Chakraborty, Rana

OBJECTIVES We aimed to characterize the frequency of major complications of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C) and adolescents present at 6 months after initial presentation. METHODS The Pediatric Research Immune Network on SARS-CoV-2 and MIS-C (PRISM) study was a prospective cohort at 20 US pediatric academic medical centers. Individuals aged younger than 21 years meeting any of the following were enrolled: SARS-CoV-2 detection within 7 days, Centers for Disease Control and Prevention (CDC) MIS-C criteria, or CDC MIS-C criteria except having involvement of 1 organ system. The study was designed to assess the proportion of children with major complications (cardiovascular, pulmonary, gastrointestinal/hepatic, renal, and/or neurologic) 6 months after presentation. RESULTS Data were analyzed on 229 hospitalized participants: 59 with COVID-19 (mean age 10.4 years; SD, 5.5) and 170 with MIS-C (mean age 10.1 years; SD, 4.8). Overall, 42.8% were female, making up 55.9% and 38.2% of the COVID-19 and MIS-C groups, respectively. Overall, the frequencies of major complications at 6 months after initial presentation were: 16/195 (8.2%) cardiovascular, 11/154 (7.1%) pulmonary, 11/154 (7.1%) gastrointestinal/hepatic, 3/152 (2.0%) renal, and 3/189 (1.6%) neurologic. Organ system complications did not differ significantly between the COVID-19 and MIS-C groups. Six of 14 (42.9%) COVID-19 and 21/26 (80.7%) MIS-C participants with at least 1 six-month complication had no underlying medical condition that may have been associated with their complication(s). CONCLUSIONS Major complications were infrequent but observed in children without underlying medical conditions, underscoring the importance of prospective follow-up to optimize management and elucidate the complications associated with severe SARS-CoV-2 infection in children.

Withdrawal Statement The authors have withdrawn the manuscript because the data it contained has been updated. Consequently, they request that this work should not be cited as a reference for any projects to ensure the use of the most current information. For any questions or further clarifications, readers are encouraged to contact the corresponding author directly

Abstract Infectious diseases (ID) research is vital for global public health, typically led by physician-scientists. This Perspective addresses challenges in the ID workforce and suggests solutions. Physician-scientists have made key discoveries that have significantly impacted human health. The importance of ID research in understanding diseases, leading to treatments and vaccines, is emphasized, along with the need to address persistent and new infections, antimicrobial resistance, and threats like HIV and influenza. The paper analyzes the physician-scientist workforce's struggles, including funding, training, and research-practice integration gaps. We suggest increased funding, better training, and mentorship, more collaborative and interdisciplinary research, and improved recognition systems. The article stresses the urgency of supporting physician-scientists in ID, advocating for proactive prevention and preparedness, and calls for immediate action to enhance ID research and care.

Abstract Background The worldwide prevalence of cytomegalovirus (CMV) infection is estimated to be 83-100%.1,2 In pregnancy, transmission to the fetus can occur through the placenta with 0.4-2.3% of all newborns affected.3 The phenotype of congenital CMV (cCMV) has a spectrum of severity; 10-20% of exposed neonates show severe clinical manifestations.4 CMV has a wide range of tropism and can infect epithelial, myeloid, and endothelial cells. However, the cellular mechanisms of cCMV infection, and how they influence disease severity in exposed fetuses during gestation are not fully outlined,5 Here, we used the NanoString™ Digital Spatial Profiler (DSP) to characterize the cell-specific proteomic profile in placental tissue from infants with cCMV. Methods Placental tissue from 5 CMV-affected and 4 CMV-unaffected pregnancies were retrieved from the Mayo Clinic tissue repository. Immune cells were identified by CD45 positivity and cytotrophoblasts (CTBs) identified by CK7. The cell-specific proteome of these tissues was identified using the NanoString™ immune cell and cell death panels. Data was analyzed by NanoString™ GeoMx technology. Results Unsupervised clustering illustrated a distinct proteome in the immune cell compartment of CMV-positive compared to CMV-negative placental tissue (Figure 1). Linear Mixed Model (LMM) analysis revealed that immune cell related proteins were significantly overexpressed in CMV+ tissue as were four proteins associated with cell death: BIM, BCLXL, PARP, neurofibromin (Figure 2). Clustering did not demonstrate a distinct proteome in the CTB compartment (Figure 3), but LMM showed that two immune markers (CD44 and HLA-DR) and a cell death protein (BCL6) were overexpressed by CTBs in CMV+ tissue (Figure 4). The proteome of immune cells, and to a lesser extent in CTBs in CMV-infected placentae differs from CMV-uninfected placentae with overexpression of proteins associated with immune activation and cell death. With new screening initiatives set to improve identification of cCMV, our results provide a starting point to identify specific biomarkers and immune pathways associated with disease severity. These biomarkers and pathways may serve as novel antiviral targets in the treatment and management of cCMV. The proteome of immune cells, and to a lesser extent in CTBs in CMV-infected placentae differs from CMV-uninfected placentae with overexpression of proteins associated with immune activation and cell death. With new screening initiatives set to improve identification of cCMV, our results provide a starting point to identify specific biomarkers and immune pathways associated with disease severity. These biomarkers and pathways may serve as novel antiviral targets in the treatment and management of cCMV. Fig 3 - The proteome of immune cells, and to a lesser extent in CTBs in CMV-infected placentae differs from CMV-uninfected placentae with overexpression of proteins associated with immune activation and cell death. With new screening initiatives set to improve identification of cCMV, our results provide a starting point to identify specific biomarkers and immune pathways associated with disease severity. These biomarkers and pathways may serve as novel antiviral targets in the treatment and management of cCMV. Fig 4 - Volcano plot illustrating the differential proteomic expression in CK7+ tissue compartment of CMV-positive placental tissue compared to CMV-negative placental tissue. Conclusion The proteome of immune cells, and to a lesser extent in CTBs in CMV-infected placentae differs from CMV-uninfected placentae with overexpression of proteins associated with immune activation and cell death. With new screening initiatives set to improve identification of cCMV, our results provide a starting point to identify specific biomarkers and immune pathways associated with disease severity. These biomarkers and pathways may serve as novel antiviral targets in the treatment and management of cCMV. Disclosures Mark R. Schleiss, MD, Moderna Vaccines: Grant Support to my Division but no personal honoraria

Abstract Background Routine childhood immunization against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts.Case Presentation A 16-year-old female with Hodgkin’s lymphoma developed a tender vesicular rash shortly after completing chemotherapy. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalization, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series against varicella in 2008 and 2012, 11 years before her diagnosis of Hodgkin’s lymphoma. The patient was treated with parenteral acyclovir upon hospitalization and was monitored clinically for cutaneous disease progression as well as sequelae. After 8 days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted over. No serious sequelae of disease such as pneumonitis, hepatitis, encephalitis, or meningitis occurred, and she made a complete recovery.Conclusions There are individual and community-wide benefits to childhood immunization against varicella. This case highlights an unusual presentation of disseminated vaccine-strain varicella-zoster virus in an adolescent with secondary immunodeficiency 11 years after completing primary immunization. In addition, this case informs pediatricians of complications that can arise in immunized subjects if they become immunosuppressed years later. Providers should be cognizant of potential vaccine virus reactivation in their differential. Considerations for work-up and management should include infection control and viral resistance in refractory cases.

Abstract Despite intensive characterization of immune responses after COVID-19 infection and vaccination, research examining protective correlates of vertical transmission in pregnancy are limited. Herein, we profiled humoral and cellular characteristics in pregnant women infected or vaccinated at different trimesters and in their corresponding newborns. We noted a significant correlation between spike S1–specific IgG antibody and its RBD-ACE2 blocking activity (receptor-binding domain–human angiotensin-converting enzyme 2) in maternal and cord plasma (P < .001, R > 0.90). Blocking activity of spike S1–specific IgG was significantly higher in pregnant women infected during the third trimester than the first and second trimesters. Elevated levels of 28 cytokines/chemokines, mainly proinflammatory, were noted in maternal plasma with infection at delivery, while cord plasma with maternal infection 2 weeks before delivery exhibited the emergence of anti-inflammatory cytokines. Our data support vertical transmission of protective SARS-CoV-2–specific antibodies. This vertical antibody transmission and the presence of anti-inflammatory cytokines in cord blood may offset adverse outcomes of inflammation in exposed newborns.

In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.

AbstractObjectiveFetal surgery has improved neonatal outcomes; however, it is unknown if the intervention contributes to the developmental of inflammatory pathologies in the placenta. Here, an association between fetal surgery and placental pathology was examined.MethodThis case‐control study compared pregnancies with fetal surgery (n = 22), pregnancies with an indication for fetal surgery but without an intervention being done (n = 13), and gestational‐age and fetus‐number matched controls (n = 36). Data on maternal, infant, and placental outcomes were abstracted. Additionally, immunohistochemistry identified expression of lymphoid and myeloid cells in the placenta on a subset of cases. Comparisons were performed using Kruskal‐Wallis or Pearson's chi‐squared tests.ResultsMaternal characteristics were comparable between groups. Most fetal interventions were for diaphragmatic hernia, spina bifida, or twin‐to‐twin transfusion syndrome. Fetuses who were operated on before birth were more likely to be born preterm (p = 0.02). There was no increase in the rate of observed placental pathologies or immune cell infiltration in fetal surgery cases compared to controls.ConclusionThe data suggest that fetal surgery is not associated with increased inflammatory or morphologic pathology in the placenta. This observation supports the growing field of fetal surgery.