Ville Peltola

Asthma and atopic dermatitis (AD) are common childhood inflammatory diseases linked to type 2 immune responses and early‐life environmental factors. Emerging evidence suggests that nasopharyngeal microbiota and immune‐regulatory cytokines may influence disease development. We investigated the association between plasma IL‐34, IL‐37, and IL‐38 levels at 24 months, nasopharyngeal bacterial colonization, and later asthma and eczema in a Finnish birth cohort ( n = 145). Children with persistent eczema at 13 and 24 months had lower IL‐37 levels than children without eczema ( p = 0.030). No associations were observed between cytokine levels and asthma at 7 years. Among children with nasopharyngeal culture data ( n = 35), those colonized at 24 months with at least one of the following bacterial species: Streptococcus pneumoniae , Moraxella catarrhalis , Staphylococcus aureus , or Haemophilus influenzae , were associated with significantly lower IL‐34 ( p = 0.015) and IL‐37 ( p = 0.006) levels. These findings suggest that IL‐34 and IL‐37 may be involved in immune responses associated with nasopharyngeal bacterial colonization and eczema during early childhood.

Background: Rhinoviruses (RV) are the most common pathogens causing respiratory tract infections, and early childhood RV wheezing illnesses are a known risk factor for childhood asthma. The role of acute upper respiratory tract infections (URTI) caused by different RV species in asthma development is not well known. Methods: We conducted a nested case‐control study in a birth cohort of 923 children followed prospectively from birth to age 7 years. Nasal swab samples collected during acute respiratory tract infections (ARI) at age 0–24 months were analyzed by PCR, and RV‐positive samples were genotyped. Each case with asthma at age 7 years was matched with three cohort children without asthma. Conditional logistic regression was used to test associations between RV wheezing illnesses or RV URTIs and asthma risk. Results: We identified 56 cases and 168 matched controls. In total, 807 RV‐positive samples were successfully classified. Wheezing illnesses caused by RV‐A and RV‐C at age 0–24 months were associated with an increased risk of asthma at age 7 years (for RV‐A, odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.05–2.43, p = 0.03; for RV‐C, OR: 1.66, 95% CI: 1.11–2.49, p = 0.01). RV‐A, RV‐B, or RV‐C positive URTIs were not associated with asthma risk. Conclusion: Both RV‐A and RV‐C ‐induced early wheezing illnesses were associated with an increased risk of childhood asthma. Acute URTIs caused by RV‐A, RV‐B, or RV‐C were not associated with asthma risk.

Finnish guidelines recommend antimicrobial treatment for acute otitis media (AOM), with both amoxicillin and amoxicillin-clavulanate as equally acceptable first-line treatment options. This study aimed to investigate in what proportion different antimicrobial agents are prescribed for children with AOM. Our hypothesis was that amoxicillin is the most frequently prescribed antimicrobial agent. This register-based cohort study included all children less than 16 years of age with a diagnosis of AOM in two Finnish hospitals in 2023. Data on children’s demographics, AOM symptoms, findings and treatment were collected individually from the patient charts. The primary outcome was the proportion of children who were prescribed amoxicillin, amoxicillin-clavulanate, or other antimicrobial agents for the treatment of AOM. The antimicrobial treatment choices and durations were compared between Turku and Vaasa and reported as percentage differences with 95% confidence intervals. A total of 1,240 children in Turku and 393 children in Vaasa were included in this study. Among these, 80.9% (1,003/1,240) and 80.7% (317/393) were prescribed amoxicillin for the treatment of AOM in Turku and Vaasa, respectively. Amoxicillin-clavulanate was the second most used antimicrobial treatment, prescribed to 10.1% (125/1,240) and 8.7% (34/393) of the children in Turku and Vaasa, respectively. Most of the children with AOM were prescribed a short 5-day course of treatment. Conclusion : A short 5-day course of amoxicillin was the most frequently prescribed antimicrobial treatment for children with AOM. The adherence to AOM guidelines appears to be high in the two hospitals studied. What is Known: • Amoxicillin and amoxicillin-clavulanate are recommended as first-line treatments for acute otitis media in Finland. • National data on real-world antibiotic choices have been limited. What is New: • Amoxicillin was the most frequently prescribed antibiotic in the two Finnish hospitals studied. • The most common treatment duration was a short 5-day course of treatment.

Background: Real‐time polymerase chain reaction (PCR), the gold standard for viral diagnostics in children, is a sensitive but resource‐intensive method. Viral antigen tests are cheaper and more rapid but have lower sensitivity. The clinical relevance of PCR positivity has been questioned because of its high sensitivity and detection in asymptomatic individuals. Thus, we hypothesized that antigen test positivity might be more indicative of active infection than PCR positivity. The aim of this study was to evaluate the antigen test mariPOC Respi test for the detection of 10 respiratory viruses versus PCR in relation to viral load, days of illness, and immunological viral response. Methods: Children 1–59 months old with lower respiratory infections were prospectively enrolled at the emergency department, Sachs′ Children and Youth Hospital, Stockholm, Sweden, between 2017 and 2019. Nasopharyngeal samples were collected from all cases ( n = 314). The sensitivity and specificity of the mariPOC Respi test were assessed in children with and without an immunological viral response (defined as a blood myxovirus resistance Protein A level > 430 μ g/L), using PCR as the reference standard. Results: The highest sensitivity for mariPOC Respi test was attained for respiratory syncytial virus (68%; 95% confidence interval: 63–73). Restricting the analysis to cases with a viral immunological response did not alter the results considerably. Conclusion: These findings do not support the idea that mariPOC Respi test positivity to a higher degree than PCR correlates with clinical relevance, as indicated by an immunological viral response. The role of antigen tests in current clinical practice requires further discussion, particularly in the post–pandemic era. Trial Registration: ClinicalTrials.gov identifier: NCT03233516

Objectives To investigate the associations of physical activity (PA) and sedentary behaviour in early childhood with asthma and reduced lung function in later childhood within a large collaborative study. Design Pooling of longitudinal data from collaborating birth cohorts using meta-analysis of separate cohort-specific estimates and analysis of individual participant data of all cohorts combined. Setting Children aged 0–18 years from 26 European birth cohorts. Participants 136 071 individual children from 26 cohorts, with information on PA and/or sedentary behaviour in early childhood and asthma assessment in later childhood. Main outcome measure Questionnaire-based current asthma and lung function measured by spirometry (forced expiratory volume in 1 s (FEV₁), FEV₁/forced vital capacity) at age 6–18 years. Results Questionnaire-based and accelerometry-based PA and sedentary behaviour at age 3–5 years was not associated with asthma at age 6–18 years (PA in hours/day adjusted OR 1.01, 95% CI 0.98 to 1.04; sedentary behaviour in hours/day adjusted OR 1.03, 95% CI 0.99 to 1.07). PA was not associated with lung function at any age. Analyses of sedentary behaviour and lung function showed inconsistent results. Conclusions Reduced PA and increased sedentary behaviour before 6 years of age were not associated with the presence of asthma later in childhood.

Prompt differentiation of viral from bacterial infections in febrile children is pivotal in reducing antibiotic overuse. Myxovirus resistance protein A (MxA) is a promising viral biomarker. We evaluated the accuracy of a point-of-care (POC) measurement for blood MxA level compared to the reference enzyme immunoassay in 228 febrile children aged between 4 weeks and 16 years, enrolled primarily at the emergency department (ED). Furthermore, we analyzed the ability of MxA to differentiate viral from bacterial infections. The mean difference between POC and reference MxA level was −76 µg/L (95% limits of agreement from −409 to 257 µg/L). Using a cutoff of 200 µg/L, POC results were uniform with the reference assay in 199 (87.3%) children. In ED-collected samples, the median POC MxA level was 571 (interquartile range [IQR], 240–955) µg/L in children with viral infections, 555 (IQR, 103–889) µg/L in children with viral-bacterial coinfections, and 25 (IQR, 25–54) µg/L in children with bacterial infections (P < .001). MxA cutoff of 101 µg/L differentiated between viral and bacterial infections with 92% sensitivity and 91% specificity. POC MxA measurement demonstrated acceptable analytical accuracy compared to the reference method, and good diagnostic accuracy as a biomarker for viral infections.

This study examined the predisposing factors, clinical picture, bacterial aetiology and clinical outcomes of infants and children with bacterial meningitis (BM). The medical records of patients under 16 years of age, treated by Turku University Hospital, Finland, from 2011 to 2018, were screened for meningitis using the International Classification of Diseases, Tenth Revision codes. Patients were included if bacteria were detected in cerebrospinal fluid (CSF) or other predefined laboratory variables indicated BM, despite CSF testing negative for bacteria. The Glasgow Outcome Scale (GOS) was used to determine outcomes. We identified 37 children with BM: 22 infants aged 0-89 days and 15 children aged 90 days to 15 years. The overall incidence was approximately 5.7/100 000/year. Nosocomial meningitis was documented in 51%. Bacterial growth was detected in the CSF or blood cultures of the majority of patients (57%). Escherichia coli (14%), group B streptococcus (11%) and Streptococcus pneumoniae (8%) were the most common pathogens. There were 14% of patients with unfavourable outcomes, namely GOS scores of 1-4, but no deaths. The incidence of paediatric BM was low during the study period, but the proportion of nosocomial meningitis was substantial. The frequency of unfavourable long-term outcomes was relatively low.

Enterovirus D68 Outbreak in Children, Finland, August–September 2022

Common health issues have been less examined in studies of early language development, particularly in relation to the child’s sex. Respiratory tract infections, often complicated by acute otitis media, are common in children during the first years of life, when early vocabulary development takes place. The present study, conducted in Finland, aimed to investigate whether possible associations between recurrent respiratory tract infections, background factors, and vocabulary growth differ in boys and girls aged 13 to 24 months. The participants (N = 462, 248 boys and 214 girls) were followed for respiratory tract infections and acute otitis media from 0 to 23 months of age. The parents completed daily symptom diaries of respiratory symptoms, physician visits, and diagnoses. The expressive vocabulary was measured with parental reports. We found that recurrent respiratory tract infections were not associated with slower vocabulary development in boys or girls. In fact, boys with recurrent respiratory tract infections had more vocabulary growth during the second year than boys who were less sick. We found that vocabulary growth was associated differently with respiratory tract infections and background factors as a function of the child’s sex. The vocabulary growth of boys seems to be more influenced by environmental factors than that of girls.