@article{AlchikhConradHoppeetal., author = {Alchikh, Maren and Conrad, Tim and Hoppe, Christian and Ma, Xiaolin and Broberg, Eeva K. and Penttinen, P. and Reiche, J. and Biere, Barbara and Schweiger, Brunhilde and Rath, Barbara}, title = {Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care. Clinical Microbiology and Infection}, series = {Clinical Microbiology and Infection}, journal = {Clinical Microbiology and Infection}, number = {06/18}, doi = {10.1016/j.cmi.2018.05.023}, pages = {1 -- 1}, language = {en} } @article{ObermeierHeimBiereetal., author = {Obermeier, Patrick and Heim, A. and Biere, Barbara and Hage, E. and Alchikh, Maren and Conrad, Tim and Schweiger, Brunhilde and Rath, Barbara}, title = {Clinical characteristics and disease severity associated with adenovirus infections in infants and children - discovery of a novel adenovirus, HAdV-D80}, series = {Clinical Infectious Diseases}, journal = {Clinical Infectious Diseases}, language = {en} } @article{ObermeierHeimBiereetal., author = {Obermeier, Patrick E and Heim, Albert and Biere, Barbara and Hage, Elias and Alchikh, Maren and Conrad, Tim and Schweiger, Brunhilde and Rath, Barbara A}, title = {Linking digital surveillance and in-depth virology to study clinical patterns of viral respiratory infections in vulnerable patient populations}, series = {iScience}, volume = {25}, journal = {iScience}, number = {5}, publisher = {Cell Press}, doi = {10.1016/j.isci.2022.104276}, abstract = {To improve the identification and management of viral respiratory infections, we established a clinical and virologic surveillance program for pediatric patients fulfilling pre-defined case criteria of influenza-like illness and viral respiratory infections. The program resulted in a cohort comprising 6,073 patients (56\% male, median age 1.6 years, range 0-18.8 years), where every patient was assessed with a validated disease severity score at the point-of-care using the ViVI ScoreApp. We used machine learning and agnostic feature selection to identify characteristic clinical patterns. We tested all patients for human adenoviruses, 571 (9\%) were positive. Adenovirus infections were particularly common and mild in children ≥1 month of age but rare and potentially severe in neonates: with lower airway involvement, disseminated disease, and a 50\% mortality rate (n = 2/4). In one fatal case, we discovered a novel virus …}, language = {en} } @article{AlchikhConradMaetal., author = {Alchikh, Maren and Conrad, Tim and Ma, Xiaolin and Broberg, Eeva K. and Penttinen, P. and Reiche, J. and Biere, Barbara and Schweiger, Brunhilde and Rath, Barbara and Hoppe, Christian}, title = {Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care}, series = {Clinical Microbiology and Infection}, volume = {25}, journal = {Clinical Microbiology and Infection}, number = {3}, issn = {1469-0691}, doi = {10.1016/j.cmi.2018.05.023}, pages = {380.e9 -- 380.e16}, language = {en} } @article{ConradKarschObermeieretal., author = {Conrad, Tim and Karsch, K. and Obermeier, Patrick and Seeber, L. and Chen, X. and Tief, Franziska and Muehlhans, S. and Hoppe, Christian and Boettcher, Sindy and Diedrich, S. and Rath, Barbara}, title = {Human Parechovirus Infections Associated with Seizures and Rash: A Syndromic Surveillance Study in Children}, series = {The Pediatric Infectious Disease Journal}, volume = {34}, journal = {The Pediatric Infectious Disease Journal}, number = {10}, language = {en} } @article{TiefHoppeSeeberetal., author = {Tief, Franziska and Hoppe, Christian and Seeber, L. and Obermeier, Patrick and Chen, X. and Karsch, K. and Muehlhans, S. and Adamou, E. and Conrad, Tim and Schweiger, Brunhilde and Adam, T. and Rath, Barbara}, title = {An inception cohort study assessing the role of bacterial co-infections in children with influenza and ILI and a clinical decision model for stringent antibiotic use}, series = {Antiviral Therapy}, volume = {21}, journal = {Antiviral Therapy}, doi = {10.3851/IMP3034}, pages = {413 -- 424}, abstract = {BACKGROUND: Influenza-like illness (ILI) is a common reason for paediatric consultations. Viral causes predominate, but antibiotics are used frequently. With regard to influenza, pneumococcal coinfections are considered major contributors to morbidity/mortality. METHODS: In the context of a perennial quality management (QM) programme at the Charit{\'e} Departments of Paediatrics and Microbiology in collaboration with the Robert Koch Institute, children aged 0-18 years presenting with signs and symptoms of ILI were followed from the time of initial presentation until hospital discharge (Charit{\'e} Influenza-Like Disease = ChILD Cohort). An independent QM team performed highly standardized clinical assessments using a disease severity score based on World Health Organization criteria for uncomplicated and complicated/progressive disease. Nasopharyngeal and pharyngeal samples were collected for viral reverse transcription polymerase chain reaction and bacterial culture/sensitivity and MaldiTOF analyses. The term 'detection' was used to denote any evidence of viral or bacterial pathogens in the (naso)pharyngeal cavity. With the ChILD Cohort data collected, a standard operating procedure (SOP) was created as a model system to reduce the inappropriate use of antibiotics in children with ILI. Monte Carlo simulations were performed to assess cost-effectiveness. RESULTS: Among 2,569 ChILD Cohort patients enrolled from 12/2010 to 04/2013 (55\\% male, mean age 3.2 years, range 0-18, 19\\% {\ensuremath{>}}5 years), 411 patients showed laboratory-confirmed influenza, with bacterial co-detection in 35\\%. Influenza and pneumococcus were detected simultaneously in 12/2,569 patients, with disease severity clearly below average. Pneumococcal vaccination rates were close to 90\\%. Nonetheless, every fifth patient was already on antibiotics upon presentation; new antibiotic prescriptions were issued in an additional 20\\%. Simulation of the model SOP in the same dataset revealed that the proposed decision model could have reduced the inappropriate use of antibiotics significantly (P{\ensuremath{<}}0.01) with an incremental cost-effectiveness ratio of -99.55?. CONCLUSIONS: Physicians should be made aware that in times of pneumococcal vaccination the prevalence and severity of influenza infections complicated by pneumococci may decline. Microbiological testing in combination with standardized disease severity assessments and review of vaccination records could be cost-effective, as well as promoting stringent use of antibiotics and a personalized approach to managing children with ILI.}, language = {en} } @article{ObermeierMuehlhansHoppeetal., author = {Obermeier, Patrick and Muehlhans, S. and Hoppe, Christian and Karsch, K. and Tief, Franziska and Seeber, L. and Chen, X. and Conrad, Tim and Boettcher, Sindy and Diedrich, S. and Rath, Barbara}, title = {Enabling Precision Medicine With Digital Case Classification at the Point-of-Care}, series = {EBioMedicine}, volume = {4}, journal = {EBioMedicine}, doi = {10.1016/j.ebiom.2016.01.008}, pages = {191 -- 196}, abstract = {Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM) are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool) is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010-06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years) entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.}, language = {en} } @article{MaConradAlchikhetal., author = {Ma, Xiaolin and Conrad, Tim and Alchikh, Maren and Reiche, J. and Schweiger, Brunhilde and Rath, Barbara}, title = {Can we distinguish respiratory viral infections based on clinical features? A prospective pediatric cohort compared to systematic literature review}, series = {Medical Virology}, volume = {28}, journal = {Medical Virology}, number = {5}, doi = {10.1002/rmv.1997}, pages = {1 -- 12}, abstract = {Studies have shown that the predictive value of "clinical diagnoses" of influenza and other respiratory viral infections is low, especially in children. In routine care, pediatricians often resort to clinical diagnoses, even in the absence of robust evidence-based criteria. We used a dual approach to identify clinical characteristics that may help to differentiate infections with common pathogens including influenza, respiratory syncytial virus, adenovirus, metapneumovirus, rhinovirus, bocavirus-1, coronaviruses, or parainfluenza virus: (a) systematic review and meta-analysis of 47 clinical studies published in Medline (June 1996 to March 2017, PROSPERO registration number: CRD42017059557) comprising 49 858 individuals and (b) data-driven analysis of an inception cohort of 6073 children with ILI (aged 0-18 years, 56\% male, December 2009 to March 2015) examined at the point of care in addition to blinded PCR testing. We determined pooled odds ratios for the literature analysis and compared these to odds ratios based on the clinical cohort dataset. This combined analysis suggested significant associations between influenza and fever or headache, as well as between respiratory syncytial virus infection and cough, dyspnea, and wheezing. Similarly, literature and cohort data agreed on significant associations between HMPV infection and cough, as well as adenovirus infection and fever. Importantly, none of the abovementioned features were unique to any particular pathogen but were also observed in association with other respiratory viruses. In summary, our "real-world" dataset confirmed published literature trends, but no individual feature allows any particular type of viral infection to be ruled in or ruled out. For the time being, laboratory confirmation remains essential. More research is needed to develop scientifically validated decision models to inform best practice guidelines and targeted diagnostic algorithms.}, language = {en} } @article{RathConradMylesetal., author = {Rath, Barbara and Conrad, Tim and Myles, Puja and Alchikh, Maren and Ma, Xiaolin and Hoppe, Christian and Tief, Franziska and Chen, Xi and Obermeier, Patrick and Kisler, Bron and Schweiger, Brunhilde}, title = {Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials}, series = {Expert Review of Anti-infective Therapy}, volume = {15}, journal = {Expert Review of Anti-infective Therapy}, number = {6}, doi = {10.1080/14787210.2017.1295847}, pages = {545 -- 568}, abstract = {Introduction: Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed. Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79). Expert commentary: The ViVI Score was correlated with risk of antibiotic use as well as need for hospitalization and intensive care. The ViVI Score was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.}, language = {en} } @article{ConradRathTiefetal., author = {Conrad, Tim and Rath, Barbara and Tief, Franziska and Karsch, K. and Muehlhans, S. and Obermeier, Patrick and Adamou, E. and Chen, X. and Seeber, L. and Peiser, Ch. and Hoppe, Christian and von Kleist, Max and Schweiger, Brunhilde}, title = {Towards a personalized approach to managing of influenza infections in infants and children - food for thought and a note on oseltamivir}, series = {Infectious Disorders - Drug Targets}, volume = {13}, journal = {Infectious Disorders - Drug Targets}, number = {1}, pages = {25 -- 33}, language = {en} } @article{SeeberConradHoppeetal., author = {Seeber, L. and Conrad, Tim and Hoppe, Christian and Obermeier, Patrick and Chen, X. and Karsch, K. and Muehlhans, S. and Tief, Franziska and Boettcher, Sindy and Diedrich, S. and Schweiger, Brunhilde and Rath, Barbara}, title = {Educating parents about the vaccination status of their children: A user-centered mobile application}, series = {Preventive Medicine Reports}, volume = {5}, journal = {Preventive Medicine Reports}, doi = {10.1016/j.pmedr.2017.01.002}, pages = {241 -- 250}, abstract = {Parents are often uncertain about the vaccination status of their children. In times of vaccine hesitancy, vaccination programs could benefit from active patient participation. The Vaccination App (VAccApp) was developed by the Vienna Vaccine Safety Initiative, enabling parents to learn about the vaccination status of their children, including 25 different routine, special indication and travel vaccines listed in the WHO Immunization Certificate of Vaccination (WHO-ICV). Between 2012 and 2014, the VAccApp was validated in a hospital-based quality management program in Berlin, Germany, in collaboration with the Robert Koch Institute. Parents of 178 children were asked to transfer the immunization data of their children from the WHO-ICV into the VAccApp. The respective WHO-ICV was photocopied for independent, professional data entry (gold standard). Demonstrating the status quo in vaccine information reporting, a Recall Group of 278 parents underwent structured interviews for verbal immunization histories, without the respective WHO-ICV. Only 9\% of the Recall Group were able to provide a complete vaccination status; on average 39\% of the questions were answered correctly. Using the WHO-ICV with the help of the VAccApp resulted in 62\% of parents providing a complete vaccination status; on average 95\% of the questions were answered correctly. After using the VAccApp, parents were more likely to remember key aspects of the vaccination history. User-friendly mobile applications empower parents to take a closer look at the vaccination record, thereby taking an active role in providing accurate vaccination histories. Parents may become motivated to ask informed questions and to keep vaccinations up-to-date.}, language = {en} } @article{RathYousefKatzensteinetal., author = {Rath, Barbara and Yousef, Kaveh and Katzenstein, D. and Shafer, R. and Sch{\"u}tte, Christof and von Kleist, Max and Merigan, T.}, title = {HIV-1 Evolution in Response to Triple Reverse Transcriptase Inhibitor Induced Selective Pressure in vitro}, series = {PLoS ONE}, volume = {8}, journal = {PLoS ONE}, number = {4}, publisher = {Public Library of Science}, doi = {10.1371/journal.pone.0061102}, pages = {e61102}, language = {en} }