Ronan Kelly
Retired 2020
Burden of Severe Pneumonia, Pneumococcal
Pneumonia and Pneumonia Deaths in Indian
States: Modelling Based Estimates
Habib Farooqui1
*, Mark Jit2,3, David L. Heymann2
, Sanjay Zodpey1
1 Public Health Foundation of India, New Delhi, India, 2 London School of Hygiene and Tropical Medicine,
London, United Kingdom, 3 Modelling and Economics Unit, Public Health England
* drhabibhasan@gmail.com
Abstract
The burden of severe pneumonia in terms of morbidity and mortality is unknown in India
especially at sub-national level. In this context, we aimed to estimate the number of severe
pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children
younger than 5 years in 2010. We adapted and parameterized a mathematical model
based on the epidemiological concept of potential impact fraction developed CHERG for
this analysis. The key parameters that determine the distribution of severe pneumonia episode
across Indian states were state-specific under-5 population, state-specific prevalence
of selected definite pneumonia risk factors and meta-estimates of relative risks for each of
these risk factors. We applied the incidence estimates and attributable fraction of risk factors
to population estimates for 2010 of each Indian state. We then estimated the number of
pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing
trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by
combining incidence estimates with case fatality ratios from multi-centric hospital-based
studies. Our results suggest that in 2010, 3.6 million (3.3?3.9 million) episodes of severe
pneumonia and 0.35 million (0.31?0.40 million) all cause pneumonia deaths occurred in
children younger than 5 years in India. The states that merit special mention include Uttar
Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26%
pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh
(6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11%
deaths). Further, we estimated that 0.56 million (0.49?0.64 million) severe episodes of
pneumococcal pneumonia and 105 thousand (92?119 thousand) pneumococcal deaths
occurred in India. The top contributors to India?s pneumococcal pneumonia burden were
Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the
need to improve access to care and increase coverage and equity of pneumonia preventing
vaccines in states with high pneumonia burden.
...
http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0129191.PDF
Pneumonia and Pneumonia Deaths in Indian
States: Modelling Based Estimates
Habib Farooqui1
*, Mark Jit2,3, David L. Heymann2
, Sanjay Zodpey1
1 Public Health Foundation of India, New Delhi, India, 2 London School of Hygiene and Tropical Medicine,
London, United Kingdom, 3 Modelling and Economics Unit, Public Health England
* drhabibhasan@gmail.com
Abstract
The burden of severe pneumonia in terms of morbidity and mortality is unknown in India
especially at sub-national level. In this context, we aimed to estimate the number of severe
pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children
younger than 5 years in 2010. We adapted and parameterized a mathematical model
based on the epidemiological concept of potential impact fraction developed CHERG for
this analysis. The key parameters that determine the distribution of severe pneumonia episode
across Indian states were state-specific under-5 population, state-specific prevalence
of selected definite pneumonia risk factors and meta-estimates of relative risks for each of
these risk factors. We applied the incidence estimates and attributable fraction of risk factors
to population estimates for 2010 of each Indian state. We then estimated the number of
pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing
trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by
combining incidence estimates with case fatality ratios from multi-centric hospital-based
studies. Our results suggest that in 2010, 3.6 million (3.3?3.9 million) episodes of severe
pneumonia and 0.35 million (0.31?0.40 million) all cause pneumonia deaths occurred in
children younger than 5 years in India. The states that merit special mention include Uttar
Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26%
pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh
(6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11%
deaths). Further, we estimated that 0.56 million (0.49?0.64 million) severe episodes of
pneumococcal pneumonia and 105 thousand (92?119 thousand) pneumococcal deaths
occurred in India. The top contributors to India?s pneumococcal pneumonia burden were
Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the
need to improve access to care and increase coverage and equity of pneumonia preventing
vaccines in states with high pneumonia burden.
...
http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0129191.PDF