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The COVID-19 pandemic has burdened healthcare systems globally. To curb high hospital admission rates, only patients with genuine medical needs are admitted. However, machine learning (ML) models to predict COVID-19 hospitalization in Asian children are lacking. This study aimed to develop and validate ML models to predict pediatric COVID-19 hospitalization. We collected secondary data with 2200 patients and 65 variables from Malaysian aged 0 to 12 with COVID-19 between 1st February 2020 and 31st March 2022. The sample was partitioned into training, internal, and external validation groups. Recursive Feature Elimination (RFE) was employed for feature selection, and we trained seven supervised classifiers. Grid Search was used to optimize the hyperparameters of each algorithm. The study analyzed 1988 children and 30 study variables after data were processed. The RFE algorithm selected 12 highly predicted variables for COVID-19 hospitalization, including age, male sex, fever, cough, rhinorrhea, shortness of breath, vomiting, diarrhea, seizures, body temperature, chest indrawing, and abnormal breath sounds. With external validation, Adaptive Boosting was the highest-performing classifier (AUROC = 0.95) to predict COVID-19 hospital admission in children. We validated AdaBoost as the best to predict COVID-19 hospitalization among children. This model may assist front-line clinicians in making medical disposition decisions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the clinical characteristics and severity of young infants hospitalized with COVID‐19 and study the relationship between breastfeeding and maternal COVID‐19 vaccination on the severity of COVID‐19. Methods: A retrospective, observational study was performed among infants aged 6 months and below hospitalized for COVID‐19 in a tertiary state hospital in Malaysia between February 1 and April 30, 2022. The primary outcome was "serious disease," defined as pneumonia requiring respiratory support or dehydration with warning signs. Multivariate logistic regression was used to determine independent predictors for serious disease. Results: A total of 102 infants were included in the study; 53.9% were males with a median age of 11 weeks (interquartile range: 5–20 weeks). Sixteen patients (15.7%) had pre‐existing comorbidities, including preterm birth. Fever was the most common presenting symptom (82.4%), followed by cough (53.9%), and rhinorrhea (31.4%). Forty‐one infants (40.2%) presented with serious disease, warranting either respiratory support or intravenous fluid therapy for dehydration. Recent maternal COVID‐19 vaccination was associated with a reduced risk of serious disease on univariate analysis but was not significant after multivariate adjustment (adjusted odds ratio [aOR] 0.39; 95% CI: 0.14–1.11; p = 0.08). Exclusive breastfeeding was protective against serious COVID‐19 in young infants, independent of other confounding factors (aOR 0.21, 95% CI: 0.06–0.71; p = 0.01). Conclusion: COVID‐19 is a serious disease with non‐specific clinical manifestations in young infants. Exclusive breastfeeding could play an important protective role. [ABSTRACT FROM AUTHOR]

Aim: Households are a significant venue for the transmission of SARS‐CoV‐2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS‐CoV‐2 in Negeri Sembilan, Malaysia. Methods: This retrospective observational study included 185 families of paediatric COVID‐19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio‐demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS‐CoV‐2. Results: Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID‐19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. Conclusions: High rates of household transmission of COVID‐19 were found, indicating households were a major setting of transmission of SARS‐CoV‐2. Our data provide insight into the risk factors for household transmission of SARS‐CoV‐2 in Malaysia. [ABSTRACT FROM AUTHOR]

Five children in Pos Lenjang, Pahang, Malaysia were PCR-positive for vivax malaria and were admitted to the hospital from 5 to 26 July 2019. One of the patients experienced three episodes of recurrence of vivax malaria. Microsatellite analysis showed that reinfection is unlikely. Drug resistance analysis indicated that Riamet (artemether–lumefantrine) is effective. Cytochrome P450 2D6 (CYP2D6) testing showed that this patient has defective CYP2D6 function. Primaquine failure to clear the Plasmodium vivax hypnozoites may be the cause of recurring infections in this patient. This report highlights the need for the development of liver-stage curative antimalarials that do not require metabolism by the CYP2D6 enzyme. [ABSTRACT FROM AUTHOR]

Introduction: A resurgence of pertussis has been reported in numerous countries. This study aimed to determine the incidence, clinical characteristics, and outcome of pertussis among infants in Sarawak, Malaysia., Methodology: We conducted a descriptive retrospective study of infants aged < 12 months with laboratory-confirmed pertussis admitted to Bintulu Hospital in Sarawak, Malaysian Borneo, from 2015 until 2021. Pertussis was confirmed in all patients using a polymerase chain reaction of nasopharyngeal aspirates., Results: Of 588 infants who had a nasopharyngeal aspirate, 108 (18%) had laboratory-confirmed pertussis. The average annual incidence was 482 per 100,000 infants aged < 12 months between 2015 and 2019, with a marked decline in 2020 and 2021. Eighty-two (76%) were < 3 months of age. Seventy-eight (72%) were unvaccinated for pertussis, including 75 (96%) who were too young to receive the first dose. A third of the cases had atypical presentations. Severe disease characterized by hypoxemia, pulmonary hypertension, recurrent apnea, encephalopathy, or cardiovascular dysfunction occurred in 32%. Forty-eight percent required humidified high-flow nasal cannula oxygen therapy and 22% required invasive ventilation. Twenty-four percent overall needed intensive care. One (1%) infant had a fatal outcome. Nearly all cases of severe disease or those that required invasive ventilation or intensive care had received ≤ 1 dose of pertussis vaccination., Conclusions: A high incidence of pertussis with a high rate of severe disease was observed in Sarawak, Malaysia, predominantly among infants too young to be vaccinated. Additional vaccination strategies such as maternal vaccination or cocooning should be considered., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Anand Mohan, Yee-Yen Tan, Rohaidah Hashim, David Chun-Ern Ng, Veronica Huey-Shin Wong, Da-Wei Liew, Su-Lin Chien, Lee-See Tan, Peter Sie-Teck Lau, Thilagam Rajandran, Yuwana Podin, Mong-How Ooi.)

The BCG vaccine is considered a safe and efficacious vaccine in the prevention of severe forms of tuberculosis. BCG osteomyelitis is a rare complication of the BCG vaccine that occurs in vaccinated young children. We report a case of BCG osteomyelitis in a male toddler, presenting with painful left wrist swelling without preceding fever or systemic symptoms. Radiographic evidence of osteomyelitis in the left wrist was observed. Initial treatment with conventional antibiotics for acute haematogenous osteomyelitis showed no improvement. The diagnosis of Mycobacterium bovis BCG osteomyelitis was confirmed via tissue samples for histopathological examination and mycobacterial cultures. The patient responded well to treatment with oral antituberculous therapy. This case highlights the importance of considering BCG osteomyelitis in the differential diagnosis of unexplained joint swelling in BCG-vaccinated young children., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.