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The aetiology of paediatric bloodstream infections changes after pneumococcal vaccination and group B streptococcus prophylaxis.

https://arctichealth.org/en/permalink/ahliterature273598
Source
Acta Paediatr. 2015 Sep;104(9):933-9
Publication Type
Article
Date
Sep-2015
Author
Joachim Luthander
Rutger Bennet
Christian G Giske
Anna Nilsson
Margareta Eriksson
Source
Acta Paediatr. 2015 Sep;104(9):933-9
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Antibiotic Prophylaxis
Bacteremia - microbiology - prevention & control
Child
Child, Preschool
Female
Gram-Positive Bacterial Infections - microbiology - prevention & control
Humans
Infant
Infant, Newborn
Male
Pneumococcal Vaccines
Retrospective Studies
Staphylococcus aureus
Streptococcus agalactiae
Streptococcus pneumoniae
Sweden
Abstract
This study explored the incidence and aetiology of bloodstream infections after patients received the pneumococcal conjugate vaccination and a risk-based intrapartum antibiotic prophylaxis against early onset sepsis caused by group B streptococcus. We also monitored clinically relevant antimicrobial resistance.
We studied 3986 positive blood cultures from children up to 17?years of age at a paediatric hospital in Stockholm, Sweden, using data from medical records before and after the initiatives, to reduce early onset sepsis, were introduced in 2007 and 2008.
Bloodstream infections caused by Streptococcus pneumoniae declined by 42% overall (5.6 to 3.2/100?000) and by 62% in previously healthy children under 36?months of age (24.2 to 9.2/100?000). Early onset sepsis caused by group B streptococcus declined by 60% (0.5 to 0.2/1000 live born children). Bacterial meningitis caused by these bacteria decreased by 70%. Staphylococcus aureus and various Gram-negative bacteria became the dominant pathogens, in both previously healthy children and those with underlying disease. Overall, antimicrobial resistance remained low between the two 5-year study periods.
Pneumococcal conjugate vaccination and risk-based intrapartum antibiotic prophylaxis against group B streptococcus effectively decreased the incidence of bloodstream infections. Empirical antibiotic therapy should target Staphylococcus aureus in?both community and hospital-acquired invasive bacterial infections.
PubMed ID
26060088 View in PubMed
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Age and risk factors influence the microbial aetiology of bloodstream infection in children.

https://arctichealth.org/en/permalink/ahliterature119258
Source
Acta Paediatr. 2013 Feb;102(2):182-6
Publication Type
Article
Date
Feb-2013
Author
Joachim Luthander
Rutger Bennet
Christian G Giske
Anna Nilsson
Margareta Eriksson
Author Affiliation
Pediatric Infectious Diseases Unit at the Pediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden. joachim.luthander@karolinska.se
Source
Acta Paediatr. 2013 Feb;102(2):182-6
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy - epidemiology - etiology - microbiology
Candidemia - drug therapy - epidemiology - etiology - microbiology
Child
Child, Preschool
Comorbidity
Drug Resistance, Bacterial
Humans
Incidence
Infant
Infant, Newborn
Pneumococcal Infections - drug therapy - epidemiology - etiology - microbiology
Retrospective Studies
Risk factors
Staphylococcal Infections - drug therapy - epidemiology - etiology - microbiology
Sweden - epidemiology
Treatment Outcome
Abstract
To study the aetiology of bloodstream infections (BSI) in children 0-17 years, the influence of age and underlying co-morbidity on BSI rate, distribution of pathogens and outcome; and to provide data on antimicrobial susceptibility patterns.
A retrospective population-based study. Data on blood cultures were collected at yearly intervals during 1998-2008. Information about risk factors, focal infection and outcome was retrieved from the patient charts.
We identified 1097 BSI. The incidence of BSI was 0.4/1000. The age-specific incidence was 2.3/1000 in neonates (0-28 days old) and 0.2/1000 in the age group 6-17 years. Staphylococcus aureus was the most common pathogen. The number of species causing BSI in previously healthy children was lower compared with children with co-morbidity. Most children requiring intensive care had a serious underlying illness. Antimicrobial resistance was rare and did not influence outcome. The case-fatality rate was 14.4% in neonates, 5.4% in children with co-morbidity and 1.7% in previously healthy children.
Mortality from BSI is low, and a limited spectrum of pathogens is isolated from previously healthy children compared with children with co-morbidity. When choosing empirical therapy for suspected BSI, age and presence of risk factors should be taken into account.
PubMed ID
23121094 View in PubMed
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Burden of severe rotavirus disease leading to hospitalization assessed in a prospective cohort study in Sweden.

https://arctichealth.org/en/permalink/ahliterature259023
Source
Scand J Infect Dis. 2014 Apr;46(4):294-302
Publication Type
Article
Date
Apr-2014
Author
Malin Rinder
Anh Nhi Tran
Rutger Bennet
Maria Brytting
Tobias Cassel
Margareta Eriksson
Deborah Frithiof
Leif Gothefors
Jann Storsaeter
Birger Trollfors
Sindri Valdimarsson
Martin Wennerström
Kari Johansen
Source
Scand J Infect Dis. 2014 Apr;46(4):294-302
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Child, Preschool
Community-Acquired Infections - epidemiology - virology
Cross Infection - epidemiology - virology
Female
Gastroenteritis - epidemiology - virology
Hospitalization - statistics & numerical data
Humans
Incidence
Infant
Infant, Newborn
Male
Prospective Studies
Rotavirus - genetics - isolation & purification
Rotavirus Infections - epidemiology - virology
Sweden - epidemiology
Abstract
The aim of this prospective cohort study was to estimate the burden of severe disease caused by rotavirus-induced gastroenteritis in Swedish children aged 38.5°C upon admission. Complications occurred in > 10% of the children, with hypertonic dehydration (32/604) and seizures (10/604) occurring most frequently.
Rotaviruses may cause severe febrile acute gastroenteritis leading to dehydration requiring acute rehydration in hospital. In addition, further complications occurred in > 10% of hospitalized children.
PubMed ID
24484415 View in PubMed
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Effectiveness of the monovalent AS03-adjuvanted influenza A(H1N1)pdm09 vaccine against hospitalization in children because of influenza.

https://arctichealth.org/en/permalink/ahliterature122416
Source
Vaccine. 2012 Aug 24;30(39):5699-702
Publication Type
Article
Date
Aug-24-2012
Author
Ake Ortqvist
Rutger Bennet
Malin Ryd Rinder
Hans Lindblad
Margareta Eriksson
Author Affiliation
Karolinska Institutet, Department of Medicine, Unit of Infectious Diseases, Karolinska Solna, Sweden. ake.ortqvist@sll.se
Source
Vaccine. 2012 Aug 24;30(39):5699-702
Date
Aug-24-2012
Language
English
Publication Type
Article
Keywords
Adjuvants, Immunologic - administration & dosage
Adolescent
Case-Control Studies
Child
Child, Preschool
Hospitalization - statistics & numerical data
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza Vaccines
Influenza, Human - epidemiology - prevention & control
Retrospective Studies
Sweden - epidemiology
Vaccination - statistics & numerical data
Abstract
We studied the effectiveness of the AS03-adjuvanted monovalent vaccine (Pandemrix(®)) for the prevention of severe pandemic influenza A(H1N1)pdm09 in children, in 2009. All children hospitalized for influenza-like illness in Stockholm County during the peak of the pandemic were included. We compared the frequency of vaccinated children between influenza A(H1N1)pdm09 PCR positive cases and PCR negative controls in a retrospective case-control study. 95 cases and 177 controls were identified. About half of the children in both groups were between 6 months and 2 years of age. Only 1/95 (1%) cases had been vaccinated more than 14 days prior to admission, compared to 23/177 controls (13%), corresponding to a vaccine effectiveness, adjusted for co-morbid conditions, of 91% (95% confidence interval [CI] 30-99). In contrast, the risk for being a case was significantly higher among children vaccinated between 1 and 14 days prior to hospitalization, than among those who were non-vaccinated 13/95 vs. 7/177 (OR 3.6, 95% CI 1.4-9.5). We conclude that a single dose of adjuvanted vaccine was highly protective against hospitalization for influenza A(H1N1)pdm09 in children 6 month to 17 years. The reason for the increased rate of hospitalizations with confirmed influenza in children just following immunization is unclear and should be studied further.
PubMed ID
22819987 View in PubMed
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The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity.

https://arctichealth.org/en/permalink/ahliterature284739
Source
Eur J Pediatr. 2017 Mar;176(3):337-342
Publication Type
Article
Date
Mar-2017
Author
Ellinor Sterky
Rutger Bennet
Ann Lindstrand
Margareta Eriksson
Anna Nilsson
Source
Eur J Pediatr. 2017 Mar;176(3):337-342
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Child, Preschool
Community-Acquired Infections - epidemiology
Comorbidity
Female
Hospitalization - statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Pneumococcal Vaccines - administration & dosage
Pneumonia, Viral - epidemiology
Retrospective Studies
Severity of Illness Index
Sweden - epidemiology
Vaccines, Conjugate - administration & dosage
Abstract
The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to
Notes
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PubMed ID
28070670 View in PubMed
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Impact on affected families and society of severe rotavirus infections in Swedish children assessed in a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature296021
Source
Infect Dis (Lond). 2018 05; 50(5):361-371
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2018

Influenza epidemiology among hospitalized children in Stockholm, Sweden 1998-2014.

https://arctichealth.org/en/permalink/ahliterature286770
Source
Vaccine. 2016 Jun 14;34(28):3298-302
Publication Type
Article
Date
Jun-14-2016
Author
Rutger Bennet
Johan Hamrin
Benita Zweygberg Wirgart
Maria Rotzén Östlund
Åke Örtqvist
Margareta Eriksson
Source
Vaccine. 2016 Jun 14;34(28):3298-302
Date
Jun-14-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Child
Child, Hospitalized
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Influenza A Virus, H1N1 Subtype
Influenza A Virus, H3N2 Subtype
Influenza B virus
Influenza, Human - epidemiology
Intensive Care Units, Pediatric
Male
Retrospective Studies
Sweden - epidemiology
Abstract
Influenza remains a common reason for the hospitalization of children. There is a need for long term studies that are also population based. We describe the epidemiology of severe influenza in a defined population 1998-2014.
Retrospective study of annually collected data of virologically confirmed influenza in hospitalized children 0-17 years living in the catchment area (230,000 children). We gathered information about comorbidity and complications from case records, and compared Influenza A, B and A(H1N1)pdm09 with respect to these factors.
A total of 922 children with influenza were hospitalized. The mean rate remained unchanged at 22.5-24.2 per 100,000 children per year. There were two major outbreaks: influenza A(H3N2) in 2003-2004 and the A(H1N1) pandemic in 2009-2010. The proportion of children with influenza B increased from 8% during the first half of the study period to 28% during the second half. The highest admission rate was found in children
PubMed ID
27155498 View in PubMed
Less detail

Interferon-gamma release assays can effectively screen migrants for the tuberculosis infection, but urgent, active cases need clinical recognition.

https://arctichealth.org/en/permalink/ahliterature280862
Source
Acta Paediatr. 2016 Jun;105(6):671-5
Publication Type
Article
Date
Jun-2016
Author
Sahar Nejat
Rutger Bennet
Source
Acta Paediatr. 2016 Jun;105(6):671-5
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Interferon-gamma Release Tests
Male
Mass Screening
Sweden - epidemiology
Tuberculin Test
Tuberculosis - diagnosis - epidemiology
Abstract
Increasing numbers of migrants to Sweden are screened for tuberculosis (TB), and a rational approach to screening is required. We evaluated positive tuberculin skin tests (TSTs) and interferon-gamma release assays (IGRAs) on paediatric migrants in relation to the TB incidence in the corresponding foreign-born populations in Stockholm.
This study examined the characteristics of migrants under the age of 18 who were referred to a paediatric TB clinic at Karolinska University Hospital from 2008 to 2014 by primary care centres in Stockholm County.
We saw 943 TST-positive children with a median age of 14 years at the TB clinic and performed IGRAs on 557. IGRA positivity ranged from 64% in migrants from Somalia to 20% in those from the former Soviet Union and eastern Europe, with an estimated population level prevalence of 18.8% and 4.2%, respectively. These were significantly correlated to TB incidence in foreign-born Stockholm children. We diagnosed active TB in 20 screened migrants, and advanced, symptomatic TB was diagnosed in 10 recently arrived migrants without screening.
IGRAs showed higher specificity than TST in identifying tuberculosis. TB screening should focus on migrants from high-incidence countries, but this may be inadequate to detect advanced TB cases.
PubMed ID
26936211 View in PubMed
Less detail

Long term effectiveness of adjuvanted influenza A(H1N1)pdm09 vaccine in children.

https://arctichealth.org/en/permalink/ahliterature269843
Source
Vaccine. 2015 May 21;33(22):2558-61
Publication Type
Article
Date
May-21-2015
Author
Åke Örtqvist
Rutger Bennet
Johan Hamrin
Malin Ryd Rinder
Hans Lindblad
Joanna Nederby Öhd
Margareta Eriksson
Source
Vaccine. 2015 May 21;33(22):2558-61
Date
May-21-2015
Language
English
Publication Type
Article
Keywords
Adjuvants, Immunologic
Adolescent
Antibodies, Viral - blood
Case-Control Studies
Child
Child, Preschool
Female
Hospitalization - statistics & numerical data
Humans
Infant
Influenza A Virus, H1N1 Subtype - immunology
Influenza A Virus, H3N2 Subtype - immunology
Influenza Vaccines - administration & dosage - immunology
Influenza, Human - diagnosis - epidemiology - prevention & control
Male
Odds Ratio
Pandemics
Retrospective Studies
Seasons
Sweden - epidemiology
Time Factors
Vaccination - statistics & numerical data
Abstract
Immunological studies have indicated that the effectiveness of AS03 adjuvanted monovalent influenza A(H1N1)pdm09 vaccine (Pandemrix) may be of longer duration than what is seen for non-adjuvanted seasonal influenza vaccines. Sixty-nine percent of children 6 months-18 years of age in Stockholm County received at least one dose of Pandemrix during the 2009 pandemic. We studied the effectiveness of the vaccine during the influenza seasons 2010-2011 and 2012-2013 in children hospitalized with virologically confirmed influenza. The season 2011-2012 was not included, since influenza A(H3N2) was the predominant circulating strain.
In a retrospective case-control study using a modified test-negative design we compared the percentage vaccinated with Pandemrix among children diagnosed with influenza A(H1N1)pdm09 (cases), with that of those diagnosed with influenza A(H3N2) or influenza B (controls) during the two seasons. We excluded children born after July 1, 2009, since only children who were 6 months of age or older received the pandemic vaccine in October-December 2009.
During the 2010-2011 season, 3/16 (19%) of children diagnosed with influenza A(H1N1)pdm09, vs. 32/41 (78%) of those with influenza A(H3N2) or influenza B had been vaccinated with Pandemrix in 2009. The odds ratio, after adjustment for sex, age and underlying diseases, for becoming a case when vaccinated with Pandemrix was 0.083 (95%CI 0.014, 0.36), corresponding to a VE of 91.7%. During the season 2012-2013, there was no difference between the two groups; 59% of children diagnosed with influenza A(H3N2)/B and 60% of those with influenza A(H1N1)pdm09 had been vaccinated with Pandemrix in 2009.
The AS03 adjuvanted monovalent influenza A(H1N1) pdm09 vaccine (Pandemrix) was effective in preventing hospital admission for influenza A(H1N1)pdm09 in children during at least two seasons.
PubMed ID
25869891 View in PubMed
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21 records – page 1 of 3.