Associate Professor Marieke van der Zalm
| Call | Senior Fellowship Plus (SFP) |
| Programme | EDCTP2 |
| Start Date | 2021-01-01 |
| End Date | 2025-12-31 |
| Project Code | TMA2019SFP2836 |
| Status | Active |
Title
The long-term consequences of pulmonary tuberculosis and respiratory viruses on lung health in young South African children
Objectives
The overarching goal of the TB-lung FACT2 project is to improve our current understanding of the long-term impact of PTB and other LRTIs on lung health in children living in resource-limited settings.
Host Organisation
| Institution | Country |
|---|---|
| Stellenbosch University | South Africa |
Study Design
Prospective observational cohort study
Sites
| Mozambique, Manhica |
Students Supervised
| Type | Name | Title | University | Start Date | End Date |
|---|---|---|---|---|---|
| PhD | Michaile Anthony | Stellenbosch University, South Africa | 2021 | ||
| MSc | Ingrid Courtney | Stellenbosch University, South Africa | 2021 | ||
| MSc | Ruan Swanenpoel | Central University of Technology, South Africa | 2022 | ||
| MPhil | Nelson Daniel | Dr | University of Cambridge | 2022 | 2023 |
| Call | Career Development Fellowship (CDF) |
| Programme | EDCTP2 |
| Start Date | 2017-07-01 |
| End Date | 2020-12-31 |
| Project Code | TMA2015CDF1012 |
| Status | Completed |
Title
The impact of pulmonary tuberculosis and other lower respiratory tract pathogens on lung function in young South African children
Objectives
To investigate the effect of TB, TB/ HIV co-infection and other common respiratory pathogens on lung function in young children.
Host Organisation
| Institution | Country |
|---|---|
| Stellenbosch University (SU) | South Africa |
Study Design
Prospective observational cohort study of children with suspected pulmonary TB including healthy controls
Sites
| Desmond Tutu TB Center Stellenbosch University, South Africa |
Phd Study
| Title | University | Start Date | End Date |
|---|---|---|---|
| the role of respiratory viruses in respiratory illnesses early in life | University of Utrecht, the Netherlands | 2005-08-01 | 2010-12-05 |
Students Supervised
| Type | Name | Title | University | Start Date | End Date |
|---|---|---|---|---|---|
| MSc | Bianca Hamman | University of Stellenbosch | 2017 | 2020 | |
| BSc | Ruan Swanenpoel | Central University of Technology | 2018 | 2019 | |
| PhD | Michaile Anthony | University of Stellenbosch | 01-01-2021 | 31-12-2024 | |
| MSc | Ingrid Courtney | University of Stellenbosch | 01-07-2020 | 31-12-2021 |
Results & Outcomes
In progress- data expected to come out July 2020
Publications
| doi: 10.1016/S1473-3099(19)30564-X. |
| doi: 10.5588/ijtld.19.0115. |
| doi: 10.1097/INF.0000000000002240. |
| doi: 10.1128/JCM.00781-18. |
| doi: 10.1128/JCM.00056-18. |
| doi: 10.1186/s13063-018-2608-5. |
| doi: 10.1093/cid/cix834. |
| DOI: 10.1093/cid/ciab018 |
| DOI: 10.1186/s12879-020-05653-9 |
| in press |
| DOI: 10.1093/cid/ciaa1666 |
| DOI: 10.1159/000512531 |
| DOI: 10.1080/17476348.2021.1828069 |
| doi: 10.1097/INF.0000000000002900 |
| doi:10.1002/ppul.25015 |
| DOI: 10.1136/bmjgh-2020-002844 |
| DOI: 10.5588/ijtld.20.0067 |
| doi: 10.2196/19154. |
| DOI: 10.1093/cid/ciab142 |
Current Organisation
Stellenbosch University, Desmond Tutu TB Centre
Current Job Title
Paediatrician and Clinical researcher
Awards
| 2018 | South African MRC Researcher Initiated grant |
| 2019 | Subcontract of NIH award for Influenza study |
| 2020 | NIH R01: Multiplexed Antigen-Specific Antibody Fc Profiling on a Chip for Point-of-Care Diagnosis of TB in HIV-infected Children |
| 2020 | NIH K43 Emerging Global leader award |
| 2020 | Stellenbosch University SEED funding for COVID-kids South Africa |
| 2021 | NIH R21/ R33: Development and implementation of pediatric mobile phone reflectance pulse oximeters and a hypoxemia surveillance system in South Africa |
| 2021 | Horizon Europe- co-investigator on VERDI- project |
| 2022 | South African MRC Researcher Initiated grant: The long-term consequences of SARS-CoV-2 on lung health in young South African children |
| 2021 | Subcontract of NIH award for Influenza/ SARS-CoV-2 study |
| 2021 | Administrative supplement NIH-K43 for SARS-CoV-2 work |
Students Supervised
| Type | Name | Title | University | Start Date | End Date |
|---|---|---|---|---|---|
| Masters | Bianca Hamman | Stellenbosch University | 2017 | 2020 | |
| Bachelor Technology | Ruan Swanenpoel | Central University of Technology | 2018 | 2019 | |
| Masters | Ingrid Courtney | Stellenbosch University | 2020 | 2022 | |
| PhD | Michaile Anthony | Stellenbosch University | 2020 | 2024 | |
| PhD | Deephti Abraham | Dr | Stellenbosch University | 2022 | 2025 |
| MPhil | Nelson Daniel | Dr | University of Cambridge | 2022 | 2023 |
| MPhil | RC Krause | Dr | Stellenbosch University | 2022 | 2023 |
Memberships
| Role | Committee/board | Start Date | End Date |
|---|---|---|---|
| Paediatric advisor | National TB think tank, South Africa | 2019 | |
| Member | Post TB working group, Union | 2019 | |
| Member | Child and adolescent TB working group, WHO | 2018 | |
| Associate editor | BMC pulmonology | 2019 |
Education
| Institution | Degree | Year |
|---|---|---|
| University of Utrecht, Netherlands | MD | 2005-08-01 |
| University Of Utrecht, Netherlands | MSc epidemiology | 2009-10-01 |
| University Of Utrecht, Netherlands | PhD | 2009-12-05 |
Areas Of Specialisation
Tuberculosis (TB) Lower Respiratory Tract Infections (LRTIs)
Grants
Grant Code:
1R21TW012212-01
Source of funding:
NIH
Amount:
208030
Role:
Researcher
Start Date:
2021-01-01
End Date:
2023-01-01
Grant Code:
OPP1212276
Source of funding:
Bill and Melinda Gates Foundation
Amount:
199948
Role:
Researcher
Start Date:
2019-01-01
End Date:
2020-01-01
Grant Code:
Subcontract to NIH (through University of the Western Cape)
Source of funding:
NIH
Amount:
100000
Role:
Principal Investigator
Start Date:
2019-01-01
End Date:
2021-01-01
Grant Code:
101103283
Source of funding:
European and Developing Countries Clinical Trials Partnership (EDCTP)
Amount:
5000000
Role:
Researcher
Start Date:
2023-01-01
End Date:
2028-01-01
Grant Code:
Subaward to 1R25TW011217-01
Source of funding:
NIH
Amount:
5000
Role:
Researcher
Start Date:
2020-01-01
End Date:
2021-01-01
Grant Code:
TMA2019SFP
Source of funding:
European and Developing Countries Clinical Trials Partnership (EDCTP)
Amount:
749825
Role:
Principal Investigator
Start Date:
2021-01-01
End Date:
2025-01-01
Grant Code:
552767
Source of funding:
South African Medical Research Council
Amount:
38500
Role:
Principal Investigator
Start Date:
2018-01-01
End Date:
2021-01-01
Grant Code:
VERDI
Source of funding:
European Union
Amount:
10000000
Role:
Researcher
Start Date:
2021-01-01
End Date:
2026-01-01
Grant Code:
K43TW011028
Source of funding:
NIH
Amount:
550000
Role:
Principal Investigator
Start Date:
2020-01-01
End Date:
2025-01-01
Grant Code:
None- Stellenbosch University SEED funding
Source of funding:
Stellenbosch University
Amount:
6000
Role:
Principal Investigator
Start Date:
2020-01-01
End Date:
2021-01-01
Grant Code:
1R01AI152158-01
Source of funding:
NIH
Amount:
1400000
Role:
Principal Investigator
Start Date:
2020-01-01
End Date:
2025-01-01
Publications
Authors:
Van Der Zalm, M.M.
Van Soelen, N.
Mandalakas, A.M.
Jacobsen, M.
Detjen, A.K.
Marx, F.M.
Grewal, H.M.S.
Cotton, M.F.
Walzl, G.
Hesseling, A.C.
Van Soelen, N.
Mandalakas, A.M.
Jacobsen, M.
Detjen, A.K.
Marx, F.M.
Grewal, H.M.S.
Cotton, M.F.
Walzl, G.
Hesseling, A.C.
Date:
2016-01-01
Journal:
Pediatric Infectious Disease Journal
Content:
Authors:
James A Seddon
Date:
2021-02-25
Journal:
Lancet Infectious Diseases
Content:
Background People who survive tuberculosis face clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. To describe the size of this issue, we aimed to estimate the number of individuals who developed first-episode tuberculosis between 1980 and 2019, the number who survived to 2020, and the number who have been treated within the past 5 years or 2 years.
Methods In this modelling study, we estimated the number of people who survived treated tuberculosis using country-level WHO data on tuberculosis case notifications, excluding those who died during treatment. We estimated the number of individuals surviving untreated tuberculosis using the difference between WHO country-level incidence estimates and notifications, applying published age-stratified and HIV-stratified case fatality ratios. To estimate survival with time, post-tuberculosis life tables were developed for each country-year by use of UN World Population Prospects 2019 mortality rates and published post-tuberculosis mortality hazard ratios.
Findings Between 1980 and 2019, we estimate that 363 million people (95% uncertainty interval [UI] 287 million–438 million) developed tuberculosis, of whom 172 million (169 million–174 million) were treated. Individuals who developed tuberculosis between 1980 and 2019 had lived 3480 million life-years (95% UI 3040 million–3920 million) after tuberculosis by 2020, with survivors younger than 15 years at the time of tuberculosis development contributing 12% (95% UI 7–17) of these life-years. We estimate that 155 million tuberculosis survivors (95% UI 138 million–171 million) were alive in 2020, the largest proportion (47% [37–57]) of whom were in the WHO South-East Asia region. Of the tuberculosis survivors who were alive in 2020, we estimate that 18% (95% UI 16–20) were treated in the past 5 years and 8% (7–9) were treated in the past 2 years.
Interpretation The number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors.
Authors:
Walters, E.
Scott, L.
Nabeta, P.
Demers, A.-M.
Reubenson, G.
Bosch, C.
David, A.
Van Der Zalm, M.
Havumaki, J.
Palmer, M.
Hesseling, A.C.
Ncayiyana, J.
Stevens, W.
Alland, D.
Denkinger, C.
Banada, P.
Scott, L.
Nabeta, P.
Demers, A.-M.
Reubenson, G.
Bosch, C.
David, A.
Van Der Zalm, M.
Havumaki, J.
Palmer, M.
Hesseling, A.C.
Ncayiyana, J.
Stevens, W.
Alland, D.
Denkinger, C.
Banada, P.
Date:
2018-01-01
Journal:
Journal of Clinical Microbiology
Content:
Authors:
Geerts, C.C.
Grobbee, D.E.
Van Der Ent, C.K.
De Jong, B.M.
Van Der Zalm, M.M.
Van Putte-Katier, N.
Kimpen, J.L.L.
Uiterwaal, C.S.P.M.
Grobbee, D.E.
Van Der Ent, C.K.
De Jong, B.M.
Van Der Zalm, M.M.
Van Putte-Katier, N.
Kimpen, J.L.L.
Uiterwaal, C.S.P.M.
Date:
2007-01-01
Journal:
Hypertension
Content:
Authors:
Van Der Zalm, M.M.
Rossen, J.W.A.
Van Ewijk, B.E.
Wilbrink, B.
Van Esch, P.C.H.M.
Wolfs, T.F.W.
Van Der Ent, C.K.
Rossen, J.W.A.
Van Ewijk, B.E.
Wilbrink, B.
Van Esch, P.C.H.M.
Wolfs, T.F.W.
Van Der Ent, C.K.
Date:
2008-01-01
Journal:
Emerging Infectious Diseases
Content:
Authors:
van der Zalm, M.M.
van Ewijk, B.E.
Wilbrink, B.
Uiterwaal, C.S.P.M.
Wolfs, T.F.W.
van der Ent, C.K.
van Ewijk, B.E.
Wilbrink, B.
Uiterwaal, C.S.P.M.
Wolfs, T.F.W.
van der Ent, C.K.
Date:
2009-01-01
Journal:
Journal of Pediatrics
Content:
Authors:
Date:
2021-01-05
Journal:
Respiration
Content:
Authors:
Date:
2021-01-15
Journal:
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Content:
Background
Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate more children on antituberculosis treatment.Methods
We analyzed data from a prospective cohort of children <13 years being routinely evaluated for pulmonary tuberculosis in Cape Town, South Africa from March 2012 to November 2017. We developed a regression model to describe the contributions of baseline clinical evaluation to the diagnosis of tuberculosis using standardized, retrospective case definitions. We included results from baseline chest radiography and Xpert MTB/RIF to the model to develop an algorithm with at least 90% sensitivity in predicting tuberculosis.Results
Data from 478 children being evaluated for pulmonary tuberculosis were analyzed (median age: 16.2 months, interquartile range: 9.8-30.9); 242 (50.6%) were retrospectively classified with tuberculosis, of which 104 (43.0%) were bacteriologically-confirmed. The area under the receiver operating characteristic curve for the final model was 0.87. Clinical evidence identified 71.4% of all tuberculosis cases in this cohort, and inclusion of baseline chest radiography results increased the proportion to 89.3%. The algorithm was 90.1% sensitive and 52.1% specific, and maintained a sensitivity of above 90% among children <2 years or with low weight-for-age.Conclusions
Clinical evidence alone was sufficient to make most clinical antituberculosis treatment decisions. The use of evidence-based algorithms may improve decentralized, rapid treatment-initiation, reducing the global burden of childhood mortality.Authors:
Date:
2021-02-01
Journal:
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Content:
Authors:
Marieke M van der Zalm
Date:
2022-12-21
Journal:
Public Health Action
Content:
BACKGROUND:
There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers’ perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB.
METHODS:
This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers’ perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding.
RESULTS:
Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child’s symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children’s early developmental milestones and future schooling.
CONCLUSION:
This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.
Authors:
Date:
2021-03-01
Journal:
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Content:
Authors:
Date:
2018-02-01
Journal:
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Content:
Background:Vaccination of human immunodeficiency virus (HIV)-infected infants with bacille Calmette-Guérin (BCG) is contraindicated. HIV-exposed newborns need a new tuberculosis vaccination strategy that protects against tuberculosis early in life and avoids the potential risk of BCG disease until after HIV infection has been excluded. Methods:This double-blind, randomized, controlled trial compared newborn MVA85A prime vaccination (1 × 108 PFU) vs Candin® control, followed by selective, deferred BCG vaccination at age 8 weeks for HIV-uninfected infants and 12 months follow-up for safety and immunogenicity. Results:A total of 248 HIV-exposed infants were enrolled. More frequent mild-moderate reactogenicity events were seen after newborn MVA85A vaccination. However, no significant difference was observed in the rate of severe or serious adverse events, HIV acquisition (n = 1 per arm), or incident tuberculosis disease (n = 5 MVA85A; n = 3 control) compared to the control arm. MVA85A vaccination induced modest but significantly higher Ag85A-specific interferon gamma (IFNγ)+ CD4+ T cells compared to control at weeks 4 and 8 (P < .0001). BCG did not further boost this response in MVA85A vaccinees. The BCG-induced Ag85A-specific IFNγ+ CD4+ T-cell response at weeks 16 and 52 was of similar magnitude in the control arm compared to the MVA85A arm at all time points. Proliferative capacity, functional profiles, and memory phenotype of BCG-specific CD4 responses were similar across study arms. Conclusions:MVA85A prime vaccination of HIV-exposed newborns was safe and induced an early modest antigen-specific immune response that did not interfere with, or enhance, immunogenicity of subsequent BCG vaccination. New protein-subunit and viral-vectored tuberculosis vaccine candidates should be tested in HIV-exposed newborns. Clinical Trials Registration:NCT01650389.
Authors:
Chabala, C.
Turkova, A.
Thomason, M.J.
Wobudeya, E.
Hissar, S.
Mave, V.
van der Zalm, M.
Palmer, M.
Kapasa, M.
Bhavani, P.K.
Balaji, S.
Raichur, P.A.
Demers, A.-M.
Hoddinott, G.
Owen-Powell, E.
Kinikar, A.
Musoke, P.
Mulenga, V.
Aarnoutse, R.
McIlleron, H.
Hesseling, A.
Crook, A.M.
Cotton, M.
Gibb, D.M.
Turkova, A.
Thomason, M.J.
Wobudeya, E.
Hissar, S.
Mave, V.
van der Zalm, M.
Palmer, M.
Kapasa, M.
Bhavani, P.K.
Balaji, S.
Raichur, P.A.
Demers, A.-M.
Hoddinott, G.
Owen-Powell, E.
Kinikar, A.
Musoke, P.
Mulenga, V.
Aarnoutse, R.
McIlleron, H.
Hesseling, A.
Crook, A.M.
Cotton, M.
Gibb, D.M.
Date:
2018-01-01
Journal:
Trials
Content:
Authors:
James A Seddon
, author
Sarah Johnson , author
Megan Palmer , author
Marieke M van der Zalm , author
Elisa Lopez-Varela , author
Jennifer Hughes , author
H Simon Schaaf , author
Sarah Johnson , author
Megan Palmer , author
Marieke M van der Zalm , author
Elisa Lopez-Varela , author
Jennifer Hughes , author
H Simon Schaaf , author
Date:
2021-02-01
Journal:
Expert Review of Respiratory Medicine
Content:
Authors:
De Jong, B.M.
Van Der Ent, C.K.
Van Putte Katier, N.
Van Der Zalm, M.M.
Verheij, T.J.M.
Kimpen, J.L.L.
Numans, M.E.
Uiterwaal, C.S.P.M.
Van Der Ent, C.K.
Van Putte Katier, N.
Van Der Zalm, M.M.
Verheij, T.J.M.
Kimpen, J.L.L.
Numans, M.E.
Uiterwaal, C.S.P.M.
Date:
2007-01-01
Journal:
Medical Care
Content:
Authors:
Date:
2022-09-29
Journal:
Clin Infect Dis
Content:
Introduction: The chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features that had high specificity for, and were strongly associated with, bacteriologically confirmed TB.
Methods: We analyzed CR data from children with presumptive intrathoracic TB prospectively enrolled in a cohort study in a high-TB burden setting and who were classified using standard clinical case definitions as "confirmed," "unconfirmed," or "unlikely" TB. We report the CR features and inter-reader agreement between expert readers who interpreted the CRs. We calculated the sensitivity and specificity of the CR features with at least moderate inter-reader agreement and analyzed the relationship between these CR features and the classification of TB in a multivariable regression model.
Results: Of features with at least moderate inter-reader agreement, enlargement of perihilar and/or paratracheal lymph nodes, bronchial deviation/compression, cavities, expansile pneumonia, and pleural effusion had a specificity of > 90% for confirmed TB, compared with unlikely TB. Enlargement of perihilar (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI], 3.80-11.72) and/or paratracheal lymph nodes (aOR: 5.14; 95% CI, 2.25-12.58), bronchial deviation/compression (aOR: 6.22; 95% CI, 2.70-15.69), pleural effusion (aOR: 2.27; 95% CI, 1.04-4.78), and cavities (aOR: 7.45; 95% CI, 3.38-17.45) were associated with confirmed TB in the multivariate regression model, whereas alveolar opacification (aOR: 1.16; 95% CI, .76-1.77) and expansile pneumonia (aOR: 4.16; 95% CI, .93-22.34) were not.
Conclusions: In children investigated for intrathoracic TB enlargement of perihilar or paratracheal lymph nodes, bronchial compression/deviation, pleural effusion, or cavities on CR strongly support the diagnosis.
Authors:
van Ewijk, B.E.
van der Zalm, M.M.
Wolfs, T.F.W.
van der Ent, C.K.
van der Zalm, M.M.
Wolfs, T.F.W.
van der Ent, C.K.
Date:
2005-01-01
Journal:
Journal of Cystic Fibrosis
Content:
Authors:
Van Ewijk, B.E.
Van Der Zalm, M.M.
Wolfs, T.F.W.
Fleer, A.
Kimpen, J.L.L.
Wilbrink, B.
Van Der Ent, C.K.
Van Der Zalm, M.M.
Wolfs, T.F.W.
Fleer, A.
Kimpen, J.L.L.
Wilbrink, B.
Van Der Ent, C.K.
Date:
2008-01-01
Journal:
Pediatrics
Content:
Authors:
Date:
2021-02-13
Journal:
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Content:
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of SARS-CoV-2 infection among children and adolescents; however, these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of COVID-19 among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and co-infections such as HIV, tuberculosis, malaria, sickle cell disease and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policymaking for COVID-19, while concurrently addressing other major diseases affecting children in African countries.
Authors:
Van Der Gugten, A.C.
Van Der Zalm, M.M.
Uiterwaal, C.S.P.M.
Wilbrink, B.
Rossen, J.W.A.
Van Der Ent, C.K.
Van Der Zalm, M.M.
Uiterwaal, C.S.P.M.
Wilbrink, B.
Rossen, J.W.A.
Van Der Ent, C.K.
Date:
2013-01-01
Journal:
Pediatric Infectious Disease Journal
Content:
Authors:
Walters, E.
Van Der Zalm, M.M.
Palmer, M.
Bosch, C.
Demers, A.-M.
Draper, H.
Goussard, P.
Schaaf, H.S.
Friedrich, S.O.
Whitelaw, A.
Warren, R.
Gie, R.P.
Hesseling, A.C.
Van Der Zalm, M.M.
Palmer, M.
Bosch, C.
Demers, A.-M.
Draper, H.
Goussard, P.
Schaaf, H.S.
Friedrich, S.O.
Whitelaw, A.
Warren, R.
Gie, R.P.
Hesseling, A.C.
Date:
2017-01-01
Journal:
Pediatric Infectious Disease Journal
Content:
Authors:
Liezl Smit
, author
Andrew Redfern , author
Sadia Murray , author
Juanita Lishman , author
Marieke M. van der Zalm , author
Gert van Zyl , author
Lilly M. Verhagen , author
Corné de Vos , author
Helena Rabie , author
Annemarie Dyk , author
Mathilda Claassen , author
Jantjie Taljaard , author
Marina Aucamp , author
Angela Dramowski , author
Andrew Redfern , author
Sadia Murray , author
Juanita Lishman , author
Marieke M. van der Zalm , author
Gert van Zyl , author
Lilly M. Verhagen , author
Corné de Vos , author
Helena Rabie , author
Annemarie Dyk , author
Mathilda Claassen , author
Jantjie Taljaard , author
Marina Aucamp , author
Angela Dramowski , author
Date:
2022-09-01
Journal:
African Journal of Emergency Medicine
Content:
Authors:
Walters, E.
Demers, A.-M.
van der Zalm, M.M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Gie, R.P.
Hesseling, A.C.
Demers, A.-M.
van der Zalm, M.M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Gie, R.P.
Hesseling, A.C.
Date:
2018-01-01
Journal:
Journal of Clinical Microbiology
Content:
Authors:
Date:
2021-04-05
Journal:
Pediatric pulmonology
Content:
Introduction
Bronchoscopy can be a useful tool in children with pulmonary tuberculosis (PTB) with severe disease potentially requiring intervention or in the face of diagnostic dilemmas. The aim of this study was to determine the value of Xpert MTB/RIF assay (Xpert) on bronchoalveolar lavage (BAL) samples in children with complicated PTB.Methods
Retrospective analysis of children with clinically diagnosed PTB, who underwent routine bronchoscopy over a five year period at a large referral hospital. BAL and other respiratory samples were tested by microscopy, culture and Xpert. We explored whether clinical, radiographic and bronchoscopy findings, and duration of antituberculosis treatment were associated with bacteriological confirmation.Results
112/146 (76.7%) children (median age 16 months) were on antituberculosis treatment for a median of 10 days at the time of bronchoscopy. Overall, bacteriological confirmation was achieved in 115 (78.7%), with 101 (69.2%) detected on BAL. Of those bacteriologically confirmed on BAL, 61.4% were positive by both Xpert and culture, 34.7% only by Xpert and 3.9% only by culture. Sensitivity and specificity of Xpert compared to culture on BAL samples for children not on antituberculosis treatment were 94.1% (95% CI 71.3, 99.8) and 68.7% (95% CI 41.3, 89.0), respectively.Conclusions
In children undergoing bronchoscopy for complicated PTB, Xpert testing of BAL had a high diagnostic yield in children already on antituberculosis treatment. Bronchoscopy should be considered if non-invasive respiratory specimens fail to confirm complicated TB. This article is protected by copyright. All rights reserved.Authors:
Date:
2020-11-10
Journal:
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Content:
BACKGROUND:Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related disease, but little is known about children living in settings with high tuberculosis and HIV burden. This study reflects clinical data on South African children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS:We collected clinical data of children aged younger than 13 years with laboratory confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town between 17th of April and 24th of July 2020. RESULTS:Hundred and fifty-nine children (median age 48·0 months (interquartile range, IQR 12·0-106·0)) were included. Hospitalized children (n=62), median age of 13·5 months (IQR 1·8-43·5) were younger than children not admitted (n=97), median age 81·0 months (IQR 34·5-120·5, p< 0·01). Thirty-three of 159 (20·8%) children had pre-existing medical conditions. Fifty-one of 62 (82·3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21/51 (41·2%) and 11/16 (68·8%) children younger than 3 months of age. Respiratory support was required in 25/51 (49·0%) children; 13/25 (52·0%) children were younger than 3 months. One child was HIV infected and 11/51 (21·2%) were HIV exposed uninfected and 7/51 (13·7%) children had a recent or new diagnosis of tuberculosis. CONCLUSION:Children less than 1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support, the access to oxygen may be limited in some LMICs which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis and SARS-CoV-2 should be explored.
Authors:
MM van der Zalm
, Swanepoel J, Zimri K, van der Zalm MM, Hoddinott G, Palmer M, Doruyter A, De Beer G, Kleynhans L, Johnson SM, Jongen V, Wademan D, Mcimeli K, Jacobs S, Swanepoel R, Van Zyl G, Allwood BW, Malherbe S, Heuvelings C, Griffith-Richards S, Whittaker E, Moore DAJ, Schaaf HS, Hesseling AC, Seddon JA.
Date:
2022-12-20
Journal:
BMJ Open
Content:
Introduction: A considerable burden of the tuberculosis (TB) epidemic is found in adolescents. The reasons for increased susceptibility to TB infection and higher incidence of TB disease in adolescence, compared with the 5-10 years old age group, are incompletely understood. Despite the pressing clinical and public health need to better understand and address adolescent TB, research in this field remains limited.
Methods and analysis: Teen TB is an ongoing prospective observational cohort study that aims to better understand the biology, morbidity and social context of adolescent TB. The study plans to recruit 50 adolescents (10-19 years old) with newly diagnosed microbiologically confirmed pulmonary TB disease and 50 TB-exposed controls without evidence of TB disease in Cape Town, South Africa, which is highly endemic for TB. At baseline, cases and controls will undergo a detailed clinical evaluation, chest imaging, respiratory function assessments and blood collection for viral coinfections, inflammatory cytokines and pubertal hormone testing. At 2 weeks, 2 months and 12 months, TB disease cases will undergo further chest imaging and additional lung function testing to explore the patterns of respiratory abnormalities. At week 2, cases will complete a multicomponent quantitative questionnaire about psychological and social impacts on their experiences and longitudinal, in-depth qualitative data will be collected from a nested subsample of 20 cases and their families.
Ethics and dissemination: The study protocol has received ethical approval from the Stellenbosch University Health Research Ethics Committee (N19/10/148). The study findings will be disseminated through peer-reviewed publications, academic conferences and formal presentations to health professionals. Results will also be made available to participants and caregivers.
Authors:
van de Pol, A.C.
van der Zalm, M.M.
Jansen, N.J.G.
van der Ent, C.K.
van Loon, A.M.
Kimpen, J.L.L.
Rossen, J.W.A.
Rovers, M.M.
Wolfs, T.F.W.
van der Zalm, M.M.
Jansen, N.J.G.
van der Ent, C.K.
van Loon, A.M.
Kimpen, J.L.L.
Rossen, J.W.A.
Rovers, M.M.
Wolfs, T.F.W.
Date:
2010-01-01
Journal:
Current Respiratory Medicine Reviews
Content:
Authors:
Allwood, B.
van der Zalm, M.
Makanda, G.
Mortimer, K.
Andre F.S., A.
Uzochukwu, E.
Denise, E.
Diane, G.
Graeme, H.
Olena, I.
Rupert, J.
Florian M., M.
Jamilah, M.
Stellah, M.
Sanne, V.K.
Andrea, R.
Ingrid, S.
Cari, S.
Dalene, V.D.
Naomi, W.
Robert, W.
van der Zalm, M.
Makanda, G.
Mortimer, K.
Andre F.S., A.
Uzochukwu, E.
Denise, E.
Diane, G.
Graeme, H.
Olena, I.
Rupert, J.
Florian M., M.
Jamilah, M.
Stellah, M.
Sanne, V.K.
Andrea, R.
Ingrid, S.
Cari, S.
Dalene, V.D.
Naomi, W.
Robert, W.
Date:
2019-01-01
Journal:
The Lancet Infectious Diseases
Content:
Authors:
Date:
2020-08-01
Journal:
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Content:
ALTHOUGH CURABLE, TB frequently leaves the individual with chronic physical and psycho-social impairment, but these consequences have been largely neglected. The 1st International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to discuss priorities and gaps in addressing this issue. A barrier to progress has been the varied terminology and nomenclature, so the Delphi process was used to achieve consensus on definitions. Lack of sufficient evidence hampered definitive recommendations in most domains, including prevention and treatment of post-TB lung disease (PTLD), but the discussions clarified the research needed. A consensus was reached on a toolkit for future PTLD measurement and on PTLD patterns to be considered. The importance of extra-pulmonary consequences and progressive impairment throughout the life-course was identified, including TB recurrence and increased mortality. Patient advocates emphasised the need to address the psychological and social impacts post TB and called for clinical guidance. More generally, there is an urgent need for increased awareness and research into post-TB complications.
Authors:
van der Zalm, M.M.
Uiterwaal, C.S.P.M.
de Jong, B.M.
Wilbrink, B.
van der Ent, C.K.
Uiterwaal, C.S.P.M.
de Jong, B.M.
Wilbrink, B.
van der Ent, C.K.
Date:
2006-01-01
Journal:
Journal of Allergy and Clinical Immunology
Content:
Authors:
van der Zalm, M.M.
Wilbrink, B.
van Ewijk, B.E.
Overduin, P.
Wolfs, T.F.W.
van der Ent, C.K.
Wilbrink, B.
van Ewijk, B.E.
Overduin, P.
Wolfs, T.F.W.
van der Ent, C.K.
Date:
2011-01-01
Journal:
Journal of Clinical Virology
Content:
Authors:
MM van der Zalm
Date:
2022-12-01
Journal:
Pediatr Infect Dis J
Content:
The effects of SARS-CoV-2 variants on disease phenotype and severity of multisystem inflammatory syndrome in children (MIS-C) are unknown. We compared the clinical phenotype of MIS-C in 129 South African children across four distinct (Ancestral type, Beta, Delta, and Omicron) variant-driven waves and found that MIS-C remains a severe disease with a stable clinical presentation, regardless of variant.
Authors:
MM van der Zalm
Date:
2022-04-25
Journal:
Afr J Emerg Med
Content:
Background: Identification of SARS-CoV-2 infected individuals is imperative to prevent hospital transmission, but symptom-based screening may fail to identify asymptomatic/mildly symptomatic infectious children and their caregivers.
Methods: A COVID-19 period prevalence study was conducted between 13 and 26 August 2020 at Tygerberg Hospital, testing all children and their accompanying asymptomatic caregivers after initial symptom screening. One nasopharyngeal swab was submitted for SARS-CoV-2 using real-time reverse-transcription polymerase chain reaction (rRT-PCR). An additional Respiratory Viral 16-multiplex rRT-PCR test was simultaneously done in children presenting with symptoms compatible with possible SARS-CoV-2 infection.
Results: SARS-Co-V 2 RT-PCR tests from 196 children and 116 caregivers were included in the analysis. The SARS-CoV-2 period prevalence in children was 5.6% (11/196) versus 15.5% (18/116) in asymptomatic caregivers (p<0.01). Presenting symptoms did not correlate with SARS-CoV-2 test positivity; children without typical symptoms of SARS-CoV-2 were more likely to be positive than those with typical symptoms (10.2% [10/99] vs 1% [1/97]; p<0.01). Children with typical symptoms (97/196; 49.5%) mainly presented with acute respiratory (68/97; 70.1%), fever (17/97; 17.5%), or gastro-intestinal complaints (12/97; 12.4%); Human Rhinovirus (23/81; 28.4%) and Respiratory Syncytial Virus (18/81; 22.2%) were frequently identified in this group. Children-caregiver pairs' SARS-CoV-2 tests were discordant in 83.3%; 15/18 infected caregivers' children tested negative. Symptom-based COVID-19 screening alone would have missed 90% of the positive children and 100% of asymptomatic but positive caregivers.
Conclusion: Given the poor correlation between SARS-CoV-2 symptoms and RT-PCR test positivity, universal testing of children and their accompanying caregivers should be considered for emergency and inpatient paediatric admissions during high COVID-19 community transmission periods. Universal PPE and optimising ventilation is likely the most effective way to control transmission of respiratory viral infections, including SARS-CoV-2, where universal testing is not feasible. In these settings, repeated point prevalence studies may be useful to inform local testing and cohorting strategies.
Authors:
Walters, E.
Van Der Zalm, M.M.
Demers, A.-M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Schaaf, H.S.
Goussard, P.
Lombard, C.J.
Gie, R.P.
Hesseling, A.C.
Van Der Zalm, M.M.
Demers, A.-M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Schaaf, H.S.
Goussard, P.
Lombard, C.J.
Gie, R.P.
Hesseling, A.C.
Date:
2019-01-01
Journal:
Pediatric Infectious Disease Journal
Content:
Authors:
Walters, E.
Demers, A.-M.
Van Der Zalm, M.M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Gie, R.P.
Hesseling, A.C.
Demers, A.-M.
Van Der Zalm, M.M.
Whitelaw, A.
Palmer, M.
Bosch, C.
Draper, H.R.
Gie, R.P.
Hesseling, A.C.
Date:
2017-01-01
Journal:
Journal of Clinical Microbiology
Content:
Authors:
Date:
2021-02-25
Journal:
The Lancet. Infectious diseases
Content:
Background
People who survive tuberculosis face clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. To describe the size of this issue, we aimed to estimate the number of individuals who developed first-episode tuberculosis between 1980 and 2019, the number who survived to 2020, and the number who have been treated within the past 5 years or 2 years.Methods
In this modelling study, we estimated the number of people who survived treated tuberculosis using country-level WHO data on tuberculosis case notifications, excluding those who died during treatment. We estimated the number of individuals surviving untreated tuberculosis using the difference between WHO country-level incidence estimates and notifications, applying published age-stratified and HIV-stratified case fatality ratios. To estimate survival with time, post-tuberculosis life tables were developed for each country-year by use of UN World Population Prospects 2019 mortality rates and published post-tuberculosis mortality hazard ratios.Findings
Between 1980 and 2019, we estimate that 363 million people (95% uncertainty interval [UI] 287 million-438 million) developed tuberculosis, of whom 172 million (169 million-174 million) were treated. Individuals who developed tuberculosis between 1980 and 2019 had lived 3480 million life-years (95% UI 3040 million-3920 million) after tuberculosis by 2020, with survivors younger than 15 years at the time of tuberculosis development contributing 12% (95% UI 7-17) of these life-years. We estimate that 155 million tuberculosis survivors (95% UI 138 million-171 million) were alive in 2020, the largest proportion (47% [37-57]) of whom were in the WHO South-East Asia region. Of the tuberculosis survivors who were alive in 2020, we estimate that 18% (95% UI 16-20) were treated in the past 5 years and 8% (7-9) were treated in the past 2 years.Interpretation
The number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors.Funding
UK Medical Research Council, the UK Department for International Development, the National Institute for Health Research, and the European and Developing Countries Clinical Trials Partnership.Authors:
Date:
2020-12-04
Journal:
BMC infectious diseases
Content:
Background: The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up.
Methods: In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8.
Results: Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0-48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8.
Conclusions: We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
Methods: In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8.
Results: Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0-48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8.
Conclusions: We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
Authors:
Van Der Zalm, M.M.
Van Soelen, N.
Mandalakas, A.M.
Jacobsen, M.
Detjen, A.K.
Marx, F.M.
Grewal, H.M.S.
Cotton, M.F.
Walzl, G.
Hesseling, A.C.
Van Soelen, N.
Mandalakas, A.M.
Jacobsen, M.
Detjen, A.K.
Marx, F.M.
Grewal, H.M.S.
Cotton, M.F.
Walzl, G.
Hesseling, A.C.
Date:
2017-01-01
Journal:
Pediatric Infectious Disease Journal
Content:
Authors:
Date:
2020-11-11
Journal:
JMIR mHealth and uHealth
Content:
Tuberculosis is the number one infectious cause of death globally. Young children, generally those younger than 5 years, are at the highest risk of progressing from tuberculosis infection to tuberculosis disease and of developing the most severe forms of tuberculosis. Most current tuberculosis drug formulations have poor acceptability among children and require consistent adherence for prolonged periods of time. These challenges complicate children's adherence to treatment and caregivers' daily administration of the drugs. Rapid developments in mobile technologies and apps present opportunities for using widely available technology to support national tuberculosis programs and patient treatment adherence. Pilot studies have demonstrated that mobile apps are a feasible and acceptable means of enhancing children's treatment adherence for other chronic conditions. Despite this, no mobile apps that aim to promote adherence to tuberculosis treatment have been developed for children. In this paper, we draw on our experiences carrying out research in clinical pediatric tuberculosis studies in South Africa. We present hypothetical scenarios of children's adherence to tuberculosis medication to suggest priorities for behavioral and educational strategies that a mobile app could incorporate to address some of the adherence support gaps faced by children diagnosed with tuberculosis. We argue that a mobile app has the potential to lessen some of the negative experiences that children associate with taking tuberculosis treatment and to facilitate a more positive treatment adherence experience for children and their caregivers.
Authors:
de Jong, B.M.
van der Ent, C.K.
van der Zalm, M.M.
van Putte-Katier, N.
Verheij, T.J.M.
Kimpen, J.L.L.
Uiterwaal, C.S.P.M.
van der Ent, C.K.
van der Zalm, M.M.
van Putte-Katier, N.
Verheij, T.J.M.
Kimpen, J.L.L.
Uiterwaal, C.S.P.M.
Date:
2009-01-01
Journal:
Pharmacoepidemiology and Drug Safety
Content:
Authors:
Van Der Zalm, M.M.
Uiterwaal, C.S.P.M.
Wilbrink, B.
Koopman, M.
Verheij, T.J.M.
Van Der Ent, C.K.
Uiterwaal, C.S.P.M.
Wilbrink, B.
Koopman, M.
Verheij, T.J.M.
Van Der Ent, C.K.
Date:
2011-01-01
Journal:
American Journal of Respiratory and Critical Care Medicine
Content:
Authors:
Wademan, D.T.
Busakwe, L.
Nicholson, T.J.
Van Der Zalm, M.
Palmer, M.
Workman, J.
Turkova, A.
Crook, A.M.
Thomason, J.
Gibb, D.M.
Seeley, J.
Hesseling, A.
Hoddinott, G.
Busakwe, L.
Nicholson, T.J.
Van Der Zalm, M.
Palmer, M.
Workman, J.
Turkova, A.
Crook, A.M.
Thomason, J.
Gibb, D.M.
Seeley, J.
Hesseling, A.
Hoddinott, G.
Date:
2019-01-01
Journal:
International Journal of Tuberculosis and Lung Disease
Content:
Authors:
Bartels, M.
van der Zalm, M.M.
van Oirschot, B.A.
Lee, F.S.
Giles, R.H.
Kruip, M.J.H.A.
Gitz-Francois, J.J.J.M.
Van Solinge, W.W.
Bierings, M.
van Wijk, R.
van der Zalm, M.M.
van Oirschot, B.A.
Lee, F.S.
Giles, R.H.
Kruip, M.J.H.A.
Gitz-Francois, J.J.J.M.
Van Solinge, W.W.
Bierings, M.
van Wijk, R.
Date:
2015-01-01
Journal:
Human Mutation
Content:
Authors:
Ahmed, S.
Mvalo, T.
Akech, S.
Agweyu, A.
Baker, K.
Bar-Zeev, N.
Campbell, H.
Checkley, W.
Chisti, M.J.
Colbourn, T.
Cunningham, S.
Duke, T.
English, M.
Falade, A.G.
Fancourt, N.S.S.
Ginsburg, A.S.
Graham, H.R.
Gray, D.M.
Gupta, M.
Hammitt, L.
Hesseling, A.C.
Hooli, S.
Johnson, A.-W.B.R.
King, C.
Kirby, M.A.
Lanata, C.F.
Lufesi, N.
MacKenzie, G.A.
McCracken, J.P.
Moschovis, P.P.
Nair, H.
Oviawe, O.
Pomat, W.S.
Santosham, M.
Seddon, J.A.
Thahane, L.K.
Wahl, B.
Van Der Zalm, M.
Verwey, C.
Yoshida, L.-M.
Zar, H.J.
Howie, S.R.C.
McCollum, E.D.
Mvalo, T.
Akech, S.
Agweyu, A.
Baker, K.
Bar-Zeev, N.
Campbell, H.
Checkley, W.
Chisti, M.J.
Colbourn, T.
Cunningham, S.
Duke, T.
English, M.
Falade, A.G.
Fancourt, N.S.S.
Ginsburg, A.S.
Graham, H.R.
Gray, D.M.
Gupta, M.
Hammitt, L.
Hesseling, A.C.
Hooli, S.
Johnson, A.-W.B.R.
King, C.
Kirby, M.A.
Lanata, C.F.
Lufesi, N.
MacKenzie, G.A.
McCracken, J.P.
Moschovis, P.P.
Nair, H.
Oviawe, O.
Pomat, W.S.
Santosham, M.
Seddon, J.A.
Thahane, L.K.
Wahl, B.
Van Der Zalm, M.
Verwey, C.
Yoshida, L.-M.
Zar, H.J.
Howie, S.R.C.
McCollum, E.D.
Date:
2020-01-01
Journal:
BMJ Global Health
Content:
Authors:
Date:
2020-08-07
Journal:
Pediatric pulmonology
Content:
INTRODUCTION:The coronavirus disease-2019 (COVID-19) era is a challenging time for respiratory teams to protect their patients and staff. COVID-19 is predominantly transmitted by respiratory droplets; in the clinical setting, aerosol generating procedures pose the greatest risk for COVID-19 transmission. Bronchoscopy is associated with increased risk of patient-to-health care worker transmission, owing to aerosolized viral particles which may be inhaled and also result in environmental contamination of surfaces. METHODS:We describe our experience with the use of modified full-face snorkeling masks for pediatric bronchoscopy procedures in four COVID-19 infected children when filtering facepieces/respirators were in limited supply. RESULTS:Bronchoscopy was urgently required in four children, and could not be delayed until COVID-19 test results were available. During the pandemic peak, when respirators were in short supply, modified full-face snorkel masks (SEAC Libera, SEAC, Italy) were worn by the bronchoscopy team. Each mask was fitted with an O-ring, adapter, and heat and moisture exchanger filter. To date, there have been no COVID-19 infections among the bronchoscopy team staff, whereas the overall Hospital staff COVID-19 prevalence rate has exceeded 13.5% (667/4949). CONCLUSION:Emergency bronchoscopy procedures on COVID-19 infected patients or patients with unknown infection status can be safely performed using modified full-face snorkel masks.
Authors:
Van Der Zalm, M.M.
Uiterwaal, C.S.P.M.
Wilbrink, B.
De Jong, B.M.
Verheij, T.J.M.
Kimpen, J.L.L.
Van Der Ent, C.K.
Uiterwaal, C.S.P.M.
Wilbrink, B.
De Jong, B.M.
Verheij, T.J.M.
Kimpen, J.L.L.
Van Der Ent, C.K.
Date:
2009-01-01
Journal:
Pediatric Infectious Disease Journal
Content: