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Pediatr Infect Dis J. 2012 Aug 20. [Epub ahead of print]
Viral and Bacterial Causes of Severe Acute Respiratory Illness among Children Less Than 5 Years Old in a High Malaria Prevalence Area of Western Kenya, 2007-2010.
Feikin DR, Njenga MK, Bigogo G, Aura B, Aol G, Audi A, Jagero G, Muluare PO, Gikunju S, Nderitu L, Winchell JM, Schneider E, Erdman DD, Oberste MS, Katz MA, Breiman RF.
Source
1International Emerging Infections Program, Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention-Kenya 2Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya 3National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
BACKGROUND:
Few comprehensive data exist on the etiology of severe acute respiratory illness (SARI) among African children.
METHODS:
From March 1, 2007, to February 28, 2010, we collected blood for culture and nasopharyngeal and oropharyngeal swabs for real-time quantitative PCR for ten viruses and three atypical bacteria among children <5 years old with SARI, defined as WHO-classified severe or very severe pneumonia or oxygen saturation <90%, who visited a clinic in rural western Kenya. We collected swabs from controls without febrile or respiratory symptoms. We calculated odds ratios (OR) for infection among cases, adjusting for age and season in logistic regression. We calculated SARI incidence, adjusting for healthcare-seeking for SARI in the community.
RESULTS:
2,973 SARI cases were identified (54% inpatient, 46% outpatient), yielding an adjusted incidence of 56 cases per 100 person-years. A pathogen was detected in 3.3% of non-contaminated blood cultures; non-typhi Salmonella (1.9%) and Streptococcus pneumoniae (0.7%) predominated. A pathogen was detected in 84% of nasopharyngeal/oropharyngeal specimens, the most common being rhino/enterovirus (50%), respiratory syncytial virus (RSV, 22%), adenovirus (16%) and influenza viruses (8%). Only RSV and influenza viruses were found more commonly among cases than controls (OR 2.9, 95% CI 1.3-6.7 and OR 4.8, 95% CI 1.1-21, respectively). Incidence of RSV, influenza viruses and S. pneumoniae were 7.1, 5.8 and 0.04 cases per 100 person-years, respectively.
CONCLUSIONS:
Among Kenyan children with SARI, RSV and influenza virus are the most likely viral causes and pneumococcus the most likely bacterial cause. Contemporaneous controls are important for interpreting upper respiratory tract specimens.
PMID:
22914561
[PubMed - as supplied by publisher]
Viral and Bacterial Causes of Severe Acute Respiratory Illness among Children Less Than 5 Years Old in a High Malaria Prevalence Area of Western Kenya, 2007-2010.
Feikin DR, Njenga MK, Bigogo G, Aura B, Aol G, Audi A, Jagero G, Muluare PO, Gikunju S, Nderitu L, Winchell JM, Schneider E, Erdman DD, Oberste MS, Katz MA, Breiman RF.
Source
1International Emerging Infections Program, Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention-Kenya 2Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya 3National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
BACKGROUND:
Few comprehensive data exist on the etiology of severe acute respiratory illness (SARI) among African children.
METHODS:
From March 1, 2007, to February 28, 2010, we collected blood for culture and nasopharyngeal and oropharyngeal swabs for real-time quantitative PCR for ten viruses and three atypical bacteria among children <5 years old with SARI, defined as WHO-classified severe or very severe pneumonia or oxygen saturation <90%, who visited a clinic in rural western Kenya. We collected swabs from controls without febrile or respiratory symptoms. We calculated odds ratios (OR) for infection among cases, adjusting for age and season in logistic regression. We calculated SARI incidence, adjusting for healthcare-seeking for SARI in the community.
RESULTS:
2,973 SARI cases were identified (54% inpatient, 46% outpatient), yielding an adjusted incidence of 56 cases per 100 person-years. A pathogen was detected in 3.3% of non-contaminated blood cultures; non-typhi Salmonella (1.9%) and Streptococcus pneumoniae (0.7%) predominated. A pathogen was detected in 84% of nasopharyngeal/oropharyngeal specimens, the most common being rhino/enterovirus (50%), respiratory syncytial virus (RSV, 22%), adenovirus (16%) and influenza viruses (8%). Only RSV and influenza viruses were found more commonly among cases than controls (OR 2.9, 95% CI 1.3-6.7 and OR 4.8, 95% CI 1.1-21, respectively). Incidence of RSV, influenza viruses and S. pneumoniae were 7.1, 5.8 and 0.04 cases per 100 person-years, respectively.
CONCLUSIONS:
Among Kenyan children with SARI, RSV and influenza virus are the most likely viral causes and pneumococcus the most likely bacterial cause. Contemporaneous controls are important for interpreting upper respiratory tract specimens.
PMID:
22914561
[PubMed - as supplied by publisher]
