Tina Tan, MD, discusses most important pediatric news of 2022 and what to look forward to in 2023


Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of Contemporary Pediatrics, talks about the most significant moments in children’s health in 2022; what the tridemic really means for pediatric health care providers; and what we have to look forward to in 2023 when it comes to new vaccines and medications.

Transcript (edited for clarity):
I think probably one of the most important issues that came up [in 2022] was the mental health crisis that occurred in the pediatric population. The pandemic really had some major effects, especially on adolescents that had underlying anxiety or depression, and really pushed these kids to the edge, where there were many more of these kids that were trying to commit suicide, which I think is just really very sad. But I think because we now recognize that there's so many mental health issues that were brought to light, we really are able to identify these kids and help them.

Other trends that I think were really important in 2022 was the approval of the COVID-19 vaccine for use in infants and children down the six months of age. You know, for a long time, during the pandemic, there was this misinformation that was out there that people believe that either children did not get COVID. Or if they got COVID, they didn't get sick. And we know that's not true. So with the approval of the vaccine, down to six months of age, we are now able to protect so many more of these kids from getting COVID. And we really have to encourage providers to vaccinate their children with the COVID-19 vaccine.

The pandemic really did change the pattern with which the respiratory viruses circulate. We don't really understand why that occurred. But we do know that RSV influenza, even COVID, these surges are occurring much, much earlier than they normally would. And, you know, the RSV surge is very interesting, because there was a surge during the summer, even though it was smaller. And then in October, we started to see a major surge, which, as you said, has really completely strained the pediatric healthcare system. One thing about RSV is that it is a respiratory virus for which the care is really supportive. So the use of antibiotics and the use of albuterol as well as steroids are not really recommended, unless the child is truly having respiratory distress, and they need those drugs for other reasons. But the normal treatment of RSV does not include the use of those agents. The problem is, is that we're also having a surge of influenza COVID-19 is now also starting to increase. And there are a number of other respiratory viruses that are surging at the same time, such as Rhino, enterovirus, adenovirus, para influenza, so it is really made, you know, trying to distinguish which respiratory illness a child has much more difficult. And, you know, we can test for all of these, but you really, you know, because they're viruses, there really is no treatment for them. And the problem is, is that when some of these kids and infants present to say, in an emergency room that's not pediatrics, or to an urgent care or a Minute Clinic, many people, you know, take a look at them. And they think, Oh, my gosh, you know, are they going to develop a bacterial infection. And this has really led to the shortage of antibiotics, because many of these kids are being placed on antibiotics unnecessarily.

The other thing that has really led to kind of a shortage in the pediatric beds situation is that many community hospitals during the pandemic closed down their pediatric units completely, primarily because they felt that they would make more money serving the adult population and not the pediatric population. And this has really led to a bed shortage in many areas where, you know, the Community Hospital is the only hospital that is close by for these kids to be evaluated in. So the vaccine that will be licensed first is a maternal vaccine, meaning that it would be pregnant women, probably between 24 and 36 weeks gestation, that would be getting this vaccine. And what we know from the phase 3 clinical trials, the data that was released, is that this vaccine is very, very effective at preventing hospitalization and lower respiratory tract disease in infants of moms who had received the RSV vaccine during pregnancy with a vaccine efficacy of around 82% at preventing these children from being hospitalized from lower tract infection during the first three months of life, and even beyond that between three and six months. of life, we know that the vaccine efficacy in preventing RSV lower tract infection and hospitalization in these young infants is around 70%. So very, very good vaccine efficacy, and is one way of protecting normal healthy infants against being hospitalized and having severe RSV disease.

The most important thing that pediatric providers can do is to vaccinate their patients against those viruses for which we have vaccines, mainly influenza, and COVID-19. With all these different viruses circulating at the same time, it is going to be critical that, you know, you provide vaccines to your patients in order to provide them with some protection, because what we're seeing in the hospital now is infants and children who are not only infected with one of these viruses, but with multiple of these viruses. And this really makes their clinical course much more complicated.

So I think the direction that IDSA wants to move in is really to address some of the disparities that were brought forth by the pandemic. And this is disparities in all age groups, but especially in the pediatric age group, and in the pregnant women group. Because most trials of drugs and vaccines that are done, generally are done in adults to begin with. And there is now a push to see whether or not some of these trials can also be started in infants and children and pregnant women in an earlier time, so that these therapeutics are available for these individuals much sooner than they normally would be available for so the Infectious Disease Society of America has always served as a resource, not only for the infectious disease physicians, but also for public health and for all other practitioners. If you go on to the Infectious Disease Society of America website, there are resources there that the general practitioner can use in their practices to provide the best care possible for their patients.

So I think what's really going to be exciting are some of the vaccines that are teed up to hopefully be approved by the beginning of 2023. I mean, one is the maternal RSV vaccine, and other one is PCV 20 or Prevnar 20, which is an increased valency pneumococcal conjugate vaccine that will provide more protection against the strains that are currently causing invasive pneumococcal disease now, as well as otitis media and pneumonia. And the other exciting vaccine that is teed up and may be licensed by sometime in mid 2023 Is the pentavalent Meningococcal vaccine. So this is a vaccine that covers meningococcal serotypes A, B, C, y and w. And I think this will greatly simplify the way that meningococcal vaccines are given and will provide the needed protection for those teenagers and young adults that are at risk for the disease.

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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