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Background: Respiratory syncytial virus is the leading cause of acute lower respiratory infection in children. We aimed to describe the clinical-epidemiologic pattern and risk factors for mortality associated with RSV infection. Methods: This is a prospective, cross-sectional study of acute lower respiratory infection in children admitted to the Children’s Hospital during 2000 to 2017. Viral diagnosis was made by fluorescent antibody techniques or real-time-polymerase chain reaction. We compared clinical-epidemiologic characteristics of RSV infection in nonfatal versus fatal cases. Multiple logistic regression was used to identify independent predictors of mortality. Results: Of 15,451 patients with acute lower respiratory infection, 13,033 were tested for respiratory viruses and 5831 (45%) were positive: RSV 81.3% (4738), influenza 7.6% (440), parainfluenza 6.9% (402) and adenovirus 4.3% (251). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV cases show a case fatality rate of 1.7% (82/4687). Fatal cases had a higher proportion of prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurologic disease (P < 0.01) and pneumonia at clinical presentation (P = 0.014). No significant difference between genders was observed. Most deaths occurred among children who had complications: respiratory distress (80.5%), nosocomial infections (45.7%), sepsis (31.7%) and atelectasis (13.4%). Independent predictors of RSV mortality were moderate-to-severe malnourishment, odds ratio (OR): 3.69 [95% confidence interval (CI): 1.98–6.87; P < 0.0001]; chronic neurologic disease, OR: 4.14 (95% CI: 2.12–8.08; P < 0.0001); congenital heart disease, OR: 4.18 (95% CI: 2.39–7.32; P< 0.0001); and the age less than 6 months, OR: 1.99 (95% CI: 1.24–3.18; P = 0.004). Conclusions: RSV showed an epidemic pattern affecting mostly young children. Malnourishment, chronic neurologic disease, congenital heart disease and the age less than 6 months were the independent risk factors for RSV mortality. Fil: Gentile, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Lucion, Maria Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Juarez, Maria del Valle. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Areso, María Soledad. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Bakir, Julia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Viegas, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez". Laboratorio de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Mistchenko, Alicia Susana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez". Laboratorio de Virología; Argentina

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infection (ALRTI) in pediatrics. Preterm infants are at a higher risk for complications. We aimed to describe and compare the clinical and epidemiological characteristics associated with ALRTI due to RSV in preterm and term infants and to establish the predictors of fatality among preterm infants.Prospective, cross-sectional study of patients admitted due to ALRTI in the 2000-2018 period. Viral diagnosis was done by indirect immunofluorescence or reverse transcription polymerase chain reaction in nasopharyngeal aspirates. Clinical and epidemiological characteristics were recorded. A multiple logistic regression model established the predictors of fatality among preterm infants.A total of 16 018 ALRTI cases were included; 13 545 (84.6 %) were tested; 6047 (45 %) were positive; RSV was prevalent in 81.1 % (4907), with a seasonal epidemic pattern; 14 % (686) were preterm infants. Comorbidities, perinatal respiratory history, congenital heart disease, malnutrition, chronic respiratory disease, bronchopulmonary dysplasia, prior hospitalization due to ALRTI, and chronic neurological disease (p0.001) were more common among preterm infants; they required more intensive care and a longer length of stay, and had a higher fatality rate (p0.01). Congenital heart disease was an independent predictor of fatality due to RSV among preterm infants (OR: 3.67 [1.25-10.8], p = 0.01).RSV showed an epidemic pattern and affected more preterm infants with certain comorbidities, with a higher morbidity and mortality, compared to term infants. RSV fatality among preterm infants was associated with congenital heart disease.Introducción. El virus sincicial respiratorio (VSR) es el principal agente causal de la infección respiratoria aguda baja (IRAB) en pediatría. Los niños prematuros tienen mayor riesgo de complicaciones asociadas con esta infección. Los objetivos fueron describir y comparar las características clínicas y epidemiológicas asociadas a IRAB por VSR en niños/as nacidos pretérmino y a término, y establecer predictores de letalidad en los prematuros. Métodos. Estudio prospectivo, transversal, de pacientes ingresados por IRAB, en el período 2000-2018. El diagnóstico virológico se realizó mediante inmunofluorescencia indirecta o reacción en cadena de la polimerasa con transcriptasa inversa de aspirados nasofaríngeos. Se registraron las características clínicoepidemiológicas. Se desarrolló un modelo de regresión logística múltiple para establecer los predictores de letalidad en prematuros. Resultados. Se incluyeron 16 018 casos de IRAB; 13 545 (el 84,6 %) fueron estudiados; 6047 (el 45 %) positivos; VSR predominó en el 81,1 % (4907); mostró un patrón epidémico estacional; el 14 % (686) fueron prematuros. Los prematuros mostraron mayor frecuencia de comorbilidades, antecedentes respiratorios perinatales, cardiopatía congénita, desnutrición, enfermedad respiratoria crónica, displasia broncopulmonar, hospitalización previa por IRAB y enfermedad neurológica crónica (p0,001); requirieron más cuidados intensivos, mayor tiempo de internación y mayor tasa de letalidad (p0,01). La cardiopatía congénita fue predictor independiente de letalidad por VSR en prematuros [OR 3,67 (1,25-10,8), p = 0,01]. Conclusión. VSR mostró un patrón epidémico, afectó a prematuros con ciertas comorbilidades con mayor morbimortalidad que los de término. La letalidad por VSR en prematuros se asoció con la cardiopatía congénita.

Acute lower respiratory tract infection (ALRTI) caused by adenovirus is a major cause of morbidity and mortality in children.To describe the clinical and epidemiological pattern and associated factors in hospitalized children.Cross-sectional study in children admitted due to ALRTI to Hospital de Niños "Ricardo Gutiérrez," in the Autonomous City of Buenos Aires, between 2000 and 2018. Viral diagnosis was done by indirect immunofluorescence in nasopharyngeal secretions. The clinical and epidemiological characteristics of adenovirus infection were compared to other respiratory viruses (respiratory syncytial virus, influenza, and parainfluenza). A multiple logistic regression was done to identify independent predictors of infection.Out of 16 018 patients with ALRTI, 13 545 were tested for respiratory viruses; 6047 (45 %) had a positive result. Adenovirus was the least common agent (4.4 % [265] of cases); it tended towards a reduction over the study period (peak in 2003) and circulated throughout the year (peak in July). In total, 63.8 % of patients were males; median age: 11 months (interquartile range: 6-20). The most common clinical presentation was pneumonia (63 %). Prior admissions due to respiratory conditions were seen in 50 %; 15.6 % were readmissions; 58.3 % had comorbidities. Ventilatory support was required by 19.2 % and complications were recorded in 44 %. The fatality rate was 7.7 %. Adenovirus infection was associated with age ≥ 12 months, male sex, clinical presentation of pneumonia, prior admissions due to respiratory conditions, and readmissions.Adenoviruses were less common than other respiratory viruses, although their morbidity and mortality were important.Introducción. La infección respiratoria aguda baja por adenovirus es una importante causa de morbimortalidad en niños. Objetivos: Describir el patrón clínicoepidemiológico y los factores asociados en niños hospitalizados. Métodos. Estudio transversal en niños ingresados por infección respiratoria aguda baja al Hospital de Niños Ricardo Gutiérrez, Buenos Aires, en 2000-2018. El diagnóstico viral se realizó mediante inmunofluorescencia indirecta en secreciones nasofaríngeas. Se compararon características clínico-epidemiológicas de infección por adenovirus con otros virus respiratorios (virus sincicial respiratorio, influenza y parainfluenza). Se utilizó regresión logística múltiple para identificar predictores independientes de infección. Resultados. De 16018 pacientes con infección respiratoria aguda baja, 13545 fueron testeados para virus respiratorios y 6047 (el 45 %) fueron positivos. Adenovirus fue el agente menos frecuente [el 4,4 % (265) de los casos]; presentó una tendencia en descenso durante todo el período estudiado (pico en 2003) y circuló durante todo el año (pico en julio). El 63,8 % eran varones; mediana de edad: 11 meses (rango intercuartílico: 6-20). La presentación clínica más frecuente fue neumonía (el 63 %). El 50 % tenía internaciones previas por causa respiratoria; el 15,6 % eran reingresos; el 58,3 % tenía comorbilidades. El 19,2 % requirió asistencia ventilatoria; el 44 % registró complicaciones. La letalidad fue del 7,7 %. La infección por adenovirus se asoció a edad ≥ 12 meses, sexo masculino, presentación clínica de neumonía, internaciones previas por causas respiratorias y reinternaciones. Conclusiones. Los adenovirus fueron detectados con menor frecuencia que los otros virus respiratorios, aunque presentaron un importante perfil de morbimortalidad.

Background Influenza is an important cause of acute lower respiratory tract infection (aLRTI), hospitalization, and mortality in children. This study aimed to describe the clinical and epidemiologic patterns and infection factors associated with influenza, and compare case features of influenza A and B. Methods In a prospective, cross-sectional study, patients admitted for aLRTI, between 2000 and 2015, were tested for respiratory syncytial virus, adenovirus, influenza, or parainfluenza, and confirmed by fluorescent antibody (FA) or real-time polymerase chain reaction (RT-PCR) assay of nasopharyngeal aspirates. Results Of 14,044 patients, 37.7% (5290) had FA- or RT-PCR-confirmed samples that identified influenza in 2.8% (394/14,044; 91.4% [360] influenza A, 8.6% [34] influenza B) of cases. Influenza frequency followed a seasonal epidemic pattern (May–July, the lowest average temperature months). The median age of cases was 12 months (interquartile range: 6–21 months); 56.1% (221/394) of cases were male. Consolidated pneumonia was the most frequent clinical presentation (56.9%; 224/394). Roughly half (49.7%; 196/394) of all cases had previous respiratory admissions; 9.4% (37/394) were re-admissions; 61.5% (241/392) had comorbidities; 26.2% (102/389) had complications; 7.8% (30/384) had nosocomial infections. The average case fatality rate was 2.1% (8/389). Chronic neurologic disease was significantly higher in influenza B cases compared to influenza A cases (p = 0.030). The independent predictors for influenza were: age 6 months, odds ratio (OR): 1.88 (95% confidence interval [CI]: 1.44–2.45); p

Background From January 2012 PCV13 was introduced into immunization program in Argentina, 2 + 1 schedule for

Poster: "18th ICID / Fri_Station_01.2 / Is Haemophilus Influenzae type b (Hib) reemerging? 25 years of meningitis surveillance in a Pediatric Hospital in Buenos Aires metropolitan area" by: "M. D. V. Juarez1, M. F. Lucion1, M. S. Areso1, M. Ana Clara1, A. Rainelli1, M. P. Della Latta2, M. Turco2, J. Bakir1, A. Gentile2; 1Buenos Aires, CABA/AR, 2Buenos Aires/AR"

Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection (ALRI) in children. We aimed to describe the clinical–epidemiological pattern and risk factors for mortality associated with RSV infection. Methods Prospective, cross-sectional study of ALRI in children admitted to a Children’s Hospital among 2000–2018. Viral diagnosis was made by fluorescent antibody techniques or real-time PCR. We compared clinical–epidemiological characteristics of RSV infection in nonfatal vs. fatal cases. Multiple logistic regression was used to identify independent predictors of mortality. Results From a total 16,018 patients with ALRI, 13,545(84.6%) were tested for respiratory viruses, 6047 (45%) were positive: RSV 81.1% (4,907), influenza 7.5% (456), parainfluenza 6.9% (419) and adenovirus 4.4% (265). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV mortality rate: 1.7% (83/4,855). Fatal cases had a higher proportion of: prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurological disease (P < 0.01) and pneumonia as clinical presentation ( Conclusion RSV showed an epidemic seasonal pattern. Malnourishment, chronic neurological disease, congenital heart disease, age under 6 months and pneumonia were the independent risk factors for RSV mortality. Disclosures All authors: No reported disclosures.

Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance.Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015).Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038).Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.

Introduction. In January 2012, Argentina introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in its immunization schedule for children younger than 2 years old. Coverage in Pilar in 2012 reached>90% for the first two doses and 60% for the third dose. Objective. To measure the effectiveness of PCV13 to reduce the incidence of consolidated pneumonia (CP)in the two-year period following its introduction in the immunization schedule. Methods. Prospective, population-based study conducted in Pilar. All children younger than 5 year sold with clinical signs of pneumonia assisted at the reference hospitals (both inpatients and utpatients) in the first two years since the vaccine introduction (2012-2013) were included. The annual incidence of CP was compared to the 2003-2005 baseline period. Clinical and radiological assessments were done as per the World Health Organization’s criteria. Results. Six hundred and sixty-six patients with clinical suspicion of pneumonia were included. CP was diagnosed in 309 patients; 52.1% were girls, 70.2% were younger than 2 years old, and 56.4% had been immunized with the PCV13; 4.5% (14/309) had bacteriological confirmation (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; others: 4). A significant reduction in the incidence of CP (per 100 000 children younger than 5 years old) was observed between the pre- and postimmunization periods, from 750 (204/27 209) to 561 (171/30 475) in 2012 and to 453 (138/30 475) in 2013; effectiveness accounted for 25.2% and 39.6%, respectively. Reduction in infants younger than 1 year old: 33.9% in 2012 and 44.6% in 2013; and in children aged 12-23 months old: 57.9% in 2013. No significant differences were observed in the incidence of CP at an older age. Conclusions. Following the introduction of PCV13 in Argentina’s immunization schedule, a fast and significant reduction in the incidence of CP was observed, mainly in infants younger than 1 year old in 2012 and in children younger than 2 years old in 2013.

In January 2012, Argentina introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in its immunization schedule for children younger than 2 years old. Coverage in Pilar in 2012 reached90% for the first two doses and 60% for the third dose.To measure the effectiveness of PCV13 to reduce the incidence of consolidated pneumonia (CP)in the two-year period following its introduction in the immunization schedule.Prospective, population-based study conducted in Pilar. All children younger than 5 year sold with clinical signs of pneumonia assisted at the reference hospitals (both inpatients and outpatients) in the first two years since the vaccine introduction (2012-2013) were included. The annual incidence of CP was compared to the 2003-2005 baseline period. Clinical and radiological assessments were done as per the World Health Organization's criteria.Six hundred and sixty-six patients with clinical suspicion of pneumonia were included. CP was diagnosed in 309 patients; 52.1% were girls, 70.2% were younger than 2 years old, and 56.4% had been immunized with the PCV13; 4.5% (14/309) had bacteriological confirmation (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; others: 4). A significant reduction in the incidence of CP (per 100 000 children younger than 5 years old) was observed between the pre- and postimmunization periods, from 750 (204/27209) to 561 (171/30 475) in 2012 and to 453 (138/30 475) in 2013; effectiveness accounted for 25.2% and 39.6%, respectively. Reduction in infants younger than 1 year old: 33.9% in 2012 and 44.6% in 2013; and in children aged 12-23 months old: 57.9% in 2013. No significant differences were observed in the incidence of CP at an older age.Following the introduction of PCV13 in Argentina's immunization schedule, a fast and significant reduction in the incidence of CP was observed, mainly in infants younger than 1 year old in 2012 and in children younger than 2 years old in 2013.Introducción. En enero de 2012, en Argentina, fue introducida la vacuna neumocócica conjugada 13-valente (13-Valent Pneumococcal Conjugate Vaccine; PCV13, por sus siglas en inglés) en el Calendario Nacional, en menores de 2 años. La cobertura en el partido de Pilar en 2012 fue90% para las primeras 2 dosis y 60% para la tercera. Objetivo. Medir la efectividad de la PCV13 en la reducción de la incidencia de neumonías consolidantes (NC), durante los dos años siguientes a su introducción en el Calendario. Métodos. Estudio prospectivo de base poblacional en Pilar. Se incluyeron todos los menores de 5 años con signos clínicos de neumonía atendidos en hospitales de referencia (ambulatorios y hospitalizados) en los primeros 2 años de la incorporación (2012-2013). Se comparó la incidencia anual de NC con el período basal 2003-2005. Evaluación clínica-radiológica, según criterio de la Organización Mundial de la Salud. Resultados. Se incluyeron 666 pacientes con sospecha clínica de neumonía. Se diagnosticó NC en 309 pacientes; 52,1% de mujeres, 70,2% menores de 2 años y 56,4% vacunado con PCV13; 4,5% (14/309) con bacteriología confirmada (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; otros: 4). Se observó una reducción significativa en la incidencia de NC (por 100 000 niños menores de 5 años) entre los períodos pre y posvacunal de 750 (204/27 209) a 561 (171/30 475) en 2012 y 453 (138/30 475) en 2013; efectividad de 25,2% y 39,6%, respectivamente. Reducción en menores de 1 año: 33,9% en 2012 y 44,6% en 2013; y en niños de 12-23 meses: 57,9% en 2013. No se observaron diferencias significativas en las incidencias en edades mayores. Conclusiones. Luego de la introducción de la PCV13 en el Calendario de Vacunación en Argentina, se observó una reducción rápida y significativa en la incidencia de NC, principalmente en menores de 1 año en 2012 y menores de 2 años en 2013.

Introduction In Argentina respiratory disease is the third leading cause of death in children under 5 years. In 2011 influenza vaccination was included in the National Calendar for children between 6 and 24 months (two doses schedule). Influenza vaccine coverage for second dose was 46.1% in 2013. The aim was to determine the proportion of delayed schedules and missed opportunities, to assess the characteristics of missed opportunities for vaccination and to explore the perception of influenza disease and vaccination from the parents of children between 6 and 24 months in different regions of Argentina in 2013. Methods Analytical observational multicenter cross-sectional study. Structured surveys were carried out to the children's parents who were between 6 and 24 months of age during the influenza virus vaccination season (April–October 2013). Chi-Square test was used to assess association and differences between proportions and categorical variables. A logistic regression model was built to identify delay predictor variables in the vaccination schedules. Missed opportunities for vaccination were characterized through the estimation of proportions. Results 1350 surveys were conducted in the three centers. We detected 65% (884/1340) of delayed influenza vaccination schedules, 97% of them associated with missed opportunities of vaccination. The independent protective factors associated with a decreases risk of delayed schedules were: (a) perception of the importance of influenza vaccination (OR = 0.42(0.18–0.94); p = 0.035), (b) having less than one year of age (OR = 0.75(0.59–0.96); p = 0.022), (c) to have received information in pediatric visits or in any media (OR = 0.71(0.56–0.90); p = 0.004). There was 38% of MOIV in 1st dose and 63.4% in 2nd dose. The main cause of MOIV in 1st dose was not detecting the need for vaccination (39%) and in 2nd dose the unknowledge of the vaccination schedule (35.3%). No cultural reasons were detected. Conclusions High frequency of delayed vaccination schedules and missed opportunities were detected. Parents had little concern about the safety of influenza vaccine.

Background: Respiratory Syncytial Virus (RSV) is the main agent that causes Acute Lower Respiratory Tract Infection (ALRI) in children. Objective: to describe the clinical and epidemiological pattern and the lethality factors associated to RSV infection. Methods: Prospective, cross sectional study of patients admitted for ALRI at “R.Gutierrez” Children Hospital, 2000-2014. Virological diagnosis of respiratory virus: RSV, adenovirus (AV), influenza (IF) and parainfluenza (PIV) was made by fluorescent antibody assay of nasopharyngeal aspirates or real time-PCR (IF). Results: from a total of 13.309 patients included, 38.6%(5118) had positive samples; RSV was predominant all through the study period 81% (4146/5118) without significant annual variations (71-88). It shows a seasonal epidemic pattern (median of epidemiological weeks of viral activity onset and offset:1935) and agrees with the lowest average temperature months. RSV was followed by IF: 7.4%, PIF:6% and AV:4.5%. From 5118 RSV cases the median of age was 7 months (0-216 months), 74%

Introducción. El virus respiratorio sincicial (VRS) es el principal agente asociado a infección respiratoria aguda baja en niños. El objetivo de este estudio fue describir el patrón clínicoepidemiológico e identificar los factores de riesgo de infección por VRS. Población y métodos. Estudio prospectivo de cohorte de pacientes internados por infección respiratoria aguda baja en el Hospital de Niños Ricardo Gutiérrez, marzo-noviembre, 2000- 2013. El diagnóstico viral para VRS, adenovirus, influenza y parainfluenza se realizó por inmunofluorescencia indirecta de aspirados nasofaríngeos.

INTRODUCTION: Respiratory syncytial virus (RSV) is the major causative organism associated with acute lower respiratory tract infections in children.The objective of this study was to describe the clinical and epidemiological pattern of RSV and identify risk factors for RSV infection. POPULATION AND METHODS: Prospective, cohort study on patients hospitalized due to acute lower respiratory tract infection at Hospital de Niños Ricardo Gutiérrez between March and November throughout the 2000-2013 period. The virological diagnosis of RSV, adenovirus, influenza and parainfluenza was performed by indirect immunofluorescence using nasopharyngeal aspirates. RESULTS: A total of 12,555 children were included, 38.2% (4798) had virus rescued from samples. RSV accounted for 81.8% of cases (3924/4798) with no significant annual variations (71.2- 88.1) and with an epidemic seasonal pattern(May through July); RSV was followed by influenza (7.6%), parainfluenza (5.9%), and adenovirus (4.7%).The median age of patients with RSV rescue (3924) was 7 months old (0- 214 months old), while 74.2% were younger than 1 year old, 43.1% were younger than 6 months old, 56.5% were males and the most common clinical presentation was bronchiolitis (60.7%). Comorbidities were observed in 41.6% of cases. The most common comorbidities were chronic respiratory disease (74%), congenital heart disease (14%), and chronic neurological disease (10.2%).Complications occurred in 25%of cases. The case fatality rate was 1.9% (74/3888). Independent predictors of RSV infection were age

In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in pediatrics.To describe clinical and epidemiological characteristics and analyse the risk factor of lethality in children hospitalized with infection pH1N1 confirmed by PCR.We identifed all suspected cases (according to Ministry of health) in 34 centers and we included all the confirmed cases of 0-18 years from 1/4/09 to 31/8/09 in a retrospective cohort study. The viral diagnosis was confirmed by RT-PCR method. Data are expressed in percentages, average, median, standard deviation, and range (IQR) as appropriate; and as a measure of association, relative risk (RR), with 95% confidence interval (95%CI). Multiple logistic regression was conducted to determine the independent risk predictors.Total number of suspected cases were: 2367; PCR was performed to 47.8% (n: 1131) being positive for pH1N1 65.5% (n: 741/1131); 57.2% males; 61.5%24 months, median age: 14 months (IQR 6-46 months); 45.1% with underlying disease; more frequent clinical pictures were: pneumonia (39,7%) and bronchiolitis 25.8%; Case-fatality rate: 5.9% (44/741). Mortality risk factors were [RR (95%CI)]: neurological disease [5.00 (2.84-8.81)], genetic disease [3.67 (1.58-8.52)], malnutrition [3,07 (1.46-6.48)] and prematurity [2.28 (1.14-4.56)]. Independent mortality predictor: neurological disease [3.84 (1.81-8.14)]. No significant association between age, chronic respiratory disease, immunosuppression and viral co-infection with lethality was observed.Almost half of children with pH1N1 infection had underlying disease; the neurological condition was a separate CFR predictor.

Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main causes of low coverage in children ≤24 month in Argentina.To determine the prevalence of DVS and the rate of MOV during the frst 24 months of life and risk factors for their occurrence.We conducted a survey among children ≤24 month's caregivers at five hospitals in different departments, between August-December/2008.Total enrolled: 1591 children; 54.2% male, median of age 8 months (0-24 months). Eighty percent concurred with vaccine-card, 75.9% consulted by pathology. Overall DVS rate: 39.7%. Most common DVS reason: the current mild disease: 38.5%. Overall MOV rate: 19.8%. Most common MOV reason: no detection of the need to vaccinate 47.8%. DTPHib and OPV vaccines had a higher risk of DVS and MOV. DVS independent predictors: age ≥6 months, administration for additionally recommended vaccines and prolonged waiting in the last vaccination. MOV independent predictors were: age ≥6 months, no compliance with prior care, and not asking for vaccines.We found a high proportion of MOV and mainly of DVS; they were associated mostly to false contraindications, lack of questioning on vaccines and difficulties in the quality of care provided to parents.

Las infecciones invasivas por Streptococcus pneumoniae (Spn) producen mortalidad elevada en países en desarrollo, con tasas entre 4 y 100 veces mayores que las de Estados Unidos o Canadá. Es el primer agente causal de neumonía en la infancia y de meningitis fuera de los brotes epidémicos por Neisseria meningitidis. La OPS, a través del grupo SIREVA, dedicado al desarrollo de vacunas en Latinoamérica, organizó un programa de vigilancia de infecciones invasivas por Spn en seis países: Argentina, Brasil, Chile, Colombia, México y Uruguay, iniciado en 1993 y que continúa actualmente. En Argentina participan en la actualidad más de 20 centros hospitalarios distribuidos en todas las áreas geográficas del país, actuando como Centro Nacional de referencia para la serotipificación y determinación de la resistencia a los antibióticos el Instituto ANLIS "Dr. Carlos G. Malbrán". Objetivos: 1) Determinar los serotipos predominantes, su resistencia a los antibióticos y los cambios temporales en infecciones invasivas por Spn de niños menores de 5 años de edad; 2) Obtener información confiable para la formulación de una vacuna conjugada adecuada para la región. Metodología: Diseño prospectivo observacional. Se incluyeron todos los niños menores de 6 años de edad internados por infecciones invasivas (neumonía, meningitis, sepsis o bacteriemia), en los que se aisló Spn de un sitio previamente estéril. Se realizó control externo de confiabilidad de los resultados, inicialmente en el laboratorio de referencia de Canadá y actualmente en el Instituto Adolfo Lutz de San Pablo. El análisis estadístico se realizó con EPIINFO 6 y con el programa WHONET de OMS. Resultados: Se destacan los siguientes hallazgos: Se aisló Spn en 1 390 muestras clínicas. La edad media (N = 1 175) fue de 19,5 meses, con 74,4% - 2 años; fueron neumonías 60,5%; meningitis 26,6%, sepsis 8,2%. Se halló sensibilidad disminuida a penicilina en 32,1% (414/1 288), con resistencia alta 16,1% e intermedia 16%. La resistencia a los antibióticos betalactámicos se incrementó en el período 1993-8. Los serotipos prevalentes fueron: 14 (32,5%), 6A/6B, 9V, 23F, 19F, 18C, 4, 5, 1. Los serotipos 14 y 6AB prevalecieron en menores de 2 años mientras que el 5 y el 1 prevalecieron en mayores de 2 años (p < 0,001). El serotipo 14, la neumonía y la edad menor de 2 años fueron los factores de riesgo para resistencia a penicilina. La representatividad para las vacunas conjugadas 7-valente, 9-valente y 11-valente fue de 53,3%, 77,4% y 82,6% respectivamente, mayor para la 7-valente en los menores de 2 años (61,2%) y en los menores de 2 años con neumonía (71,2%). Más del 90% de los serotipos aislados con algún grado de resistencia estuvieron contenidos en las tres vacunas analizadas. Conclusiones: Un programa nacional de vigilancia de Spn invasivo fue desarrollado en Argentina y otros países latinoamericanos. Se identificaron por primera vez los serotipos predominantes en infecciones invasivas y se comprobó el incremento significativo de la resistencia a penicilina y otros antibióticos, similar a lo informado en casi todos los países del mundo. Se obtuvo información epidemiológica válida para evaluar estrategias de prevención con nuevas vacunas Since 1993, the PAHO, through the Regional Vaccine System (SIREVA Group) organized a surveillance protocol of invasive Streptococcus pneumoniae (Spn) infections in children less than 5 years old in six Latin-American countries: Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. In Argentina more than 20 hospitals are now participating in this project. Objectives: 1) To determine the predominant serotypes, the antibiotic resistance and changes along the time. 2) To know the representativity of the serotypes isolated in the new conjugated vaccines. Methodology: Children less than 6 years old hospitalized by Spn invasive infections were included (pneumonia, meningitis, bacteremia o sepsis). The ANLISS "Dr. Carlos G. Malbrán" Institute was the reference center for Spn serotyping and antibiotic resistance determination. Results: Spn was isolated from 1 390 clinical samples. The average age was 19.5 months, 74.4% belonged to children equal or less than 2 years of age. The main clinical diagnosis were: pneumonia 60.5%, meningitits 26.6%, fever without foccus (bacteremia) or sepsis 8.2%. Decreased penicillin sensitivity (DPS) was found in 32.1% of the cases, with high resistance in 16.1% and intermediate resistance in 16%; the increase of DPS in the 1993-98 period was significant, like in other countries. The more frequent serotypes were: 14 (32.5%), 6A/6B, 9V, 23F, 19F, 18C, 4, 5, and 1. Serotypes 14 and 6AB were prevalent in children less than 2 years old and serotypes 5 and 1, in children than 2 years older (p < 0.001). Serotype 14, pneumonia and age less than 2 years were risk factors for penicillin resistance. Finally, the representativity of the serotypes in the new conjugated vaccines 7-valent, 9-valent and 11-valent was: 53.3%, 77.4% and 82.6% respectively. For the 7-valent vaccine, was higher in the less than 2 years old group (61.2%), and for this age group with pneumonia (71.2%). More than 90% of penicillin resistant serotypes were included in the three conjugated vaccines. Conclusions: A national surveillance program was developped in Argentina and other Latin-American countries. Prevalent invasive Spn serotypes were identified; a significative increase in penicillin and other antibiotic resistance was found, like in almost all countries. This epidemiologic information is of great importance for evaluating the new conjugated vaccines

Introducción: Streptococcus pneumoniae (Sp) causa enfermedades invasivas de alta morbimortalidad, registrándose en la última década un aumento de la resistencia antibiótica. Material y métodos. Con el objetivo de estudiar la epidemiología del Sp, su susceptibilidad antibiótica y los factores de riesgo de resistencia a penicilina (RP), se evaluaron en forma prospectiva 274 pacientes con infecciones invasivas por Sp internados en el HNRG entre 1993 y 1999, inclusive. La mediana de edad fue de 21,5 meses (rango 1-180), la relación varón/mujer fue de 1,7:1; 11,8% eran desnutridos de II-III grado; 52,6% tenía enfermedad de base (respiratoria crónica o recidivante, 38,9%). A partir del aislamiento bacteriológico de Sp se realizó el seguimiento clínico-epidemiológico del paciente. Resultados: De 293 presentaciones clínicas, la más frecuente fue neumonía (64,2%), siguiendo meningitis (11,6%), sepsis/bacteriemia (10,9%), peritonitis (7,8%) y 16 pacientes presentaron formas asociadas. El Sp se recuperó de 325 materiales de cultivo: en sangre 55,1%; líquido pleural 27,1%; LCR 9,2%; líquido peritoneal 5,5% y otros 3,1%. La RP global fue: 31,8% (87/274), con 17,9% resistencia (R) alta, observándose diferencias en la distribución anual. El 65,5% (57/87) de las cepas RP también lo eran a cefalosporinas de tercera generación (C3ªG). Los factores de riesgo de infección por SpRP fueron: infección intrahospitalaria (RR 2,72; 2,00- 3,69), tratamiento previo con b-lactámicos (RR 2,61; 1,91-3,55), neumonía (RR 2,06; 1,32-3,22), edad < 2 años (RR 1,72; 1,18-2,49). Los predictores independientes hallados con el análisis multivariado fueron: tratamiento antibiótico previo con b-lactámicos (p = 0,0003), infección intra hospitalaria (p = 0,0019) y neumonía (p = 0,0445). La letalidad fue de 6,2% (17/274), no presentando correlación con la RP. Conclusión: Este tipo de estudios permite orientar conductas terapéuticas y el uso prudente de antibióticos Introduction. Streptococcus pneumoniae (Sp) is a main cause of morbidity and mortality in children, and the increasing rates of drug resistant strains have been reported. The objectives of this study were to determine the epidemiology of invasive pneumococcal infections and the risk factors of Sp penicillin resistance (PR). Material & methods: Two hundred seventy four children with invasive pneumococcal infections hospitalized in a children hospital, in the 1993-1999 period; the median age was 21.5 months (1 month-18 years), the male to female ratio was 1.7:1. Fifty two percent of cases reported an underlying disease. Results: The most frequent diseases were: pneumonia 64.2%, meningitis 11.6%, sepsis/bacteriemia 10.9%, peritonitis 7.8%. Sp was recovered in 325 samples: blood in 55.1%, pleural fluid 27.1%, cerebrospinal fluid (CSF) 9.2%, peritoneal fluid 5.5% and other fluids obtained by puncture 3.1%. PR rate was 31,8% (87/274), 17.9% were highly resistant. Differences in the annual distribution was observed. 65.5% from PR strains were resistant to third generation cephalosporins too. PR was associated with: previous beta-lactam antibiotics therapy (RR 2.61; 1.91-3.55); nosocomial infection (RR 2.72; 2.00-3.69), pneumonia (RR 2.06; 1.32-3.22), and age under two years (RR 1.72; 1.18-2.49). Results from multivariate logistic regression analysis of binary predictors of PR were: previous beta-lactam antibiotics therapy (p = 0,0003), nosocomial infection (p = 0,0019) and pneumonia (p = 0,0445). Mortality was 6,2% (17/274) without correlation with PR. Conclusion: These findings suggest the need for a continuous surveillance, control of drug resistant pneumococci and vaccination with an effective vaccine among high-risk patients