Summary Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive pneumococcal diseases (IPD) in children, including those with sickle cell disease (SCD). A systematic review of the English literature published between 2000 and 2017 was undertaken to evaluate the serotype distribution, clinical presentation and outcomes of IPD in children with SCD in PCV programmes. We identified 475 potential studies and included 16 publications, involving 9438 children up to 22 years of age with SCD and 182 IPD episodes (prevalence, 1·9%. 95% confidence interval [CI], 1·7–2·2%). Septicaemia was the most prevalent clinical presentation (84/137; 61%) followed by lower respiratory tract infection (39/137; 29%) and meningitis (12/137, 9%). More than half the serotypes associated with IPD (88/148; 59·5%) were not included in the 13‐valent PCV; of these, 54% (44/82) were due to serogroup 15. The crude case fatality rate was 11·5% (21/182 cases; 95% CI, 7·3–17·1%). Most cases of IPD in children with SCD were due to serotypes that are not included in any of the licensed PCVs. IPD in children with SCD remains associated with high morbidity and mortality, highlighting the importance of strict adherence to daily penicillin prophylaxis. Until a serotype‐independent pneumococcal vaccine becomes available, higher‐valent PCVs should include serogroup 15 to protect this highly vulnerable group of children.

Metastable Sn-NiSn4 eutectic can form in electronic solder joints and is a reliability concern. Here the competition between stable Sn-Ni3Sn4 and metastable Sn-NiSn4 eutectic growth is studied during unidirectional solidification. The stable and metastable eutectic points are measured, the dynamics of eutectic growth and the transition between the two eutectics is investigated by synchrotron radiography, and the crystallography of eutectic growth is measured by EBSD. It is shown that the Sn-Ni3Sn4 eutectic has a highly irregular morphology with diverging and converging rods because monoclinic Ni3Sn4 grows only along [010] without a reproducible orientation relationship (OR) with Sn. The metastable Sn-NiSn4 eutectic has a more regular broken-lamellar morphology and a reproducible OR with Sn. The critical velocity between the two eutectics is less than 1 µm/s which is discussed in terms of the small temperature difference between the two eutectic points and the kinetic growth advantages of the metastable eutectic.

INTRODUCTION Streptococcus agalactiae (Group B Streptococcus, GBS) is an uncommon cause of septic arthritis in the adult population. In recent years, there has been an increase in the incidence of GBS septic arthritis. This study aims to compare the clinical presentation, investigations, microbiology and outcome of management in patients with GBS and non-GBS septic arthritis. METHODS Retrospective review of hospital surgical records was done to identify all patients treated surgically at our institution from January 2011 to January 2016 for primary septic arthritis. Patients were categorised into two groups: those with culture-proven GBS septic arthritis and those with causative pathogens that were not GBS. Patients who were medically unfit for surgical intervention as well as those who declined interventional procedures were excluded from the study. RESULTS A total of 83 patients were included in the study: 62 (74.7%) had non-GBS septic arthritis and 21 (25.3%) had GBS septic arthritis. Patients with GBS septic arthritis were more likely to have polyarticular involvement (p < 0.001) and involvement of less common sites such as the elbow joint. They were also more likely to have elevated inflammatory markers (C-reactive protein > 150 mg/L; p = 0.017) and positive blood cultures (p = 0.02), and were typically healthy adults with no medical comorbidities (p = 0.012). CONCLUSION Patients with GBS septic arthritis were more likely to present with polyarticular involvement, positive blood cultures and higher levels of C-reactive protein on admission, and tended to be healthier individuals with no medical comorbidities.

IntroductionTransverse myelitis (TM) is a neurological disorder causing acute cord injury as a result of acute inflammation, and it is often associated with infectious or autoimmune disease. 20% of all cases of TM occur in children.Since 2015, an outbreak of Zika Virus infection (ZiKV) has been reported in over 30 countries. Emerging evidence suggest ZikV causes a spectrum of neurologic diseases. However, its association with TM, especially in children, is not well described.MethodsWe undertook a systematic review of the English literature published from 1947 to August 2017 to evaluate the risk factors, distribution, pathogenesis, clinical presentation, management and outcomes of TM following Zika virus infection. Data sources included MEDLINE, EMBASE, Cochrane library, and references within identified articles. We also searched the papers using the ISI web of knowledge, to identify relevant articles and conference proceedings.ResultsWe identified 102 potential studies, of which 9 were duplicates and 89 were excluded on the basis of title and abstracts. Of the 4 eligible studies [5–8], there were 6275 with suspected ZiKV in all age groups. 695 cases were confirmed ZiKV either by RT-PCR in plasma, CSF and urine, ELIZA or MRI while excluding other aetiologies. There were 11 (1.6%) cases of TM. Among 3 studies reporting clinical characteristics and outcome, the mean age was 23 years (Range 15–43) and 63% (n=5/8) of cases were male. 40% (n=4/10) required admission to the ITU, with no reported case fatality.Conclusions and clinical implicationsComplications from ZiKV, although uncommon, may be severe. With international spread, clinicians need to be aware that ZiKV may be associated with TM. As only 10% of cases were children, standardising the collection and reporting for individual cases across regions and countries would further allow meaningful analysis of the data collected, enabling monitoring of trends over time.

IntroductionSince 2015, an outbreak of Zika Virus infection (ZiKV) has been reported in over 30 countries. Emerging evidence suggest ZikV causes a spectrum of neurologic diseases both directly and by secondary autoimmunity. In pregnancy, ZiKV is a well-known cause of congenital brain abnormalities, including microcephaly.1 It has also been linked with Guillain-Barre syndrome.2 However, its association with meningoencephalitis is not well described, especially in children.MethodsWe undertook a systematic review of the English literature published from 1947 to August 2017 to evaluate the risk factors, distribution, pathogenesis, clinical presentation, management and outcomes of encephalitis following Zika virus infection. Data sources included MEDLINE, EMBASE, Cochrane library, and references within identified articles. We also searched the papers using the ISI web of knowledge, to identify relevant articles and conference proceedings.ResultsWe identified 167 potential studies, of which 16 were duplicates and 140 were excluded on the basis of title and abstracts (figure 1). There were 9784 with suspected ZiKV in all age groups. 1411 cases were confirmed ZiKV either by RT-PCR in plasma, CSF and urine, ELIZA or MRI. There were 26 (1.8%) cases of meningoencephalitis. Among eight studies reporting clinical characteristics and outcomes of 16 cases, the mean age was 43 years (Range 19–81) and 75% (n=12) of cases were male. 63% (n=10) of the cases required admission to ITU, with a crude case fatality rate of 12% (n=2).Conclusions and clinical implicationsComplications from ZiKV, although uncommon, may be severe. With international spread, clinicians need to be aware that ZiKV may be associated with meningoencephalitis. Although our review found a paucity of evidence of Zika virus associated meningoencephalitis in children, standardising the collection and reporting for individual cases across regions and countries would further allow meaningful analysis of the data collected, enabling monitoring of trends over time.