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Background: A 2014 survey showed nutritional management could be improved in Belgian pediatric departments. This follow-up survey aimed to: (1) list allied health resources/staffing in Belgian pediatric departments, (2) survey nutritional screening and follow-up, and (3) identify barriers. Methods: A nationwide survey (February–April 2021) via national and regional pediatric associations. Results: 61/90 (67.8%) of Belgian pediatric departments responded (80.1% of all Belgian pediatric hospital beds); 60.7% of the respondents were from larger centers (LCs, ≥20 beds). A dietitian was present in 80.3% of all responding units (LCs vs. smaller centers (SCs): p = 0.133), compared to 46.5% in the 2014 survey. Most dietitians seldom or never participate in ward rounds (86.9%) and participate only ad hoc to case discussions (72.1%). Systematic nutritional screening is implemented in 32.8% of pediatric departments. The screening tool STRONGkids is used in 30% of responding centers, compared to 21% in 2014. The most common barriers to conducting nutritional screening were lack of time (59.0%), a lack of knowledge (47.5%), and a lack of staff (42.6%). In French-speaking centers (FrCs), a positive screening result most often led to referral to a dietitian (86.7%), whereas in Dutch-speaking centers (DuCs), it more frequently resulted in a discussion with the pediatrician about nutritional management (54.3%) than referral to a dietitian (34.8%). Nutritional follow-up after discharge is most often conducted by a physician, with or without the involvement of a dietitian (95.1%), rather than a dietitian alone (3.3%). Malnutrition management barriers included "no barriers" (50.8%), a lack of knowledge (34.4%), a lack of reimbursement (24.6%), and a lack of time (24.6%). The barriers remain largely unchanged compared to 2014. Conclusions: The increasing availability of dietitians and the use of a screening tool in pediatric departments suggest an encouraging but limited improvement in nutritional care in Belgium. Persistent barriers that have remained unchanged since 2014 continue to hinder substantial advancements in nutritional care. [ABSTRACT FROM AUTHOR]

The majority of respiratory syncytial virus (RSV) infections in young children are managed in primary care, however, the disease burden in this setting remains poorly defined. We did a prospective cohort study in primary care settings in Belgium, Italy, Spain, the Netherlands, and the UK during the RSV seasons of 2020–21 (UK only; from Jan 1, 2021), 2021–22, and 2022–23. Children aged younger than 5 years presenting to their general practitioner or primary care paediatrician with symptoms of an acute respiratory tract infection were eligible for RSV testing. Children who tested positive for RSV were consented and followed up for 30 days via a physician clinical report (initial primary care visit on day 1) and two parent-report questionnaires (days 14 and 30). We assessed the burden of RSV in terms of clinical course (symptoms, illness duration, and complications), health-care resource utilisation (primary care visits, emergency department visits, hospitalisation rate, and medication use), and societal impact (daycare or school absence and parental work absence) for the 30-day follow-up period. Among 3414 tested children, 1124 (32·9%; 95% CI 31·3–34·5) tested positive for RSV. Among children with data on age, RSV positivity rate was 38·9% (36·1–41·7; n=466 of 1198) in children younger than 1 year and 25·9% (24·0–27·9; n=513 of 1979) in those aged 1 to <5 years. Of the 1124 RSV-positive children, 878 (78·1%) were enrolled and had day 1 data collected (median age 11·1 months [IQR 6·0–22·0]; 446 [50·9%] boys and 431 [49·1%] girls [N=877]). RSV illness lasted a mean of 11·7 days (95% CI 11·2–12·2; n=794). At day 14 and day 30, any remaining symptoms were reported in 451 of 804 (56·1% [95% CI 52·6–59·6]) and 261 of 724 (36·0% [32·6–39·7]) children. The mean number of primary care visits per child ranged from 1·4 (95% CI 1·2–1·6; the Netherlands) to 3·0 (2·8–3·3; Spain), and was higher in children younger than 1 year (2·7 visits [2·4–2·9]) than in those aged 1 to <5 years (2·1 [1·9–2·2]). Prescribed medication use varied, from 25 of 96 children (26·0% [95% CI 17·6–36·0]; the UK) to 228 of 297 children (76·8% [71·5–81·5]; Italy), with bronchodilators and antibiotics being the most commonly prescribed medicines across all countries. Prescribed medication use was reported in 258 of 418 children aged 1 to <5 years (61·7% [56·9–66·4]) and 196 of 394 children younger than 1 year (49·7% [44·7–54·8]). Missed working days by parents due to their child's RSV illness were reported in 340 of 744 cases (45·7% [42·1–49·4]); the mean number of missed workdays ranged from 1·3 days (95% CI 0·5–2·2) in Spain to 4·1 days (3·3–5·0) in Belgium. RSV infections in children younger than 5 years in primary care are associated with substantial symptomatology, health-care utilisation, and parental work absence. Notable differences in RSV burden existed across countries, likely due to differences in primary health-care systems, clinical practice, and health-care-seeking behaviour. This study emphasises the importance of considering country-specific primary care burden estimates when considering the implementation of RSV immunisations programmes. Sanofi and AstraZeneca. [ABSTRACT FROM AUTHOR]

New vaccination programs measure economic success through cost-effectiveness analysis (CEA) based on an outcome evaluated over a certain time frame. The reimbursement price of the newly approved vaccine is then often reliant on a simulated ideal effect projection because of limited long-term data availability. This optimal cost-effectiveness result is later rarely adjusted to the observed effect measurements, barring instances of market competition-induced price erosion through the tender process. However, comprehensive and systematic monitoring of the vaccine effect (VE) for the evaluation of the real long-term economic success of vaccination is critical. It informs expectations about vaccine performance with success timelines for the investment. Here, an example is provided by a 15-year assessment of the rotavirus vaccination program in Belgium (RotaBIS study spanning 2005 to 2019 across 11 hospitals). The vaccination program started in late 2006 and yielded sub-optimal outcomes. Long-term VE surveillance data provided insights into the infection dynamics, disease progression, and vaccine performance. The presented analysis introduces novel conceptual frameworks and methodologies about the long-term economic success of vaccination programs. The CEA evaluates the initial target vaccination population, considering vaccine effectiveness compared with a historical unvaccinated group. Cost-impact analysis (CIA) covers a longer period and considers the whole vaccinated and unvaccinated population in which the vaccine has direct and indirect effects. The economic success index ratio of CIA over CEA outcomes evaluates long-term vaccination performance. Good performance is close to the optimal result, with an index value ≤1, combined with a low CEA. This measurement is a valuable aid for new vaccine introductions. It supports the establishment of robust monitoring protocols over time. [ABSTRACT FROM AUTHOR]

Background: Intense physical exercise in athletes increases the risk to develop exercise‐induced bronchocontriction (EIB). We aimed to study EIB prevalence and explore methods for effective EIB screening. Methods: Three hundred twenty‐seven adolescent athletes (12–18 years) performing at least 12 h of sports a week were included. The evaluation consisted of spirometry, eucapnic voluntary hyperpnoea test (EVH) to evaluate for EIB, FeNO, skin prick testing, blood sampling (serum markers of epithelial damage and mast cell activation), and questionnaires (AQUA©, ACT, ACQ, and exposure and symptom‐related questions). Results: Of all athletes, 22% tested positive for EIB (n = 72), 14% reported a previous asthma diagnosis and 40% were atopic. Eighty percent of EIB+ athletes did not use any inhalation therapy. EIB+ athletes were significantly younger, had decreased FEV1/FVC (%), and increased post‐EVH‐reversibility (%) post‐salbutamol compared with EIB− athletes. Furthermore, EIB was significantly associated with previous asthma diagnosis and atopy. The best predictors for a positive EVH test were AQUA© score ≥ 6 (sensitivity of 78%, p =.0171) and wheezing during exercise (specificity of 82%, p =.0002). FeNO negatively and significantly correlated with maximal fall in FEV1 post‐EVH test in atopic athletes (r = −.2735, p =.0056). Maximal fall in FEV1 was also associated with prior PM10 exposure (p =.036). Serum markers of epithelial damage were significantly associated with training type, training intensity, EIB severity, and prior air pollution exposure. Conclusion: Our findings support the effectiveness of a systematic respiratory screening approach, including baseline questionnaires, lung function tests, and FeNO measurement, to improve EIB detection in adolescent athletes in whom respiratory response to EVH testing is associated with prior exposure to air pollution. [ABSTRACT FROM AUTHOR]

Keywords: AQUA questionnaire; athletes; atopy; FeNO EN AQUA questionnaire athletes atopy FeNO 1 5 5 03/30/23 20230301 NES 230301 Allergic sensitization and allergic diseases have been reported to have a high prevalence in athletes.[[1]] Moreover, atopy has been significantly associated with bronchial hyperreactivity and exercise-induced bronchoconstriction in elite athletes.[[3]] Sensitization to allergens is generally determined by a skin prick test (SPT) and/or allergen-specific serum IgE analysis.[5] Recently, the Allergy Questionnaire for Athletes (AQUA©),[6] a screening tool to predict atopy in elite adult athletes, was validated for screening of atopy in young elite athletes.[7] This screening tool may help with the early identification of atopy, which may burden the physical performances, and is especially helpful in young elite athletes.[5] Increased fractional exhaled NO (FeNO) levels are, considered to be an effective, noninvasive tool to assess the presence of eosinophilic airway inflammation and as tool to diagnose childhood asthma.[[8], [10]] This has also been correlated with allergic sensitization.[11] Therefore, we hypothesize that measuring FeNO levels may also be a useful noninvasive method to predict atopy in this population. The AUC of FeNO increased from 0.765 ( I p i < .0001) to 0.814 ( I p i < .0001) if we considered multiple sensitizations (participants with >=2 positive SPTs; Figure 1C), suggesting that FeNO levels might be a useful indicator for multiple sensitizations within atopic athletes. Can AQUA© questionnaire and FeNO predict atopy in early-career athletes? (C) ROC curve indicating the sensitivity and specificity of AQUA© (left) and FeNO (right) to predict atopy and multiple sensitizations (for FeNO). [Extracted from the article]