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Aim: Respiratory testing with rapid antigen tests (RATs) in children under 5 years of age may be uncomfortable and presents specific challenges to testing due to compliance and procedural distress. The aim of this study was to investigate sensitivity and feasibility of self‐collected nasal and saliva RAT tests compared with a combined nose and throat (CTN) swab PCR in children under 5. Methods: Children aged between 1 month and 5 years, with confirmed COVID‐19 or who were a household contact within 7 days were included. A saliva RAT, nasal RAT and CTN swab were collected by the parent. SARS‐CoV‐2 cycle threshold (Ct) values for CTN tested by PCR were compared with saliva and nasal RAT results. Parent preference for method of sample was recorded. Results: Forty‐one children were recruited with median age of 1.5 (interquartile range 0.7–4.0) years. Only 22/41 (54%) of parents were able to successfully collect a saliva RAT from their child. Sensitivity of the nasal RAT and saliva RAT was 0.889 (95% confidence interval (CI) 0.739–0.969) and 0.158 (95% CI 0.034–0.396), respectively. Upper limit of nasal RAT detection by CTN Ct value was higher than saliva (36.05 vs. 27.29). While saliva RAT was rated most comfortable, nasal RAT was rated the preferred specimen by parents for future testing, due to saliva collection difficulties and time taken. Conclusions: Rapid antigen testing with nasal RAT is a more feasible and sensitive method for SARS‐CoV‐2 detection in young children compared with saliva RAT. [ABSTRACT FROM AUTHOR]

Aim: We describe the clinical profile of children and outcomes of influenza immunisation for patients in a paediatric intensive care unit (PICU). Methods: Over two influenza seasons: 19/04/2018 to 07/08/2018 and 02/05/2019 to 10/10/2019, an immunisation nurse and PICU nurse coordinator met weekly and identified patients to receive the influenza vaccine. An inpatient list of PICU patients was screened for eligible patients: greater than 6 months of age, did not have imminent procedures (e.g. surgery) or were not critically unwell, as determined by the treating team, to receive the influenza vaccine. Patients were excluded if they had undergone surgery in the previous 24 hours or were being treated palliatively. Results: Sixty patients in PICU were identified, with 43% (26/60) receiving the vaccine while in PICU and 17% (10/60) once discharged from PICU to the general ward environment. The majority of patients immunised were in PICU due to cardiac surgery/cardiology or general medical conditions, such as cerebral palsy or RSV bronchiolitis. There were no reported adverse events following immunisation. Conclusions: We have demonstrated the suitability and acceptability of children in the PICU receiving the seasonal influenza vaccine and tailored interventions to follow‐up once discharged from PICU to optimise protection. [ABSTRACT FROM AUTHOR]

The global disruption of the COVID‐19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID‐19 in children, summarising the most up‐to‐date data including recent developments regarding variants of concern. The acute infection with SARS‐CoV‐2 is generally mild in children, whilst the post‐infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) and 'long COVID' in children, are more complex. Given that most research on COVID‐19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID‐19 in children needs to be prioritised. [ABSTRACT FROM AUTHOR]

Children globally have been profoundly impacted by the coronavirus disease 2019 (COVID‐19) pandemic. This review explores the direct and indirect public health impacts of COVID‐19 on children. We discuss in detail the transmission dynamics, vaccination strategies and, importantly, the 'shadow pandemic', encompassing underappreciated indirect impacts of the pandemic on children. The indirect effects of COVID‐19 will have a long‐term impact beyond the immediate pandemic period. These include the mental health and wellbeing risks, disruption to family income and attendant stressors including increased family violence, delayed medical attention and the critical issue of prolonged loss of face‐to‐face learning in a normal school environment. Amplification of existing inequities and creation of new disadvantage are likely additional sequelae, with children from vulnerable families disproportionately affected. We emphasise the responsibility of paediatricians to advocate on behalf of this vulnerable group to ensure the longer‐term effects of COVID‐19 public health responses on the health and wellbeing of children are fully considered. [ABSTRACT FROM AUTHOR]

A dual-antigen enzyme-linked immunosorbent assay allows the assessment of severe acute respiratory syndrome coronavirus 2 antibody seroprevalence in a low-transmission setting. Globally, health-care workers (HCWs) have experienced a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that causes coronavirus disease 2019 (COVID-19), reflecting their increased risk of exposure.1 In Victoria, 20 502 people (as of 29 April 2021) have been infected with SARS-CoV-2, of which 17% of cases are HCWs.2,3 Despite the Australian Government advocating for serosurveys as part of the national COVID-19 Surveillance Plan,4 few have been undertaken.5,6 A meta-analysis from several countries indicated a seroprevalence of 8.7% (range 0-45.3%) in HCWs.7 There is likely to be less workplace SARS-CoV-2 exposure in paediatric hospitals due to the lower incidence of paediatric hospitalisations8,9; however, there are few published surveys in this setting10 and none amongst paediatric HCWs in Australia. Seroprevalence of SARS-CoV-2 among frontline healthcare personnel during the first month of caring for COVID-19 patients - Nashville, Tennessee. Our study in a paediatric hospital identified a very low rate of SARS-CoV-2 antibodies in HCWs; 2.2% using the DiaSorin assay. [Extracted from the article]

Aim: Ensuring children with special risk medical conditions (SRMC) are protected from influenza is important. The study objective was to describe influenza vaccination practices of medical professionals caring for children with SRMC and explore characteristics associated with a vaccine recommendation.Methods: Design: Cross-sectional survey.Setting/participants: Treating paediatric specialists and general practitioners of children with confirmed SRMCs. Postal questionnaire administered from March to September 2018 (option for online response). Characteristics associated with providing a recommendation were explored using univariable and multivariable analyses.Results: Overall response rate of 24.8% with the sample representative of the eligible population in terms of practice location and years practicing medicine. There was a higher response from females and sub-specialists. Of the 198 completed survey responders, 97.8% were aware of the recommendation, yet only 38.4% reported they 'always' routinely recommended influenza vaccine and fewer (19.5%) were very confident in understanding all 'medically at risk' conditions. Medical professionals were more likely to provide a recommendation always or mostly, if they received annual influenza vaccination themselves (adjusted odds ratio (aOR) 3.96, confidence interval (CI) 1.12-14.03), had confidence in understanding all 'medically at risk' conditions (aOR 1.82, CI 1.04-3.17) and perceived ownership of the responsibility to provide the recommendation (aOR 7.35, CI 1.67-32.26). Regional practising medical professionals were less likely to provide a recommendation (aOR 0.25 CI 0.10-0.70).Conclusions: We need to improve medical professionals' knowledge through reminders and access to consistent and concise information about what constitutes a SRMC. Increasing medical professionals' engagement in the influenza vaccination programme could also provide a sense of responsibility fostering provider endorsement. [ABSTRACT FROM AUTHOR]

Aim Preterm infants are at increased risk of vaccine preventable diseases. An audit in 2007 identified suboptimal immunisation status of preterm infants. The aim of this study was to complete the 'audit loop', reviewing preterm infants' immunisation status at a single tertiary paediatric hospital. Methods A retrospective follow-up immunisation audit was conducted at The Royal Children's Hospital, Melbourne, neonatal unit. The 'audit loop' included a preterm infants' reminder sticker and feedback of the original audit findings to Royal Children's Hospital health-care professionals. Immunisation status was determined using the Australian Childhood Immunisation Register record for all admitted preterm infants born <32 weeks gestation ( July 2008- June 2009). Results Conducted in March 2011, the median age of participants ( n = 57) was 2.5 years (range 1.7-3.1 years). Forty-four per cent (25/57) had a history of chronic lung disease, 86% (49/57) were <1500 g and 42% (24/57) <28 weeks gestation. The majority (96% (55/57)) were up to date with routine immunisations at 12 months of age. There was a 2.4-fold increase, compared with the original audit, for receipt of the additional recommended hepatitis B vaccine at 12 months of age, as well as influenza vaccine in infants with chronic lung disease. Conclusion This study showed that a simple reminder combined with education strategies can improve vaccine delivery in special risk groups such as preterm infants. [ABSTRACT FROM AUTHOR]

Aim To compare immunisation coverage of a cerebral palsy ( CP) cohort with the known general population vaccination coverage statistics. Methods A cohort of children with CP aged less than 7 years was extracted from the Victorian Cerebral Palsy Register. The vaccination status of these children was compared with the general population using the Australian Childhood Immunisation Register ( ACIR). Details that were audited included overall 'up-to-date' status of immunisations and individual vaccines missed. Results The CP cohort consisted of 449 children. Eighty-six or 19.2% (95% confidence intervals 15.6-23.1%) of these children were not 'up to date' ( NUTD) with the Australian immunisation schedule at the time of the ACIR data link (13 March 2009). This NUTD result is well above the general population percentage (range 6.4-8%). This group was divided into subgroups based on age, with all groups having significantly lower rates of immunisation, varying from 100% NUTD in the youngest subgroup to 18.6% in the oldest subgroup. The most common vaccine NUTD was MMR (measles, mumps and rubella), followed by polio and DTaP (diphtheria-tetanus-acellular pertussis). Conclusion This study demonstrates that children with CP are at high risk of incomplete and delayed immunisation, a significant problem given the increased health-care needs of this patient group and their increased vulnerability to the complications of vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Aim: To determine Australian neonatologists' recommendations for the immunisation of ex-preterm infants and compare their actual immunisation status with recommended Australian guidelines. Methods: A self-administered nine-part questionnaire of current immunisation practices was sent to all Neonatologists in Australia (2006). A complementary retrospective immunisation audit was conducted in two tertiary neonatal units in Melbourne. Hospital records and the Australian Childhood Immunisation Register (ACIR) were reviewed; consenting parents were interviewed and primary care physicians' vaccination records were requested. A random sample of preterm infants born between July 2003 and June 2005 at <32 weeks' gestation were selected. Results: (i) Neonatologists Survey: The response rate was 68% and the majority of neonatologists (89%) were aware of the current guidelines, but adherence to them varied from 43% to 79%. One-fifth of neonatologists personally do not receive annual influenza vaccination; and (ii) Immunisation Audit: Conducted between October 2006-May 2007 it included: 100 hospital records; 97 ACIR records; 47 parent interviews and 43 primary care vaccination records. Overall vaccination coverage was 90% at 12 months of age. Only 20% (10/50) of infants with chronic lung disease received an influenza vaccination. Vaccines were delayed by greater than one month in 15% of participants for the 2 month DTPa vaccine and 43% at 6 months. Conclusions: The neonatologists survey highlighted variable adherence with immunisation guidelines. The audit confirmed preterm infants are frequently experiencing delayed vaccination and recommended additional vaccinations are often not being received. Formulation of strategies to ensure complete and timely immunisation are required, including better utilisation of the ACIR. [ABSTRACT FROM AUTHOR]

Aim: The aim of this survey was to identify the current practices of paediatric oncologists in Australia and New Zealand regarding the immunisation of children treated for cancer. Methods: The survey was a nine-part questionnaire of current immunisation practices emailed to all paediatric oncologists practising in Australia (nine centres) and New Zealand (three centres) in June 2006. Results: Overall response rate was 82% (37 of 45 oncologists). Ninety-four per cent of respondents would recommend commencing ‘booster’ vaccinations at 6 months post completion of chemotherapy, in keeping with the current guidelines. Seventy-four per cent would recommend varicella vaccination. Intensity of the chemotherapy treatment was felt to be important, with 97% recommending re-immunising after a high-intensity regimen and only 48% after a lower-intensity regimen. Sixty-nine per cent stated they would recommend yearly influenza vaccinations for their patients. Conclusion: This survey highlights the variability of practice in Australasia; for example, nearly one-third do not recommend yearly influenza vaccination for their patients. The level of chemotherapy intensity was an important factor for paediatric oncologists in determining whether ‘booster’ vaccinations were recommended. This is an important cancer survivorship issue and review of the evidence-base and implementation of these guidelines is required. [ABSTRACT FROM AUTHOR]

The article presents a case study of a two-year-old boy presented with a tender and swollen right elbow, who developed high temperatures due to cervical neck abscess. The recurrent infections require antibiotic therapy with multi drugs including meropenem, gentamicin, voriconazole with empirical antimycotic therapy for fever. The symptoms resolved slowly with the addition of prednisolone to treat inflammation.

The article discusses various reports published within the issue, including one by K. Ressler on the immunization of infants admitted to a hospital and another by V.J.C. Jacobson on patient recall systems for improving immunization rates.