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Safety concerns about novel vaccines and necessity of COVID-19 vaccination for children, especially with underlying medical conditions, are the obstacle of COVID-19 vaccination program among pediatric population. The study was conducted to investigate the vaccine hesitancy reasons among the parents, and to monitor the adverse events of inactivated COVID-19 vaccines in children and teenagers with underlying medical conditions in China. Children with underlying medical conditions encountered to the Immunization Advisory Clinic for COVID-19 vaccine counseling were enrolled. They were given immunization recommendation and followed up at 72 h and 28 d after immunization to monitor the immunization compliance after consultation and adverse events. A total of 324 children aged 3–17 y were included. The top three primary medical conditions for counseling were allergy (33.6%), neurological diseases (31.2%) and rheumatic diseases (8.3%). COVID-19 vaccination was promptly recommended for 242 (74.7%) children. Seventy-one (65.7%) children who had allergy issues were recommend to take vaccination, which was significantly lower than that of other medical conditions ( p < .05). The follow-up record showed that 180 children received 340 doses of inactivated COVID-19 vaccine after consultation. Overall, 39 (21.6%) children reported at least one adverse event within 28 d of either vaccination. No serious adverse reactions were observed. No difference of adverse effects between the first dose and the second dose of vaccination except fever. Parents’ hesitancy in COVID-19 vaccination for children with underling medical conditions are mainly due to the safety concerns. Specialist consultation is helpful to improve the vaccine uptake.

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An unprecedented surge of Omicron infections appeared nationwide in China in December 2022 after the adjustment of COVID-19 response policy. In this study, we report the clinical and virological characteristics of SARS-CoV-2 Omicron BA.5 infections among children in Shanghai during the outbreak in late December 2022. We sequenced the 64 SARS-CoV-2 positive samples obtained from hospitalized children. The genomic monitoring revealed that the current outbreak was driven by the BA.5.2.48 and BF.7.14 subvariants. Additionally, children with BA.5.2.48 infection were more frequently observed to experience vomiting/diarrhea compared to those with BF.7.14 infection. The high-frequency unique non-synonymous mutations were present in BA.5.2.48 (N: Q241K) and BF.7.14 (nsp2: V94I, nsp12: L247F, S: C1243F, ORF7a: H47Y) with respect to their parental lineages. Of these mutations, C1243F mutation in S protein, L247F mutation in nsp12, and H47Y mutation in ORF7a protein were predicted to have a deleterious effect on the protein function. Besides, H47Y mutation was also found to increase the stability of ORF7a protein. Therefore, attention should be paid to these specific mutations, especially for H47Y mutation, which could serve as a viral immune escape strategy due to the potential immunomodulatory ability of the ORF7a protein. Continuous genomic monitoring and clinical manifestation assessments of the emerging variants will be crucial for effective responses to the ongoing COVID-19 pandemic.

Background: Pediatric bacterial meningitis (PBM) remains a devastating disease that causes substantial neurological morbidity and mortality worldwide. However, there are few large-scale studies on the pathogens causing PBM and their antimicrobial resistance (AMR) patterns in China. The present multicenter survey summarized the features of the etiological agents of PBM and characterized their AMR patterns.Methods: Patients diagnosed with PBM were enrolled retrospectively at 13 children’s hospitals in China from 2016 to 2018 and were screened based on a review of cerebrospinal fluid (CSF) microbiology results. Demographic characteristics, the causative organisms and their AMR patterns were systematically analyzed.Results: Overall, 1193 CSF bacterial isolates from 1142 patients with PBM were obtained. The three leading pathogens causing PBM were Staphylococcus epidermidis (16.5%), Escherichia coli (12.4%) and Streptococcus pneumoniae (10.6%). In infants under 3 months of age, the top 3 pathogens were Escherichia coli (116/523; 22.2%), Enterococcus faecium (75/523; 14.3%), and Staphylococcus epidermidis (57/523; 10.9%). However, in children more than 3 months of age, the top 3 pathogens were Staphylococcus epidermidis (140/670; 20.9%), Streptococcus pneumoniae (117/670; 17.5%), and Staphylococcus hominis (57/670; 8.5%). More than 93.0% of Escherichia coli isolates were sensitive to cefoxitin, piperacillin/tazobactam, cefoperazone/sulbactam, amikacin and carbapenems, and the resistance rates to ceftriaxone, cefotaxime and ceftazidime were 49.4%, 49.2% and 26.4%, respectively. From 2016 to 2018, the proportion of methicillin-resistant coagulase-negative Staphylococcus isolates (MRCoNS) declined from 80.5% to 72.3%, and the frequency of penicillin-resistant Streptococcus pneumoniae (PRSP) isolates increased from 75.0% to 87.5%. The proportion of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli fluctuated between 44.4% and 49.2%, and the detection rate of ESBL production in Klebsiella pneumoniae ranged from 55.6% to 88.9%. The resistance of Escherichia coli strains to carbapenems was 5.0%, but the overall prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) was high (54.5%).Conclusions: Staphylococcus epidermidis, Escherichia coli and Streptococcus pneumoniae were the predominant pathogens causing PBM in Chinese patients. The distribution of PBM causative organisms varied by age. The resistance of CoNS to methicillin and the high incidence of ESBL production among Escherichia coli and Klebsiella pneumoniae isolates were concerning. CRKP poses a critical challenge for the treatment of PBM.