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Williams DJ, Shah SS. Community-Acquired Pneumonia in the Conjugate Vaccine Era. J Pediatric Infect Dis Soc 2012; 1:314-28. [PMID: 26619424 PMCID: PMC7107441 DOI: 10.1093/jpids/pis101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
Abstract
Community-acquired pneumonia (CAP) remains one of the most common serious infections encountered among children worldwide. In this review, we highlight important literature and recent scientific discoveries that have contributed to our current understanding of pediatric CAP. We review the current epidemiology of childhood CAP in the developed world, appraise the state of diagnostic testing for etiology and prognosis, and discuss disease management and areas for future research in the context of recent national guidelines.
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Affiliation(s)
- Derek J. Williams
- Division of Hospital Medicine, The Monroe Carell Jr Children's Hospital at Vanderbilt, and,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Divisions of,Corresponding Author: Derek J. Williams, MD, MPH, 1161 21st Ave. South, CCC 5311 Medical Center North, Nashville, TN 37232. E-mail: derek.
| | - Samir S. Shah
- Infectious Diseases and,Hospital Medicine, Cincinnati Children's Hospital Medical Center,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
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202
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Turner C, Turner P, Cararra V, Eh Lwe N, Watthanaworawit W, Day NP, White NJ, Goldblatt D, Nosten F. A high burden of respiratory syncytial virus associated pneumonia in children less than two years of age in a South East Asian refugee population. PLoS One 2012. [PMID: 23185545 PMCID: PMC3502361 DOI: 10.1371/journal.pone.0050100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pneumonia is a major cause of childhood mortality and morbidity approximately 1.6 million deaths and 150 million episodes occur annually in children <5 years. Respiratory syncytial virus (RSV) may be responsible for up to 25% of cases and 12% of deaths making it an important potential vaccine target, although data from South East Asia is scarce. Methods We followed a birth cohort of Burmese refugee children, born over a one year period, for two years. Pneumonia episodes were diagnosed using WHO criteria. A chest radiograph, nasopharyngeal aspirate and non-specific markers of infection were taken during each episode. Results The incidence of RSV-associated pneumonia was 0.24 (95% CI 0.22–0.26) episodes per child year. All children with pneumonia received antibiotic treatment, following WHO guidelines. The highest incidence was in the 2–12 month age group. The commonest diagnosis in a child with RSV-associated pneumonia was non-severe pneumonia (239/362∶66.0%), however the incidence of RSV-associated severe or very severe pneumonia was 0.08 (95% CI 0.01–0.10) episodes per child year. Birth in the wet season increased the risk of severe disease in children who had their first episode of RSV-associated pneumonia aged 2–11 months (OR 28.7, 95% CI 6.6–125.0, p<0.001). RSV episodes were highly seasonal being responsible for 80.0% of all the pneumonia episodes occurring each October and November over the study period. Conclusions There was a high incidence of RSV associated pneumonia in this refugee population. Interventions to prevent RSV infection have the potential to reduce the incidence of clinically diagnosed pneumonia and hence unnecessary antibiotic usage in this population.
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203
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Ohuma EO, Okiro EA, Ochola R, Sande CJ, Cane PA, Medley GF, Bottomley C, Nokes DJ. The natural history of respiratory syncytial virus in a birth cohort: the influence of age and previous infection on reinfection and disease. Am J Epidemiol 2012; 176:794-802. [PMID: 23059788 PMCID: PMC3481264 DOI: 10.1093/aje/kws257] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study aimed to quantify the effect of age, time since last infection, and infection history on the rate of respiratory syncytial virus infection and the effect of age and infection history on the risk of respiratory syncytial virus disease. A birth cohort of 635 children in Kilifi, Kenya, was monitored for respiratory syncytial virus infections from January 31, 2002, to April 22, 2005. Predictors of infection were examined by Cox regression and disease risk by binomial regression. A total of 598 respiratory syncytial virus infections were identified (411 primary, 187 repeat), with 409 determined by antigen assay and 189 by antibody alone (using a “most pragmatic” serologic definition). The incidence decreased by 70% following a primary infection (adjusted hazard ratio = 0.30, 95% confidence interval: 0.21, 0.42; P < 0.001) and by 59% following a secondary infection (hazard ratio = 0.41, 95% confidence interval: 0.22, 0.73; P = 0.003), for a period lasting 6 months. Relative to the age group <6 months, all ages exhibited a higher incidence of infection. A lower risk of severe disease following infection was independently associated with increasing age (P < 0.001) but not reinfection. In conclusion, observed respiratory syncytial virus incidence was lowest in the first 6 months of life, immunity to reinfection was partial and short lived, and disease risk was age related.
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Affiliation(s)
- E O Ohuma
- Kenya Medical Research Institute, Centre for Geographic Medicine Research, Kilifi, Kenya.
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204
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Suzuki A, Lupisan S, Furuse Y, Fuji N, Saito M, Tamaki R, Galang H, Sombrero L, Mondoy M, Aniceto R, Olveda R, Oshitani H. Respiratory viruses from hospitalized children with severe pneumonia in the Philippines. BMC Infect Dis 2012; 12:267. [PMID: 23092190 PMCID: PMC3519714 DOI: 10.1186/1471-2334-12-267] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumonia remains a leading cause of child death in developing countries. The viruses in severe pneumonia remain poorly defined. METHODS The study was conducted at the Eastern Visayas Regional Medical Center in Tacloban City, Philippines from May 2008 to May 2009. Patients aged 8 days to 13 years old who were admitted to the Department of Pediatrics with severe pneumonia were enrolled for the study. Upon admission, polymerase chain reaction was performed using nasopharyngeal swabs and blood cultures to detect respiratory viruses and bacteria, respectively. RESULT Among the 819 patients enrolled, at least one virus was detected in 501 cases (61.2%). In addition, 423 cases were positive for a single virus while bacteria were detected in the blood culture sample of 31 cases. The most commonly detected viruses were human rhinoviruses (n = 189), including types A (n = 103), B (n = 17), and C (n = 69), and respiratory syncytial virus (RSV) (n = 165). Novel viruses such as human metapneumovirus, human coronavirus NL63, human bocavirus, and human polyomaviruses WU and KI were also detected. There were 70 deaths, and one or more viruses were detected in 35 (50%) of these cases. Positivity only for influenza A virus (OR = 4.3, 95% CI = 1.3-14.6) was significantly associated with fatal outcome. From the blood culture, Burkholderia cepacia group (n = 9), Streptococcus pneumoniae (n = 4), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 1), and Salmonella C1 (n = 1) were also isolated. CONCLUSION Viruses were commonly detected in children with severe pneumonia in the Philippines. Hence, viral etiologies should be considered while developing better effective strategies to reduce child pneumonia-related deaths in developing countries.
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Affiliation(s)
- Akira Suzuki
- Department of Virology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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205
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Almajhdi FN, Alshaman MS, Amer HM. Molecular characterization and phylogenetic analysis of human parainfluenza virus type 3 isolated from Saudi Arabia. J Med Virol 2012; 84:1304-11. [PMID: 22711360 DOI: 10.1002/jmv.23326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Human parainfluenza virus 3 (HPIV-3) is a leading cause of respiratory disease in children worldwide. Previous sequence analyses of the entire virus genome, among different HPIV-3 strains, demonstrated that HN is the most variable gene. There is a dearth of data on HPIV-3 strains circulating in Saudi Arabia. In this report, HPIV-3 was screened in nasopharyngeal aspirates collected from hospitalized children with acute respiratory disease during two successive seasons (2007/08 and 2008/09) using nested RT-PCR. Out of 73 samples collected during 2007/08, seven (9.59%) were positive; while 3 out of 107 samples collected during 2008/09 (2.8%) were positive. Virus isolation in cell culture was successful using HEp2, but not Vero cells. The identity of the isolated viruses was confirmed using immunofluorescence and neutralization assays. To elucidate the genetic characteristics and phylogeny of Saudi HPIV-3 strains, the complete HN gene sequence of two selected Saudi strains was analyzed in comparison to 20 strains isolated by others from different countries worldwide. Both strains showed the highest degree of sequence homology with Indian strains, followed by Chinese and most Japanese strains. Phylogenetic analysis confirmed that these strains fell into a distinct Asian lineage. This study is the first in Saudi Arabia to recover HPIV-3 isolates of confirmed identity, and to generate sequence data that may help in understanding virus diversity and evolution.
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Affiliation(s)
- Fahad N Almajhdi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia.
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206
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Østergaard MS, Nantanda R, Tumwine JK, Aabenhus R. Childhood asthma in low income countries: an invisible killer? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:214-9. [PMID: 22623048 DOI: 10.4104/pcrj.2012.00038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.
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Affiliation(s)
- Marianne Stubbe Østergaard
- Department of General Practice and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
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207
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Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings. Vaccine 2012; 30:7134-40. [PMID: 23026690 DOI: 10.1016/j.vaccine.2012.09.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/08/2012] [Accepted: 09/13/2012] [Indexed: 11/24/2022]
Abstract
Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant women during the 2009 influenza pandemic. We conclude with an analysis of data gaps and necessary activities to facilitate implementation of maternal influenza immunization programs in resource-limited settings.
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208
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Thompson MG, Breiman RF, Hamel MJ, Desai M, Emukule G, Khagayi S, Shay DK, Morales K, Kariuki S, Bigogo GM, Njenga MK, Burton DC, Odhiambo F, Feikin DR, Laserson KF, Katz MA. Influenza and malaria coinfection among young children in western Kenya, 2009-2011. J Infect Dis 2012; 206:1674-84. [PMID: 22984118 DOI: 10.1093/infdis/jis591] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although children <5 years old in sub-Saharan Africa are vulnerable to both malaria and influenza, little is known about coinfection. METHODS This retrospective, cross-sectional study in rural western Kenya examined outpatient visits and hospitalizations associated with febrile acute respiratory illness (ARI) during a 2-year period (July 2009-June 2011) in children <5 years old. RESULTS Across sites, 45% (149/331) of influenza-positive patients were coinfected with malaria, whereas only 6% (149/2408) of malaria-positive patients were coinfected with influenza. Depending on age, coinfection was present in 4%-8% of outpatient visits and 1%-3% of inpatient admissions for febrile ARI. Children with influenza were less likely than those without to have malaria (risk ratio [RR], 0.57-0.76 across sites and ages), and children with malaria were less likely than those without to have influenza (RR, 0.36-0.63). Among coinfected children aged 24-59 months, hospital length of stay was 2.7 and 2.8 days longer than influenza-only-infected children at the 2 sites, and 1.3 and 3.1 days longer than those with malaria only (all P < .01). CONCLUSIONS Coinfection with malaria and influenza was uncommon but associated with longer hospitalization than single infections among children 24-59 months of age.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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209
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Webb C, Ngama M, Ngatia A, Shebbe M, Morpeth S, Mwarumba S, Bett A, Nokes DJ, Seale AC, Kazungu S, Munywoki P, Hammitt LL, Scott JAG, Berkley JA. Treatment failure among Kenyan children with severe pneumonia--a cohort study. Pediatr Infect Dis J 2012; 31:e152-7. [PMID: 22692700 PMCID: PMC3691501 DOI: 10.1097/inf.0b013e3182638012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of childhood mortality worldwide. The World Health Organization recommends presumptive treatment based on clinical syndromes. Recent studies raise concerns over the frequency of treatment failure in Africa. METHODS We applied a definition of treatment failure to data prospectively collected from children who were 2-59 months of age with severe, or very severe, pneumonia admitted to Kilifi District Hospital, Kenya, from May 2007 through May 2008 and treated using World Health Organization guidelines. The primary outcome was treatment failure at 48 hours. RESULTS Of 568 children, median age 11 months, 165 (29%) had very severe pneumonia, 30 (5.3%) a positive HIV test and 62 (11%) severe malnutrition. One hundred eleven (20%; 95% confidence interval: 17-23%) children failed treatment at 48 hours and 34 (6.0%) died; 22 (65%) deaths occurred before 48 hours. Of 353 children with severe pneumonia, without HIV or severe malnutrition, 42 (12%) failed to respond at 48 hours, 15 (4.3%) failed at 5 days and 1 child (0.3%) died. Among 215 children with either severe pneumonia complicated by HIV or severe malnutrition, or very severe pneumonia, 69 (32%) failed to treatment at 48 hours, 47 (22%) failed at 5 days and 33 (16%) died. Treatment failure at 48 hours was associated with shock, bacteremia, very severe pneumonia, oxygen saturation in hemoglobin <95%, severe malnutrition, HIV and age <1 year in multivariable models. CONCLUSIONS In this setting, few children with uncomplicated severe pneumonia fail treatment or die under current guidelines. Deaths mainly occurred early and may be reduced by improving prevention, prehospital care and treatment of sepsis.
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Affiliation(s)
- Clare Webb
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Mwanajuma Ngama
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Anthony Ngatia
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Mohammed Shebbe
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Susan Morpeth
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Salim Mwarumba
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Ann Bett
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - D. James Nokes
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Department of Biological Sciences, University of Warwick, Coventry, UK.
| | - Anna C. Seale
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sidi Kazungu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Patrick Munywoki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Laura L. Hammitt
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - J. Anthony G. Scott
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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210
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An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa. Pediatr Crit Care Med 2012; 13:e275-81. [PMID: 22596071 DOI: 10.1097/pcc.0b013e3182417848] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections. DESIGN Retrospective descriptive study. SETTING Pediatric intensive care unit in a tertiary pediatric hospital situated in Cape Town, South Africa. PATIENTS All children (n = 195; 20% pediatric intensive care unit admissions) with positive respiratory viral isolates between April 1 and December 31, 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic, clinical, laboratory, and outcome data were recorded from medical folders. Complete data were available for 175 patients (median age [interquartile range] 4.7 months [2.3-12.9 months]; 49% male). One hundred four (59.4%) patients had comorbid conditions; 30 (17%) were HIV-infected. Rhinovirus (n = 76 [39%]), respiratory syncytial virus (n = 54 [27.7%]), adenovirus (n = 30 [15.4%]), influenza A (n = 26 [13.3%]), parainfluenza (n = 23 [11.8%]), and human metapneumovirus (n = 12 [6.2%]) were most commonly isolated. Ninety-five infections (51.4%) were isolated >48 hrs after admission. Seasonal patterns were identified for respiratory syncytial virus, human metapneumovirus, and influenza A, whereas others occurred throughout the year. Twenty-five patients (14.3%) had more than one viral isolate. Presumed bacterial coinfection, which occurred in 68 (39%) patients (18 [26.5%] HIV-infected), was associated with significantly longer pediatric intensive care unit and hospital stays but not with mortality. Twenty patients died (11%, standardized mortality ratio 0.64). High Pediatric Index of Mortality scores, HIV exposure and infection, nosocomial infection, and influenza A infection were associated with mortality. CONCLUSIONS Viral respiratory tract infection is common in this pediatric intensive care unit associated with significant morbidity and mortality, which may relate to the high burden of comorbidity and HIV.
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211
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Feikin DR, Njenga MK, Bigogo G, Aura B, Aol G, Audi A, Jagero G, Muluare PO, Gikunju S, Nderitu L, Balish A, Winchell J, Schneider E, Erdman D, Oberste MS, Katz MA, Breiman RF. Etiology and Incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007-2010. PLoS One 2012; 7:e43656. [PMID: 22937071 PMCID: PMC3427162 DOI: 10.1371/journal.pone.0043656] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/23/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few comprehensive data exist on disease incidence for specific etiologies of acute respiratory illness (ARI) in older children and adults in Africa. METHODOLOGY/PRINCIPAL FINDINGS From March 1, 2007, to February 28, 2010, among a surveillance population of 21,420 persons >5 years old in rural western Kenya, we collected blood for culture and malaria smears, nasopharyngeal and oropharyngeal swabs for quantitative real-time PCR for ten viruses and three atypical bacteria, and urine for pneumococcal antigen testing on outpatients and inpatients meeting a ARI case definition (cough or difficulty breathing or chest pain and temperature >38.0 °C or oxygen saturation <90% or hospitalization). We also collected swabs from asymptomatic controls, from which we calculated pathogen-attributable fractions, adjusting for age, season, and HIV-status, in logistic regression. We calculated incidence by pathogen, adjusting for health-seeking for ARI and pathogen-attributable fractions. Among 3,406 ARI patients >5 years old (adjusted annual incidence 12.0 per 100 person-years), influenza A virus was the most common virus (22% overall; 11% inpatients, 27% outpatients) and Streptococcus pneumoniae was the most common bacteria (16% overall; 23% inpatients, 14% outpatients), yielding annual incidences of 2.6 and 1.7 episodes per 100 person-years, respectively. Influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human metapneumovirus were more prevalent in swabs among cases (22%, 6%, 8% and 5%, respectively) than controls. Adenovirus, parainfluenza viruses, rhinovirus/enterovirus, parechovirus, and Mycoplasma pneumoniae were not more prevalent among cases than controls. Pneumococcus and non-typhi Salmonella were more prevalent among HIV-infected adults, but prevalence of viruses was similar among HIV-infected and HIV-negative individuals. ARI incidence was highest during peak malaria season. CONCLUSIONS/SIGNIFICANCE Vaccination against influenza and pneumococcus (by potential herd immunity from childhood vaccination or of HIV-infected adults) might prevent much of the substantial ARI incidence among persons >5 years old in similar rural African settings.
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Affiliation(s)
- Daniel R Feikin
- Global Disease Detection Division, Centers for Disease Control and Prevention, International Emerging Infections Program, Kisumu, Kenya.
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212
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Abstract
The Fluid Expansion as Supportive Therapy (FEAST) trial in an African setting without intensive care facilities found that bolus fluid therapy for severe infections (including malaria and viral infections) resulted in a significantly higher mortality than those not given a bolus. This was a high-quality study of 3170 children with 48 h mortality as the primary outcome. Despite the different setting and diseases than in a developed country context, it could be argued that this study calls into question the wisdom of bolus fluid regimes for sepsis, and perhaps even the concept of 'compensated shock' in the Advanced Paediatric Life Support protocol. Some have tried to attack the ethics of the study, but this is unjustified. The implications for paediatric practice in Africa are that intravenous fluids need to be monitored more closely, and the practice of giving boluses to every 'query septic infant and child' needs to be examined more critically.
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Affiliation(s)
- David Brewster
- School of Medicine, University of Botswana, Gaborone, Botswana.
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213
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Hammitt LL, Kazungu S, Morpeth SC, Gibson DG, Mvera B, Brent AJ, Mwarumba S, Onyango CO, Bett A, Akech DO, Murdoch DR, Nokes DJ, Scott JAG. A preliminary study of pneumonia etiology among hospitalized children in Kenya. Clin Infect Dis 2012; 54 Suppl 2:S190-9. [PMID: 22403235 PMCID: PMC3297554 DOI: 10.1093/cid/cir1071] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of childhood death in the developing world. Higher-quality etiological data are required to reduce this mortality burden. METHODS We conducted a case-control study of pneumonia etiology among children aged 1-59 months in rural Kenya. Case patients were hospitalized with World Health Organization-defined severe pneumonia (SP) or very severe pneumonia (VSP); controls were outpatient children without pneumonia. We collected blood for culture, induced sputum for culture and multiplex polymerase chain reaction (PCR), and obtained oropharyngeal swab specimens for multiplex PCR from case patients, and serum for serology and nasopharyngeal swab specimens for multiplex PCR from case patients and controls. RESULTS Of 984 eligible case patients, 810 (84%) were enrolled in the study; 232 (29%) had VSP. Blood cultures were positive in 52 of 749 case patients (7%). A predominant potential pathogen was identified in sputum culture in 70 of 417 case patients (17%). A respiratory virus was detected by PCR from nasopharyngeal swab specimens in 486 of 805 case patients (60%) and 172 of 369 controls (47%). Only respiratory syncytial virus (RSV) showed a statistically significant association between virus detection in the nasopharynx and pneumonia hospitalization (odds ratio, 12.5; 95% confidence interval, 3.1-51.5). Among 257 case patients in whom all specimens (excluding serum specimens) were collected, bacteria were identified in 24 (9%), viruses in 137 (53%), mixed viral and bacterial infection in 39 (15%), and no pathogen in 57 (22%); bacterial causes outnumbered viral causes when the results of the case-control analysis were considered. CONCLUSIONS A potential etiology was detected in >75% of children admitted with SP or VSP. Except for RSV, the case-control analysis did not detect an association between viral detection in the nasopharynx and hospitalization for pneumonia.
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Affiliation(s)
- Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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214
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Levine OS, O'Brien KL, Deloria-Knoll M, Murdoch DR, Feikin DR, DeLuca AN, Driscoll AJ, Baggett HC, Brooks WA, Howie SRC, Kotloff KL, Madhi SA, Maloney SA, Sow S, Thea DM, Scott JA. The Pneumonia Etiology Research for Child Health Project: a 21st century childhood pneumonia etiology study. Clin Infect Dis 2012; 54 Suppl 2:S93-101. [PMID: 22403238 PMCID: PMC3297546 DOI: 10.1093/cid/cir1052] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Pneumonia Etiology Research for Child Health (PERCH) project is a 7-country, standardized, comprehensive evaluation of the etiologic agents causing severe pneumonia in children from developing countries. During previous etiology studies, between one-quarter and one-third of patients failed to yield an obvious etiology; PERCH will employ and evaluate previously unavailable innovative, more sensitive diagnostic techniques. Innovative and rigorous epidemiologic and analytic methods will be used to establish the causal association between presence of potential pathogens and pneumonia. By strategic selection of study sites that are broadly representative of regions with the greatest burden of childhood pneumonia, PERCH aims to provide data that reflect the epidemiologic situation in developing countries in 2015, using pneumococcal and Haemophilus influenzae type b vaccines. PERCH will also address differences in host, environmental, and/or geographic factors that might determine pneumonia etiology and, by preserving specimens, will generate a resource for future research and pathogen discovery.
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Affiliation(s)
- Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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215
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Murdoch DR, O'Brien KL, Driscoll AJ, Karron RA, Bhat N. Laboratory methods for determining pneumonia etiology in children. Clin Infect Dis 2012; 54 Suppl 2:S146-52. [PMID: 22403229 DOI: 10.1093/cid/cir1073] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Laboratory diagnostics are a core component of any pneumonia etiology study. Recent advances in diagnostic technology have introduced newer methods that have greatly improved the ability to identify respiratory pathogens. However, determining the microbial etiology of pneumonia remains a challenge, especially in children. This is largely because of the inconsistent use of assays between studies, difficulties in specimen collection, and problems in interpreting the presence of pathogens as being causally related to the pneumonia event. The laboratory testing strategy for the Pneumonia Etiology Research for Child Health (PERCH) study aims to incorporate a broad range of diagnostic testing that will be standardized across the 7 participating sites. We describe the current status of laboratory diagnostics for pneumonia and the PERCH approach for specimen testing. Pneumonia diagnostics are evolving, and it is also a priority of PERCH to collect and archive specimens for future testing by promising diagnostic methods that are currently under development.
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Affiliation(s)
- David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand.
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216
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Fawkner-Corbett DW, Duarte MCMB, Rose K, Fonceca A, Bezerra P, Hopkins M, Britto M, Cuevas LE, Correia JB, McNamara PS. The impact of the H1N1 influenza pandemic on clinical presentations and viral epidemiology of acute respiratory infection in preschool children in Brazil. Pediatr Infect Dis J 2012; 31:653-5. [PMID: 22414906 PMCID: PMC3378642 DOI: 10.1097/inf.0b013e3182501ff4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We assessed the impact of the H1N1 influenza pandemic on acute respiratory infection in young children from low-income families in Brazil. Influenza (specifically H1N1) detection in acute respiratory infection quintupled during the pandemic and, during its peak, it was associated with 30% of all acute respiratory infection visits to the emergency department. H1N1 was also associated with increased risk of hospitalization and coinfection.
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217
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Wingerter SL, Bachur RG, Monuteaux MC, Neuman MI. Application of the world health organization criteria to predict radiographic pneumonia in a US-based pediatric emergency department. Pediatr Infect Dis J 2012; 31:561-4. [PMID: 22333702 DOI: 10.1097/inf.0b013e31824da716] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The World Health Organization (WHO) established guidelines that rely on simple clinical signs for the diagnosis of childhood pneumonia in resource-limited settings. Our objective was to evaluate the test characteristics of the WHO criteria for the diagnosis of radiographic pneumonia in the emergency department setting. METHODS We prospectively collected clinical information from children ≤5 years of age presenting to a US-based pediatric emergency department who had a chest radiograph performed for suspicion of pneumonia. Patients were classified as meeting the WHO case definition of pneumonia if they had both 1) cough or difficulty breathing and 2) age-specific WHO-defined tachypnea. The primary outcome was radiographic pneumonia based on the final radiology report. Among children with cough or with difficulty breathing, receiver operator characteristic curve analysis was used to evaluate the test characteristics of triage respiratory rate, temperature and oxygen saturation for the diagnosis of radiographic pneumonia. RESULTS Two thousand eight children were enrolled. Median age was 19 months, and 28.5% had tachypnea based upon age-specific respiratory rate thresholds. Of the 324 children with radiographic pneumonia, 111 met the WHO case definition of pneumonia (sensitivity = 34.3%, 95% confidence interval: 29.1-39.7). Triage respiratory rate demonstrated an area under the curve of 0.54 for the diagnosis of radiographic pneumonia. The area under the curve for triage temperature and oxygen saturation was 0.56 and 0.60, respectively. CONCLUSIONS The WHO criteria demonstrated poor sensitivity for the diagnosis of radiographic pneumonia in a US-based pediatric emergency department. Compared with respiratory rate, oxygen saturation offered slightly improved test characteristics. Although applied to a different target population, these findings suggest the WHO criteria may not be a sensitive screening tool for the diagnosis of pneumonia in children.
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Affiliation(s)
- Sarah L Wingerter
- Division of Emergency Medicine, Children's Hospital Boston, Boston, Boston, MA 02115, USA.
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218
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Moore HC, de Klerk N, Keil AD, Smith DW, Blyth CC, Richmond P, Lehmann D. Use of data linkage to investigate the aetiology of acute lower respiratory infection hospitalisations in children. J Paediatr Child Health 2012; 48:520-8. [PMID: 22077532 PMCID: PMC7166791 DOI: 10.1111/j.1440-1754.2011.02229.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To document the aetiology of acute lower respiratory infection (ALRI) hospitalisations in Western Australian children by linking population-based laboratory data with hospital morbidity data. METHODS Data from all ALRI hospitalisations and laboratory records related to respiratory pathogens between 2000 and 2005 were extracted and linked through a population-based record linkage system. The proportion of specimens that were positive for each respiratory viral or bacterial pathogen was documented. RESULTS Eight thousand nine hundred and eighty (45.2%) ALRI hospitalisations were linked to a laboratory record. Admissions to a private hospital and admissions from non-metropolitan areas were less likely to have a linked laboratory record. In 57.9% of linked hospitalisations, a respiratory virus and/or a bacterial pathogen was identified. Frequently identified viral pathogens included respiratory syncytial virus (RSV; n= 3226; 39.5% of those tested), influenza viruses (n= 664; 8.5%), parainfluenza virus type 3 (n= 348; 4.6%), picornaviruses (n= 292; 22.3%) and adenoviruses (n= 211; 2.7%). RSV was identified in 63.7% of bronchiolitis admissions in those aged under 6 months and 33.1% of pneumonia admissions in those aged under 12 months. Influenza viruses were identified in 81.6% of influenza-coded admissions. When a test was requested, Bordetella pertussis was identified in 21.2% of ALRI hospitalisations (n= 354), including 86.8% of whooping cough-coded admissions. CONCLUSIONS This is the first report of population-based data linkage between statewide laboratory data and hospitalisation records and demonstrates proof of principle. RSV continues to be an important pathogen in ALRI. As pathogens were identified across all diagnoses, relying on hospital diagnosis coding alone may not accurately estimate the burden of different categories of ALRI.
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Affiliation(s)
- Hannah C Moore
- Telethon Institute for Child Health Research, Centre for Child Health Research, Schools of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.
| | - Nicholas de Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, Schools of
| | - Anthony D Keil
- PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children
| | - David W Smith
- Telethon Institute for Child Health Research, Centre for Child Health Research, Schools of,Pathology and Laboratory Medicine,,Biological, Biomolecular and Chemical Sciences,Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Paediatrics and Child Health, University of Western Australia,PathWest Laboratory Medicine WA, QEII Medical Centre
| | - Peter Richmond
- Paediatrics and Child Health, University of Western Australia,PathWest Laboratory Medicine WA, QEII Medical Centre
| | - Deborah Lehmann
- Telethon Institute for Child Health Research, Centre for Child Health Research, Schools of
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219
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Chidlow GR, Laing IA, Harnett GB, Greenhill AR, Phuanukoonnon S, Siba PM, Pomat WS, Shellam GR, Smith DW, Lehmann D. Respiratory viral pathogens associated with lower respiratory tract disease among young children in the highlands of Papua New Guinea. J Clin Virol 2012; 54:235-9. [PMID: 22595309 PMCID: PMC3383990 DOI: 10.1016/j.jcv.2012.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/03/2012] [Accepted: 04/17/2012] [Indexed: 11/18/2022]
Abstract
Background Acute lower respiratory tract infections (ALRI) commonly result in fatal outcomes in the young children of Papua New Guinea (PNG). However, comprehensive studies of the viral aetiology of ALRI have not been conducted in PNG for almost 30 years. Objectives To determine the viruses associated with ALRI among children living in the PNG highlands using sensitive molecular detection techniques. Study design Pernasal swabs were collected routinely between 1 week and 18 months of age and also during episodes of ALRI, as part of a neonatal pneumococcal conjugate vaccine trial. A tandem multiplex real-time PCR assay was used to test for a comprehensive range of respiratory viruses in samples collected from 221 young children. Picornavirus typing was supported by DNA sequence analysis. Results Recognized pathogenic respiratory viruses were detected in 198/273 (73%) samples collected from children with no evidence of ALRI and 69/80 (86%) samples collected during ALRI episodes. Human rhinoviruses (HRV) species A, B and C were detected in 152 (56%) samples from non-ALRI children and 50 (63%) samples collected during ALRI episodes. Partial structural region sequences for two new species C rhinoviruses were added to the GenBank database. ALRI was associated with detection of adenovirus species B (p < 0.01) or C (p < 0.05), influenza A (p < 0.0001) or respiratory syncytial virus (p < 0.0001). Multiple viruses were detected more often during ALRI episodes (49%) than when children displayed no symptoms of ALRI (18%) (p < 0.0001). Conclusions The burden of infection with respiratory viruses remains significant in young children living in the PNG highlands.
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Affiliation(s)
- Glenys R Chidlow
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, Australia.
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220
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Onyango CO, Welch SR, Munywoki PK, Agoti CN, Bett A, Ngama M, Myers R, Cane PA, Nokes DJ. Molecular epidemiology of human rhinovirus infections in Kilifi, coastal Kenya. J Med Virol 2012; 84:823-31. [PMID: 22431032 PMCID: PMC3500870 DOI: 10.1002/jmv.23251] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 11/17/2022]
Abstract
This study reports pediatric surveillance over 3 years for human rhinovirus (HRV) at the District Hospital of Kilifi, coastal Kenya. Nasopharyngeal samples were collected from children presenting at outpatient clinic with no signs of acute respiratory infection, or with signs of upper respiratory tract infection, and from children admitted to the hospital with lower respiratory tract infection. Samples were screened by real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR) and classified further to species by nucleotide sequencing of the VP4/VP2 junction. Of 441 HRV positives by real-time RT-PCR, 332 were classified to species, with 47% (155) being HRV-A, 5% (18) HRV-B, and 48% (159) HRV-C. There was no clear seasonal pattern of occurrence for any species. The species were present in similar proportions in the inpatient and outpatient sample sets, and no significant association between species distribution and the severity of lower respiratory tract infection in the inpatients could be determined. HRV sequence analysis revealed multiple but separate clusters in circulation particularly for HRV-A and HRV-C. Most HRV-C clusters were distinct from reference sequences downloaded from GenBank. In contrast, most HRV-A and HRV-B sequences clustered with either known serotypes or strains from elsewhere within Africa and other regions of the world. This first molecular epidemiological study of HRV in the region defines species distribution in accord with reports from elsewhere in the world, shows considerable strain diversity and does not identify an association between any species and disease severity.
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221
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Marr N, Turvey SE. Role of human TLR4 in respiratory syncytial virus-induced NF-κB activation, viral entry and replication. Innate Immun 2012; 18:856-65. [PMID: 22535679 DOI: 10.1177/1753425912444479] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
TLRs play a key role in innate immune defenses. It was previously reported that purified respiratory syncytial virus (RSV) fusion protein elicits an inflammatory response in hematopoietic cells, which required expression of TLR4 and its co-receptor CD14. However, a biological role of TLR4 in immunity to RSV, as initially proposed, has remained inconclusive and controversial. Here, we directly assess the role of human TLR4 and its co-receptors in NF-κB activation, viral entry and replication using intact virions rather than purified RSV components. We used HEK 293 reporter cells that are highly permissive for RSV and that either express or a lack a functional human TLR4/MD-2/CD14 complex. We demonstrate that RSV-mediated NF-κB activation, viral entry and replication are independent of the expression of a functional human TLR4/MD-2/CD14 complex and that, in turn, human TLR4 activation by LPS remains unaffected in RSV-infected cells. Thus, although isolated viral compounds such as purified RSV F protein may bind TLR4 and/or CD14, a direct interaction between intact RSV particles and the human TLR4 receptor complex does not seem to play a biological role in RSV pathogenesis.
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Affiliation(s)
- Nico Marr
- Department of Pediatrics, University of British Columbia and the Child & Family Research Institute, Vancouver, Canada.
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The epidemiology and clinical characteristics of respiratory syncytial virus infection in children at a public pediatric referral hospital in Mexico. Int J Infect Dis 2012; 16:e508-13. [PMID: 22525227 DOI: 10.1016/j.ijid.2012.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 02/24/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospital in Mexico. METHODS We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.
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223
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Gilani Z, Kwong YD, Levine OS, Deloria-Knoll M, Scott JAG, O'Brien KL, Feikin DR. A literature review and survey of childhood pneumonia etiology studies: 2000-2010. Clin Infect Dis 2012; 54 Suppl 2:S102-8. [PMID: 22403223 PMCID: PMC3693495 DOI: 10.1093/cid/cir1053] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/20/2011] [Indexed: 01/20/2023] Open
Abstract
The Pneumonia Etiology Research for Child Health (PERCH) project is the largest multicountry etiology study of childhood pneumonia since the Board on Science and Technology in International Development studies of the 1980s. However, it is not the only recent or ongoing pneumonia etiology study, and even with seven sites, it cannot capture all epidemiologic settings in the developing world. Funding providers, researchers and policymakers rely on the best available evidence to strategically plan programs, new research directions and interventions. We aimed to describe the current landscape of recent pneumonia etiology studies in children under 5 years of age in the developed and developing world, as ascertained by a literature review of relevant studies with data since the year 2000 and a survey of researchers in the field of childhood pneumonia. We collected information on the study population, study design, case definitions, laboratory samples and methods and identified pathogens. A literature review identified 88 studies with child pneumonia etiology results. As of June 2010, our survey of researchers identified an additional 65 ongoing and recently completed child pneumonia etiology studies. This demonstrates the broad existing context into which the PERCH study must be placed. However, the landscape analysis also reveals a multiplicity of case definitions, levels of clinician involvement, facility types, specimen collection, and laboratory techniques. It reinforces the need for the standardization of methods and analyses for present and future pneumonia etiology studies in order to optimize their cumulative potential to accurately describe the microbial causes of childhood pneumonia.
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Affiliation(s)
- Zunera Gilani
- Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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224
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Deloria-Knoll M, Feikin DR, Scott JAG, O'Brien KL, DeLuca AN, Driscoll AJ, Levine OS. Identification and selection of cases and controls in the Pneumonia Etiology Research for Child Health project. Clin Infect Dis 2012; 54 Suppl 2:S117-23. [PMID: 22403225 PMCID: PMC3297551 DOI: 10.1093/cid/cir1066] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/22/2011] [Indexed: 12/02/2022] Open
Abstract
Methods for the identification and selection of patients (cases) with severe or very severe pneumonia and controls for the Pneumonia Etiology Research for Child Health (PERCH) project were needed. Issues considered include eligibility criteria and sampling strategies, whether to enroll hospital or community controls, whether to exclude controls with upper respiratory tract infection (URTI) or nonsevere pneumonia, and matching criteria, among others. PERCH ultimately decided to enroll community controls and an additional human immunodeficiency virus (HIV)-infected control group at high HIV-prevalence sites matched on age and enrollment date of cases; controls with symptoms of URTI or nonsevere pneumonia will not be excluded. Systematic sampling of cases (when necessary) and random sampling of controls will be implemented. For each issue, we present the options that were considered, the advantages and disadvantages of each, the rationale for the methods selected for PERCH, and remaining implications and limitations.
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Affiliation(s)
- Maria Deloria-Knoll
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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225
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Bhat N, O'Brien KL, Karron RA, Driscoll AJ, Murdoch DR. Use and evaluation of molecular diagnostics for pneumonia etiology studies. Clin Infect Dis 2012; 54 Suppl 2:S153-8. [PMID: 22403230 PMCID: PMC3297547 DOI: 10.1093/cid/cir1060] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/21/2011] [Indexed: 01/16/2023] Open
Abstract
Comprehensive microbiological testing will be a core function of the Pneumonia Etiology Research for Child Health (PERCH) project. The development stage of PERCH provided the time and resources necessary for us to conduct a comprehensive review of the current state of respiratory diagnostics. These efforts allowed us to articulate the unique requirements of PERCH, establish that molecular methods would be central to our testing strategy, and focus on a short list of candidate platforms. This process also highlighted critical challenges in the general design and interpretation of diagnostic evaluation studies, particularly in the field of respiratory infections. Although our final molecular diagnostic platform was ultimately selected on the basis of operational and strategic considerations determined by the specific context of PERCH, our review highlighted several conceptual and practical challenges in respiratory diagnostics that have broader relevance for the performance and interpretation of pneumonia research studies.
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Affiliation(s)
- Niranjan Bhat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine
| | | | - Ruth A. Karron
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - David R. Murdoch
- Department of Pathology, University of Otago
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
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226
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Yu X, Lu R, Wang Z, Zhu N, Wang W, Julian D, Chris B, Lv J, Tan W. Etiology and clinical characterization of respiratory virus infections in adult patients attending an emergency department in Beijing. PLoS One 2012; 7:e32174. [PMID: 22389685 PMCID: PMC3289638 DOI: 10.1371/journal.pone.0032174] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute respiratory tract infections (ARTIs) represent a serious global health burden. To date, few reports have addressed the prevalence of respiratory viruses (RVs) in adults with ARTIs attending an emergency department (ED). Therefore, the potential impact of respiratory virus infections on such patients remains unknown. METHODOLOGY/PRINCIPAL FINDINGS To determine the epidemiological and clinical profiles of common and recently discovered respiratory viruses in adults with ARTIs attending an ED in Beijing, a 1-year consecutive study was conducted from May, 2010, to April, 2011. Nose and throat swab samples from 416 ARTI patients were checked for 13 respiratory viruses using multiple reverse transcription polymerase chain reaction(RT-PCR) assays for common respiratory viruses, including influenza viruses (Flu) A, B, and adenoviruses (ADVs), picornaviruses (PICs), respiratory syncytial virus (RSV), parainfluenza viruses (PIVs) 1-3, combined with real-time RT-PCR for human metapneumovirus (HMPV) and human coronaviruses (HCoVs, -OC43, -229E, -NL63, and -HKU1). Viral pathogens were detected in 52.88% (220/416) of patient samples, and 7.21% (30/416) of patients tested positive for more than one virus. PICs (17.79%) were the dominant agents detected, followed by FluA (16.11%), HCoVs (11.78%), and ADV (11.30%). HMPV, PIVs, and FluB were also detected (<3%), but not RSV. The total prevalence and the dominant virus infections detected differed significantly between ours and a previous report. Co-infection rates were high for HCoV-229E (12/39, 30.76%), PIC (22/74, 29.73%), ADV (12/47, 25.53%) and FluA (15/67, 22.39%). Different patterns of clinical symptoms were associated with different respiratory viruses. CONCLUSIONS The pattern of RV involvement in adults with ARTIs attending an ED in China differs from that previously reported. The high prevalence of viruses (PIC, FluA, HCoVs and ADV) reported here strongly highlight the need for the development of safe and effective therapeutic approaches for these viruses.
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Affiliation(s)
- Xiaoyan Yu
- Key Laboratory for Laboratory Medicine of Ministry of Education, Institute of Medical Virology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Roujian Lu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Zhong Wang
- Peking Union Medical College Hospital, CAMS, Beijing, China
| | - Na Zhu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Wen Wang
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Druce Julian
- Virology Department, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Birch Chris
- Virology Department, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Jianxin Lv
- Key Laboratory for Laboratory Medicine of Ministry of Education, Institute of Medical Virology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- * E-mail: (WT); (JL)
| | - Wenjie Tan
- Key Laboratory for Laboratory Medicine of Ministry of Education, Institute of Medical Virology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
- * E-mail: (WT); (JL)
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Homaira N, Luby SP, Petri WA, Vainionpaa R, Rahman M, Hossain K, Snider CB, Rahman M, Alamgir ASM, Zesmin F, Alam M, Gurley ES, Zaman RU, Azim T, Erdman DD, Fry AM, Bresee J, Widdowson MA, Haque R, Azziz-Baumgartner E. Incidence of respiratory virus-associated pneumonia in urban poor young children of Dhaka, Bangladesh, 2009-2011. PLoS One 2012; 7:e32056. [PMID: 22384139 PMCID: PMC3285198 DOI: 10.1371/journal.pone.0032056] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/19/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of childhood death in Bangladesh. We conducted a longitudinal study to estimate the incidence of virus-associated pneumonia in children aged <2 years in a low-income urban community in Dhaka, Bangladesh. METHODS We followed a cohort of children for two years. We collected nasal washes when children presented with respiratory symptoms. Study physicians diagnosed children with cough and age-specific tachypnea and positive lung findings as pneumonia case-patients. We tested respiratory samples for respiratory syncytial virus (RSV), rhinoviruses, human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV 1, 2, 3), and adenoviruses using real-time reverse transcription polymerase chain reaction assays. RESULTS Between April 2009-March 2011, we followed 515 children for 730 child-years. We identified a total of 378 pneumonia episodes, 77% of the episodes were associated with a respiratory viral pathogen. The overall incidence of pneumonia associated with a respiratory virus infection was 40/100 child-years. The annual incidence of pneumonia/100 child-years associated with a specific respiratory virus in children aged < 2 years was 12.5 for RSV, 6 for rhinoviruses, 6 for HMPV, 4 for influenza viruses, 3 for HPIV and 2 for adenoviruses. CONCLUSION Young children in Dhaka are at high risk of childhood pneumonia and the majority of these episodes are associated with viral pathogens. Developing effective low-cost strategies for prevention are a high priority.
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Affiliation(s)
- Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
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228
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Esposito S, Daleno C, Prunotto G, Scala A, Tagliabue C, Borzani I, Fossali E, Pelucchi C, Principi N. Impact of viral infections in children with community-acquired pneumonia: results of a study of 17 respiratory viruses. Influenza Other Respir Viruses 2012; 7:18-26. [PMID: 22329841 PMCID: PMC5780730 DOI: 10.1111/j.1750-2659.2012.00340.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Please cite this paper as: Esposito et al. (2012) Impact of viral infections in children with community‐acquired pneumonia: results of a study of 17 respiratory viruses. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00340.x. Background Little is known about the prevalence of viral infections in children with community‐acquired pneumonia (CAP). Objectives To describe the clinical and virological data collected from children with radiographically confirmed CAP in whom 17 respiratory viruses were sought in respiratory secretion samples during the acute phase of the disease. Patients and methods The study involved 592 children with radiographically confirmed CAP whose respiratory secretion samples were tested using the Luminex xTAG Respiratory Virus Panel Fast assay, which simultaneously detects influenza A virus, influenza B virus, respiratory syncytial virus (RSV)‐A and ‐B, parainfluenzavirus‐1, ‐2, ‐3, and ‐4, adenovirus, human metapneumovirus, coronaviruses 229E, NL63, OC43, and HKU1, enterovirus/rhinovirus, and bocavirus. A real‐time PCR assay was used to identify the rhinovirus in the enterovirus/rhinovirus‐positive samples. Results A total of 435 children (73·5%) were positive for at least one virus: the most frequently detected was RSV, which was found in 188 (31·7%), followed by rhinovirus (n = 144, 24·3%), bocavirus (n = 60, 10·1%), influenza viruses (n = 57, 9·6), and hMPV (n = 49, 8·2%). Viral co‐infections were found in 117 children (19·7% of the enrolled children; 26·9% of those with viral infections). Marginal differences were found between the infections owing to a single virus. Co‐infections showed radiographic evidence of alveolar pneumonia significantly more frequently than single infections (OR 1·72, 95% CI 1·05–2·81). Conclusions The findings of this study highlight the importance of respiratory viruses (mainly RSV and rhinovirus) in children with CAP and show the characteristics of both the single infections and co‐infections associated with the disease.
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Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Schmidt AC, Schaap-Nutt A, Bartlett EJ, Schomacker H, Boonyaratanakornkit J, Karron RA, Collins PL. Progress in the development of human parainfluenza virus vaccines. Expert Rev Respir Med 2011; 5:515-26. [PMID: 21859271 DOI: 10.1586/ers.11.32] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In children under 5 years of age, human parainfluenza viruses (HPIVs) as a group are the second most common etiology of acute respiratory illness leading to hospitalization, surpassed only by respiratory syncytial virus but ahead of influenza viruses. Using reverse genetics systems for HPIV serotypes 1, 2 and 3 (HPIV1, 2 and 3), several live-attenuated HPIVs have been generated and evaluated as intranasal vaccines in adults and in children. Two vaccines against HPIV3 were found to be well tolerated, infectious and immunogenic in Phase I trials in HPIV3-seronegative infants and children and should progress to proof-of-concept trials. Vaccines against HPIV1 and HPIV2 are less advanced and have just entered pediatric trials.
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Affiliation(s)
- Alexander C Schmidt
- RNA Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Nascimento-Carvalho CM, Cardoso MRA, Meriluoto M, Kemppainen K, Kantola K, Ruuskanen O, Hedman K, Söderlund-Venermo M. Human bocavirus infection diagnosed serologically among children admitted to hospital with community-acquired pneumonia in a tropical region. J Med Virol 2011; 84:253-8. [DOI: 10.1002/jmv.22268] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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231
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Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, Simmerman JM, Gordon A, Sato M, Howie S, Krishnan A, Ope M, Lindblade KA, Carosone-Link P, Lucero M, Ochieng W, Kamimoto L, Dueger E, Bhat N, Vong S, Theodoratou E, Chittaganpitch M, Chimah O, Balmaseda A, Buchy P, Harris E, Evans V, Katayose M, Gaur B, O'Callaghan-Gordo C, Goswami D, Arvelo W, Venter M, Briese T, Tokarz R, Widdowson MA, Mounts AW, Breiman RF, Feikin DR, Klugman KP, Olsen SJ, Gessner BD, Wright PF, Rudan I, Broor S, Simões EAF, Campbell H. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011; 378:1917-30. [PMID: 22078723 DOI: 10.1016/s0140-6736(11)61051-9] [Citation(s) in RCA: 662] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years. METHODS We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality. FINDINGS We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49-162 million) new cases of influenza (data from nine studies), 20 million (13-32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1-2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28,000-111,500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting. INTERPRETATION Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available. FUNDING WHO; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK.
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Abstract
BACKGROUND Pneumonia is among the leading causes of illness and death in children <5 years of age worldwide. There is little information on the viral etiology of severe pneumonia in low-income countries, where the disease burden is particularly high. METHODS We analyzed nasopharyngeal aspirates from 629 children 2 to 35 months of age meeting World Health Organization criteria for severe pneumonia and presenting at Kanti Children's Hospital, Kathmandu, Nepal, from January 2006 through June 2008. We examined one specimen from each child for 7 respiratory viruses using reverse transcription polymerase chain reaction. RESULTS We detected one or more respiratory viruses in 188 (30%; confidence interval: 26.4%-33.7%) of the 627 specimens with a valid polymerase chain reaction result, of which 88 (14%) yielded respiratory syncytial virus (RSV), 28 (4.5%) influenza A, 24 (5.8%) parainfluenza virus (PIV) type 3, 23 (3.7%) PIV type 1, 17 (2.7%) influenza B, 9 (1.4%) human metapneumovirus, and 5 (0.8%) PIV type 2. Episodes of severe pneumonia occurred in an epidemic pattern with 2 main annual peaks, the viral infections contributing importantly to these epidemics. The largest peaks of severe pneumonia coincided with peaks of RSV infection, which occurred during the last part of the monsoon season and in winter. CONCLUSIONS RSV was the dominant respiratory viral pathogen detected in young Nepalese children hospitalized with severe pneumonia.
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Johnstone-Robertson SP, Mark D, Morrow C, Middelkoop K, Chiswell M, Aquino LDH, Bekker LG, Wood R. Social mixing patterns within a South African township community: implications for respiratory disease transmission and control. Am J Epidemiol 2011; 174:1246-55. [PMID: 22071585 DOI: 10.1093/aje/kwr251] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A prospective survey of social mixing patterns relevant to respiratory disease transmission by large droplets (e.g., influenza) or small droplet nuclei (e.g., tuberculosis) was performed in a South African township in 2010. A total of 571 randomly selected participants recorded the numbers, times, and locations of close contacts (physical/nonphysical) and indoor casual contacts met daily. The median number of physical contacts was 12 (interquartile range (IQR), 7-18), the median number of close contacts was 20 (IQR, 13-29), and the total number of indoor contacts was 30 (IQR, 12-54). Physical and close contacts were most frequent and age-associative in youths aged 5-19 years. Numbers of close contacts were 40% higher than in corresponding populations in industrialized countries (P < 0.001). This may put township communities at higher risk for epidemics of acute respiratory illnesses. Simulations of an acute influenza epidemic predominantly involved adolescents and young adults, indicating that control strategies should be directed toward these age groups. Of all contacts, 86.2% occurred indoors with potential exposure to respiratory droplet nuclei, of which 27.2%, 20.1%, 20.0%, and 8.0% were in transport, own household, crèche/school, and work locations, respectively. Indoor contact time was long in households and short during transport. High numbers of indoor contacts and intergenerational mixing in households and transport may contribute to exceptionally high rates of tuberculosis transmission reported in the community.
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Affiliation(s)
- Simon P Johnstone-Robertson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Western Cape, South Africa.
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Specific viruses detected in nigerian children in association with acute respiratory disease. J Trop Med 2011; 2011:690286. [PMID: 22007241 PMCID: PMC3191740 DOI: 10.1155/2011/690286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/14/2011] [Accepted: 07/06/2011] [Indexed: 11/05/2022] Open
Abstract
Occurrence of different viruses in acute respiratory tract infections of Nigerian children was examined. Respiratory swabs were collected from 246 children referred to hospital clinics because of acute respiratory symptoms from February through May 2009. Validated real-time RT-PCR techniques revealed nucleic acids of at least one virus group in 189 specimens (77%). Human rhinoviruses and parainfluenza viruses were present each in one third of the children. Adenoviruses, enteroviruses, human metapneumovirus, human bocavirus, and influenza C virus were also relatively common. Possibly due to their seasonal occurrence, influenza A and B virus, and respiratory syncytial virus were detected rarely. We conclude that all major groups of respiratory tract viruses are causing illness in Nigerian children.
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Venter M, Lassaunière R, Kresfelder TL, Westerberg Y, Visser A. Contribution of common and recently described respiratory viruses to annual hospitalizations in children in South Africa. J Med Virol 2011; 83:1458-68. [PMID: 21678450 PMCID: PMC7166348 DOI: 10.1002/jmv.22120] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The contribution of viruses to lower respiratory tract disease in sub‐Saharan Africa where human immunodeficiency virus may exacerbate respiratory infections is not well defined. No data exist on some of these viruses for Southern Africa. Comprehensive molecular screening may define the role of these viruses as single and co‐infections in a population with a high HIV‐AIDS burden. To address this, children less than 5 years of age with respiratory infections from 3 public sector hospitals, Pretoria South Africa were screened for 14 respiratory viruses, by PCR over 2 years. Healthy control children from the same region were included. Rhinovirus was identified in 33% of patients, RSV (30.1%), PIV‐3 (7.8%), hBoV (6.1%), adenovirus (5.7%), hMPV (4.8%), influenza A (3.4%), coronavirus NL63 (2.1%), and OC43 (1.8%). PIV‐1, PIV‐2, CoV‐229E, ‐HKU1, and influenza B occurred in <1.5% of patients. Most cases with adenovirus, influenza A, hMPV, hBoV, coronaviruses, and WU virus occurred as co‐infections while RSV, PIV‐3, and rhinovirus were identified most frequently as the only respiratory pathogen. Rhinovirus but not RSV or PIV‐3 was also frequently identified in healthy controls. A higher HIV sero‐prevalence was noticed in patients with co‐infections although co‐infections were not associated with more severe disease. RSV, hPMV, PIV‐3, and influenza viruses had defined seasons while rhinovirus, adenovirus, and coronavirus infections occurred year round in this temporal region of sub‐Saharan Africa. J. Med. Virol. 83:1458–1468, 2011. © 2011 Wiley‐Liss, Inc.
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Affiliation(s)
- Marietjie Venter
- Department of Medical Virology, University of Pretoria, South Africa.
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The epidemiology of respiratory syncytial virus lower respiratory tract infections in children less than 5 years of age in Indonesia. Pediatr Infect Dis J 2011; 30:778-84. [PMID: 21487330 DOI: 10.1097/inf.0b013e318218ab9e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the epidemiology of respiratory syncytial virus (RSV) lower respiratory tract infections (LRI) is well known in industrialized countries, the burden in developing Asian countries is not well studied. METHODS To define the burden of RSV disease in children <5 years of age in rural and urban Indonesia, infants and children were enrolled from peri-urban and rural subdistricts, in the following 2 cohorts: (a) a cross-sectional cohort of approximately 100 children from each of 2 subdistricts in the following 5 age groups: 3 to 5, 6 to 8, 9 to 11, 12 to 23, and 24 to 48 months; (b) a birth cohort of all newborns in both subdistricts during the 28 months of the study. All subjects were visited weekly at home. Children with World Health Organization-defined LRI or wheezing had a nasal wash for detection of RSV using an enzyme immunoassay and polymerase chain reaction. RESULTS Of the 2014 children studied, 1074 were in the cross-sectional and 940 in the newborn cohorts. Of the 802 episodes of LRI, 163 were caused by RSV. The RSV LRI incidence per 1000 child-years (C-Y) was higher in rural areas (57.25 vs. 38.54), P < 0.05. No RSV LRI occurred in the first 2 months of life and the peak incidence was in the 6- to 8-month-old infants (103/1000 C-Y). The rates were lowest in those <6 months, 16.5 per 1000 C-Y, compared with 83.1 per 1000 C-Y in those 6 to 11 months of age (P < 0.001), 66.99 in those 12 to 23 months of age, and 28.1 in 2- to 5-year-olds. CONCLUSIONS In Indonesia, the incidence of RSV LRI in the first 6 months of life is relatively low with most disease occurring in older children.
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Abstract
Viral respiratory infections cause significant morbidity and mortality in infants and young children as well as in at-risk adults and the elderly. Although many viral pathogens are capable of causing respiratory disease, vaccine development has to focus on a limited number of pathogens, such as those that commonly cause serious lower respiratory illness (LRI). Whereas influenza virus vaccines have been available for some time (see the review by Clark and Lynch in this issue), vaccines against other medically important viruses such as respiratory syncytial virus (RSV), the parainfluenza viruses (PIVs), and metapneumovirus (MPVs) are not available. This review aims to provide a brief update on investigational vaccines against RSV, the PIVs, and MPV that have been evaluated in clinical trials or are currently in clinical development.
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Affiliation(s)
- Alexander C Schmidt
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 10001, USA.
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Honkinen M, Lahti E, Österback R, Ruuskanen O, Waris M. Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clin Microbiol Infect 2011; 18:300-7. [PMID: 21851481 PMCID: PMC7128628 DOI: 10.1111/j.1469-0691.2011.03603.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Clin Microbiol Infect 2012; 18: 300–307 Abstract Few comprehensive studies have searched for viruses and bacteria in children with community‐acquired pneumonia (CAP). We identified 76 children hospitalized for pneumonia. Induced sputum samples were analysed for 18 viruses by antigen detection and PCR, and for six bacteria by culture and PCR. Viruses were found in 72% of samples, bacteria in 91%, and both in 66%. Rhinovirus (30%), human bocavirus (18%) and human metapneumovirus (14%) were the most commonly detected viruses. Two viruses were found in 22% of samples and three in 8%. The most common bacteria found were Streptococcus pneumoniae (50%), Haemophilus influenzae (38%), and Moraxella catarrhalis (28%). Rhinovirus–S. pneumoniae was the most commonly found combination of virus and bacterium (16%). All six children with treatment failure had both viruses and bacteria detected in the sputum. Otherwise, we found no special clinical characteristics in those with mixed viral–bacterial detections. With modern molecular diagnostic techniques, there are high rates of both viral and bacterial identification in childhood CAP. The clinical significance of mixed viral–bacterial infections remains unclear, although we found a potential association between them and treatment failure.
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Affiliation(s)
- M Honkinen
- Department of Paediatrics, Turku University Hospital, Turku, Finland
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Improved detection of respiratory viruses in pediatric outpatients with acute respiratory illness by real-time PCR using nasopharyngeal flocked swabs. J Clin Microbiol 2011; 49:3365-7. [PMID: 21775539 DOI: 10.1128/jcm.02231-10] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Detection of respiratory viruses by real-time multiplexed PCR (M-PCR) and of respiratory syncytial virus (RSV) by M-PCR and immunofluorescence (IF) was evaluated using specimens collected by nasopharyngeal flocked swabbing (NFS) and nasal washes (NW). In children with mild respiratory illness, NFS collection was superior to NW collection for detection of viruses by M-PCR (sensitivity, 89.6% versus 79.2%; P = 0.0043). NFS collection was noninferior to NW collection in the detection of RSV by IF.
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Carrol ED, Mankhambo LA, Guiver M, Banda DL, Denis B, Dove W, Jeffers G, Molyneux EM, Molyneux ME, Hart CA, Graham SM. PCR improves diagnostic yield from lung aspiration in Malawian children with radiologically confirmed pneumonia. PLoS One 2011; 6:e21042. [PMID: 21695128 PMCID: PMC3114850 DOI: 10.1371/journal.pone.0021042] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/17/2011] [Indexed: 11/28/2022] Open
Abstract
Background Accurate data on childhood pneumonia aetiology are essential especially from regions where mortality is high, in order to inform case-management guidelines and the potential of prevention strategies such as bacterial conjugate vaccines. Yield from blood culture is low, but lung aspirate culture provides a higher diagnostic yield. We aimed to determine if diagnostic yield could be increased further by polymerase chain reaction (PCR) detection of bacteria (Streptococcus pneumoniae and Haemophilus influenzae b) and viruses in lung aspirate fluid. Methods A total of 95 children with radiological focal, lobar or segmental consolidation had lung aspirate performed and sent for bacterial culture and for PCR for detection of bacteria, viruses and Pneumocystis jirovecii. In children with a pneumococcal aetiology, pneumococcal bacterial loads were calculated in blood and lung aspirate fluid. Results Blood culture identified a bacterial pathogen in only 8 patients (8%). With the addition of PCR on lung aspirate samples, causative pathogens (bacterial, viral, pneumocystis) were identified singly or as co-infections in 59 children (62%). The commonest bacterial organism was S.pneumoniae (41%), followed by H. influenzae b (6%), and the commonest virus identified was adenovirus (16%), followed by human bocavirus (HBoV) (4%), either as single or co-infection. Conclusions In a select group of African children, lung aspirate PCR significantly improves diagnostic yield. Our study confirms a major role of S.pneumoniae and viruses in the aetiology of childhood pneumonia in Africa.
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Affiliation(s)
- Enitan D Carrol
- Department of Women's and Children's Health, The University of Liverpool, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
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Ortiz JR, Lafond KE, Wong TA, Uyeki TM. Pandemic influenza in Africa, lessons learned from 1968: a systematic review of the literature. Influenza Other Respir Viruses 2011; 6:11-24. [PMID: 21668669 PMCID: PMC3175329 DOI: 10.1111/j.1750-2659.2011.00257.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Please cite this paper as: Ortiz et al. (2012) Pandemic influenza in Africa, lessons learned from 1968: a systematic review of the literature. Influenza and Other Respiratory Viruses 6(1), 11–24. Background To help understand the potential impact of the 2009 H1N1 pandemic in Africa, we reviewed published data from Africa of the two previous influenza pandemics. Methods We conducted a systematic search of three biomedical databases for articles in any language on 1957 H2N2 or 1968 H3N2 pandemic influenza virus infection in Africa published from January 1950 through August 2008. Results We identified 1327 potentially relevant articles, and 298 warranted further review. Fourteen studies on 1968 H3N2 influenza met inclusion criteria, while two studies identified describing 1957 H2N2 were excluded for data limitations. Among these 14 studies, community attack rates for symptomatic infection during all 1968 pandemic waves were around 20%. However, the proportion infected in communities ranged from 6% in isolated communities to 100% in enclosed populations. A total of 22–64% of sampled clinic patients and 8–72% of hospitalized patients had evidence of 1968 H3N2 virus infection. After the second pandemic wave, up to 41–75% of persons tested had serological evidence of 1968 H3N2 virus infection. Conclusion The 1968 H3N2 influenza pandemic, generally regarded as mild worldwide, appears to have had a substantial impact upon public health in Africa. Without more epidemiologic data the impact of the 2009 H1N1 pandemic in Africa cannot be assumed to have been mild. Assessment of the burden of 2009 H1N1 virus and future influenza pandemics in Africa should attempt to assess disease impact by a variety of methods, including substudies among specific populations.
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Affiliation(s)
- Justin R Ortiz
- Department of Medicine, University of Washington, Seattle, USA.
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Bezerra PGM, Britto MCA, Correia JB, Duarte MDCMB, Fonceca AM, Rose K, Hopkins MJ, Cuevas LE, McNamara PS. Viral and atypical bacterial detection in acute respiratory infection in children under five years. PLoS One 2011; 6:e18928. [PMID: 21533115 PMCID: PMC3078930 DOI: 10.1371/journal.pone.0018928] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 03/11/2011] [Indexed: 02/03/2023] Open
Abstract
Background Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil. Methods Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA. Findings 407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia. Interpretation This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively.
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Affiliation(s)
- Patrícia G. M. Bezerra
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Faculdade Pernambucana de Saúde, Recife, Brazil
| | - Murilo C. A. Britto
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Faculdade Pernambucana de Saúde, Recife, Brazil
| | - Jailson B. Correia
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
| | | | - Angela M. Fonceca
- Department of Child Health, University of Liverpool, Institute of Child Health, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Katie Rose
- Department of Child Health, University of Liverpool, Institute of Child Health, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Mark J. Hopkins
- Liverpool Specialist Virology Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Luis E. Cuevas
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Paul S. McNamara
- Department of Child Health, University of Liverpool, Institute of Child Health, Alder Hey Children's Hospital, Liverpool, United Kingdom
- * E-mail:
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Abstract
About 200 million cases of viral community-acquired pneumonia occur every year-100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection. In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia. Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia. However, no clinical algorithm exists that will distinguish clearly the cause of pneumonia. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Apart from neuraminidase inhibitors for pneumonia caused by influenza viruses, there is no clear role for use of specific antivirals to treat viral community-acquired pneumonia. Influenza vaccines are the only available specific preventive measures. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries.
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MESH Headings
- Adult
- Age Distribution
- Age Factors
- Antiviral Agents/therapeutic use
- Biomarkers/blood
- Child
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/epidemiology
- Community-Acquired Infections/virology
- Comorbidity
- Developing Countries/statistics & numerical data
- Diagnosis, Differential
- Global Health
- Humans
- Immunocompetence
- Lung/diagnostic imaging
- Lung/pathology
- Lung/virology
- Pandemics
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/prevention & control
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/mortality
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/virology
- Radiography
- Specimen Handling
- United States/epidemiology
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Affiliation(s)
- Olli Ruuskanen
- Department of Paediatrics, Turku University Hospitals, Turku, Finland.
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244
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O'Grady KAF, Torzillo PJ, Rockett RJ, Whiley DM, Nissen MD, Sloots TP, Lambert SB. Successful application of a simple specimen transport method for the conduct of respiratory virus surveillance in remote Indigenous communities in Australia. Trop Med Int Health 2011; 16:766-72. [PMID: 21418445 PMCID: PMC7169666 DOI: 10.1111/j.1365-3156.2011.02757.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Surveillance programs and research for acute respiratory infections in remote Aboriginal communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting respiratory samples from a remote setting for viral PCR compared with frozen specimens. METHODS We sampled every individual who presented to a remote Aboriginal community clinic in a non-epidemic respiratory season. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for 16 viruses was undertaken using real-time multiplex PCR. RESULTS A total of 140 participants were enrolled who contributed 150 study visits. Respiratory illnesses accounted for 10% of the reasons for presentation. Sixty-one viruses were identified in 50 (33.3%) presentations for 40 (28.6%) individuals; bocavirus and rhinovirus were the most common viruses identified (14.0% and 12.6% of episodes respectively). The sensitivity for any virus detected in mailed specimens was 67.2% (95%CI 55.4, 78.9) compared to 65.6% (95%CI 53.7, 77.5) for frozen specimens. CONCLUSION The mailing of unfrozen nasal specimens from remote communities does not compromise the viability of the specimen for viral studies.
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245
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Dulek DE, Peebles RS. Viruses and asthma. Biochim Biophys Acta Gen Subj 2011; 1810:1080-90. [PMID: 21291960 PMCID: PMC3130828 DOI: 10.1016/j.bbagen.2011.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 01/19/2023]
Abstract
Background Viral respiratory infection has long been known to influence the occurrence of asthma exacerbations. Over the last 20 years much effort has been put into clarifying the role that viral respiratory infections play in the eventual development of asthma. Scope of review In this review we give a general background of the role of viruses in the processes of asthma exacerbation and asthma induction. We review recent additions to the literature in the last 3 years with particular focus on clinical and epidemiologic investigations of influenza, rhinovirus, bocavirus, respiratory syncytial virus, and metapneumovirus. Major conclusions The development of asthma emerges from a complex interaction of genetic predisposition and environmental factors with viral infection likely playing a significant role in the effect of environment on asthma inception. This article is part of a Special Issue entitled: Biochemistry of Asthma. General significance Further understanding of the role that viruses play in asthma exacerbation and inception will contribute to decreased asthma morbidity in the future. This article is part of a Special Issue entitled: Biochemistry of Asthma.
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Affiliation(s)
- Daniel E Dulek
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232-2650, USA.
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246
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Waitumbi JN, Kuypers J, Anyona SB, Koros JN, Polhemus ME, Gerlach J, Steele M, Englund JA, Neuzil KM, Domingo GJ. Outpatient upper respiratory tract viral infections in children with malaria symptoms in Western Kenya. Am J Trop Med Hyg 2010; 83:1010-3. [PMID: 21036828 DOI: 10.4269/ajtmh.2010.10-0174] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A cross-sectional study was performed in children 5 through 10 years of age presenting to outpatient clinics in Nyanza Province, Kenya, in which nasal swab and blood specimens were collected during the high malaria transmission season. Patients presenting with malaria-like symptoms within 4 days of fever onset were enrolled in the study. Plasmodium parasitemia was determined by blood smear microscopy. Nasal swabs were screened for a panel of respiratory viruses by polymerase chain reaction. Influenza A, rhinoviruses, and other respiratory viruses were detected in 18%, 26%, and 12% of 197 specimens, respectively. Four of 36 patients with influenza A had a positive malaria blood slide, compared with 20 of 52 patients with rhinovirus. A significant burden of disease caused by influenza A in febrile children during the study period was observed, highlighting the need for further research into the burden of influenza disease in regions where malaria is holoendemic.
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Affiliation(s)
- John N Waitumbi
- Walter Reed Project/Kenya Medical Research Institute, Kisumu, Kenya.
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