Australian Paediatric Surveillance Unit Annual Report 2018

ZusammenfassungDie rezidivierende Larynxpapillomatose (RLP) wird in 90 % der Fälle durch die humanen Papillomviren (HPV) 6 und 11 verursacht. Unklar ist, ob Rezidive durch Neuinfektion oder Ausbreitung infizierter Zellen entstehen. Symptomatische und z. T. kurative Therapie ist die laserchirurgische bzw. konventionelle mikrochirurgische Abtragung. Die Operation zielt auf die Linderung der Atemnot und Verbesserung der Stimme. Im Krankheitsverlauf werden Patienten, insbesondere Kinder, durch Stimmprobleme, wiederholte operative Abtragungen, pulmonale Manifestationen und psychologische Traumata beeinträchtigt. Die Impfung mit Gardasil 9 (Merck & Co., Rahway, NJ, USA) beugt Neuinfektionen mit HPV 6, 11, 16, 18, 31, 33, 45, 52 und 58 vor und induziert Impfantigen-spezifische Antikörper und CD4+-T-Helferzellen. Die RLP ist nach aktueller Studienlage durch eine prophylaktische Impfung vermeidbar. Die Behandlung ist mit dem allgemeinen Impfrisiko verbunden (EMA-Zulassung: Mädchen, Jungen ab 9 Jahren). Studien zeigen zudem, dass der Impfstoff nach Entfernung HPV-assoziierter Neoplasien/Papillome Rezidiven vorbeugt. Die Erweiterung der Impfempfehlung für die Rezidivprophylaxe HPV-assoziierter Erkrankungen und als prophylaktische Impfung bei Männern würde zusätzlich die Anwendbarkeit und Herdenimmunität fördern. Für seltene und therapieresistente Fälle mit laryngotrachealer Beteiligung ist die systemische Therapie mit Bevacizumab (Avastatin; Genentech, San Francisco, CA, USA), einem VEGF-Antikörper, eine vielversprechende adjuvante Therapiemöglichkeit.

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Rezidivierende Larynxpapillomatose

Coordes

Grund

Mainka

et al. 2022

HNO

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Severe Influenza-Associated Neurological Disease in Australian Children: Seasonal Population-Based Surveillance 2008–2018

Donnelley

Teutsch

Zurynski

et al. 2022

Journal of the Pediatric Infectious Diseases Society

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Background Influenza-associated neurological disease (IAND) is uncommon but can result in death or neurological morbidity in children. We aimed to describe the incidence, risk factors, and outcome of children with IAND from seasonal influenza in Australia. Methods We analyzed national, population-based, surveillance data for children aged ≤ 14 years with severe influenza and neurological involvement, over 11 Australian influenza seasons, 2008–2018, by the Australian Paediatric Surveillance Unit. Results There were 633 laboratory-confirmed cases of severe influenza reported. Of these, 165 (26%) had IAND. The average annual incidence for IAND was 3.39 per million children aged ≤ 14 years. Compared to cases without neurological complications, those with IAND were more likely to have a pre-existing neurological disease (odds ratio [OR] 3.03, P < .001), but most children with IAND did not (n = 135, 82%). Children with IAND were more likely to receive antivirals (OR 1.80, P = .002), require intensive care (OR 1.79, P = .001), require ventilation (OR 1.99; P = .001), and die (OR 2.83, P = .004). Conclusions IAND is a preventable cause of mortality, predominantly in otherwise well children. Incidence estimates validate previous sentinel site estimates from Australia. IAND accounted for a quarter of all severe influenza, is associated with intensive care unit admission, and accounted for half of all influenza deaths.

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Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children

Teutsch

Zurynski

Nuñez

et al. 2020

Pediatric Infectious Disease Journal

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Background: Severe complications of influenza in children are uncommon but may result in admission to hospital or an intensive care unit (ICU) and death. Methods: Active prospective surveillance using the Australian Paediatric Surveillance Unit with monthly reporting by pediatricians of national demographic and clinical data on children with <15 years of age hospitalized with severe complications of laboratory-confirmed influenza during ten influenza seasons 2008–2017. Results: Of 722 children notified, 613 had laboratory-confirmed influenza and at least one severe complication. Most (60%) were <5 years of age; 10% were <6 months, hence ineligible for vaccination. Almost half of all cases were admitted to ICU and 30 died. Most children were previously healthy: 40.3% had at least one underlying medical condition. Sixty-five different severe complications were reported; pneumonia was the most common, occurring in over half of all cases. Influenza A accounted for 68.6% hospitalizations; however, influenza B was more often associated with acute renal failure (P = 0.014), rhabdomyolysis (P = 0.019), myocarditis (P = 0.015), pericarditis (P = 0.013), and cardiomyopathy (P = 0.035). Children who died were more likely to be older (5–14 years), have underlying medical conditions, be admitted to ICU, and have encephalitis, acute renal failure, or myocarditis. Only 36.1% of all children reported received antiviral medications, and 8.5% were known to be vaccinated for seasonal influenza. Conclusions: Severe influenza complications cause morbidity and mortality in children, which may increase if coinfection with COVID-19 occurs in the 2020 season and beyond. Increased vaccination rates, even in healthy children, early diagnosis and timely antiviral treatment are needed to reduce severe complications and death.

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Australian Paediatric Surveillance Unit Annual Report 2018

Cited by 7 publications

References 14 publications

Rezidivierende Larynxpapillomatose

Rezidivierende Larynxpapillomatose

Severe Influenza-Associated Neurological Disease in Australian Children: Seasonal Population-Based Surveillance 2008–2018

Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children

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