| 1. |
- Alfvén, Tobias, et al.
(författare)
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Mpox hos barn – svenskt perspektiv : Mpox and children - a Swedish perspective
- 2023
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Ingår i: Läkartidningen. - 0023-7205. ; 120
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Mpox (monkeypox) is an infection caused by the monkeypox virus, which belongs to the same family as the smallpox virus. Sporadic infections in humans have been known since the 1970s. Since spring 2022 there has been a global epidemic. The large majority of the mpox cases in the ongoing epidemic have been reported in adult men, the number of infected children is small. The typical manifestation of mpox includes a rash that initially presents as maculopapular lesions and then develops into vesicles and eventually crusts. Transmission of the virus primarily occurs through close contact with infected individuals, particularly through contact with unhealed blisters or wounds, as well as through sexual contacts and exposure to body fluids. In cases of documented close contact with an infected individual, post-exposure prophylaxis is recommended and may also be administered to children whose guardians have contracted mpox.
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| 2. |
- Almqvist, Catarina, et al.
(författare)
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Season of birth, childhood asthma and allergy in a nationwide cohort : Mediation through lower respiratory infections
- 2020
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Ingår i: Clinical and Experimental Allergy. - Stockholm : Wiley. - 0954-7894 .- 1365-2222. ; 50:2, s. 222-230
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have suggested an association between season of birth and risk of childhood asthma and allergic disease. The association may be modified by birth year and region, or mediated by respiratory tract infections.ObjectiveWe aimed to estimate the association between season of birth and risk of childhood asthma/wheeze or allergic rhinoconjunctivitis in a population‐based setting, and the mediating effect of lower respiratory infections.MethodsTwo population‐based cohorts were identified from the nationwide Swedish Medical Birth, Patient and Prescribed Drug Registers. The association between birth month/season and asthma/wheeze incidence was analysed using Cox proportional regression in the younger cohort born 2005‐2010 (n = 582 494) and asthma/allergic rhinoconjunctivitis prevalence during the 7th year of life using log‐binomial models in the older cohort born 2001‐2004 (n = 367 583). Interactions were formally tested. Mediation analyses to address the effect of lower respiratory infections were performed in the older cohort using the R package “medflex.”ResultsChildren born during fall and winter had an increased risk of asthma/wheeze after 2 years of age in the younger cohort: hazard ratio 1.24 (95% confidence interval, CI 1.17, 1.33) for winter and risk of prevalent asthma during their 7th year of life in the older cohort; prevalence ratio (PR) 1.12 (95% CI 1.08, 1.16) for winter. These estimates were partly mediated by lower respiratory infections; the indirect effect for winter compared with summer was PR 1.03 (95% CI 1.03, 1.04). The association was similar for allergic rhinoconjunctivitis in the 7th year of life, but not mediated by respiratory infections.ConclusionWe found that the association between season of birth and risk of childhood asthma/wheeze, but not allergic rhinoconjunctivitis, is partly mediated through lower respiratory infections.Clinical relevanceThis has important implications for patient care, such as asthma management programmes to notify timing of seasonality for viral respiratory tract infections.
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| 3. |
- Arthur Rhedin, Samuel
(författare)
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Severe viral respiratory tract infections in children
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory tract infections (RTIs) are estimated to cause 703.000 deaths annually in children below five years. The majority of RTIs in children are caused by viruses, yet the number of antivirals approved for treatment of these infections is very limited. Moreover, it is sometimes complicated to distinguish between bacterial and viral RTIs, which results in overuse of antibiotics. The aim of this thesis is to improve the understanding of the causative role of respiratory viruses in children with severe RTI, with the long-term goal to improve diagnostics, facilitate the development of new antiviral drugs and reduce unnecessary antibiotic use. To achieve this, a number of specific objectives have been assessed. The spread of the Influenza A H1N1(pdm09) i.e. the swine flu pandemic was slower than expected when it reached Europe during Spring 2009. This was suggested to be due to negative viral interference by circulating rhinovirus (RV). In Paper I, children with influenza-like illness were assessed during the swine flu pandemic in 2009. Co-infections were specifically assessed in influenza-positive patients with regard to disease severity. No significant difference was found between patients with single versus viral co-infection. Co-infection with influenza and RV was not uncommon, which contradicted the proposed hypothesis of viral interference. Moreover, the study showed that several different viruses were present in the children with suspected influenza, underscoring the overlap of disease presentation of different respiratory viruses. PCR is a very sensitive method for detecting viruses, yet the significance of a finding in upper respiratory specimens has been questioned. In Paper II, we assessed the role of viruses in acute respiratory illness in a case-control study. Respiratory syncytial virus (RSV), human metapneumovirus (hMPV) and parainfluenza virus were highly associated with acute respiratory illness. In contrast, detection of other viruses was common in asymptomatic controls, showing the complexity in interpreting PCR-positivity for these viruses. Community-acquired pneumonia (CAP) is a disease that traditionally has been considered a predominantly bacterial disease. Nevertheless, successful immunization against the two major bacterial causes, Streptococcus pneumoniae and Haemophilus influenza, has contributed to a declining incidence of the disease and has likely also led to a relative increase of other etiologic agents. In Paper III, the role of viruses in CAP was assessed in another case-control study. Viruses were detected in the majority of cases and RSV, hMPV and influenza were highly associated with CAP. The study suggests that viruses have a major role in childhood CAP and indicates that viral CAP is an underdiagnosed disease. Viral RTIs affect also immunosuppressed children. Neutropenia is a common adverse effect in children receiving chemotherapeutic treatment for malignancies. The condition highly increases the risk for septicemia, and fever is sometimes the only symptom. However, in the majority of episodes of febrile neutropenia, no causative agent can be identified. In Paper IV, respiratory viruses were assessed in immunosuppressed children during episodes of febrile neutropenia. Interestingly, respiratory viruses were detected in almost half of the episodes, whereas laboratory confirmed septicemia was infrequent (9%). Moreover, the majority of children had cleared their virus at follow-up suggesting a causal relationship between the detected viruses and the episodes of febrile neutropenia. This thesis has contributed to an improved understanding of the role of viruses in severe RTIs in children stressing the urgent need for new diagnostic tests that better distinguish between viral and bacterial disease. It also forwards the need for improved treatment options and new vaccines against viral RTIs in children.
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| 4. |
- Nybond, Susanna, et al.
(författare)
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Adenoviral detection by recombinase polymerase amplification and vertical flow paper microarray.
- 2019
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Ingår i: Analytical and Bioanalytical Chemistry. - : Springer. - 1618-2642 .- 1618-2650. ; 411:4, s. 813-822
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Tidskriftsartikel (refereegranskat)abstract
- Respiratory viral infections often mimic the symptoms of infections caused by bacteria; however, restricted and targeted administration of antibiotics is needed to combat growing antimicrobial resistance. This is particularly relevant in low-income settings. In this work, we describe the use of isothermal amplification of viral DNA at 37 °C coupled to a paper-based vertical flow microarray (VFM) setup that utilizes a colorimetric detection of amplicons using functionalized gold nanoparticles. Two oligonucleotide probes, one in-house designed and one known adenoviral probe were tested and validated for microarray detection down to 50 nM using a synthetic target template. Furthermore, primers were shown to function in a recombinase polymerase amplification reaction using both synthetic template and viral DNA. As a proof-of-concept, we demonstrate adenoviral detection with four different adenoviral species associated with respiratory infections using the paper-based VFM format. The presented assay was validated with selected adenoviral species using the in-house probe, enabling detection at 1 ng of starting material with intra- and inter-assay %CV of ≤ 9% and ≤ 13%. Finally, we validate our overall method using clinical samples. Based on the results, the combination of recombinase polymerase amplification, paper microarray analysis, and nanoparticle-based colorimetric detection could thus be a useful strategy towards rapid and affordable multiplexed viral diagnostics.
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| 5. |
- Rhedin, Samuel, et al.
(författare)
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Myxovirus resistance protein A for discriminating between viral and bacterial lower respiratory tract infections in children- The TREND study
- 2022
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Ingår i: Clinical Microbiology and Infection. - : Elsevier BV. - 1198-743X .- 1469-0691. ; 28:9, s. 1251-1257
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Discriminating between viral and bacterial lower respiratory tract infection (LRTI) in children is challenging, leading to an excessive use of antibiotics. Myxovirus resistance protein A (MxA) is a promising biomarker for viral infections. The primary aim of the study was to assess differences in blood MxA levels between children with viral and bacterial LRTI. Secondary aims were to assess differences in blood MxA levels between children with viral LRTI and asymptomatic controls and to assess MxA levels in relation to different respiratory viruses. Methods: Children with LRTI were enrolled as cases at Sachs' Children and Youth Hospital, Stockholm, Sweden. Nasopharyngeal aspirates and blood samples for analysis of viral PCR, MxA, and C-reactive protein were systematically collected from all study subjects in addition to standard laboratory/radiology assessment. Aetiology was defined according to an algorithm based on laboratory and radiological findings. Asymptomatic children with minor surgical disease were enrolled as controls. Results: MxA levels were higher in children with viral LRTI (n = 242) as compared to both bacterial (n = 5) LRTI (p < 0.01, area under the curve (AUC) 0.90, 95% CI: 0.81 to 0.99), and controls (AUC 0.92, 95% CI: 0.88 to 0.95). In the subgroup of children with pneumonia diagnosis, a cutoff of MxA 430 mg/l discriminated between viral (n = 29) and bacterial (n = 4) aetiology with 93% (95% CI: 78-99%) sensi-tivity and 100% (95% CI: 51-100%) specificity (AUC 0.98, 95% CI: 0.94 to 1.00). The highest MxA levels were seen in cases PCR positive for influenza (median MxA 1699 mg/l, interquartile range: 732 to 2996) and respiratory syncytial virus (median MxA 1115 mg/l, interquartile range: 679 to 2489). Discussion: MxA accurately discriminated between viral and bacterial aetiology in children with LRTI, particularly in the group of children with pneumonia diagnosis, but the number of children with bacterial LRTI was low.
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| 6. |
- Rhedin, Samuel, et al.
(författare)
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Risk factors for multisystem inflammatory syndrome in children – A population-based cohort study of over 2 million children
- 2022
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Ingår i: The Lancet Regional Health - Europe. - : Elsevier BV. - 2666-7762. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although severe acute COVID-19 is rare in children, SARS-CoV-2 infection can trigger the novel post-infectious condition multisystem inflammatory syndrome in children (MIS-C). Increased knowledge on risk factors for MIS-C could improve our understanding of the pathogenesis of the condition and better guide targeted public health interventions. The aim of the study was to assess risk factors for MIS-C with the aim to identify vulnerable children. Methods: A register-based cohort study including all children and adolescents <19 years born in Sweden between March 1, 2001- December 31, 2020 was performed. Data on sociodemographic risk factors and comorbidities (sex, age, parental region of birth, parental education, asthma, autoimmune disease, chromosomal anomalies, chronic heart disease, chronic lung disease, obesity, life-limiting condition) were retrieved from national health and population registers. The outcome was MIS-C diagnosis according to the Swedish Pediatric Rheumatology Quality Register during March 1, 2020 – December 8, 2021. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis. Incidence rates per 100 000 person-years were calculated assuming a Poisson distribution. Findings: Among 2 117 443 children included in the study, 253 children developed MIS-C, corresponding to an incidence rate of 6·8 (95% CI: 6·0-7·6) per 100 000 person-years. Male sex (HR 1·65, 95% CI: 1·28-2·14), age 5-11 years (adjusted HR 1·44, 95% CI: 1·06-1·95 using children 0-4 years as reference), foreign-born parents (HR 2·53, 95% CI: 1·93-3·34), asthma (aHR 1·49, 95% CI: 1·00-2·20), obesity (aHR 2·15, 95% CI: 1·09-4·25) and life-limiting conditions (aHR 3·10, 95% CI: 1·80-5·33) were associated with MIS-C. Children 16-18 years had a reduced risk for MIS-C (aHR 0·45, 95% CI: 0·24-0·85). Interpretation: We report increased risks for MIS-C in children with male sex, age 5-11 years, foreign-born parents, asthma, obesity, and life-limiting condition. Knowing these risk populations might facilitate identification of children with MIS-C and potentially guide targeted public health interventions. Nevertheless, the absolute risks for MIS-C were very low. Funding: Financial support was provided from the Swedish Research Council (grant no 2018-02640), the Swedish Heart-Lung Foundation (grant no 20210416), the Asthma and Allergy Association, Ake Wiberg foundation, the Samariten Foundation, the Society of Child Care, and Region Stockholm.
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