BACKGROUND: Overall reduction of antibiotic use is a widely adopted public health goal. Given evidence that consuming probiotics reduce the incidence, duration and/or severity of certain types of common acute infections, we hypothesized that probiotics are associated with reduced antibiotic use. This systematic review of randomized controlled trials (RCTs) assessed the impact of probiotic supplementation (any strain, dose or duration), compared to placebo, on antibiotic utilization for common, acute infections in otherwise healthy people of all ages. METHODS: We searched 13 electronic databases including MEDLINE, Embase and CENTRAL from inception to 17th January 2017. Backward and forward citation searches were also conducted. Two reviewers independently selected studies for inclusion and extracted study data. We assessed risk of bias for individual studies using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model. RESULTS: We screened 1533 citations, and of these, 17 RCTs met our predefined inclusion criteria. All 17 were conducted in infants and/or children with a primary aim of preventing acute respiratory tract infections, acute lower digestive tract infections or acute otitis media. Included studies used 13 probiotic formulations, all comprising single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Trial quality was variable. Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a lower risk of being prescribed antibiotics, relative to those who received placebo (Pooled Relative Risk = 0.71, 95% CI: 0.54-0.94). When restricted to five studies with a low risk of bias, the pooled relative risk was 0.46 (95% CI: 0.23-0.97). Significant statistical heterogeneity was present in effect size estimates, which appeared to be due to one trial which could partly be considered as an outlier. CONCLUSIONS: Probiotics, provided to reduce the risk for common acute infections, may be associated with reduced antibiotic use in infants and children. Additional well-designed studies are needed to substantiate these findings in children and explore similar findings in other population groups.

Toxocariasis, one of a group of parasitic diseases known as neglected parasitic infections, is a disease caused by the larvae of two species of Toxocara roundworms, Toxocara canis, from dogs, and less commonly Toxocara cati, from cats. Although most infected individuals are asymptomatic, clinical manifestations may include fever, fatigue, coughing, wheezing, or abdominal pain (visceral toxocariasis) or vision loss, retina damage, or eye inflammation (ocular toxocariasis). To assess U.S. pediatrician knowledge of toxocariasis, we conducted an electronic survey of American Academy of Pediatrics members. Of the 2,684 respondents, 1,120 (47%) pediatricians correctly selected toxocariasis as the diagnosis in an unknown case presentation with findings typical for toxocariasis; overall 1,695 (85%) stated they were not confident that their knowledge of toxocariasis was current. This knowledge gap suggests a need for improved toxocariasis awareness and education for U.S. pediatricians, especially those caring for children at risk for infection.

The 27th edition of the 2006 Report of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, known to most clinicians as "The Red Book," is considered the "Bible" of pediatric infectious diseases. In addition to providing an updated and exhaustive summary of the clinical manifestations, etiology, epidemiology, diagnostic tests, treatment, isolation, and control measures for >200 pediatric infectious diseases, this reference discusses a number of related topics, including management. With >350 liaisons and collaborators from the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, the Canadian Paediatric Society, the World Health Organization, and others, the 12-member 2004–2006 Committee on Infectious Diseases issued the current edition, which reflects the state of the art at the time of publication and is updated every 3 years.

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The publication of each of these texts during 2008—declared the International Year of Sanitation by the United Nations General Assembly to draw attention to the 2.6 billion people without access to basic sanitation—is timely. Each seeks to provide practical information and guidance to increase the proportion of the population with access to sanitation.

Although <2% of coronavirus disease 2019 (COVID-19) infections are reported in the pediatric population, children with comorbidities such as congenital heart disease and those at a younger age are more likely to become critically ill.1-3 Remdesivir has been reported to be efficacious in adults with COVID-194; however, there are no studies in children. Convalescent plasma (CP) can contain neutralizing antibodies to viruses,5 and has been used during previous viral epidemics with clinical improvement.6-11 COVID-19 CP (C19-CP) may be useful in critically ill adults, resulting in improvement in inflammatory markers, pulmonary lesions, and mortality.12 However, the impact of C19-CP in pediatric patients, particularly infants with developing immune systems and significant comorbidities, is completely unknown. We present an infant with cardiopulmonary failure secondary to unrepaired congenital heart disease exacerbated by COVID-19. Given postsurgical complications of children with viral respiratory infection,13-17 the patient required clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for surgical candidacy. We hypothesized that C19-CP administration may clear SARS-CoV-2 following failure of remdesivir.

Background: Balancing the prevention of infections in pediatric healthcare settings with family-centered care is challenging. Visitor restriction policies (VRP) are difficult to implement and enforce. The purpose of this study was to delineate the timing, indications for, and assessment of VRP in pediatric facilities. Methods: The Infectious Diseases Society of America Emerging Infections Network surveyed 334 pediatric infectious disease consultants via an electronic survey. Descriptive analyses were performed. Results: One hundred and seventy (51%) of eligible respondents completed a survey between 12 July and 15 August 2016. Of these, 44 (27%) reported not knowing if their facility had a VRP and 17 (10%) reported having a policy but were unfamiliar with details; both groups were excluded from further analyses. 104 (61%) reported being somewhat familiar with the details of their VRP and 92 (88%) had a VRP in all inpatient units. Age-based VRP were reported by 77/104 (74%), symptom-based by 101 (97%), and outbreak-specific by 78 (75%). VRP were also implemented in the emergency department by 5 (5%), outpatient clinic by 9 (9%), day surgery by 6 (6%), or radiology by 3 (3%). Symptom-based VRP were seasonal in 24 (24%) of facilities, with 71 (70%) implemented year-round. Communication of VRP to families occurred at admission at 89 (87%) and through signage in care areas by 65 (64%). Communication of VRP to staff occurred by email for 79 (77%), by meetings for 56 (55%) and by signage in staff only areas for 50 (49%). Enforcement was the responsibility of nursing (82, 80%), registration clerks (59, 58%), unit clerks (54, 53%), the infection prevention team (32, 31%), or clinicians (16, 16%). The effectiveness of VRP was assessed by 63 (62%) through active surveillance of hospital acquired respiratory infections; 29 (28%) used active surveillance of healthcare worker exposures and 30 (29%) used patient/family satisfaction. Conclusion: VRP vary in scope, implementation, enforcement, and physician awareness in pediatric facilities. A prospective multisite evaluation of outcomes would facilitate the adoption of uniform guidance.

Objective: To evaluate if routine supplementation of Lactobacillus rhamnosus GG ATCC 53103 (LGG) is associated with a decreased risk of necrotizing enterocolitis in very low birth weight (VLBW) infants. Study design: Retrospective observational cohort study of VLBW (<1500 g) infants at a single center from 2008 to 2016. LGG supplementation with Culturelle at a dose of 2.5 to 5 × 10 9 CFU/day began in 2014. We used multivariable logistic regression to evaluate the association between LGG supplementation and necrotizing enterocolitis (modified Bell stage IIA or greater), after adjusting for potential confounders. We also compared changes in necrotizing enterocolitis incidence before and after implementation of LGG using a statistical process control chart. Results: We evaluated 640 VLBW infants with a median gestational age of 28.7 weeks (IQR 26.3-30.6); 78 (12%) developed necrotizing enterocolitis. The median age at first dose of LGG was 6 days (IQR 3-10), and duration of supplementation was 32 days (IQR 18-45). The incidence of necrotizing enterocolitis in the epoch before LGG implementation was 10.2% compared with 16.8% after implementation. In multivariable analysis, LGG supplementation was associated with a higher risk of necrotizing enterocolitis (aOR 2.10, 95 % CI 1.25-3.54, P =.005). We found no special cause variation in necrotizing enterocolitis after implementation of LGG supplementation. There were no episodes of Lactobacillus sepsis during 5558 infant days of LGG supplementation. Conclusions: In this study, routine LGG supplementation was not associated with a decreased risk of necrotizing enterocolitis. Our findings do not support the use of the most common probiotic preparation currently supplemented to VLBW infants in the US.

Rotavirus and norovirus are important etiologies of gastroenteritis among hospitalized children. During 2012-2013, we tested 207 residual stool specimens from children with healthcareassociated vomiting and/or diarrhea for rotavirus and norovirus. Twenty (10%) were rotavirus positive, and 3 (3%) were norovirus positive, stressing the importance of these pathogens in hospitalized children.

Plasmodium falciparum malaria is one of the leading infectious causes of childhood mortality in Africa. EP-1300 is a polyepitope plasmid DNA vaccine expressing 38 cytotoxic T cell epitopes and 16 helper T cell epitopes derived from P. falciparum antigens expressed predominantly in the liver phase of the parasite's life cycle. We performed a phase 1 randomized, placebo-controlled, dose escalation clinical trial of the EP-1300 DNA vaccine administered via electroporation using the TriGrid Delivery System device (Ichor Medical Systems). Although the delivery of the EP-1300 DNA vaccine via electroporation was safe, tolerability was less than that usually observed with standard needle and syringe intramuscular administration. This was primarily due to acute local discomfort at the administration site during electroporation. Despite the use of electroporation, the vaccine was poorly immunogenic. The reasons for the poor immunogenicity of this polyepitope DNA vaccine remain uncertain.