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Murphy C, MacLeod WB, Forman LS, Mwananyanda L, Kwenda G, Pieciak RC, Mupila Z, Thea D, Chikoti C, Yankonde B, Ngoma B, Chimoga C, Gill CJ. Risk Factors for Respiratory Syncytial Virus-Associated Community Deaths in Zambian Infants. Clin Infect Dis 2021; 73:S187-S192. [PMID: 34472570 PMCID: PMC8411252 DOI: 10.1093/cid/ciab453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of infant deaths. Its epidemiology in low- and middle-income countries is poorly understood. Risk factors associated with RSV-associated infant deaths that occur in community settings are incompletely known. METHODS Community deaths for infants aged 4 days to 6 months were identified during a 3-year postmortem RSV prevalence study at the main city morgue in Lusaka, Zambia, where 80% of deaths are registered. This analysis focuses on the subset of deaths for which an abbreviated verbal autopsy was available and intended to sort deaths into respiratory or nonrespiratory causes by clinical adjudication. Posterior nasopharyngeal swab samples were collected within 48 hours of death and tested for RSV using quantitative reverse-transcription polymerase chain reaction. Associations between potential risk factors were determined as relative risks with 95% confidence intervals (CIs). RESULTS We prospectively enrolled 798 community infant deaths with verbal autopsies and RSV laboratory results, of which 62 results were positive. The mean age of the infants was 10 weeks, and 41.4% of them were male. Of all deaths, 44% were attributed to respiratory causes. RSV was detected in 7.8% of the community infants and was significantly associated with respiratory deaths (risk ratio, 4.0 [95% CI, 2.2-7.1]). Compared with older infants, those aged 0-8 weeks had a 2.83 (95% CI, 1.30-6.15) increased risk of dying with RSV. The risk of RSV for the 0-8-week age group increased to 5.24 (1.56-33.14) with adjustment for demographics, parental education, and geography. RSV deaths were increased with domiciliary overcrowding and were concentrated in poor and dense neighborhoods in Lusaka (risk ratio, 2.00 [95% CI, 1.22-3.27]). CONCLUSION RSV is a significant contributor to community respiratory deaths in this population, particularly in the first 3 months of life and in the more poor and dense parts of Lusaka.
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Affiliation(s)
| | - William B MacLeod
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Leah S Forman
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, Massachusetts, USA
| | - Lawrence Mwananyanda
- Right to Care Zambia, Lusaka, Zambia.,Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Geoffrey Kwenda
- University of Zambia, School of Health Sciences, Department of Biomedical Sciences, Lusaka, Zambia
| | - Rachel C Pieciak
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | | | - Donald Thea
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | | | | | | | | | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
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Mpabalwani EM, Lukwesa-Musyani C, Imamba A, Nakazwe R, Matapo B, Muzongwe CM, Mufune T, Soda E, Mwenda JM, Lutz CS, Pondo T, Lessa FC. Declines in Pneumonia and Meningitis Hospitalizations in Children Under 5 Years of Age After Introduction of 10-Valent Pneumococcal Conjugate Vaccine in Zambia, 2010-2016. Clin Infect Dis 2020; 69:S58-S65. [PMID: 31505628 PMCID: PMC6761309 DOI: 10.1093/cid/ciz456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. Methods Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010–December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1–4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010–June 2013 and July 2014–December 2016, respectively. Results At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4–50.3%) and 28.8% (95% CI 17.7–38.7%) among children aged <1 year and 1–4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2–79.0%) and 61.6% (95% CI 50.4–70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1–4 years (39.3%, 95% CI 16.2–57.5%). Conclusions PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.
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Affiliation(s)
- Evans M Mpabalwani
- University of Zambia, School of Medicine, Department of Pediatrics & Child Health Unit, Ministry of Health, Ndeke House, Lusaka, Zambia.,Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Chileshe Lukwesa-Musyani
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Akakambama Imamba
- Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Ruth Nakazwe
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Belem Matapo
- World Health Organization Zambia Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Chilweza M Muzongwe
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Trust Mufune
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Elizabeth Soda
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chelsea S Lutz
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, United States Department of Energy, Washington, DC
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Adiku TK, Asmah RH, Rodrigues O, Goka B, Obodai E, Adjei AA, Donkor ES, Armah G. Aetiology of Acute Lower Respiratory Infections among Children Under Five Years in Accra, Ghana. Pathogens 2015; 4:22-33. [PMID: 25629622 PMCID: PMC4384070 DOI: 10.3390/pathogens4010022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/22/2014] [Accepted: 01/14/2015] [Indexed: 11/16/2022] Open
Abstract
The study aimed to investigate the aetiological agents and clinical presentations associated with acute lower respiratory infections (ALRI) among children under five years old at the Korle-Bu Teaching Hospital in Ghana. This was a cross-sectional study carried from February to December 2001. Nasopharyngeal aspirates and venous blood specimens obtained from 108 children with features suggestive of ALRI, were cultured and the isolated bacterial organisms were identified biochemically. Nasopharyngeal aspirates were also tested for Respiratory Syncitial Virus (RSV) antigen using a commercial kit (Becton Dickinson Directigen RSV test kit). A multiplex reverse transcription-PCR (RT-PCR) was also used to detect and characterize RSV using extracted RNA. Socio-demographic and clinical data were also obtained from the study subjects. Bronchopneumonia (55.5%), bronchiolitis (25%), lobar pneumonia (10.2), non-specific ALRI (4.6%), TB, bronchitis and respiratory distress (0.67%) were diagnosed. The prevalence of septicaemia was 10% and bacteria isolated were Staphylococcus aureus, Streptococcus pneumoniae and enteric bacteria, including Salmonella spp., Enterobacter spp and Klebsiella spp, were isolated. Out of the 108 cases, 18% tested positive for RSV, with two cases having RSV as the only aetiological pathogen detected. The subtyping analysis of RSV strains by a multiplex RT-PCR showed that subgroups A and B circulated in the season of analysis.
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Affiliation(s)
- Theophilus K Adiku
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
| | - Richard H Asmah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Ghana, Accra, Ghana.
| | - Onike Rodrigues
- Department of Child Health, University of Ghana Medical School, Accra, Ghana.
| | - Bamenla Goka
- Department of Child Health, University of Ghana Medical School, Accra, Ghana.
| | - Evangeline Obodai
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
| | - Andrew A Adjei
- Department of Pathology, University of Ghana Medical School, Accra, Ghana.
| | - Eric S Donkor
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
| | - George Armah
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Souza LSDF, Ramos EAG, Carvalho FM, Guedes VMCR, Souza LS, Rocha CM, Soares AB, Velloso LDF, Macedo IS, Moura FEA, Siqueira M, Fortes S, de Jesus CC, Santiago CMG, Carvalho AMDS, Arruda E. Viral respiratory infections in young children attending day care in urban Northeast Brazil. Pediatr Pulmonol 2003; 35:184-91. [PMID: 12567386 DOI: 10.1002/ppul.10194] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A cohort of children attending a day care center in Salvador (Bahia, Brazil) was studied prospectively to determine the incidence of viral respiratory infectious episodes and to identify the viruses associated with them. Two hundred seventy-one nasopharyngeal samples were collected over a 1-year period for examination, using indirect immunofluorescence with monoclonal antibodies against adenovirus, influenza A and B, parainfluenzae 1-3, and respiratory syncytial virus, and reverse transcriptase-polymerase chain reaction for picornavirus. Examination yielded positive results in 116 samples (42.8%). Rhinovirus was identified alone in 56 samples (48.3%) and was observed along with other viruses in 11 additional samples. Incidence density of viral respiratory infectious episodes was 7.66 episodes/1,000 child-days.
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Affiliation(s)
- Leda Solano de Freitas Souza
- Department of Pediatrics and Department of Preventive Medicine, Faculty of Medicine Federal University of Bahia, Salvador, Bahia, Brazil.
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Affiliation(s)
- Pedro A Piedra
- Department of Molecular Virology, Baylor College of Medicine, Houston, TX 77030, USA.
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