Children

Objective: To evaluate parental attitudes towards vaccination in children with inflammatory bowel disease (IBD), assess the level of adherence to immunization schedules, and identify key barriers hindering vaccination. Materials and Methods: A comparative survey was conducted involving 215 respondents, divided into an IBD group (109 parents of children with IBD) and a control group (106 parents of healthy children). The majority of respondents were mothers (96%) with higher education (81% and 79%, respectively) residing in a major metropolitan area. We assessed demographic data, vaccination history of both children and parents, sources of medical information, and reasons for vaccine refusal. Results: Routine vaccination coverage in children under 6 years of age was high and comparable in both groups (>93%). The majority of parents in the IBD group (n = 68; 62%) expressed a positive attitude towards vaccination. However, following the onset of IBD, only 24 (22%) continued vaccination, while 85 (78%) reported a categorical refusal to continue immunization. It was found that parents tend to misinterpret normal post-vaccination reactions as vaccine complications. A significant factor contributing to refusal is the lack of information from attending physicians and reliance on the Internet as a primary information source. Additionally, low rates of adult revaccination were noted, with over 30% of parents in both groups not being vaccinated in adulthood. Conclusions: The low vaccination rate in children with IBD after disease onset is driven not by initial anti-vaccination sentiment, but by acquired fears and a lack of professional communication from primary care providers and specialists. Improving immunization coverage requires the active implementation of educational programs for parents regarding vaccine safety during immunosuppressive therapy, as well as the development of specific guidelines for attending physicians.

Human cytomegalovirus (HCMV) and Human Immunodeficiency Virus (HIV) are two pathogens known to have dramatic consequences when contracted early in life. In addition to having a significant impact when acquired individually, these two viruses are known to frequently cause coinfections. Indeed, also in the modern era, HCMV remains one of the most prevalent coinfections in newborns of mothers living with HIV, including both HIV-positive children regardless of their immune status, and those exposed to HIV but uninfected (HEU). In children with HIV infection, HCMV coinfection has historically been associated with AIDS-defining disease, high mortality, and prolonged, elevated HCMV viral load. Although timely administration of antiretroviral therapy prevents immunodeficiency in people living with HIV and thus reduces the incidence of full-blown HCMV disease in cases of coinfection, emerging data suggest that HCMV-induced immune activation and aging persist, potentially contributing to long-term, non-AIDS-related comorbidities. Growing evidence indicates that also HCMV amplifies HIV susceptibility, disease progression, and immune dysregulation through multiple synergistic mechanisms. Moreover, congenital and early postnatal HCMV infections occur at significantly higher rates in HEU newborns than in HIV-unexposed children and are associated with worse clinical outcomes, particularly when HCMV viral loads are high. This review summarizes current knowledge on the epidemiology, clinical impact, and immunopathogenetic interactions of early HCMV–HIV coinfection in pediatric populations. By integrating recent findings with historical evidence, it highlights critical mechanistic and epidemiological gaps that warrant further investigation.

Type 1 diabetes (T1D) is a common chronic autoimmune disease in childhood, often presenting abruptly and frequently complicated by diabetic ketoacidosis at diagnosis. T1D develops through well-defined presymptomatic stages characterized by islet autoimmunity and progressive dysglycemia, offering a window for early identification. This narrative review summarizes current evidence on screening for T1D in children and adolescents, focusing on target populations, screening strategies, and methodological approaches for autoantibody detection. Data from major international programs involving familial, high-risk, and general population screening are discussed, highlighting their impact on reducing diabetic ketoacidosis at onset, improving metabolic outcomes, and facilitating structured follow-up and family education. Advances in assay technologies, including electrochemiluminescence, multiplex platforms, and novel ultrasensitive methods, have enhanced the feasibility and accuracy of large-scale screening. The review also examines the public health implications, cost-effectiveness, and ethical considerations of implementing population-based screening, particularly in light of emerging disease-modifying therapies such as teplizumab. Overall, available evidence supports screening as a meaningful strategy to shift T1D diagnosis from an acute emergency to a predictable clinical trajectory, with potential benefits extending from individual patient outcomes to healthcare system sustainability.