Miguela Caniza

St. Jude Children's Research Hospital · Department of Infectious Diseases

Background Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hôpital Saint Damien -...

Infectious complications remain major contributors to adverse outcomes in patients treated for non-communicable disease, particularly in resource limited settings. We performed a 5-year retrospective study of primary bloodstream infections at a dedicated pediatric oncology center in Guatemala. Two hundred and twelve episodes occurring in 194 unique...

PURPOSE Children with cancer are at high risk for poor outcomes, and health care providers are often unfamiliar with best practices in infection care and prevention (IC&P) in this small and fragile population. Graduates of training courses in IC&P in immunocompromised hosts identified a need for a community that would enable members to share health...

Background: Central lines are essential for the care of children with cancer. Aims: To determine the risk factors, characteristics, cost of hospital care, and antibiotic use in pediatric oncology patients with central line-associated bloodstream infections (CLABSIs). Methods: During 2018–2019, we calculated the rate of CLABSIs in our pediatric hema...

Background: The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. How�ever, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by heal...

Responses to the early (February–July 2020) COVID-19 pandemic varied widely, globally. Reasons for this are multiple but likely relate to the healthcare and financial resources then available, and the degree of trust in, and economic support provided by, national governments. Cultural factors also affected how different populations reacted to the v...

The management of febrile neutropenia (FN) in pediatrics is evolving. Our objective was to describe current practices for the care of patients with FN in pediatric oncology centers in Latin America and identify areas for practice improvement. We used an online survey to enroll eligible healthcare providers who treat children with cancer in Latin Am...

Background: Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents wit...

Background: Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents wi...

Background In October 2018, the Hispaniola Project was initiated to build local expertise in infection care and prevention at three pediatric oncology units (POUs) in Haiti and the Dominican Republic. Surveillance of healthcare-associated infections (HAI) was a central aim. Severe and prolonged neutropenia is a frequent risk factor for infections i...

Background Infectious in pediatric patients with cancer are common and can be life-threatening. Understanding risks for infections, mechanisms of progression, and diagnostic and therapeutic interventions is essential for quality care. Clinical guidance emerges frequently from high-income countries and dissemination of information using traditional...

Background/Aims Severe infections are the most important causes of morbidity and mortality in children with cancer. In Peru, a major limitation for an optimal treatment of children with fever and neutropenia due to chemotherapy is the delay in the administration of the first dose of antibiotics. We performed an intervention aimed to decrease the ti...

Background In late 2019, a novel coronavirus, SARS-CoV-2, was reported in China, which rapidly spread across the globe. The WHO declared a pandemic of coronavirus disease (COVID-19) in early 2020. In March, both the Dominican Republic and Haiti reported their first cases. The three pediatric oncology units (POUs) that make up the St. Jude Global In...

Background Hand hygiene (HH) is a basic measure to prevent the spread of infections in healthcare settings. We describe HH practices and resources in three pediatric oncology units (POUs) in Haiti and the Dominican Republic that comprise the Hispaniola Project (HP1: Santiago; HP2: Santo Domingo; HP3: Port-au-Prince). This project, started in Januar...

The incidence of several respiratory viral infections has been shown to be related to climate. Because humans spend most of their time indoors, measures of indoor climate, rather than outdoor climate, may be better predictors of disease incidence and transmission. Therefore, understanding the relationship between indoor and outdoor climate will hel...

The incidence of several respiratory viral infections has been shown to be related to climate. Because humans spend most of their time indoors, measures of indoor climate, rather than outdoor climate, may be better predictors of disease incidence and transmission. Therefore, understanding the relationship between indoor and outdoor climate will hel...

PURPOSE Time to antibiotic administration (TTA) is a commonly used standard of care in pediatric cancer settings in high-income countries. Effective interventions to improve outcomes in cancer patients with febrile neutropenia (FN) often address timely and appropriate antibiotic administration. We assessed the effectiveness of a locally adapted mul...

Background Skilled healthcare professionals are critical for providing quality healthcare for children with cancer globally. Training curricula addressing the knowledge needs in infection care and prevention (ICP) in cancer are scarce. Program description We implemented a 10-week blended course in ICP. The distance learning had four 2-week modules...

Background Children with cancer in low-income countries are at risk of dying 10 times more than children with similar disease in countries with more resources; and more than half of the deaths are due to infectious complications. Risks of infectious mortality could be reduced by systematically implementing care and infection prevention, for which t...

Introduction Pediatric cancer patients merit the placement of central lines for the treatments they receive. Subcutaneous central ports (SCs) and peripherally inserted central catheters (PICCs) are the most frequently used lines. PICCs have gained popularity due to the ease of insertion, which can be invaluable in the pediatric oncology setting for...

Background Well-trained and dedicated personnel for infection care and prevention is essential for optimal care in pediatric oncology centers. Feedback from global collaborators consistently identifies education and training as a priority. We collaboratively designed and implemented a blended methodology training course focused on four essential th...

Background Fever and neutropenia (FN) is a frequent complication in pediatric oncology patients, especially in high-risk patients. In our institution, 43% of acute lymphoblastic leukemia (ALL) patients in induction have at least one hospitalization for FN. A lack of institutional guidelines has led to misuse of antibiotics, prolonged antibiotic wai...

Background Chemotherapy and radiotherapy for oncologic diseases can cause oral complications during therapy or thereafter. These oral complications and their consequences may interfere with cancer treatment, prolong hospital stay, and increase overall treatment costs. Therefore, oral examination of children with cancer by healthcare providers must...

Background In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriat...

Background Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbi...

The COVID‐19 pandemic quickly led to an abundance of publications and recommendations, despite a paucity of information on how COVID‐19 affects children with cancer. This created a dire need for a trusted resource with curated information and a space for the pediatric oncology community to share experiences. The Global COVID‐19 Observatory and Reso...

The management of febrile neutropenia (FN) in pediatrics is evolving. Our objective was to describe current practices for the care of patients with FN in pediatric oncology centers in Latin America and identify areas for practice improvement. We used an online survey to enroll eligible healthcare providers who treat children with cancer in Latin Am...

BACKGROUND The GCCCR is a collaboration between SIOP and SJCRH to describe the natural history of SARS-CoV-2 in children with cancer across the world. METHODS The GCCCR is a deidentified registry of patients <19 years of age with cancer or recipients of a hematopoietic stem cell transplant and laboratory-confirmed SARS-CoV-2 infection. Demographic...

Background: The St Jude Global Academy Neuro-Oncology Training Seminar (NOTS) is a hybrid course in pediatric neuro-oncology specifically designed for physicians from low-income and middle-income countries. Methods: The curriculum for the course was created by conducting a targeted needs assessment that evaluated 11 domains of care for children...

PURPOSE Infection prevention among children with cancer is a major challenge at Children Hospital Lahore (CHL), a public health care facility in Pakistan with 1,000 new pediatric cancer admissions annually. The objective has been to reduce infections through collaboration between CHL and the St Jude Children’s Hospital Global Infectious Disease pro...

Background Continuous quality improvement (QI) has become an essential process for healthcare in the United States. However, QI is still nascent in global healthcare settings and many healthcare providers are unfamiliar with QI methodology. We set out to provide training in QI to assist global healthcare providers in their efforts to impact infecti...

The COVID‐19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarize general principles for continuing multidisciplinary care during the SARS‐CoV‐2 (COVID‐19) pandemic. With contributions from the l...

The COVID‐19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarize general principles for continuing multidisciplinary care during the SARS‐CoV‐2 (COVID‐19) pandemic. With contributions from the l...

A major challenge in developing improved influenza vaccines is the identification of broadly reactive and protective epitopes. While it is generally believed that the specificity of the antibody response to hemagglutinin (HA) is relatively narrow, we and others have identified individuals that mount a cross-reactive neutralizing antibody response a...

The COVID-19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarise general principles for continuing multi-disciplinary care during the SARS-CoV-2 (COVID-19) pandemic. With contributions from the...

The COVID-19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarise general principles for continuing multi-disciplinary care during the SARS-CoV-2 (COVID-19) pandemic. With contributions from the...

PURPOSE Our objective was to provide regionally appropriate, resource-conscious recommendations for the diagnosis and treatment of pediatric patients with febrile neutropenia. METHODS A multinational panel of Central American and Caribbean clinicians who deliver pediatric oncology care prioritized clinically important questions and then used the G...

This case describes the instructional design process of a workbook accompanying a four-day infection prevention and control global training. Working closely with global health professionals, the instructional designer assessed the needs, the attitudes of learners, and conducted a task analysis of the training content. Subsequently, she designed ins...

Background Pediatric cancer patients have a higher risk of morbidity and mortality due to respiratory viral infections than do other patient populations. Objectives To investigate the causative viruses of respiratory infections and their burden among pediatric cancer patients in Lebanon. Study Design Nasopharyngeal swabs along with clinical and d...

Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and...

Background: In Paraguay, a low-middle income country (GDP per capita of USD 4,728.7), pediatric cancer is the second cause of mortality in children and adolescents 5-19 years of age. There are approximately 300 new cases of pediatric cancer per year. The Pediatric Cancer Center (PCC) of the School of Medicine (SoM) receives 120 new cases per year,...

Brown recluse spider bites can cause local and systemic signs, including rash, dermonecrosis, edema, hemolysis, and acute kidney failure. These are mostly attributed to sphingomyelinase D, the main toxin. To evaluate the severity of the disease in pediatric patients with and without neutropenia, we retrospectively reviewed records of patients treat...

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middl...

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middl...

Our primary objective was to describe the incidence of proven or probable invasive fungal infections (IFIs), a devastating complication of hematopoietic stem cell transplant (HSCT), in HCST in a middle‐income country. Secondary objectives were to describe factors associated with IFIs and outcomes. In this single center retrospective study, pediatri...

Severe bronchiolitis is the most common reason for hospitalization among children younger than 2 years. This study analyzed the prevalence of community-acquired respiratory virus infection and the risk factors for hospitalization of Mexican children with severe bronchiolitis treated in an Emergency department. This retrospective study included 134...

Background: In low- and middle-income countries (LMICs), inconsistent or delayed management of fever contributes to poor outcomes among pediatric patients with cancer. We hypothesized that standardizing practice with a clinical algorithm adapted to local resources would improve outcomes. Therefore, we developed a resource-specific algorithm for fe...

Previous studies have reported associations of IFITM3 SNP rs12252 with severe influenza, but evidence of association and the mechanism by which risk is conferred remain controversial. We prioritized SNPs in IFITM3 on the basis of putative biological function and identified rs34481144 in the 5' UTR. We found evidence of a new association of rs344811...

Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, lit...

Comprehensive care for children and adolescents with cancer is one of the major challenges for the public health system in our countries where childhood cancer represents a public health problem and a social problem. Pediatric cancer in Paraguay, a country with limited resources, is a social and public health problem because of the consequences tha...

E-learning has been widely used in the infection control field and has been recommended for use in hand hygiene (HH) programs by the World Health Organization. Such a strategy is effective and efficient for infection control, but factors such as learner readiness for this method should be determined to assure feasibility and suitability in low-to m...

Fungal diseases are an important cause of mortality in immunocompromised hosts, and their incidence in pediatric cancer patients in low- to middle-income countries is underestimated. In this review, we present relevant, up-to-date information about the most common opportunistic and endemic fungal diseases among children with cancer, their geographi...

Introduction: Acute lymphoblastic leukemia (ALL) is one of the most common oncological diseases in the pediatric age. Until recently, in developing countries, the average of overall survival and disease-free rates remained at about 50%. There is limited information in developing countries regarding the prognostic factors for mortality and no publis...

Background/objective: A qualitative method study identified perceived barriers and motivations for hand hygiene (HH) practice in a pediatric oncology unit in Guatemala. Methods: Data collection included focus groups with participants grouped by job type. Focus group responses were assessed using content analysis. Participants included nurse supe...

Background: The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries. Objectives: To det...

Conclusion: Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. VZV vaccine recommendations for pediatric cancer patients in developed countries may be generalizable to developing countries. What is Known: • Current recommendations, based on evidence from pediatric ca...

Infections are the most important cause of morbidity and mortality in children treated for acute lymphoblastic leukemia (ALL). The rates of infection-associated mortality are up to 10-times higher in low- and middle-income countries (LMIC) than in high-income countries. The prevention, early recognition and management of infectious complications is...

Introduction. In 2010, St Jude began a 12-week infection control (IC) course using e-learning & face-to-face methodologies to train Latin-American infection preventionists in IC competencies. In 2014, we added a weekly hands-on practicum for reinforcing learned course elements. It consisted of using the Infection Control Assessment Tool (ICAT) deve...

In Paraguay, cancer is among the leading causes of death among children. We report challenges and solutions for building the country's first pediatric cancer center at the National University School of Medicine (PCC-SM) and describe the outcomes of the National Network for Pediatric Cancer. We found that children with acute lymphoblastic leukemia t...

Tuberculosis is a major health concern in Mexico, especially among the native population. Tuberculomas are a frequent and severe complication of pediatric tuberculosis, these are observed as tumors in neuroimaging studies but are often not diagnosed adequately. We present a case of a 12-year-old native Mexican girl Huichol ethnicity diagnosed with...