The INF-ACT Pediatric Network: A New Tool for Early Detection of Infectious Threats

Speaker: Cristina Moracas, Italy

Background and Rationale:

The session opened with the urgent need for preparedness against future pandemics, highlighting the WHO’s 2023 warning: “The next pandemic is not a matter of if, but when.”

In response, the INF-ACT Pediatric Network (Infectious Active Against Infection) was established in Naples in October 2023.

The network operates under Italy’s National Recovery and Resilience Plan, involving 12 pediatric clinical centres across North, Central, and South Italy.

Objective:

To identify, monitor, and respond to emerging and reemerging infectious threats in the pediatric population through real-time, collaborative data and sample sharing.

Definition of an Infectious Threat:

An infectious threat is defined as:

• A clinical condition resembling infectious disease,
• Occurring in clusters, or linked to:
  1. A new pathogen, or
  2. A known pathogen with atypical features,
• It must be serious, new, and unexplained.

The Network’s Four Pillars:

Workflow of Threat Detection:

• Identification: A potential threat is discussed during monthly calls.
• Verification: Similar cases are reported by centers via messaging/email over 2–3 weeks.
• Monitoring: If validated, the network launches enhanced monitoring beyond its centers.
• Alert: Data is shared with public health authorities for control measures and publication.

Pertussis Outbreak Case Study:

1. In Jan 2024, an unusual number of pertussis hospitalizations in infants was noted by two centres.
2. Within months, more cases were confirmed by other centres.
3. In April, data was shared with the National Institute of Health.
4. Outcomes:
   1. 108 hospitalizations, 3 deaths
   2. >25% required oxygen, 12 needed ICU care.
   3. 95% of infants were born to unvaccinated mothers.
   4. The alert led to SRV (Strategic Risk Vaccination) campaigns for over 400 mothers.

Other Infections Detected:

• Myocarditis outbreak in adolescents (80% rise vs. 2023); 50% tested positive for parvovirus B19.
• Adenovirus with bacterial-like inflammation, linked to increased antibiotic use.
• Hypertransaminasemia identified as a severity marker in influenza.
• Complicated pneumonia outbreak (March 2025).
• Analysis of AIDS, comorbidities, and co-infections in viral illnesses (April 2025).

Impact and Collaborations:

1. From 6 to 12 clinical centres involved.
2. Over 1,000 patients enrolled and 300+ biological samples collected.
3. INF-ACT collaborates with:
   1. National Institute of Health
   2. Italian epidemiological systems
   3. Future plans include international network integration.

Conclusion:

The INF-ACT Pediatric Network is a proactive, clinician-led surveillance system capable of detecting pediatric infectious threats early, triggering timely public health alerts, and guiding outbreak response—complementing existing public systems through faster and collaborative action.

ESPID 2025, 26-30 May, Bucharest