The Etiology of Childhood Pneumonia in The Gambia: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.

Autor:	Howie SRC; From the Medical Research Council Unit, Basse, The Gambia.; Department of Paediatrics, University of Auckland, New Zealand., Ebruke BE; From the Medical Research Council Unit, Basse, The Gambia., McLellan JL; From the Medical Research Council Unit, Basse, The Gambia.; The University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada., Deloria Knoll M; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Dione MM; From the Medical Research Council Unit, Basse, The Gambia.; International Livestock Research Institute, Kampala, Uganda., Feikin DR; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Haddix M; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Hammitt LL; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Machuka EM; From the Medical Research Council Unit, Basse, The Gambia., Murdoch DR; Department of Pathology, University of Otago, Christchurch, New Zealand.; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand., O'Brien KL; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Ofordile O; From the Medical Research Council Unit, Basse, The Gambia., Olutunde OE; From the Medical Research Council Unit, Basse, The Gambia., Parker D; From the Medical Research Council Unit, Basse, The Gambia.; AstraZeneca, Cambridge, United Kingdom., Prosperi C; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Salaudeen RA; From the Medical Research Council Unit, Basse, The Gambia.; Medical Microbiology Department, Lagos University Teaching Hospital, Lagos, Nigeria., Shamsul A; From the Medical Research Council Unit, Basse, The Gambia., Mackenzie G; From the Medical Research Council Unit, Basse, The Gambia.; Murdoch Children's Research Institute, Melbourne, Australia.; London School of Hygiene & Tropical Medicine., Antonio M; From the Medical Research Council Unit, Basse, The Gambia.; Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine.; Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom., Zaman SMA; From the Medical Research Council Unit, Basse, The Gambia.; London School of Hygiene & Tropical Medicine.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2021 Sep 01; Vol. 40 (9S), pp. S7-S17.
DOI:	10.1097/INF.0000000000002766
Abstrakt:	Background: Pneumonia remains the leading cause of death in young children globally. The changing epidemiology of pneumonia requires up-to-date data to guide both case management and prevention programs. The Gambia study site contributed a high child mortality, high pneumonia incidence, low HIV prevalence, Haemophilus influenzae type b and pneumococcal conjugate vaccines-vaccinated rural West African setting to the Pneumonia Etiology Research for Child Health (PERCH) Study. Methods: The PERCH study was a 7-country case-control study of the etiology of hospitalized severe pneumonia in children 1-59 months of age in low and middle-income countries. Culture and nucleic acid detection methods were used to test nasopharyngeal/oropharyngeal swabs, blood, induced sputum and, in selected cases, lung or pleural fluid aspirates. Etiology was determined by integrating case and control data from multiple specimens using the PERCH integrated analysis based on Bayesian probabilistic methods. Results: At The Gambia study site, 638 cases of World Health Organization-defined severe and very severe pneumonia (286 of which were chest radiograph [CXR]-positive and HIV-negative) and 654 age-frequency matched controls were enrolled. Viral causes predominated overall (viral 58% vs. bacterial 28%), and of CXR-positive cases respiratory syncytial virus (RSV) accounted for 37%, Streptococcus pneumoniae 13% and parainfluenza was responsible for 9%. Nevertheless, among very severe cases bacterial causes dominated (77% bacterial vs. 11% viral), led by S. pneumoniae (41%); Mycobacterium tuberculosis, not included in "bacterial", accounted for 9%. 93% and 80% of controls ≥1 year of age were, respectively, fully vaccinated for age against Haemophilus influenzae and S. pneumoniae. Conclusions: Viral causes, notably RSV, predominated in The Gambia overall, but bacterial causes dominated the severest cases. Efforts must continue to prevent disease by optimizing access to existing vaccines, and to develop new vaccines, notably against RSV. A continued emphasis on appropriate case management of severe pneumonia remains important. Competing Interests: M.D.K. has received funding for consultancies from Merck, Pfizer, Novartis, and grant funding from Merck. M.H. has received grant funding from Pfizer and from Merck. L.L.H. has received grant funding from GlaxoSmithKline, Pfizer and Merck. K.L.O. has received grant funding from GlaxoSmithKline and Pfizer and participates on technical advisory boards for Merck, Sanofi-Pasteur, PATH, Affinivax and ClearPath. C.P. has received grant funding from Merck. S.R.C.H. has a patent Lipocalin-2 as a Biomarker for Pneumococcal Infection Status pending. The other authors have no conflicts of interest to disclose. The funding mentioned here for these authors was unrelated to this study. (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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