Invasive Pneumococcal Infections Among Moroccan Children: Pneumococcal Vaccination Challenges in the Mature Vaccine Era.

BACKGROUND: Streptococcus pneumoniae, a major contributor to global morbidity and mortality, disproportionately affects children, the elderly, and immunocompromised individuals. Despite vaccination efforts, the challenge of serotype replacement highlights the ongoing struggle against invasive pneumococcal diseases (IPD) in Morocco, emphasizing the need for updated public health strategies and vaccine efficacy assessments. METHODS: This study was conducted at the Ibn Rochd University Hospital Center and the Mohammed VI University Hospital Center from 2019 to 2022, focusing on hospitalized children. It involved the analysis of 74 strains of IPD, assessing the distribution of pneumococcal serotypes and their antibiotic sensitivity in the post-vaccination era. RESULTS: The prevalence of meningitis or meningo-encephalitis was found to be 66% among the study subjects, with the most frequent serotypes being 3, 19A, 6B, 14, and 11. These serotypes varied significantly by age and location. Coverage rates for the pneumococcal conjugate vaccines, PCV-10 and PCV-13, were 20.27% and 56.75%, respectively. Notably, 43% of the strains were non-vaccine serotypes, with serotypes 3 and 19 accounting for 36% of the infections in children, indicating a lack of vaccine efficacy against these types. Additionally, 31.3% of the strains were Penicillin non-susceptible Streptococcus pneumoniae (PNSP), with 81.25% associated with non-vaccine serotypes. CONCLUSIONS: This study highlights the persistence of IPD in Moroccan children, revealing significant challenges despite vaccination efforts. With the reintroduction of PCV-13, concerns about the efficacy against non-vaccine serotypes, particularly 3 and 19A, remain. Continuous surveillance and adaptable vaccination strategies are essential to combat these serotype replacements and ensure the effectiveness of future preventive measures.

Survey on the management of childhood epilepsy among general practitioners in the area of Marrakech.

BACKGROUND: Epilepsy is a common chronic neurological disorder in the pediatric population and its evolution can be fatal. It represents a major public health problem as well as an economic burden for the families of affected children, health systems and the overall economies of countries. This further accentuates the role that general practitioners can play in the management of childhood epilepsy in the face of the persistent lack of neurologists and neuro-pediatricians in our country. METHODS: In order to assess the knowledge and therapeutic habits of general practitioners, we carried out a descriptive and cross-sectional study with general practitioners practicing in the two healthcare sectors: public and private, and in two settings: urban and rural, during the year 2018. The data was collected through a pre-established survey. RESULTS: In total, 155 general practitioners responded to the survey. For 85.2% of physicians, the diagnosis of childhood epilepsy was based on interrogation, physical examination, and EEG. While brain imaging would be systematic regardless of the type of epilepsy for 45.2% of doctors. Only 6 doctors (3.9%) had knowledge of the latest classifications of the "ILAE". For treatment, the majority of physicians (65.5%) adopted first-line monotherapy with valproate in leading position. Almost half of the doctors (48.4%) found that education of parents and children was always necessary. None of the GPs interviewed in our series assessed the academic impact of epilepsy. Only 32% of doctors had received continuing education on epilepsy. CONCLUSION: The data from our study demonstrates that continuing education on the management of childhood epilepsy and the greater involvement of general practitioners were essential elements in improving care.

Impact of Covid-19 pandemic on pediatric meningitis incidence in central Morocco.

Bacterial meningitis is a diagnostic, therapeutic, and prophylactic emergency, particularly for children. In Morocco, meningitis remains a major public health challenge with lethality between 10% and 12% of cases. Our objective is to determine the impact of COVID-19 pandemic on the incidence of pediatric meningitis in central Morocco. A retrospective epidemiological study was carried out in the Department of Pediatric Emergencies of the Mother and Child Hospital of Marrakech in Morocco. Data were collected from patient files of Meningitis cases reported during the confinement period in March, April, and May of 2019 and 2020 respectively. Then, data were analyzed using SPSS software. The results showed a notification of 72 cases of suspected meningitis between March 2019 and March 2020 with dominance of boys (up to 70%) and age range of 1 month to 2 years (up to 34%). We noted a decrease in the number of patients hospitalized for suspected meningitis during COVID-19 pandemic. The final diagnosis of suspected meningitis was confirmed for 20% of the cases during the containment period against only 2.38% before the pandemic. This difference was statistically significant (P<0.05). Our investigations confirm the effect of the COVID-19 pandemic on the incidence of bacterial meningitis of children in the study area, more investigations are needed to generalize and explain these results in Morocco.

The characterization of a hospitalized population at the pediatric emergency service of Mother and Child Hospital, Marrakech, Morocco.

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of the general health care system. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)) and age, season, and weight. Thus, for the association between the digestive system diseases and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for the skin and subcutaneous tissue diseases and the autumn season (aOR=11.37, 95% CI= 1.272-101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

The characterization of a hospitalized population at the pediatric emergency service of mother and child hospital, Marrakech, Morocco

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of general health care. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of Male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and age, season, and weight. Thus, for the association between Diseases of the digestive system and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for Diseases of the skin and subcutaneous tissue and the autumn season (aOR=11.37, 95% CI= 1.272-<101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

Subcutaneous emphysema and pneumomediastinum in child with asthma revealing occult foreign body aspiration: a case report.

BACKGROUND: Exacerbations of asthma constitute the most common cause of pneumomediastinum and subcutaneous emphysema in children. Foreign body aspiration is a rare cause of pneumomediastinum and subcutaneous emphysema. Foreign body aspiration leading to the occurrence of pneumomediastinum in a child with asthma may go unnoticed and be wrongly attributed to asthma, which leads to delayed diagnosis as well as to life-threatening and long-term complications. CASE PRESENTATION: We describe a case of a 6-year-old Moroccan boy with asthma who was admitted to our emergency department for acute dyspnea and persistent dry cough. The patient was initially treated as having acute asthma exacerbation. Owing to insufficient clinical and radiographic improvement with asthma treatment, a rigid bronchoscopy under general anesthesia was performed. A pumpkin seed was removed from the left main bronchus. Clinical and radiographic improvement was achieved after foreign body extraction. CONCLUSIONS: This case emphasizes that the possibility of foreign body aspiration should always and carefully be considered by the emergency physician when faced with a child with asthma presenting with pneumomediastinum and subcutaneous emphysema as an important differential diagnosis even in the absence of a history of foreign body aspiration.