Papers by Vassiliki Papaevangelou
Journal of Virological Methods, Mar 1, 2012
Group A rotaviruses (RVs) are important pathogens that cause acute, dehydrating gastroenteritis i... more Group A rotaviruses (RVs) are important pathogens that cause acute, dehydrating gastroenteritis in infants and young children. In this study, a multiplex real-time polymerase chain reaction protocol using primers and TaqMan(®) probes specific for viral VP4 and VP7 genes was evaluated. This assay offers simultaneous genotyping and quantification of the most common RV genotypes G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8]. It was compared to the molecular typing results provided by conventional PCR. A total of 92 archived stool specimens obtained from children younger than 5 years old with the diagnosis of acute gastroenteritis were examined. Real-time PCR assay detected rotavirus strains among the most common genotype combinations G4P[8] (70.7%), G1P[8] (10.9%), G2P[4] (5.4%), G9P[8] (2.2%). This new assay described has an acceptable sensitivity (low limit 6.3×10(2)copies/g of stool).
The Journal of Pediatric Research
We present an adolescent girl with severe kyphoscoliosis and inability of walking due to progress... more We present an adolescent girl with severe kyphoscoliosis and inability of walking due to progressive pseudorheumatoid dysplasia (PPD) who was initially misdiagnosed as juvenile idiopathic arthritis for 9 years. The lack of inflammatory joint involvement and inflammatory laboratory parameters, along with the characteristic radiological findings should raise suspicion for PPD.
Children
The aim of the present study was to assess the psychological impact of hospitalization during the... more The aim of the present study was to assess the psychological impact of hospitalization during the COVID-19 pandemic on parents and their offspring. We performed a nationwide cross-sectional study in Greece based on an Internet questionnaire survey. A convenience sample of parents whose offspring had been hospitalized due to COVID-19 (including multisystem inflammatory syndrome in children, MIS-C), diagnosed with COVID-19 but not hospitalized, and hospitalized for another reason during the pandemic were enrolled. Parental stress was assessed using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale (IES-R) tools, and childhood mental wellbeing with the Children’s Revised Impact of Event 13 (CRIES-13) scale. Out of 214 received responses, stress levels were significantly higher in parents whose children had been admitted for COVID-19 or MIS-C versus those not admitted or admitted for other reasons (p < 0.001, for PSS/IES-R). Parental and childhood stress levels w...
European Journal of Pediatrics
School closures were enforced as measures to restrain the COVID-19 pandemic, based on the assumpt... more School closures were enforced as measures to restrain the COVID-19 pandemic, based on the assumption that young children may play a key role in SARS-CoV-2 spread. This study aims to determine the prevalence of SARS-CoV-2 IgG antibodies in children and corresponding parents, in order to improve surveillance and estimate the prevalence of asymptomatic or subclinical COVID-19 cases. A prospective multicenter study was conducted between March and June 2021 in Greece. Children admitted to the hospital or examined in outpatient clinics for reasons other than COVID-19 and their parents were tested for anti-Spike SARS-CoV-2 IgG in serum. A questionnaire about clinical and demographic data was completed. The study included 823 participants: 427 children and 396 corresponding parents. The overall seroprevalence was 16.4% in parents and 13.8% in children. Among families with ≥ 1 seropositive child or parent, the combination of a seropositive parent and a corresponding seronegative child was 29.6%, a seronegative parent and a corresponding seropositive child was 24.7%, and a seropositive child with a corresponding seropositive parent was 45.7%. Age, level of education, and school or work attendance were not significantly associated with increased seropositivity. On the contrary, ethnic minority of Roma, close contact with known COVID-19 case, previous symptoms consistent with COVID-19, and mass gatherings were risk factors for seropositivity. Conclusion: The spread of SARS-CoV-2 during a period of lockdown in Greece was low in children and comparable to adults most likely due to intrafamilial transmission. Accordingly, it is unlikely that children have boosted virus transmission. What is Known: • In the earliest months of the pandemic, it was demonstrated that children had significantly lower seroprevalence rates than the older age groups, due to the fact that children had decreased exposure to the virus, because of early public health interventions, such as school and day care closure. • Later, further studies reported that children have similar incidence rate of SARS-CoV-2 infection compared to adults in households and community settings. What is New: • In this seroprevalence study, the spread of SARS-CoV-2 infection during a period of lockdown in Greece with the predominance of the Alphavariant was particularly low in children and comparable to adults, most likely due to intrafamilial transmission. • These study findings will be useful for decisions regarding non-pharmaceutical interventions during the pandemic, and especially, to guide in designing and implementing appropriate containment measures for schools and social gatherings.
Frontiers in Immunology
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with a higher risk for severe morbidity and mortality when compared with infection in non-pregnant women of childbearing age. An increasing number of countries recommend immunization against SARS-CoV-2 in pregnant women. Recent studies provide preliminary and supportive evidence on safety, immunogenicity and effectiveness of coronavirus disease 2019 (COVID-19) vaccines in pregnant women; however, important knowledge gaps remain which warrant further studies. This collaborative consensus paper provides a review of the current literature on COVID-19 vaccines in pregnant women, identifies knowledge gaps and outlines priorities for future research to optimize protection against SARS-CoV-2 in the pregnant women and their infants.
Epidemiology and Infection, 2021
As most children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prese... more As most children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present with mild symptoms or they are asymptomatic, the optimal strategy for molecular testing it is not well defined. The aim of the study was to determine the extent and aetiology of molecular testing for SARS-CoV-2 in Greek paediatric departments during the first phase of the pandemic and identify possible differences in incidence, depending on the age group and geographical area. We conducted a nationwide study of molecular testing for SARS-CoV-2 of children in paediatric departments between March and June 2020. A total of 65 paediatric departments participated in the study, representing 4901 children who were tested for SARS-CoV-2 and 90 (1.8%) were positive. Most paediatric cases were associated with topical outbreaks. Adolescents 11–16 years had the highest positivity rate (3.6%) followed by children 6–10 years (1.9%). However, since the testing rate significantly differed between age...
Journal of Nuclear Medicine Technology, 2021
Rotor syndrome (RS) is a benign, inherited, commonly misdiagnosed cause of conjugated hyperbiliru... more Rotor syndrome (RS) is a benign, inherited, commonly misdiagnosed cause of conjugated hyperbilirubinemia whose identification prevents unnecessary invasive investigations. We present the case of a 3-y-old boy with phenotypic and laboratory findings of RS but negative genetic test results, whose diagnosis was confirmed by hepatobiliary scintigraphy.
Pediatric Allergy and Immunology, 2021
Background The maturation of innate immune responses in health and atopy is still incompletely un... more Background The maturation of innate immune responses in health and atopy is still incompletely understood. Methods We aimed to evaluate age-related trajectories of the TLR3 and TLR7/8 pathways across the lifespan and whether these differ between healthy and atopic individuals. Peripheral blood mononuclear cells (PBMCs) were isolated from 39 otherwise healthy atopic and 39 non-atopic subjects, aged 0-45 years. Selected cytokines involved in antiviral responses were measured by Luminex in culture supernatants of poly(I:C)-and R848-stimulated PBMCs. The non-parametric correlation between age and cytokine
The Lancet Child & Adolescent Health, 2021
Background Vancomycin is the most widely used antibiotic for neonatal Gram-positive sepsis, but c... more Background Vancomycin is the most widely used antibiotic for neonatal Gram-positive sepsis, but clinical outcome data of dosing strategies are lacking. The NeoVanc programme comprised extensive pre-clinical studies to inform an optimised vancomycin dosing randomised controlled trial (RCT). The primary objective was to compare the efficacy of an optimised regimen to a standard regimen in infants with late onset sepsis, known or suspected to be caused by Gram-positive microorganisms. Methods NeoVanc was an open-label, parallel, phase IIb, non-inferiority RCT comparing efficacy and toxicity of an "optimised" regimen of vancomycin to a "standard" regimen in infants 90 days. Infants with ≥3 clinical/laboratory sepsis criteria or confirmed Gram-positive sepsis with ≥1 clinical/laboratory criterion were enrolled from 22 neonatal intensive care units in 5 European countries. Randomisation was 1:1 to the optimised regimen (25mg/kg loading dose followed by 5±1 days of 15 mg/kg q12h or q8h dependent on postmenstrual age (PMA)) or standard regimen (no loading dose; a 10±2 day course at 15 mg/kg q24h, q12h, or q8h). The primary endpoint was successful outcome at end of vancomycin therapy (EVT) and no clinically/microbiologically significant relapse/new infection requiring anti-staphylococcal antibiotics within 10 days of EVT. Non-inferiority margin was-10%. Secondary endpoints included abnormal hearing screening. Recruitment stopped at 242 (120 optimised arm; 122 standard arm) infants; it was not possible to reach the sample size of 300 within remaining trial timelines. Trial registration: ClinicalTrials.gov (NCT02790996).
Human Vaccines & Immunotherapeutics, 2021
ABSTRACT Measles is an important vaccine preventable disease with significant morbidity and morta... more ABSTRACT Measles is an important vaccine preventable disease with significant morbidity and mortality. Although measles vaccine is a safe and effective vaccine available worldwide for more than 50 years, still immunization efforts have not successfully reached the WHO goal of 95% vaccination coverage. Hesitancy is especially increased amongst parents of children with chronic conditions. Contraindications for measles-containing vaccines are well defined and include history of anaphylactic reactions to neomycin, history of severe allergic reaction to previous vaccination, pregnancy, and severe immunosuppression. Concurrently, precautions for measles-containing vaccines include amongst other, history of thrombocytopenia or thrombocytopenic purpura and personal or family history of seizures of any etiology. This article aims to address misconceptions on measles vaccine safety and review data on adverse events among special groups of subjects at increased risk following measles immunization.
Frontiers in Allergy, 2021
Introduction:Acute bronchiolitis is one of the most common respiratory infections in infancy. Alt... more Introduction:Acute bronchiolitis is one of the most common respiratory infections in infancy. Although most infants with bronchiolitis do not get hospitalized, infants with hospitalized bronchiolitis are more likely to develop wheeze exacerbations during the first years of life. The objective of this prospective cohort study was to develop machine learning models to predict incidence and persistence of wheeze exacerbations following the first hospitalized episode of acute bronchiolitis.Methods:One hundred thirty-one otherwise healthy term infants hospitalized with the first episode of bronchiolitis at a tertiary pediatric hospital in Athens, Greece, and 73 age-matched controls were recruited. All patients/controls were followed up for 3 years with 6-monthly telephone reviews. Through principal component analysis (PCA), a cluster model was used to describe main outcomes. Associations between virus type and the clusters and between virus type and other clinical characteristics and dem...
JCR: Journal of Clinical Rheumatology, 2020
To the Editor: P STPIP1-associated myeloid-related proteinemia inflammatory syndrome (PAMI) is an... more To the Editor: P STPIP1-associated myeloid-related proteinemia inflammatory syndrome (PAMI) is an autoinflammatory condition associated with mutations in the PSTPIP1 gene that encodes the proline-serine-threonine phosphatase-interactive protein 1. Mutations of the gene were first described in patients diagnosed with PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum, acne), whereas later an association with other related phenotypes called PSTPIP1-associated inflammatory disease (PAID) was revealed. PSTPIP1-associated myeloid-related proteinemia inflammatory syndrome is a PAID and is characterized by hyperzincemia, extremely high levels of serum calprotectin (MRP 8/14 or S100A8/9), features of systemic chronic inflammation, pancytopenia, hepatosplenomegaly, and failure to thrive. Following the initial description of the syndrome in 2015, very few cases are reported in the literature since. We report the case of a 16-year-old female patient with PAMI, which developed macrophage activation syndrome following treatment with colchicine.
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
COVID-19 pandemic has raised questions on pregnant women and newborns' management. Guidelines, is... more COVID-19 pandemic has raised questions on pregnant women and newborns' management. Guidelines, issued by most international agencies and national bodies, recommend rooming-in and direct breastfeeding. In the early days of this pandemic, breastfeeding practices have been challenged by fear among both parents and healthcare workers occasionally resulting in mother-newborn separation. We herein review current breastfeeding guidelines and discuss remaining questions and challenges. As we are facing the second wave of this pandemic, more information is gathered, especially regarding possible virus transmissibility through breastfeeding, enabling more definite instructions about breastfeeding practices.
Clinical Rheumatology, 2020
Case presentation A 15-year-old female was referred with forehead lesions starting 3 months befor... more Case presentation A 15-year-old female was referred with forehead lesions starting 3 months before, initially treated as acne. She was also suffering from recurrent otitis media, treated with 3 courses of antibiotics over the last 45 days. Four weeks ago, she was admitted to another institution with symptoms of arthralgias, myalgias, and low-grade fever up to 37.8°C. Her physical exam revealed ulcerative lesions of the forehead (Fig. 1) and pre-auricular area bilaterally, muscle tenderness, hemorrhagic lesions of the nasal mucosa, aphthous ulcers of the buccal mucosa, gum hemorrhagic lesions, right side perforated tympanic membrane, and otorrhea. No sinusitis, rhinitis, or chronic cough was ever reported. Blood pressure was 115/78 mmHg. Chest X-ray revealed nodular lesions and CT chest confirmed the presence of 2 large nodular lesions up to 1.5 cm of diameter as well as multiple smaller nodules (Fig. 2). The paranasal sinuses imaging revealed mastoid cells, sphenoid sinus, and the ethmoid cells filled with secretions, with demineralization of the septations of the latter. Forehead skin lesion biopsy revealed ulcerative lesions with fibroinflammatory exudate and granulomatous reaction of the dermis, but no lesions suggestive of vasculitis. Blood testing revealed WBC 11360/μL (Ne
Background Measles outbreaks constitute considerable healthcare burden and pose significant risk ... more Background Measles outbreaks constitute considerable healthcare burden and pose significant risk for unvaccinated children due to underlying medical conditions. In Greece we have been facing a measles outbreak since May 2017, involving more than 2700 cases (www.keelpno.gr). Highest frequency has been observed among unvaccinated Roma children (60.2%) and partially vaccinated adolescents and young adults (78.8% of cases in general population). Measles vaccination is recommended for outbreak control. Our aim is to present a small case series of previously unvaccinated children with underlying severe neurologic disease who were vaccinated during the measles outbreak over the past 12 months and to describe vaccination associated adverse effects.
SAGE Open Medicine, 2018
Objective: Measurement of salivary biomarkers can provide important information regarding hypotha... more Objective: Measurement of salivary biomarkers can provide important information regarding hypothalamic–pituitary–adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit. Methods: We enrolled 79 pediatric intensive care unit patients (2–14 years) over a 2-year period, which satisfy the including criteria, but finally salivary biomarkers were evaluated in 65 patients. Saliva samples were collected within 24 h of admission at 8 a.m., 2 p.m. and 8 p.m. to examine potential disruption of circadian rhythm. Results: Overall, the salivary biomarkers were increased; specifically, medi...
Journal of Hospital Infection, 2018
Background: Healthcare-associated infections (HCAIs) are associated with increased morbidity and ... more Background: Healthcare-associated infections (HCAIs) are associated with increased morbidity and mortality and with excess costs. Central line-associated bloodstream infections (CLABSIs) are the most common HCAIs in neonates and children. Aim: To establish national benchmark data for rates of CLABSI in neonatal and paediatric intensive care units (NICUs and PICUs) and paediatric oncology units (ONCs). Methods: Active surveillance for CLABSI was conducted from June 2016 to February 2017. A collaborative of 14 NICUs, four PICUs, and six ONCs participated in the programme. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the Centers for Disease Control and Prevention's 2014 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL-days, patient-days, and susceptibility of isolated organisms. Findings: A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL-days, and the CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs, and 2.78 per 1000 CL-days in ONCs. A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%), followed by Grampositive cocci (29%), non-fermenting Gram-negative bacteria (16%), and fungi (16%). Overall, 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and 37% to carbapenems.
Allergologia et Immunopathologia, 2018
Aim: To prospectively evaluate interferences between viruses of the upper respiratory tract in as... more Aim: To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children. Methods: Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses. Results: Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52-54.75, p = 0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14-14.16, p = 0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10-12.14, p = 0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02-16.05, p = 0.046). No other significant associations between viruses were observed. Conclusion: Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear.
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Papers by Vassiliki Papaevangelou