1
|
Nyamwaya DK, Otiende M, Mwango L, Kariuki SM, Otieno B, Omuoyo DO, Githinji G, Kitsao BS, Karanja HK, Gitonga JN, de Laurent ZR, Davies A, Mwarumba S, Agoti CN, Thumbi SM, Hamaluba MM, Newton CR, Bejon P, Warimwe GM. Incidence of chikungunya virus infections among Kenyan children with neurological disease, 2014-2018: A cohort study. PLoS Med 2022; 19:e1003994. [PMID: 35550620 PMCID: PMC9135332 DOI: 10.1371/journal.pmed.1003994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurological complications due to chikungunya virus (CHIKV) infection have been described in different parts of the world, with children being disproportionately affected. However, the burden of CHIKV-associated neurological disease in Africa is currently unknown and given the lack of diagnostic facilities in routine care it is possible that CHIKV is an unrecognized etiology among children with encephalitis or other neurological illness. METHODS AND FINDINGS We estimated the incidence of CHIKV infection among children hospitalized with neurological disease in Kilifi County, coastal Kenya. We used reverse transcriptase polymerase chain reaction (RT-PCR) to systematically test for CHIKV in cerebrospinal fluid (CSF) samples from children aged <16 years hospitalized with symptoms of neurological disease at Kilifi County Hospital between January 2014 and December 2018. Clinical records were linked to the Kilifi Health and Demographic Surveillance System and population incidence rates of CHIKV infection estimated. There were 18,341 pediatric admissions for any reason during the 5-year study period, of which 4,332 (24%) had CSF collected. The most common clinical reasons for CSF collection were impaired consciousness, seizures, and coma (47%, 22%, and 21% of all collections, respectively). After acute investigations done for immediate clinical care, CSF samples were available for 3,980 admissions, of which 367 (9.2%) were CHIKV RT-PCR positive. Case fatality among CHIKV-positive children was 1.4% (95% CI 0.4, 3.2). The annual incidence of CHIKV-associated neurological disease varied between 13 to 58 episodes per 100,000 person-years among all children <16 years old. Among children aged <5 years, the incidence of CHIKV-associated neurological disease was 77 per 100,000 person-years, compared with 20 per 100,000 for cerebral malaria and 7 per 100,000 for bacterial meningitis during the study period. Because of incomplete case ascertainment due to children not presenting to hospital, or not having CSF collected, these are likely minimum estimates. Study limitations include reliance on hospital-based surveillance and limited CSF sampling in children in coma or other contraindications to lumbar puncture, both of which lead to under-ascertainment of incidence and of case fatality. CONCLUSIONS In this study, we observed that CHIKV infections are relatively more common than cerebral malaria and bacterial meningitis among children hospitalized with neurological disease in coastal Kenya. Given the wide distribution of CHIKV mosquito vectors, studies to determine the geographic extent of CHIKV-associated neurological disease in Africa are essential.
Collapse
Affiliation(s)
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lilian Mwango
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | - Alun Davies
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Samuel M. Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Washington, United States of America
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
- Center for Epidemiological Modelling and Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | | | | | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - George M. Warimwe
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
2
|
Barsosio HC, Gitonga JN, Karanja HK, Nyamwaya DK, Omuoyo DO, Kamau E, Hamaluba MM, Nyiro JU, Kitsao BS, Nyaguara A, Mwakio S, Newton CR, Sang R, Wright D, Sanders EJ, Seale AC, Agoti CN, Berkley JA, Bejon P, Warimwe GM. Congenital microcephaly unrelated to flavivirus exposure in coastal Kenya. Wellcome Open Res 2020; 4:179. [PMID: 32175480 PMCID: PMC7059837 DOI: 10.12688/wellcomeopenres.15568.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Zika virus (ZIKV) was first discovered in East Africa in 1947. ZIKV has caused microcephaly in the Americas, but it is not known whether ZIKV is a cause of microcephaly in East Africa. Methods: We used surveillance data from 11,061 live births at Kilifi County Hospital in coastal Kenya between January 2012 and October 2016 to identify microcephaly cases and conducted a nested case-control study to determine risk factors for microcephaly. Gestational age at birth was estimated based on antenatal ultrasound scanning ('Scanned cohort') or last menstrual period ('LMP cohort', including births ≥37 weeks' gestation only). Controls were newborns with head circumference Z scores between >-2 and ≤2 SD that were compared to microcephaly cases in relation to ZIKV exposure and other maternal and newborn factors. Results: Of the 11,061 newborns, 214 (1.9%, 95%CI 1.69, 2.21) had microcephaly. Microcephaly prevalence was 1.0% (95%CI 0.64, 1.70, n=1529) and 2.1% (95%CI 1.81, 2.38, n=9532) in the scanned and LMP cohorts, respectively. After excluding babies <2500 g (n=1199) in the LMP cohort the prevalence was 1.1% (95%CI 0.93, 1.39). Microcephaly showed an association with being born small for gestational age (p<0.001) but not with ZIKV neutralising antibodies (p=0.6) or anti-ZIKV NS1 IgM response (p=0.9). No samples had a ZIKV neutralising antibody titre that was at least fourfold higher than the corresponding dengue virus (DENV) titre. No ZIKV or other flavivirus RNA was detected in cord blood from cases or controls. Conclusions: Microcephaly was prevalent in coastal Kenya, but does not appear to be related to ZIKV exposure; the ZIKV response observed in our study population was largely due to cross-reactive responses to DENV or other related flaviviruses. Further research into potential causes and the clinical consequences of microcephaly in this population is urgently needed.
Collapse
Affiliation(s)
- Hellen C Barsosio
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | - Everlyn Kamau
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Joyce U Nyiro
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Stella Mwakio
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Daniel Wright
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Anna C Seale
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Aiken AM, Mturi N, Njuguna P, Mohammed S, Berkley JA, Mwangi I, Mwarumba S, Kitsao BS, Lowe BS, Morpeth SC, Hall AJ, Khandawalla I, Scott JAG. Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study. Lancet 2011; 378:2021-2027. [PMID: 22133536 PMCID: PMC3242162 DOI: 10.1016/s0140-6736(11)61622-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In sub-Saharan Africa, community-acquired bacteraemia is an important cause of illness and death in children. Our aim was to establish the magnitude and causes of hospital-acquired (nosocomial) bacteraemia in African children. METHODS We reviewed prospectively collected surveillance data of 33,188 admissions to Kilifi District Hospital, Kenya, between April 16, 2002, and Sept 30, 2009. We defined bacteraemia as nosocomial if it occurred 48 h or more after admission. We estimated the per-admission risk, daily rate, effect on mortality, and microbial cause of nosocomial bacteraemia and analysed risk factors by multivariable Cox regression. The effect on morbidity was measured as the increase in hospital stay by comparison with time-matched patients without bacteraemia. FINDINGS The overall risk of nosocomial bacteraemia during this period was 5·9/1000 admissions (95% CI 5·2-6·9) but we recorded an underlying rise in risk of 27% per year. The incidence was 1·0/1000 days in hospital (0·87-1·14), which is about 40 times higher than that of community-acquired bacteraemia in the same region. Mortality in patients with nosocomial bacteraemia was 53%, compared with 24% in community-acquired bacteraemia and 6% in patients without bacteraemia. In survivors, nosocomial bacteraemia lengthened hospital stay by 10·1 days (3·0-17·2). Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter spp, group D streptococci, and Pseudomonas aeruginosa accounted for three-quarters of nosocomial infections. Nosocomial bacteraemia was significantly associated with severe malnutrition (hazard ratio 2·52, 95% CI 1·79-3·57) and blood transfusion in children without severe anaemia (4·99; 3·39-7·37). INTERPRETATION Our findings show that although nosocomial bacteraemia is rare, it has serious effects on morbidity and mortality, and the microbiological causes are distinct from those of community-acquired bacteraemia. Nosocomial infections are largely unrecognised or undocumented as a health risk in low-income countries, but they are likely to become public health priorities as awareness of their occurrence increases and as other prominent childhood diseases are progressively controlled. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Alexander M Aiken
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene and Tropical Medicine, London, UK.
| | - Neema Mturi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Ministry of Medical Services, Kilifi District Hospital, Kilifi, Kenya
| | - Patricia Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Ministry of Medical Services, Kilifi District Hospital, Kilifi, Kenya
| | - Shebe Mohammed
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Ministry of Medical Services, Kilifi District Hospital, Kilifi, Kenya
| | - James A Berkley
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Isaiah Mwangi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwarumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Barnes S Kitsao
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Brett S Lowe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Susan C Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Andrew J Hall
- London School of Hygiene and Tropical Medicine, London, UK
| | - Iqbal Khandawalla
- Ministry of Medical Services, Kilifi District Hospital, Kilifi, Kenya
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, UK
| |
Collapse
|