TY - JOUR
T1 - Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India
AU - Farrar, Daniel S.
AU - Awasthi, Shally
AU - Fadel, Shaza A.
AU - Kumar, Rajesh
AU - Sinha, Anju
AU - Fu, Sze Hang
AU - Wahl, Brian
AU - Morris, Shaun K.
AU - Jha, Prabhat
N1 - Funding Information:
Funding: Canadian Institutes of Health Research, Bill and Melinda Gates Foundation, National Institutes of Health
Funding Information:
4Division of Reproductive Biology, Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
Publisher Copyright:
© 2019, Association of Support to Oral Health Research (APESB). All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - Future control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate-region, and clinical syndromes from 243,000 verbal autopsies in the nationally-representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99%CI 1.51-1.82; Versus the April minimum). Higher RRs at 1-11 months suggested respiratory syncytial virus (RSV) etiology. India’s humid subtropical region experienced a unique summerpneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48-1.85) and January (RR 1.37, 1.23-1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1-59-months in 2015 with prevalence surveys, we estimate 40,600 pneumonia deaths from Streptococcus pneumoniae, 20,700 from RSV, 12,600 from influenza, and 7,200 from Haemophilus influenza type b and 24,700 diarrheal deaths from rotavirus. Careful mortality studies can elucidate etiologies and inform vaccine introduction.
AB - Future control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate-region, and clinical syndromes from 243,000 verbal autopsies in the nationally-representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99%CI 1.51-1.82; Versus the April minimum). Higher RRs at 1-11 months suggested respiratory syncytial virus (RSV) etiology. India’s humid subtropical region experienced a unique summerpneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48-1.85) and January (RR 1.37, 1.23-1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1-59-months in 2015 with prevalence surveys, we estimate 40,600 pneumonia deaths from Streptococcus pneumoniae, 20,700 from RSV, 12,600 from influenza, and 7,200 from Haemophilus influenza type b and 24,700 diarrheal deaths from rotavirus. Careful mortality studies can elucidate etiologies and inform vaccine introduction.
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U2 - 10.7554/eLife.46202
DO - 10.7554/eLife.46202
M3 - Article
C2 - 31453804
AN - SCOPUS:85072588340
SN - 2050-084X
VL - 8
JO - eLife
JF - eLife
M1 - e46202
ER -