Showing papers by "Evan J. Anderson published in 2012"

Prevalence and Characteristics of Human Metapneumovirus Infection Among Hospitalized Children at High Risk for Severe Lower Respiratory Tract Infection

Abstract: BACKGROUND: Human metapneumovirus (HMPV) is a significant cause of respiratory tract infections. Little is known about HMPV in children who are at high risk for lower respiratory tract infection (LRTI). METHODS: To determine the prevalence of HMPV in high-risk children and to identify HMPV risk factors, children ≤24 months with prematurity, chronic lung disease, and/or congenital cardiac disease who were hospitalized with LRTI were prospectively enrolled. Nasopharyngeal aspirates were tested for HMPV, respiratory syncytial virus (RSV), influenza A and B, and parainfluenza types 1-3. Demographics, medical history, and outcomes for those with HMPV and RSV were compared. A multivariate analysis was performed to determine HMPV risk factors. RESULTS: Over 4 years, 1126 eligible children were enrolled. Pathogens were identified in 61% of subjects. HMPV was identified in 9.0%, second to RSV (45%). Coinfection with HMPV and RSV occurred in <1% of subjects. Subjects infected with HMPV were older (8.2 vs 4.0 months, P < .001), were born more prematurely (27 vs 33 weeks, P < .001), and more commonly had chronic lung disease (59.3% vs 21.8%, P 12 were associated with a decreased risk. CONCLUSIONS: HMPV was detected in 9% of high-risk children who were hospitalized with lower respiratory tract disease, representing the second most common virus in this population. Compared with all other subjects (including RSV-infected), subjects infected with HMPV were older but were born more prematurely.

Indirect Protection and Indirect Measures of Protection From Rotavirus in Adults

Abstract: TO THE EDITOR—We read with interest the recent article by Lopman et al [1], who used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) data from the Nationwide Inpatient Sample (NIS) to document a decline in rotavirus and cause-unspecified gastroenteritis in 2008 in patients <24 years of age following widespread implementation of pediatric rotavirus vaccination. Despite the fact that administrative coding (ICD-9CM) data have been widely used [1–6], we are unaware of data regarding how well these codes identify hospitalized adults with all-cause gastroenteritis. In addition, important differences exist in the ICD-9CM codes used in studies, depending on whether the focus was on foodborne illness or all-cause gastroenteritis. Analysis of administrative data that was performed for rotavirus in children showed an underestimation of rotavirus in that population [7]. As part of an institutional review board–approved study of the prevalence of rotavirus among adults hospitalized at Northwestern Memorial Hospital (Chicago, Illinois) from 1 December 2005 through 30 November 2006, who had a stool specimen submitted for bacterial stool culture (BSC) [8], we compared how well ICD9CM codes were able to identify patients with gastroenteritis when compared with having a BSC obtained, a surrogate for a clinical diagnosis of gastroenteritis. We used the criteria from the sentinel study of Mounts et al [3]. Any patient with an ICD-9CM code of 008.45 (Clostridium difficile) was reviewed and Table 1. Comparison Between Patients With an ICD-9CM Code Consistent With Gastroenteritis and Those Who Have a Bacterial Stool Culture Saved

The glory of guidelines and the twilight of reality: controversies and challenges in the prevention and treatment of HIV in children.

Abstract: Since the discovery of HIV 30 years ago, we have learned much about HIV in children and adolescents. Dramatic declines have occurred in mother-to-child transmission of HIV in resource-rich countries. Resource-poor countries struggle with improving prevention of mother-to-child transmission due to the lack of universal antiretroviral treatment for pregnant and nursing mothers. In children infected with HIV, pharmacokinetic, safety and efficacy data have been determined for many of the older drugs. Data are lacking for the newer, safer and more effective currently available drugs, resulting in the pediatric guidelines lagging behind adult recommendations. Although guidelines for prevention and treatment are helpful, the way they are created causes them to lag behind new scientific evidence, and in some situations they will be confusing or only based on expert opinion. Improving prevention of HIV infection in adolescents and young adults and in treating those who become HIV infected is crucially important. T...