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To slow the spread of the 2019 novel coronavirus disease (COVID-19) and reduce the associated morbidity and mortality, the Children's National Hospital developed a multidisciplinary, collaborative vaccine program aimed at equitably and expeditiously vaccinating the pediatric population of the surrounding community. Interdepartmental collaboration, professional expertise, and community partnerships allowed for a dynamic and successful program design that began as large volume-centralized vaccine clinics and expanded to smaller volume ambulatory clinics. This strategy proved successful at meeting local vaccine demand; however, strategies to improve vaccine uptake in communities with high rates of hesitancy are still needed to maximize vaccine equity.

Children and adolescents living with primary or secondary immunodeficiencies often have an unpredictable prognosis and benefit from palliative care as a standard part of their regular care. This chapter illustrates the challenges faced by children and adolescents living with HIV, which have parallels to issues encountered by children with other immunodeficiencies. The nuances of palliative care management for children living with HIV are detailed according to various aspects of care: physical; structure and process of care of patients and families; psychological and psychiatric; social, cultural, spiritual, religious, and existential; ethical and legal, and care of the patient nearing the end of life.

Intestinal fatty acid binding protein (iFABP) levels did not differ between human immunodeficiency virus type 1 (HIV-1)– infected infants and uninfected infants exposed to HIV-1, but those who breastfed had substantially lower levels. Zonulin levels increased from 3 to 5.3 months of age with perinatal acquisition of HIV-1 despite early antiretroviral treatment. Biomarkers of intestinal integrity (ie, iFABP and zonulin) were compared in 56 HIV-1–positive African infants who received early antiretroviral treatment and 53 HIV-1–exposed but uninfected (HEU) controls. Despite heightened inflammation and immune activation in HIV-positive infants, iFABP and zonulin levels at 3 months of age were not different from those in HEU infants and largely were not correlated with inflammatory and immune activation biomarkers. However, zonulin levels increased and became significantly higher in HIV-positive infants as compared to HEU infants by 5 months of age, despite viral suppression due to antiretroviral treatment. These findings have implications for intestinal integrity biomarker profiling in perinatal HIV-1 infection.

This article discusses the interaction between HIV infection, the gut microbiome, inflammation and immune activation, and HIV reservoirs, along with interventions to target the microbiome and their implications for HIV remission and cure.Most studies show that HIV-infected adults have a gut microbiome associated with decreased bacterial richness and diversity, and associated systemic inflammation and immune activation. A unique set of individuals, elite controllers, who spontaneously control HIV replication, have a similar microbiome to HIV-uninfected individuals. Conversely, exposure to maternal HIV in infants was shown to alter the gut microbiome, even in infants who escaped perinatal infection. Emerging research highlights the importance of the metabolomics and metaproteomics of the gut microbiome, which may have relevance for HIV remission and cure. Together, these studies illustrate the complexity of the relationship between HIV infection, the gut microbiome, and its systemic effects.Understanding the association of HIV with the microbiome, metabolome, and metaproteome may lead to novel therapies to decrease inflammation and immune activation, and impact HIV reservoir size and vaccine responses. Further research in this area is important to inform HIV remission and cure treatments.

Mycobacterium cosmeticum is a rapidly growing mycobacterium that was recently identified. However, its role in human infection has not been well described. We present a case of an extremely premature neonate born with bacteraemia due to M. cosmeticum that resolved without sequelae. The infection likely occurred during a prolonged intrauterine transfusion procedure.