Search

Aim: Pre‐admission viral screening is used only in exceptional situations such as pandemics. We therefore evaluated pre‐admission screening for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), respiratory syncytial virus (RSV) and influenza during the COVID‐19 pandemic, comparing epidemiology and clinical features of admitted children. Methods: Children were screened at a paediatric emergency department from 1 March 2020 to 30 June 2022 by nasopharyngeal sampling and polymerase chain reaction kit. We retrospectively retrieved positive results from the laboratory and scrutinised charts of admitted children. Results: Out of 15 927 screened children, 522, 127 and 572 were positive and admitted with RSV, influenza A or SARS‐CoV‐2, respectively. Of these, 29 (5.6%), 26 (24.1%) and 245 (44.8%) were incidental findings, lacking symptoms of infection. RSV and influenza A were initially absent but re‐emerged in the autumn of 2021. The rate of COVID‐19 rose when the Omicron variant emerged in December 2021. The median age of children with RSV was 0.3 years, of those with influenza A 6.7 years and of those with COVID‐19 1.6 years. Major complications were rare. Conclusion: Frequent incidental detections of SARS‐CoV‐2 likely reflected widespread presence of a mild infection. Clinically, COVID‐19 was like other viral respiratory infections in children. [ABSTRACT FROM AUTHOR]

Aim: The pneumococcal conjugate vaccine, which covered seven serotypes of Streptococcus pneumoniae (PCV7), was introduced in Stockholm, Sweden, in 2007. It was replaced by a 13‐valent vaccine (PCV13) in 2011. We previously reported a decreased incidence of pneumonia and sinusitis among young children 4 years after the introduction of the PCV7. This study followed the incidence of pneumonia, sinusitis, mastoiditis and meningitis for four more years. Methods: We studied validated hospital registry data covering children up to 17 years of age, who were hospitalised in the Stockholm region from 2003 to 2016, when the child population peaked at 485 687. All 11 115 cases diagnosed with pneumonia, coded as bacterial pneumonia, sinusitis, mastoiditis, bacterial meningitis or empyema, were identified. The controls had viral pneumonia or pyelonephritis. Results: The incidence rates for children under 2 years of age hospitalised for sinusitis, mastoiditis and meningitis decreased significantly by 61%–79% during the eight‐year post‐vaccination period. Hospitalisations for bacterial pneumonia decreased by 19%–25% in the same age group. These changes were probably due to both the vaccines and changes in diagnosis routines. Conclusion: The effect of vaccination on children under 2 years of age was sustained 8 years after the introduction of the pneumococcal conjugate vaccines. [ABSTRACT FROM AUTHOR]

Aim: Human bocavirus 1 (HBoV1) has been associated with respiratory tract infections in children. We aimed at retrospectively describing patient characteristics, seasonality, pre‐existing medical conditions, codetections, clinical manifestations and complications of HBoV1 infection in relation to viral load in the child population in Stockholm, with the overarching aim of elucidating the clinical significance of HBoV1. Methods: We included all hospitalised children 0—17 years testing positive for HBoV1 by real‐time polymerase chain reaction on nasopharyngeal aspirates 1 July 2008—30 June 2019. Patients with HBoV1 single detection, high viral load expressed as an HBoV1‐DNA cycle threshold (Ct) < 25, or both, were separately analysed. We retrieved information on pre‐existing conditions and clinical course from the medical records. Results: We found 768 episodes in 727 children, 496 (64.6%) male and 441 (60.7%) previously healthy. The median age was 17.6 months. Most (476/768, 62.0%) episodes occurred during December–March. HBoV1 was in 549 episodes (71.5%) codetected with other viruses. Ct < 25 was independently associated with young age, single detection of HBoV1 and presentation early in the epidemic season. We saw few differences in clinical manifestations between the subgroups. Conclusion: Our findings are consistent with primary HBoV1 infection causing mild‐to‐severe respiratory tract manifestations in young children. [ABSTRACT FROM AUTHOR]

Background: Vaccination against rotavirus was offered in Stockholm to children born on 1 March 2014 and onwards with 85% coverage after two years. We investigated changes in nosocomial diarrhoea 2010—2018 in children admitted to Astrid Lindgren Children's Hospital, Stockholm, Sweden. Methods: We retrospectively identified cases from diagnostic and virology department registers. Complications and chronic medical conditions were retrieved from the case records. Children <18 years of age who developed diarrhoea ≥48 h after admission for another diagnosis and had a faecal sample submitted to the virology department were included. Results: There were 474 episodes of nosocomial diarrhoea. Of these, 401 (85%) occurred in children with chronic medical conditions. In children <5 years the rates of nosocomial rotavirus gastroenteritis, with 95% confidence intervals, significantly decreased from 0.34 (0.25—0.45) per 100 admissions prevaccination to 0.09 (0.04—0.17) postvaccination and from 0,66 (0.48—0.88) to 0.16 (0.07—0.30) cases per 1000 hospital days. Postvaccination norovirus became the most frequent pathogen. Virus-positive cases were more common in young children and in winter months. Conclusions: Before the initiation of rotavirus vaccination, norovirus and rotavirus were equally common causes of nosocomial diarrhoea. Postvaccination, rotavirus was reduced by approximately 75% while the frequency of other viruses did not change. [ABSTRACT FROM AUTHOR]

In Stockholm, Sweden, rotavirus vaccination was offered to children born after 1 March 2014. Our aim was to describe rates of hospitalisation due to community-acquired gastroenteritis before and after the introduction of the vaccine, and aetiology, underlying medical conditions and complications in admitted children. We retrospectively included patients from our catchment area hospitalised with a diagnosis of gastroenteritis during ten infection seasons 2008/2009–2017/2018, whereof six seasons prevaccination and four seasons postvaccination. We studied virus detection data and the patients' medical records. We included 3718 episodes in 3513 children. In 2967 (80%), stools were tested with virus isolation, ELISA, PCR, or bacterial culture; 479 (16%) tested negative. The incidence rates, with 95% confidence intervals, for children <5 years hospitalised for rotavirus gastroenteritis were 2.9 (2.8–3.1) per 1000 person-years prevaccination and 0.65 (0.56–0.74) postvaccination, for a rate ratio (RR) of 0.22 (0.19–0.26, p <.001). The rates for all-cause gastroenteritis were 5.6 (5.4–5.9) prevaccination and 2.5 (2.3–2.7) postvaccination, RR 0.45 (0.42–0.50, p <.001). In 5–17-year-old children norovirus dominated with little change over time. Of patients <5 years, those with underlying conditions constituted a larger proportion postvaccination than prevaccination (30.7% vs. 24.2%, p <.001). A complication other than dehydration, most commonly seizures, arose in 8.8% of the patients <5 years prevaccination and 11.4% postvaccination (p <.05). Rotavirus vaccination reduced the number of children <5 years requiring hospital care for gastroenteritis. We saw no replacement of rotavirus by other viruses. [ABSTRACT FROM AUTHOR]

Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Realworld data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care. [ABSTRACT FROM AUTHOR]

Aim: This study explored the differences in demographic and socio‐economic factors between children hospitalised due to four common viral infections. Methods: Demographic data were obtained from Statistics Sweden on >3000 children admitted to Astrid Lindgren Children's Hospital in 2009–2014 with rotavirus, influenza, respiratory syncytial virus (RSV) or chickenpox. We compared demographic and socio‐economic factors between case groups using logistic regression with rotavirus cases as reference. Results: There were differences in the median age at admission; RSV cases were younger (0.4 years), influenza (2.4 years) and chickenpox cases (2.7 years) older than rotavirus cases (1.2 years). RSV, influenza and chickenpox cases lived in families with more children than rotavirus cases. RSV and influenza cases were more likely to have underlying chronic conditions. Mothers of RSV cases were more likely to be born in Sweden. Further socio‐economic differences were not robustly confirmed in sensitivity analyses. Conclusion: We found a few differences in demographic factors between children hospitalised with the four common infections, which were mainly explained by the epidemiology and transmission patterns of these infections. [ABSTRACT FROM AUTHOR]

Sixty-five children born to women who all used amphetamine during pregnancy were followed prospectively up to the age of 8 years. There was a statistically significant correlation between the extent (among and duration) of amphetamine exposure during fetal life and psychometric tests, aggressive behavior, adjustment and general assessment, indicating a worse outcome for children who had been more exposed to the drug. Alcohol use during pregnancy as well as attitude towards pregnancy also showed a statistical correlation to the outcome. Predictors of the child's psychosocial environment were few and only maternal psychiatric treatment, alcohol abuse and number of custodians correlated with aggressive behavior and general assessment.

Aim: Since the introduction in 1979 of rapid testing using immunofluorescence, we have collected information about children hospitalised for confirmed respiratory syncytial virus (RSV) infection in the northern Stockholm area. We here report hospitalisation rates, risk factors and complications in 2008‐2016 compared with 1986‐1998. Methods: Microbiological laboratory reports and retrospective chart review. Comparison of the two periods was complicated by changing testing routines, with a more sensitive method and increased testing of older children in the late period. Results: In infants, there was an 12.3% increase in the population‐based rate of hospital admission for RSV infection from 12.2 to 13.7/1000. Including all children <5 years, there was a 48% increase from 2.7 to 4.0/1000. The median length of stay remained unchanged at 3 days. The need of intensive care decreased in healthy infants but remained high in older children with comorbidity. Conclusion: Considering the changed diagnosis routines, we believe that the rate of hospital admission of infants for RSV infection was unchanged throughout the observed years. The increased rates of older children with confirmed RSV likely resulted from increased testing of children with risk factors for a complicated course. [ABSTRACT FROM AUTHOR]

Aim: Children with osteomyelitis present with a range of signs and symptoms and with varying degree of severity. The purpose of this study was to provide data on a population‐based 10‐year material of children with acute osteomyelitis. Methods: All children, 0–14 years in Stockholm Region with acute osteomyelitis hospitalised in July 2005–June 2015, were retrospectively studied. Time to hospital presentation, disease localization, inflammation markers, imaging procedures, microbiology, severity classified by the presence of complications, surgical procedures, hospital length of stay and seasonal variation were recorded. Results: There were 430 children with acute osteomyelitis; 61% were boys. The incidence per 100 000 person‐years was 11.6; 9.3 in girls and 13.1 in boys. Median age at admission was 2.9 years with no peak later in childhood. Median time from first symptom to diagnosis was 4 days (range 1–21) and 48% of the cases were localised to femur or tibia. Mean C‐reactive protein was 59 mg/L (range 1–376). Blood (n = 82) or tissue cultures (n = 54) were positive in 118 (28%) children. The most common pathogen was Staphylococcus aureus (n = 88) followed by Streptococcus pyogenes (n = 12). Surgery was performed in 71 children (17%). There was no mortality. Severe complications were seen in 14 (3.3%) children, five of whom were admitted to intensive care. Median hospital length of stay was 4 days (range 1–60). Conclusions: Osteomyelitis in children is a diagnostic challenge with a low yield of positive bacterial cultures. Few children with uncomplicated disease need surgery, but the risk of severe complications is not negligible. [ABSTRACT FROM AUTHOR]

Aim: We present our results using interferon-gamma release assays in any child <18 years or tuberculin skin tests in Bacille Calmette-Guérin unvaccinated children for tuberculosis contact investigation in Stockholm, Sweden.Methods: During 2000-2019, we investigated 892 children with a median age of seven years. We explored associations between TB infection and characteristics such as closeness to contact, age, sex, BCG status and foreign origin.Results: The overall rates were for TB infection 10.2% (n = 91) and for TB disease 1.1% (n = 10). In addition to infectiousness of index case and closeness of contact, foreign background, male sex and increasing age were independently associated with infection. In foreign-born children, the rates of tuberculosis infection and disease were 18.7% and 3.9%, respectively. In 18/46 (39%) infected foreign-born children, a baseline negative tuberculosis test supported a diagnosis of recent infection.Conclusion: Foreign background, older age and male sex were associated with infection. In a significant proportion of infected children, a previous negative test made recent infection likely. [ABSTRACT FROM AUTHOR]

Aim: To determine the urinary tetranor‐prostaglandin E2 metabolite in healthy infants and in hospitalised infants with upper and lower respiratory tract as well as gastrointestinal infections. Methods: A prospective cross‐sectional study to determine baseline concentrations of urinary tetranor‐prostaglandin E2 metabolite was conducted in 81 healthy infants aged one week to one year and in 142 hospitalised infants with infections. Prostaglandin metabolite levels were measured by liquid chromatography tandem mass spectrometry. Results: In healthy infants, urinary prostaglandin E2 metabolite levels decreased with age and did not differ between girls and boys. Infections of the lower respiratory (n = 78) and gastrointestinal tract (n = 12) correlated with increased levels of the prostaglandin E2 metabolite. In contrast, infants hospitalised with upper respiratory tract infections (n = 23) exhibited similar levels as healthy, age‐matched controls. Lower prostaglandin E2 levels were found after treatment with acetaminophen in hospitalised children. Prostaglandin E2 metabolite levels did not correlate with length of hospitalisation or need for respiratory support. Conclusion: This study first provides normal levels of urinary prostaglandin E2 metabolite in infants and secondly demonstrates elevated levels in hospitalised children with lower respiratory tract and gastrointestinal infections. [ABSTRACT FROM AUTHOR]

Background: Few prospective cohort studies have estimated the overall impact of severe rotavirus gastroenteritis (RVGE) leading to hospitalization on families and society. We assessed human and economic resources needed to care for an affected average child aged <5 years in Sweden. Methods: The study was conducted in Astrid Lindgren Children’s Hospital which serves approximately 14% of all Swedish children <5 years of age. All children admitted with acute gastroenteritis in the study period were tested for rotavirus. Health care consumption was collected prospectively and publically available unit costs used to calculate direct costs. Non-medical and indirect costs were collected in interviews with families using a standardized questionnaire during the hospital stay and approximately 14 days post-discharge. Results: 144/206 children (70%) with laboratory-confirmed RVGE were included. The median age was 14 months. The average total cost per hospitalized child was €3894, of which €2169 (56%) was due to direct healthcare-related costs (including Emergency Department visits and in-patient care), €104 (2%) to non-medical direct costs and €1621 (42%) to indirect costs due to productivity loss. Carers of children with severe RVGE were absent from work on average five days per study child: four days during hospitalization of affected child and one day due to gastroenteritis in the carer. Conclusions: Costs for RVGE are dominated by direct costs which are similar to some other countries in Europe, but indirect costs due to productivity loss are also important, and should be considered in decisions to introduce rotavirus vaccines into national vaccination programmes. [ABSTRACT FROM AUTHOR]

Background:Minors with a stated age <18 years unaccompanied by a responsible adult form an increasing part of refugees to Europe. They are older than other asylum-seeking children and many come from countries with a high tuberculosis (TB) incidence. During the 2015 refugee crisis, 35,369 of 162,877 refugees (22%) seeking asylum in Sweden were unaccompanied minors, which gave us the opportunity to study their burden of TB infection and disease. Methods:Of the unaccompanied minors seeking asylum in Sweden during 2015, 2936 (8.3%) were allocated to northern Stockholm. Of these, 2422 were from countries with an incidence of TB exceeding 100/105, and were screened for TB infection with a Mantoux tuberculin skin test or a QuantiFERON-TB Gold®. Those from countries with a lower TB incidence were screened only if they had other risk factors for TB exposure. Results:Of those screened, 349 had a positive test and were referred to the northern paediatric TB clinic at Astrid Lindgren Children’s Hospital. Of these, 16 had TB disease and 278 latent tuberculosis infection (LTBI), while we considered 53 uninfected. In addition, eight sought medical attention with symptomatic TB outside the screening system. Cohort rates were 6.8% of LTBI and 0.5% of TB in minors from Afghanistan and 26–32% of LTBI and 3.4–3.5% of TB among those from Eritrea, Ethiopia or Somalia. Conclusion:We conclude that TB infection and disease is common among asylum-seeking unaccompanied minors, especially among those from the Horn of Africa. [ABSTRACT FROM AUTHOR]

Background: Patients' participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient's active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients' experiences of patient participation in Web-based interventions in clinical practice.Objective: The objective of our study was to explore patients' experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care.Methods: Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis.Results: One theme, "It's about me," and 4 categories, "Take part in a flexible framework of own priority," "Acquire knowledge and insights," "Ways toward change," and "Personal and environmental conditions influencing participation," were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one's own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual's emotional and cognitive resources and restrictions, as well as health care professionals and significant others' attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA.Conclusions: Patient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment. [ABSTRACT FROM AUTHOR]

Aim: This study described the epidemiology and clinical features of childhood tuberculosis (TB) in Stockholm over a 45-year period, when there was a resurge of tuberculosis concomitant with increased immigration.Methods: We describe 220 children up to the age of 16 years with active TB, seen at the Astrid Lindgren Children's Hospital from 1971 to 2015. The study period was divided into three 15-year periods.Results: Cases increased from ten children in 1971-1985 to 76 in 1986-2000 and 134 in 2001-2015, with overall incidence increasing from <1 to four per 100 000. From 2001 to 2015, 79% of cases, or at least one parent, were born in high-incidence countries. The incidence in this group was 35 per 100 000, but remained at 0.9 per 100 000 in other children. After 2000, most cases were detected by active contact tracing and immigrant screening. The most common manifestation was from the lungs. Meningitis and miliary tuberculosis were found in 7%, with two deaths. Antimicrobial resistance was an increasing problem.Conclusion: The increasing incidence of TB in Stockholm was largely limited to children with a background in high-incidence countries. Most children today have subclinical forms of TB. Although preventive measures are effective, severe cases still occur, especially among adolescent immigrants. [ABSTRACT FROM AUTHOR]