To investigate the trend and spatial distribution of pediatric second-dose COVID-19 vaccination coverage among children aged 5 to 11 years in Brazil, in 2022 and 2023.

This was a time series analysis study using vaccination and target population data extracted from the Ministry of Health Vacinômetro platform. The second-dose coverage trend was estimated by joinpoint regression (segmented regression), while spatial distribution was analyzed using choropleth maps to identify regional variations between the Brazilian states.

Average monthly percentage change (AMPC) in vaccination coverage in Brazil as a whole remained stable during the period (AMPC -8.30%), with significant geographical heterogeneity. The Northern region (AMPC 5.76%) had a rising trend, in particular in the states of Acre (AMPC 23.42%) and Amazonas (AMPC 18.26%). Falling trends were observed in the Southeast region (AMPC -8.30%) as well as in specific states, such as Mato Grosso do Sul (AMPC -4.74%), Pará (AMPC -4.71%) and Rio de Janeiro (AMPC -4.27%). Fourteen states (51.9%) had a stable trend. The time series revealed initial increase in 2022, followed by deceleration and stabilization in 2023.

A significant and uneven variation in pediatric second-dose COVID-19 vaccination coverage was observed between 2022 and 2023. The results highlight the urgent need for targeted strategies to increase vaccination adherence, especially in areas with lower coverage.

This study aimed to analyze vaccination coverage temporal and spatial heterogeneities in the basic children schedule in the Brazilian Unified National Health System (SUS) in state capitals and macroregions from 2010 to 2021 by a new monitoring indicator. This is an ecological study at the level of Brazilian capitals and year of registration of doses. An indicator based on the ratio between applied doses and the minimum expected number of doses (i.e., the recommended vaccination coverage in the complete basic vaccination schedule for children: BCG, hepatitis A and B, meningococcal conjugate C and its booster, pentavalent, pneumococcal 10-valent and its booster, poliomyelitis and its booster, human rotavirus, triple bacterial, and the first and second triple viral doses) was proposed. Dose ratios were temporally and spatially analyzed by generalized additive and conditional autoregressive models. This study found a significant drop in vaccination coverage for all immunobiologicals from 2015 onward. The coverage of most vaccines remained below the minimum targets of the Brazilian Ministry of Health. This study also observed differences in reduction magnitude (greater in Northern and Northeastern capitals in recent years, particularly during the COVID-19 pandemic). The proposed indicator facilitated statistical treatment, using only an information system and the recommended goals and making it possible to assess significant vaccination drops over time, with differences between capitals and macroregions. This study found priority regions for Brazilian National Immunization Program actions, such as intensifying and diversifying immunization campaigns to achieve the past high vaccination coverage.

During the COVID-19 pandemic, some patients experienced difficulty attending regular in-hospital cardiac rehabilitation (CR) after discharge. This study investigated the impact of CR in older patients with cardiovascular disease (CVD) by comparing outcomes before, during, and after the COVID-19 pandemic.

In this post hoc analysis of a single-center registry, 505 patients aged ≥ 65 years (mean age 82) were included. Outcomes were compared between participants in a 4-month outpatient CR program after discharge and non-participants. Patients were categorized into three periods: before the COVID-19 pandemic (n = 173), during the COVID-19 pandemic (n = 217), and after the COVID-19 pandemic (n = 105). Cardiovascular (CV) events and non-CV events were followed.

As the primary endpoint, cumulative hospitalization for worsening HF was significantly lower in the CR group across all time periods (p < 0.001, p < 0.001, and p = 0.019, respectively). Cumulative non-CV event-free survival was significantly higher in the CR group before and after the COVID-19 pandemic (p < 0.001, p = 0.030, respectively) but showed no significant differences during the pandemic. Before the pandemic, participation in CR was significantly associated with hospitalization for worsening HF (hazard ratio [HR], 0.538; 95% confidence interval [CI], 0.294-0.982; p = 0.043). During and after the pandemic, this association was not.

CR appears to have a protective effect against CV events in older patients with CVD. Although the COVID-19 pandemic disrupted this positive trend, the findings support CR as a cornerstone of recovery in this population.

A key feature of asthma is hypoxia, which triggers erythropoietin (EPO) production to stimulate erythropoiesis and compensate for oxygen deficits. This study investigates the impact of asthma controller medications on erythropoietic response by evaluating serum EPO levels and reticulocyte counts among asthma patients at Murtala Muhammad Specialist Hospital, Kano.

This study is a comparative cross-sectional study involving 180 participants, comprising 60 asthmatics on controller medications, 60 treatment-naive patients with asthma, and 60 apparently healthy controls. Serum EPO levels were determined by ELISA, while complete blood count (CBC) and reticulocyte count were determined by automated hematology analyzer and manual method, respectively.

The study revealed significant differences in EPO levels (p = 0.00001), reticulocyte counts (p = 0.0004), and hematological parameters (p = 0.009) among the three groups. Treatment-naive asthmatics exhibited elevated reticulocyte counts (2.50 (IQR: 3.50)) and EPO levels (38.88 mIU/mL (IQR: 25.6 mIU/mL)), suggesting enhanced erythropoiesis in response to hypoxia. In contrast, asthmatics on controller medications showed a negative correlation (ϱ = - 0.564) between EPO levels and reticulocyte counts, indicating a potential suppressive effect of corticosteroids on erythropoiesis.

Asthma is associated with increased erythropoietin production; it is however suppressed by inhaled corticosteroid therapy.

The Military Health System offers geographically distributed SARS-CoV-2 incidence estimates to support critical national pandemic surveillance, but this has not been previously assessed. The objective was to identify confirmed, probable, and possible SARS-CoV-2 infections with laboratory and clinical evidence and compare cumulative incidence to the general United States population.

An observational, retrospective epidemiologic study using medical records from the United States Military Health System (inclusive of active duty) collected from outpatient and inpatient facilities worldwide, both United States Military and non-military treatment facilities. Direct standardization to the general US population was used to calculate sex-adjusted cumulative incidence, stratified by age, for 10 Health and Human Services regions for active duty and non-active duty beneficiary populations, with Spearman's rho correlations for age and region strata.

Among Military Health System beneficiaries, 2,219,987 cases were identified, with 27.4% laboratory-confirmed cases alongside 35.0% probable and 37.6% possible cases identified using clinical ICD-10-CM evidence. Peaks in cases occurred November 2020-January 2021, August 2021-September 2021, and January 2022. Age-stratified and sex-adjusted cumulative incidence across 10 geographical regions reflected these temporal patterns among both active duty (90% of age and region-specific correlation coefficients >0.7) and non-active duty beneficiaries (80% of age and region-specific correlation coefficients >0.7). Cumulative incidence was higher among active duty beneficiaries compared to the United States general population, particularly those ages 18-49 years, with adjusted cumulative incidence ratios consistently greater than 1. The cumulative incidence ratios for non-active duty beneficiaries were more consistent and closer to 1. The sensitivity analysis of laboratory-confirmed cases among active duty personnel demonstrated consistently lower adjusted cumulative incidence than United States general population.

Temporal patterns in cases among Military Health System beneficiaries reflect cases measured nationally by the Centers for Disease Control and Prevention. Applying a comprehensive algorithm of clinical and laboratory data from a large electronic health system, such as the Military Health System, may improve case capture during an emergent epidemic providing incidence estimates and regional impact in support of U. S. national surveillance.

SARS-CoV-2 remains globally circulating, yet post-pandemic comprehensive molecular, serological, and population-level immunity data from low-resource settings such as Ethiopia are limited. This study employed genomic surveillance with seroepidemiological assessment to characterize the epidemiology of SARS-CoV-2 among individuals presenting with influenza-like illness (ILI) and severe acute respiratory infection (SARI) between May 2023 and April 2024 across 21 influenza sentinel surveillance sites representing diverse regions of Ethiopia.

Respiratory swabs from 8,881 ILI/SARI patients were tested for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR). Whole-genome sequencing was performed on samples with cycle threshold (Ct) values ≤ 30 using Oxford Nanopore Technology, and serological testing was performed on blood samples collected from participants aged ≥12 years using the WANTAI enzyme-linked immunosorbent assay (ELISA) targeting the spike receptor-binding domain (RBD).

Among 8,881 participants, the overall SARS-CoV-2 detection rate was 3.3 (95% CI: 2.9-3.6). Compared to children under 2 years, older age groups had significantly higher odds of infection: 15-49 years (AOR: 1.60; 95% CI: 1.16-2.21), 50-64 years (AOR: 2.15; 95% CI: 1.31-3.54), and ≥65 years (AOR: 2.37; 95% CI: 1.42-3.95). ILI cases demonstrated higher positivity than SARI cases (AOR: 2.26; 95% CI: 1.75-2.91). SARS-CoV-2 was detected across all seasons, with positivity rates ranging from 1.9% in spring to 6.0% in summer. Whole-genome sequencing of (n = 80) revealed exclusive circulation of Omicron lineages, identifying 19 Omicron sub-lineages, predominantly JN.1.18 (31.3%), JN.1 (8.8%), XBB.1.28 (8.8%), BA.2.86 (7.5%), and XBB.1.34.1 (6.3%). Serological analysis of 690 samples demonstrated 96.8% (95% CI: 95.2-98.0%) seropositivity, with no significant demographic variation.

This study demonstrates the continued circulation of SARS-CoV-2 in Ethiopia, primarily among adults with influenza-like illness, with distinct seasonal peaks during the summer. The Omicron variant remained dominant, with JN.1 and its descendants prevailing since late 2023 in parallel with a national rise in COVID-19 cases. These findings reinforce that ongoing genomic and syndromic surveillance utilizing established ILI/SARI platforms remain vital for monitoring viral evolution and guiding targeted public health interventions in low-resource settings.

Acute bronchiolitis is a frequent cause of hospitalization in early childhood and has been associated with subsequent respiratory morbidity. However, its long-term impact on mental health has not been extensively studied.

This population-based cohort study used data from the National Health Insurance Service (NHIS) in South Korea, including 985,957 children born between 2002 and 2003, followed until December 2021. Children hospitalized for acute bronchiolitis (n = 25,550) were compared to a matched unexposed cohort (n = 102,220). The primary outcomes were 24 predefined mental health disorders, categorized into early-onset (before 10 years) and late-onset (after 10 years) conditions. Hazard ratios (HRs) were estimated using proportional hazards models, adjusting for potential confounders. The modifying effects of asthma and atopic dermatitis were also evaluated.

The median age at hospitalization for bronchiolitis was 8 months (IQR, 3-20 months). Over a mean follow-up of 15 years, the incidence rate of any mental health disorder was 187.9 and 153.9 per 10,000 person-years in the bronchiolitis and unexposed cohorts, respectively. The adjusted hazard ratio (aHR) for any mental health disorder in the bronchiolitis cohort was 1.20 (95% CI, 1.16-1.23). Early-onset developmental disorders showed aHR of 1.34 (95% CI, 1.26-1.43), and late-onset psychiatric disorders had aHR of 1.18 (95% CI, 1.15-1.22). There was a progressive increase in risk for multiple mental health disorders (p < 0.01). Asthma (p = 0.77) and atopic dermatitis (p = 0.48) did not significantly modify this risk.

Children hospitalized for acute bronchiolitis showed an increased risk of developing mental health disorders. These findings provide epidemiologic evidence supporting the need for long-term mental health surveillance and supportive care in this population.

To determine whether the joint use of the Pediatric Comorbidity Index (PCI) and the Pediatric Complex Chronic Condition classification version 3 (PCCC) improves prediction of severe outcomes and resource use among children hospitalized with respiratory tract infections.

Retrospective nationwide cohort study.

Acute care hospitals contributing to the nationwide claims database.

All children < 15 years admitted to acute care hospitals due to respiratory tract infection between April 2018 and March 2024 (N = 275,296).

Generalized linear models estimated associations of PCI and PCCC scores with severe outcomes-mechanical ventilation, intensive-care admission, or in-hospital death-plus length of stay and total costs. Interactions were assessed on additive and multiplicative scales. Stratification by PCI and PCCC scores revealed that the risks of severe conditions increased from 3.7% at PCI 0% to 8.6% at PCI 4 for children with a PCCC score of 0 and from 11.3% to 38.5% among children with a PCCC score of 1. Among those with PCCC ≥ 2, the risk was high at PCI 0 (52.6%) and did not increase monotonically across PCI strata (range 35.8%-52.6%). Interaction analyses revealed negative additive interactions (-27.1% to -58.5%) and sub-multiplicative interactions (multiplicative index 0.41-0.73), indicating that combined use of PCI and PCCC refines risk stratification beyond either measure alone.

Our findings suggest that combining the PCI and PCCC scores yields more precise risk stratification and may support more appropriate allocation of healthcare resources for children with varying levels of comorbidity.

Objective:To compare sleep architecture characteristics and the incidence of sleep subtypes in children with obstructive sleep apnea（OSA） across different weight categories. Methods:We retrospectively analyzed children who underwent polysomnographic monitoring in our hospital from January 1, 2017 to December 30, 2022, categorizing them as normal weight（Group A）, underweight（Group B）, overweight（Group C）, and obese（Group D）. We then compared differences in sleep structure, respiratory events, oxygenation indices, and sleep subtypes between these groups. Results:Statistical analysis revealed significant gender differences between Groups A and D, B and C, and B and D. Groups A and B exhibited higher percentages of REM sleep than Group D（P<0.05）. Respiratory indices, including OAHI, AHI, ODI, HI, and NREMAHI, were significantly elevated in Group D compared to the other groups（P<0.05）. REMAHI was lower in Groups A and C compared to Group D（P<0.05）. The minimum oxygen saturation, minimum oxygen saturation during NREM sleep, and minimum oxygen saturation during REM sleep were lower in Group D than in Group A（P<0.05）. The proportion of children with severe OSA was higher in Group D than in the other groups（P<0.05）. There was no significant difference in adenoid size distribution among the four groups. No significant difference was found in the incidence of R-OSA（REM-related OSA） among the four groups. The incidence of P-OSA（positional OSA） was higher in Group C than in Groups A and B（P<0.05） and higher in Group D than in Groups A and B（P<0.05）. Conclusion:The prevalence of P-OSA was higher among overweight and obese groups, with the obese group experiencing the highest rates of severe OSA, more frequent hypoxemia, and reduced REM sleep duration.

Cystic fibrosis (CF) is a life-shortening genetic disorder traditionally mischaracterised as affecting only populations of European descent. This framing has contributed to under-recognition of CF in African populations, despite emerging evidence of both common and region-specific cystic fibrosis transmembrane conductance regulator mutations across the continent. Diagnostic barriers, structural inequities and lack of surveillance further exacerbate disparities in care and visibility.

This scoping review aims to characterise CF in African populations by synthesising evidence on clinical presentation, diagnostic practices, genotypic diversity, prevalence and structural barriers to care. We will include case reports, cohort studies, registry analyses and other primary data sources involving individuals of African descent with suspected or confirmed CF. Key outcomes include clinical phenotype, age at diagnosis, mutation profile, diagnostic testing access and mortality. Data sources include Ovid Medline, Embase, Ebsco Global Health, CAB Abstracts and Web of Science Core Collection. Multiple-reviewer screening and extraction will be conducted. We will use narrative synthesis, thematic analysis and meta-analysis for prevalence where feasible.

No ethical approval is required as the review uses published data. Results will be shared with clinicians, researchers and CF networks in Africa and globally to inform diagnostic strategies and policy.