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Infectious Diseases and Immunology

Differentiating True Measles Cases From Vaccine Shedding
 Differentiating True Measles Cases From Vaccine Shedding 1024 683 Mary Bates, PhD
By: Mary Bates, PhD

Shedding of measles vaccine RNA can occur for up to four weeks post vaccination. Detection of measles vaccine RNA following vaccination is not uncommon and may occur up to four weeks post-vaccination, according to a new study from Nationwide Children’s Hospital. “The frequency at which detection after MMR occurs in this patient population really highlights,…

Featured Researcher — Katherine Bline, MD
 Featured Researcher — Katherine Bline, MD 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Katherine Bline, MD, is a critical care medicine physician and principal investigator in the Center for Vaccines and Immunity at Nationwide Children’s Hospital. Experience caring for some of the hospital’s sickest children in the pediatric intensive care unit (PICU) and mentors who pushed her to understand phenomena she observed clinically have helped Dr. Bline find…

Predicting Disease Severity and Assessing Long-Term Outcomes of Pediatric La Crosse Virus
 Predicting Disease Severity and Assessing Long-Term Outcomes of Pediatric La Crosse Virus 1024 683 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM

Limited data exist on mosquito-borne La Crosse Virus in children, underscoring the importance of determining which patients are at risk for severe disease and long-term neurobehavioral difficulties.   La Crosse Virus (LACV) is a neuroinvasive arbovirus spread by the Aedes triseriatus mosquito, causing symptoms such as vomiting, seizures and altered mental status (AMS). Within the…

SARS-CoV-2 RNA in the Blood is Associated With Worse Outcomes in Kids
 SARS-CoV-2 RNA in the Blood is Associated With Worse Outcomes in Kids 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Researchers have identified a risk factor for more severe illness in children with COVID-19: detectable levels of SARS-CoV-2 RNA circulating in the blood. Children with detectable SARS-CoV-2 RNA in the blood, called RNAemia, were more likely to require oxygen and be admitted to the intensive care unit than children with COVID-19 who did not have…

Codetection of Respiratory Bacteria in Infants With RSV Infection Associated With Worse Outcomes
 Codetection of Respiratory Bacteria in Infants With RSV Infection Associated With Worse Outcomes 1024 575 Lauren Dembeck
By: Lauren Dembeck
Color photo of Black father holding infant on shoulder in front of nursery background with clouds on the wall

The interaction between the bacteria and respiratory syncytial virus (RSV) appears to be synergistic. Researchers are now working to understand the underlying biological mechanisms. Researchers at Nationwide Children’s Hospital have discovered that codetection of Haemophilus influenzae and Streptococcus pneumoniae in the upper respiratory tract of previously healthy infants with RSV infection was independently associated with…

Risk for Serious Complications From Vaccine-Preventable Infections After Hematopoietic Cell Transplant
 Risk for Serious Complications From Vaccine-Preventable Infections After Hematopoietic Cell Transplant 1024 683 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Clinician-scientists reveal the burden of vaccine-preventable infections among children post-transplant, when immunity is low and risk is high. When a hematopoietic cell transplant (HCT) recipient at Nationwide Children’s Hospital was diagnosed with a vaccine-preventable infection (VPI), treating clinicians decided to evaluate the burden of VPI in HCT patients at Nationwide Children’s and elsewhere. The team…

What Pediatricians Should Know about Long COVID
 What Pediatricians Should Know about Long COVID 1024 683 Octavio Ramilo, MD
By: Octavio Ramilo, MD

More than 4 million children have tested positive for SARS-CoV-2 in the United States. According to the American Academy of Pediatrics, long-term effects from COVID-19 can be significant, regardless of initial disease severity. Medical providers across the nation, including here at Nationwide Children’s Hospital, are seeing an increase in cases of what is being called…

When Dismantling Bacterial Biofilms, the First Line of Defense Comes From Within
 When Dismantling Bacterial Biofilms, the First Line of Defense Comes From Within 1024 575 Natalie Wilson
By: Natalie Wilson
Illustration showing the precise pattern of a biofilm - a perfect, 3D matrix

Researchers identified the mechanism behind the anti-biofilm properties of a protein found in all vertebrates. Too little of this protein allows disease-causing bacteria protected by biofilms to spread, while too much can lead to septic shock. Could a molecule of this protein be engineered to destroy biofilms without negative effects on the body? A team…

Occurrence and Cost of Infections After Heart Transplant
 Occurrence and Cost of Infections After Heart Transplant 1024 683 Mary Bates, PhD
By: Mary Bates, PhD
Dr. Emily Hayes

Researchers identify risk factors, long-term outcomes of vaccine-preventable infections following heart transplantation in pediatric patients. Recently, a study using the Pediatric Health Information System (PHIS) database found that one in six pediatric solid organ transplant recipients were hospitalized with respiratory syncytial virus (RSV) or vaccine-preventable illness in the first five years after transplant. Within this…

Providing Education and PrEP for Teens at Risk for HIV
 Providing Education and PrEP for Teens at Risk for HIV 1024 683 Abbie Miller
By: Abbie Miller

In a recent PediaCast CME, Mike Patrick, MD, and Megan Brundrett, MD, share important information about offering PrEP and HIV-related education in your primary care practice. Listen to the Full Episode About 20% of new cases of HIV, the virus that causes Acquired Immunodeficiency Syndrome (AIDS), are occurring in youth aged 13 to 24. HIV/AIDS…

Understanding Immune Responses to Build a Better Vaccine
 Understanding Immune Responses to Build a Better Vaccine 1024 606 Abbie Miller
By: Abbie Miller

Researchers have used studies of respiratory syncytial virus and infant immune responses to develop a promising vaccine candidate. Respiratory syncytial virus (RSV) is an incredibly common yet potentially deadly pathogen. Almost everyone becomes infected with RSV during their first three years of life, but for certain populations — infants and elderly or immunocompromised people —…

Introducing a New SARS-CoV-2 Vaccine Candidate
 Introducing a New SARS-CoV-2 Vaccine Candidate 1024 512 Abbie Miller
By: Abbie Miller
coronavirus

The new vaccine candidate takes advantage of the long and successful history of the measles vaccine. A team of researchers from The Ohio State University and Nationwide Children’s have built a novel vaccine candidate against SARS-CoV-2. The candidate, published in Proceedings of the National Academy of Sciences (PNAS), used the measles vaccine as a vector…

CLABSI in Hematology and Oncology: Progress Toward Zero
 CLABSI in Hematology and Oncology: Progress Toward Zero 1024 576 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
Blood cells

A thorough review of five years of CLABSI data reveals key gaps in clinical knowledge that must be addressed to further reduce infection rates. For some time, any bloodstream infection (BSI) in a patient with a central venous catheter was considered a central line-associated bloodstream infection (CLABSI). In 2013, refined definitions enabled a distinction between…

Prevention and Treatment of Early-Onset Sepsis in Newborns
 Prevention and Treatment of Early-Onset Sepsis in Newborns 1024 575 Mary Bates, PhD
By: Mary Bates, PhD

Continued surveillance is needed to monitor pathogen distribution and antibiotic resistance. Early-onset sepsis remains a potentially fatal condition among newborns, particularly pre-term infants. According to a new study published in JAMA Pediatrics, ongoing surveillance is required to optimize prevention and treatment strategies. The study included data from 18 centers of the Eunice Kennedy Shriver National Institute…

Improving the Care and Management of Urinary Tract Infections Through Collaboration
 Improving the Care and Management of Urinary Tract Infections Through Collaboration 150 150 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM

The Urinary Tract Infection Global Alliance (UTIGA) is a new professional society that is dedicated to combatting the many challenges in UTI management and care through collaboration. With nearly 150 million people affected by urinary tract infections (UTIs) annually across the globe, UTIs are a major health problem. Both the term ‘UTI’ and the infection’s…

Eosinophilic Pneumonia Brought on by Vaping
 Eosinophilic Pneumonia Brought on by Vaping 1024 680 Mary Bates, PhD
By: Mary Bates, PhD

A case study emphasizes the importance of a detailed history in differentiating between eosinophilic and infectious pneumonia. Eosinophilic pneumonia is a rare and potentially life-threatening condition. It is often seen in previously healthy individuals and can be difficult to distinguish from infectious pneumonia, leading to delays in the appropriate treatment. According to a new case…

Study of Children With COVID-19 Admitted to US and Canadian Pediatric Intensive Care Units
 Study of Children With COVID-19 Admitted to US and Canadian Pediatric Intensive Care Units 1024 683 Abbie Miller
By: Abbie Miller

Publication examines the characteristics and outcomes of children with COVID-19 who were admitted to North American PICUs. While two studies from Wuhan, China, have indicated that COVID-19 disease burden and severity seems to be lower in children, it remains to be seen how children around the world will fare as the pandemic progresses. In March…

Systems Analyses Unravel Clinical Phenotypes in Infants with Respiratory Syncytial Virus Infection
 Systems Analyses Unravel Clinical Phenotypes in Infants with Respiratory Syncytial Virus Infection 1024 575 Mary Bates, PhD
By: Mary Bates, PhD

RSV disease severity is influenced by innate immune responses, viral loads and patient age. Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children, although most cases result in mild disease. To develop effective antivirals and vaccines, a better understanding of the different clinical, immunologic and virologic factors present in infants with mild…

What Could COVID-19 Mean for Pediatrics?
 What Could COVID-19 Mean for Pediatrics? 1024 683 Abbie Miller
By: Abbie Miller

As COVID-19 spreads across the globe, experts are digging into the data and establishing protocols to better understand the illness in the context of pediatrics. As COVID-19, the illness caused by a novel coronavirus, has reached pandemic status, life has changed dramatically. At Nationwide Children’s Hospital, the halls are uncharacteristically quiet as a “stay at…

Study Shows Promising Host-Targeted Approach for the Prevention and Cure of Gonorrhoea in Women
 Study Shows Promising Host-Targeted Approach for the Prevention and Cure of Gonorrhoea in Women 1024 683 Nationwide Children's
By: Nationwide Children's

In research published in mBio, researchers from the Abigail Wexner Research Institute (AWRI) at Nationwide Children’s Hospital and Griffith University’s Institute for Glycomics have discovered non-antibiotic (host-targeted) therapies for the effective treatment of Neisseria gonorrhoeae infections by repurposing existing drugs. Gonorrhoea is the second most commonly reported sexually transmitted infection (STI). The Centers for Disease Control and…

Answers to Burning Questions About Pediatric Urinary Tract Infections
 Answers to Burning Questions About Pediatric Urinary Tract Infections 1024 683 Abbie Miller
By: Abbie Miller

Nationwide Children’s urologists and nephrologists recently co-hosted a Twitter chat for primary care providers, answering common questions about pediatric urinary tract infections (UTIs). Below is a summary of the questions and answers, adapted for brevity and clarity. Q: What causes UTIs in children? A: UTIs are typically caused by uropathogenic E. coli bacteria that invade the urinary…

Asymptomatic Infants With Congenital Cytomegalovirus May Still Have Detectable, Significant Abnormalities
 Asymptomatic Infants With Congenital Cytomegalovirus May Still Have Detectable, Significant Abnormalities 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
Color photo of Black father holding infant on shoulder in front of nursery background with clouds on the wall

More than half of high-risk CMV-positive newborns may have abnormalities not detected by a physical exam alone. A study in 34 infants with a normal physical exam despite a positive diagnosis of congenital cytomegalovirus (CMV) — a viral infection that can lead to neurodevelopmental delays and permanent hearing loss — found that in more than…

CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea
 CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea 1024 575 Samantha Morsink
By: Samantha Morsink

CMV is the leading non-genetic cause of sensorineural hearing loss in infancy and childhood. Identification of newborns with congenital CMV infection can improve their outcomes by early intervention programs and/or antiviral treatment. Cytomegalovirus, or CMV, infects almost everyone at some point in time, and it is one of the most common congenital infections worldwide. While…

What You Need to Know About Tick-Borne Diseases
 What You Need to Know About Tick-Borne Diseases 1024 575 Mike Patrick, MD
By: Mike Patrick, MD

Update: July 2021, this content has been reviewed for accuracy. The downloadable practice tool has been replaced with an updated version. Ranges of disease-carrying ticks are shifting in the United States. Combined with family travel, this means physicians and families should have a wider lens on what tick-borne diseases they might encounter. Ticks represent a…

An Infant. A Virus. An Emergency IND. A Life Saved.
 An Infant. A Virus. An Emergency IND. A Life Saved. 150 150 Abbie Miller
By: Abbie Miller

Clinician scientists collaborate to use virus-specific T-cells from the mother to successfully treat a systemic adenovirus infection in a preterm infant. It’s not every day that researchers can say that they’ve written and submitted and emergency investigational new drug (EIND) application to the Food & Drug Administration (FDA) and saved a life. But that’s what…

Novel Metric Predicts Severity of Community-Acquired Pneumonia
 Novel Metric Predicts Severity of Community-Acquired Pneumonia 150 150 Rachael Hardison
By: Rachael Hardison

Researchers utilize a biomarker to predict disease severity during early stages of pneumonia. Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in children. Each year, 4 percent of children under 5 years of age will develop CAP in industrialized countries. Although pneumonia is common, diagnosing and treating it remains a challenge for…

Study Provides New Clinical Evidence That Avoids Painful Tests for Infants With Fever
 Study Provides New Clinical Evidence That Avoids Painful Tests for Infants With Fever 150 150 Nationwide Children's
By: Nationwide Children's

Should “Non-High Risk Patients” With Uncomplicated Influenza be Given Antivirals?
 Should “Non-High Risk Patients” With Uncomplicated Influenza be Given Antivirals? 150 150 Michael T. Brady, MD
By: Michael T. Brady, MD

This question references a recommendation from the Centers for Disease Control and Prevention that is open to interpretation. For years, the CDC has recommended that all “hospitalized, severely ill and high-risk patients with suspected or confirmed influenza should be treated with antivirals.” Those at high risk include children younger than 2 years of age and…

Weaving an Antimicrobial Safety Net
 Weaving an Antimicrobial Safety Net 150 150 Kevin Mayhood
By: Kevin Mayhood

Stewards thread together monitoring programs and new protocols while trimming unwarranted tests and diagnostic speed. This story also appeared in the Spring/Summer 2018 print issue. Download a PDF of the print issue. Studies estimate that 30 to 50 percent of antimicrobials prescribed in hospitals and up to 50 percent prescribed in outpatient settings are either unnecessary…

Reevaluate the Evaluation of Febrile Infants?
 Reevaluate the Evaluation of Febrile Infants? 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
Black and white photo of infant crying in hospital

For decades, complete blood cell counts have been the go-to way to identify babies at high risk for serious bacterial infections. But recent research shows the popular lab test isn’t as useful as everyone thought. The Pediatric Emergency Care Applied Research Network (PECARN) has worked for the past decade to both evaluate new technologies and…

Immune Cell Subtype Tied to Asthma in Mice Found in Humans With Viral Infections
 Immune Cell Subtype Tied to Asthma in Mice Found in Humans With Viral Infections 969 533 Kevin Mayhood
By: Kevin Mayhood
Illustration of NK Cells, T Cells, other immune cells floating across white background

If asthma development in people parallels mice, the cells’ mechanisms may provide a target for disease prevention. A subtype of neutrophil, labeled CD49d+ PMN, which is necessary to drive asthma and allergies in a mouse model, also accumulates in the nasal fluid of people with symptoms of an upper respiratory viral infection, researchers have discovered. Neutrophils are…

On the Road to Eliminating RSV
 On the Road to Eliminating RSV 150 150 Abbie Miller
By: Abbie Miller

With the recent publication of two papers, researchers shed light on factors that influence disease severity and immune response to respiratory syncytial virus infection in infants and young children. “RSV is a very common infection in infants and young children – almost everyone will be infected by age 2. In the United States, 2-3 percent…

Math Model Reveals Immune System Secrets
 Math Model Reveals Immune System Secrets 150 150 Brianne Moore
By: Brianne Moore

Natural killer (NK) cells are a key part of the innate immune system, activating to destroy virally infected cells or tumor cells detected in the body. While the mechanism of detection of infected cells by NK cells is well understood, some aspects of how NK cells communicate with other immune cells are not. Due to…

Many Respiratory Pathogens, One Test: The Respiratory Infection Array
 Many Respiratory Pathogens, One Test: The Respiratory Infection Array 150 150 Jeb Phillips
By: Jeb Phillips

A multiplex polymerase chain reaction assay newly available for outpatients is faster and more comprehensive than conventional testing for causes of upper respiratory infection. ‘Tis the season for coughs, runny noses and the challenge of trying to pinpoint which pathogen is causing your patient’s particular upper respiratory infection. Clinical presentations are similar for a number…

Two Genes Linked to Postpartum Immunity Revival in Women With Persistent Hepatitis C
 Two Genes Linked to Postpartum Immunity Revival in Women With Persistent Hepatitis C 150 150 Kevin Mayhood
By: Kevin Mayhood

Research may provide a model for identifying immune factors needed to control chronic infections. Alternative forms of two genes are associated with a boost in immunity to hepatitis C after childbirth, a study led by a Nationwide Children’s Hospital physician-researcher shows. At three months postpartum, the number of viruses circulating in the blood declined sharply…

What Pediatricians Need to Know About the New Meningococcal B Vaccine
 What Pediatricians Need to Know About the New Meningococcal B Vaccine 150 150 Michael T. Brady, MD
By: Michael T. Brady, MD

Michael T. Brady, MD, infectious diseases specialist at Nationwide Children’s Hospital and primary author of the recent American Academy of Pediatrics position paper on the meningococcal B vaccine, shares what you need to know about this controversial vaccine. Meningococcal serotype B (MenB) causes the majority of invasive meningococcal disease in infants and young children. Though…

Specialized Test Detects Bacterial Infections in Youngest Infants with Fever
 Specialized Test Detects Bacterial Infections in Youngest Infants with Fever 150 150 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD

The diagnostic test has potential to prevent painful testing, unnecessary antibiotics and hospitalizations for many of the more than 500,000 febrile infants who arrive at hospitals each year. Physicians from Children’s Hospital of Michigan, UC Davis Medical Center and Nationwide Children’s Hospital, in collaboration with 19 other pediatric emergency departments around the country, have established…

A Novel, Promising Strategy for Diagnosing UTIs in Children
 A Novel, Promising Strategy for Diagnosing UTIs in Children 150 150 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD

Antimicrobial peptides may be effective biomarkers for diagnosing urinary tract infections in children. Urinary tract infections (UTIs) are one of the most common infections in children and account for millions of unplanned pediatrician and urgent care visits each year in the United States. Previous research has shown that antimicrobial peptides, referred to as AMPs, are…

Vaccine Fails to Reactivate Immunity to Hepatitis C Virus
 Vaccine Fails to Reactivate Immunity to Hepatitis C Virus 150 150 Abbie Miller
By: Abbie Miller

T cells remain inactivated even after immunization in subjects with persistent, controlled infections. Two papers recently published in Hepatology uncovered evidence of permanent immune system damage after hepatitis C virus (HCV) infection. The studies used a vaccine currently in clinical trials to attempt to restore immunity against HCV in animal models and humans with chronic HCV infection. “In chronic HCV, CD8+…

HIV in the Millennial World
 HIV in the Millennial World 150 150 Abbie Miller
By: Abbie Miller

Adolescents and young adults ages 13 to 24 comprise an increasingly large proportion of new HIV infections in the United States. A new generation of youth is experiencing increasing rates of HIV transmission, and data from the Centers for Disease Control and Prevention (CDC) indicate half of those infected youth (ages 13-24) don’t even know…

Revealing the Secrets of Sepsis
 Revealing the Secrets of Sepsis 969 533 Abbie Miller
By: Abbie Miller
Illustration of NK Cells, T Cells, other immune cells floating across white background

Charting new territory in the understanding of how the immune system responds to sepsis. Two children are admitted to the hospital with sepsis. Both receive antibiotics and fluid resuscitation within the critical first hour. Why does one get better after the initial crisis while the other goes on to develop additional infections and multiple organ…

Ebola in Children Creates Ethical Quandary
 Ebola in Children Creates Ethical Quandary 150 150 Kevin Mayhood
By: Kevin Mayhood

Do you keep a parent in the room while the virus rages inside a child? The Ebola outbreak in Guinea, Liberia and Sierra Leone has challenged emergency preparedness at Children’s Hospitals and Clinics of Minnesota like nothing before — even more than the early days of AIDS and outbreaks of measles and H1N1 flu, says Infection Prevention…

A Shift in the Antibiotic Prophylaxis Debate?
 A Shift in the Antibiotic Prophylaxis Debate? 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

The RIVUR trial laid to rest certain questions surrounding antimicrobial prophylaxis in children with vesicoureteral reflux. But it also launched a new debate. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trialwas supposed to provide clear direction for pediatric urologists. To date, it is the largest double-blind, placebo-controlled, randomized, multicenter study examining urinary tract infection…

Bacterial or Viral? New Technique to Clear Muddy Waters
 Bacterial or Viral? New Technique to Clear Muddy Waters 150 150 Jan Arthur
By: Jan Arthur

Transcriptional profiling could help reduce inappropriate administration of antibiotics for lower respiratory infections in hospitalized patients. Lower respiratory tract infections (LRTIs) are one of the most frequent reasons for hospitalization in adults and children worldwide. However, in most cases, establishing the cause of the infection is challenging and many patients undergo unnecessary treatment with antibiotics…

The High Cost of Antibiotic Redundancy
 The High Cost of Antibiotic Redundancy 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

As many as 78 percent of non-federal U.S. hospitals frequently prescribe redundant antibiotics, according to a study appearing in the journal Infection Control and Hospital Epidemiology. Over a four-year period, these hospitals accounted for 32,507 cases of antibiotic regimens with overlapping antimicrobial spectra, resulting in more than $12 million in avoidable health care expenses. There are very few clinical…