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Background With the future epidemiology and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uncertain, the use of safe and effective coronavirus disease 2019 (COVID-19) vaccines in pediatric populations remains important. Methods We report data from two open-label substudies of an ongoing phase 1/2/3 master study (NCT05543616) investigating the safety and immunogenicity of a variant-adapted bivalent COVID-19 vaccine encoding ancestral and Omicron BA.4/BA.5 spike proteins (bivalent BNT162b2). The open-label groups presented here evaluate dose 4 with bivalent BNT162b2 in 6-month- to <12-year-olds who previously received three original (monovalent) BNT162b2 doses. In 6-month- to <5-year-olds, primary immunogenicity objectives were to demonstrate superiority (neutralizing titer) and noninferiority (seroresponse rate) to Omicron BA.4/BA.5 and noninferiority (neutralizing titer and seroresponse rate) to SARS-CoV-2 ancestral strains in participants who received bivalent BNT162b2 dose 4 compared with a matched group who received three doses of original BNT162b2 in the pivotal pediatric study (NCT04816643). In 5- to <12-year-olds, primary immunogenicity comparisons were descriptive. Reactogenicity and safety following vaccination were evaluated. Results In 6-month- to <5-year-olds, dose 4 with bivalent BNT162b2 met predefined immunogenicity superiority and noninferiority criteria against Omicron BA.4/BA.5 and ancestral strains when compared with dose 3 of original BNT162b2. In 5- to <12-year-olds, bivalent BNT162b2 induced robust Omicron BA.4/BA.5 and ancestral strain neutralizing titers comparable with dose 3 of original BNT162b2. The safety profile for dose 4 of bivalent BNT162b2 given as dose 4 was consistent with that of original BNT162b2 in 6-month- to <12-year-olds. Reactogenicity events were generally mild to moderate. No adverse events led to discontinuation. Conclusions These safety and immunogenicity data support a favorable benefit-risk profile for a variant-adapted BNT162b2 in children <12 years old. [ABSTRACT FROM AUTHOR]

Background: Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. Methods: A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. Results: Mean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. Conclusions: These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment. Author summary: Chagas cardiomyopathy is a manifestation of end-organ damage from Trypanosoma cruzi parasitic infection. Most infections occur in Mexico, Central and South America but disease is present globally due to migration. Approximately 30% of those with Chagas disease develop cardiomyopathy years after infection from persistent heart muscle and conduction system inflammation, which can be life-threatening. Unfortunately, Chagas disease remains underdiagnosed and identifying those at risk for severe disease remains challenging. The 2018 American Heart Association guidelines recommend ECG and cardiac rhythm strip, but there is no consensus on the approach to further cardiac evaluation in the US or management of Chagas cardiomyopathy. This study retrospectively analyzed symptoms and cardiac examination of migrants predominantly from endemic Central American countries who were diagnosed with Chagas disease and received care at Boston Medical Center. Most patients were asymptomatic and nearly half had evidence of cardiomyopathy. Echocardiogram abnormalities were present in approximately one-third of asymptomatic individuals with normal ECGs. Some individuals had significant abnormalities found on heart rhythm monitors or cardiac magnetic resonance imaging which led to management changes. These findings underscore the importance of routine echocardiograms, consideration of cardiac rhythm monitoring, and thorough cardiac assessment in people with Chagas disease regardless of symptoms. [ABSTRACT FROM AUTHOR]

In this retrospective review of travel-associated dengue reported to GeoSentinel, complicated dengue occurred in 95 of 5958 (2%) patients. The most common laboratory findings and signs were thrombocytopenia, elevated aminotransferase, bleeding, and plasma leakage. Clinicians should monitor patients with dengue for warning signs that may indicate progression to severe disease. Visual Abstract. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: In this retrospective review of travel-associated dengue reported to GeoSentinel, complicated dengue occurred in 95 of 5958 (2%) patients. The most common laboratory findings and signs were thrombocytopenia, elevated aminotransferase, bleeding, and plasma leakage. Clinicians should monitor patients with dengue for warning signs that may indicate progression to severe disease. Background: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. Objective: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). Design: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. Setting: 20 of 71 international GeoSentinel sites. Patients: Returning travelers with complicated dengue. Measurements: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. Results: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n  = 27 [31%]) and Southeast Asia (n  = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n  = 3), severe liver disease (n  = 3), myocarditis (n  = 2), and neurologic symptoms (n  = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG−) and 12 as secondary (IgM−/IgG+) dengue. Limitations: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. Conclusion: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study. Primary Funding Source: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation. [ABSTRACT FROM AUTHOR]

Background International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. Methods Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. Results From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n = 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n  = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n  = 9; 19%), expertise abroad (n  = 9; 19%), lower cost (n  = 8; 17%) and convenience (n  = 7; 15%); a third (n  = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. Conclusions International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications. [ABSTRACT FROM AUTHOR]

Each year, millions of nonimmigrants visit the United States. Nonimmigrants are defined by the Department of Homeland Security as foreign nationals granted temporary admission into the United States for a [...]