BackgroundComplications of scabies and impetigo such as glomerulonephritis and invasive bacterial infection in Australian Aboriginal children remain significant problems and the overall global burden of disease attributable to these skin infections remains high despite the availability of effective treatment. We hypothesised that one factor contributing to this high burden is that skin infection is under-recognised and hence under-treated, in settings where prevalence is high.MethodsWe conducted a prospective, cross-sectional study to assess the burden of scabies, impetigo, tinea and pediculosis in children admitted to two regional Australian hospitals from October 2015 to January 2016. A retrospective chart review of patients admitted in November 2014 (mid-point of the prospective data collection in the preceding year) was performed. Prevalence of documented skin infection was compared in the prospective and retrospective population to assess clinician recognition and treatment of skin infections.Results158 patients with median age 3.6 years, 74% Aboriginal, were prospectively recruited. 77 patient records were retrospectively reviewed. Scabies (8.2% vs 0.0%, OR N/A, p = 0.006) and impetigo (49.4% vs 19.5%, OR 4.0 (95% confidence interval [CI 2.1–7.7) were more prevalent in the prospective analysis. Skin examination was only documented in 45.5% of cases in the retrospective review. Patients in the prospective analysis were more likely to be prescribed specific treatment for skin infection compared with those in the retrospective review (31.6% vs 5.2%, OR 8.5 (95% CI 2.9–24.4).ConclusionsScabies and impetigo infections are under-recognised and hence under-treated by clinicians. Improving the recognition and treatment of skin infections by clinicians is a priority to reduce the high burden of skin infection and subsequent sequelae in paediatric populations where scabies and impetigo are endemic.

Childhood vaccination has played a critical role in the reduction of morbidity and mortality from communicable diseases, including specific respiratory pathogens. Acute lower respiratory infection (ALRI) of both bacterial and viral aetiology continues to impact global child health. Key bacterial pathogens including Streptococcus pneumoniae and Haemophilus influenza type b are specifically targeted with current vaccination programmes, while at present there are less effective strategies for the prevention of viral disease. Influenza vaccines, including both live attenuated intranasal vaccines and inactivated influenza vaccines, are limited by seasonal strain variation and unsustained immunity. Research into the development of a universal influenza vaccine is ongoing; potential targets are the conserved regions of the virus such as the M2e antigen and hemagglutinin stalk. Respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV3) are the viral pathogens most commonly causing ALRI in children, particularly the infant population. Currently, no vaccine exists for either virus. Over the last decade, promising advances have been made. Protection of neonates via maternal RSV immunisation is being assessed in a phase III clinical trial, with many other candidates for RSV and PIV3 at less advanced stages of development.

A 10-month-old Indigenous boy presented to a paediatric hospital with fever, lethargy and mild left elbow swelling. After initial observation, he developed petechiae and persistent fevers. Following collection of a blood culture, he was commenced on intravenous (IV) ceftriaxone and vancomycin.Neisseria meningitidis was cultured from blood (serogroup W135). C-reactive protein was elevated at 200 mg/L (normal <5 mg/L). Ceftriaxone monotherapy was continued (50 mg/kg 12 hourly). After initial improvement, progressive elbow swelling prompted an ultrasound on day 6, confirming a joint effusion.Frank pus was identified during joint washout (culture negative; meningococcal W135 polymerase chain reaction (PCR) positive). His elbow inflammation significantly improved by day 8 and C-reactive protein decreased to 18 mg/L. On day 9, he developed new-onset left knee swelling. Joint washout revealed a white cell count of 103 200 × 10 6 (95% neutrophils), which was culture negative and meningococcal W135 PCR positive. By day 13, with improved mobility, the patient was changed to oral cefixime 100 mg daily. On day 16, left knee swelling and fever recrudesced; ultrasound confirmed a further effusion. IV ceftriaxone was recommenced. Repeat knee washout was culture and meningococcal PCR negative. White cell count

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