s_cid=mm7045e1_w † † COVID-19 was confirmed with laboratory detection of SARS-CoV-2 by reverse transcription-polymerase chain reaction or antigen test. § § Patients with MIS-C as the reason for hospitalization included patients who met the clinical case definition for MIS-C (clinically severe illness requiring hospitalization in a person aged <21 years with fever, laboratory evidence of inflammation, multisystem [≥2] organ involvement and no alternative plausible diagnosis, and evidence of current or recent SARS-CoV-2 infection by reverse transcription polymerase chain reaction, serology or antigen test, or COVID-19 exposure within the 4 weeks preceding symptom onset [https:// emergency.cdc.gov/han/2020/han00432.asp]) and were hospitalized for diagnosis and management of MIS-C, based on chart review.

No abstract

Washing hands often, especially during times when one is likely to acquire and spread pathogens,* is one important measure to help prevent the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), as well as other pathogens spread by respiratory or fecal-oral transmission (1,2). Studies have reported moderate to high levels of self-reported handwashing among adults worldwide during the COVID-19 pandemic (3-5) † ; however, little is known about how handwashing behavior among U.S. adults has changed since the start of the pandemic. For this study, survey data from October 2019 (prepandemic) and June 2020 (during pandemic) were compared to assess changes in adults' remembering to wash their hands in six situations. § Statistically significant increases in reported handwashing were seen in June 2020 compared with October 2019 in four of the six situations; the odds of remembering to wash hands was 2.3 times higher among respondents after coughing, sneezing, or blowing their nose, 2.0 times higher before eating at a restaurant, and 1.7 times higher before eating at home. Men, young adults aged 18-24 years, and non-Hispanic White (White) adults were less likely to remember to wash hands in multiple situations. Strategies to help persons remember to wash their hands frequently and at important times should be identified and implemented, especially among groups reporting low prevalence of remembering to wash their hands. Data from ConsumerStyles fall and summer surveys conducted by Porter Novelli Public Services in October 2019 and June 2020 were analyzed for this study. ¶ These data are collected by Porter Novelli Public Services through Ipsos' Knowledge Panel, an online market research panel. This panel is designed to be representative of the noninstitutionalized U.S. population, and panel members are recruited randomly by mail through probability, address-based sampling. Respondents receive points for participating in the panel, which can be used to redeem cash and prizes. The samples from each year were weighted to match the U.S. population across eight * https://www.cdc.gov/handwashing/when-how-handwashing.html. †

Background Encephalitis is an inflammatory condition of the brain associated with long-term neurologic sequelae and even death in children. Although viruses are often implicated, an etiology is not identified in the majority of cases. Metagenomics-based next-generation sequencing (mNGS) is a high-throughput sequencing technique that can enhance the detection of novel or low-frequency pathogens. Methods Hospitalized immunocompetent children aged 6 months to 18 years with encephalitis of unidentified etiology were eligible for enrollment. Demographic, historical, and clinical information was obtained, and residual blood and cerebrospinal fluid (CSF) samples were subjected to mNGS. Pathogens were identified by querying the sequence data against the NCBI GenBank database. Results Twenty children were enrolled prospectively between 2013 and 2017. mNGS of CSF identified 7 nonhuman nucleic acid sequences of significant frequency in 6 patients, including that of Mycoplasma bovis, parvovirus B19, Neisseria meningitidis, and Balamuthia mandrillaris. mNGS also detected Cladophialophora species, tobacco mosaic virus, and human bocavirus, which were presumed to be contaminants or nonpathogenic organisms. One patient was found to have positive serology results for California encephalitis virus, but mNGS did not detect it. Patients for whom mNGS identified a diagnosis had a significantly higher CSF white blood cell count, a higher CSF protein concentration, and a lower CSF glucose level than patients for whom mNGS did not identify a diagnosis. Conclusion We describe here the results of a prospective cohort analysis to evaluate mNGS as a diagnostic tool for children with unexplained encephalitis. Although mNGS detected multiple nonpathogenic organisms, it also identified multiple pathogens successfully and was most useful in patients with a CSF abnormality.

Background Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with SARS-CoV-2 infection. Methods In this retrospective cohort study, we applied the U.S. Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged April 2020–January 2021 from four Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A COVID-19 hospitalizations were identified using International Classification of Diseases, Tenth Revision encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the two cohorts, and described clinical characteristics of MIS-A patients. Results We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5,755 COVID-19 hospitalizations (ratio 1: 523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs. 26.1%, p &lt; 0.01) and to be non-Hispanic Black persons (81.8% vs. 50.0%, p = 0.04). Ten patients with MIS-A (90.9%) had at least one underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, eight (72.7%) required mechanical ventilation, two (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice. Conclusions MIS-A is severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk.

Background Recent population-based data are limited regarding influenza-associated hospitalizations in U.S. children. Methods We identified children &lt;18 years hospitalized with laboratory-confirmed influenza during 2010–2019 seasons through CDC’s Influenza Hospitalization Surveillance Network. Adjusted hospitalization and in-hospital mortality rates were calculated, and multivariable logistic regression was conducted to evaluate risk factors for pneumonia, intensive care unit (ICU) admission, mechanical ventilation, and death. Results Over 9 seasons, adjusted influenza-associated hospitalization incidence rates ranged from 10–375 per 100,000 persons each season and were highest among infants &lt;6 months. Rates decreased with increasing age. The highest in-hospital mortality rates were observed in children &lt;6 months (0.73 per 100,000 persons). Over time, antiviral treatment significantly increased from 56% to 85% (P &lt; .001) and influenza vaccination rates increased from 33% to 44% (P = .003). Among the 13,235 hospitalized children, 2,676 (20%) of hospitalized children were admitted to the ICU, 2,262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died during hospitalization. As compared with those &lt;6 months of age, hospitalized children ≥13 years had higher odds of pneumonia (adjusted odds ratios [aOR], 2.7; 95% confidence interval [CI], 2.1–3.4), ICU admission (aOR, 1.6; 95% CI, 1.3–1.9), mechanical ventilation (aOR, 1.6; 95% CI, 1.1–2.2), and death (aOR, 3.3; 95% CI, 1.2–9.3). Conclusions Hospitalization and death rates were greatest in younger children at the population level. Among hospitalized children, however, older children had a higher risk of severe outcomes. Continued efforts to prevent and attenuate influenza in children are needed.

There are currently 12 species and over 100 serotypes that have been identified in the enterovirus genus, including the coxsackieviruses, echoviruses, and polioviruses. Since their discovery 65 years ago, much has been discovered and continues to be researched regarding the pathogenicity and scope of disease of nonpolio enteroviruses. Like many infections, enteroviruses have been found to affect neonates much differently, and often more severely, than older children and adults. Neonatal infections often cause mild illnesses with nonspecific symptoms, but they may also have severe presentations involving the cardiovascular, gastrointestinal, hematologic, or central nervous systems. This article provides an overview of what is known about nonpolio enteroviruses in neonates including epidemiology, transmission, clinical presentation, diagnosis, and treatment.

Objectives: To describe COVID-19-related pediatric hospitalizations during a period of B.1.617.2 (Delta) variant predominance and to determine age-specific factors associated with severe illness. Patients and Methods: We abstracted data from medical charts to conduct a cross-sectional study of patients aged &lt;21 years hospitalized at 6 US children's hospitals during July–August 2021 for COVID-19 or with an incidental positive SARS-CoV-2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. Results: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with RSV (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1–4 years (PR 1.96); and obesity in patients aged 5–11 (PR 2.20) and 12–17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged &lt;1 (PR 1.82), 5–11 (PR 3.72), and 12–17 years (PR 3.19) Conclusions: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged &lt;5 years, obesity in those aged 5–17 years, and other underlying conditions for all age groups &lt;18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19