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Immunology (primary Immunodeficiency Syndromes
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Stephan Strobel, Alison M. Jones
Antibiotics: for mild antibody deficiencies antibiotic prophylaxis (or early recourse to antibiotics) can be highly effective. Azithromycin is a frequent first choice. Early treatment of breakthrough infection, guided by microbiology where possible.
Understanding and Diagnosing Herpes Simplex Virus
Published in Marie Studahl, Paola Cinque, Tomas Bergström, Herpes Simplex Viruses, 2017
Genital herpes is most commonly caused by HSV-2, but may also be caused by HSV-1 (181). Genital herpes is a public health problem for several reasons, including psychosocial suffering, morbidity associated with each recurrence, and transmission of virus from mother to baby, and genital HSV is an identified risk factor for the transmission of HIV (182). The prevalence of genital HSV in the general population has likely been underestimated because of the lack of reliable diagnostic tests. Recent large seroepidemiological studies have illustrated that genital herpes is largely a subclinical disease and that spread can occur inadvertently through asymptomatic shedding (138). Recent debate has suggested that validated type-specific serology could help in curbing this outbreak and access to the new rapid, type-specific serological assays may further bring this issue to public attention (36). Increased awareness may help in both efficient management of patients and infection control. Now a gold standard in the diagnosis of neurological HSV disease, PCR may soon play an important role in the management of genital HSV disease, in being able to identify subclinical shedding and breakthrough infection. The use of a multiplex PCR assay to screen for several venereal diseases simultaneously, may alter the way these patients are managed and will alleviate the need for expensive, less sensitive, and slower culture techniques, and ultimately reduce cost (3).
Viral Infections in HIV Disease
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Wei Su, Cindy Berthelot, Clay J. Cockerell
VZV vaccine should not be administered to persons who have primary or acquired immunodeficiency except for HIV-seropositive children with no or mild clinical disease.55 Children with HIV should be followed up closely after VZV vaccination because they have an increased risk of breakthrough infection.
Tixagevimab/cilgavimab for prevention and treatment of COVID-19: a review
Published in Expert Review of Anti-infective Therapy, 2022
Regardless of dose utilized, undosed control groups had higher rates of breakthrough infections, hospitalizations, and deaths versus groups who received tixagevimab/cilgavimab, which were statistically significant in most instances [27–29,33,36]. Seven studies reported death rates, which were lower in the tixagevimab/cilgavimab group (0.3% to 0.5%) compared with control groups (0.9% to 8.3%) [26–30,33,36]. In the nine studies that reported hospitalization rates, rates were lower for tixagevimab/cilgavimab recipients versus control (ranging from 0.1% to 3.4% versus 0.5% to 11.3%) [26,27,29,30,33,35,36,39]. One study in immunocompromised individuals found reduced rates of a composite of COVID-19 infection, COVID-19 hospitalization, and all-cause mortality with tixagevimab/cilgavimab versus the control group [33]. Rates of breakthrough infection–loosely defined across the studies as a COVID-19 infection that occurred after dosing with tixagevimab/cilgavimab regardless of severity, and which could be symptomatic or asymptomatic–ranged from 1.2% to 11.1% following the 150 mg/150 mg dosing regimen [27,30–32,35–37]. Overall, lower rates of COVID-19 (all ≤1.8%) were observed in studies where individuals received a higher dose (predominantly 300 mg/300 mg) of tixagevimab/cilgavimab [29,33,34]. The highest rate of breakthrough infection was 13.8%, but the dosing regimen was not reported in that study [39].
Monoclonal antibodies for the treatment of COVID-19 infection in children
Published in Expert Review of Anti-infective Therapy, 2022
Vaccines are still the most effective strategy to stop and prevent the spread of COVID-19. However, in cases where vaccines are unable to prevent breakthrough infection, more treatments are needed. MAbs are an emerging therapy for COVID-19, however we have limited evidence for their safety and efficacy in children, and many have waning efficacy in the face of new variants. Small molecule antiviral therapies are another potential treatment for COVID-19 in children in an outpatient setting, though neither mAb nor small molecule antiviral treatments have significant supporting evidence in children. In rare circumstances, such as profound immunodeficiency, mAb treatments may still have an important role in treating children infected with SARS-CoV-2, though developing a strong evidence base for these decisions will be challenging if not impractical. Ultimately, these decisions are likely to be made at the level of individual cases using expert opinion as the primary guiding principle.
Willingness to receive a booster dose of inactivated coronavirus disease 2019 vaccine in Taizhou, China
Published in Expert Review of Vaccines, 2022
Tao-Hsin Tung, Xiao-Qing Lin, Yan Chen, Mei-Xian Zhang, Jian-Sheng Zhu
The coronavirus disease 2019 (COVID-19) pandemic has lasted for nearly two years, and vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been available for one year; nevertheless, the global pandemic continues [1]. The outbreak occurred all over the world, and there have been several resurgent outbreaks in China [2]. Recently, it has been reported that some fully vaccinated individuals can still experience infection with SARS-CoV-2, or be hospitalized for or even die of COVID-19 [3]. A breakthrough infection is defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from an individual ≥14 days after completion of all recommended doses of licensed COVID-19 vaccine(s) [4]. This brings new challenges to regular prevention and control of the epidemic situation. The COVID-19 pandemic remains dangerous and, as such, needs to be taken seriously.