Search

Globally, the most common infectious cause of death among children 1-59 months of age is lower respiratory tract infection (1). Despite vaccine availability, Streptococcus pneumoniae causes a substantial proportion of [...]

Background: Data available for RSV and influenza infections among children < 2 years in Mongolia are limited. We present data from four districts of Ulaanbaatar from April 2015 to June 2021. Methods: This study was nested in an enhanced surveillance project evaluating pneumococcal conjugate vaccine (PCV13) impact on the incidence of hospitalized lower respiratory tract infections (LRTIs). Our study was restricted to children aged < 2 years with arterial O2 saturation < 93% and children with radiological pneumonia. Nasopharyngeal (NP) swabs collected at admission were tested for RSV and influenza using qRT‐PCR. NP swabs of all patients with radiological pneumonia and of a subset of randomly selected NP swabs were tested for S. pneumoniae (S.p.) by qPCR and for serotypes by culture and DNA microarray. Results: Among 5705 patients, 2113 (37.0%) and 386 (6.8%) had RSV and influenza infections, respectively. Children aged 2–6 months had a higher percentage of very severe RSV infection compared to those older than 6 months (42.2% versus 31.4%, p‐value Fisher's exact = 0.001). S.p. carriage was detected in 1073/2281 (47.0%) patients. Among S.p. carriage cases, 363/1073 (33.8%) had S.p. and RSV codetection, and 82/1073 (7.6%) had S.p. and influenza codetection. S.p. codetection with RSV/influenza was not associated with more severe LRTIs, compared to only RSV/influenza cases. Conclusion: In Mongolia, RSV is an important pathogen causing more severe LRTI in children under 6 months of age. Codetection of RSV or influenza virus and S.p. was not associated with increased severity. [ABSTRACT FROM AUTHOR]

Objective To quantify the impact of the change in definition of severe pneumonia on documented pneumonia burden. Methods We reviewed existing data acquired during observational hospitalized pneumonia studies, before the introduction of the pneumococcal conjugate vaccine, in infants aged 2-23 months from Fiji, Gambia, Lao People's Democratic Republic, Malawi, Mongolia and Viet Nam. We used clinical data to calculate the percentage of all-cause pneumonia hospitalizations with severe pneumonia, and with primary end-point consolidation, according to both the 2005 or 2013 World Health Organization (WHO) definitions. Where population data were available, we also calculated the incidence of severe pneumonia hospitalizations according to the different definitions. Findings At six of the seven sites, the percentages of all-cause pneumonia hospitalizations due to severe pneumonia were significantly less (P < 0.001) according to the 2013 WHO definition compared with the 2005 definition. However, the percentage of severe pneumonia hospitalizations, according to the two definitions of severe pneumonia, with primary end-point consolidation varied little within each site. The annual incidences of severe pneumonia hospitalizations per 100 000 infants were significantly less (all P < 0.001) according to the 2013 definition compared with the 2005 definition, ranging from a difference of -301.0 (95% confidence interval, CI: -405.2 to -196.8) in Fiji to -3242.6 (95% CI: -3695.2 to -2789.9) in the Gambia. Conclusion The revision of WHO's definition of severe pneumonia affects pneumonia epidemiology, and hence the interpretation of any pneumonia intervention impact evaluation. Objectif Quantifier l'impact de la modification de la definition de pneumonie severe sur le fardeau documente de la pneumonie. Methodes Nous avons examine les donnees existantes obtenues dans le cadre d'etudes d'observation de la pneumonie hospitaliere, avant l'introduction du vaccin antipneumococcique conjugue, chez des nourrissons ages de 2 a 23 mois aux Fidji, en Gambie, au Malawi, en Mongolie, en Republique democratique populaire lao et au Viet Nam. Nous avons utilise des donnees cliniques pour calculer le pourcentage d'hospitalisations pour une pneumonie toutes causes confondues avec une pneumonie severe, et avec une consolidation des criteres d'evaluation primaire, selon les definitions de l'Organisation mondiale de la Sante (OMS) de 2005 et 2013. Lorsque des donnees demographiques etaient disponibles, nous avons egalement calcule l'incidence des hospitalisations pour une pneumonie severe selon les differentes definitions. Resultats Dans six des sept sites, les pourcentages d'hospitalisations pour une pneumonie toutes causes confondues en raison d'une pneumonie severe etaient nettement plus faibles (P < 0,001) selon la definition de l'OMS de 2013 en comparaison avec la definition de 2005. Neanmoins, le pourcentage d'hospitalisations pour une pneumonie severe, selon les deux definitions de la pneumonie severe, avec une consolidation des criteres d'evaluation primaire variait peu dans chaque site. Les incidences annuelles d'hospitalisations pour une pneumonie severe pour 100 000 nourrissons etaient nettement plus faibles (total P < 0,001) selon la definition de 2013 en comparaison avec la definition de 2005, la difference allant de -301,0 (intervalle de confiance, IC, a 95%: de -405,2 a -196,8) aux Fidji a -3242,6 (IC a 95%I: -de 3695,2 a -2789,9) en Gambie. Conclusion La revision de la definition de l'OMS de la pneumonie severe affecte l'epidemiologie de la pneumonie et, par consequent, l'interpretation de toute evaluation de l'impact d'une intervention contre la pneumonie. Objetivo Cuantificar el impacto del cambio en la definicion de neumonia grave sobre la carga de neumonia documentada. Metodos Se revisaron los datos existentes adquiridos durante los estudios observacionales de neumonia hospitalizada, antes de la introduccion de la vacuna antineumococica conjugada, en lactantes de 2 a 23 meses de edad procedentes de Fiji, Gambia, Malawi, Mongolia, la Republica Democratica Popular Lao y Vietnam. Se utilizaron datos clinicos para calcular el porcentaje de hospitalizaciones por neumonia de cualquier causa con neumonia grave, y con consolidacion del punto final primario, de acuerdo con las definiciones de la Organizacion Mundial de la Salud (OMS) de 2005 o 2013. Cuando se dispuso de datos demograficos, tambien se calculo la incidencia de las hospitalizaciones por neumonia grave de acuerdo con las diferentes definiciones. Resultados En seis de los siete sitios, los porcentajes de hospitalizaciones por neumonia de cualquier causa con neumonia grave fueron significativamente menores (p < 0,001) segun la definicion de la OMS de 2013 en comparacion con la de 2005. Sin embargo, el porcentaje de hospitalizaciones por neumonia grave, segun las dos definiciones de neumonia grave, con consolidacion del punto final primario vario poco dentro de cada sitio. La incidencia anual de hospitalizaciones por neumonia grave por cada 100.000 lactantes fue significativamente menor (total p < 0,001) segun la definicion de 2013 en comparacion con la de 2005 y oscilo entre una diferencia de -301,0 (intervalo de confianza, IC, del 95%: -405,2 a -196,8) en Fiji y -3242,6 (IC del 95%: -3695,2 a -2789,9) en Gambia. Conclusion La revision de la definicion de neumonia grave de la OMS afecta a la epidemiologia de la neumonia y, por tanto, a la interpretacion de cualquier evaluacion del impacto de una intervencion para la neumonia., Introduction Pneumonia is the leading cause of post-neonatal deaths in children younger than 5 years, with many of the deaths occurring in low- and middle-income countries. (1,2) Several interventions exist [...]

Influenza virus infections cause substantial illness and death worldwide, in particular among persons Nonetheless, establishing a clinical association between pathogen detection and illness remains challenging. Contradicting results have been reported [...]

Streptococcus pneumoniae serotype 1 is highly invasive Oand rarely carried asymptomatically (1). The incidence of serotype 1 invasive pneumococcal disease (IPD) fluctuates year to year; disease is associated with outbreaks [...]

Background There is an ongoing need to assess the impact of pneumococcal conjugate vaccines (PCVs) to guide the use of these potentially valuable but under-utilized vaccines against pneumonia, which is one of the most common causes of post-neonatal mortality. Methods We conducted a systematic review of the literature on PCV10 and PCV13 impact on all-cause, radiologically confirmed and severe pneumonia hospitalisation rates as well as all-cause and pneumonia-specific mortality rates. We included studies that were published from 2003 onwards, had a post-licensure observational study design, and reported on any of our defined outcomes in children aged between 0-9 years. We derived incidence rates (IRs), incidence rate ratios (IRRs) or percent differences (%). We assessed all studies for risk of bias using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results We identified a total of 1885 studies and included 43 comparing one or more of the following hospitalised outcomes of interest: all-cause pneumonia (n=27), severe pneumonia (n=6), all-cause empyema (n=8), radiologically confirmed pneumonia (n=8), pneumococcal pneumonia (n=7), and pneumonia mortality (n=10). No studies evaluated all-cause mortality. Studies were conducted in all WHO regions except South East Asia Region (SEAR) and low- or middle-income countries (LMICs) in the Western Pacific Region (WPR). Among children <5 years old, PCV impact ranged from 7% to 60% for all-cause pneumonia hospitalisation, 8% to 90% for severe pneumonia hospitalisation, 12% to 79% for radiologically confirmed pneumonia, and 45% to 85% for pneumococcal confirmed pneumonia. For pneumonia-related mortality, impact was found in three studies and ranged from 10% to 78%. No obvious differences were found in vaccine impact between PCV10 and PCV13. One study found a 17% reduction in all-cause pneumonia among children aged 5-9 years, while another found a reduction of 81% among those aged 5-17 years. A third study found a 57% reduction in all-cause empyema among children 5-14 years of age. Conclusion We found clear evidence of declines in hospitalisation rates due to all-cause, severe, radiologically confirmed, and bacteraemic pneumococcal pneumonia in children aged <5 years, supporting ongoing use of PCV10 and PCV13. However, there were few studies from countries with the highest <5-year mortality and no studies from SEAR and LMICs in the WPR. Standardising methods of future PCV impact studies is recommended. [ABSTRACT FROM AUTHOR]

Background A systematic review in 2019 found reductions in antimicrobial resistance (AMR) of pneumococcal vaccine serotypes following pneumococcal conjugate vaccine (PCV) introduction. However, few low- or middle-income countries were included as not many had introduced higher valent PCVs (PCV10 or PCV13). The aim of our review is to describe AMR rates in these samples following the introduction of PCV10 or PCV13. Methods We conducted a systematic literature review of published papers that compared AMR for invasive pneumococcal disease (IPD), otitis media (OM) and nasopharyngeal carriage (NPC) samples following introduction of PCV10 or PCV13 to the pre-PCV period. Included studies published from July 2017 to August 2020 had a post-licensure observational study design and reported on our defined outcomes: IPD, OM, NPC and other (sputum or mixed invasive and non-invasive pneumococcal) isolates from people of all ages. Rates of AMR in the pre- and post-period were extracted. Results Data were extracted from 31 studies. Among IPD isolates, penicillin AMR rates following PCV10 or PCV13 introduction declined in 32% (n=9/29) of included studies, increased in 34% (n=10/29) and showed no change in 34% (n=10/29). Cephalosporins AMR declined in 32% (n=6/19) of studies, increased in 21% (n=4/19) and showed no change in 47% (n=9/19). Macrolides AMR declined in 33% (n=4/12) of studies, increased in 50% (n=6/12), and showed no change in 17% (n=2/12). AMR to other antibiotics (including multidrug resistance) declined in 23% (n=9/39) of studies, increased in 41% (n=16/39) and showed no change in AMR in 36% (n=14/39). There were no obvious differences between AMR; in setting which used PCV10 vs PCV13, according to time since PCV introduction or by World Bank income status of the respective country. The only study including OM isolates found no change in penicillin resistance. There were few studies on AMR in NPC (four studies), OM (one study) or other isolates (five studies). The results followed similar patterns to IPD isolates. Conclusions We observed considerable heterogeneity in the findings between and within studies, e.g. no evidence of reduction in amoxicillin AMR with an increase in macrolides AMR. Reasons for such diverse findings include the period covered by different studies and variation in other pressures towards AMR. [ABSTRACT FROM AUTHOR]

Objectives: Pneumococcal conjugate vaccines (PCVs) are effective in reducing pneumococcal disease. We measured 13-valent PCV (PCV13) effect on different pneumococcal outcomes using diverse studies in Lao People's Democratic Republic. Methods: Studies included: pre-PCV13 population-based record review of hospitalized childhood pneumonia cases; acute respiratory infection (ARI) study post-PCV13 to demonstrate effectiveness (VE) against hypoxic pneumonia; invasive pneumococcal disease (IPD) surveillance in all ages (2004–2018); carriage studies in children hospitalized with ARI (2013–2019); community carriage surveys pre- and post-PCV13. Results: Annual pneumonia incidence rate in children pre-PCV13 was 1,530 (95% confidence interval [CI] 1,477–1,584) per 100,000. Adjusted VE against hypoxic pneumonia was 37% (95% CI 6–57%). For IPD, 85% (11/13) of cases were due to vaccine-types pre-PCV13, and 43% (3/7) post-PCV13 in children aged <5 years; for ≥5 years, 61% (27/44) and 42% (17/40), respectively. For ARI cases, adjusted VE for vaccine-type carriage was 39% (95% CI 4–60) in <5 year olds; slightly higher than community surveys (23% [95% CI 4–39%] in 12–23 month olds). Conclusions: Despite limited baseline data, we found evidence of PCV13 impact on disease and carriage. Our approach could be used in similar settings to augment existing WHO PCV evaluation guidelines. [ABSTRACT FROM AUTHOR]

Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination. [ABSTRACT FROM AUTHOR]

Background Streptococcus pneumoniae is one of the most common bacteria causing pneumonia and the World Health Organization (WHO) recommends first-line treatment of pneumonia with penicillins. Due to increases in the frequency of penicillin resistance, this systematic review aimed to determine the clinical outcomes of children with pneumonia in low- and middle-income countries (LMICs), with penicillin-group resistant pneumococci in respiratory and/or blood cultures specimens. Methods English-language articles from January 2000 to November 2020 were identified by searching four databases. Systematic reviews and epidemiological studies from LMICs that included children aged one month to 9 years and reported outcomes of pneumonia with a penicillin-resistant pneumococcus in respiratory and blood culture specimens with or without comparison groups were included. Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. A narrative synthesis of findings based on the results of included studies was performed. Results We included 7 articles involving 2864 children. One strong- and four medium-quality studies showed no difference in clinical outcomes (duration of symptoms, length of hospital stay and mortality) between those children with penicillin non-susceptible compared to susceptible pneumococci. Two weak quality studies suggested better outcomes in the penicillin-susceptible group. Conclusions Current evidence suggests no difference in clinical outcomes of child pneumonia due to a penicillin-resistant S. pneumoniae and as such, there is no evidence to support a change in current WHO antibiotic guidelines. [ABSTRACT FROM AUTHOR]

Background Severe childhood pneumonia requires treatment in hospital by trained health care workers. It is therefore important to determine if health facilities provide quality health services for children with acute respiratory infections (ARI), including pneumonia. Using established indicators from WHO to measure quality of care (QoC) as a reference standard, this review aims to evaluate how well existing tools assess QoC for children presenting to health facilities with ARI. Methods Existing assessment tools identified from a published systematic literature review that evaluated QoC assessment tools for children (<15 years) in health facilities for all health conditions were included in this ARI-specific review. 27 ARI-specific indicators or "quality measures" from the WHO "Standards for improving quality of care for children and young adolescents in health facilities" were selected for use as a reference standard to assess QoC for children presenting to health facilities with ARI symptoms. Each included assessment tool was evaluated independently by two paediatricians to determine how many of the WHO ARI quality measures were assessable by the tool. The assessment tools were then ranked in order of percentage of ARI quality measures assessable. Results Nine assessment tools that assessed QoC for children attending health facilities were included. Two hospital care tools developed by WHO had the most consistency with ARI-specific indicators, assessing 22/27 (81.5%) and 20/27 (74.1%) of the quality measures. The remaining tools were less consistent with the ARI-specific indicators, including between zero to 16 of the 27 quality measures. The most common indicators absent from the tools were assessment of appropriate use of pulse oximetry and administration of oxygen, how often oxygen supply was unavailable, and mortality rates. Conclusions The existing WHO hospital-based QoC assessment tools are comprehensive but could be enhanced by improved data quality around oxygen availability and appropriate use of pulse oximetry and oxygen administration. Any tools, however, should be considered within broader assessments of QoC, rather than utilised in isolation. Further adaptation to local settings will improve feasibility and facilitate progress in the delivery of quality health care for children with ARI. Registration The protocol of the original systematic review was registered in PROSPERO ID: CRD42020175652. [ABSTRACT FROM AUTHOR]