Objectives An evidence synthesis informed the 2023 WHO infection prevention and control (IPC) guideline for Ebola disease (EBOD) and Marburg disease (MARD).Design A series of rapid reviews addressed 14 key questions (KQs) related to IPC measures for EBOD and MARD across three themes: (1) transmission/exposure, (2) personal protective equipment (PPE) and (3) decontamination/disinfection.Data sources Databases (Embase, Cochrane Database of Systematic Reviews, CENTRAL, Global Index Medicus) were searched from inception to May 2024, in addition to searches in MEDLINE and bio/medRxiv servers through an artificial intelligence tool (continuous active learning, CAL).Eligibility criteria Eligible populations included health workers (HWs), staff and patients in healthcare and/or community settings. Interventions included PPE evaluation, hand hygiene/glove decontamination, spraying of HWs, handling of heavily soiled linen, management of the deceased, environmental decontamination, work exclusion and the IPC ring approach. Infection with EBOD or MARD was a primary outcome of interest and secondary outcomes of interest varied by key question.Data extraction and synthesis Screening, data extraction, quality assessment (Cochrane RoB-2, Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I)) and evaluation of the certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation (GRADE)) were conducted by an independent reviewer with verification. Data and relevant contextual information were narratively synthesised.Results Following screening of 5540 studies in CAL and 1062 full texts, nine studies were included that addressed four KQs: one related to transmission/exposure (IPC ring approach), two related to PPE (head/neck skin and mucous membranes coverage; order of eye protection and head covering) and one related to disinfection/decontamination (spraying of HWs during PPE doffing). No studies were included for the remaining KQs, but relevant contextual information in reviewed studies was summarised for all KQs. Evidence was judged to be of low or very low certainty using the GRADE framework due to risk of bias, indirectness and imprecision, and substantive conclusions could not be drawn on the effectiveness of the evaluated IPC interventions.Conclusions While providing the evidence base for the WHO IPC guideline for EBOD and MARD, this series of rapid reviews identified several critical research gaps.PROSPERO registration number CRD#42022331537.

Respiratory viral infection (RVI) outbreaks pose a significant threat to health. They are associated with patient morbidity and mortality, staff absenteeism, and financial burden on the healthcare system. There is a need for strategies to reduce RVI transmission in hospitals. One proposal is implementation of continuous masking policies. However, the effectiveness of such policies in mitigating RVI spread is unclear. We conducted a systematic review of the literature to determine the effectiveness of continuous masking in reducing the incidence and transmission of RVIs amongst patients and healthcare workers (HCWs) in hospitals. We systematically searched for original articles published between 2000-2024 according to a pre-determined search criterion. Studies were screened by two reviewers in Covidence. One reviewer extracted the data from eligible studies into a pre-determined data extraction form. For studies that reported only count data, results were summarized narratively. Meta-analysis to pool unadjusted or adjusted outcome measures for studies that report a statistical comparison between masking policies and transmission of infections will be considered if appropriate. Joanna Briggs Institute tools will be used for critical appraisal. 3691 studies were identified. 17 met eligibility criteria. 12 studies were conducted in single-center adult hospitals. 4 studies were conducted in pediatric hospitals, with 2 in neonatal centers. One study was conducted on a hospital system. The studied infections were influenza A/B, parainfluenza 1-3, adenovirus, respiratory syncytial virus (RSV), traditional human coronavirus strains, human metapneumovirus, SARS-CoV-2, and rhinovirus/enterovirus. Eight studies assessed the impact of a masking policy on infection rate in patients. All 8 reported masking policies reduce RVI transmission in patients. 9 studies assessed the impact of a masking policy on infection rate in HCWs. 7 were associated with reductions in RVI transmission in HCWs, whereas 2 showed no statistically significant change. The studies identified in this systematic review were associated with a reduction in RVI transmission with the use of continuous masking amongst patients. The evidence for continuous masking was less consistent for preventing RVI transmission amongst HCW with two studies reporting it was not effective. Our findings suggest that masking policies may play a role in RVI prevention but there are significant limitations with the use of observational design and masking in conjunction with other prevention measures. However, assessment of the quality of the papers is pending. Future directions will include assessing secondary outcomes like masking adherence and assessing adjusted analyses form confounding which are critically important.

on behalf of the Guideline Development Group Outbreaks of Ebola and Marburg disease have continued to occur since the Zaire ebolavirus outbreak in West Africa 2014-16.In response, the World Health Organisation (WHO) published a new infection prevention and control (IPC) guideline for both diseases in August 2023, 1 which replaces those issued in 2014 and 2016. 2 -4 This article summarises the process involved in developing the updated guideline and includes an infographic (fig 1) to highlight key IPC recommendations from the guideline, following the patient care pathway from the community to a healthcare facility to discharge.The full guideline is available as a downloadable PDF on both the WHO website (Infection prevention and control guideline for Ebola and Marburg disease, August 2023, who.int) and the web based MAGICapp platform.

Children and neonates are highly vulnerable to the impact of antimicrobial resistance. Substantial barriers are faced in relation to research and development of antibacterial agents for use in neonates, children, and adolescents aged yonger than 19 years, and focusing finite resources on the most appropriate agents for development and paediatric optimisation is urgently needed. In November and December, 2022, following the successes of previous similar disease-focused exercises, WHO convened the first Paediatric Drug Optimisation (PADO) exercise for antibiotics, aiming to provide a shortlist of antibiotics to be prioritised for paediatric research and development, especially for use in regions with the highest burden of disease attributable to serious bacterial infection. A range of antibiotics with either existing license for children or in clinical development in adults but with little paediatric data were considered, and PADO priority and PADO watch lists were formulated. This Review provides the background and overview of the exercise processes and its outcomes as well as a concise review of the literature supporting decision making. Follow-up actions to implement the outcomes from the PADO for antibiotics process are also summarised. This Review highlights the major beneficial influence the collaborative PADO process can have, both for therapeutic drug class and disease-specific themes, in uniting efforts to ensure children have access to essential medicines across the world.

A 21-year-old woman presented to the emergency department with a 2-week history of lesions on her left hand. As a student in an agriculture program, she had had ungloved contact with goats and the mouth of a baby calf during a farm practicum 1 week before presentation. The animals had no evidence of

Asymptomatic coronavirus disease 2019 (COVID-19) has been reported as a significant driver of COVID-19 outbreaks. Our hospital ward outbreak analysis suggests that comprehensive symptoms and signs assessment, in combination with adequate follow-up, allows a more precise determination of COVID-19 symptoms. Asymptomatic infection was quite uncommon among adults in this setting.

[Voir la version anglaise de l’article ici : www.cmaj.ca/lookup/doi/10.1503/cmaj.221293][1] Une femme de 21 ans s’est présentée aux urgences pour des lésions à la main gauche persistant depuis 2 semaines. Dans le cadre de ses études dans un programme de formation agricole, elle avait eu

Abstract Background Risk factors for nosocomial COVID-19 outbreaks continue to evolve. The aim of this study was to investigate a multi-ward nosocomial outbreak of COVID-19 between 1st September and 15th November 2020, occurring in a setting without vaccination for any healthcare workers or patients. Methods Outbreak report and retrospective, matched case–control study using incidence density sampling in three cardiac wards in an 1100-bed tertiary teaching hospital in Calgary, Alberta, Canada. Patients were confirmed/probable COVID-19 cases and contemporaneous control patients without COVID-19. COVID-19 outbreak definitions were based on Public Health guidelines. Clinical and environmental specimens were tested by RT-PCR and as applicable quantitative viral cultures and whole genome sequencing were conducted. Controls were inpatients on the cardiac wards during the study period confirmed to be without COVID-19, matched to outbreak cases by time of symptom onset dates, age within ± 15 years and were admitted in hospital for at least 2 days. Demographics, Braden Score, baseline medications, laboratory measures, co-morbidities, and hospitalization characteristics were collected on cases and controls. Univariate and multivariate conditional logistical regression was used to identify independent risk factors for nosocomial COVID-19. Results The outbreak involved 42 healthcare workers and 39 patients. The strongest independent risk factor for nosocomial COVID-19 (IRR 3.21, 95% CI 1.47–7.02) was exposure in a multi-bedded room. Of 45 strains successfully sequenced, 44 (97.8%) were B.1.128 and differed from the most common circulating community lineages. SARS-CoV-2 positive cultures were detected in 56.7% (34/60) of clinical and environmental specimens. The multidisciplinary outbreak team observed eleven contributing events to transmission during the outbreak. Conclusions Transmission routes of SARS-CoV-2 in hospital outbreaks are complex; however multi-bedded rooms play a significant role in the transmission of SARS-CoV-2.

[Voir la version anglaise de l’article ici: www.cmaj.ca/lookup/doi/10.1503/cmaj.221385][1] Un nourrisson de 4 mois de sexe féminin, entièrement vacciné et au développement normal, a été orienté vers notre clinique de dermatologie pour une éruption cutanée papuleuse diffuse extrêmement

Background A paucity of data is available on virologic and biochemical characteristics of paediatric Ebolavirus dis-ease (EVD), compared to adults. Methods We conducted a retrospective chart review of children (< 16 years old) and a comparator group of young adults (16-44 years) from two treatment centres during the 2018-2020 EVD epidemic in Eastern Democratic Republic of the Congo. Statistical methods included chi-squared and Fisher's exact tests (dichotomous and categorical variables), Mann-Whitney U-test (continuous variables), multivariable linear regression (for determinants of admission viral load), linear mixed-effects models (for analysis of longitudinal viral load), and Cox proportional hazard models (to examine risk factors for mortality). Findings We included 73 children and 234 adults admitted from April to October 2019. Paediatric patients commonly had electrolytes imbalances: hypokalaemia in 26/73 (36%), hyperkalaemia in 38/73 (52%), and hyponatraemia in 54/73 (74%). Hypoglycaemia occurred in 20/73 (27%), acute kidney injury in 43/73 (59%), and rhabdomyolysis in 35/73 (48%). Biochemical abnormalities were detected in a similar proportion of children and adults. The viral load (VL, log(10) copies/mL) at admission (7.2 versus 6.5, p=0.0001), the peak viral load (7.5 versus 6.7, p=< 0.0001), and the time for viraemia clearance (16 days versus 12 days, p=< 0.0001) were significantly different in children. The duration of hospital stay was prolonged in children (20 versus 16 days, p=< 0.0001). Risk factors for mortality in children were: VL > 7.6 log(10)copies/mL, alanine transaminase > 525 U/L, C-reactive protein > 100 mg/L, blood urea nitrogen > 7.5 mmol/L, rhabdomyolysis, and. acute kidney injury. Interpretation Paediatric EVD patients, like adults, experience multiorgan dysfunction with life-threatening electrolyte imbalances, hypoglycaemia, kidney injury, liver injury, and rhabdomyolysis. Paediatric patients have significantly higher VLs throughout the course of EVD than adults. Copyright (C) 2022 Published by Elsevier Ltd.

Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2-3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation. Conclusion Exposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP.

Version 10.0 1. Update to summary paragraph for convalescent sera based on recent large RCT publication and minor amendment to the summary statement for convalescent sera -page 5, page 22 2. Update to Non-steroidal anti-inflammatory drugs (NSAIDs) summary paragraph based on recent publication of large cohort study -page 22 3. Update to summary paragraph for colchicine use in paediatric patients with COVID-19 to include data from two recent large RCTs -page 23 4. Minor amendment to remdesivir information in treatment table 3 to reflect availability of drug

Abstract Primary Subject area Infectious Diseases Background In the second largest outbreak of Ebolavirus disease (EVD) on record (Democratic Republic of Congo, 2018-2020), 3470 cases were confirmed, 29% of them among children under 18 years of age. Objectives To describe virologic and biochemical characteristics of pediatric patients with EVD, and to compare these to a control group of adults with EVD. Design/Methods Retrospective medical record review of children < 16 years old from two treatment centres in North Kivu, DRC. A control group of patients 16-44 years old was included as a reference comparator group. Patient demographics, serial measurements of viral load, serial biochemistry panel, and frequent point-of-care glucose test results were abstracted from the chart record. Funding provided by the Association for Health Innovation in Africa (AFHIA). Results Seventy-three children and 234 adults were included, admitted from April 24 to October 14, 2019. Pediatric patients commonly had electrolyte imbalances (36% hypokalemia, 52% hyperkalemia, and 74% hyponatremia), AKI (51%), elevated liver enzymes (median peak ALT 380 IU/L and AST 570 IU/L), and rhabdomyolysis (48%). Viral load at admission (7.2 versus 6.5 log10copies/mL, p=0.0001), peak viral load (7.5 versus 6.7 log10copies/mL, p<0.0001), and time to clearance of viremia (16 versus 12 days p<0.0001) were significantly different in children. Duration of hospital stay (20 versus 16 days, p<0.0001) was prolonged in children, a direct consequence of slower clearance of viremia. There was no significant difference between groups in other laboratory values. Factors including ALT >525 U/L, viral load (VL) >7.6 log10copies/mL, BUN >7.5 mmol/L, and CRP >100 mg/L were associated with mortality in children, as in adults. In a multivariable logistic regression model, ALT and VL remained statistically significant independent predictors of mortality. Conclusion Pediatric patients with EVD, like adults, experience multi-organ involvement with life-threatening kidney and liver injury, rhabdomyolysis, and electrolyte imbalances. Pediatric patients have significantly higher viral loads throughout the course of EVD than adults.

Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, commonly infect children and typically cause mild upper respiratory tract infections. Three novel coronaviruses of zoonotic origin have emerged during the past two decades: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV) and the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. These novel coronaviruses are known to cause severe illness and death predominantly in older adults and those with underlying comorbidities. Consistent with what has been observed during the outbreaks of SARS and MERS, children with COVID-19 are more likely to be asymptomatic or to have mild-to-moderate illness, with few deaths reported in children globally thus far. Clinical symptoms and laboratory and radiological abnormalities in children have been similar to those reported in adults but are generally less severe. A rare multisystem inflammatory syndrome in children (MIS-C) which has resulted in critical illness and some deaths has recently been described. Clinical trials for therapeutics and vaccine development should include paediatric considerations. Children may play an important role in the transmission of infection and outbreak dynamics and could be a key target population for effective measures to control outbreaks. The unintended consequences of the unprecedented scale and duration of pandemic control measures for children and families around the world should be carefully examined.

Ebola virus (EBOV) causes an extremely contagious viral haemorrhagic fever associated with high mortality. While, historically, children have represented a small number of total cases of Ebolavirus disease (EVD), in recent outbreaks up to a quarter of cases have been in children. They pose unique challenges in clinical management and infection prevention and control. In this review of paediatric EVD, the epidemiology of past EVD outbreaks with specific focus on children is discussed, the clinical manifestations and laboratory findings are described and key developments in clinical management including specific topics such as viral persistence and breastfeeding while considering unique psychosocial and anthropological considerations for paediatric care including of survivors and orphans and the stigma they face are discussed. In addition to summarising the literature, perspectives based on the authors’ experience of EVD outbreaks in the Democratic Republic of the Congo (DRC) are described.Abbreviations: ARDS: acute respiratory distress syndrome; aOR: adjusted odds ratio; ALT: alanine transferase; ALIMA: Alliance for International Medical Action; AST: aspartate transaminase; BUN: blood urea nitrogen; CNS: central nervous system; CUBE: chambre d’urgence biosécurisée pour épidémie; COVID-19: coronavirus disease 2019; Ct: cycle threshold; DRC: Democratic Republic of Congo; ETC: ebola treatment centre; ETU: ebola treatment unit; EBOV: ebola virus; EVD: ebolavirus disease; FEAST: fluid expansion as supportive therapy; GP: glycoprotein; IV: intravenous; MEURI: monitored emergency use of unregistered interventions; NETEC: National Ebola Training and Education Centre; NP: nucleoprotein; ORS: oral rehydration solution; PALM: Pamoja Tulinde Maisha; PREVAIL: Partnership for Research on Ebola Virus in Liberia; PPE: personal protective equipment; PCR: polymerase chain reaction; PEP: post-exposure prophylaxis; RDTs: rapid diagnostic tests; RT: reverse transcriptase; RNA: ribonucleic acid; UNICEF: United Nations International Children’s Emergency Fund; USA: United States of America; WHO: World Health Organization

KEY POINTS A 74-year-old woman with type 2 diabetes mellitus presented to hospital following new-onset focal seizure characterized by right-sided facial droop and numbness, with spread to the right eye and slurred speech. These symptoms resolved before she presented to hospital. Neuroimaging with

A 64-year-old woman with Waldenström macroglobulinemia presented with seizures and was found to have multifocalNocardia farcinica cerebral abscesses. Nocardia species are an uncommon cause of cerebral abscesses that can occur spontaneously via inoculation from the environment, especially in immunocompromised patients, and usually appear with concomitant pulmonary disease. Nocardia infections generally portend a worse prognosis than other organisms causing the same clinical syndrome because they are difficult to treat. Treatment of cerebral Nocardia consists of combination therapy upfront with a sulfonamide and another agent, with long treatment regimens of up to a year.

We present the case of a 74-year-old woman who recently emigrated from the Philippines to Canada, with an unusual etiology for her breast lump. Based on review of breast histopathology by a pathologist, as well as parasitology specialist and clinical history, the causative organism of this breast lump was Schistosoma japonicum. This is an uncommon manifestation of schistosomiasis, which causes more than 40 million clinical infections annually.