Nasopharyngeal carriage of Streptococcus pneumoniae is a key factor for transmission, invasive disease, and antimicrobial resistance. Data on pneumococcal carriage in children in Cypriot are limited. We conducted a cross sectional study from December 2023 to May 2024, during a period of high PCV10 and PCV13 vaccine coverage in Cyprus, including children aged six months to six years who attended outpatient clinics in Cyprus. Nasopharyngeal swabs were cultured, and Streptococcus pneumoniae isolates were identified using conventional methods and confirmed by polymerase chain reaction. Serotyping was performed using multiplex polymerase chain reaction, latex agglutination, and whole-genome sequencing when needed. Antimicrobial susceptibility was assessed according to European guidelines. Logistic regression was used to identify risk factors for carriage. A total of 809 children were included, 83.85

Background/Objectives: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated skin disorder caused by Staphylococcus aureus (S. aureus), mainly affecting young children. This study aimed to describe the epidemiology, clinical features, microbiology, and management of pediatric SSSS and to explore factors associated with culture positivity, antimicrobial resistance, and complications. Methods: Retrospective cohort study of children hospitalized with SSSS at the major tertiary pediatric hospital in Greece, from January 2009 to December 2019. Exploratory association testing and parsimonious logistic regression were performed. Results: Overall, 51 children with a mean (±SD) age 2.5 ± 2 years were identified. Prior to diagnosis, 70.6% (36/51) of children had not received any antibiotic treatment. S. aureus was isolated from cultures in 43.1% (22/51) of cases. Carriage of S. aureus was detected in 34.0% (16/47) of children and 37.0% (10/27) of parents. Antibiotic resistance (%) for S. aureus was penicillin 95.5%, oxacillin 4.5%, erythromycin 4.5%, clindamycin 9.1%, mupirocin 40.9%, and fusidic acid 18.2%. Annual incidence of SSSS was estimated at 0.00-0.32/1000 hospitalizations from 2009 to 2016, but increased after 2017, reaching the highest incidence in 2019 (1.05/1000 hospitalizations); 50.7% of cases occurred in 2018-2019 (p < 0.001). During this period, resistance to oxacillin (MRSA strains) did not change (p = 0.53), whereas resistance to mupirocin increased over time, from 0% in 2009-2014 to 34.6% in 2018-2019 (p = 0.05). Penicillin was excluded from the composite drug-resistance outcome. Child nasal S. aureus carriage was independently associated with positive S. aureus culture (adjusted odds ratio [aOR] 4.18, 95% CI 1.14-15.27; p = 0.031) and with non-penicillin antibiotic resistance (aOR 25.68, 95% CI 2.64-249.50; p = 0.005). Elevated inflammatory markers were independently associated with complications (aOR 13.66, 95% CI 1.47-126.64; p = 0.021). Regarding treatment, clindamycin was the first-line agent in 58.8% (30/51) and was used as monotherapy in 49.0% (25/51). Conclusions: A notable increase in the incidence of SSSS was detected after 2017. Oxacillin resistance remained stable, but mupirocin resistance increased. Child nasal S. aureus carriage was associated with culture positivity and clinically relevant non-penicillin antibiotic resistance. Continuous surveillance is necessary as regional resistance patterns should guide therapy.

We report six paediatric cases of pharyngitis caused by Streptococcus dysgalactiae subsp. equisimilis presenting to a Greek public hospital over one year. All children had fever and cervical lymphadenopathy and tested negative for Streptococcus pyogenes. All cases came from a common socioeconomically disadvantaged, high-density setting; however, molecular typing detected two types, stG4 and stC36. All isolates were susceptible to beta-lactams, vancomycin, linezolid and co-trimoxazole. Resistance to macrolides and lincosamides was detected in three isolates and one was resistant to tetracycline. Given the increasing global incidence of this pathogen, this report provides regional data and underscores the need for improved surveillance.

BACKGROUND:Cefiderocol is a novel siderophore-conjugated cephalosporin with activity against antimicrobial-resistant Gram-negative bacteria. Despite increasing off-label use in critically ill neonates and children, data on its safety and effectiveness remain limited. METHODS:We performed a retrospective case series of neonatal and pediatric patients (≤18 years) who received off-label cefiderocol across 3 tertiary-care hospitals in Greece for suspected or documented infections due to multidrug-resistant Gram-negative bacteria. We also conducted a systematic review of pediatric cases published through June 2025. RESULTS:Fifteen patients [median age 65 months (range 4-183)] received 21 cefiderocol courses. The systematic review identified 37 additional treatment courses (32 patients, 6 of them <3 months of age), primarily for bloodstream infections (86%), pneumonia (24.3%) and febrile neutropenia (18.9%). Most patients had received multiple antibiotics before and concomitantly with cefiderocol for extensively resistant Gram-negative bacteria. Clinical response occurred in 16/21 (76.2%) courses in the case series study and 22/28 (78.6%) courses in the systematic review. Microbiologic clearance was observed in 7/9 (78%) courses in the case series. Cefiderocol was well-tolerated without serious adverse events in all cases. Most isolates (14/18, 78%) were susceptible to cefiderocol according to current breakpoints, with a single instance of resistance emergence. CONCLUSIONS:This is the largest pediatric cohort to date combining real-world and published cefiderocol cases, suggesting that cefiderocol is a safe, well-tolerated and potentially effective option for severe, difficult-to-treat antimicrobial-resistant Gram-negative infections in neonates and children. These results support cautious off-label use in critically ill patients, while underscoring the urgent need for further pediatric trials.

Importance Clesrovimab is a long-acting monoclonal antibody approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants who are born during or entering their first RSV season; data concerning clesrovimab from a second RSV season among children who remain at risk for severe disease are needed. Objective To evaluate the safety and tolerability of clesrovimab (105 mg) vs palivizumab in RSV season 1 in infants at increased risk for severe RSV disease. Key secondary objectives include describing the safety of 210 mg of clesrovimab in RSV season 2 in children who remain at increased risk for severe RSV disease, clesrovimab pharmacokinetics, and the incidence of RSV-associated disease. Design, Setting, and Participants SMART (MK-1654-007) was a randomized, partially masked, palivizumab-controlled, phase 3 clinical trial, conducted at 110 sites in 27 countries and territories between November 30, 2021, and November 20, 2025. The population constituted palivizumab-eligible infants, including those with prematurity, chronic lung disease of prematurity, or hemodynamically significant congenital heart disease. Interventions Participants, randomized 1:1 and stratified by region and condition, received clesrovimab (105 mg) on day 1 followed by placebo on day 28 or monthly palivizumab (15 mg/kg) up to 5 doses (1 dose per month). Eligible infants received open-label clesrovimab (210 mg) before their second RSV season. Main Outcomes and Measures The primary outcome was the observed proportions of participants experiencing adverse events (AEs) after clesrovimab or palivizumab in season 1. Results Overall, 997 infants (500 [50.2%] male; median age, 2.6 [range, 0.0-12.0] months) received clesrovimab, 105 mg (n = 498) or palivizumab (n = 499) in season 1; 276 received clesrovimab, 210 mg open-label in season 2. In season 1, the proportions of participants experiencing AEs were comparable between treatment groups. In season 2, clesrovimab, 210 mg was well tolerated. Incidence rates of RSV-associated medically attended lower respiratory infection (MALRI) were comparable between clesrovimab and palivizumab (3.2% [95% CI, 1.8%-5.2%] and 3.4% [95% CI, 2.0%-5.6%], respectively) through day 150 in season 1; total RSV-associated MALRI incidence through day 180 after a 210-mg dose in season 2 was 7.3% (95% CI, 4.4%-11.4%). Conclusions and Relevance In this randomized clinical trial, clesrovimab was well tolerated in infants at increased risk for severe RSV disease through 2 RSV seasons. These findings support the use of clesrovimab in children who remain at risk for severe RSV disease in their second RSV season. Trial Registration ClinicalTrials.gov Identifier: NCT04938830

To investigate SARS-CoV-2 antibody kinetics and household transmission, infected children along with their families were tested for anti-nucleocapsid antibodies at 1, 3, 6, 9 and 12 months post-SARS-CoV-2 infection during the Ancestral, Alpha, Delta, and Omicron waves. We prospectively included SARS-CoV-2 acute infected children (n = 189). After household recruitment (n = 76 households), the total study population was 228 children and 105 adults. The median age (IQR) of children and adults was 96 (115) months and 504 (96) months, respectively. Anti-nucleocapsid (anti-N) COI (cut-off index) titers peaked at three months post-infection and declined thereafter (p-value < 0.001), and 89.2% remained seropositive at 12 months. Children displayed significantly higher anti-N COI titers than adults during the Delta (p-value: 0.018) and Omicron (p-value: 0.047) periods. Household contact anti-N positivity (evidence of infection) was associated with pediatric index cases (aOR: 1.61, 95% CI: 1.11-2.35; p-value: 0.013) and elevated early anti-N COI titers (aOR: 1.24 per log10 unit, 95% CI: 1.05-1.48; p-value: 0.011). Higher secondary attacks were detected in Delta (aOR: 2.12, 95% CI: 1.19-3.77; p-value: 0.011) and Omicron (aOR: 2.75, 95% CI: 1.44-5.25; p-value: 0.002) compared to Ancestral. Waning of SARS-CoV-2 anti-N titers was faster in secondary cases (aHR: 1.62, 95% CI: 1.01-2.59; p-value: 0.047, Cox model) and during Omicron infection (aHR: 1.74 vs. Ancestral, 95% CI: 1.08-2.79; p-value: 0.023). In contrast, waning was slower in SARS-CoV-2 cases with higher baseline anti-N COI titers (aHR: 0.77, 95% CI: 0.64-0.93; p-value: 0.011). These findings demonstrate variant-specific, age-dependent antibody kinetics, emphasizing that pediatric index cases were associated with higher odds of household infection.

BACKGROUND:Monoclonal antibody (mAb) nirsevimab, which targets the antigenic site Ø of the prefusion F protein (pre-F) of RSV, was introduced for RSV prophylaxis in several countries. METHODS:A systematic search was conducted between January 1, 2022, and July 31, 2026 for studies analyzing substitutions within the epitope of pre-F RSV protein, which is the target of nirsevimab, after the implementation of the mAb. We searched across PubMed, Scopus, Web of Science and ClinicalTrial.gov for studies involving children with confirmed RSV infection, that conducted genomic analysis. RESULTS:Seven studies (five observational and two randomized controlled trials) including 2156 RSV-positive samples (RSV-A: 1347, RSV-B: 809) were analyzed. RSV-A strains showed limited variability within antigenic site Ø, with K65R being the most common substitution and K209E being the only intermediate-resistance RSV-A substitution. RSV-B strains demonstrated substantially higher substitution frequencies, particularly involving I206M, Q209R, and S211N. Most identified substitutions appeared to represent naturally occurring polymorphisms and retained susceptibility to nirsevimab, while multiple RSV-B substitutions and combinations involving residues 64-68 and 204-208 demonstrated reduced susceptibility or high-level resistance. Resistance-associated variants were detected in 28 of 2156 (1.3%) RSV-positive samples and exclusively among nirsevimab breakthrough infections. In a sub-analysis restricted to nirsevimab-treated individuals, resistance-associated variants were significantly more frequent among RSV-B than RSV-A (9.8% vs 0.5%; p < 0.001). CONCLUSION:Most substitutions that were detected within the nirsevimab antigenic site reflect ongoing natural RSV evolution and do not significantly affect nirsevimab susceptibility. However, detection of resistance-associated variants highlights the importance of continuous genomic and phenotypic surveillance.

Streptococcus pneumoniae continues to cause invasive pneumococcal disease (IPD) and non-IPD in children, despite widely implemented pneumococcal conjugate vaccines (PCVs). This study evaluated the impact of PCV7 and PCV13 on pneumococcal disease (PD), serotype distribution, and antimicrobial resistance in children ≤14 years in Athens, Greece. We conducted a retrospective multicenter study in five pediatric hospitals covering ~80% of Athens' pediatric population in three time periods; pre-PCV (1996-2005), post-PCV7 (2006-2010), and post-PCV13 (2011-2021). Clinical, microbiological, and demographic data were collected for children with PD. Capsular typing was performed by the Quellung reaction. Untypeable or antiserum cross-reacting isolates were typed by Next Generation Sequencing (NGS). The minimal inhibitory concentrations (MICs) were determined by Etest. A total of 2546 children with PD were identified and included in the analysis; 1233 (48.4%) with IPD and 1313 (51.6%) with non-IPD. PCVs significantly impacted disease patterns: IPD declined from 59% in the pre-PCV period to 35.1% in post-PCV13, while age distribution shifted toward older children (p < .001). All PCV7/13 serotypes decreased significantly in the post-PCV periods, except serotype 3 which increased, contributing substantially to empyema cases. Vaccine failures were 9.8% of cases, mostly attributed to serotypes 3, 19A, and 19F. Multidrug resistance (MDR) rates rose from 12.9% in pre-PCV to 24.8% in post-PCV13 period (p < .001), with MDR serotypes 19F and 23F decreasing over time and 19A becoming the predominant MDR phenotype (47.1%) in the post-PCV13 era. These findings underscore the dynamic nature of PD in the post-PCV era and highlight the ongoing need for surveillance studies, vaccine updates and resistance monitoring.

Background/Objectives: Streptococcus pyogenes (Group A beta-hemolytic streptococcus, GAS) is the most common cause of bacterial pharyngitis and a major contributor to morbidity and mortality worldwide. There has been an increase in invasive GAS infections and related deaths in several European countries post-COVID-19 pandemic. We aimed to assess parental knowledge, attitudes, and practices regarding GAS pharyngotonsillitis, with a focus on antibiotic use and misuse. Methods: A cross-sectional questionnaire-based study was conducted on a convenience sample of parents of children admitted to the Pediatric Ward or visiting the Pediatric Emergency Department of the University General Hospital of Patras, Greece (September 2024-February 2025). For knowledge assessment, the questionnaire consisted of 10 True/False questions, based on which a total knowledge score was calculated. For attitude and practice assessment, the questionnaire consisted of 10 Likert scale questions. A Negative Practice Score was calculated as a sum of the answers in five practices with a negative perspective, with higher scores indicating worse practices and lower scores indicating better practices. Results: The study enrolled 378 parents, 79% of them were aware that not all children with a sore throat need antibiotics, and 61% believed asymptomatic children with a positive strep antigen test should receive antibiotics. Concerns about GAS transmissibility were high (76%), while attitudes about severity were mixed. A median GAS total knowledge score of 6 (IQR: 4-7) indicated moderate knowledge. Multivariable analysis revealed that male parents, non-immigrants, those previously hospitalized for GAS infection, and those informed by pediatricians or reliable websites had significantly higher knowledge scores. Regarding practices, most parents (72%) disagreed with requesting antibiotics from pediatricians, and 93.9% did not administer leftover antibiotics. Additionally, 58% expressed more concerns in recent years due to the increase in invasive infections. The median GAS Negative Practice Score was 10.5 (IQR: 7.0-13.0), indicating generally good practices, as lower scores correspond to fewer negative practices. Older parents and those with higher knowledge scores were also linked to fewer negative practices in multivariable analysis. Conclusions: These findings highlight the importance of targeted education on GAS pharyngotonsillitis and the need to focus on specific population groups to reduce antibiotic misuse.

Respiratory syncytial virus (RSV) is a leading cause of pediatric respiratory infections. This systematic review and meta-analysis aims to estimate the in-hospital positivity among children in Europe post-COVID-19 and prior to the implementation of the recent RSV prophylactic strategies. A systematic search was conducted across three databases: PubMed, Scopus and Web of Science from 01/01/2021-31/12/2025. Studies enrolling children aged 0-18 years who were hospitalized with respiratory infection and detected positive for RSV were eligible for inclusion. A random-effect model was applied and heterogeneity was assessed using I2 statistics. Thirty-eight studies met the inclusion criteria, encompasing 66,065 children. The overall pooled RSV in-hospital positivity was 48% (95%CI: 41%-56%). Positivity estimates per year were: 53% (95%CI:49%-56%) for 2021-2022, 49% (95%CI:36%-62%) for 2022-2023, and 62% (95%CI:51%-73%) for 2023-2024 (p = 0.308). RSV positivity in studies with infants (<12-months-old) was 69% vs 30% in studies including older children (0-18 years). Among RSV-positive patients, co-infections were detected in 17%, respiratory support was required in 62% and ICU/NICU admission in 11%. RSV-B predominated over RSV-A during the study period. A substantial burden of RSV-related hospitalizations was detected, especially in infants < 12-months-old; however, the overall pooled positivity estimate should be interpreted with caution. These findings provide an important pre-immunization baseline for evaluating the impact of maternal RSV vaccination and monoclonal antibodies and support the need for continued RSV surveillance across Europe.

Reactive infectious mucocutaneous eruption (RIME) is increasingly recognized as a pediatric syndrome in which severe mucositis follows a recent infection and cutaneous involvement is usually limited. Although Mycoplasma pneumoniae remains the prototype trigger, influenza, SARS-CoV-2, adenovirus, respiratory syncytial virus, and other respiratory pathogens can produce a similar clinical phenotype. This narrative review summarizes pediatric RIME/MIRM literature and selected adult or comparator-disease evidence when direct pediatric data are unavailable, explicitly distinguishing direct RIME evidence from extrapolated mechanisms. This review synthesizes current evidence on the immunopathogenesis of RIME in children, with emphasis on how pathogen-specific factors intersect with innate and adaptive immune pathways to drive mucosal injury. We discuss the central roles of epithelial sensing, inflammasome activation, cytokine amplification, neutrophil recruitment, and T-cell polarization, and we relate these mechanisms to the severe oral, ocular, and anogenital disease that often defines pediatric presentations. We also integrate emerging proteomic data showing recurring molecular programs, including acute-phase and complement activation, neutrophil-associated epithelial injury, and interferon-inducible antiviral responses. In addition, we review the possible contribution of genetic susceptibility, especially variation in innate immune sensors and cytokine signaling pathways, to disease severity and recurrence. Finally, we address the main diagnostic challenges, histopathologic and imaging findings, differential diagnosis from Stevens-Johnson syndrome, erythema multiforme, and Kawasaki disease, and the implications of these insights for risk stratification and treatment. Taken together, current evidence supports RIME as a pathogen-triggered, mucosa-predominant inflammatory syndrome in which exaggerated host responses, rather than pathogen presence alone, shape the clinical phenotype.

Acquisition of multiple carbapenemase genes by Klebsiella pneumoniae (Kp) is an emerging public health threat. Here, we aim to elucidate the population structure of Kp blood isolates carrying two different carbapenemase genes and identify the mechanism facilitating their dissemination. The study was conducted in a tertiary healthcare center between 2014 and 2022. Twenty-four patients with bacteremia caused by Kp carrying two different carbapenemase genes were identified. All 24 blood isolates were analyzed by short-read genome sequences supplemented by long reads in a selected number of isolates. All isolates carried blaKPC (23 blaKPC-2, 1 blaKPC-3) and blaVIM-1 genes, along with a variety of antimicrobial resistance determinants. The isolates were clustered in six clonal lineages (ST39, ST147, ST323, ST258, ST3035, and ST340). Long-read genome sequences demonstrated that each carbapenemase gene was located in a separate group of plasmids: the blaKPC-2 on a fusion of IncFIB(pQil) and IncFII(K) plasmids, the blaKPC-3 on IncX3, the blaVIM-1 on IncC, or a fusion of the IncFIB(pNDM-Mar) and IncHI1B(pNDM-MAR) plasmids. Comparison of plasmid content of eight isolates carrying a single carbapenemase gene from a previous study with eight isolates carrying two carbapenemase genes from the present study, matched by clonal lineages, revealed that the second carbapenemase gene was acquired by addition of another plasmid. Identical plasmids were found within the same lineage and across lineages. These findings suggest that dissemination of carbapenemase genes in our hospital setting was driven by multiple plasmids across a variety of highly efficient clones.

Background Invasive meningococcal disease (IMD) is an acute, severe infection that continues to pose a significant public health challenge worldwide because of its potential for mortality and long-term sequelae. Objectives This study aimed to assess therapeutic approaches focused on the use of first-line antibiotics as well as practices for dexamethasone treatment in patients with meningococcal meningitis in Greece. Methods A retrospective analysis was conducted on pediatric patients aged up to 16 years identified through laboratory records from the Hellenic National Meningitis Reference Laboratory (HNML) between 2010 and 2020. The data collected included age, treatment regimens, antibiotic susceptibility, and clinical outcomes. Results A total of 161 patients admitted to 9 hospitals across Greece were identified. The medical records of 91 (56.5%) patients were retrieved. The median age was 36 months. All the meningococcal isolates were susceptible to third-generation cephalosporins (ceftriaxone, cefotaxime), which are empirical treatments for 97.7% of the cases, whereas penicillin resistance was recorded in 15.2% of the isolates. The case fatality rate was 5.5% (5 cases). The administration of dexamethasone to 31 patients (34%) with meningococcal meningitis was associated with a nonsignificant reduction in adverse outcomes (12.9% vs. 29%). One fatal case occurred in the nondexamethasone group. Conclusion Third-generation cephalosporins are confirmed as effective empirical treatments for IMD in Greece. Owing to the small size of our cohort, the use of adjunctive dexamethasone was not significantly associated with improved outcomes in this cohort.

BACKGROUND:To eradicate cervical cancer, the World Health Organization (WHO) targets 90 % human papillomavirus (HPV) vaccination coverage in girls by the age of 15 until 2030. In Greece, data regarding how close the country is to meeting this target, is completely lacking. OBJECTIVES:To assess annual HPV vaccination coverage among individuals aged 9-15 years in Greece (2022-2024). METHODS:This is a retrospective, population-based cohort study using the Greek National Electronic Prescription Database to record all HPV vaccine doses dispensed from 1/1/2019 to 31/12/2024. The annual vaccination coverage was estimated as the proportion of eligible population receiving at least one dose or the full vaccination scheme from January 1st, 2019, through December 31st of the respective reference year. Full vaccination scheme by age 15 was defined - according to national recommendations - as two doses at a minimum interval of 6 months. RESULTS:From 2022 to 2024, the proportion of individuals 9-15 years old, who appropriately initiated vaccination increased from 34.7 % (2022) to 41.4 % (2024) in girls and from 10.8 % (2022) to 31.4 % (2024) in boys. The proportion of children who initiate HPV vaccination at the age of 9, increased from 3.5 % and 3.4 % in 2022 to 8.0 % and 7.4 % in 2024 in girls and boys respectively. Among girls turning 15, appropriate vaccine initiation rate marginally exceeded 63.0 % throughout the study period while full vaccination coverage increased from 47.7 % in 2022 to almost 52.5 % in 2024. CONCLUSION:Despite notable improvements in HPV vaccination uptake among adolescents in Greece between 2022 and 2024, coverage levels remain suboptimal relative to the WHO's 90 % target. Limited early initiation despite national recommendations starting at age 9, highlight the need for targeted strategies to promote timely HPV vaccination and accelerate progress toward elimination goals.

Febrile seizures are common among young children but unusual in adolescents. This report presents an exceptionally rare case of fever with seizures resulting from Bacillus cereus bacteremia in a previously healthy adolescent. Timely diagnosis and appropriate antibiotic treatment were critical for the patient's recovery. A review of the relevant literature highlights the rarity and importance of recognizing systemic Bacillus cereus infections in adolescents. Systemic infections caused by Bacillus cereus, which are often linked to mild gastrointestinal diseases and febrile seizures, have rarely been documented in pediatric patients, except for neonates or immunocompromised individuals. This unique case highlights the critical importance of considering Bacillus cereus infection in the differential diagnosis of unusual fever and seizures in adolescents, particularly with recent dietary exposures like rice consumption.

As the pediatric COVID-19 landscape evolves, it is essential to evaluate whether SARS-CoV-2 infection predisposes children to allergic disorders. This narrative review synthesizes current epidemiological and immunological evidence linking pediatric COVID-19 with new-onset atopy. Epidemiological data remain heterogeneous: large Korean and multinational cohorts report increased risks of asthma and allergic rhinitis following COVID-19, whereas U.S. cohorts show neutral or protective associations, highlighting geographic and methodological variability. Mechanistic insights provide biological plausibility: epithelial injury and the release of alarmin cytokines (IL-33, IL-25, TSLP) promote Th2 polarization and ILC2 expansion, while epigenetic “scars” (e.g., LMAN2 methylation changes) and hematopoietic stem cell reprogramming may sustain long-term Th2 bias. Cytokine memory involving IL-7 and IL-15 contributes to altered T- and B-cell homeostasis, whereas disrupted regulatory T-cell function may reduce tolerance thresholds. Paradoxical trade-offs exist, such as ACE2 downregulation in allergic airways, which may lower viral entry but simultaneously amplify type-2 inflammation. Together, these processes suggest that SARS-CoV-2 infection could foster a pro-allergic milieu in susceptible children. Although current evidence is inconclusive, integrating epidemiological surveillance with mechanistic studies is crucial for predicting and alleviating post-COVID allergic outcomes. Longitudinal pediatric cohorts and interventions targeting epithelial alarmins or microbiome restoration may hold promise for prevention.

BACKGROUND:Vaccines are one of the most effective healthcare tools to prevent morbidity and mortality from infectious diseases. RESEARCH DESIGN AND METHODS:A decision tree model was used to evaluate the public health and economic impact of the Greek pediatric national immunization program (NIP) over the lifetime of the 2022 Greek birth cohort. The model included nine Greek NIP routine vaccines for children aged 2 months to 11 years, targeting 14 vaccine-preventable diseases: diphtheria, hepatitis A, hepatitis B, Haemophilus influenzae type B, measles, meningococcal disease, mumps, pertussis, pneumococcal disease, poliomyelitis, rotavirus, rubella, tetanus, and varicella. The outcomes (discounted 3% annually) included estimated disease cases and deaths averted, life-years (LYs) and quality-adjusted life-years (QALYs) gained, total costs averted (2022 euros), and benefit-cost ratios (BCR) from healthcare-sector and societal perspectives. RESULTS:The Greek pediatric NIP prevented 447,221 disease cases and 242 deaths, resulting in 6,682 LYs and 9,741 total QALYs gained for the 2022 birth cohort. Costs averted were €23.2 million (BCR = 1.3) from the healthcare-sector perspective; costs averted from the societal perspective were €201.4 million (BCR = 3.1), plus €514.0 million in value of QALYs gained (BCR = 8.5). CONCLUSION:The Greek pediatric NIP provides extensive public health and economic benefits for Greece by reducing morbidity and mortality from vaccine-preventable diseases.

Background:After lifting non-pharmaceutical interventions (NPIs) against the transmission of SARS-CoV-2, various countries experienced an increase in invasive Group A Streptococcal (iGAS) infections. We aimed to characterise the paediatric outbreak across Europe and to analyse the influence of viral infections. Methods:We conducted an interrupted time-series analysis based on data from 15 European countries from the PEGASUS consortium. We assessed the evolution of the number of iGAS cases aged 1 month to 18 years between 01/01/2018 and 03/31/2024, comparing the post-NPIs period (01-04-2022 until 31-03-2024) to the baseline period (01-01-2018 until 31-03-2020). Further analyses were performed by country, clinical phenotype, age and severity, including sensitivity analyses. We then explored whether certain iGAS phenotypes correlated with trends in RSV, influenza and VZV across countries over time using Google Trends data. Findings:We included 2091 iGAS cases over the study period; 79 children (3.6%) died and 580 (27.7%) required PICU admission. We estimated an overall increase of +229.8% (95% CI (141.9-341.6)) among iGAS cases from October 2022 to March 2024, compared to the baseline period. The observed increases varied across clinical phenotypes, ranging from +62.7% (95% CI (8.3-157.9)) for osteo-articular infections to +238.7% (95% CI 75.8-464.8) for pneumonia. We observed a strong correlation between the incidence of iGAS pneumonia and RSV (Rho: 0.57, 95% CI [0.11-0.79]) and influenza (Rho 0.69, 95% CI 0.35-0.87); and between skin and soft tissue infections and VZV (Rho: 0.73, 95% CI [0.42-0.89]). Interpretation:The patterns observed across Europe during this outbreak demonstrate an association between respiratory viruses as well as VZV, and iGAS. Funding:This study has received funding from ESPID, INOPSU and the Northwest Clinics. The COPP study group was supported by grants of the Dutch National Health Council (ZonMW) project number 10430072110007 and the Christine Bader Foundation.

Recent advances in biotechnology have fundamentally reshaped the landscape of vaccine development, offering innovative strategies to improve immunogenicity, safety and accessibility. This review explores the cutting-edge platforms—including mRNA, DNA, virus-like particles, viral and bacterial vectors, and bacteriophage-based vaccines—that are redefining how vaccine antigens are delivered to the immune system. We also discuss alternative delivery methods, such as transcutaneous and mucosal immunization, which have the potential to improve vaccine acceptance and distribution, as well as next-generation adjuvants targeting innate immune receptors aiming to further enhance vaccine efficacy, especially in vulnerable populations. By synthesizing these innovations, this review highlights how biotechnology is enabling the design of safer, more efficient, and more adaptable vaccines to address both existing and emerging infectious diseases.

Introduction: Data about compliance with perioperative antimicrobial prophylaxis (PAP) guidelines in the pediatric population are limited. This study aims to evaluate PAP adherence in pediatric surgical subspecialty departments. Methods: A prospective cohort study was conducted from September 2023 to October 2024 at “Aghia Sophia” Children’s Hospital, Athens, Greece. Children <16 years old undergoing surgical procedures in the neurosurgery (NS), orthopedics (OP), and otolaryngology (ORL) departments were included. Data on demographics, surgical characteristics, and PAP practices (timing, agent, duration, and redosing) were collected and compliance with the international guidelines was evaluated. Results: A total of 301 children were included, with a median age (IQR) of 7 (8) years. PAP was received by 249/301 (82.7%) children (100% in the OP and NS, and 48% in the ORL). However, indications for PAP had 50.8% of children: 102/103 (99%) in the NS, 47/98 (47.9%) in the OP, and 4/48 (8.3%) in the ORL. Most children received broad-spectrum or combination of antimicrobials and/or antibiotics for longer duration. Appropriate PAP according to the guidelines was administered in 0% children in NS, 2% in OP, and 2.1% in ORL. Multivariable analysis in the ORL regarding the use of PAP revealed that shorter procedures (≤60 min; OR: 22.9, p = 0.003) and clean wounds (OR: 33.4, p < 0.001) were significantly associated with not using PAP. Conclusions: This study highlights gaps in the PAP guideline adherence in pediatric surgical departments, and the need for educational interventions to improve compliance and reduce antimicrobial use. Based on these findings, we plan to implement an educational intervention in order to optimize PAP practices in the pediatric population.