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Ma ZY, Deng H, Hua LD, Lei W, Zhang CB, Dai QQ, Tao WJ, Zhang L. Suspension microarray-based comparison of oropharyngeal swab and bronchoalveolar lavage fluid for pathogen identification in young children hospitalized with respiratory tract infection. BMC Infect Dis 2020; 20:168. [PMID: 32087697 PMCID: PMC7036252 DOI: 10.1186/s12879-020-4900-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory tract infection (RTI) in young children is a leading cause of morbidity and hospitalization worldwide. There are few studies assessing the performance for bronchoalveolar lavage fluid (BALF) versus oropharyngeal swab (OPS) specimens in microbiological findings for children with RTI. The primary purpose of this study was to compare the detection rates of OPS and paired BALF in detecting key respiratory pathogens using suspension microarray. METHODS We collected paired OPS and BALF specimens from 76 hospitalized children with respiratory illness. The samples were tested simultaneously for 8 respiratory viruses and 5 bacteria by suspension microarray. RESULTS Of 76 paired specimens, 62 patients (81.6%) had at least one pathogen. BALF and OPS identified respiratory pathogen infections in 57 (75%) and 49 (64.5%) patients, respectively (P > 0.05). The etiology analysis revealed that viruses were responsible for 53.7% of the patients, whereas bacteria accounted for 32.9% and Mycoplasma pneumoniae for 13.4%. The leading 5 pathogens identified were respiratory syncytial virus, Streptococcus pneumoniaee, Haemophilus influenzae, Mycoplasma pneumoniae and adenovirus, and they accounted for 74.2% of etiological fraction. For detection of any pathogen, the overall detection rate of BALF (81%) was marginally higher than that (69%) of OPS (p = 0.046). The differences in the frequency distribution and sensitivity for most pathogens detected by two sampling methods were not statistically significant. CONCLUSIONS In this study, BALF and OPS had similar microbiological yields. Our results indicated the clinical value of OPS testing in pediatric patients with respiratory illness.
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Affiliation(s)
- Zhan-Ying Ma
- Dongguan Maternal and Child Health Care Hospital, Dongguan, 523120, China
| | - Hua Deng
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Li-Dong Hua
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Wen Lei
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Chang-Bin Zhang
- Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Qi-Qiang Dai
- Guangzhou DaAn Clinical Laboratory Center, YunKang Group, Guangzhou, 51000, China
| | - Wei-Jing Tao
- Guangzhou DaAn Clinical Laboratory Center, YunKang Group, Guangzhou, 51000, China
| | - Liang Zhang
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, China.
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Effect of High Calorie Diet on Intestinal Flora in LPS-Induced Pneumonia Rats. Sci Rep 2020; 10:1701. [PMID: 32015367 PMCID: PMC6997398 DOI: 10.1038/s41598-020-58632-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/17/2020] [Indexed: 12/19/2022] Open
Abstract
Intestinal flora plays an important role in inflammatory response to systemic or local organs of its host. High calorie diet has been shown to aggravate the condition of pneumonia and delay recovery, especially in children. However, the underlying mechanisms remain unclear. This study placed SPF rats in a conventional environment, high calorie diet or LPS atomization was performed respectively or combined. Analysis of high-throughput sequencing of intestinal content combined with animal weight, organ index, serum inflammatory factors indicators and bioinformatics found that after pulmonary infection combined with a high-calorie diet, rats showed significant changes such as weight loss and increased lung weight index, and their lung and intestinal tissues showed more obvious inflammatory changes. And its gut flora structure suggests, the abundance of Leuconostocaceae in significantly reduced; abundance of Staphylococcus, Planococcaceae, Staphylococcus, Staphylococcaceae, Bacillales, Gemellales and Aerococcus significant increased. The study showed that high calorie diet and LPS atomization synergistically promoted pneumonia process in rat pups, which is related to changes in structure of intestinal flora. It is worth noting that pneumonia rats fed by convention diet also causing intestinal flora imbalance.
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Alves MS, da Silva Cariolano M, Dos Santos Ferreira HL, Sousa de Abreu Silva E, Felipe KKP, Monteiro SG, de Sousa EM, Abreu AG, Campbell LA, Rosenfeld ME, Hirata MH, Hirata RDC, Bastos GM, de Paula Abreu Silva IC, Lima-Neto LG. High frequency of Chlamydia pneumoniae and risk factors in children with acute respiratory infection. Braz J Microbiol 2020; 51:629-636. [PMID: 31997263 DOI: 10.1007/s42770-020-00229-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022] Open
Abstract
This study was performed as a contribution for a better understanding of Chlamydia pneumoniae frequency in children with respiratory infections. A total of 416 children were recruited from two clinical centers in Sao Luis, Brazil. Of these patients, 165 children had upper respiratory tract infections (URTI), 150 had community-acquired pneumonia (CAP), and 101 were asymptomatic volunteer children. Clinical and epidemiological data from the participants were recorded. Nasopharyngeal swab samples were collected to extract DNA. C. pneumoniae DNA positivity and copy numbers were obtained by an absolute quantitative real-time PCR method. RESULTS: Positivity for C. pneumoniae DNA was higher in samples from URTI children (38.2%) and from CAP children (18.0%) than in those from the control group (7.9%; p < 0.001). Moreover, C. pneumoniae DNA was denser in children with URTI than in asymptomatic children. Considering the cutoff, the highest value of C. pneumoniae DNA found in asymptomatic children of the 3.98 log10 copies/mL, 8.5% (14/165) of the children with URTI, and 3.3% (5/150) with CAP presented high copy numbers of C. pneumoniae DNA. CONCLUSION: Taken together, these results revealed a high frequency of C. pneumoniae in both children with URTI and CAP.
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Affiliation(s)
- Matheus Silva Alves
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Marilha da Silva Cariolano
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Elen Sousa de Abreu Silva
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Silvio Gomes Monteiro
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Eduardo Martins de Sousa
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil
| | - Afonso Gomes Abreu
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Michael E Rosenfeld
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil.,Institute Dante Pazzanese of Cardiology, Sao Paulo, SP, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Lidio Gonçalves Lima-Neto
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil. .,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil.
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54
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Knobbe RB, Diallo A, Fall A, Gueye AD, Dieng A, van Immerzeel TD, Ba A, Diop A, Diop A, Niang M, Boye CS. Pathogens Causing Respiratory Tract Infections in Children Less Than 5 Years of Age in Senegal. Microbiol Insights 2019; 12:1178636119890885. [PMID: 31908474 PMCID: PMC6937528 DOI: 10.1177/1178636119890885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/03/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction: While acute respiratory tract infections are the main cause of paediatric mortality and morbidity worldwide, pathogen patterns shift due to factors such as hygiene, vaccinations, and antibiotic resistance. Knowledge about current cause of respiratory infections is lacking, particularly in low- and middle-income countries. The aim of this study was to identity the various respiratory pathogens causing acute respiratory tract infections in children below 5 years of age visiting a sub-urban primary care clinic in Senegal. Methods: A case-control study was performed in September and October 2018. Oropharyngeal swabs were collected from cases; infants with fever and respiratory symptoms, and controls; children involved in the vaccination programme. Viral identification was conducted by polymerase chain reaction for 21 different viruses; bacteria were identified by culture studies. Associations between microorganisms, acute respiratory infection and severity of disease were calculated by multivariate regression adjusting for confounders such as age, sex, and living area. Results: Overall, 102 cases and 96 controls were included. Microorganisms were detected in 90.1% of cases and 53.7% of controls (P < .001). Influenza virus A (including H1N1), influenza virus B, respiratory syncytial virus (RSV), and Streptococcus pneumoniae were independently associated with acute respiratory tract infections. Co-detection of two or more pathogens was present in 49.5% of cases; 31.7% of cases had a pneumonia and 90.2% was treated with antibiotics. Conclusions: This case-control study in a primary care setting in sub-Saharan Africa found influenza virus A and B, RSV, and S pneumoniae to be the main causes of acute respiratory tract infections in children below 5 years of age. We recommend evaluation of antibiotics prescription behaviour in this setting.
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Affiliation(s)
- Rebecca B Knobbe
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.,Paediatric Infectious Disease and Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Abdallah Diallo
- Paediatric Medical Care Unit, Institut de Pédiatrie Sociale de Pikine, Dakar, Senegal
| | - Amary Fall
- Medical Virology Unit, Pasteur Institute, Dakar, Senegal
| | - Aida D Gueye
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Assane Dieng
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | | | - Abou Ba
- Paediatric Unit, Albert Royer Hospital, Dakar, Senegal
| | - Amadou Diop
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Abdoulaye Diop
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Mbayame Niang
- Medical Virology Unit, Pasteur Institute, Dakar, Senegal
| | - Cheikh Sb Boye
- Laboratory of Bacteriology and Virology, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
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Respiratory syncytial, parainfluenza and influenza virus infection in young children with acute lower respiratory infection in rural Gambia. Sci Rep 2019; 9:17965. [PMID: 31784567 PMCID: PMC6884537 DOI: 10.1038/s41598-019-54059-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/23/2019] [Indexed: 01/06/2023] Open
Abstract
Respiratory viral infections contribute significantly to morbidity and mortality worldwide, but representative data from sub-Saharan Africa are needed to inform vaccination strategies. We conducted population-based surveillance in rural Gambia using standardized criteria to identify and investigate children with acute lower respiratory infection (ALRI). Naso- and oropharyngeal swabs were collected. Each month from February through December 2015, specimens from 50 children aged 2–23 months were randomly selected to test for respiratory syncytial (RSV), parainfluenza (PIV) and influenza viruses. The expected number of viral-associated ALRI cases in the population was estimated using statistical simulation that accounted for the sampling design. RSV G and F proteins and influenza hemagglutinin genes were sequenced. 2385 children with ALRI were enrolled, 519 were randomly selected for viral testing. One or more viruses were detected in 303/519 children (58.4%). RSV-A was detected in 237 and RSV-B in seven. The expected incidence of ALRI associated with RSV, PIV or influenza was 140 cases (95% CI, 131–149) per 1000 person-years; RSV incidence was 112 cases (95% CI, 102–122) per 1000 person-years. Multiple strains of RSV and influenza circulated during the year. RSV circulated throughout most of the year and was associated with eight times the number of ALRI cases compared to PIV or IV. Gambian RSV viruses were closely related to viruses detected in other continents. An effective RSV vaccination strategy could have a major impact on the burden of ALRI in this setting.
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56
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O'Brien KL, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Higdon MM, Howie SR, Deloria Knoll M, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, Prosperi C, Scott JAG, Shi Q, Thea DM, Wu Z, Zeger SL, Adrian PV, Akarasewi P, Anderson TP, Antonio M, Awori JO, Baillie VL, Bunthi C, Chipeta J, Chisti MJ, Crawley J, DeLuca AN, Driscoll AJ, Ebruke BE, Endtz HP, Fancourt N, Fu W, Goswami D, Groome MJ, Haddix M, Hossain L, Jahan Y, Kagucia EW, Kamau A, Karron RA, Kazungu S, Kourouma N, Kuwanda L, Kwenda G, Li M, Machuka EM, Mackenzie G, Mahomed N, Maloney SA, McLellan JL, Mitchell JL, Moore DP, Morpeth SC, Mudau A, Mwananyanda L, Mwansa J, Silaba Ominde M, Onwuchekwa U, Park DE, Rhodes J, Sawatwong P, Seidenberg P, Shamsul A, Simões EA, Sissoko S, Wa Somwe S, Sow SO, Sylla M, Tamboura B, Tapia MD, Thamthitiwat S, Toure A, Watson NL, Zaman K, Zaman SM. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet 2019; 394:757-779. [PMID: 31257127 PMCID: PMC6727070 DOI: 10.1016/s0140-6736(19)30721-4] [Citation(s) in RCA: 484] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings. METHODS We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1-59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data. FINDINGS Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6-97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3-65·6) of causes, whereas bacteria accounted for 27·3% (23·3-31·6) and Mycobacterium tuberculosis for 5·9% (3·9-8·3). Viruses were less common (54·5%, 95% CrI 47·4-61·5 vs 68·0%, 62·7-72·7) and bacteria more common (33·7%, 27·2-40·8 vs 22·8%, 18·3-27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4-34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus-enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site's aetiological fraction. INTERPRETATION In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes. FUNDING Bill & Melinda Gates Foundation.
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57
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Farrar DS, Awasthi S, Fadel SA, Kumar R, Sinha A, Fu SH, Wahl B, Morris SK, Jha P. Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India. eLife 2019; 8:e46202. [PMID: 31453804 PMCID: PMC6759316 DOI: 10.7554/elife.46202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022] Open
Abstract
Control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate region, and clinical syndromes from 243,000 verbal autopsies in the nationally representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99% CI 1.51-1.82; versus the April minimum). Higher RRs at 1-11 months suggested respiratory syncytial virus (RSV) etiology. India's humid subtropical region experienced a unique summer pneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48-1.85) and January (RR 1.37, 1.23-1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1-59 months with prevalence surveys, we estimate 40,600 pneumonia deaths from Streptococcus pneumoniae, 20,700 from RSV, 12,600 from influenza, and 7200 from Haemophilus influenzae type b and 24,700 diarrheal deaths from rotavirus occurred in 2015. Careful mortality studies can elucidate etiologies and inform vaccine introduction.
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Affiliation(s)
- Daniel S Farrar
- Centre for Global Health ResearchSt. Michael’s Hospital and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Shally Awasthi
- Department of PediatricsKing George's Medical UniversityLucknowIndia
| | - Shaza A Fadel
- Centre for Global Health ResearchSt. Michael’s Hospital and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Rajesh Kumar
- Department of Community Medicine, School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Anju Sinha
- Division of Reproductive Biology, Maternal and Child HealthIndian Council of Medical ResearchNew DelhiIndia
| | - Sze Hang Fu
- Centre for Global Health ResearchSt. Michael’s Hospital and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Brian Wahl
- International Vaccine Access CenterJohns Hopkins Bloomberg School of Public HealthBaltimoreUnited States
| | - Shaun K Morris
- Centre for Global Child Health, Division of Infectious DiseasesHospital for Sick Children and Dalla Lana School of Public Health, University of TorontoTorontoCanada
| | - Prabhat Jha
- Centre for Global Health ResearchSt. Michael’s Hospital and Dalla Lana School of Public Health, University of TorontoOntarioCanada
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Kesteman T, Ghassani A, Hajjar C, Picot V, Osman M, Alnajjar Z, Komurian-Pradel F, Messaoudi M, Pouzol S, Soulaiman HG, Vanhems P, Ramilo O, Karam-Sarkis D, Najjar-Pellet J, Hamze M, Endtz H. Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol. Gates Open Res 2019; 2:19. [PMID: 33103065 PMCID: PMC7569241 DOI: 10.12688/gatesopenres.12811.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.
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Affiliation(s)
| | | | - Crystel Hajjar
- Faculté de Pharmacie, Université Saint-Joseph, Beirut, Lebanon
| | | | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement, Lebanese University, Tripoli, Lebanon
| | | | | | | | | | | | | | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, 69002, France
| | - Octavio Ramilo
- Nationwide Childrens' Hospital and the Ohio State University College of Medicine, Columbus, OH, 43205, USA
| | - Dolla Karam-Sarkis
- Laboratoire des Agents Pathogènes, Faculté de Pharmacie, Université Saint-Joseph, Beirut, Lebanon.,Laboratoire Rodolphe Mérieux, Université Saint-Joseph, Beirut, Lebanon
| | | | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement, Lebanese University, Tripoli, Lebanon
| | - Hubert Endtz
- Fondation Mérieux, Lyon, 69002, France.,Erasmus Medical Center, Rotterdam, The Netherlands
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59
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Krishnan A, Kumar R, Broor S, Gopal G, Saha S, Amarchand R, Choudekar A, Purkayastha DR, Whitaker B, Pandey B, Narayan VV, Kabra SK, Sreenivas V, Widdowson MA, Lindstrom S, Lafond KE, Jain S. Epidemiology of viral acute lower respiratory infections in a community-based cohort of rural north Indian children. J Glob Health 2019; 9:010433. [PMID: 31131104 PMCID: PMC6513504 DOI: 10.7189/jogh.09.010433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In India, community-based acute lower respiratory infections (ALRI) burden studies are limited, hampering development of prevention and control strategies. Methods We surveyed children <10 years old at home weekly from August 2012-August 2014, for cough, sore throat, rhinorrhoea, ear discharge, and shortness of breath. Symptomatic children were assessed for ALRI using World Health Organization definitions. Nasal and throat swabs were obtained from all ALRI cases and asymptomatic controls and tested using polymerase chain reaction for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza viruses (IV). We estimated adjusted odds ratios (aOR) using logistic regression to calculate etiologic fractions (EF). We multiplied agent-specific ALRI incidence rates by EF to calculate the adjusted incidence as episodes per child-year. Results ALRI incidence was 0.19 (95% confidence interval (CI) = 0.18-0.20) episode per child-year. Association between virus and ALRI was strongest for RSV (aOR = 15.9; 95% CI = 7.3-34.7; EF = 94%) and least for IV (aOR = 4.6; 95% CI = 2.0-10.6; EF = 78%). Adjusted agent-specific ALRI incidences were RSV (0.03, 95% CI = 0.02-0.03), hMPV (0.02, 95% CI = 0.01-0.02), PIV (0.02, 95% CI = 0.01-0.02), and IV (0.01, 95% CI = 0.01-0.01) episode per child-year. Conclusions ALRI among children in rural India was high; RSV was a significant contributor.
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Affiliation(s)
- Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- SGT Medical College, Hospital & Research Institute, Gurgaon, India
| | - Giridara Gopal
- All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India
| | | | | | | | - Brett Whitaker
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharti Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Marc-Alain Widdowson
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stephen Lindstrom
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Seema Jain
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India.,US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rhedin SA, Eklundh A, Ryd-Rinder M, Naucler P, Mårtensson A, Gantelius J, Zenk I, Andersson-Svahn H, Nybond S, Rasti R, Lindh M, Andersson M, Peltola V, Waris M, Alfvén T. Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study. JMIR Res Protoc 2019; 8:e12705. [PMID: 31025954 PMCID: PMC6658235 DOI: 10.2196/12705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background There is a need to better distinguish viral infections from antibiotic-requiring bacterial infections in children presenting with clinical community-acquired pneumonia (CAP) to assist health care workers in decision making and to improve the rational use of antibiotics. Objective The overall aim of the Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) study is to improve the differential diagnosis of bacterial and viral etiologies in children aged below 5 years with clinical CAP, by evaluating myxovirus resistance protein A (MxA) as a biomarker for viral CAP and by evaluating an existing (multianalyte point-of-care antigen detection test system [mariPOC respi] ArcDia International Oy Ltd.) and a potential future point-of-care test for respiratory pathogens. Methods Children aged 1 to 59 months with clinical CAP as well as healthy, hospital-based, asymptomatic controls will be included at a pediatric emergency hospital in Stockholm, Sweden. Blood (analyzed for MxA and C-reactive protein) and nasopharyngeal samples (analyzed with real-time polymerase chain reaction as the gold standard and antigen-based mariPOC respi test as well as saved for future analyses of a novel recombinase polymerase amplification–based point-of-care test for respiratory pathogens) will be collected. A newly developed algorithm for the classification of CAP etiology will be used as the reference standard. Results A pilot study was performed from June to August 2017. The enrollment of study subjects started in November 2017. Results are expected by the end of 2019. Conclusions The findings from the TREND study can be an important step to improve the management of children with clinical CAP. International Registered Report Identifier (IRRID) DERR1-10.2196/12705
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Affiliation(s)
- Samuel Arthur Rhedin
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
| | - Annika Eklundh
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet & Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Jesper Gantelius
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ingela Zenk
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Helene Andersson-Svahn
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Susanna Nybond
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Reza Rasti
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Matti Waris
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tobias Alfvén
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Merida-Vieyra J, Aquino-Andrade A, Palacios-Reyes D, Murata C, Ribas-Aparicio RM, De Colsa Ranero A. Detection of Mycoplasma pneumoniae in Mexican children with community-acquired pneumonia: experience in a tertiary care hospital. Infect Drug Resist 2019; 12:925-935. [PMID: 31118700 PMCID: PMC6503500 DOI: 10.2147/idr.s193076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/29/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose: Mycoplasma pneumoniae is an important cause of community-acquired pneumonia (CAP). Information on the prevalence of M. pneumoniae in pediatric patients with CAP in Mexico is limited. The aim of this study was to detect M. pneumoniae in hospitalized pediatric patients with CAP. Patients and methods: We performed a descriptive study in a tertiary-level pediatric reference center, obtaining 154 respiratory samples from patients under 18 years of age and diagnosed with CAP. M. pneumoniae was detected by real-time polymerase chain reaction (PCR) targeting the p1 and CARDS genes. Complete blood cell count, measurement of C-reactive protein and detection of IgM and IgG anti-P1 were performed. Clinical, epidemiological and radiological data of the patients were analyzed. Results: M. pneumoniae was detected by real-time PCR in 26.6% of the samples. 39% of the cases occurred during the spring season. A total of 83% of the patients with M. pneumoniae had some underlying disease; renal disease, autoimmune disease and primary immunodeficiencies had a significant association with M. pneumoniae CAP. Children under 6 years of age represented 53.7% of the cases. Fever and cough were the most frequent symptoms. IgM and IgG were positive in 1.9% and 14% of the patients, respectively. In the chest X-ray, 17.1% of the patients showed multifocal alveolar infiltrates pattern. The complications in this series were 26.8%. The mortality in this study was 4.9%. Conclusion: This is the first report in Mexico about M. pneumoniae as a causal agent of CAP in a tertiary care pediatric hospital using real-time PCR and serology. M. pneumoniae was responsible for 26.6% of the cases and was frequent in children under 6 years of age. In addition, we described the clinical presentation in patients with underlying diseases.
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Affiliation(s)
- Jocelin Merida-Vieyra
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria (INP), Mexico City, Mexico
- Biological Production and Control Laboratory, Escuela Nacional de Ciencias Biológicas, Instituto Politecnico Nacional, Mexico City, Mexico
| | | | | | | | - Rosa Maria Ribas-Aparicio
- Biological Production and Control Laboratory, Escuela Nacional de Ciencias Biológicas, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Agustin De Colsa Ranero
- Molecular Microbiology Laboratory, Department of Pediatric Infectious Diseases, INP, Mexico City, Mexico
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Bhuiyan MU, Snelling TL, West R, Lang J, Rahman T, Granland C, de Gier C, Borland ML, Thornton RB, Kirkham LAS, Sikazwe C, Martin AC, Richmond PC, Smith DW, Jaffe A, Blyth CC. The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case -control study. Thorax 2019; 74:261-269. [PMID: 30337417 PMCID: PMC6467248 DOI: 10.1136/thoraxjnl-2018-212096] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. METHODS A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated. RESULTS From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively. CONCLUSIONS Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Rachel West
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jurissa Lang
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Tasmina Rahman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Caitlyn Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Camilla de Gier
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Meredith L Borland
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Emergency Medicine, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Ruth B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter C Richmond
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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Acute Respiratory Illness in Rural Haiti. Int J Infect Dis 2019; 81:176-183. [PMID: 30772468 PMCID: PMC7173118 DOI: 10.1016/j.ijid.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
Top viruses detected in Haitian children are Rhinovirus, Influenza A and Adenovirus. Top bacteria detected in Haitian children are S. pneumoniae and S. aureus. Younger children are more likely to have Influenza A and S. pneumoniae detected. Younger children are more likely to present with fever and diagnosed with pneumonia. These data support early use of Influenza A and S. pneumoniae vaccines in Haiti.
Objectives Acute Respiratory Infection (ARI) is the most common cause of childhood morbidity and mortality in developing countries, including Haiti. Our objective was to detect pathogens found in children with ARI in rural Haiti to help develop evidence-based guidelines for treatment and prevention. Methods Retrospective study of students with ARI at four schools in rural Haiti. Viral and/or bacterial pathogens were identified by qPCR in 177 nasal swabs collected from April 2013 through November 2015. Results Most common viruses detected were Rhinovirus (36%), Influenza A (16%) and Adenovirus (7%), and bacteria were Streptococcus pneumoniae (58%) and Staphylococcus aureus (28%). Compared to older children, children aged 3–5 years had more Influenza A (28% vs. 9%, p = 0.002) and Adenovirus detected (14% vs. 3%, p = 0.01). Similarly, S. pneumoniae was greatest in children 3–5 years old (71% 3–5yrs; 58% 6–15 years; 25% 16–20 years; p = 0.008). Children 3–10 years old presented with fever more than children 11–20 years old (22% vs 7%; p = 0.02) and were more often diagnosed with pneumonia (28% vs 4%, p < 0.001). Conclusions Younger children had increased fever, pneumonia, and detection of Influenza A and S. pneumoniae. These data support the need for influenza and pneumococcus vaccination in early childhood in Haiti.
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Novel Immunoprotective Proteins of Streptococcus pneumoniae Identified by Opsonophagocytosis Killing Screen. Infect Immun 2018; 86:IAI.00423-18. [PMID: 29891544 DOI: 10.1128/iai.00423-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022] Open
Abstract
The success of polysaccharide conjugate vaccines represents a major advance in the prevention of pneumococcal disease, but the power of these vaccines is limited by partial spectrum of coverage and high cost. Vaccines using immunoprotective proteins are a promising alternative type of pneumococcal vaccines. In this study, we constructed a library of antisera against conserved pneumococcal proteins predicted to be associated with cell surface or virulence using a combination of bioinformatic prediction and immunization of rabbits with recombinant proteins. Screening of the library by an opsonophagocytosis killing (OPK) assay identified the OPK-positive antisera, which represented 15 (OPK-positive) proteins. Further tests showed that virtually all of these OPK-positive antisera conferred passive protection against lethal infection of virulent pneumococci. More importantly, immunization with recombinant forms of three OPK-positive proteins (SP148, PBP2b, and ScpB), alone or in combination, conferred significant protection against lethal challenge of pneumococcal strains representing capsular serotypes 3, 4, and 6A in a mouse sepsis model. To our best knowledge, this work represents the first example in which novel vaccine candidates are successfully identified by the OPK screening. Our data have also provided further confirmation that the OPK activity may serve as a reliable in vitro surrogate for evaluating vaccine efficacy of pneumococcal proteins.
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65
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Nascimento-Carvalho AC, Vilas-Boas AL, Fontoura MSH, Vuorinen T, Nascimento-Carvalho CM. Respiratory viruses among children with non-severe community-acquired pneumonia: A prospective cohort study. J Clin Virol 2018; 105:77-83. [PMID: 29908521 PMCID: PMC7106541 DOI: 10.1016/j.jcv.2018.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
Respiratory viruses were detected in almost all children with non-severe pneumonia. Multiple virus detection comprised two thirds of these cases. RSVA-B, FluA-B, PIV1-4 were similarly found among multiple or sole detection cases.
Background Community-acquired pneumonia (CAP) causes a major burden to the health care system among children under-5 years worldwide. Information on respiratory viruses in non-severe CAP cases is scarce. Objectives To estimate the frequency of respiratory viruses among non-severe CAP cases. Study design Prospective study conducted in Salvador, Brazil. Out of 820 children aged 2–59 months with non-severe CAP diagnosed by pediatricians (respiratory complaints and radiographic pulmonary infiltrate/consolidation), recruited in a clinical trial (ClinicalTrials.gov Identifier NCT01200706), nasopharyngeal aspirate samples were obtained from 774 (94.4%) patients and tested for 16 respiratory viruses by PCRs. Results Viruses were detected in 708 (91.5%; 95%CI: 89.3–93.3) cases, out of which 491 (69.4%; 95%CI: 65.9–72.7) harbored multiple viruses. Rhinovirus (46.1%; 95%CI: 42.6–49.6), adenovirus (38.4%; 95%CI: 35.0–41.8), and enterovirus (26.5%; 95%CI: 23.5–29.7) were the most commonly found viruses. The most frequent combination comprised rhinovirus plus adenovirus. No difference was found in the frequency of RSVA (16.1% vs. 14.6%; P = 0.6), RSVB (10.9% vs. 13.2%; P = 0.4) influenza (Flu) A (6.3% vs. 5.1%; P = 0.5), FluB (4.5% vs. 1.8%; P = 0.09), parainfluenza virus (PIV) 1 (5.1% vs. 2.8%; P = 0.2), or PIV4 (7.7% vs. 4.1%; P = 0.08), when children with multiple or sole virus detection were compared. Conversely, rhinovirus, adenovirus, enterovirus, bocavirus, PIV2, PIV3, metapneumovirus, coronavirus OC43, NL63, 229E were significantly more frequent among cases with multiple virus detection. Conclusions Respiratory viruses were detected in over 90% of the cases, out of which 70% had multiple viruses. Several viruses are more commonly found in multiple virus detection whereas other viruses are similarly found in sole and in multiple virus detection.
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Affiliation(s)
| | - Ana-Luisa Vilas-Boas
- Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.
| | | | - Tytti Vuorinen
- Department of Clinical Virology, Turku University Hospital, Department of Virology, Turku University, Turku, Finland.
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Khuri-Bulos N, Lawrence L, Piya B, Wang L, Fonnesbeck C, Faouri S, Shehabi A, Vermund SH, Williams JV, Halasa NB. Severe outcomes associated with respiratory viruses in newborns and infants: a prospective viral surveillance study in Jordan. BMJ Open 2018; 8:e021898. [PMID: 29780032 PMCID: PMC5961648 DOI: 10.1136/bmjopen-2018-021898] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess virus-specific hospitalisation rates, risk factors for illness severity and seasonal trends in children hospitalised with acute respiratory infections (ARI). DESIGN Prospective cohort study. SETTING A government hospital serving low-income and middle-income population in Amman, Jordan. PARTICIPANTS Children under 2 years of age hospitalised with fever and/or respiratory symptoms (n=3168) from 16 March 2010 to 31 March 2013. Children with chemotherapy-associated neutropenia and newborns who had never been discharged after birth were excluded from the study. OUTCOME MEASURES Hospitalisation rates and markers of illness severity: admission to intensive care unit (ICU), mechanical ventilation (MV), oxygen therapy, length of stay (LOS) and death. RESULTS Of the 3168 subjects, 2581 (82%) had at least one respiratory virus detected, with respiratory syncytial virus (RSV) being the most predominant pathogen isolated. During admission, 1013 (32%) received oxygen therapy, 284 (9%) were admitted to ICU, 111 (4%) were placed on MV and 31 (1%) children died. Oxygen therapy was higher in RSV-only subjects compared with human rhinovirus-only (42%vs29%, p<0.001), adenovirus-only (42%vs21%, p<0.001) and human parainfluenza virus-only (42%vs23%, p<0.001) subjects. The presence of an underlying medical condition was associated with oxygen therapy (adjusted OR (aOR) 1.95, 95% CI 1.49 to 2.56), ICU admission (aOR 2.51, 95% CI 1.71 to 3.68), MV (aOR 1.91, 95% CI 1.11 to 3.28) and longer LOS (aOR1.71, 95% CI 1.37 to 2.13). Similarly, younger age was associated with oxygen therapy (0.23, 95% CI 0.17 to 0.31), ICU admission (aOR 0.47, 95% CI 0.30 to 0.74), MV (0.28, 95% CI 0.15 to 0.53) and longer LOS (aOR 0.47, 95% CI 0.38 to 0.59). Pneumonia was strongly associated with longer LOS (aOR 2.07, 95% CI 1.65 to 2.60), oxygen therapy (aOR 2.94, 95% CI 2.22 to 3.89), ICU admission (aOR 3.12, 95% CI 2.16 to 4.50) and MV (aOR 3.33, 95% CI 1.85 to 6.00). Virus-specific hospitalisation rates ranged from 0.5 to 10.5 per 1000 children. CONCLUSION Respiratory viruses are associated with severe illness in Jordanian children hospitalised with ARI. Prevention strategies such as extended breast feeding, increased access to palivizumab and RSV vaccine development could help decrease hospitalisation rates and illness severity, particularly in young children with underlying medical conditions.
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Affiliation(s)
| | - Lindsey Lawrence
- Department of Pediatrics, Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Bhinnata Piya
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Asem Shehabi
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Sten H Vermund
- Department of Pediatrics, Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John V Williams
- Pediatrics, Infectious Diseases, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natasha B Halasa
- Department of Pediatrics, Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Kesteman T, Ghassani A, Hajjar C, Picot V, Osman M, Alnajjar Z, Komurian-Pradel F, Messaoudi M, Soulaiman HG, Vanhems P, Ramilo O, Karam-Sarkis D, Najjar-Pellet J, Hamze M, Endtz H. Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol. Gates Open Res 2018; 2:19. [DOI: 10.12688/gatesopenres.12811.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.
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Dananché C, Sánchez Picot V, Bénet T, Messaoudi M, Chou M, Wang J, Pape JW, Awasthi S, Bavdekar A, Rakoto-Andrianarivelo M, Sylla M, Nymadawa P, Russomando G, Komurian-Pradel F, Endtz H, Paranhos-Baccalà G, Vanhems P, For The Gabriel Network. Burden of Influenza in Less Than 5-Year-Old Children Admitted to Hospital with Pneumonia in Developing and Emerging Countries: A Descriptive, Multicenter Study. Am J Trop Med Hyg 2018; 98:1805-1810. [PMID: 29663903 DOI: 10.4269/ajtmh.17-0494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
This descriptive 4-year study reports the proportion of detection of influenza viruses in less than 5-year-old children hospitalized for pneumonia in eight developing and emerging countries and describes clinical and microbiological characteristics of influenza-related pneumonia cases. Hospitalized children presenting radiologically confirmed pneumonia aged 2-60 months were prospectively enrolled in this observational standardized study. Mean proportion of isolated influenza virus was 9.7% (95% confidence interval: 7.9-11.8%) among 888 pneumonia children analyzed, with moderate heterogeneity between countries-ranging from 6.2% in Cambodia to 18.8% in Haiti. The clinical characteristics of children with influenza-related pneumonia were not substantially different from those of other pneumonia cases. Influenza A H1N1-related pneumonia cases appeared as more severe than pneumonia cases related to other strains of influenza. Streptococcus pneumoniae was detected more often in blood samples from influenza-related cases than in those without detected influenza viruses (19.7% versus 9.5%, P = 0.018). Influenza-related pneumonia is frequent among children less than 5 years old with pneumonia, living in developing and emerging countries. Influenza might be a frequent etiologic agent responsible for pneumonia or a predisposing status factor for pneumococcal-related pneumonia in this population.
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Affiliation(s)
- Cédric Dananché
- Infection Control and Epidemiology Department, Hospices Civils de Lyon, Lyon, France.,Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Valentina Sánchez Picot
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Thomas Bénet
- Infection Control and Epidemiology Department, Hospices Civils de Lyon, Lyon, France.,Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Mélina Messaoudi
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Jianwei Wang
- MOH Key Laboratory of the Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, Fondation Mérieux, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jean-William Pape
- Centres GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), Port-au-Prince, Haiti
| | - Shally Awasthi
- Chatrapati Shahu Ji Maharaj Medical University, Lucknow, India
| | | | | | | | | | | | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Hubert Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Gláucia Paranhos-Baccalà
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Philippe Vanhems
- Infection Control and Epidemiology Department, Hospices Civils de Lyon, Lyon, France.,Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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Bhuiyan MU, Snelling TL, West R, Lang J, Rahman T, Borland ML, Thornton R, Kirkham LA, Sikazwe C, Martin AC, Richmond PC, Smith DW, Jaffe A, Blyth CC. Role of viral and bacterial pathogens in causing pneumonia among Western Australian children: a case-control study protocol. BMJ Open 2018; 8:e020646. [PMID: 29549211 PMCID: PMC5857668 DOI: 10.1136/bmjopen-2017-020646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/27/2017] [Accepted: 02/12/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia. With the availability of molecular diagnostics, viruses are frequently detected in children with pneumonia either as primary pathogens or predispose to secondary bacterial infection. Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. Since the introduction of pneumococcal vaccines, very few comprehensive studies from developed countries have attempted to determine the bacterial and viral aetiology of pneumonia. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies. METHODS AND ANALYSIS We are conducting a prospective case-control study (PneumoWA) where cases are children with radiologically confirmed pneumonia admitted to Princess Margaret Hospital for Children (PMH) and controls are healthy children identified from PMH outpatient clinics and from local community immunisation clinics. The case-control ratio is 1:1 with 250 children to be recruited in each arm. Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored. ETHICS AND DISSEMINATION This study has been approved by the human research ethics committees of PMH, Perth, Australia (PMH HREC REF 2014117EP). Findings will be disseminated at research conferences and in peer-reviewed journals.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Rachel West
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Jurissa Lang
- PathWest Laboratory Medicine WA, Perth, Australia
| | - Tasmina Rahman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | - Meredith L Borland
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Ruth Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | | | - Andrew C Martin
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Peter C Richmond
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | | | - Adam Jaffe
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Christopher C Blyth
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
- PathWest Laboratory Medicine WA, Perth, Australia
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Affiliation(s)
- Aubree Gordon
- 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Arthur Reingold
- 2Division of Epidemiology, School of Public Health, University of California, 101 Haviland Hall, Berkeley, CA 94720 USA
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71
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Malosh RE, Martin ET, Ortiz JR, Monto AS. The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review. Vaccine 2017; 36:141-147. [PMID: 29157959 PMCID: PMC5736984 DOI: 10.1016/j.vaccine.2017.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
Background Lower respiratory tract infections (LRTI) are a major cause of morbidity and mortality worldwide, particularly in young children and older adults. Influenza is known to cause severe disease but the risk of developing LRTI following influenza virus infection in various populations has not been systematically reviewed. Such data are important for estimating the impact specific influenza vaccine programs would have on LRTI outcomes in a community. We sought to review the published literature to determine the risk of developing LRTI following an influenza virus infection in individuals of any age. Methods and findings We conducted a systematic review to identify prospective studies that estimated the incidence of LRTI following laboratory-confirmed influenza virus infection. We searched PubMed, Medline, and Embase databases for relevant literature. We supplemented this search with a narrative review of influenza and LRTI. The systematic review identified two prospective studies that both followed children less than 5 years. We also identified one additional pediatric study from our narrative review meeting the study inclusion criteria. Finally, we summarized recent case-control studies on the etiology of pneumonia in both adults and children. Conclusions There is a dearth of prospective studies evaluating the risk of developing LRTI following influenza virus infection. Determining the burden of severe LRTI that is attributable to influenza is necessary to estimate the benefits of influenza vaccine on this important public health outcome. Vaccine probe studies are an efficient way to evaluate these questions and should be encouraged going forward.
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Affiliation(s)
- Ryan E Malosh
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | | | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, MI, United States.
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