Data on the influence of sociodemographic characteristics on the epidemiology of community-acquired bacteremia in vaccinated populations remains limited. We aimed to examine the association between sociodemographic characteristics and the epidemiology of pediatric community acquired bacteremia.Rates of Community Acquired Bacteremia in Low and High Socioeconomic Status Populations This retrospective study was conducted in two hospitals serving populations with significant socioeconomic disparities (low socioeconomic status [SES] rank 2/10 vs. high SES: rank 7/10, based on the Central Bureau of Statistics' scale). We included all cases of community-acquired bacteremia in patients< 18 years between 2016-2023. Bacteremia rates were calculated per 1,000 blood cultures drawn. Rates of true bacteremia and the distribution of isolates were compared between hospitals. S.pneumoniae isolates were further analyzed to determine serotype coverage by the Prevenar 13 and Prevenar 20 vaccines. We identified 298 cases of community-acquired bacteremia. Bacteremia rates were higher in low- vs. high-SES children < 3 years (10.5 vs. 5.2 cases/1,000 cultures; RR -2, P < 0.01 and 10.06 vs. 4.1 per 1,000 cultures; RR-2.4, P < 0.01, in those aged < 3 months and 3–36 months, respectively). S.pneumoniae was the leading isolate among children aged 3–36 months (n=55, 44.3% in low vs. n=36, 22.3% in high-SES populations). In the low-SES population, S.pyogenes (10.4%) and N.meningitidis (7.0%) were the next most common isolates, while K.kingae (16.0%) and M.catarrhalis (11.7%) followed in the high-SES population. Non-Prevnar 13 S.pneumoniae serotypes accounted for 94.4% of cases in high-SES and 89% in low-SES populations (P = 0.4). Prevnar 20 covered isolates accounted for 50.9% in low-SES and 38.8% in high-SES populations (P = 0.2). Low-SES children < 3 years had more than twice the risk of bacteremia compared to high-SES children, with higher rates of S.pyogenes and N.meningitidis. Non–Prevnar 13 S. pneumoniae serotypes accounted for the majority of cases in both populations, with a substantial proportion covered by the recently introduced Prevnar 20 vaccine, highlighting its potential to reduce the burden of invasive pneumococcal disease. All Authors: No reported disclosures

An outbreak of enteroviral meningitis occurred in Israel between August 2025 and May 2026. Echovirus type 17 was identified in 72 hospitalised patients, most of them infants (n = 44). Many patients (n = 45) were from densely populated Haredi (strictly Orthodox) communities. Clinical course was mild. Phylogenetic analysis suggests extensive local transmission. Echovirus 17 infections declined abruptly following the implementation of community restrictions imposed during a military conflict. This outbreak highlights the value of routine molecular enterovirus surveillance.

Background The first 1000 days of life, spanning from conception to two years of age, constitute a critical period for growth, neurodevelopment, immune maturation, and metabolic programming. Nutritional exposures during this developmental window have lasting effects on cognitive function, physical health, and disease susceptibility throughout life. Given the rapid evolution of nutritional evidence and variability among international recommendations, general pediatricians require practical, evidence-based guidance to optimize infant and early childhood nutrition. Methods This EPA-UNEPSA overview integrates current evidence from peer-reviewed literature, international clinical guidelines, and expert consensus regarding nutritional requirements and feeding practices during the first 1000 days. A structured search of PubMed/MEDLINE, Scopus, and Web of Science (2000–February 2026) was complemented by recommendations from major international organizations, including the World Health Organization, UNICEF, the American Academy of Pediatrics, and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Emphasis was placed on high-quality evidence addressing nutrient requirements, feeding strategies, neurodevelopment, and long-term health outcomes. Results This review summarizes current recommendations on breastfeeding, complementary feeding, early allergen introduction, probiotic use, and appropriate supplementation, together with the physiological roles, dietary sources, and clinical significance of essential macro- and micronutrients during early life. Particular attention is given to nutrients critical for brain development. The review also highlights the importance of nutrient timing, bioavailability, nutrient interactions, and individualized nutritional assessment. Evidence indicates that deficiencies during sensitive developmental periods may result in serious impairments in neurodevelopment, growth, immune competence, and long-term metabolic health, whereas inappropriate supplementation may also adversely affect outcomes. Conclusions Optimal nutrition during the first 1000 days represents one of the most effective strategies for promoting lifelong health and human development. By translating current scientific evidence and international recommendations into practical clinical guidance, this EPA-UNEPSA overview provides general pediatricians with a comprehensive framework to support evidence-based nutritional counseling, prevent nutrient deficiencies, optimize neurodevelopment, and improve long-term health outcomes.

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood and often represents the first manifestation of the “atopic march,” preceding the development of other allergic diseases such as food allergy, allergic rhinitis, and asthma. With allergic diseases collectively affecting approximately 20% of the global population, the need for a coordinated and evidence-based approach to pediatric management is increasingly important. AD imposes a significant burden on affected children and their families, contributing to impaired quality of life through persistent pruritus, sleep disturbances, psychological stress, and socioeconomic costs.This overview, developed by the Working Group on Pediatric Allergy and Immunology of the European Pediatric Association–Union of National European Pediatric Societies and Associations (EPA-UNEPSA), in collaboration with the International Pediatric Association, summarizes key discussions and conclusions from the international “EPA-UNEPSA for U Conference” on the management of AD, held in Portorož, Slovenia, in February–March 2025. The article focuses on the management of AD in pediatric primary care and integrates current evidence from peer-reviewed literature and widely accepted clinical guidelines.The report reviews essential aspects of diagnosis, disease assessment, and stepwise management strategies in children from birth to 18 years of age, including skin barrier care, pharmacologic treatments, and complementary therapeutic approaches. Particular emphasis is placed on the role of primary care pediatricians in early recognition, patient and caregiver education, prevention of disease exacerbations, and coordination of multidisciplinary care. The overview highlights the importance of an integrative approach that bridges dermatology, allergology, nutrition, and psychosocial support in order to optimize long-term outcomes for children with AD.By summarizing current knowledge and expert consensus, this article aims to provide practical, clinically oriented recommendations to support primary care pediatricians in the comprehensive management of pediatric AD.

Aim To examine the validity of lateral neck x ray (LNXR) for the diagnosis of retropharyngeal infection (RPI) in emergency room (ER) settings. Effectiveness of conservative treatment with IV antibiotics for RPI was also examined. Methods A retrospective analysis of patients diagnosed with RPI at a university-affiliated primary care center, between the years 2012-2022. Pre-vertebral space diameter at C2 level on LNXR was compared to a control group as well as before and after treatment. A sensitivity analysis was performed. Results 44 and 20 patients were included in the study and control group, respectively. Median pre-vertebral thickness was significantly different between the groups (14.9 mm [IQR: 12.5, 18.4] vs. 4.1 mm [3.6, 5], p<0.001). Sensitivity and specificity of LNXR combined with clinical presentation for RPI diagnosis were 87% and 74%, respectively. Median pre-vertebral space diameter before and after treatment declined significantly (14.3 mm [12.3, 18.1] vs. 7.2 mm [4.6, 9.6], p<0.001). Conclusions LNXR is a good and valid modality for the diagnosis of RPI, in conjunction with clinical presentation in ER setting. IV antibiotics are efficient for most children with RPI. Neck CT and surgical intervention should be reserved for select patients.

In numerous Northern Hemisphere countries, the winter season of 2022-2023 has posed exceptional challenges for healthcare providers and pediatricians, primarily as a result of an unprecedented rise in respiratory tract infections 1) European Centre for Disease Prevention and Control. Intensified circulation of respiratory syncytial virus (RSV) and associated hospital burden in the EU/EEA. https://www.ecdc.europa.eu/en/publications-data/intensified-circulation-respiratory-syncytial-virus-rsv-and-associated-hospital (Accessed, 08 August, 2023) Google Scholar . Globally, a plethora of studies has indicated that the implementation and subsequent relaxation of nonpharmacological interventions (NPIs) to curb the transmission of SARS-CoV-2 have profoundly altered the epidemiological landscape of pediatric infectious diseases 2) Brueggemann A.B. Jansen van Rensburg M.J. Shaw D. et al. Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: a prospective analysis of surveillance data. Lancet Digit Health. 2021; 3: e360-e370 Abstract Full Text Full Text PDF PubMed Google Scholar , 3) Izu A. Nunes M.C. Solomon F. et al. All-cause and pathogen-specific lower respiratory tract infection hospital admissions in children younger than 5 years during the COVID-19 pandemic (2020-22) compared with the pre-pandemic period (2015-19) in South Africa: an observational study. Lancet Infect Dis. 2023; 23: 1031-1041 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 4) Levy C. Cohen R. Infectious diseases in the COVID-19 era: gaps between countries. Lancet Infect Dis. 2023; Abstract Full Text Full Text PDF Scopus (1) Google Scholar , 5) Yeoh D.K. Foley D.A. Minney-Smith C.A. et al. Impact of Coronavirus Disease 2019 Public Health Measures on Detections of Influenza and Respiratory Syncytial Virus in Children During the 2020 Australian Winter. Clin Infect Dis. 2021; 72: 2199-2202 Crossref PubMed Scopus (237) Google Scholar . Frequently, a resurgence follows a decline in cases. Nevertheless, the enduring consequences of these transformations remain shrouded in uncertainty and defy accurate prognostication. It is prudent, however, to monitor trends in developed Southern Hemisphere countries, renowned for their robust epidemiological surveillance systems 6) Australian Influenza Surveillance Reports – 2023. https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023#:∼:text=The%20Australian%20Influenza%20Surveillance%20Report,influenza%20associated%20hospitalisations . (Accessed, 08 August, 2023) Google Scholar , as a harbinger of what patterns might lie ahead.

These pages from the European Pediatric Association by Pettoello-Mantovani et al summarize and duplicate scientific information recently published, Preparing for uncertainty: endemic pediatric viral diseases after Covid-19 pandemic disruption [Lancet 2022 Jul 14;S0140-6736(22)01277-6. https://doi.org/10.1016/S0140-6736(22)1277-6] by Messacar et al. (citation 9). There was no intent by the authors to appropriate Dr. Messacar's findings or conclusions, but rather to report his findings for the benefit of general pediatricians. The authors would like to apologise for any inconvenience caused. Epidemiologic Changes Caused by the Preventive Measures for the Coronavirus Disease 2019 Pandemic: An Additional Challenge for PediatriciansThe Journal of PediatricsVol. 252PreviewAfter the World Health Organization declared pandemic status and implemented restrictive measures to counter the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there was a reduction in major pediatric diseases caused by common seasonal viruses.1,2 The typical increase in pediatric outpatient visits and workload in emergency departments and hospital wards that characterizes the winter season, usually dominated by respiratory syncytial virus (RSV) and influenza viruses, was not seen. Full-Text PDF

Prescription and nonprescription drug shortages are not a new phenomenon.1Donnelly K.A. Zocchi M.S. Katy T.A. Fox E.R. Pines J.M. van den Anker J.N. et al.Prescription drug shortages: pediatric emergency and critical care medications.Pediatr Emerg Care. 2021; 37: e726-e731PubMed Google Scholar The recent health crisis caused by the COVID-19 pandemic has further highlighted a chronic shortage of drugs and medical equipment in many western countries. This is a growing problem for Europe's national health systems. In recent years, shortages of all types of drugs have become increasingly common in hospital pediatrics and primary care and pose a threat to the health of adults and children in Europe and the US.1Donnelly K.A. Zocchi M.S. Katy T.A. Fox E.R. Pines J.M. van den Anker J.N. et al.Prescription drug shortages: pediatric emergency and critical care medications.Pediatr Emerg Care. 2021; 37: e726-e731PubMed Google Scholar, 2Banerjee R. Thurm C.W. Fox R. Hersh A.L. Antibiotic Shortages in Pediatrics.Pediatrics. 2018; 142e20180858Crossref PubMed Scopus (4) Google Scholar, 3European Civic University AllianceCIVIS member universities united against COVID-19.https://civis.eu/en/news/civis-member-universities-united-against-covid-19Date accessed: February 8, 2023Google Scholar As early as April 2020, the Alliance of European University Hospitals warned that the increasing demand from intensive care units for anesthetics, antibiotics, muscle relaxants, and "off-label" drugs for the treatment of COVID-19 could lead to stock-outs.3European Civic University AllianceCIVIS member universities united against COVID-19.https://civis.eu/en/news/civis-member-universities-united-against-covid-19Date accessed: February 8, 2023Google Scholar However, after 2020, with declining production, logistical problems, and export and storage bans due to the current pandemic-related health crisis, the risk of shortage has increased.4Cohen R. Pettoello-Mantovani M. Giardino I. Carrasco-Sanz A. Somekh E. Levy C. The shortage of amoxicillin: an escalating public health crisis in pediatrics faced by several western countries.J Pediatr. 2023; https://doi.org/10.1016/j.jpeds.2023.01.001Abstract Full Text Full Text PDF Scopus (1) Google Scholar In September 2020, the European Union (EU) Parliament voted on a resolution calling for the EU to become more self-sufficient in health care.5European UnionEuropean parliament resolution of 17 September 2020 on the shortage of medicines.https://www.europarl.europa.eu/doceo/document/TA-9-2020-0228_EN.htmlDate accessed: February 8, 2023Google Scholar In the text, the members of the European Parliament called for securing stocks, restoring local production of medicines, and ensuring better European coordination of national health strategies. Unfortunately, 2 years later, the problem has not been solved, but to the contrary has worsened. Currently, public health systems are facing a drug shortage crisis of unforeseen magnitude, one, ie, seriously undermining the public health of European nations.3European Civic University AllianceCIVIS member universities united against COVID-19.https://civis.eu/en/news/civis-member-universities-united-against-covid-19Date accessed: February 8, 2023Google Scholar In particular, primary care pediatrics is in great distress6Tufts L. Worthy M. Putty K. Wallace T. Waldeck K. Waldeck J.M. et al.Improving resident experience during the pediatric intensive care unit rotation.Global Pediatrics. 2023; 3100029https://doi.org/10.1016/j.gpeds.2022.100029Crossref Google Scholar due to the shortage of essential drugs to ensure the health of the pediatric population. Between 2000 and 2018, drug shortages in the EU grew up to 20 times.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar However, according to a note from the European Commission, the availability of widely used essential products continued to decline significantly after that date.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar As discussed by the EU report, the causes are complex and include production problems, industry quotas, and legal parallel trade, ie, the import of medicines from other member states where the price is lower.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar Other causes are epidemics and natural disasters, which cause unforeseen increases in demand, and the cost of medicines, which is set at the national level.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar The EU is increasingly dependent on third countries, particularly India and China, for the production of active pharmaceutical ingredients, chemical raw materials, and drugs.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar,8D'Apolito M. Colia A.L. Lasalvia M. Capozzi V. Falcone M.P. Pettoello-Mantovani M. et al.Urea-induced ROS accelerate senescence in endothelial progenitor cells.Atherosclerosis. 2017; 263: 127-136Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Unfortunately, the solutions adopted by the EU do not seem to have succeeded in mitigating the problem of drug shortages, despite the fact that the European Parliament had called for strengthening the production of medicines in Europe and setting minimum quality standards for health care, adopting best practices for stockpile management, increasing joint purchasing of medicines, and simplifying the transfer of medicines between member states. In its 2017 resolution, the European Parliament called for better tracking of research and development costs, public funding, and market expenditures to make medicines more affordable.9European UnionREPORT on EU options for improving access to medicines.https://www.europarl.europa.eu/doceo/document/A-8-2017-0040_EN.htmlDate accessed: February 8, 2023Google Scholar In April 2020, the European Commission issued guidelines to counter drug shortages due to the coronavirus pandemic,10European Union ParliamentAddressing shortages of medicines. commission guidelines to avoid shortages of medicines during the pandemic and establish a coordinated approach across Europe.https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/649402/EPRS_BRI(2020)649402_EN.pdfDate accessed: February 8, 2023Google Scholar calling on member states to suspend export bans, avoid national stockpiles, and increase and reorganize production.11Pettoello-Mantovani C. Olivieri B. Food safety and public health within the frame of the EU legislation.Global Pediatrics. 2022; 2100020https://doi.org/10.1016/j.gpeds.2022.100020Crossref Google Scholar However, the problem of drug shortages still seems to be unresolved and a threat to the health of children. This commentary, jointly authored by the European Confederation of Primary Care Pediatricians and the European Paediatric Association/Union of National European Paediatric Societies and Associations, highlights a joint statement issued by the 2 leading European pediatric societies addressing the serious problem of drug shortages in primary care pediatrics in Europe (Table).TableAddressing drug shortages in primary care pediatrics in EuropeJoint statement by• ECPCP• EPA-UNEPSADrug shortages challenge health care systems around the world. Authorities and public agencies in Europe and the US are now reporting shortages of commonly prescribed medications in pediatric settings. This situation raises fears that most of the drugs used to treat various pediatric conditions will be in short supply for the current winter season and for months to come.ECPCP and EPA-UNEPSA emphasize that drug shortages can pose health risks to patients through undertreatment, medication errors, increased length of hospital stay, and adverse reactions due to attempts to replace unavailable drugs. Populations around the globe are in the transition phase from pandemic COVID to endemic COVID. The unseasonably early increase in respiratory infections in Europe during the winter 2022-23 is caused by unusual immunologic gaps. The early winter flu wave in children places an unexpected burden on pediatric primary care and increased demand for specialty anti-infective drugs. Children are a particularly vulnerable patient group with very limited pharmaceutical treatment options. This exposed them to adverse outcomes caused by shortages of essential medications. Problems with production and supply of existing drugs reduce the availability of critical products and preparations.ECPCP and EPA-UNEPSA stress that a joint effort to understand the source of the problem can help resolve the current emergency and strengthen the preparedness of public health systems to deal with the next inevitable crisis.Finally, the 2 leading European pediatric societies raise awareness among stakeholders, including health care professionals, legislators, and public health administrators, of the problem of drug shortages in primary care pediatrics and emphasize the importance of their close and effective interaction and collaboration to adequately address the recurring problem of drug shortages in this key public health area.The appendix to this statement briefly discusses the general issue of drug shortages, its implications for primary care pediatrics, and possible useful measures to address this problem at the international, national, and local levels.APPENDIX• Global geopolitical dimension of medicine shortageDrug shortages have taken on a global geopolitical dimension. The COVID-19 crisis has made the geopolitical dimension of drug shortages evident, highlighting the dependence of the European Union and the US on countries outside their borders for the production of active pharmaceutical ingredients (APIs) and drugs. According to information from the generic drug industry, China is a major producer of pharmaceutical inputs, particularly raw materials, intermediates, and APIs. The country is also considered by far the largest supplier of APIs or key intermediates for some essential drugs, such as analgesics (painkillers) or anti-infectives.• Challenges by new seasonal epidemiological featuresAn unusually rapid onset of the annual flu season, caused by respiratory syncytial virus, influenza A and B, and many other viruses, has created a surge in demand for prescribed amoxicillin and pain relievers that parents can purchase without a prescription. Because these epidemiological features were unexpected, they could not be predicted and the increase in demand could not be anticipated.• Medicines fall short in pediatric primary care.More than 86% of European hospital pharmacists are experiencing difficulties in sourcing different types of medicines, and 66% report this as a daily or weekly problem. These shortages in Europe involve originator drugs in 51.8% of cases, and while the percentage rises to about 60% if we include generic formulations.1Donnelly K.A. Zocchi M.S. Katy T.A. Fox E.R. Pines J.M. van den Anker J.N. et al.Prescription drug shortages: pediatric emergency and critical care medications.Pediatr Emerg Care. 2021; 37: e726-e731PubMed Google Scholar In particular, the prescription antibiotic amoxicillin is in short supply due to increased demand. Certain liquid formulations and suppositories of paracetamol (US: acetaminophen) and ibuprofen which are frequently recommended as fever-medicine and painkillers fall short in 26 European countries (as reported by the European Medicines Agency) and in the US.• Missing priority for pediatric medicine.Child-friendly medicines are neglected when measuring accessibility to medicines. There is no comprehensive overview of available data on children's medications. Children do not have a voice and cannot advocate for themselves by demanding more attention and investment in the production of children's medicines, which is currently limited probably because of limited earnings. Children need advocates on their behalf to obtain adequate data and improve access to child-friendly medicines.Tackling children's medicine shortage in primary care pediatrics:There is no magic solution to avoid the shortage of children's medicines in primary care. However, actions are needed to respond to the shortage at different international, national, and local levels with different stakeholders.• Actions expected by international organizations and agencies (European Commission, European Union, European Medicines Agency, World Health Organization).Ensure the production and supply of essential medicines for children in all countries. Proposed changes to European Union pharmaceutical law should include more stringent obligations for the supply of medicines and more timely notifications of shortages. Improve communications among different countries regarding medications supply and stock files to better balance between demand and supply• Actions expected by the national governments and public health authorities.Protection of children's health through improved monitoring of causes of drug shortages and consideration of new regulations and legislation to ensure sufficient production and supply of essential medicines for children in hospitals and primary pediatric care. Promotion of healthy lifestyle for children and adolescents. Assure the prevention of infections with public promotion of vaccines and nonpharmaceutical personal protection to interrupt transmissions.• Actions expected from the pharmaceutical industry.Avoid production shortages, which often recognize internal problems within pharmaceutical companies, and poor or temporary unavailability of distribution. Promote independent national production and storage of primary substances for essential drugs.• Actions expected by pharmacies.Improve frequent communication with prescribers and providers about available medications. Advise parents on over-the-counter medications and alternatives. Check in-store alternatives first if some products are not available. Improve promotion of the use of generic versions of brand-name products, which are perfectly safe and often a much more convenient option.• Actions expected of pediatricians.Ambulatory pediatric care providers must be advocates for the safety of patients and protect children from drug shortages. They must be aware of current shortages and implement mitigation strategies. Implementing resilience strategies. Avoid unnecessary treatment of fever and viral infections. In cases of nonsevere otitis media, upper respiratory tract infections, and sinusitis, waiting is an option. Patients will be satisfied if the reasons for forgoing antibiotic treatment are explained. If amoxicillin is indicated and liquid formulations are not available, prescribe drugs that have not been affected by the shortage, including amoxicillin in tablets, chewable tablets, or dispersible formulations that are able to take. When amoxicillin cannot be used, consider the following alternatives: amoxicillin/clavulanate. Avoid cephalosporins, as resistance problems are becoming more important. If antipyretics/analgesics are indicated, including acetaminophen, paracetamol, or ibuprofen, and liquid formulations are not available, prescribe tablets, chewable tablets, or dispersible formulations for children who are able to take these formulations. The latter have been affected by the shortage to a lesser extent. Consider prescribing alternative drugs. Advise parents and caregivers that most tablets can be split/shredded and capsules can be opened. Both can be mixed with any tasty liquid. Chewable tablets can also be divided. Consider using complementary and alternative medicine, when possible. Follow guidelines regarding judicious usage of antibiotics, antipyretics, and other medications• Actions expected from parents.Avoid wasting medicines (disposing medicines before their expiration date). Avoid pressuring doctors to prescribe antibiotics for minor illnesses. Strengthen the ability to cope with infectious symptoms. Use natural methods and medicine whenever it is safe, applicable, and advisable.ECPCP, European Confederation of Primary Care Pediatricians; EPA-UNEPSA, European Paediatric Association-Union of National European Paediatric Societies and Association. Open table in a new tab ECPCP, European Confederation of Primary Care Pediatricians; EPA-UNEPSA, European Paediatric Association-Union of National European Paediatric Societies and Association. Children are a particularly vulnerable patient group12Petito A. Pop T.L. Namazova-Baranova L. Mestrovic J. Nigri L. Vural M. et al.The burden of depression in adolescents and the importance of early recognition.J Pediatr. 2020; 218: 265-267.e1Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar with very limited pharmaceutical treatment options.12Petito A. Pop T.L. Namazova-Baranova L. Mestrovic J. Nigri L. Vural M. et al.The burden of depression in adolescents and the importance of early recognition.J Pediatr. 2020; 218: 265-267.e1Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar This limitation exposed them to adverse outcomes caused by shortages of essential medications. The European Confederation of Primary Care Pediatricians and European Paediatric Association/Union of European National Paediatric Societies and Associations emphasize the importance of ensuring optimal use of pediatric drugs in hospitals and ambulatory settings, through stock redistribution, consideration of alternative drugs, and optimization of pharmacy sales. Finally, the 2 societies jointly emphasize the dual need, on the one hand, to strengthen the EU production and supply resilience and, on the other hand, to increase price transparency and public funding for research and development.7European UnionREPORT on the shortage of medicines – how to address an emerging problem.https://www.europarl.europa.eu/doceo/document/A-9-2020-0142_EN.htmlDate accessed: February 8, 2023Google Scholar,9European UnionREPORT on EU options for improving access to medicines.https://www.europarl.europa.eu/doceo/document/A-8-2017-0040_EN.htmlDate accessed: February 8, 2023Google Scholar The authors declare no conflicts of interest.

Introduction: Inactivated polio virus (IPV) vaccinations are a mainstay of immunization schedules in developed countries, while oral polio vaccine (OPV) is administered in developing countries and is the main vaccine in outbreaks. Due to circulating wild poliovirus (WPV1) detection in Israel (2013), oral biva-lent polio vaccination (bOPV) was administered to IPV primed children and incorporated into the vacci-nation regimen.Objectives: We aimed to determine the extent and timeframe of fecal and salivary polio vaccine virus (Sabin strains) shedding following bOPV vaccination among IPV primed children.Methods: Fecal samples were collected from a convenience sample of infants and toddlers attending 11 Israeli daycare centers. Salivary samples were collected from infants and toddlers following bOPV vaccination.Results: 398 fecal samples were collected from 251 children (ages: 6-32 months), 168 received bOPV vaccination 4-55 days prior to sample collection. Fecal excretion continued among 80 %, 50 %, and 20 %, 2, 3, and 7 weeks following vaccination. There were no significant differences in the rate and duration of positive samples among children immunized with 3 or 4 IPV doses. Boys were 2.3-fold more likely to excrete the virus (p = 0.006). Salivary shedding of Sabin strains occurred in 1/47 (2 %) and 1/49 (2 %) sam-ples 4, and 6 days following vaccination respectively.Conclusions: Fecal detection of Sabin strains among IPV-primed children continues for 7 weeks; addi-tional doses of IPV do not augment intestinal immunity; limited salivary shedding occurs for up to a week. This data can enhance understanding of intestinal immunity achieved by different vaccination schedules and guide recommendations for contact precautions of children following bOPV vaccination.& COPY; 2023 Published by Elsevier Ltd.

he antibiotic amoxicillin is usually recommended as a first-line treatment for many common infections affecting children, including otitis, pneumonia, sinusitis, and strep throat. 1 It is an effective, relatively inexpensive drug that is available in generic formulations. 2For years, pediatricians have feared a major health crisis caused by the growing phenomenon of antibiotic resistance. 3Among the various causes, including unnecessary use of antibiotics in agriculture, poor sanitation practices, and poor infection control in hospitals and clinics, overuse and misuse of antibiotics in clinical practice have been recognized to be the main factors accelerating antibiotic resistance. 4However, antibiotic shortages have never been considered as a possible critical issue in public health and health care delivery.In particular, the unavailability of essential first-line antibiotics, such as amoxicillin, was considered a remote posibility. 5ontrary to these expectations, Authorities and Public Agencies in Europe and the US are now reporting shortages of amoxicillin, [6][7][8][9] raising concerns that one of the most widely used antibiotics for the treatment of various pediatric conditions 10,11 will be in short supply for the current winter season and for months to come.This commentary, jointly authored by members of French, Israel, and Italian Societies of Pediatrics, in collaboration with the Confederation of European Pediatricians and the European Pediatric Association/Union of European National Pediatric Societies and Associations, briefly outlines the current public health crisis caused by the shortage of amoxicillin, which exposes children to life-threatening conditions. 12The goal is to raise awareness among pediatricians, public health officials, and governments about the risks caused by prolonged drug shortages and particularly the unavailability of amoxicillin in Western countries and other areas of the world.

Background:Estimating real-world vaccine effectiveness is challenging as a variety of population factors can impact vaccine effectiveness. We aimed to assess the population-level reduction in cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, hospitalizations, and mortality due to the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination campaign in Israel during January-February 2021. Methods:A susceptible-infected-recovered/removed (SIR) model and a Dynamic Survival Analysis (DSA) statistical approach were used. Daily counts of individuals who tested positive and of vaccine doses administered, obtained from the Israeli Ministry of Health, were used to calibrate the model. The model was parameterized using values derived from a previous phase of the pandemic during which similar lockdown and other preventive measures were implemented in order to take into account the effect of these prevention measures on COVID-19 spread. Results:Our model predicted for the total population a reduction of 648 585 SARS-CoV-2 cases (75% confidence interval [CI], 25 877-1 396 963) during the first 2 months of the vaccination campaign. The number of averted hospitalizations for moderate to severe conditions was 16 101 (75% CI, 2010-33 035), and reduction of death was estimated at 5123 (75% CI, 388-10 815) fatalities. Among children aged 0-19 years, we estimated a reduction of 163 436 (75% CI, 0-433 233) SARS-CoV-2 cases, which we consider to be an indirect effect of the vaccine. Conclusions:Our results suggest that the rapid vaccination campaign prevented hundreds of thousands of new cases as well as thousands of hospitalizations and fatalities and has probably averted a major health care crisis.

After the World Health Organization declared pandemic status and implemented restrictive measures to counter the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there was a reduction in major pediatric diseases caused by common seasonal viruses.1Somekh I. Somech R. Pettoello-Mantovani M. Somekh E. Changes in routine pediatric practice in light of coronavirus 2019 (COVID-19).J Pediatr. 2020; 224: 190-193Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,2Cohen R. Pettoello-Mantovani M. Somekh E. Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immunity debt associated to coronavirus disease-2019 pandemic in children.J Pediatr. 2021; 242: 260-261.e3Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The typical increase in pediatric outpatient visits and workload in emergency departments and hospital wards that characterizes the winter season, usually dominated by respiratory syncytial virus (RSV) and influenza viruses, was not seen. Diseases such as bronchiolitis, asthma, and gastroenteritis, the protagonists of pediatric age, had drastically reduced or disappeared. This commentary, prepared by the Social Pediatrics Working Group of the European Association of Pediatrics, Union of National Pediatric Societies and Associations, reports and briefly discusses data from the literature and the impact of preventive measures, established in various countries to contain the coronavirus disease 2019 (COVID-19) pandemic, on the seasonal epidemiology of various pediatric infectious diseases. The purpose of the article is to raise awareness of this anthropogenic epidemiologic phenomenon and to emphasize the importance of being adequately trained to properly address this new challenge in their practice. Preventive measures taken to contain the COVID-19 pandemic have changed the spread of SARS-CoV-2 infection and also the predictable seasonal pattern of many endemic viral diseases in children.2Cohen R. Pettoello-Mantovani M. Somekh E. Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immunity debt associated to coronavirus disease-2019 pandemic in children.J Pediatr. 2021; 242: 260-261.e3Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Preventive measures have included the use of universal masks, school closures, travel restrictions, bans on mass gatherings, and other public health and physical removal measures to control COVID-19. Before 2020, outside tropical areas, RSV, and nonpandemic influenza viruses had their peak epidemic in winter in the Northern and Southern Hemispheres. In temperate climates, enteroviruses circulated from summer to fall, according to established cyclical and epidemiologic patterns.3Pons-Salort M. Oberste S. Pallansch M. Abedi G.R. Takahashi S. Grenfell B.T. et al.The seasonality of nonpolio enteroviruses in the United States: patterns and drivers.Proc Natl Acad Sci USA. 2018; 115: 3078-3083Crossref PubMed Scopus (69) Google Scholar The COVID-19 pandemic altered these patterns, and in many regions of the world, the usual circulation of these viruses was absent for more than a year only to reoccur unexpectedly.2Cohen R. Pettoello-Mantovani M. Somekh E. Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immunity debt associated to coronavirus disease-2019 pandemic in children.J Pediatr. 2021; 242: 260-261.e3Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar An unprecedented low incidence of respiratory viral infections4Weinberger Opek M. Yeshayahu Y. Glatman-Freedman A. Kaufman Z. Sorek N. Brosh-Nissimov T. Delayed respiratory syncytial virus epidemic in children after relaxation of COVID-19 physical distancing measures, Ashdod, Israel, 2021.Euro Surveill. 2021; 26: 2100706Crossref Scopus (68) Google Scholar,5Van Brusselen D. De Troeyer K. Ter Haar E. Vander Auwera A. Poschet K. Van Nuijs S. et al.Bronchiolitis in COVID-19 times: a nearly absent disease?.Eur J Pediatr. 2021; 180: 1969-1973Crossref PubMed Scopus (102) Google Scholar was recorded in 2020. Notably, there was no typical winter increase in RSV-related pediatric hospitalizations.4Weinberger Opek M. Yeshayahu Y. Glatman-Freedman A. Kaufman Z. Sorek N. Brosh-Nissimov T. Delayed respiratory syncytial virus epidemic in children after relaxation of COVID-19 physical distancing measures, Ashdod, Israel, 2021.Euro Surveill. 2021; 26: 2100706Crossref Scopus (68) Google Scholar,6Haapanen M. Renko M. Artama M. Kuitunen I. The impact of the lockdown and the re-opening of schools and day cares on the epidemiology of SARS-CoV-2 and other respiratory infections in children—a nationwide register study in Finland.EClinicalMedicine. 2021; 34: 100807Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar However, following the reduction in COVID-19 measures, an unseasonal increase in respiratory viral infections has been observed in many temperate areas of the world, such as in Europe and the United States, where climatic factors, including temperature, humidity, and ultraviolet radiation, may play a role in viral spread.7Nenna R. Matera L. Pierangeli A. Oliveto G. Viscido A. Petrarca L. et al.First COVID-19 lockdown resulted in most respiratory viruses disappearing among hospitalised children, with the exception of rhinoviruses.Acta Paediatr. 2022; 111: 1399-1403Crossref PubMed Scopus (10) Google Scholar In many European countries, there was a complete absence of RSV cases during the Fall/Winter of 202020/21, and a resurgence of interseasonal cases was observed during May-June 2021, with epidemic spikes affecting several age groups, including young children, particularly those from neighborhoods with lower socioeconomic status.4Weinberger Opek M. Yeshayahu Y. Glatman-Freedman A. Kaufman Z. Sorek N. Brosh-Nissimov T. Delayed respiratory syncytial virus epidemic in children after relaxation of COVID-19 physical distancing measures, Ashdod, Israel, 2021.Euro Surveill. 2021; 26: 2100706Crossref Scopus (68) Google Scholar,8Edwards K.M. The impact of social distancing for severe acute respiratory syndrome coronavirus 2 on respiratory syncytial virus and influenza burden.Clin Infect Dis. 2021; 72: 2076-2078Crossref PubMed Scopus (17) Google Scholar After the collapse of global influenza circulation in early 2020, unseasonal outbreaks of influenza A occurred in the Spring-Summer of 2022 in the Northern Hemisphere, although strain B remained absent.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar Enterovirus D68 infection, suspected of causing a polio-like illness called acute flaccid myelitis, did not occur in 2020; however, the virus reappeared in the fall of 2021 in Europe outside the expected 2-year cycles.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar Return patterns of these viral outbreaks have been heterogeneous among locations, populations, and among different pathogens, making any prediction difficult.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar Although many infections, and associated morbidity and mortality, were prevented by measures taken to prevent COVID-19 infection, this resulted in reduced exposure to endemic viruses and created an immune gap in susceptible groups of individuals who avoided infection and subsequent response to protect themselves from future infection.10Pettoello-Mantovani M. Carrasco-Sanz A. Huss G. Mestrovic J. Vural M. Pop T.L. et al.Viewpoint of the European Pediatric Societies over severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in children younger than age 12 years amid return to school and the surging virus variants.J Pediatr. 2021; 239: 250-251.e2PAbstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The decline in childhood vaccination that has occurred in some settings may have contributed to this immune gap for vaccine-preventable diseases such as influenza, measles, chickenpox, and, in some countries, polio.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar,10Pettoello-Mantovani M. Carrasco-Sanz A. Huss G. Mestrovic J. Vural M. Pop T.L. et al.Viewpoint of the European Pediatric Societies over severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in children younger than age 12 years amid return to school and the surging virus variants.J Pediatr. 2021; 239: 250-251.e2PAbstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The cumulative effect of new susceptible birth cohorts decreasing immunity over time with reduced exposure to common endemic viruses and delayed vaccination rates in some settings widen this immunity gap and increase the potential for future outbreaks of endemic viruses. The case of COVID-19 pandemic suggests that in the future, health services are likely to face unexpected nonseasonal epidemic outbreaks due to groups of more susceptible populations of children who are simultaneously exposed to multiple endemic viruses.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar The size and timing of outbreaks of specific pathogens are difficult to predict because they depend on many dynamic factors, including the seasonality and transmissibility of individual pathogens and the duration of preventive measures for containment, as in the case of COVID-19 infection. The imposition of public health preventive measures could have a great impact on the magnitude of future epidemics of endemic viral diseases in children and generate seasonal changes in immunity and host susceptibility of various infectious diseases.11Abuidhail J. Tamim F. Abdelrahman R.Y. Al-Shalabi E. Knowledge and practices of breastfeeding mothers towards prevention of the emerging corona virus (COVID-19).Global Pediatr. 2022; 2: 100024https://doi.org/10.1016/j.gpeds.2022.100024Crossref Google Scholar The unprecedented natural experiment that occurred during the COVID-19 pandemic may offer a unique research experience for understanding the dynamics of typical childhood viruses. The observed differences among pathogens could help elucidate the role of behavioral factors, climate, immunity, and, more generally, current lifestyle, in influencing the transmission of endemic infectious diseases among children.12Johannesen C.K. van Wijhe M. Tong S. Fernández L.V. Heikkinen T. van Boven M. et al.Age-specific estimates of respiratory syncytial virus-associated hospitalizations in 6 European countries: a time series analysis.J Infect Dis. 2022; 226: S29-S37Crossref PubMed Scopus (11) Google Scholar Another likely effect of the delay in circulation and the resulting immune gap could be a temporary change in the age distribution of viral infections, as susceptible children may be exposed for the first time to some infectious pathogens at a later age than in the past.12Johannesen C.K. van Wijhe M. Tong S. Fernández L.V. Heikkinen T. van Boven M. et al.Age-specific estimates of respiratory syncytial virus-associated hospitalizations in 6 European countries: a time series analysis.J Infect Dis. 2022; 226: S29-S37Crossref PubMed Scopus (11) Google Scholar In addition, decreased maternal exposure and immunity to common endemic viruses, resulting in a lack of transplacental antibodies transferred to the newborn, could make young children more vulnerable to infection.9Messacar K. Baker R.E. Park S.W. Nguyen-Tran H. Cataldi J.R. Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after Covid-19 pandemic disruption.Lancet. 2022; (in press)https://doi.org/10.1016/S0140-6736(22)01277-6Abstract Full Text Full Text PDF Scopus (18) Google Scholar In this regard, age-related differences in disease presentation are also likely to vary by pathogen. For example, the risk of severe RSV disease is greater in younger children, so delayed exposure might reduce the severity of disease in infants and even adults infected later in life,12Johannesen C.K. van Wijhe M. Tong S. Fernández L.V. Heikkinen T. van Boven M. et al.Age-specific estimates of respiratory syncytial virus-associated hospitalizations in 6 European countries: a time series analysis.J Infect Dis. 2022; 226: S29-S37Crossref PubMed Scopus (11) Google Scholar although young children, unprotected by maternal antibodies, might be more likely to develop more severe disease.11Abuidhail J. Tamim F. Abdelrahman R.Y. Al-Shalabi E. Knowledge and practices of breastfeeding mothers towards prevention of the emerging corona virus (COVID-19).Global Pediatr. 2022; 2: 100024https://doi.org/10.1016/j.gpeds.2022.100024Crossref Google Scholar In view of the possibility of a re-emergence of SARS-CoV-2 infection or further unexpected pandemics in the next years, public health authorities should raise awareness among community health workers about the need to ensure access to services and continuity of vaccination programs. Pediatricians should be informed so that they can adapt their diagnostic and reporting algorithms accordingly. This should be an integral part of the overall delivery of health care to their patients during new infectious emergencies. Ensuring continuity of routine immunization and addressing gaps in previous immunization history is an essential element of public health support during new pandemics. Surveillance systems should be strengthened by increasing the awareness of health workers to ensure that vaccine-preventable and other communicable diseases are detected appropriately despite a possible change in their typical epidemiologic patterns.

To examine and compare the medical burden of measles, influenza and COVID-19 outbreaks in the city of Bnei Brak, Israel. The study was conducted during 2018–2021. The numbers of hospitalisations for these infections and their complications were recorded. Hospitalisation rates were determined by using the number of children residing in Bnei Brak and hospitalised with these infections during the study period as the numerators. The denominators were the estimated paediatric cases of measles, influenza and COVID-19 in Bnei Brak and were calculated under both pragmatic and conservative assumptions. A total of 247, 65 and 32 children were hospitalised with influenza, COVID-19 and measles respectively. Complication rates were higher following measles than after influenza and SARS-CoV-2 infections. Hospitalisation rates were 10% for measles, 0.6%-1.2% for influenza and 0.15% - 0.25% for COVID-19 infections. Relative risks (RR) with 95% confidence intervals (CI) for hospitalisation following measles compared with COVID-19 ranged from 42 (26.3–67.3) to 70.1 (43.8–112.1), while the relative risks for influenza hospitalisation ranged from 2.5 (1.83–3.41) to 8.2 (6.0–11.2), compared with COVID-19 infection. Hospitalisation rates and direct medical burdens of measles and influenza were significantly higher than those of COVID-19 infection in children.