TY - JOUR
T1 - Viral and bacterial causes of severe acute respiratory illness among children aged less than 5 years in a high malaria prevalence area of Western Kenya, 2007-2010
AU - Feikin, Daniel R.
AU - Njenga, M. Kariuki
AU - Bigogo, Godfrey
AU - Aura, Barrack
AU - Aol, George
AU - Audi, Allan
AU - Jagero, Geoffrey
AU - Muluare, Peter O.
AU - Gikunju, Stella
AU - Nderitu, Leonard
AU - Winchell, Jonas M.
AU - Schneider, Eileen
AU - Erdman, Dean D.
AU - Steven Oberste, M.
AU - Katz, Mark A.
AU - Breiman, Robert F.
PY - 2013/1
Y1 - 2013/1
N2 - Background: Few comprehensive data exist on the etiology of severe acute respiratory illness (SARI) among African children. Methods: From March 1, 2007 to February 28, 2010, we collected blood for culture and nasopharyngeal and oropharyngeal swabs for real-time quantitative polymerase chain reaction for 10 viruses and 3 atypical bacteria among children aged <5 years with SARI, defined as World Health Organization-classified severe or very severe pneumonia or oxygen saturation <90%, who visited a clinic in rural western Kenya. We collected swabs from controls without febrile or respiratory symptoms. We calculated odds ratios for infection among cases, adjusting for age and season in logistic regression. We calculated SARI incidence, adjusting for healthcare seeking for SARI in the community. Results: Two thousand nine hundred seventy-three SARI cases were identified (54% inpatient, 46% outpatient), yielding an adjusted incidence of 56 cases per 100 person-years. A pathogen was detected in 3.3% of noncontaminated blood cultures; non-typhi Salmonella (1.9%) and Streptococcus pneumoniae (0.7%) predominated. A pathogen was detected in 84% of nasopharyngeal/oropharyngeal specimens, the most common being rhino/enterovirus (50%), respiratory syncytial virus (RSV, 22%), adenovirus (16%) and influenza viruses (8%). Only RSV and influenza viruses were found more commonly among cases than controls (odds ratio 2.9, 95% confidence interval: 1.3-6.7 and odds ratio 4.8, 95% confidence interval: 1.1-21, respectively). Incidence of RSV, influenza viruses and S. pneumoniae were 7.1, 5.8 and 0.04 cases per 100 person-years, respectively. Conclusions: Among Kenyan children with SARI, RSV and influenza virus are the most likely viral causes and pneumococcus the most likely bacterial cause. Contemporaneous controls are important for interpreting upper respiratory tract specimens.
AB - Background: Few comprehensive data exist on the etiology of severe acute respiratory illness (SARI) among African children. Methods: From March 1, 2007 to February 28, 2010, we collected blood for culture and nasopharyngeal and oropharyngeal swabs for real-time quantitative polymerase chain reaction for 10 viruses and 3 atypical bacteria among children aged <5 years with SARI, defined as World Health Organization-classified severe or very severe pneumonia or oxygen saturation <90%, who visited a clinic in rural western Kenya. We collected swabs from controls without febrile or respiratory symptoms. We calculated odds ratios for infection among cases, adjusting for age and season in logistic regression. We calculated SARI incidence, adjusting for healthcare seeking for SARI in the community. Results: Two thousand nine hundred seventy-three SARI cases were identified (54% inpatient, 46% outpatient), yielding an adjusted incidence of 56 cases per 100 person-years. A pathogen was detected in 3.3% of noncontaminated blood cultures; non-typhi Salmonella (1.9%) and Streptococcus pneumoniae (0.7%) predominated. A pathogen was detected in 84% of nasopharyngeal/oropharyngeal specimens, the most common being rhino/enterovirus (50%), respiratory syncytial virus (RSV, 22%), adenovirus (16%) and influenza viruses (8%). Only RSV and influenza viruses were found more commonly among cases than controls (odds ratio 2.9, 95% confidence interval: 1.3-6.7 and odds ratio 4.8, 95% confidence interval: 1.1-21, respectively). Incidence of RSV, influenza viruses and S. pneumoniae were 7.1, 5.8 and 0.04 cases per 100 person-years, respectively. Conclusions: Among Kenyan children with SARI, RSV and influenza virus are the most likely viral causes and pneumococcus the most likely bacterial cause. Contemporaneous controls are important for interpreting upper respiratory tract specimens.
KW - Africa
KW - Kenya
KW - Streptococcus pneumoniae
KW - pneumonia
KW - respiratory viruses
KW - severe acute respiratory illness
UR - http://www.scopus.com/inward/record.url?scp=84871735103&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871735103&partnerID=8YFLogxK
U2 - 10.1097/INF.0b013e31826fd39b
DO - 10.1097/INF.0b013e31826fd39b
M3 - Review article
C2 - 22914561
AN - SCOPUS:84871735103
SN - 0891-3668
VL - 32
SP - e14-e19
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 1
ER -