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Al-Jumaili A, Dawood HN, Ikram D, Al-Jabban A. Pneumococcal Disease: Global Disease Prevention Strategies with a Focus on the Challenges in Iraq. Int J Gen Med 2023; 16:2095-2110. [PMID: 37275330 PMCID: PMC10237204 DOI: 10.2147/ijgm.s409476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
Pneumococcal disease is a global public health concern that significantly contributes to clinical disease burden and economic burden. Patients frequently afflicted are young children and older adults, as well as the immunocompromised population. Immunization is the most effective public health strategy to combat pneumococcal disease and several vaccine formulations have been developed in this regard. Although vaccines have had a significant global impact in reducing pneumococcal disease, there are several barriers to its success in Iraq. The war and conflict situation, increasing economic crises and poverty, poor vaccine accessibility in the public sector, and high vaccine costs are a few of the major obstacles that impede a successful immunization program. The last reported third dose pneumococcal conjugate vaccine coverage for Iraq was 37% in 2019, which is expected to reduce even further owing to the COVID-19 pandemic. Thus, strategies and policies to improve pneumococcal vaccine availability and coverage need to be strengthened to achieve maximum benefits of immunization. In the current review, we provide an overview of the existing knowledge on pneumococcal disease-prevention strategies across the globe. The main aim of this manuscript is to discuss the current status and challenges of pneumococcal vaccination in Iraq as well as the strategies to prevent pneumococcal infections.
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Affiliation(s)
- Ali Al-Jumaili
- Pediatric Department, Central Pediatric Teaching Hospital, Baghdad, Iraq
| | - Haider N Dawood
- Internal Medicine Department, Al-Imamain Al-Kadhimin Medical City, Baghdad, Iraq
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Sacoor C, Vitorino P, Nhacolo A, Munguambe K, Mabunda R, Garrine M, Jamisse E, Magaço A, Xerinda E, Sitoe A, Fernandes F, Carrilho C, Maixenchs M, Chirinda P, Nhampossa T, Nhancale B, Rakislova N, Bramugy J, Nhacolo A, Ajanovic S, Valente M, Massinga A, Varo R, Menéndez C, Ordi J, Mandomando I, Bassat Q. Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13931.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using, among other tools, the innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS). Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.
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Arguni E, Wijaya CS, Indrawanti R, Safitri Laksono I, Ishiwada N. Pediatric Invasive Pneumococcal Disease (IPD) in Yogyakarta, Indonesia: A Case Series. Glob Pediatr Health 2022; 9:2333794X221108963. [PMID: 35784808 PMCID: PMC9244929 DOI: 10.1177/2333794x221108963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
Given the fact that invasive pneumococcal disease (IPD) has a high clinical burden, particularly among children in developing countries, data on its occurrence and clinical profile in Indonesia is still insufficient. We presented 3 cases of IPD in children who were admitted to Dr. Sardjito General Hospital, Yogyakarta, Indonesia between 2016 and 2019. While our first 2 patients had milder course of disease, our third patient who presented with meningoencephalitis had poor outcome. Risk factors shown in our cases were young age and malignancy history. Multiple antibiotic resistance was observed in our isolates. The fact that none of our patients have received pneumococcal vaccination marks the necessity of this vaccine especially for at-risk children.
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Affiliation(s)
- Eggi Arguni
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Conroy Surya Wijaya
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ratni Indrawanti
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ida Safitri Laksono
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
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Massinga AJ, Garrine M, Messa A, Nobela NA, Boisen N, Massora S, Cossa A, Varo R, Sitoe A, Hurtado JC, Ordi J, Mucavele H, Nhampossa T, Breiman RF, Whitney CG, Blau DM, Bassat Q, Mandomando I. Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization. BMC Infect Dis 2021; 21:526. [PMID: 34090384 PMCID: PMC8178901 DOI: 10.1186/s12879-021-06245-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 12/31/2022] Open
Abstract
Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06245-x.
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Affiliation(s)
| | - Marcelino Garrine
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Lisbon, Portugal
| | - Augusto Messa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nélio A Nobela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - António Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Hélio Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | | | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. .,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique.
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Mpabalwani EM, Lukwesa-Musyani C, Imamba A, Nakazwe R, Matapo B, Muzongwe CM, Mufune T, Soda E, Mwenda JM, Lutz CS, Pondo T, Lessa FC. Declines in Pneumonia and Meningitis Hospitalizations in Children Under 5 Years of Age After Introduction of 10-Valent Pneumococcal Conjugate Vaccine in Zambia, 2010-2016. Clin Infect Dis 2020; 69:S58-S65. [PMID: 31505628 PMCID: PMC6761309 DOI: 10.1093/cid/ciz456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. Methods Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010–December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1–4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010–June 2013 and July 2014–December 2016, respectively. Results At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4–50.3%) and 28.8% (95% CI 17.7–38.7%) among children aged <1 year and 1–4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2–79.0%) and 61.6% (95% CI 50.4–70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1–4 years (39.3%, 95% CI 16.2–57.5%). Conclusions PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.
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Affiliation(s)
- Evans M Mpabalwani
- University of Zambia, School of Medicine, Department of Pediatrics & Child Health Unit, Ministry of Health, Ndeke House, Lusaka, Zambia.,Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Chileshe Lukwesa-Musyani
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Akakambama Imamba
- Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Ruth Nakazwe
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Belem Matapo
- World Health Organization Zambia Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Chilweza M Muzongwe
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Trust Mufune
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Elizabeth Soda
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chelsea S Lutz
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, United States Department of Energy, Washington, DC
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Massora S, Lessa FC, Moiane B, Pimenta FC, Mucavele H, Chaúque A, Cossa A, Verani JR, Tembe N, da Gloria Carvalho M, Muñoz-Almagro C, Sigaúque B. Invasive disease potential of Streptococcus pneumoniae serotypes before and after 10-valent pneumococcal conjugate vaccine introduction in a rural area, southern Mozambique. Vaccine 2019; 37:7470-7477. [PMID: 31575493 PMCID: PMC10962395 DOI: 10.1016/j.vaccine.2019.09.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/02/2019] [Accepted: 09/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is a significant cause of morbidity and mortality among children worldwide. In April 2013, Mozambique introduced 10-valent PCV (PCV10) into the National Expanded Program on immunization using a three-dose schedule at 2, 3, and 4 months of age. We aimed to evaluate the invasive disease potential of pneumococcal serotypes among children in our region before and after PCV10 introduction. METHODS We used data from ongoing population-based surveillance for IPD and cross-sectional pneumococcal carriage surveys among children aged <5 years in Manhiҫa, Mozambique. To determine the invasive disease potential for each serotype pre- and post-PCV10 introduction, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated comparing serotype-specific prevalence in IPD and in carriage. For each serotype, OR and 95% CI > 1 indicated high invasive disease potential and OR and 95% CI < 1 indicated low invasive disease potential. RESULTS In the pre-PCV10 period, 524 pneumococcal isolates were obtained from 411 colonized children and IPD cases were detected in 40 children. In the post-PCV10 period, 540 pneumococcal isolates were obtained from 507 colonized children and IPD cases were detected in 30 children. The most prevalent serotypes causing IPD pre-PCV10 were 6A (17.5%), 6B (15.0%), 14 (12.5%), 23F (10.0%) and 19F (7.5%), and post-PCV10 were 6A (36.7%), 13 (10%), 1 (10.0%), 6B (6.7%) and 19A (6.7%). Serotypes associated with high invasive disease potential pre-PCV10 included 1 (OR:22.3 [95% CI 2.0; 251.2]), 6B (OR:3.1 [95% CI 1.2; 8.1]), 14 (OR: 3.4 [95% CI 1.2; 9.8]) and post-PCV10 included serotype 6A (OR:6.1[95% CI 2.7; 13.5]). CONCLUSION The number of serotypes with high invasive disease potential decreased after PCV10 introduction. Serotype 6A, which is not included in PCV10, was the most common cause of IPD throughout the study and showed a high invasive potential in the post-PCV10 period.
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Affiliation(s)
- Sérgio Massora
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Fernanda C Lessa
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Benild Moiane
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Fabiana C Pimenta
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Hélio Mucavele
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Alberto Chaúque
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Anélsio Cossa
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Jennifer R Verani
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Nelson Tembe
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Maria da Gloria Carvalho
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | - Carmen Muñoz-Almagro
- Molecular Microbiology Department, Instituto de Recerca Pediatrica, University Hospital Sant Joan de Deu, Barcelona, Spain; Ciber of Epidemiology and Public Health, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Betuel Sigaúque
- Fundação Manhiça, Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
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Bos JC, van Hest RM, Mistício MC, Nunguiane G, Lang CN, Beirão JC, Mathôt RAA, Prins JM. Pharmacokinetics and Pharmacodynamic Target Attainment of Benzylpenicillin in an Adult Severely Ill Sub-Saharan African Patient Population. Clin Infect Dis 2019; 66:1261-1269. [PMID: 29112711 DOI: 10.1093/cid/cix961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/01/2017] [Indexed: 12/14/2022] Open
Abstract
Background In intensive care (ICU) patients, systemic exposure of β-lactam antibiotics can be altered, and positive clinical outcome is associated with increasing fT > MIC ratios. In sub-Saharan African hospitals, benzylpenicillin (PEN) is frequently used for the empiric treatment of severe pneumococcal infections. Pharmacokinetic data for non-ICU hospitalized populations are lacking. Methods We performed a population pharmacokinetic (PPK) study in an adult Mozambican hospital population treated intravenously with PEN from October 2014 through November 2015. Four blood samples/patient were collected for total PEN (PENt) and unbound PEN (PENu) concentration measurement. We developed a PPK model through nonlinear mixed-effects analysis and performed simulations for different patient variable, dosing, and pharmacodynamic target scenarios. Results One hundred twelve participants yielded 387 PENt and 53 PENu concentrations. The median body mass index was 18.3 (range, 10.5-31.3) kg/m2 and the median albumin concentration and creatinine clearance (CrCl) were 29 (range, 12-44) g/L and 80 (range, 3-195) mL/minute, respectively. In a 1-compartment model, CrCl was positively correlated with PENt clearance. For infections with a microorganism with a minimum inhibitory concentration (MIC) of 1 mg/L, simulations demonstrated that with 3 million IU (1.8 g) every 6 hours, 74.1% would have a PENu concentration greater than the MIC during half of the dosing interval (fT > MIC = 50%), whereas this was 24.8% for the fT > MIC = 100% target. For pathogens with an MIC of 0.06 mg/L, these percentages were 98.2% and 72.3%, respectively. Conclusions Severely ill adult sub-Saharan African patients may be at high risk for underexposure to PENu during routine intermittent bolus dosing, especially when their renal function is intact and when infected with pathogens with intermediate susceptibility.
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Affiliation(s)
- Jeannet C Bos
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Reinier M van Hest
- Department of Hospital Pharmacy, Division of Clinical Pharmacology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Mabor C Mistício
- Research Center for Infectious Diseases of the Faculty of Health Sciences, Catholic University of Mozambique, Beira
| | - Ginto Nunguiane
- Research Center for Infectious Diseases of the Faculty of Health Sciences, Catholic University of Mozambique, Beira
| | - Cláudia N Lang
- Research Center for Infectious Diseases of the Faculty of Health Sciences, Catholic University of Mozambique, Beira
| | - José C Beirão
- Research Center for Infectious Diseases of the Faculty of Health Sciences, Catholic University of Mozambique, Beira
| | - Ron A A Mathôt
- Department of Hospital Pharmacy, Division of Clinical Pharmacology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
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Njuma Libwea J, Bebey Kingue SR, Taku Ashukem N, Kobela M, Boula A, Sinata KS, Koki Ndombo P. Assessing the causes of under-five mortality and proportion associated with pneumococcal diseases in Cameroon. A case-finding retrospective observational study: 2006-2012. PLoS One 2019; 14:e0212939. [PMID: 30995230 PMCID: PMC6469747 DOI: 10.1371/journal.pone.0212939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vital registration data outlining causes of deaths (CoD) are important for a sustainable health system, targeted interventions and other relevant policies. There is data paucity on vital registration systems in developing countries. We assessed the leading causes and proportions of under-five deaths, and particularly those related to pneumococcal infections in Yaoundé, Cameroon, using hospital registration data. METHODS A retrospective case-finding observational study design was used to access and identify data on 817 death cases in children under-five years of age recorded in health facilities in Yaoundé, within the period January 1, 2006 and December 31, 2012. Patients' files were randomly selected and needed information including demographic data, date of admission, clinical and laboratory diagnosis, principal and/or underlying causes of death were abstracted into structured case report forms. The International Classification of Diseases and Clinical Modifications 10th revision (ICD-10-CM) codes (ICD10Data.com 2017 edition) were used to classify the different CoD, retrospectively. Ascertainment of CoD was based on medical report and estimates were done using the Kaplan-Meier procedure and descriptive statistics. RESULTS Of the 817 death records assessed, malaria was the leading CoD and was responsible for 17.5% of cases. Meningitis was the second largest CoD with 11.0%; followed by sepsis (10.0%), Streptococcus pneumoniae infections (8.3%), malnutrition (8.3%), gastro-enteritis / diarrhoea (6.2%), anaemia (6.1%) and HIV (3.5%), respectively. CONCLUSION The main CoD in this population are either treatable or vaccine-preventable; a trend consistent with previous reports across developing countries. Besides, the health effects from non-communicable infections should not be neglected. Therefore, scaling-up measures to reduce causes of under-five deaths will demand sustainable efforts to enhance both treatment and disease prevention strategies, to avoid a decline in the progress towards reducing under-five deaths by 2/3 from the 1990 baseline.
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Affiliation(s)
- John Njuma Libwea
- Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
- Expanded Programme on Immunization, Yaoundé, Cameroon
- * E-mail:
| | - Sandrine Rachel Bebey Kingue
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Faculty of Sciences, Department of Medical Microbiology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Nadesh Taku Ashukem
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Faculty of Sciences, Department of Microbiology, University of Buea, Buea, Cameroon
| | - Marie Kobela
- Expanded Programme on Immunization, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Angeline Boula
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
| | - Koulla-Shiro Sinata
- Faculty of Sciences, Department of Microbiology, University of Buea, Buea, Cameroon
- Ministry of Public Health, Yaoundé, Cameroon
| | - Paul Koki Ndombo
- Mother & Child Centre (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Early Declines in Vaccine Type Pneumococcal Carriage in Children Less Than 5 Years Old After Introduction of 10-valent Pneumococcal Conjugate Vaccine in Mozambique. Pediatr Infect Dis J 2018; 37:1054-1060. [PMID: 30216295 DOI: 10.1097/inf.0000000000002134] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pneumococcal carriage is a precursor of invasive pneumococcal disease. Mozambique introduced 10-valent pneumococcal conjugate vaccine (PCV10) in April 2013, using a 3-dose schedule without a booster. We evaluated PCV10 impact on pneumococcal carriage and colonization density by HIV status. METHODS We conducted 2 cross-sectional surveys (pre and post PCV10 introduction) among children 6 weeks to 59 months old. Participants included HIV-infected children presenting for routine care at outpatient clinics and a random sample of HIV-uninfected children from the community. We collected demographic data, vaccination history and nasopharyngeal swabs. Swabs were cultured and isolates serotyped by Quellung. We selected serotypes 11A, 19A and 19F for bacterial density analyses. We compared vaccine-type (VT) carriage prevalence from the pre-PCV10 with the post-PCV10 period by HIV status. FINDINGS Prevalence of VT carriage declined from 35.9% (110/306) pre already defined in the background. It should be pre-PCV (PCV) to 20.7% (36/174 fully vaccinated) post PCV (P < 0.001) in HIV-uninfected and from 34.8% (144/414) to 19.7% (27/137 fully vaccinated) (P = 0.002) in HIV-infected children. Colonization prevalence for the 3 serotypes (3, 6A, 19A) included in the 13-valent PCV but not in PCV10 increased from 12.4% (38/306) to 20.7% (36/174 fully vaccinated) (P = 0.009) among HIV- uninfected children, mainly driven by 19A; no significant increase was observed in HIV-infected children. VT carriage among unvaccinated children decreased by 30% (P = 0.005) in HIV-infected children, with no significant declines observed in HIV-uninfected children. CONCLUSION Declines in VT carriage were observed in both HIV-uninfected and HIV-infected children after PCV10 introduction with an early signal of herd effect especially in HIV-infected children. Ongoing monitoring of increases in 19A carriage and disease is necessary.
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Sigaúque B, Kobayashi M, Vubil D, Nhacolo A, Chaúque A, Moaine B, Massora S, Mandomando I, Nhampossa T, Bassat Q, Pimenta F, Menéndez C, Carvalho MDG, Macete E, Schrag SJ. Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015. PLoS One 2018; 13:e0191193. [PMID: 29351318 PMCID: PMC5774717 DOI: 10.1371/journal.pone.0191193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/29/2017] [Indexed: 12/03/2022] Open
Abstract
Background Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001–2015, with a focus on GBS epidemiology and strain characteristics. Methods Community-level birth and mortality data were obtained from Manhiça’s demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhiça district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing. Results There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (≥0.12 μg/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone. Conclusion A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies.
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Affiliation(s)
- Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- John Snow Inc. (JSI) on the Maternal and Child Survival Program–MCSP (USAID Grantee), Maputo, Mozambique
- * E-mail:
| | - Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Delfino Vubil
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Alberto Chaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Benild Moaine
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Sérgio Massora
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Center for International Health Research, and Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Fabiana Pimenta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Center for International Health Research, and Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Stephanie J. Schrag
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
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Sigaúque B, Verani JR, Massora S, Vubil D, Quintó L, Acácio S, Mandomando I, Bassat Q, Nhampossa T, Pimenta F, Sacoor C, Carvalho MDG, Macete E, Alonso PL. Burden of invasive pneumococcal disease among children in rural Mozambique: 2001-2012. PLoS One 2018; 13:e0190687. [PMID: 29304066 PMCID: PMC5755904 DOI: 10.1371/journal.pone.0190687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background Invasive pneumococcal disease (IPD) is a major cause of illness and death among children worldwide. 10-valent pneumococcal conjugate vaccine (PCV10) was introduced as part of the Mozambican routine immunization program in April 2013. We characterized the IPD burden in a rural area of Mozambique before PCV introduction and estimated the potential impact of this intervention. Methods We conducted population-based surveillance for IPD, defined as S. pneumoniae isolated from blood or cerebrospinal fluid, among children <5 years old admitted to Manhiça District Hospital, a referral hospital in a rural area with high prevalence of human immunodiciency virus infection. S. pneumoniae was identified using standard microbiologic methods and serotyped using sequential multiplex PCR or Quellung. IPD incidence was calculated among cases from a defined catchment area. Results From January 2001 through December 2012, we isolated 768 cases of IPD, 498 (65%) of which were bacteraemic pneumonia episodes. A total of 391 (51%) were from the catchment area, yielding IPD incidence rates of 479, 390 and 107 episodes per 100,000 children-years at risk among children <12, 12–23 and 24-<60 months old, respectively. The overall IPD incidence fluctuated and showed a downward trend over time. In these same age groups, in-hospital death occurred in 48 (17%), 26 (12%), and 21 (13%) of all IPD cases, respectively. Overall 90% (543/603) of IPD isolates were available for serotyping; of those, 65% were covered by PCV10 and 83% by PCV13. Among 77 hospital deaths associated with serotyped IPD, 49% and 69% were caused by isolates included in the PCV10 and PCV13, respectively. Conclusions We describe very high rates of IPD among children in rural Mozambique that were declining before PCV introduction. Children <1 year old have the greatest incidence and case fatality; although the rates remain high among older groups as well. Most IPD episodes and many deaths among children <5 years old will likely be prevented through PCV10 introduction in Mozambique.
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Affiliation(s)
- Betuel Sigaúque
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
- * E-mail: ,
| | - Jennifer R. Verani
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sérgio Massora
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
| | - Delfino Vubil
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Sozinho Acácio
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Inácio Mandomando
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Quique Bassat
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Tacilta Nhampossa
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Fabiana Pimenta
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Charfudin Sacoor
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
| | - Maria da Gloria Carvalho
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eusebio Macete
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
| | - Pedro L. Alonso
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM); Maputo, Mozambique
- ISGlobal, Barcelona Center of International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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Li X, Lin Y, Yao G, Wang Y. The Influence of Vaccine on Febrile Seizure. Curr Neuropharmacol 2018; 16:59-65. [PMID: 28745219 PMCID: PMC5771385 DOI: 10.2174/1570159x15666170726115639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/09/2017] [Accepted: 04/27/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The protective value of vaccines to the public has made vaccines among the major public health prophylactic measures through the entire history. However, there has been some controversy about their safety; particularly concerns have been rising about febrile seizures (FS). Vaccination was found to be the second most common cause of FS. METHODS We research and collect relative online content for reviewing the effects of vaccine in FS. RESULTS there is no causal relationship between FS and vaccination. This relationship is complex by other factors, such as age, genetic inheritance, type of vaccine, combination of different types of vaccines and the timing of vaccination. CONCLUSION In order to reduce FS after vaccination, it is important to understand the mechanism of epilepsy and relationship between specific vaccines and FS. Parents should be informed that some vaccines could be associated with an increased risk of FS, particularly, in children with personal and family history of FS. Children with genetic epilepsy syndrome are prone to seizures and certain vaccinations should be avoided in these children. It is highly recommended to choose vaccines with lower risk of developing FS and to administer these vaccines during the low risk window of immunizations schedule.
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Affiliation(s)
- Xin Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin130041, P.R. China
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Yang Lin
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin130041, P.R. China
| | - Gang Yao
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin130041, P.R. China
| | - Yicun Wang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin130041, P.R. China
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Childhood pneumococcal disease in Africa - A systematic review and meta-analysis of incidence, serotype distribution, and antimicrobial susceptibility. Vaccine 2017; 35:1817-1827. [PMID: 28284682 DOI: 10.1016/j.vaccine.2017.02.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/30/2017] [Accepted: 02/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV). METHODS To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000 to 2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models. RESULTS We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively. CONCLUSIONS Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.
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Bassat Q, Lanaspa M, Machevo S, O'Callaghan-Gordo C, Madrid L, Nhampossa T, Acácio S, Roca A, Alonso PL. Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models. Trop Med Int Health 2016; 21:1147-56. [DOI: 10.1111/tmi.12738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Quique Bassat
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Miguel Lanaspa
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Sónia Machevo
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Cristina O'Callaghan-Gordo
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- Centre for Research in Environmental Epidemiology; Barcelona Spain
| | - Lola Madrid
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- National Institute of Health; Ministry of Health; Maputo Mozambique
| | - Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- National Institute of Health; Ministry of Health; Maputo Mozambique
| | - Anna Roca
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- Medical Research Council Unit; Banjul The Gambia
| | - Pedro L. Alonso
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
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Abstract
AIM We aimed to describe the detection rate spectrum of clinical manifestations, and outcome of pneumococcal disease in children younger than 5 years admitted to the largest referral pediatric hospital in Egypt. MATERIALS AND METHODS This was a hospital-based study to detect laboratory-confirmed Streptococcus pneumoniae cases among children younger than 5 years. Data on demographic characteristics, clinical diagnosis, comorbidities, diagnostic tests, antibiotic resistance, and clinical outcome were collected during the study years from 2008 to 2011. RESULTS During the 4-year study period, 22 018 cases younger than 5 years had cultures performed at Cairo University Pediatric Hospital microbiology laboratory. We estimated the annual detection rate of total Streptococcus pneumonia infection to be 54.5/100 000. The incidence of invasive pneumococcal disease (IPD) was half the incidence of non-IPD (18.2 and 36.4/100 000, respectively). Infants of 1 year or younger were statistically more vulnerable to Streptococcus pneumonia infection compared with children between 1 and 5 years of age (annual rate: 110.5/100 000 and 21.6/100 000, respectively). The overall pneumococcal annual case fatality was 33.3% and was higher in IPD (75%) than in non-IPD (12.5%) cases. There was an obviously increasing trend of the pneumococcal detection rate throughout the 4 years of the study (P<0.0001). CONCLUSION AND RECOMMENDATIONS Our results confirm the substantial and increasing pneumococcal infection, the emerging of multidrug resistant isolates, and the vulnerability of the younger age group and high-risk population, which calls for a national surveillance to inform policy and decision-making before national wide vaccine introduction.
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Mandomando I, Bassat Q, Sigaúque B, Massora S, Quintó L, Ácacio S, Nhampossa T, Vubil D, Garrine M, Macete E, Aide P, Sacoor C, Herrera-León S, Ruiz J, Tennant SM, Menéndez C, Alonso PL. InvasiveSalmonellaInfections Among Children From Rural Mozambique, 2001–2014. Clin Infect Dis 2015; 61 Suppl 4:S339-45. [DOI: 10.1093/cid/civ712] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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18
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Lanaspa M, O'Callaghan-Gordo C, Machevo S, Madrid L, Nhampossa T, Acácio S, de la Horra C, Friaza V, Campano E, Alonso PL, Calderón EJ, Roca A, Bassat Q. High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia. Clin Microbiol Infect 2015; 21:1018.e9-1018.e15. [PMID: 26231980 DOI: 10.1016/j.cmi.2015.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/08/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022]
Abstract
We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa and to investigate PCP-associated risk factors. During 2006-2007 we used molecular methods to test children younger than 5 years old admitted with severe pneumonia to a hospital in southern Mozambique for Pneumocystis infection. We recruited 834 children. PCP prevalence was 6.8% and HIV prevalence was 25.7%. The in-hospital and delayed mortality were significantly higher among children with PCP (20.8% vs. 10.2%, p 0.021, and 11.5% vs. 3.6%, p 0.044, respectively). Clinical features were mostly overlapping between the two groups. Independent risk factors for PCP were age less than a year (odds ratio (OR) 6.34, 95% confidence interval (CI) 1.86-21.65), HIV infection (OR 2.99, 95% CI 1.16-7.70), grunting (OR 2.64, 95% CI 1.04-6.73) and digital clubbing (OR 10.75, 95% CI 1.21-95.56). PCP is a common and life-threatening cause of severe pneumonia in Mozambican children. Mother-to-child HIV transmission prevention should be strengthened. Better diagnostic tools are needed.
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Affiliation(s)
- M Lanaspa
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - C O'Callaghan-Gordo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - S Machevo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - L Madrid
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - T Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; National Institute of Health (INS), Ministry of Health, Mozambique
| | - S Acácio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; National Institute of Health (INS), Ministry of Health, Mozambique
| | - C de la Horra
- CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - V Friaza
- CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - E Campano
- CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - P L Alonso
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - E J Calderón
- CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
| | - A Roca
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Medical Research Council Unit, Banjul, The Gambia
| | - Q Bassat
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Kularatna S, Wijesinghe P, Abeysinghe M, Karunaratne K, Ekanayake L. Burden of invasive pneumococcal disease (IPD) in Sri-Lanka: Deriving a reasonable measure for vaccine introduction decision making. Vaccine 2015; 33:3122-8. [DOI: 10.1016/j.vaccine.2015.04.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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Adewoyin AS. Management of sickle cell disease: a review for physician education in Nigeria (sub-saharan Africa). Anemia 2015; 2015:791498. [PMID: 25667774 PMCID: PMC4312619 DOI: 10.1155/2015/791498] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
Abstract
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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Leopold SJ, van Leth F, Tarekegn H, Schultsz C. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother 2014; 69:2337-53. [PMID: 24879668 DOI: 10.1093/jac/dku176] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of antimicrobial resistance (AMR) amongst bacterial pathogens in sub-Saharan Africa (sSA), despite calls for continent-wide surveillance to inform empirical treatment guidelines. METHODS We searched PubMed and additional databases for susceptibility data of key pathogens for surveillance, published between 1990 and 2013. Extracted data were standardized to a prevalence of resistance in populations of isolates and reported by clinical syndrome, microorganism, relevant antimicrobial drugs and region. RESULTS We identified 2005 publications, of which 190 were analysed. Studies predominantly originated from east sSA (61%), were hospital based (60%), were from an urban setting (73%) and reported on isolates from patients with a febrile illness (42%). Quality procedures for susceptibility testing were described in <50% of studies. Median prevalence (MP) of resistance to chloramphenicol in Enterobacteriaceae, isolated from patients with a febrile illness, ranged between 31.0% and 94.2%, whilst MP of resistance to third-generation cephalosporins ranged between 0.0% and 46.5%. MP of resistance to nalidixic acid in Salmonella enterica Typhi ranged between 15.4% and 43.2%. The limited number of studies providing prevalence data on AMR in Gram-positive pathogens or in pathogens isolated from patients with a respiratory tract infection, meningitis, urinary tract infection or hospital-acquired infection suggested high prevalence of resistance to chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline and low prevalence to third-generation cephalosporins and fluoroquinolones. CONCLUSIONS Our results indicate high prevalence of AMR in clinical bacterial isolates to antimicrobial drugs commonly used in sSA. Enhanced approaches for AMR surveillance are needed to support empirical therapy in sSA.
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Affiliation(s)
- Stije J Leopold
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hayalnesh Tarekegn
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Chaïbou Y, Sanou I, Congo-Ouedraogo M, Kienou MC, Ouattara K, Somlaré H, Traoré AS, Sangaré L. Streptococcus pneumoniae invasive infections in Burkina Faso, 2007 to 2011. Med Mal Infect 2014; 44:117-22. [PMID: 24612507 DOI: 10.1016/j.medmal.2014.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 12/01/2013] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We had for aim to determine the epidemiology of meningeal and lung invasive infections due to Streptococcus pneumoniae in Burkina Faso. MATERIAL AND METHODS We screened for S. pneumoniae with the usual bacteriology techniques and with real time polymerase chain reaction (rt-PCR) in 7917 samples of cerebrospinal fluid (CSF) and pleural fluid (PF) collected in the Ouagadougou Yalgado Ouedraogo Teaching Hospital, from 2007 to 2011. RESULTS S. pneumoniae was identified in 476 (6%) samples including 455 (5.7%) in CSF and 21 (0.3%) in PF. Sixty-seven percent of invasive infections occurred in patients 15 years of age or less, without any significant sex ratio difference. The infections occurred most frequently between January and August, with the first and most important peak between January and May (dry season) and the second peak between June and August (at the beginning of rain season). The introduction of rt-PCR proved the under diagnosing of invasive infections by usual bacteriological methods (latex agglutination assay and culture). CONCLUSION Invasive pneumococcal infections occur mainly in patients 15 years of age or less, without any difference in sex ratio and with peaks in the dry season. Vaccinal schedules should include all age ranges in Burkina Faso.
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Affiliation(s)
- Y Chaïbou
- Centre de recherche en sciences biologiques, alimentaires et nutritionnelles, université de Ouagadougou, 03 BP 7131, Ouagadougou 03, Burkina Faso.
| | - I Sanou
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso; UFR en sciences de la santé (UFR-SDS), université de Ouagadougou, 03 BP 7021, Ouagadougou 03, Burkina Faso
| | - M Congo-Ouedraogo
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - M C Kienou
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - K Ouattara
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - H Somlaré
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - A S Traoré
- Centre de recherche en sciences biologiques, alimentaires et nutritionnelles, université de Ouagadougou, 03 BP 7131, Ouagadougou 03, Burkina Faso
| | - L Sangaré
- Service de bactériologie-virologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou 03, Burkina Faso; UFR en sciences de la santé (UFR-SDS), université de Ouagadougou, 03 BP 7021, Ouagadougou 03, Burkina Faso
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Makani J, Ofori-Acquah SF, Nnodu O, Wonkam A, Ohene-Frempong K. Sickle cell disease: new opportunities and challenges in Africa. ScientificWorldJournal 2013; 2013:193252. [PMID: 25143960 PMCID: PMC3988892 DOI: 10.1155/2013/193252] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/09/2013] [Indexed: 12/26/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most common genetic causes of illness and death in the world. This is a review of SCD in Africa, which bears the highest burden of disease. The first section provides an introduction to the molecular basis of SCD and the pathophysiological mechanism of selected clinical events. The second section discusses the epidemiology of the disease (prevalence, morbidity, and mortality), at global level and within Africa. The third section discusses the laboratory diagnosis and management of SCD, emphasizing strategies that been have proven to be effective in areas with limited resources. Throughout the review, specific activities that require evidence to guide healthcare in Africa, as well as strategic areas for further research, will be highlighted.
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Affiliation(s)
- J. Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S. F. Ofori-Acquah
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- School of Allied Health Sciences, College of Health Sciences, University of Ghana, Ghana
| | - O. Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - A. Wonkam
- Division of Human Genetics, Faculty of Heath Sciences, University of Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
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Maimaiti N, Ahmed Z, Md Isa Z, Ghazi HF, Aljunid S. Clinical Burden of Invasive Pneumococcal Disease in Selected Developing Countries. Value Health Reg Issues 2013; 2:259-263. [PMID: 29702874 DOI: 10.1016/j.vhri.2013.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure the clinical burden of invasive pneumococcal disease (IPD) in selected developing countries. METHODS This is an extensive literature review of published articles on IPD in selected developing countries from East Asia, South Asia, Middle East, sub-Saharan Africa, and Latin America. We reviewed all the articles retrieved from the knowledge bases that were published between the years 2000 and 2010. RESULTS After applying the inclusion, exclusion, and quality criteria, the comprehensive review of the literature yielded 10 articles with data for pneumococcal meningitis, septicemia/bacteremia, and pneumonia. These selected articles were from 10 developing countries from five different regions. Out of the 10 selected articles, 8 have a detailed discussion on IPD, one of them has s detailed discussion on bacteremia and meningitis, and another one has discussed pneumococcal bacteremia. Out of these 10 articles, only 5 articles discussed the case-fatality ratio (CFR). In our article review, the incidence of IPD ranged from less than 5/100,000 to 416/100,000 population and the CFR ranged from 12.2% to 80% in the developing countries. CONCLUSIONS The review demonstrated that the clinical burden of IPD was high in the developing countries. The incidence of IPD and CFR varies from region to region and from country to country. The IPD burden was highest in sub-Saharan African countries followed by South Asian countries. The CFR was low in high-income countries than in low-income countries.
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Affiliation(s)
- Namaitijiang Maimaiti
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia; Department of Community Health, Faculty of Medicine, UKM.
| | - Zafar Ahmed
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia; International Centre for Case-Mix and Clinical Coding, UKM Medical Centre
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, UKM
| | - Hasanain Faisal Ghazi
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia; Department of Community Health, Faculty of Medicine, UKM
| | - Syed Aljunid
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia; International Centre for Case-Mix and Clinical Coding, UKM Medical Centre
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Al Awaidy ST, Al Obeidani I, Al Busaidy SS, Al Mahrouqi S. Epidemiology of invasive pneumococcal infection among hospitalized children aged less than 5 years in Oman. Vaccine 2012; 30 Suppl 6:G7-G10. [PMID: 23228359 DOI: 10.1016/j.vaccine.2012.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in Omani children. We retrospectively reviewed cases admitted in children <5 years of age who were admitted in one of 4 tertiary care facilities within the Muscat Governorate. These cases represented nearly 95% of all IPD admissions recorded throughout the country from 1 January 2006 to 31 December 2006. Cases of IPD were identified using the ICD-10 discharge code. Case definition required microbiological confirmation (i.e., isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid or any other normally sterile biological fluid) or clinical diagnosis in the absence of a specimen. A total of 41 cases of IPD were identified. The annual incidence of IPD was 26.1 per 100,000 in children <2 years old and 18.6 per 100,000 in children <5 years old. Among the reported IPD cases, 22 (54%) isolates were resistant to at least one antibiotic and 15 (37%) of patients had a known comorbid medical condition. These results demonstrate that the incidence of IPD in Oman during 2006 was high compared to many of the neighboring countries and provides baseline data on the incidence of IPD in an era before the introduction of the pneumococcal conjugate vaccine (PCV). In light of evidence for a significant incidence of IPD, we recommended that a nationwide surveillance system be put in place to monitor the incidence of IPD in children <5 years of age in Oman and to document the impact of PCV.
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Aguilar R, Moraleda C, Quintó L, Renom M, Mussacate L, Macete E, Aguilar JL, Alonso PL, Menéndez C. Challenges in the diagnosis of iron deficiency in children exposed to high prevalence of infections. PLoS One 2012; 7:e50584. [PMID: 23209786 PMCID: PMC3507793 DOI: 10.1371/journal.pone.0050584] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/23/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While WHO guidelines recommend iron supplements to only iron-deficient children in high infection pressure areas, these are rarely implemented. One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria. Secondly, currently used markers to diagnose iron deficiency are also modified by infections. With the objective of improving iron deficiency diagnosis and thus, its management, we evaluated the performance of iron markers in children exposed to high infection pressure. METHODOLOGY/PRINCIPAL FINDINGS Iron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUC(ROC)) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively). CONCLUSIONS/SIGNIFICANCE Iron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent.
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Affiliation(s)
- Ruth Aguilar
- Barcelona Centre for International Heath Research, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Díez-Padrisa N, Bassat Q, Morais L, O’Callaghan-Gordo C, Machevo S, Nhampossa T, Ibarz-Pavón AB, Quintó L, Alonso PL, Roca A. Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique. Trop Med Int Health 2012; 17:1100-7. [DOI: 10.1111/j.1365-3156.2012.03035.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Increased risk of death in human immunodeficiency virus-infected children with pneumococcal meningitis in South Africa, 2003-2005. Pediatr Infect Dis J 2011; 30:1075-80. [PMID: 21799459 DOI: 10.1097/inf.0b013e31822cca05] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumococcal disease is a major global cause of morbidity and mortality. This study evaluated risk factors for mortality in children with pneumococcal meningitis and other invasive pneumococcal diseases (IPD). METHODS The study population included patients <15 years of age with laboratory-confirmed IPD and available outcome data between January 1, 2003 and December 31, 2005 as reported to a national laboratory-based surveillance program. Meningitis was defined by having pneumococcus identified from cerebrospinal fluid culture, while other IPD included patients with pneumococci identified from other normally sterile site specimens. Risk factors for mortality were evaluated using multivariable logistic regression. RESULTS A total of 2251 patients with IPD were reported from sentinel sites: 581 with laboratory-confirmed meningitis and 1670 with other IPD. The case-fatality ratio was 35% (205/581) among meningitis cases and 18% (300/1670) among other IPD cases (P < 0.001). Among individuals with available human immunodeficiency virus (HIV) status data, HIV coinfection was less likely among patients with meningitis compared with other IPD (74% [244/328] vs. 82% [880/1067] P < 0.001). On multivariable analysis, HIV-infected status (odds ratio [OR]: 5.34, 95% confidence interval [CI]: 2.32-12.29), Pitt bacteremia score ≥4 (OR: 3.08, 95% CI: 1.21-7.83) and age group <1 year (OR: 2.58, 95% CI: 1.21-5.51) were independent predictors of death among patients with meningitis. Among children with other IPD, malnutrition was an independent predictor of death while HIV infection was not independently associated with increased risk of death. CONCLUSIONS Pneumococcal meningitis is associated with a high case-fatality ratio among South African children and this is increased by HIV coinfection. Increasing access to antiretroviral therapy and a catch-up program for pneumococcal conjugate vaccine among HIV-infected and malnourished children could reduce this excess mortality.
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Bassat Q, Machevo S, O'Callaghan-Gordo C, Sigaúque B, Morais L, Díez-Padrisa N, Ribó JL, Mandomando I, Nhampossa T, Ayala E, Sanz S, Weber M, Roca A, Alonso PL. Distinguishing malaria from severe pneumonia among hospitalized children who fulfilled integrated management of childhood illness criteria for both diseases: a hospital-based study in Mozambique. Am J Trop Med Hyg 2011; 85:626-34. [PMID: 21976562 DOI: 10.4269/ajtmh.2011.11-0223] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.
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Affiliation(s)
- Quique Bassat
- Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Spain.
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Roca A, Hill PC, Townend J, Egere U, Antonio M, Bojang A, Akisanya A, Litchfield T, Nsekpong DE, Oluwalana C, Howie SRC, Greenwood B, Adegbola RA. Effects of community-wide vaccination with PCV-7 on pneumococcal nasopharyngeal carriage in the Gambia: a cluster-randomized trial. PLoS Med 2011; 8:e1001107. [PMID: 22028630 PMCID: PMC3196470 DOI: 10.1371/journal.pmed.1001107] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 09/06/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Introduction of pneumococcal conjugate vaccines (PCVs) of limited valency is justified in Africa by the high burden of pneumococcal disease. Long-term beneficial effects of PCVs may be countered by serotype replacement. We aimed to determine the impact of PCV-7 vaccination on pneumococcal carriage in rural Gambia. METHODS AND FINDINGS A cluster-randomized (by village) trial of the impact of PCV-7 on pneumococcal nasopharyngeal carriage was conducted in 21 Gambian villages between December 2003 to June 2008 (5,441 inhabitants in 2006). Analysis was complemented with data obtained before vaccination. Because efficacy of PCV-9 in young Gambian children had been shown, it was considered unethical not to give PCV-7 to young children in all of the study villages. PCV-7 was given to children below 30 mo of age and to those born during the trial in all study villages. Villages were randomized (older children and adults) to receive one dose of PCV-7 (11 vaccinated villages) or meningococcal serogroup C conjugate vaccine (10 control villages). Cross-sectional surveys (CSSs) to collect nasopharyngeal swabs were conducted before vaccination (2,094 samples in the baseline CSS), and 4-6, 12, and 22 mo after vaccination (1,168, 1,210, and 446 samples in CSS-1, -2, and -3, respectively). A time trend analysis showed a marked fall in the prevalence of vaccine-type pneumococcal carriage in all age groups following vaccination (from 23.7% and 26.8% in the baseline CSS to 7.1% and 8.5% in CSS-1, in vaccinated and control villages, respectively). The prevalence of vaccine-type pneumococcal carriage was lower in vaccinated than in control villages among older children (5 y to <15 y of age) and adults (≥15 y of age) at CSS-2 (odds ratio [OR] = 0.15 [95% CI 0.04-0.57] and OR = 0.32 [95% CI 0.10-0.98], respectively) and at CSS-3 (OR = 0.37 [95% CI 0.15-0.90] for older children, and 0% versus 7.6% for adults in vaccinated and control villages, respectively). Differences in the prevalence of non-vaccine-type pneumococcal carriage between vaccinated and control villages were small. CONCLUSIONS Vaccination of Gambian children reduced vaccine-type pneumococcal carriage across all age groups, indicating a "herd effect" in non-vaccinated older children and adults. No significant serotype replacement was detected. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Anna Roca
- Medical Research Council Unit, The Gambia.
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Erythropoietin levels are not independently associated with malaria-attributable severe disease in Mozambican children. PLoS One 2011; 6:e24090. [PMID: 21912616 PMCID: PMC3166067 DOI: 10.1371/journal.pone.0024090] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 07/29/2011] [Indexed: 12/26/2022] Open
Abstract
Background Severe malaria is difficult to differentiate from other forms of malaria or other infections with similar symptoms. Any parameter associated to malaria-attributable severe disease could help to improve severe malaria diagnosis. Methodology This study assessed the relation between erythropoietin (EPO) and malaria-attributable severe disease in an area of Mozambique with moderate malaria transmission. 211 children <5 years, recruited at Manhiça District Hospital or in the surrounding villages, were included in one of the following groups: severe malaria (SM, n = 44), hospital malaria without severity (HM, n = 49), uncomplicated malaria (UM, n = 47), invasive bacterial infection without malaria parasites (IBI, n = 39) and healthy community controls (C, n = 32). Malaria was diagnosed by microscopy and IBI by blood/cerebrospinal fluid culture. Principal Findings Mean EPO concentration in the control group was 20.95 U/l (SD = 2.96 U/l). Values in this group were lower when compared to each of the clinical groups (p = 0.026 C versus UM, p<0.001 C vs HM, p<0.001 C vs SM and p<0.001 C vs IBI). In the 3 malaria groups, values increased with severity [mean = 40.82 U/l (SD = 4.07 U/l), 125.91 U/l (SD = 4.99U/l) and 320.87 U/l (SD = 5.91U/l) for UM, HM and SM, respectively, p<0.001]. The IBI group [mean = 101.75 U/l (SD = 4.12 U/l)] presented lower values than the SM one (p = 0.002). In spite of the differences, values overlapped between study groups and EPO levels were only associated to hemoglobin. Hemoglobin means of the clinical groups were 93.98 g/dl (SD = 14.77 g/dl) for UM, 75.96 g/dl (SD = 16.48 g/dl) for HM, 64.34 g/dl (SD = 22.99 g/dl) for SM and 75.67 g/dl (SD = 16.58 g/dl) for IBI. Conclusions Although EPO levels increase according to malaria severity and are higher in severe malaria than in bacteremia, the utility of EPO to distinguish malaria-attributable severe disease is limited due to the overlap of values between the study groups and the main role of hemoglobin in the expression of EPO.
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Lubell Y, Turner P, Ashley EA, White NJ. Susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asia to macrolide antibiotics. Trop Med Int Health 2011; 16:1192-205. [PMID: 21740488 DOI: 10.1111/j.1365-3156.2011.02837.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To review the literature on the susceptibility of common community pathogens in sub-Saharan Africa and Asia to the macrolide antibiotics. METHODS Inclusion criteria required that isolates were collected since 2004 to ensure results were of contemporary relevance. The data were aggregated by region, age group and sterility of site of culture sample. RESULTS A total of 51 studies were identified, which reported the macrolide antimicrobial susceptibilities of common bacterial pathogens isolated since 2004. In general, there was less macrolide resistance in African than in Asian isolates. Most African studies reported high levels of macrolide susceptibility in Streptococcus pneumoniae, whereas most Chinese studies reported high levels of resistance. There was very little information available for Gram-negative organisms. CONCLUSIONS Susceptibility of the pneumococcus to macrolides in SSA remains high in many areas, and good activity of azithromycin has been shown against Salmonellae spp. in Asia. In urban areas where high antibiotic consumption is prevalent, there was evidence of increased resistance to macrolides. However, there is no information on susceptibility from large areas in both continents.
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Affiliation(s)
- Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Memish ZA, El-Saed A, Al-Otaibi B, Shaalan MA, Alola SA, Thaqafi AO. Epidemiology of invasive pneumococcal infection in children aged five years and under in Saudi Arabia: a five-year retrospective surveillance study. Int J Infect Dis 2010; 14:e708-12. [PMID: 20627645 DOI: 10.1016/j.ijid.2010.02.2242] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 11/16/2009] [Accepted: 02/01/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The epidemiology of invasive pneumococcal disease (IPD) in children aged <or=5 years in Saudi Arabia has not been described. We conducted a retrospective surveillance study to describe the epidemiology of IPD in the population of children aged <or=5 years served by the National Guard Health Affairs hospitals in central and western regions of Saudi Arabia. METHODS We reviewed the medical records of children <or=5 years old admitted to the King Abdulaziz Medical City hospitals in Riyadh and Jeddah with pneumococcal infections for the period January 1999 through December 2003. Only microbiologically confirmed IPD cases (meningitis or bacteremia) were included in the analysis. RESULTS A total of 82 IPD cases, 19 (23.2%) meningitis and 63 (76.8%) bacteremia, were diagnosed during the five-year period. Of these, 12.2% (10/82) died, with a case-fatality slightly but insignificantly higher in cases of meningitis (15.8%) than bacteremia (11.1%). The average annual IPD incidence was 17.4 per 100,000 (4.0 for meningitis and 13.4 for bacteremia). The incidence was roughly similar in males and females (18.3 and 16.6, respectively; p=0.663) and was almost 4-fold higher in the first year of life compared to the next four years (40.6 and 11.5, respectively; p<0.001). The average annual IPD mortality was 2.1 per 100,000 and was higher in the first year of life compared to the next four years (5.2 and 1.3 , respectively; p=0.043). CONCLUSIONS In the pre-vaccination era (1999-2003) in Saudi Arabia, IPD incidence was comparable to the pre-vaccination incidence rates from many industrialized countries, with children aged <or=1 year suffering the highest IPD risk among those aged <or=5 years.
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Affiliation(s)
- Ziad A Memish
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Díez-Padrisa N, Bassat Q, Machevo S, Quintó L, Morais L, Nhampossa T, O'Callaghan-Gordo C, Torres A, Alonso PL, Roca A. Procalcitonin and C-reactive protein for invasive bacterial pneumonia diagnosis among children in Mozambique, a malaria-endemic area. PLoS One 2010; 5:e13226. [PMID: 20976241 PMCID: PMC2954814 DOI: 10.1371/journal.pone.0013226] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 09/07/2010] [Indexed: 12/04/2022] Open
Abstract
Background Pneumonia is the major cause of mortality and morbidity in children worldwide. Procalcitonin (PCT) and C-reactive protein (CRP) are used in developed countries to differentiate between viral and bacterial causes of pneumonia. Validity of these markers needs to be further explored in Africa. Methodology and Principal Findings We assessed the utility of PCT and CRP to differentiate viral from invasive bacterial pneumonia in children <5 years hospitalized with clinical severe pneumonia (CSP) in rural Mozambique, a malaria-endemic area with high HIV prevalence. Prognostic capacity of these markers was also evaluated. Out of 835 children with CSP, 87 fulfilled definition of viral pneumonia and 89 of invasive bacterial pneumonia. In absence of malaria parasites, levels of PCT and CRP were lower in the viral group when compared to the invasive bacterial one (PCT: median = 0.21 versus 8.31 ng/ml, p<0.001; CRP: 18.3 vs. 185.35 mg/l, p<0.001). However, in presence of malaria parasites distribution between clinical groups overlapped (PCT: median = 23.1 vs. 21.75 ng/ml, p = 0.825; CRP: median = 96.8 vs. 217.4 mg/l, p = 0.052). None of the two markers could predict mortality. Conclusions Presence of malaria parasites should be taken into consideration, either for clinical or epidemiological purposes, if using PCT or CRP to differentiate viral from invasive bacterial pneumonia in malaria-endemic areas.
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Affiliation(s)
- Núria Díez-Padrisa
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
| | - Quique Bassat
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
- Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Barcelona, Spain
| | - Sonia Machevo
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Llorenç Quintó
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Luis Morais
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
- Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique
| | - Cristina O'Callaghan-Gordo
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
| | - Antoni Torres
- Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Bunyola, Spain
| | - Pedro L. Alonso
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
| | - Anna Roca
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçaõ em Saúde da Manhiça, Manhiça, Mozambique
- * E-mail:
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Invasive pneumococcal disease in Fiji: clinical syndromes, epidemiology, and the potential impact of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2010; 29:870-2. [PMID: 20622710 DOI: 10.1097/inf.0b013e3181ec7ae2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Invasive pneumococcal disease (IPD) epidemiology and the potential impact of the pneumococcal conjugate vaccine in Fiji are documented. The annual incidence was 26.5 and 10.9 in those aged <5 and > or =55 years per 100,000, respectively. The case fatality rate was 9.4% and 67% in <5 and >65 year olds, respectively. One pneumococcal death and case would be prevented in <5 years olds for every 1930 and 128 infants vaccinated with 7vPCV, respectively.
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Sigaúque B, Roca A, Bassat Q, Morais L, Quintó L, Berenguera A, Machevo S, Bardaji A, Corachan M, Ribó J, Menéndez C, Schuchat A, Flannery B, Soriano-Gabarró M, Alonso PL. Severe pneumonia in Mozambican young children: clinical and radiological characteristics and risk factors. J Trop Pediatr 2009; 55:379-87. [PMID: 19401405 DOI: 10.1093/tropej/fmp030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of hospitalization and death among children in Africa. We describe the clinical presentation of severe pneumonia among hospitalized children in a malaria endemic area with a high prevalence of HIV infection. METHODS As part of a 2-year prospective study of radiologically confirmed pneumonia, chest radiographs, malaria parasite counts and bacterial blood cultures were systematically performed for children 0-23 months admitted with severe pneumonia. Radiographs were interpreted according to WHO guidelines. HIV tests were performed during a 12-month period. RESULTS Severe pneumonia accounted for 16% of 4838 hospital admissions among children 0-23 months; 43% of episodes had endpoint consolidation, 15% were associated with bacteremia and 11% were fatal. Fever, cough >3 days, crepitations, hypoxemia and absence of malaria parasitemia were associated with radiologically confirmed pneumonia. Nineteen per cent of children with severe pneumonia and 27% with radiologically confirmed pneumonia had clinical malaria. HIV-prevalence was 26% among children hospitalized with severe pneumonia and HIV-testing results. HIV infection, anaemia, malnutrition, hypoxemia and bacteremia were associated with fatal episodes of severe pneumonia. CONCLUSION Treatment of admitted children with severe pneumonia is complicated in settings with prevalent HIV and malaria. Children with severe pneumonia and clinical malaria require antibiotic and antimalarial treatment. In addition to vertical programs, integrated approaches may greatly contribute to reduction of pneumonia-related mortality.
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Affiliation(s)
- Betuel Sigaúque
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique.
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Mandomando I, Macete E, Sigaúque B, Morais L, Quintó L, Sacarlal J, Espasa M, Vallès X, Bassat Q, Aide P, Nhampossa T, Machevo S, Ruiz J, Nhacolo A, Menéndez C, Kotloff KL, Roca A, Levine MM, Alonso PL. Invasive non-typhoidalSalmonellain Mozambican children. Trop Med Int Health 2009; 14:1467-74. [DOI: 10.1111/j.1365-3156.2009.02399.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Obaro S. Seven-valent pneumococcal conjugate vaccines for developing countries. Expert Rev Vaccines 2009; 8:1051-61. [PMID: 19627187 DOI: 10.1586/erv.09.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Protein conjugate bacterial vaccines for invasive pneumococcal diseases have revolutionized the epidemiology of invasive bacterial disease in young children in most of the developed world, but only a small proportion of children at greatest risk of dying from this disease are vaccinated in less developed countries. Pneumococcal disease kills more children than any other illness - more than AIDS, malaria and measles combined. While the noble effort of international agencies to promote the use of pneumococcal vaccines is commendable, studies from several developing countries have failed to recognize invasive pneumococcal disease as a major problem. Thus, even at considerably subsidized vaccine pricing, this failure to recognize the pneumococcal disease burden will deter the introduction of vaccine programs in areas where it is most needed. This lack of awareness creates an impassé for the acceptance of a 'solution'. Whether this absence of evidence is real or simply misleading deserves further urgent evaluation. Such an evaluation could propose the use of the vaccine as a 'probe' for defining the problem. In settings where disease burden is likely to be highest, disease surveillance is nonexistent, childhood immunization programs are fractured or nonexistent, and there is no system to ensure delivery, even if the vaccine is offered free of charge. Ongoing challenges with global polio eradication programs suggest that, critical to the success of any immunization program, is investment in setting up credible disease surveillance systems for vaccine preventable diseases to generate local or regional disease burden data. This will promote local ownership of any immunization programs and reveal myths about a 'hidden agenda' by foreign vaccine manufacturers.
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Affiliation(s)
- Stephen Obaro
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI 48824, USA.
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Bassat Q, Guinovart C, Sigaúque B, Mandomando I, Aide P, Sacarlal J, Nhampossa T, Bardají A, Morais L, Machevo S, Letang E, Macete E, Aponte JJ, Roca A, Menéndez C, Alonso PL. Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital. Trop Med Int Health 2009; 14:1011-9. [PMID: 19552643 DOI: 10.1111/j.1365-3156.2009.02326.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the prevalence, aetiology and prognostic implications of coexisting invasive bacterial disease in children admitted with severe malaria in a rural Mozambican Hospital. METHODS Retrospective study of data systematically collected from June 2003 to May 2007 in a rural Mozambican hospital, from all children younger than 5 years admitted with severe malaria. RESULTS Seven thousand and forty-three children were admitted with a diagnosis of malaria. 25.2% fulfilled the criteria for severe malaria. 5.4% of the children with severe malaria and valid blood culture results had a concomitant bacteraemia. Case fatality rates of severe malaria cases rose steeply when bacteraemia was also present (from 4.0% to 22.0%, P < 0.0001), and bacteraemia was an independent risk factor for death among severe malaria patients (adjusted OR 6.2, 95% CI 2.8-13.7, P = 0.0001). Streptococcus pneumoniae, Gram-negative bacteria, Staphilococcus aureus and non-typhoid Salmonella (NTS) were the most frequently isolated microorganisms among severe malaria cases. Their frequency and associated case fatality rates (CFR) varied according to age and to syndromic presentation. Streptococcus pneumoniae had a relatively low CFR, but was consistently associated with severe malaria syndromes, or anaemia severity groups. No clear-cut relationship between malarial anaemia and NTS bacteraemia was found. CONCLUSIONS The coexistence of malaria and invasive bacterial infections is a frequent and life-threatening condition in many endemic African settings. In Mozambique, S. pneumoniae is the leading pathogen in this interaction, possibly as a consequence of the high HIV prevalence in the area. Measures directed at reducing the burden of both those infections are urgently needed to reduce child mortality in Africa.
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Affiliation(s)
- Quique Bassat
- Barcelona Center for International Health Research, University of Barcelona, Barcelona, Spain.
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Moïsi JC, Saha SK, Falade AG, Njanpop-Lafourcade BM, Oundo J, Zaidi AKM, Afroj S, Bakare RA, Buss JK, Lasi R, Mueller J, Odekanmi AA, Sangaré L, Scott JAG, Knoll MD, Levine OS, Gessner BD. Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study. Clin Infect Dis 2009; 48 Suppl 2:S49-56. [PMID: 19191619 PMCID: PMC2863072 DOI: 10.1086/596481] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. METHODS We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. RESULTS A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P< .001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P< .001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for >or=1000 cells/mL; P< .001 by test for trend). CONCLUSIONS The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.
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Affiliation(s)
- Jennifer C Moïsi
- GAVI Alliance's PneumoADIP, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
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Sacarlal J, Nhacolo AQ, Sigaúque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P, Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardají A, Letang E, Saúte F, Aponte JJ, Thompson R, Alonso PL. A 10 year study of the cause of death in children under 15 years in Manhiça, Mozambique. BMC Public Health 2009; 9:67. [PMID: 19236726 PMCID: PMC2656537 DOI: 10.1186/1471-2458-9-67] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 46 million of the estimated 60 million deaths that occur in the world each year take place in developing countries. Further, this mortality is highest in Sub-Saharan Africa, although causes of mortality in this region are not well documented. The objective of this study is to describe the most frequent causes of mortality in children under 15 years of age in the demographic surveillance area of the Manhiça Health Research Centre, between 1997 and 2006, using the verbal autopsy tool. METHODS Verbal autopsy interviews for causes of death in children began in 1997. Each questionnaire was reviewed independently by three physicians with experience in tropical paediatrics, who assigned the cause of death according to the International Classification of Diseases (ICD-10). Each medical doctor attributed a minimum of one and a maximum of 2 causes. A final diagnosis is reached when at least two physicians agreed on the cause of death. RESULTS From January 1997 to December 2006, 568,499 person-year at risk (pyrs) and 10,037 deaths were recorded in the Manhiça DSS. 3,730 deaths with 246,658 pyrs were recorded for children under 15 years of age. Verbal autopsy interviews were conducted on 3,002 (80.4%) of these deaths. 73.6% of deaths were attributed to communicable diseases, non-communicable diseases accounted for 9.5% of the defined causes of death, and injuries for 3.9% of causes of deaths. Malaria was the single largest cause, accounting for 21.8% of cases. Pneumonia with 9.8% was the second leading cause of death, followed by HIV/AIDS (8.3%) and diarrhoeal diseases with 8%. CONCLUSION The results of this study stand out the big challenges that lie ahead in the fight against infectious diseases in the study area. The pattern of childhood mortality in Manhiça area is typical of developing countries where malaria, pneumonia and HIV/AIDS are important causes of death.
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Affiliation(s)
- Jahit Sacarlal
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Q Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | - Fatima Abacassamo
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Pedro Aide
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Sonia Machevo
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Eusébio V Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Catarina David
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Emili Letang
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Saúte
- National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - John J Aponte
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ricardo Thompson
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Pedro L Alonso
- Centro de Investigação em Saúde da Manhiça (CISM), Mozambique
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Abstract
BACKGROUND Although community-acquired bacteremia is an important cause of childhood mortality in Africa, recognition of disease burden and potential impact of bacterial vaccines is limited. METHODS Blood cultures for bacterial pathogens were conducted systematically among children <15 years of age admitted to Manhiça District Hospital, from 2001 to 2006. RESULTS Blood-stream infections were identified in 8% (1550/19,896) of pediatric hospital admissions. Nontyphoidal Salmonella (NTS) and Pneumococcus were the most prevalent pathogens isolated (26% and 25% of 1550 cases, respectively). Until 28 days of life, Staphylococcus aureus (39%) and group B Streptococcus (20%) predominated. Incidence of community-acquired bacteremia per 100,000 child-years was 1730/10 in children <1 year old, 782/10 in 1-4 year oldd, and 49/10 in children 5 years and older. Case-fatality of bacteremia was 12%. Community-acquired bacteremia associated mortality accounted for 21% (162/788) of hospital deaths. Resistance to antibiotics commonly used in Mozambique was high among invasive isolates of Haemophilus influenzae, Escherichia coli, and NTS. CONCLUSIONS Community-acquired bacteremia is an important cause of pediatric hospital admission and death in rural African hospitals. The high burden of disease, mortality, and pattern of antibiotic resistance associated with bacteremia underscore the need for prevention in Sub-Saharan Africa.
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Roca A, Quintó L, Abacassamo F, Morais L, Vallès X, Espasa M, Sigaúque B, Sacarlal J, Macete E, Nhacolo A, Mandomando I, Levine MM, Alonso PL. Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique. Trop Med Int Health 2008; 13:818-26. [DOI: 10.1111/j.1365-3156.2008.02061.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Estimates for the year 2000 suggested that there were approximately 21.5 million infections and 200,000 deaths from typhoid fever globally each year, making the disease one of the most serious infectious disease threats to public health on a global scale. However, these estimates were based on little data, especially from Africa. Global prominence and high-profile outbreaks have created the perception in Kenya that typhoid is a common cause of febrile illness. The Widal test is used widely in diagnosis. We have reviewed recent literature, taking the perspective of a healthcare provider, to collate information on the prevalence of typhoid in children particularly, and to explore the role of clinical diagnosis and diagnosis based on a crude, but common, interpretation of the Widal test. Data suggest that typhoid in children in rural Africa is uncommon, perhaps 100 times or 250 times less common than invasive disease because of Haemophilus influenzae or Streptococcus pneumoniae, respectively. Frequent use of the Widal test may result in many hundreds of over-treatment episodes for every true case treated and may perpetuate the perception that typhoid is common. Countries such as Kenya need better bacterial disease surveillance systems allied to better information for healthcare providers to promote appropriate decision-making on prevention and treatment strategies.
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Affiliation(s)
- Evanson Mweu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Nairobi, Kenya, and College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Sigaúque B, Roca A, Sanz S, Oliveiras I, Martínez M, Mandomando I, Vallès X, Espasa M, Abacassamo F, Sacarlal J, Macete E, Nhacolo A, Aponte J, Levine M, Alonso P. Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique. Acta Trop 2008; 105:21-7. [PMID: 17959132 DOI: 10.1016/j.actatropica.2007.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Revised: 01/03/2007] [Accepted: 01/05/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases. METHODS As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003. RESULTS During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol. CONCLUSIONS S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.
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Morais L, Carvalho MDG, Roca A, Flannery B, Mandomando I, Soriano-Gabarró M, Sigauque B, Alonso P, Beall B. Sequential multiplex PCR for identifying pneumococcal capsular serotypes from South-Saharan African clinical isolates. J Med Microbiol 2007; 56:1181-1184. [PMID: 17761480 DOI: 10.1099/jmm.0.47346-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A serial multiplex PCR approach was reformulated for pneumococcal serotyping to test 153 clinical isolates from children in Mozambique. This approach identified serotypes in 139 (90.8%) of 153 isolates; 126 (82.4%) were identified within two reactions. This approach in developing countries would require minimal training and could provide useful serotype information without requiring transport of specimens.
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Affiliation(s)
- Luis Morais
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, CP1929 Maputo, Mozambique
| | - Maria da Glória Carvalho
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Anna Roca
- Centre de Salut Internacional (CSI), Hospital Clinic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, CP1929 Maputo, Mozambique
| | - Brendan Flannery
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Inacio Mandomando
- Instituto Nacional de Saúde Ministério de Saúde, Maputo, Mozambique
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, CP1929 Maputo, Mozambique
| | - Montserrat Soriano-Gabarró
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Betuel Sigauque
- Instituto Nacional de Saúde Ministério de Saúde, Maputo, Mozambique
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, CP1929 Maputo, Mozambique
| | - Pedro Alonso
- Centre de Salut Internacional (CSI), Hospital Clinic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, CP1929 Maputo, Mozambique
| | - Bernard Beall
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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