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High rates of pneumonia in children under two years of age in a South East Asian refugee population.

Turner C, Turner P, Carrara V, Burgoine K, Tha Ler Htoo S, Watthanaworawit W, Day NP, White NJ, Goldblatt D, Nosten F - PLoS ONE (2013)

Bottom Line: Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80-0.99, p = 0.03).Raised CRP and neutrophil values were associated with PEP.Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.

View Article: PubMed Central - PubMed

Affiliation: Shoklo Malaria Research Unit, Mae Sot, Thailand. claudia@tropmedres.ac

ABSTRACT

Background: There are an estimated 150 million episodes of childhood pneumonia per year, with 11-20 million hospital admissions and 1.575 million deaths. Refugee children are particularly vulnerable, with poorly defined pneumonia epidemiology.

Methods: We followed a birth cohort of 955 refugee infants, born over a one-year period, until two years of age. Clinical and radiographic pneumonia were diagnosed according to WHO criteria. Detailed characteristics were collected to determine risk factors for clinical, radiological and multiple episodes of pneumonia. Investigations were taken during a pneumonia episode to help determine or to infer an aetiological diagnosis.

Findings: The incidence of clinical pneumonia was 0.73 (95% CI 0.70-0.75) episodes per child year (/CY) and of radiological primary endpoint pneumonia (PEP) was 0.22/CY (95% CI 0.20-0.24). The incidence of pneumonia without severe signs was 0.50/CY (95% CI 0.48-0.53), severe pneumonia 0.15/CY (95% CI 0.13-0.17) and very severe pneumonia 0.06/CY (0.05-0.07). Virus was detected, from a nasopharyngeal aspirate, in 61.3% of episodes. A reduced volume of living space per person (IRR 0.99, 95% CI 0.99-1.0, p = 0.003) and young maternal age (IRR 1.59, 95% CI 1.12-2.27, p = 0.01) were risk factors for developing pneumonia. The risk of a child having >1 episode of pneumonia was increased by having a shorter distance to the next house (IRR 0.86, 95% CI 0.74-1.00, p = 0.04). Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80-0.99, p = 0.03). Raised CRP and neutrophil values were associated with PEP.

Conclusions: There was a high incidence of pneumonia in young children in this SE Asian refugee population. Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.

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Virus detection by month of year and total number of NPAs taken.
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pone-0054026-g001: Virus detection by month of year and total number of NPAs taken.

Mentions: Viruses were detected in NPA specimens in 654/1,067 (61.3%) pneumonia episodes. Detection of multiple viruses was not uncommon: 174/1,067 (16.3%) were positive for two viruses and 14/1,067 (1.3%) were positive for three viruses. The most commonly detected virus was RSV, in 362/1,067 (33.9%) of cases. RSV detection was significantly associated with a radiological diagnosis of OI (p = 0.001) and was not associated with PEP (p = 0.2). There was no association between any of the viruses and a radiologic diagnosis of PEP. However, RSV was identified in 31.0% of PEP cases. These cases were more likely to have a high neutrophil count and a high CRP, compared to other pneumonia cases where RSV was detected (OR 2.3, 95% CI 1.5–3.5, p<0.001), implying that these cases represented a bacterial superinfection of RSV associated pneumonia. Pneumonia and identification of virus was highly seasonal (Figure 1).


High rates of pneumonia in children under two years of age in a South East Asian refugee population.

Turner C, Turner P, Carrara V, Burgoine K, Tha Ler Htoo S, Watthanaworawit W, Day NP, White NJ, Goldblatt D, Nosten F - PLoS ONE (2013)

Virus detection by month of year and total number of NPAs taken.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539989&req=5

pone-0054026-g001: Virus detection by month of year and total number of NPAs taken.
Mentions: Viruses were detected in NPA specimens in 654/1,067 (61.3%) pneumonia episodes. Detection of multiple viruses was not uncommon: 174/1,067 (16.3%) were positive for two viruses and 14/1,067 (1.3%) were positive for three viruses. The most commonly detected virus was RSV, in 362/1,067 (33.9%) of cases. RSV detection was significantly associated with a radiological diagnosis of OI (p = 0.001) and was not associated with PEP (p = 0.2). There was no association between any of the viruses and a radiologic diagnosis of PEP. However, RSV was identified in 31.0% of PEP cases. These cases were more likely to have a high neutrophil count and a high CRP, compared to other pneumonia cases where RSV was detected (OR 2.3, 95% CI 1.5–3.5, p<0.001), implying that these cases represented a bacterial superinfection of RSV associated pneumonia. Pneumonia and identification of virus was highly seasonal (Figure 1).

Bottom Line: Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80-0.99, p = 0.03).Raised CRP and neutrophil values were associated with PEP.Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.

View Article: PubMed Central - PubMed

Affiliation: Shoklo Malaria Research Unit, Mae Sot, Thailand. claudia@tropmedres.ac

ABSTRACT

Background: There are an estimated 150 million episodes of childhood pneumonia per year, with 11-20 million hospital admissions and 1.575 million deaths. Refugee children are particularly vulnerable, with poorly defined pneumonia epidemiology.

Methods: We followed a birth cohort of 955 refugee infants, born over a one-year period, until two years of age. Clinical and radiographic pneumonia were diagnosed according to WHO criteria. Detailed characteristics were collected to determine risk factors for clinical, radiological and multiple episodes of pneumonia. Investigations were taken during a pneumonia episode to help determine or to infer an aetiological diagnosis.

Findings: The incidence of clinical pneumonia was 0.73 (95% CI 0.70-0.75) episodes per child year (/CY) and of radiological primary endpoint pneumonia (PEP) was 0.22/CY (95% CI 0.20-0.24). The incidence of pneumonia without severe signs was 0.50/CY (95% CI 0.48-0.53), severe pneumonia 0.15/CY (95% CI 0.13-0.17) and very severe pneumonia 0.06/CY (0.05-0.07). Virus was detected, from a nasopharyngeal aspirate, in 61.3% of episodes. A reduced volume of living space per person (IRR 0.99, 95% CI 0.99-1.0, p = 0.003) and young maternal age (IRR 1.59, 95% CI 1.12-2.27, p = 0.01) were risk factors for developing pneumonia. The risk of a child having >1 episode of pneumonia was increased by having a shorter distance to the next house (IRR 0.86, 95% CI 0.74-1.00, p = 0.04). Infants were at risk of having an episode of PEP if there was a shorter distance from stove to bed (IRR 0.89, 95% CI 0.80-0.99, p = 0.03). Raised CRP and neutrophil values were associated with PEP.

Conclusions: There was a high incidence of pneumonia in young children in this SE Asian refugee population. Viral infections were important, however CXR and non-specific marker findings suggested that bacteria may be involved in up to a third of cases.

Show MeSH
Related in: MedlinePlus