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Rybak A, Ouldali N, Angoulvant F, Minodier P, Biscardi S, Madhi F, Hau I, Santos A, Bouvy E, Dubos F, Martinot A, Dommergues MA, Gras-Le Guen C, Launay E, Levieux K, Zenkhri F, Craiu I, Lorrot M, Gillet Y, Mezgueldi E, Faye A, Béchet S, Varon E, Cohen R, Levy C. Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study. Front Pediatr 2022; 10:782894. [PMID: 35391746 PMCID: PMC8980475 DOI: 10.3389/fped.2022.782894] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/31/2022] [Indexed: 01/13/2023] Open
Abstract
Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 were implemented in March 2020. These measures were followed by a major impact on viral and non-viral diseases. We aimed to assess the impact of NPI implementation in France on hospitalized community-acquired pneumonia (hCAP) frequency and the clinical and biological characteristics of the remaining cases in children. We performed a quasi-experimental interrupted time-series analysis. Between June 2014 and December 2020, eight pediatric emergency departments throughout France reported prospectively all cases of hCAP in children from age 1 month to 15 years. We estimated the impact on the monthly number of hCAP using segmented linear regression with autoregressive error model. We included 2,972 hCAP cases; 115 occurred during the NPI implementation period. We observed a sharp decrease in the monthly number of hCAP after NPI implementation [-63.0% (95 confidence interval, -86.8 to -39.2%); p < 0.001]. Children with hCAP were significantly older during than before the NPI period (median age, 3.9 vs. 2.3 years; p < 0.0001), and we observed a higher proportion of low inflammatory marker status (43.5 vs. 33.1%; p = 0.02). Furthermore, we observed a trend with a decrease in the proportion of cases with pleural effusion (5.3% during the NPI period vs. 10.9% before the NPI; p = 0.06). NPI implementation during the COVID-19 (coronavirus disease 2019) pandemic led not only to a strong decrease in the number of hCAP cases but also a modification in the clinical profile of children affected, which may reflect a change in pathogens involved.
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Affiliation(s)
- Alexis Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France.,INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France
| | - Naïm Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France
| | - François Angoulvant
- Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Philippe Minodier
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France
| | - Sandra Biscardi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Fouad Madhi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Isabelle Hau
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Audrey Santos
- Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Emilie Bouvy
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - François Dubos
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Alain Martinot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Marie-Aliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Christèle Gras-Le Guen
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Elise Launay
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Karine Levieux
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ferielle Zenkhri
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Irina Craiu
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Mathie Lorrot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Université Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Ellia Mezgueldi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Albert Faye
- INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Emmanuelle Varon
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,National Reference Center for Pneumococci, Laboratoire de Microbiologie, Hôpital Intercommunal, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Neonates Department, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Pneumococcal Conjugate Vaccine Protection against Coronavirus-Associated Pneumonia Hospitalization in Children Living with and without HIV. mBio 2021; 12:mBio.02347-20. [PMID: 33419872 PMCID: PMC7845626 DOI: 10.1128/mbio.02347-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
SARS-CoV-2 may cause severe hospitalization, but little is known about the role of secondary bacterial infection in these severe cases, beyond the observation of high levels of reported inflammatory markers, associated with bacterial infection, such as procalcitonin. We did a secondary analysis of a double-blind randomized trial of pneumococcal conjugate vaccine (PCV) to examine its impact on human coronavirus (CoV) infections before the pandemic. In December 2019 a new coronavirus (CoV) emerged as a human pathogen, SARS-CoV-2. There are few data on human coronavirus infections among individuals living with HIV. In this study we probed the role of pneumococcal coinfections with seasonal CoVs among children living with and without HIV hospitalized for pneumonia. We also described the prevalence and clinical manifestations of these infections. A total of 39,836 children who participated in a randomized, double-blind, placebo-controlled clinical trial on the efficacy of a 9-valent pneumococcal conjugate vaccine (PCV9) were followed for lower respiratory tract infection hospitalizations until 2 years of age. Nasopharyngeal aspirates were collected at the time of hospitalization and were screened by PCR for four seasonal CoVs. The frequency of CoV-associated pneumonia was higher in children living with HIV (19.9%) than in those without HIV (7.6%, P < 0.001). Serial CoV infections were detected in children living with HIV. The case fatality risk among children with CoV-associated pneumonia was higher in those living with HIV (30.4%) than without HIV (2.9%, P = 0.001). C-reactive protein and procalcitonin levels were elevated in 36.8% (≥40 mg/liter) and 64.7% (≥0.5 ng/ml), respectively, of the fatal cases living with HIV. Among children without HIV, there was a 64.0% (95% CI: 22.9% to 83.2%) lower incidence of CoV-associated pneumonia hospitalizations among PCV9 recipients compared to placebo recipients. These data suggest that Streptococcus pneumoniae infections might have a role in the development of pneumonia associated with endemic CoVs, that PCV may prevent pediatric CoV-associated hospitalization, and that children living with HIV with CoV infections develop more severe outcomes.
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Trevisan K, Cristina-Pereira R, Silva-Amaral D, Aversi-Ferreira TA. Theories of Aging and the Prevalence of Alzheimer's Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9171424. [PMID: 31317043 PMCID: PMC6601487 DOI: 10.1155/2019/9171424] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/22/2019] [Accepted: 05/14/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Aging and AD are associated in some way, then it is reasonable to ask whether or not it is possible to age without AD inexorably appearing at any moment, depending on the period of life. Therefore, the goal of this review is to verify, in light of some aging theories, the prevalence of AD. METHODS For the purpose of this manuscript, the indexers Alzheimer, aging, Alzheimer, and aging were considered; theories of aging were researched. The research was conducted using PubMed, Medline, Scopus, Elsevier, and Google Scholar. RESULTS The most common subjects in the papers analyzed for this manuscript were aging and Alzheimer's disease. The association between Alzheimer and theories of aging seems inconclusive. CONCLUSIONS Accordingly, the general idea is that AD is associated with aging in such a way that almost all people will present this disease; however, it is plausible to consider that the increase in life expectancy will generate a high prevalence of AD. In a general sense, it seems that the theories of aging explain the origin of AD under superlative and catastrophic considerations and use more biomolecular data than social or behavioral data as the bases of analysis, which may be the problem.
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Affiliation(s)
- Kaynara Trevisan
- Laboratory of Physical Anthropology and Biomathematics, Department of Anatomy, Institute of Biomedical Science, Federal University of Alfenas, Alfenas, Brazil
| | - Renata Cristina-Pereira
- Laboratory of Physical Anthropology and Biomathematics, Department of Anatomy, Institute of Biomedical Science, Federal University of Alfenas, Alfenas, Brazil
| | - Danyelle Silva-Amaral
- Laboratory of Physical Anthropology and Biomathematics, Department of Anatomy, Institute of Biomedical Science, Federal University of Alfenas, Alfenas, Brazil
| | - Tales Alexandre Aversi-Ferreira
- Laboratory of Physical Anthropology and Biomathematics, Department of Anatomy, Institute of Biomedical Science, Federal University of Alfenas, Alfenas, Brazil
- Department of Physiology, School of Medicine and Pharmaceutical Sciences, System Emotional Science, University of Toyama, Toyama, Japan
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Impact of PCV13 on community-acquired pneumonia by C-reactive protein and procalcitonin levels in children. Vaccine 2017; 35:5058-5064. [PMID: 28778617 DOI: 10.1016/j.vaccine.2017.06.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Many countries have observed an early and strong impact of implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (CAP). High levels of C-reactive protein (CRP) and procalcitonin (PCT) are considered biomarkers of bacterial infection (particularly infection due to pneumococcus); therefore, PCV13 implementation should have different effectiveness on CAP depending on the levels of these two biomarkers. To demonstrate this assumption, we analyzed the evolution of number of CAP cases seen in pediatric emergency departments in France after PCV13 implementation (in 2010) by levels of these two biomarkers. METHODS From June 2009 to May 2015, 8 pediatric emergency units prospectively enrolled all children (1month to 15years) with radiologically confirmed CAP. RESULTS A cohort of 9586 children with CAP was enrolled (median age 3years). CAP with pleural effusion (PE-CAP) and proven pneumococcal pneumonia (PP-CAP) accounted for 5.5% and 2.0% of cases. During the study period, the number of cases of overall CAP decreased by 25.4%, hospitalized CAP by 30.5%, PE-CAP by 63.4%, CAP with CRP level≥100mg/L by 50.9%, CAP with PCT level≥4ng/L by 60.4% and PP-CAP by 86.4%. We found no change in number of cases of CAP with low levels of CRP (<20 or <40mg/L) or PCT (<0.5ng/mL). The number of cases of CAP overall increased (20.0%) in the last year of the study as compared with the preceeding year but not cases with CRP level≥100mg/L and/or PCT level≥4ng/mL. CONCLUSION PCV13 implementation has had a strong impact on number of CAP cases with high levels of CRP and/or PCT in children but no impact on that with low levels of these two biomarkers. Five years after PCV13 implementation, a sustained reduction in CAP cases is observed.
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Salih KMA, El-Samani EF, Bilal JA, Eldouch W, Ibrahim SA. Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan. J Clin Diagn Res 2015; 9:SC04-7. [PMID: 26436013 DOI: 10.7860/jcdr/2015/13771.6377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. OBJECTIVES This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. MATERIALS AND METHODS A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. RESULTS Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). CONCLUSION AND RECOMMENDATION Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.
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Affiliation(s)
- Karimeldin Mohamed Ali Salih
- Associate Professor, Deparment of Pediatrics, Bahri University, College of Medicine, Sudan and King Khalid University, College of Medicine , Abha, KSA
| | - El-Fatih El-Samani
- Professor, Deparment of Community Medicine & Epidemiology Department, Ahfad University for Women , Khartoum, Sudan
| | - Jalal Ali Bilal
- Assistant Professor, Deparment of Pediatrics, Qassim University, College of Medicine , Buraydah, KSA
| | - Widad Eldouch
- Consultant Pediatrician, Deparment of Pediatrics, Ministry of Health , Sudan
| | - Salah Ahmed Ibrahim
- Professor, Deparment of Pediatrics, University of Khartoum, Faculty of Medicine , Sudan
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Lanaspa M, Annamalay AA, LeSouëf P, Bassat Q. Epidemiology, etiology, x-ray features, importance of co-infections and clinical features of viral pneumonia in developing countries. Expert Rev Anti Infect Ther 2014; 12:31-47. [PMID: 24410617 PMCID: PMC7103723 DOI: 10.1586/14787210.2014.866517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pneumonia is still the number one killer of young children globally, accounting for 18% of mortality in children under 5 years of age. An estimated 120 million new cases of pneumonia occur globally each year. In developing countries, management and prevention efforts against pneumonia have traditionally focused on bacterial pathogens. More recently however, viral pathogens have gained attention as a result of improved diagnostic methods, such as polymerase chain reaction, outbreaks of severe disease caused by emerging pathogens, discovery of new respiratory viruses as well as the decrease in bacterial pneumonia as a consequence of the introduction of highly effective conjugate vaccines. Although the epidemiology, etiology and clinical characterization of viral infections are being studied extensively in the developed world, little data are available from low- and middle-income countries. In this paper, we review the epidemiology, etiology, clinical and radiological features of viral pneumonia in developing countries.
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Affiliation(s)
- Miguel Lanaspa
- Barcelona Center for International Health Research, Hospital Clinic, University of Barcelona, Rosello 132, 08036 Barcelona, Spain
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Chiu SS, Ho PL, Khong PL, Ooi C, So LY, Wong WHS, Chan ELY. Population-based incidence of community-acquired pneumonia hospitalization in Hong Kong children younger than 5 years before universal conjugate pneumococcal immunization. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:225-9. [PMID: 25070281 DOI: 10.1016/j.jmii.2014.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/07/2014] [Accepted: 05/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to document the incidence of pediatric hospitalization for bacterial pneumonia before universal childhood conjugate pneumococcal vaccination using two different methods of diagnosis. METHODS By following the World Health Organization (WHO) chest radiography (CXR) protocol, two radiologists independently read the CXRs of a cohort of systematically recruited children younger than 5 years. The children had acute respiratory infections and were admitted to one of two hospitals that care for 72.5% of all pediatric admissions on Hong Kong Island. Medical records were reviewed for clinical manifestation and to identify bacterial pneumonia diagnosed by pediatricians. RESULTS In children younger than 5 years, the incidences of bacterial pneumonia, as diagnosed by pediatricians and by the WHO CXR standard, were 775.7 per 100,000 population [95% confidence interval (CI, 591.8-998.3)] and 439.5 per 100,000 population (95% CI, 304.6-614.5), respectively. The study period was from 2002 to 2004. CONCLUSION This study provided a reliable baseline estimate of the hospitalization burden of pneumococcal pneumonia in Hong Kong children before the advent of universal conjugate pneumococcal vaccination.
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Affiliation(s)
- Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China.
| | - Pak-Leung Ho
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong SAR, China
| | - Clara Ooi
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong SAR, China
| | - Lok Yee So
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - Wilfred H S Wong
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Eunice L Y Chan
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
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Early Impact of 13-Valent Pneumococcal Conjugate Vaccine on Community-Acquired Pneumonia in Children. Clin Infect Dis 2014; 58:918-24. [DOI: 10.1093/cid/ciu006] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Song JY, Eun BW, Nahm MH. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect Chemother 2013; 45:351-66. [PMID: 24475349 PMCID: PMC3902818 DOI: 10.3947/ic.2013.45.4.351] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/02/2023] Open
Abstract
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizing the upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularly antigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji General Hospital, Seoul, Korea
| | - Moon H Nahm
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ; Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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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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Cohen JF, Leis A, Lecarpentier T, Raymond J, Gendrel D, Chalumeau M. Procalcitonin predicts response to beta-lactam treatment in hospitalized children with community-acquired pneumonia. PLoS One 2012; 7:e36927. [PMID: 22615848 PMCID: PMC3355171 DOI: 10.1371/journal.pone.0036927] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/17/2012] [Indexed: 11/19/2022] Open
Abstract
Background Antibiotic treatment of community-acquired pneumonia (CAP) in children remains mostly empirical because clinical and paraclinical findings poorly discriminate the principal causes of CAP. Fast response to beta-lactam treatment can be considered a proxy of pneumococcal aetiology. We aimed to identify the best biological predictor of response to beta-lactam therapy in children hospitalized for CAP. Methods A retrospective, single-centre cohort study included all consecutive patients 1 month to 16 years old hospitalized in a teaching hospital in Paris, France, because of CAP empirically treated with a beta-lactam alone from 2003 to 2010. Uni- and multivariate analyses were used to study the ability of routine biological parameters available in the Emergency Department to predict a favourable response to beta-lactam (defined as apyrexia within 48 hours of treatment onset). Results Among the 125 included patients, 85% (106) showed a favourable response to beta-lactam. In multivariate logistic regression, we found procalcitonin (PCT) the only independent predictor of apyrexia (p = 0.008). The adjusted odds ratio for the decadic logarithm of PCT was 4.3 (95% CI 1.5–12.7). At ≥3 ng/mL, PCT had 55.7% sensitivity (45.7–65.3), 78.9% specificity (54.4–93.9), 93.7% positive predictive value (84.5–98.2), 24.2% negative predictive value (14.2–36.7), 2.64 positive likelihood ratio (1.09–6.42) and 0.56 negative likelihood ratio (0.41–0.77). In the 4 children with a PCT level ≥3 ng/mL and who showed no response to beta-lactam treatment, secondary pleural effusion had developed in 3, and viral co-infection was documented in 1. Conclusions PCT is the best independent biologic predictor of favourable response to beta-lactam therapy in children hospitalized for CAP. Thus, a high PCT level is highly suggestive of pneumococcal aetiology. However, a 3-ng/mL cut-off does not seem compatible with daily medical practice, and additional research is needed to further define the role of PCT in managing CAP in children.
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Affiliation(s)
- Jérémie F Cohen
- Department of Pediatrics, Saint-Vincent-de-Paul and Necker-Enfants-Malades Hospital, AP-HP, Université Paris-Descartes, Paris, France.
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Vaccination and acute phase mediator production in chickens challenged with low pathogenic avian influenza virus; novel markers for vaccine efficacy? Vaccine 2012; 30:3097-105. [DOI: 10.1016/j.vaccine.2012.02.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/07/2012] [Accepted: 02/20/2012] [Indexed: 12/11/2022]
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Abstract
OBJECTIVES Common-sense illness beliefs are important because they influence actions that people take to prevent and treat disease. This research (1) asked younger and older adults about their illness representations of Alzheimer's disease (AD) and (2) manipulated beliefs about AD preventability to determine causal relationships in the data. METHOD In Study 1, the beliefs of younger (age 18-38; n = 82) and older (age 58-89; n = 57) adults about the causes of and ways to prevent AD were compared. In Study 2, younger adults were randomly assigned to read information stating either that AD can be prevented or not. RESULTS Compared to younger adults, older adults saw themselves as less at risk, t(137) = 3.03, p = 0.003, d = 0.52, were more likely to believe that AD is preventable, t(137) = 5.01, p < 0.001, d = 0.87 and were more likely to report engaging in behaviors to prevent AD, χ(2)(1, 139) = 19.01, p < 0.001, r = 0.37. Manipulating beliefs in Study 2 caused those told that AD was preventable to see themselves as less at risk, report more prevention behaviors, and hold those with the disease more responsible for their fate. CONCLUSION These findings highlight the association of illness representations with reports of behavior and show a disconnect between beliefs and what we currently know about AD.
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Affiliation(s)
- Lindsay N Anderson
- Department of Psychology, University of Colorado at Colorado Springs, USA.
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Vernet G, Saha S, Satzke C, Burgess D, Alderson M, Maisonneuve JF, Beall B, Steinhoff M, Klugman K. Laboratory-based diagnosis of pneumococcal pneumonia: state of the art and unmet needs. Clin Microbiol Infect 2011; 17 Suppl 3:1-13. [DOI: 10.1111/j.1469-0691.2011.03496.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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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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Pneumonies à pneumocoque hautement probables chez les enfants vaccinés gardés en collectivité. Arch Pediatr 2010; 17:373-7. [DOI: 10.1016/j.arcped.2009.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 11/20/2009] [Indexed: 11/17/2022]
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O'Grady KF, Carlin JB, Chang AB, Torzillo PJ, Nolan TM, Ruben A, Andrews RM. Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in indigenous infants in Australia. Bull World Health Organ 2010; 88:139-46. [PMID: 20428371 PMCID: PMC2814482 DOI: 10.2471/blt.09.068239] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 08/03/2009] [Accepted: 08/10/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) in preventing pneumonia, diagnosed radiologically according to World Health Organization (WHO) criteria, among indigenous infants in the Northern Territory of Australia. METHODS We conducted a historical cohort study of consecutive indigenous birth cohorts between 1 April 1998 and 28 February 2005. Children were followed up to 18 months of age. The PCV7 programme commenced on 1 June 2001. All chest X-rays taken within 3 days of any hospitalization were assessed. The primary endpoint was a first episode of WHO-defined pneumonia requiring hospitalization. Cox proportional hazards models were used to compare disease incidence. FINDINGS There were 526 pneumonia events among 10,600 children - an incidence of 3.3 per 1000 child-months; 183 episodes (34.8%) occurred before 5 months of age and 247 (47.0%) by 7 months. Of the children studied, 27% had received 3 doses of vaccine by 7 months of age. Hazard ratios for endpoint pneumonia were 1.01 for 1 versus 0 doses; 1.03 for 2 versus 0 doses; and 0.84 for 3 versus 0 doses. CONCLUSION There was limited evidence that PCV7 reduced the incidence of radiologically confirmed pneumonia among Northern Territory indigenous infants, although there was a non-significant trend towards an effect after receipt of the third dose. These findings might be explained by lack of timely vaccination and/or occurrence of disease at an early age. Additionally, the relative contribution of vaccine-type pneumococcus to severe pneumonia in a setting where multiple other pathogens are prevalent may differ with respect to other settings where vaccine efficacy has been clearly established.
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Affiliation(s)
- K F O'Grady
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, 0811, Australia.
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Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RAN, Nohynek H, Riley ID, Makela H. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev 2009; 2009:CD004977. [PMID: 19821336 PMCID: PMC6464899 DOI: 10.1002/14651858.cd004977.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pneumonia, caused by Streptococcus pneumoniae, is a major cause of morbidity and mortality among children in low-income countries. The effectiveness of pneumococcal conjugate vaccines (PCVs) against invasive pneumococcal disease (IPD), pneumonia, and mortality needs to be evaluated. OBJECTIVES To update the 2004 review on the efficacy of PCVs in preventing vaccine-serotypes IPD (VT-IPD) , X-ray defined pneumonia among HIV-1 negative children, and other new outcomes. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1990 to Week 4 February 2009); and EMBASE (1974 to March 2009). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing PCV with placebo, or another vaccine, in children under two with IPD and clinical / radiographic pneumonia as outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies, extracted data, and evaluated their corresponding risks of bias. Differences were resolved by discussion. Meta-analysis used the inverse variance method. MAIN RESULTS We identified 11 publications from six RCTs conducted in Africa, US, Philippines and Finland where 57,015 children received PCV; while 56,029 received placebo or another vaccine. Seven publications provided high quality evidence on PCV efficacy against IPD and four provided moderate quality evidence against pneumonia. None of the five trials with all-cause mortality data were powered to investigate this outcome. Only two trials have data on all-cause admissions.The main analysis for this review involved HIV-1 negative children and used the pooled results of random-effects model, intent-to-treat analysis (ITT).Pooled vaccine efficacy (VE) for VT-IPD was 80% (95% confidence interval (CI) 58% to 90%, P < 0.0001); all serotypes-IPD, 58% (95% CI 29% to 75%, P = 0.001); World Health Organization X-ray defined pneumonia was 27% (95% CI 15% to 36%, P < 0.0001); clinical pneumonia, 6% (95% CI 2% to 9%, P = 0.0006); and all-cause mortality, 11% (95% CI -1% to 21%, P = 0.08). Analysis involving HIV-1 positive children had similar findings. AUTHORS' CONCLUSIONS PCV is effective in preventing IPD, X-ray defined pneumonia, and clinical pneumonia among HIV-1 negative and HIV-1 positive children under two years. The impact was greater for VT-IPD than for all serotypes-IPD, and for X-ray defined pneumonia than for clinical pneumonia. An 11% reduction with a 95% CI of -1% to 21% and a P = 0.08 is compatible with reduction in all-cause mortality.
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Affiliation(s)
- Marilla G Lucero
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Vernoni E Dulalia
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Leilani T Nillos
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Gail Williams
- School of Population Health, Queensland UniversityAustralian Centre for International and Tropical Health and NutritionHerston RoadHerstonQueenslandAustralia4006
| | - Rhea Angela N Parreño
- Research Institute for Tropical MedicineDepartment of Epidemiology and BiostatisticsAlabangMuntinlupa CityPhilippines1781
| | - Hanna Nohynek
- National Institute for Health and WelfareDepartment of Vaccines, Unit of Clinical TrialsMannerheimintie 166HelsinkiFinland00300
| | - Ian D Riley
- School of Population Health, Queensland UniversityAustralian Centre for International and Tropical Health and NutritionHerston RoadHerstonQueenslandAustralia4006
| | - Helena Makela
- National Institute for Health and WelfareDepartment of Vaccines, Unit of Clinical TrialsMannerheimintie 166HelsinkiFinland00300
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Carrol ED, Mankhambo LA, Jeffers G, Parker D, Guiver M, Newland P, Banda DL, Molyneux EM, Heyderman RS, Molyneux ME, Hart CA. The diagnostic and prognostic accuracy of five markers of serious bacterial infection in Malawian children with signs of severe infection. PLoS One 2009; 4:e6621. [PMID: 19675669 PMCID: PMC2721152 DOI: 10.1371/journal.pone.0006621] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 07/05/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early recognition and prompt and appropriate antibiotic treatment can significantly reduce mortality from serious bacterial infections (SBI). The aim of this study was to evaluate the utility of five markers of infection: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), CD163 and high mobility group box-1 (HMGB1), as markers of SBI in severely ill Malawian children. METHODOLOGY AND PRINCIPAL FINDINGS Children presenting with a signs of meningitis (n = 282) or pneumonia (n = 95), were prospectively recruited. Plasma samples were taken on admission for CRP, PCT, sTREM-1 CD163 and HMGB1 and the performance characteristics of each test to diagnose SBI and to predict mortality were determined. Of 377 children, 279 (74%) had SBI and 83 (22%) died. Plasma CRP, PCT, CD163 and HMGB1 and were higher in HIV-infected children than in HIV-uninfected children (p<0.01). In HIV-infected children, CRP and PCT were higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and PCT and CD163 were higher in non-survivors (p = 0.001, p = 0.05 respectively). In HIV-uninfected children, CRP and PCT were also higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and CD163 was higher in non-survivors (p = 0.05). The best predictors of SBI were CRP and PCT, and areas under the curve (AUCs) were 0.81 (95% CI 0.73-0.89) and 0.86 (95% CI 0.79-0.92) respectively. The best marker for predicting death was PCT, AUC 0.61 (95% CI 0.50-0.71). CONCLUSIONS Admission PCT and CRP are useful markers of invasive bacterial infection in severely ill African children. The study of these markers using rapid tests in a less selected cohort would be important in this setting.
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Affiliation(s)
- Enitan D Carrol
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
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Klugman KP, Madhi SA, Albrich WC. Novel approaches to the identification of Streptococcus pneumoniae as the cause of community-acquired pneumonia. Clin Infect Dis 2008; 47 Suppl 3:S202-6. [PMID: 18986290 DOI: 10.1086/591405] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Current diagnostic tests lack sensitivity for the identification of the bacterial etiology of pneumonia. Attempts during the past 2 decades to improve sensitivity of detection of bacterial constituents in blood by use of antibody-antigen complexes and polymerase chain reaction have been disappointing. Recent data using pneumococcal conjugate vaccines as probes suggest that increased levels of both C-reactive protein and procalcitonin may be useful adjuncts to chest radiographs in the selection of patients with presumed bacterial pneumonia for inclusion in clinical trials. Among pneumococcal diagnostics currently under investigation, quantitative real-time polymerase chain reaction of respiratory secretions, as well as urinary antigen detection and pneumococcal surface adhesin A serological analysis for adults, are candidates for use in future clinical trials of antibiotics.
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Affiliation(s)
- Keith P Klugman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Dinleyici EC, Yargic ZA. Pneumococcal conjugated vaccines: impact of PCV-7 and new achievements in the postvaccine era. Expert Rev Vaccines 2008; 7:1367-1394. [DOI: 10.1586/14760584.7.9.1367] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Cheung YB, Zaman SMA, Ruopuro ML, Enwere G, Adegbola RA, Greenwood B, Cutts FT. C-reactive protein and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children. Trop Med Int Health 2008; 13:603-11. [DOI: 10.1111/j.1365-3156.2008.02050.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Madhi SA, Klugman KP. World Health Organisation definition of "radiologically-confirmed pneumonia" may under-estimate the true public health value of conjugate pneumococcal vaccines. Vaccine 2006; 25:2413-9. [PMID: 17005301 DOI: 10.1016/j.vaccine.2006.09.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The public health benefit of conjugate pneumococcal vaccine (PCV) in preventing pneumonia would only be appreciated if the tool used for measuring "pneumococcal pneumonia" had good sensitivity. Exploratory studies in South Africa indicate that the sensitivity of "radiologically-confirmed pneumonia" (CXR-AC) underestimates the burden of pneumococcal pneumonia prevented by PCV by as much as 63%. The use of alternate markers such as C-reactive protein enhance the ability of measuring the burden of pneumonia preventable by PCV. A broadened definition of "pneumococcal pneumonia" which includes episodes of pneumonia associated with CXR-AC and those associated with an abnormal chest radiograph other than CXR-AC associated with a CRP of > or =40mg/l should be considered an a priori outcome in future PCV efficacy trials.
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Affiliation(s)
- Shabir A Madhi
- University of the Witwatersrand/Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, South Africa.
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Obaro SK, Madhi SA. Bacterial pneumonia vaccines and childhood pneumonia: are we winning, refining, or redefining? THE LANCET. INFECTIOUS DISEASES 2006; 6:150-61. [PMID: 16500596 PMCID: PMC7106399 DOI: 10.1016/s1473-3099(06)70411-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bacterial pneumonia is a substantial cause of childhood morbidity and mortality worldwide, but determination of pathogen-specific burden remains a challenge. In less developed settings, the WHO recommended guidelines are useful for initiating care, but are non-specific. Blood culture has low sensitivity, while radiological findings are non-specific and do not discriminate between viral and bacterial causes of pneumonia. In vaccine probe studies, efficacy is dependent on the specificity of the study outcome to detect pneumonia and the impact of the vaccine on the selected outcome, and may underestimate the true burden of bacterial pneumonia. The rising incidence of antibiotic resistance, emerging respiratory pathogens, potential replacement pneumococcal disease following widespread introduction of pneumococcal polysaccharide-protein conjugate vaccine, the limited specificity of chest radiography, and the poor sensitivity of blood culture are substantial obstacles to accurate surveillance. We provide an overview of the diagnostic challenges of bacterial pneumonia and highlight the need for refining the current diagnostic approach to ensure adequate epidemiological surveillance of childhood pneumonia and the success, or otherwise, of any immunisation strategies.
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Affiliation(s)
- Stephen K Obaro
- Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA.
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Madhi SA, Kohler M, Kuwanda L, Cutland C, Klugman KP. Usefulness of C-reactive protein to define pneumococcal conjugate vaccine efficacy in the prevention of pneumonia. Pediatr Infect Dis J 2006; 25:30-6. [PMID: 16395099 DOI: 10.1097/01.inf.0000195787.99199.4a] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES AND METHODS This study explored whether C-reactive protein (CRP) and/or procalcitonin levels were useful to measure vaccine efficacy (VE) and impact against the burden of pneumonia of a 9-valent pneumococcal conjugate vaccine (PCV), compared with chest radiograph-confirmed alveolar consolidation (CXR-AC) as an outcome. Sera obtained from children participating in a phase 3 PCV efficacy trial who were hospitalized for treatment of clinically diagnosed lower respiratory tract infection (C-LRTI) were retrospectively analyzed for CRP and procalcitonin measurements. RESULTS For non-human immunodeficiency virus (HIV)-infected children, the VE estimates for C-LRTI with CRP levels of > or =40 mg/dL (VE 26.3%; P = 0.003) or CRP levels of > or =120 mg/dL (VE 41.0%; P = 0.003) were 1.7-fold (P = 0.002) and 2.7-fold (P < 0.0001) greater, respectively, than that for CXR-AC (VE 15.1%; P= 0.15). The sensitivity of CXR-AC as an outcome to detect the burden of pneumonia prevented by PCV was 44% (95% confidence interval, 36-55%) in comparison with C-LRTI with CRP levels of > or =40 mg/dL and 73% (95% confidence interval, 58-92%) in comparison with C-LRTI with CRP levels of > or =120 mg/dL. CRP also helped to measure the PCV efficacy for children with C-LRTI but the absence of CXR-AC, for whom the outcome of C-LRTI with CRP levels of > or =40 mg/dL (VE 31.5%; P = 0.007) increased the VE estimate 19.8-fold (P < 0.0001) in comparison with C-LRTI alone (VE 1.6%; P = 0.78) and 3.2-fold (P = 0.005) in comparison with WHO-defined severe pneumonia (VE 10.0%; P = 0.17). Although there was a significant correlation between CRP and procalcitonin levels (Spearman's rho = 0.45; P < 0.0001), the use of procalcitonin levels did not improve either the specificity or sensitivity of measuring the effect of PCV against pneumonia for non-HIV-infected children. The observations were similar for HIV-infected children. CONCLUSIONS CRP levels of > or =40 mg/dL provide a better measure than chest radiographs to assess the effect of PCV in preventing pneumonia.
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Affiliation(s)
- Shabir A Madhi
- University of the Witwatersrand/Medical Research Council/National Institute of Communicable Diseases-Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.
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