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Multiple Sclerosis (Houndmills,... Dec 2023Mumps-Measles-Rubella (MMR) and Varicella zoster vaccines (VAR) are live attenuated vaccines, usually administered in a two-dose scheme at least 4 weeks apart.... (Observational Study)
Observational Study
BACKGROUND
Mumps-Measles-Rubella (MMR) and Varicella zoster vaccines (VAR) are live attenuated vaccines, usually administered in a two-dose scheme at least 4 weeks apart. However, single-dose immunization schemes may also be effective and can reduce delays in immunosuppressive treatment initiation in patients with multiple sclerosis (pwMS) who need to be immunized.
OBJECTIVES
To evaluate the immunogenicity of a single-dose attempt (SDA) versus the standard immunization scheme (SIS) with VAR and/or MMR in pwMS.
METHODS
Retrospective observational study in pwMS vaccinated against VAR and/or MMR. We compared seroprotection rates and antibody geometric mean titers (GMTs) between the two strategies.
RESULTS
Ninety-six patients were included. Thirty-one patients received VAR and 67 MMR. In the SDA group, the seroprotection rate was 66.7% (95% confidence interval (CI): 53.3-78.3) versus 97.2% (95% CI: 85.5-99.9) in the SIS ( < 0.001). For the seroprotected patients, GMTs were similar for both schemes.
CONCLUSION
An SDA of VAR and/or MMR vaccines could be sufficient to protect almost two-thirds of patients. Testing immunogenicity after a single dose of VZ and/or MMR could be included in routine clinical practice to achieve rapid immunization.
Topics: Humans; Infant; Chickenpox Vaccine; Vaccines, Attenuated; Rubella; Multiple Sclerosis; Mumps; Measles; Vaccination; Antibodies, Viral
PubMed: 37728389
DOI: 10.1177/13524585231200303 -
Cureus Aug 2023Sjögren's syndrome is an autoimmune disease characterized by the destruction of exocrine glands. Clinically, this results in the loss of tear and saliva production....
Sjögren's syndrome is an autoimmune disease characterized by the destruction of exocrine glands. Clinically, this results in the loss of tear and saliva production. Although xerophthalmia and xerostomia, also known as sicca, is a common presentation among adults, paediatric patients more often present with recurrent parotitis and glandular enlargement. Overall, symptoms can vary, making initial diagnosis challenging. Approximately 80% of patients with Sjögren's syndrome experience parotid gland enlargement, however, salivary cysts are rare. Herein, we present a case of paediatric Sjögren's syndrome where a 12-year-old female presented with a two-month history of bilateral parotid masses. The patient denied any history of xerostomia, xerophthalmia, or constitutional symptoms. Imaging revealed bilateral complex cystic intraparotid masses. A right parotid gland biopsy was performed showing parotid gland parenchyma with dense lymphoplasmacytic infiltrate. Ultimately, the presumptive diagnosis of Sjögren's syndrome was made. This case illustrates the importance of a thorough workup to aid in diagnostic certainty. Parotid cysts associated with Sjögren's are rare but should be considered within the differential diagnosis for paediatric patients with parotid swelling/mass.
PubMed: 37674949
DOI: 10.7759/cureus.43033 -
Cureus Jul 2023Juvenile recurrent parotitis (JRP) is a rare recurrent non-obstructive inflammatory swelling of the parotid gland occurring most commonly in children aged three to six...
Juvenile recurrent parotitis (JRP) is a rare recurrent non-obstructive inflammatory swelling of the parotid gland occurring most commonly in children aged three to six years. JRP is usually idiopathic and presents as a painful swelling recurring on either side of the face at least twice within six months. We report the case of an eight-year-old Saudi boy with a painful acute right-sided parotid swelling and a history of similar occurrences bilaterally at least four times a year for two years. The routine laboratory investigations were unremarkable. Ultrasonography of the parotid glands suggested parotitis with cervical lymphadenopathy. He was treated conservatively and remained asymptomatic for a year. Although rare, an accurate diagnosis of JRP is possible with adequate history, physical examination, and lab investigations, supplemented with radiographic findings.
PubMed: 37644943
DOI: 10.7759/cureus.42632 -
Expert Review of Vaccines 2023Studies on quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines have indicated a twofold increased relative risk of febrile convulsion (FC) after the... (Review)
Review
INTRODUCTION
Studies on quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines have indicated a twofold increased relative risk of febrile convulsion (FC) after the first dose compared to MMR and V administered at the same medical visit (MMR+V).
AREAS COVERED
This narrative review contextualizes FC occurrence after the first MMRV vaccine dose from a clinical perspective and outlines approaches to attenuate FC occurrence post-vaccination.
EXPERT OPINION
While the relative FC risk increases after the first dose of MMRV compared to MMR+V vaccine in measles-naïve infants, the attributable risk is low the overall FC risk in the pediatric population triggered by other causes, like natural exposure to pathogens or routine vaccination. No increased risk of FC has been reported after MMRV co-administration with other routine vaccines compared to MMRV alone. Based on our findings and considering the MMRV vaccination benefits (fewer injections, higher coverage, better vaccination compliance), the overall benefit-risk profile of MMRV vaccine is considered to remain positive. Potential occurrence of FC in predisposed children (e.g. with personal/family history of FC) may be attenuated if they receive MMR+V instead of MMRV as the first dose. It is also important to monitor vaccinees for fever during the first 2 weeks post-vaccination.
Topics: Child; Humans; Infant; Chickenpox; Chickenpox Vaccine; Herpesvirus 3, Human; Measles; Measles-Mumps-Rubella Vaccine; Mumps; Risk Assessment; Rubella; Seizures, Febrile; Vaccines, Attenuated; Vaccines, Combined; Viral Vaccines
PubMed: 37642012
DOI: 10.1080/14760584.2023.2252065 -
Cureus Jul 2023Sjogren's syndrome (SS) is an autoimmune disorder characterized by the destruction of exocrine glands by lymphocytic infiltration. Children and teenagers are less...
Sjogren's syndrome (SS) is an autoimmune disorder characterized by the destruction of exocrine glands by lymphocytic infiltration. Children and teenagers are less commonly affected. The initial symptoms of SS in teenagers might vary, depending on whether parotitis or other systemic organ involvement is present. Glandular involvement with the clinical hallmarks of dry eyes and dry mouth is common. Our case report is about a young woman who was admitted with acute flaccid paralysis and severe respiratory distress with extremely low serum potassium; further investigation revealed distal renal tubular acidosis. The patient was ultimately diagnosed with primary SS with high levels of SS-a/SS-b antibodies and a positive Schirmer's test. Our case demonstrates that hypokalemic paralysis can be a manifestation of SS, even though it is a rare cause.
PubMed: 37637659
DOI: 10.7759/cureus.42604 -
Journal of Otolaryngology - Head & Neck... Aug 2023Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling in children. The purpose of this systematic review was to determine... (Review)
Review
BACKGROUND
Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling in children. The purpose of this systematic review was to determine the diagnostic and therapeutic effectiveness of sialendoscopy in children affected by JRP.
METHODS
A systematic literature search was performed in PubMed, EMBASE, Scopus and the Cochrane Library until April 2022, without language restrictions or specified start date. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS).
RESULTS
Our review included 524 patients and 646 sialendoscopies. The sample sizes of the different studies ranged from 3 to 77 subjects. Most authors performed sialendoscopy under general anesthesia. The mean percentage of recurrences observed was 25.1% (95% confidence intervals) (CI 23.6-26.6). There was a statistically significant relationship between the number of attacks/year and recurrences (p < 0.05). The percentage of recurrences according to the type of irrigation/flushing used ranged from 22.2% to 25.2%, with no significant differences between the use of corticosteroids alone (25.2% of recurrences), corticosteroids plus antibiotics (25% of recurrences) or saline alone (22.2% of recurrences). Sialoendoscopy has proved in all cases to be a valid method for the diagnosis of JRP, but it does not allow a reliable differential diagnosis with other autoimmune parotitis such as Sjögren's syndrome.
CONCLUSION
According to our results, parotid sialoendoscopy was 74.9% effective as a primary treatment in the prevention of recurrent symptoms in JRP. The type of ductal irrigation used did not significantly influence the prognostic outcome.
Topics: Child; Humans; Parotitis; Parotid Gland; Anesthesia, General; Recurrence
PubMed: 37598195
DOI: 10.1186/s40463-023-00658-1 -
Pediatric Rheumatology Online Journal Aug 2023Childhood Sjögren's Disease (cSjD) is an underdiagnosed phenomenon with clinical and pathophysiological nuances in contrast to Sjögren's Disease (SjD) in the adult...
BACKGROUND
Childhood Sjögren's Disease (cSjD) is an underdiagnosed phenomenon with clinical and pathophysiological nuances in contrast to Sjögren's Disease (SjD) in the adult population. While adults typically experience sicca symptoms, children with cSjD often present with recurrent parotitis, diverse autoantibody profiles, and renal and neurological manifestations. Diagnosis and classification in pediatric rheumatology remain controversial due to the reliance on adult-focused diagnostic criteria and the lack of standardized treatment and understanding of outcomes. The purpose of the paper is to propose a multimodal treatment plan and demonstrate the effectiveness of sialendoscopy in the management of cSjD.
CASE PRESENTATION
We present the case of a twelve-year-old female diagnosed with cSjD using the 2016 American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) diagnostic criteria for SjD. In addition to medical management, she underwent sialendoscopy with triamcinolone irrigation under sedation and was monitored for progress via salivary gland ultrasonography (SGUS). Over the course of one year, she demonstrated significant improvement in symptoms, with serial SGUS scores gradually decreasing by five points.
CONCLUSIONS
This paper proposes a multimodal treatment plan involving sialendoscopy and medical management as a non-invasive and potentially more effective approach for cSjD. Standardized monitoring through SGUS scoring allows objective and quantifiable measurement of treatment progress, enabling better assessment of glandular tissue status. Recurrence is possible, and each cSjD patient may present differently. Nevertheless, our year-long observation of a patient with cSjD demonstrates that sialendoscopy, as seen in adults, can promote remission of recurrent parotitis in children as well.
Topics: Adult; Female; Child; Humans; Parotitis; Salivary Glands; Sjogren's Syndrome; Ultrasonography; Rheumatology; Chronic Disease
PubMed: 37574559
DOI: 10.1186/s12969-023-00870-3 -
Vaccine Sep 2023Vaccine surveillance for children in England focuses on coverage at ages 1, 2, and 5 years. Previous studies exploring vaccine timeliness have used different arbitrary...
INTRODUCTION
Vaccine surveillance for children in England focuses on coverage at ages 1, 2, and 5 years. Previous studies exploring vaccine timeliness have used different arbitrary categories to define whether vaccines were received 'late' or 'on time'. This paper aims to provide more detailed and holistic information on timing and patterns of vaccine uptake across the childhood immunisation schedule in England.
METHODS
We included all children born in England between 2006 and 2014 and registered in the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record. We described vaccine uptake for representative antigens (pertussis, pneumococcus, measles) by age in days and stratified by ethnicity, region and birth cohort. Alluvial diagrams were used to illustrate common journeys through the vaccination schedule, and we applied survival analysis using accelerated failure time models (AFT) to predict age of vaccine receipt based on timing of previous doses.
RESULTS
573,015 children were followed up until their fifth birthday, when they had 90.16 % coverage for two doses of measles, mumps, rubella (MMR) vaccine and 88.78% coverage for four doses of diphtheria, tetanus, pertussis (DTP) vaccine. Overall, the later the age at which a vaccine was due, the more delay in vaccination. Children of Black Ethnicity or from London showed deviating uptake patterns. If a child received their third DTP dose more than a year later than recommended, they would receive the next dose 2.7 times later than a child who was vaccinated on time. A smaller delay was found for children who did not receive first MMR dose on time.
DISCUSSION
We showed that the risk of vaccination delay increased with the age of the child and significant delay of previous doses. Primary care data can help to promptly identify children at higher risk of delayed vaccination.
Topics: Child; Humans; Infant; Measles-Mumps-Rubella Vaccine; Cohort Studies; Whooping Cough; Vaccination; Immunization Schedule; Measles; Mumps; Diphtheria-Tetanus-Pertussis Vaccine
PubMed: 37574342
DOI: 10.1016/j.vaccine.2023.08.002 -
Vaccine Aug 2023Vaccines, especially live attenuated vaccines, in children with JIA pose a great challenge due to both potential lower immunogenicity and safety as a result of...
INTRODUCTION
Vaccines, especially live attenuated vaccines, in children with JIA pose a great challenge due to both potential lower immunogenicity and safety as a result of immunosuppressive treatment. For many years, in the Netherlands, JIA patients receive a measles-mumps-rubella (MMR) booster vaccine at the age of nine years as part of the national immunization program.
OBJECTIVES
To study long-term humoral immunoprotection in a large cohort of JIA patients who received the MMR booster vaccine while being treated with immunomodulatory therapies at the Wilhelmina Children's Hospital in Utrecht, the Netherlands.
METHODS
MMR-specific IgG antibody concentrations in stored serum samples of vaccinated JIA patients were determined with chemiluminescent microparticle immunoassays (CMIA). Samples were analyzed five years after MMR booster vaccination and at last available follow-up visit using both crude and adjusted analyses. Additional clinical data were collected from electronic medical records.
RESULTS
In total, 236 samples from 182 patients were analyzed, including 67 samples that were available five years post-vaccination, and an additional 169 samples available from last visits with a median duration after vaccination of 6.9 years (IQR: 2.8-8.8). Twenty-eight patients were using biologic disease-modifying antirheumatic drugs (bDMARDS) of whom 96% anti-TNF agents and 4% tocilizumab. Percentages of protective antibody levels against measles after five years were significantly lower for patients who used bDMARD therapy at vaccination compared to patients who did not: 60% versus 86% (P = 0.03). For mumps (80% versus 94%) and rubella (60% versus 83%) this difference did not reach statistical significance (P = 0.11 and P = 0.07, respectively). Antibody levels post-vaccination decreased over time, albeit not significantly different between bDMARD users and non-bDMARD users.
CONCLUSION
The MMR booster vaccine demonstrated long-term immunogenicity in the majority of children with JIA from a large cohort, although lower percentages of protective measles antibody levels were observed in bDMARD users. Hence, it might be indicated to measure antibody levels at least five years after MMR booster vaccination in the latter group and advice an extra booster accordingly.
Topics: Humans; Child; Infant; Mumps; Arthritis, Juvenile; Tumor Necrosis Factor Inhibitors; Rubella; Measles; Vaccination; Measles-Mumps-Rubella Vaccine; Antibodies, Viral
PubMed: 37516575
DOI: 10.1016/j.vaccine.2023.07.052 -
Ear, Nose, & Throat Journal Jul 2023We report a case of a healthy 62-year-old male with no identifiable risk factors who presented with a 2-week history of progressive unilateral parotid gland enlargement...
We report a case of a healthy 62-year-old male with no identifiable risk factors who presented with a 2-week history of progressive unilateral parotid gland enlargement and tenderness followed by subsequent otorrhea. A computed tomography scan and ultrasound confirmed a markedly enlarged posterior aspect of the parotid gland with the evidence of necrosis. The culture of aspirated fluid grew . Purulent fluid was then noted draining from the external auditory canal, via the fissure of Santorini. The patient was treated with antibiotics, pain management, and daily parotid massage with complete resolution of the parotitis. Acute bacterial parotitis with subsequent drainage and otorrhea through the fissures of Santorini is rare, with only a few reported cases in the literature.
PubMed: 37482687
DOI: 10.1177/01455613231186052