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IntroductionThe high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures.MethodsA global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management.ResultsNinety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision.ConclusionSeven key actions for improving RSV prevention and management in LMICs are proposed.

Introduction the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored. Methods using a cross sectional survey, a pre-tested and validated questionnaire on a “Google form” was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test. Results among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH. Conclusion vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.

Purpose of reviewHuman mpox disease (formerly monkeypox) was first diagnosed in an infant in the Democratic Republic of the Congo in 1970. Mpox was rarely reported outside West and Central Africa until the global outbreak in May 2022. On 23 July 2022, the WHO declared mpox a public health emergency of international concern. These developments warrant a global update on pediatric mpox.Recent findingsMpox epidemiology in endemic African countries has changed from predominantly affecting children under 10 years to adults 20–40 years old. This shift also applies to the global outbreak, where 18–44-year-old adult men who have sex with men are disproportionately affected. Furthermore, the proportion of children affected in the global outbreak is less than 2%, while children under 18 years constitute nearly 40% of cases in African countries. The highest mortality rates remain among both children and adults in African countries.SummaryMpox epidemiology has shifted to adults and is affecting relatively few children in the current global outbreak. However, infants, immunocompromised children and African children are still at high risk of severe disease. Mpox vaccines and therapeutic interventions should be accessible to at-risk and affected children globally, especially to those living in endemic African countries.

Pneumocystis infection has proven difficult to study partly due to the lack of reliable culture system for the organism. 7 The mode of transmission is not firmly established but airborne human to human transmission is likely. Infections are almost always limited to the lungs and cannot be cultured reliably outside the lungs. 7,8 Clinical signs and symptoms are non-specific and confirmation is hampered by inability to reliably perform in vitro culture. 5 Definitive diagnosis in resource limited ABSTRACT Pneumocystis pneumonia (PJP), initially thought to be rare in this part of the world, has over the years, been diagnosed and treated in our center. PJP should be considered in a young child 3 to 6 months of age with very severe pneumonia, known or suspected to be HIV infected. It should be suspected when severity of illness is out of proportion with the chest findings and chest x-ray is normal or shows minimal or bilateral interstitial infiltrates. Treatment is oral or intravenous high dose cotrimoxazole given 6-8 hourly for 3 weeks and the addition of prednisolone. The objective of this report is to describe the presentation, challenges of diagnosing and management of PJP in children in a developing country. Report of 3 cases aged 3, 4 and 41/2 months, exposed to the HIV. All developed severe pneumonia characteristic of PJP and all responded to treatment with high dose cotrimoxazole and Prednisolone. A high index of suspicion is needed to diagnose PJP in a resource poor setting like ours. It is common in HIV positive children but can also occur in HIV negative individuals as shown by these case reports. A presumptive diagnosis can be made in a young child, usually below 6 months of age, very ill with severe pneumonia and minimal chest findings who responds to cotrimoxazole. Addition of prednisolone has been found to improve the outcome. Antibiotics should continue to cover for co-existing bacterial pneumonia.

Background: Tuberculosis (tb) causes significant morbidity and mortality worldwide. In Nigeria, the exact prevalence is not known but a progressive increase of the disease has been observed, with "epidemic states" reported in certain clusters. Even with the newer diagnostic tests for tb, diagnostic difficulties still occur. As a result, several diagnostic criteria have been adopted to aid the diagnosis of tuberculosis in these children. The main objective of this study was to identify Tb in children who were either living with adults who have Tb or in the environment of adults with Tb. Methodology: This was a prospective cross-sectional study conducted in Eku and Oria communities in Ethiope East Local Government Area of Delta State. Eku housed the Tuberculosis and Leprosy Referral Hospital where adults with tb were admitted in the first two months of their treatment. 128 children under 19 years of age were studied over a 3-month period. After obtaining relevant information from every child, a full physical examination and certain laboratory investigations were done. Results: There were 68 males and 60 females. The prevalence of Tb was 68% in those children living among adults with tb within the hospital and 50.6% in those living in the environment or community (p = 0.05). The prevalence of Tb in Bacille Calmette Guerin (BCG) immunized children was 66.2% as against 46.7% in those not vaccinated. Twenty-six of the infected children (57.8%) had only pulmonary disease while 45.7% had affectation of 2 or more organs. The positive predictive values of elevated erythrocyte sedimented rate (ESR), elevated white blood cells (WBC) count and positive gastric aspirates (GA) in diagnosing tb were 60.3%, 70.5% and 0% respectively, while that of abnormal chest X-ray (CXR) and positive Mantoux reaction were 93.6% and 93.7% respectively. Conclusion: The alarming prevalence of tb in these children was not surprising considering their contacts with the tb patients and was representative of simi-* Corresponding author. A. U. Ewa et al.81 lar high incidence areas as a whole. Active case finding efforts should be intensified for childhood contacts of adults with Tb for early identification of children with tuberculosis.

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