV season. Previous studies have shown that the nirsevimab binding site is highly conserved. However, investigations of the geotemporal evolution of potential escape variants in recent (ie, 2015-2021) RSV seasons have been minimal. Here, we examine prospective RSV surveillance data to assess the geotemporal prevalence of RSV A and B, and functionally characterise the effect of the nirsevimab binding-site substitutions identified between 2015 and 2021. METHOD(S): We assessed the geotemporal prevalence of RSV A and B and nirsevimab binding-site conservation between 2015 and 2021 from three prospective RSV molecular surveillance studies (the US-based OUTSMART-RSV, the global INFORM-RSV, and a pilot study in South Africa). Nirsevimab binding-site substitutions were assessed in an RSV microneutralisation susceptibility assay. We contextualised our findings by assessing fusion-protein sequence diversity from 1956 to 2021 relative to other respiratory-virus envelope glycoproteins using RSV fusion protein sequences published in NCBI GenBank. FINDINGS: We identified 5675 RSV A and RSV B fusion protein sequences (2875 RSV A and 2800 RSV B) from the three surveillance studies (2015-2021). Nearly all (25 [100%] of 25 positions of RSV A fusion proteins and 22 [88%] of 25 positions of RSV B fusion proteins) amino acids within the nirsevimab binding site remained highly conserved between 2015 and 2021. A highly prevalent (ie, >40.0% of all sequences) nirsevimab binding-site Ile206Met:Gln209Arg RSV B polymorphism arose between 2016 and 2021. Nirsevimab neutralised a diverse set of recombinant RSV viruses, including new variants containing binding-site substitutions. RSV B variants with reduced susceptibility to nirsevimab neutralisation were detected at low frequencies (ie, prevalence <1.0%) between 2015 and 2021. We used 3626 RSV fusion-protein sequences published in NCBI GenBank between 1956 and 2021 (2024 RSV and 1602 RSV B) to show that the RSV fusion protein had lower genetic diversity than influenza haemagglutinin and SARS-CoV-2 spike proteins. INTERPRETATION: The nirsevimab binding site was highly conserved between 1956 and 2021. Nirsevimab escape variants were rare and have not increased over time. FUNDING: AstraZeneca and Sanofi.Copyright © 2023 Elsevier Ltd. All rights reserved.

Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design. METHODS: We searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery. RESULTS: We identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation -0.55, 95% CI -0.81 to -0.09). CONCLUSIONS: Patients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.

'Partnering with Poise': Alexander technique online group classes are a promising intervention to decrease loss-of-self and increase agency for care partners of people living with dementia

Background: Studies show 1:1 in-person Alexander technique (AT) sessions can reduce anxiety and musculoskeletal pain with long-term benefits [1-4]. Care partners (CP) often experience role engulfment and loss of self [5]. AT is an embodied approach to choose functional patterns that transform disruptive stress reactions to adaptive responses, increasing confidence, self-control, and self-awareness. Previous in-person group course results from 71 Parkinson's CP showed promise with benefits retained at 12 months. COVID-19 provided an opportunity to test synchronous online AT-based courses for CP of people living with dementia. Method(s): Design: Controlled feasibility trial. AT group: 14 participants (12F/2M) from 9 states;mean age 68;72% provided 41+ hrs/wk care for family member with dementia;13 lived with care-receiver. Control group: 9 participants (8F/1M) from 4 states;mean age 63;67% provided 41+ hrs/wk care;6 lived with family care-receiver. AT groups met 90 min/week x 10wks. Intervention(s): Delivered in-home via Zoom. Embodied self-management strategies included intentional strategies to interrupt automatic reactions and affirm centrality of the self, taught via verbal and visual instruction, activities, anatomical models/images, and demonstration videos. AT principles were embedded in everyday activities (gait, sit-to-stand, IADLs, etc.). Outcome Measures: Self-report, executive function, anonymous evaluations, interviews. Result(s): 70% retention, 87% attendance. AT group improved executive function (Digit Span p =.003;Stroop p =.05);control group did not. AT group reported increased self-efficacy (caregiver scale p =.08);and reduced fear (p =.004);control group did not. On 0-10 scale, mean rating was >9 for novelty of ideas, practical tools for physical self-management, and would recommend to a friend;and >8 for enjoyment of group interaction, practical tools for self-management of emotions and reactions, and prevention of pain;7.9 for feeling better prepared for CP daily challenges. Six-month follow-up is underway. Conclusion(s): Alexander technique shows promise as a long-term self-management approach to reduce loss-of-self in CP of people living with cognitive decline. Group classes can provide cost-effective delivery with social benefits. Online classes can increase accessibility. A full-scale study is merited. 1.Little (2008) 2.MacPherson (2015) 3.Klein (2014) 4.Stallibrass (2002) 5.Skaff, Pearlin (1992). Copyright © 2022 the Alzheimer's Association.

A SURVEY TO EVALUATE IMPACT OF THE COVID-19 PANDEMIC ON PULMONARY AND CRITICAL CARE FELLOWSHIP

SESSION TITLE: Novel Education and Assessments of Trainees SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The COVID-19 pandemic impacted many healthcare providers, especially pulmonary and critical care [PCC] fellows who cared for critically ill COVID-19 patients. We undertook this project to better clarify which aspects of training were impacted by the pandemic and which operational policies were beneficial or a cause of strife among fellows. METHODS: An electronic survey was sent to current and former fellows [n= 14] of an academic university-based PCC program. Questions on demographics included age, sex, martial status, year of training, and number of children were included. Questions pertaining to the program preparedness and satisfaction, communication, rotational changes, and education were assessed with yes & no questions, Likert scale, multiple choice, and open style questions. All responses were de-identified. RESULTS: The mean age was 35 ± 4 years;54% of the fellows had children. 92% of the fellows were concerned of spreading COVID-19 to their families. Due to the pandemic, 23% fellows felt they worked more hours. A vast majority of fellows [84%] felt that their personal lives were affected. 70% experienced major changes in their academic rotations. Almost half of those surveyed [46%] felt they had no control over their rotations. Due to cancellation of lectures and conferences, 77% felt that their learning was negatively impacted, which was not salvaged by remote learning. All fellows [100%] stated there was a reduction in non-COVID procedures such as endobronchial ultrasound [EBUS]. Although all fellows felt supported by the program director, 62% thought that support from non-PCC residents and fellows was inadequate, especially with intensive care unit [ICU] procedures. 31% fellows thought that the hospital was overwhelmed whereas, 23% thought the hospital was not prepared for the pandemic. 92% of the fellows did not feel that the program placed them at unnecessary risk for COVID-19 exposure. However, 31% stated that one or more of their colleagues had tested positive for COVID-19 from March 2020 to July 2020. The overall fellowship experience was rated Very Good by 31%, Good by 31% and Bad by 7.0%. 58% fellows were satisfied, 33% were very satisfied, and none were dissatisfied with the fellowship program. CONCLUSIONS: The educational, personal aspects and overall experience with the PCC fellowship was negatively affected by the COVID-19 pandemic. PCCM fellows felt they had little support from non-PCC residents and fellows, especially in the ICU. CLINICAL IMPLICATIONS: By identifying challenges that PCC fellows experienced during the pandemic, we hope that more attention will be paid to the issues raised above. DISCLOSURES: No relevant relationships by Rubin Cohen No relevant relationships by Pratibha Kaul No relevant relationships by Sindhubarathi Murali No relevant relationships by Saketh Velapati

Vaccinating children: The pros and cons.

Vaccinating children against Covid raised a debate, due to generally mild clinical presentation. The decision to vaccinate teenagers was motivated by the global public health need: to decrease transmission to other age groups. Among adolescents, the efficacy (better immunity than in young adults) and safety of vaccines was clearly demonstrated. Among 5-to-12-year-olds, due to lower contamination the collective benefit is less clear, and when the m-RNA vaccines were available for this age group, the Omicron variant was predominant and their effect on non-severe infections and transmission had yet to be determined. Individual benefit is based both on somatic criteria and on the child's schooling and mental health. Children under 5 years of age received a 3 µg dose of vaccine, which is one tenth of the adult dose, resulting in immunogenicity similar to that of 16-to-25-year-olds.

From the original SARS-CoV-2 strain to the Omicron variant: Predictors of COVID-19 in ambulatory symptomatic children.

OBJECTIVES: To determine the predictors of a positive SARS-CoV-2 test in a pediatric ambulatory setting. PATIENTS AND METHODS: We performed a cross-sectional prospective study (November 2020-February 2022) of 93 ambulatory settings in France. We included symptomatic children < 15 years old tested for SARS-CoV-2. For each period corresponding to the spread of the original strain and its variants (period 1: original strain; period 2: Alpha, period 3: Delta; period 4: Omicron), we used a multivariate analysis to estimate adjusted odds ratios (aORs) associated with COVID-19 among age, signs, symptoms or contact, and 95 % confidence intervals (95CIs). RESULTS: Of 5,336 children, 13.9 % (95CI 13.0-14.8) had a positive test. During the first three periods, the positivity rate ranged from 5.6 % (95CI 4.6-6.7) to 12.6 % (95CI 10.8-14.6). The main factors associated with a positive test were contact with an infected adult at home or outside the home (aOR 11.5 [95CI 4.9-26.9] to 38.9 [95CI 19.3-78.7]) or an infected household child (aOR 15.0 [95CI 4.8-47.1] to 28.4 [95CI 8.7-92.6]). By contrast, during period 4, aORs for these predictors were substantially lower (2.3 [95CI 1.1-4.5] to 5.5 [95CI 3.2-7.7]), but the positivity rate was 45.7 % (95CI 42.3-49.2). CONCLUSIONS: In pediatric ambulatory settings, before the Omicron period, the main predictor of a positive test was contact with an infected person. During the Omicron period, the odds of these predictors were substantially lower while the positivity rate was higher. An accurate diagnostic strategy should only rely on testing and not on age, signs, symptoms or contact.

Lung Function and Radiographic Disease Worse Among Former Miners in Central Appalachia Than Other Regions of the United States

RATIONALE The COVID-19 pandemic has disrupted national spirometric surveillance of active and former U.S. coal miners since March 2020. Consequently data collected by the Health Resources and Services Administration (HRSA)-funded Black Lung Clinics Program (BLCP) represents the only major source of recent health data on U.S. former coal miners. Using the first available year of national BLCP data we examined associations between mining region and radiographic disease and lung function impairment. METHODS We analyzed pre-bronchodilator spirometry and International Labour Office chest radiograph classifications from miners seen across 15 BLCP grantees from July 1 2020 to June 30 2021. We calculated percent predicted (PP) and lower limits of normal (LLN) for forced expiratory volume in one second (FEV1) forced vital capacity (FVC) and FEV1/FVC ratio. We determined prevalence of patterns of spirometric abnormality (restrictive obstructive/mixed) and moderate to severe impairment (FEV1<70PP). We classified miners who worked the majority of their coal mining career in Kentucky Virginia or West Virginia as Central Appalachian miners. We examined associations between region worked and lung function impairment using logistic regression. RESULTS The 2,891 miners were predominantly non- Hispanic white (98.1%) and male (99.4%) with mean age 66 years (SD9.3). Mean coal mining tenure was 26 years (SD10.7) and 66% (n=1,900) were Central Appalachian miners. Thirty-seven percent had never smoked. Among those with chest radiographs (n=2,464 85%) Central Appalachian miners had a significant three-fold increase in progressive massive fibrosis (PMF) prevalence compared to miners who worked elsewhere in the U.S. (9% vs 3% p<.0001). Smoking history and spirometry were available in 66% (n=1,918). Of these 40% of never-smokers had abnormal spirometry (obstruction/mixed 10%;restriction 30%);among ever-smokers, 54% had abnormal spirometry (obstruction/mixed 27%;restriction 27%). Abnormal FEV1 was present in 30% of never smokers and 42% of ever-smokers. Mean FEV1PP was significantly lower among Central Appalachian miners compared to miners from other regions. Controlling for age, tenure, and pack-years, Central Appalachian miners had significantly elevated odds of having FEV1 impairment compared to non-Central Appalachian miners (OR 1.31, 95%CI 1.06,1.62). A subanalysis controlling for category of radiographic disease showed that odds of impairment remained elevated among Central Appalachian miners (OR 1.24, 95%CI 0.97,1.60). CONCLUSIONS Controlling for smoking, age, and tenure, former miners who worked most of their career in Central Appalachia have significantly increased odds of disabling impairment. These findings highlight the important role of HRSA-funded black lung clinics in understanding work-related lung disease among U.S. coal miners.

Adapting an in-person cognitive embodiment course to online delivery for people living with Parkinson's disease and their care partners

Objective: Alexander technique (AT) is a cognitive embodiment approach applied during daily life. We tested the feasibility and potential of online AT-based group courses for people living with PD (PwP) and included care partners to enhance dyadic relationship and retention of benefits. Background: An RCT showed that 1:1 AT sessions reduced motor symptoms in PwP with retention of benefits at 6 months [1-2]. Recent data suggest in-person AT-based group courses also hold promise. The COVID-19 pandemic gave an opportunity to test synchronous online AT-based courses. Methods: Design: Uncontrolled feasibility trial;3 groups met for 105 min, twice/wk, for 8 or 9 wks. Participants: 16 PwP and 14 care partners began the course. Intervention: Courses were delivered in-home via Zoom. Coursework included functional anatomy and self-management strategies via verbal instruction, anatomical models and images, demonstration, and activities. AT principles were embedded in everyday acts such as gait, sit-to-stand, speech, and IADLs. Review handouts and session recordings were provided. Outcome Measures: Functional reach, one-leg stance, TUG, 7-item Physical Performance Test, symptommanagement self-report, anonymous course evaluations, posture photos, audio interviews. Results: 94% of PwP completed the course (c.f. 65% for in-person course). Average course attendance by PwP was 86% (c.f. 91% in-person). PwP improved functional reach (p = .03) and simulated eating (p = .06). Subjectively, PWP reported improved physical self-control and ability to manage falls, shuffling gait, upright posture, garbled speech, and anxiety (all p < .05). On a 0-10 scale, evaluations averaged >9 for novelty of ideas and practicality of tools for physical symptom-management and for care partners' likelihood to remember and use what they had learned, and > 8.5 for everyone feeling better prepared to meet the daily demands of living with PD. Conclusion: AT training shows promise to improve selfmanagement of PD motor and non-motor symptoms. Online classes can increase accessibility and retention for PwP and their care partners. Larger RCTs are needed to statistically verify improvement, optimize delivery, compare to other approaches, and investigate AT combined with exercise. Six-month follow-up data are being collected for presentation, along with subjective data from care partners about their partners' symptom management.

Attitude des mères vis-à-vis des vaccinations non obligatoires des nourrissons et l'impact sur leur couverture vaccinale

Introduction En France, la vaccination généralisée contre les infections invasives à méningocoque B (MenB) est désormais recommandée pour l'ensemble des nourrissons dès l'âge de 2 mois, depuis le 22 juin 2021. La décision de son remboursement est en attente. Elle n'est pas obligatoire, contrairement aux autres vaccins du calendrier vaccinal des deux premières années. La vaccination généralisée contre les gastroentérites à rotavirus a d'abord été recommandée en 2014 puis suspendue en 2015. Elle contribuerait à la réduction de la surcharge du système de soins déjà sous tension et encore plus affaibli par la pandémie Covid-19. L'absence actuelle de prise en charge de ces deux vaccins pourrait être un frein à l'obtention d'une couverture vaccinale (CV) optimale. Au travers de l'enquête ‘Vaccinoscopie', nous avons évalué auprès de mères de nourrissons leur opinion et attitude vis-à-vis de ces deux vaccinations et estimé leur CV. Matériels et méthodes Etude réalisée du 1er septembre au 25 octobre 2021 sur internet par questionnaire auto-administré, auprès d'un échantillon représentatif de 3000 mères d'enfants âgés de 0-35 mois. Résultats La perception du caractère utile/indispensable de la vaccination MenB a progressé en 2021 vs 2020 (88,7 % vs 86,9 %, p<0,05). La proportion des mères ayant connaissance de l'existence de cette vaccination a augmenté de 42,6 % en 2020 à 54,3 % en 2021 (p<0,05). Cependant, les mères suivies en Protection Maternelle et Infantile sont moins au courant de l'existence de la vaccination MenB (40,2 % vs 54,3 %, p<0,05). Près de 6 % des enfants de 12-23 mois ont reçu au moins une dose de vaccin MenB en 2021 par rapport à 3,7 % en 2020 (p<0,05). Concernant les enfants de 2-5 mois, nés depuis la recommandation, près de 4 % ont reçu au moins une dose de vaccin MenB en 2021 (+1,8 % vs 2020, p > 0,05). Le médecin traitant est la première source d'information des mères concernant la vaccination de leur enfant. Plus de 81 % des mères vaccineraient leur enfant de 0-23 mois contre Men B s'il était recommandé par un professionnel de santé en leur mentionnant au préalable la nouvelle recommandation. Seules 48 % des mères perçoivent la vaccination contre le Rotavirus comme utile/indispensable, sans progression significative par rapport à 2020. Après lecture d'un argumentaire évoquant le rationnel de la vaccination rotavirus, plus de 53 % des mères vaccineraient leur enfant de 0-6 mois sur conseil du professionnel de santé. Le premier frein à cette vaccination est le souhait que l'enfant développe ses propres défenses immunitaires. En 2ème position on retrouve la crainte des effets indésirables et la perception d'un nombre élevé de vaccins en général. En 2021, la CV était de 6,2 % chez les nourrissons de 6-11 mois pour au moins une dose de vaccin et de 5,2 % pour un schéma complet. Conclusion Ces résultats montrent que les CV des vaccins MenB et rotavirus restent très faibles par rapport à celles des vaccins obligatoires. L'acceptabilité des mères n'est pas l'unique paramètre favorisant une CV optimale : la position des autorités de santé et l'adhésion des professionnels de santé sont également des facteurs clés de succès d'une politique vaccinale, comme démontré avec la vaccination obligatoire chez les nourrissons. Liens d'intérêts déclarés L.M. est une employée du groupe de sociétés GSK

Augmentation des infections invasives à Hib chez les jeunes enfants dans un contexte de couverture vaccinale élevée en France, 2018-2021

Introduction Les infections invasives à Haemophilus influenzae (Hib) chez les jeunes enfants sont devenues très rares depuis l'introduction de la vaccination contre Hib dans le calendrier vaccinal du nourrisson en 1993. Depuis 2013, le schéma complet de vaccination repose sur 2 doses en primo-vaccination (2, 4 mois) et 1 dose de rappel (11 mois). Cette vaccination est obligatoire pour les enfants nés à partir de 2018. Cette étude vise à caractériser l'augmentation de l'incidence des infections invasives à Hib chez les jeunes enfants observée depuis 2018. Matériels et méthodes Nous avons inclus les infections invasives à Hib chez les enfants âgés de moins de 5 ans en France métropolitaine entre 2001 et 2021 confirmées par le Centre national de référence (CNR) des méningocoques et Haemophilus influenzae. Les critères de confirmation biologique étaient les suivants: isolement ou détection de Hib à partir d'un site stérile;ou épiglottite associée à l'isolement de Hib dans un prélèvement trachéal. Les données du CNR ont été complétées par les données recueillies par les pédiatres participant à l'observatoire national des méningites bactériennes de l'enfant coordonné par ACTIV-GPIP. Pour la période 2018-2021, les cas ont été décrits selon leurs caractéristiques cliniques, épidémiologiques et leur statut vaccinal pour Hib. Pour les enfants ayant reçu un schéma complet, la réponse en anticorps a été analysée par le CNR à partir de prélèvements sanguins recueillis lors de l'admission à l'hôpital, puis 3 à 8 semaines plus tard. Résultats Le nombre d'infections invasives à Hib chez les enfants âgés de moins de 5 ans a fortement augmenté au cours des dernières années, passant de moins de 6 cas par an sur la période 2011-2017 à 13 en 2018, 12 en 2019, 21 en 2020 et 44 en 2021. L'incidence a notamment augmenté chez les enfants âgés de 6-11 mois, 19-35 mois et 3-4 ans. Au cours de la période 2018-2021, la proportion de cas correctement vaccinés pour leur âge était élevée : 24/29 (72%) des enfants âgés de 6 à 11 mois, et 27/39 (69%) des enfants âgés de 12 mois et plus. Pour 11 des 14 cas pour lesquels la réponse en anticorps a été explorée au CNR, la cinétique des anticorps après l'admission suggérait une réponse anamnestique en faveur d'un échec vaccinal secondaire. Conclusion Cette analyse a mis en évidence une augmentation des infections invasives à Hib chez les jeunes enfants en 2020 et 2021. Cela contraste avec la diminution observée pour d'autres bactéries à transmission respiratoire responsables d'infections invasives en lien avec les mesures de lutte contre le COVID-19. La proportion élevée de cas correctement vaccinés pour leur âge est préoccupante. Des études complémentaires sont nécessaires pour évaluer l'immunogénicité, l'efficacité, et la durée de protection de la vaccination des nourrissons selon le schéma actuellement en vigueur. Aucun lien d'intérêt

[Pediatric Nephrology in the Time of Corona]

INTRODUCTION: Symptomatic coronavirus 2019 (COVID-19) infection usually presents with upper airway symptoms, but may lead to complications, such as pneumonia and involvement of other organs, or even death. Children often have a mild clinical course or may be asymptomatic, however, a severe complication of multisystem inflammatory syndrome has been described in rare cases. In severe COVID-19 infection, acute kidney injury may manifest even in children without comorbidities. The aim of this review is to present available data on renal involvement in pediatric COVID-19, and disease manifestations in children with underlying chronic kidney disease (CKD) or children receiving immunosuppressive medications due to kidney transplantation or glomerular disease. Although it could be assumed that children with CKD, including immunosuppressed patients, might be a high risk group for infection and severity of COVID-19 disease, this is not supported by current available data.

Real-World Efficacy of Venetoclax-Based Regimens in Patients with Chronic Lymphocytic Leukemia in Israel: A Multicenter Prospective Study

Background: The BCL-2 inhibitor venetoclax in combination with an anti-CD20 monoclonal antibody (rituximab or obinutuzumab) has demonstrated superior outcomes and manageable safety as compared to chemo-immunotherapy in phase III clinical trials for chronic lymphocytic leukemia (CLL). Moreover, venetoclax-based regimens induced high rates of undetectable minimal residual disease (uMRD). Prospective data on the effectiveness of venetoclax-based regimens specifically with regard to achieving uMRD in a real-world setting are still lacking. Here we report the first interim analysis for efficacy and safety of an ongoing nationwide real-world study of venetoclax based therapy for CLL/small lymphocytic lymphoma (SLL). Method: A prospective observational nationwide multicenter study. Treatment-naïve (TN) and relapsed/refractory (R/R) CLL/SLL patients were enrolled in 13 medical centers in Israel. The primary endpoint was clinical response, per physician assessment 12-months after the initiation of venetoclax treatment. Key secondary endpoints included progression free survival (PFS), overall survival (OS) and uMRD as assessed at a central laboratory by 8-color flow-cytometry. Results: Between February 10, 2019, and Jun 17, 2021 (data cut), 199 CLL/SLL patients were enrolled from 13 medical centers in Israel to receive venetoclax based therapy. The study included 83 TN and 116 R/R evaluable CLL/SLL patients with a median age of 69 years (range, 34-85) and 70.5 years (range, 25-91), respectively (Table 1). R/R patients had received a median of one prior therapy with a range up to 8, of these patients 60 (51.7%) were previously treated with a B-cell receptor inhibitor (BCRi) including ibrutinib in 52 (44.8%) and idelalisib in combination with rituximab in 6 (5.2%). TN patients had been treated with venetoclax in combination with obinutuzumab (92.8%) or rituximab (4.8%) and R/R patients received either venetoclax with rituximab (60.3%) or obinutuzumab (9.5%), venetoclax monotherapy (25.8%) or triple therapy with venetoclax, rituximab and ibrutinib in 5 (4.3%). Dose escalation of venetoclax to the recommended dose of 400 mg daily was achieved in 80.7% (n=67) of TN and 81% (n=94) of R/R patients. The median duration of ramp-up was 38 and 42 days in TN and R\R patients, respectively. Prior to therapy, tumor lysis syndrome (TLS) risk was considered high in 12% and 29.3% of TN and R/R patients, respectively (Table 1). Laboratory TLS occurred in one TN patient and 4 R/R patients, whereas 3 of the R/R patients experienced clinical TLS. Nineteen TN and 75 R/R patients had a follow-up of at least 12 months or discontinued study prematurely. The 12-month overall response rate (ORR) for TN and R/R patients was 89.5% [complete response (CR) 13 (68.4%), partial response (PR) 4 (21.1%)] and 73.3% [CR 37 (49.3%), PR 18 (24%)], respectively. In the R/R cohort, the 12-month ORR among assessed patients was 67.6% (25/37) in BCRi-exposed versus 85.7% (30/35) in BCRi-naïve patients. At 12 months, peripheral blood uMRD (<0.01%) was achieved in 12 out of 14 (85.7%) TN and 26 out of 38 (68.4%) R/R evaluated patients. At a median follow-up of 5.1 months (range, 0.5-15.6) for TN and 10.1 months (range, 0-25.7) for R/R patients, the median PFS and OS, for both cohorts have not been reached. The estimated 12-month PFS was 90.9% for TN and 81.1% for R/R patients. For R/R patients with prior exposure to BCRi, the estimated 12-month PFS was 69.6% versus 94.8% in BCRi-naïve patients (figure 1). Grade ≥3 adverse events (AEs) were reported in 34.9% of TN patients and 43.9% R/R patients. The most frequent grade ≥3 AEs documented were neutropenia (TN: 19.2% and R/R 17.2%), infections (TN: 4.8% and R/R: 21.5%) and febrile neutropenia (TN: 2.4% and in R/R: 2.6%). COVID-19 occurred in 7 patients including one death. At the time of data cut, 10 deaths occurred, one TN and 9 R/R patients. Causes for death included infections (5 patients), disease progression (2 patients), acute myeloid leukemia/ myelodysplastic syndrome (2 patients) and a soft-tissue sarcoma (1 patient). Conclusions: This first interim analysis of our ongoing prospective real-world study of venetoclax-based treatment for TN and R/R CLL/SLL, demonstrates high efficacy together with a high proportion of undetectable MRD levels and a favorable toxicity profile. These efficacy results are comparable to those reported in previous Phase III clinical trials for CLL, with no new safety signals. [Formula presented] Disclosures: Herishanu: AbbVie: Consultancy, Honoraria, Research Funding;Janssen: Honoraria;Roche: Honoraria;AstraZeneca: Honoraria. Goldschmidt: AbbVie: Consultancy, Research Funding. Itchaki: Janssen: Consultancy, Honoraria, Research Funding;AbbVie: Consultancy, Honoraria, Research Funding. Levi: AbbVie: Consultancy, Research Funding. Aviv: AbbVie: Honoraria, Research Funding. Fineman: AbbVie: Research Funding. Dally: AbbVie: Honoraria, Research Funding. Tadmor: Janssen: Consultancy, Honoraria, Research Funding;AbbVie: Consultancy, Honoraria, Research Funding. Ruchlemer: AbbVie: Consultancy, Honoraria, Research Funding. Abadi: AbbVie: Honoraria, Research Funding. Shvidel: AbbVie: Honoraria, Research Funding. Braester: AbbVie: Honoraria, Research Funding. Cohen: AbbVie: Current Employment, Current equity holder in publicly-traded company. Frankel: AbbVie: Current Employment, Current equity holder in publicly-traded company. Ofek: AbbVie: Current Employment, Current equity holder in publicly-traded company. Berelovich: AbbVie: Current Employment, Current equity holder in publicly-traded company. Grunspan: AbbVie: Current Employment, Other: May hold equity. Benjamini: Janssen: Consultancy, Honoraria, Research Funding;AbbVie: Consultancy, Honoraria, Research Funding.

POSTER ABSTRACTS: P41 PERCEIVED ACCESS TO REPRODUCTIVE HEALTH CARE AND INTEREST IN TELEMEDICINE IN RURAL COLORADO

Objectives: To evaluate rural Colorado women's perceived access to and preferences for receiving reproductive health care services in their communities. Methods: We conducted a cross-sectional, online survey of English and Spanish-speaking women 18-45 years old who are registered to vote in rural Colorado zip codes. Eligible participants were recruited with postcard mailings. Survey questions assessed experiences, beliefs, and preferences regarding facets of reproductive health care, including contraception, miscarriage, and abortion. We performed descriptive and bivariate statistics. Results: Respondents (n=373) had a mean age of 33 years (SD=7.0) and were majority white (86%) and insured (90%;24% publicly insured) from a representative distribution of rural zip codes. Most (74%) noted barriers to obtaining reproductive health care in their communities, with an average of 3.4 barriers cited per person. The most common barriers were too few providers in their communities (83%) and long distance to obtain care (68%). Many (48%) had used telemedicine, primarily (77%) since the COVID-19 pandemic. About half (54%) of respondents were somewhat or very interested in using telemedicine for reproductive health care services. Interest in telemedicine did not significantly differ by perceived barriers to accessing care (p=0.19) or previous use of telemedicine (p=0.11). Conclusions: Most reproductive-aged, rural Colorado women endorsed barriers to obtaining reproductive health care in their communities. While many rural women are interested in using telemedicine for reproductive health care, many are not. Our findings indicate that additional innovative solutions are needed to improve access to care in rural communities.

Calculating Reputation Risk of Financial Institutions

The reputation risk is one of significant risks affecting reliability and credibility of commercial banks. It is one of the main assets Financials Institution have to calculate and keep it safe. It's a smooth slope, once your reputation is damaged, it has a direct and indirect impact on the organization income, profit and your financial strength. This subject is relatively new and the current literature deals with the need to manage the risk of reputation, identifies factors which are difficult to estimate and usually without any action plan. According to The Basel Committee on Banking Supervision [1], banks failed to recognize the reputational risks associated with their off-balance sheet vehicles, securitization schemes, overall liquidity positions, and business practices [4]. Our contribution is the mathematical analysis of the probability and effect of reputation risk's factors. This article will focus on the way to calculate Reputation Risk in Risk Assets terms and its influence on the Capital Adequacy Ratio.