SUNScholar - Browsing by Author "Seddon, J. A."

Browsing by Author "Seddon, J. A."

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Bacille Calmette-Guerin (BCG) vaccine and the COVID-19 pandemic : responsible stewardship is needed
(The Union, 2020) Schaaf, H. S.; Du Preez, K.; Kruger, M.; Solomons, R.; Taljaard, J. J.; Rabie, H.; Seddon, J. A.; Cotton, M. F.; Tebruegge, M.; Curtis, N.; Hesseling, A. C.
We believe that responsible stewardship of the bacille Calmette-Guérin (BCG) vaccine in the context of the COVID-19 epidemic is urgently needed. Live attenuated BCG is currently the only licensed vaccine to protect against tuberculosis (TB). Neonatal BCG vaccination has proven efficacy in protecting infants and young children against life-threatening disseminated forms of TB, including TB meningitis and miliary TB.
Clinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB
(International Union Against Tuberculosis and Lung Disease, 2020-11) Cox, V.; McKenna, L.; Acquah, R.; Reuter, A.; Wasserman, S.; Vambe, D.; Ustero, P.; Udwadia, Z.; Trivino-Duran, L.; Tommasi, M.; Skrahina, A.; Seddon, J. A.; Rodolfo, R.; Rich, M.; Padanilam, X.; Oyewusi, L.; Ohler, L.; Lungu, P.; Loveday, M.; Khan, U.; Khan, P.; Hughes, J.; Hewison, C.; Guglielmetti, L.; Furin, J.
Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second ‘Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
Decentralised care for child contacts of multidrug-resistant tuberculosis
(The Union, 2012-09-21) Seddon, J. A.; Hesseling, A. C.; Dunbar, R.; Cox, H.; Hughes, J.; Fielding, K.; Godfrey-Faussett, P.; Schaaf, H. S.
SETTING: Cape Town, South Africa. OBJECTIVE: To determine the number of multidrug-resistant tuberculosis (MDR-TB) child contacts routinely identified by health services, and whether a model of decentralised care improves access. METHODS: All MDR-TB source cases registered in Cape Town from April 2010 to March 2011 were included. All child contacts assessed at hospital and outreach clinics were recorded from May 2010 to June 2011. Electronic probabilistic matching was used to match source cases with potential child contacts; the number of children accessing decentralised (Khayelitsha) and hospital-based care was compared. RESULTS: Of 1221 MDR-TB source cases identified, 189 (15.5%) were registered in Khayelitsha; 31 (16.4%) had at least one child contact assessed. In contrast, 95 (9.2%) of the 1032 source cases diagnosed in the other Cape Town subdistricts (hospital-based care) had at least one child contact assessed (P = 0.003). Children in Khayelitsha were seen at a median of 71 days (interquartile range [IQR] 37–121 days) after source case diagnosis compared to 90 days (IQR 56–132 days) in other subdistricts (P = 0.15). CONCLUSION: Although decentralised care led to an increased number of child contacts being evaluated, both models led to the assessment of a small number of potential child MDR-TB contacts, with considerable delay in assessment.
Global shortages of BCG vaccine and tuberculous meningitis in children
(Elsevier, 2019) Du Preez, K.; Seddon, J. A.; Schaaf, H. S.; Hesseling, A. C.; Starke, J. R.; Osman, M.; Lombard, C. J.; Solomons, R.
ENGLISH ABSTRACT: No abstract available.
High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis
(BMC (part of Springer Nature), 2020-12-04) Van Der Zalm, M. M.; Walters, E.; Claassen, M.; Palmer, M.; Seddon, J. A.; Demers, A. M.; Shaw, M. L.; McCollum, E. D.; Van Zyl, G. U.; Hesseling, A. C.
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 22.0months; (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.
Pediatric multidrug-resistant tuberculosis clinical trials : challenges and opportunities
(Elsevier on behalf of International Society for Infectious Diseases, 2017) McAnaw, S. E.; Hesseling, A. C.; Seddon, J. A.; Dooley, K. E.; Garcia-Prats, A. J.; Kim, S.; Jenkins, H. E.; Schaaf, H. Simon; Sterling, T. R.; Horsburgh, C. R.
On June 17, 2016, RESIST-TB, IMPAACT, Vital Strategies, and New Ventures jointly hosted the Pediatric Multidrug Resistant Tuberculosis Clinical Trials Landscape Meeting in Arlington, Virginia, USA. The meeting provided updates on current multidrug-resistant tuberculosis (MDR-TB) trials targeting pediatric populations and adult trials that have included pediatric patients. A series of presentations were given that discussed site capacity needs, community engagement, and additional interventions necessary for clinical trials to improve the treatment of pediatric MDR-TB. This article presents a summary of topics discussed, including the following: current trials ongoing and planned; the global burden of MDR-TB in children; current regimens for MDR-TB treatment in children; pharmacokinetics of second-line anti-tuberculosis medications in children; design, sample size, and statistical considerations for MDR-TB trials in children; selection of study population, design, and treatment arms for a trial of novel pediatric MDR-TB regimens; practical aspects of pediatric MDR-TB treatment trials; and strategies for integrating children into adult tuberculosis trials. These discussions elucidated barriers to pediatric MDR-TB clinical trials and provided insight into necessary next steps for progress in this field. Investigators and funding agencies need to respond to these recommendations so that important studies can be implemented, leading to improved treatment for children with MDR-TB.
Presentation and outcome of culture-confirmed isoniazid-resistant rifampicin-susceptible tuberculosis in children
(International Union Against Tuberculosis and Lung Disease, 2016) Garcia-Prats, Anthony J.; Du Plessis, L.; Draper, H. R.; Burger, A.; Seddon, J. A.; Zimri, K.; Hesseling, Anneke C.; Schaaf, H. Simon
Setting: Isoniazid-resistant rifampicin-susceptible (HRRS) tuberculosis (TB) is the most prevalent form of drug-resistant TB globally, and may be a risk factor for poor outcomes. HRRS-TB in children has been poorly described. Objective: To characterize the clinical presentation, treatment, and clinical and microbiological outcomes, and factors associated with poor outcomes among children with culture-confirmed HRRS-TB. Design: Retrospective hospital-based cohort study. Results: Of the 72 children included, median age 50.1 months (IQR 21.5-102.5), 42% were male. Forty-four (51%) had a potential source case; only 13 were confirmed HRRS-TB. Twelve of 66 tested (17%) were HIV-infected, and 36 of 60 (60%) with pulmonary TB had severe disease. Seventy had treatment data; median total duration was 11.3 months (IQR 9-12.3); 25 (36%) initiated treatment with a 3-drug intensive phase; 52 (74%) received a fluoroquinolone. Of 63 with known outcome, 55 (88%) had a favourable outcome; 1 died and 3 had treatment failure. Ten had positive follow-up cultures at ≥2 months after starting treatment (17% of all PTB and 27% of those with follow-up culture data); older age (p=0.008), previous TB treatment (p=0.023) and severe PTB (p=0.018) were associated with failure to culture-convert at ≥2 months. Conclusions: Although overall outcomes were good, prolonged culture positivity and cases of treatment failure emphasize the need for additional attention to clinical management of children with HRRS-TB.
Where are we in the battle of ending tuberculosis in children and adolescents in South Africa?
(Health & Medical Publishing Group, 2020) Du Preez, K.; Seddon, J. A.; Schaaf, H. Simon; Hesseling, A. C.
Ambitious targets to end tuberculosis (TB) were set at the United Nations General Assembly High-Level Meeting (UNHLM) on TB in September 2018, with children and adolescents specifically noted as key populations deserving of more attention. [1] In addition, the World Health Organization (WHO) launched a revised ‘Roadmap towards ending TB in children and adolescents’,[2] outlining key actions that should be taken at country level to engage relevant stakeholders to optimally prevent and treat TB in these age groups

Browsing by Author "Seddon, J. A."

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