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

Daniel Feikin, M. Kariuki Njenga, Godfrey Bigogo, Barrack Aura, George Aol, Allan Audi, Geoffrey Jagero, Peter O. Muluare, Stella Gikunju, Leonard Nderitu, Jonas M. Winchell, Eileen Schneider, Dean D. Erdman, M. Steven Oberste, Mark A. Katz, Robert F. Breiman

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish (US)
JournalPediatric Infectious Disease Journal
Volume32
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Fingerprint

Kenya
Orthomyxoviridae
Malaria
Streptococcus pneumoniae
Odds Ratio
Incidence
Confidence Intervals
Respiratory Syncytial Viruses
Enterovirus
Adenoviridae
Salmonella
Respiratory System
Inpatients
Real-Time Polymerase Chain Reaction
Pneumonia
Fever
Outpatients
Logistic Models
Oxygen
Viruses

Keywords

  • Africa
  • Kenya
  • pneumonia
  • respiratory viruses
  • severe acute respiratory illness
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

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. / Feikin, Daniel; Njenga, M. Kariuki; Bigogo, Godfrey; Aura, Barrack; Aol, George; Audi, Allan; Jagero, Geoffrey; Muluare, Peter O.; Gikunju, Stella; Nderitu, Leonard; Winchell, Jonas M.; Schneider, Eileen; Erdman, Dean D.; Steven Oberste, M.; Katz, Mark A.; Breiman, Robert F.

In: Pediatric Infectious Disease Journal, Vol. 32, No. 1, 01.2013.

Research output: Contribution to journalReview article

Feikin, D, Njenga, MK, Bigogo, G, Aura, B, Aol, G, Audi, A, Jagero, G, Muluare, PO, Gikunju, S, Nderitu, L, Winchell, JM, Schneider, E, Erdman, DD, Steven Oberste, M, Katz, MA & Breiman, RF 2013, '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', Pediatric Infectious Disease Journal, vol. 32, no. 1. https://doi.org/10.1097/INF.0b013e31826fd39b
Feikin, Daniel ; Njenga, M. Kariuki ; Bigogo, Godfrey ; Aura, Barrack ; Aol, George ; Audi, Allan ; Jagero, Geoffrey ; Muluare, Peter O. ; Gikunju, Stella ; Nderitu, Leonard ; Winchell, Jonas M. ; Schneider, Eileen ; Erdman, Dean D. ; Steven Oberste, M. ; Katz, Mark A. ; Breiman, Robert F. / 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. In: Pediatric Infectious Disease Journal. 2013 ; Vol. 32, No. 1.
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abstract = "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.",
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AU - Feikin, Daniel

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 - pneumonia

KW - respiratory viruses

KW - severe acute respiratory illness

KW - Streptococcus pneumoniae

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