- Email: [email protected]
Incidence and severity of childhood pneumonia in the Drakenstein Child Lung Health Study, a birth cohort in South Africa
16th ICID Abstracts / International Journal of Infectious Diseases 21S (2014) 1–460
Type: Poster Presentation
Type: Poster Presentation
Final Abstract Number: 55.001 Session: Pediatric and Perinatal Infections Date: Friday, April 4, 2014 Time: 12:45-14:15 Room: Ballroom
Final Abstract Number: 55.002 Session: Pediatric and Perinatal Infections Date: Friday, April 4, 2014 Time: 12:45-14:15 Room: Ballroom
Etiologic profile of micro-organisms causing severe pneumonia in children under five in India
Incidence and severity of childhood pneumonia in the Drakenstein Child Lung Health Study, a birth cohort in South Africa
R. Das 1,∗ , M. Singh 2 , A. Agarwal 2 , P. Ray 3
D.M. le Roux ∗ , L. Myer, M.P. Nicol, H. Zar
1
University of Cape Town, Cape Town, South Africa
All India Institute of Medical Sciences, Bhubaneswar, India 2 Post Graduate Institute of Medical Education and Research, Chandigarh, India 3 Postgraduate Institute of Medical Education and Research, Chandigarh India, Chandigarh, India
293
Background: Pneumonia is the single largest killer of children under-five worldwide. The disease takes the lives of over 2 million children under the age of five every year - nearly one fourth of these deaths occur in India alone. About half of pneumonia cases in India are caused by bacteria and could be treated with antibiotics. Methods & Materials: This open-label two-arm randomized clinical trial was conducted to determine the differences in failure of treatment with a 7-day course of oral amoxicillin administered for first 48 hours in the hospital followed by 5 days at home in comparison to being administered at home for all 7 days, in children 3 to 59 months old who have WHO defined severe pneumonia. Respiratory syncytial virus (RSV) antigen in nasal washings using ELISA method, and standard microbiological techniques to isolate S. pneumoniae and H. influenzae from baseline nasopharyngeal swabs were carried out. Results: A total of 377 children were included. The samples obtained from the enrolled patients revealed that 36.87% had S. pneumoniae, 16.44% had H. influenza, and 53.31% had RSV colonization. There were no significant differences in rates of isolation between the home and the hospital group (p = 0.53). The rates of isolation of these organisms were not predictive of treatment failure with oral amoxicillin. Conclusion: S. pneumoniae is the most common bacterial cause of severe pneumonia in children under-five in India. Oral amoxicillin given in the home setting is as good when given in hospital setting.
Background: Childhood pneumonia remains the major cause of global under-5 mortality. Conjugate vaccinations against Streptococcus pneumoniae (PCV13)was introduced into the South African primary health care program in 2009, while immunisation against Haemophilus influenzae b has been in place for a decade. This study investigated the incidence and severity of pneumonia in a South African birth cohort with high coverage for these vaccines. Methods & Materials: Active pneumonia case detection was performed from June 2012 to November 2013, in infants enrolled in the Drakenstein Child Lung Health study, a birth cohort study in a peri-urban area of South Africa. Pneumonia case definitions and treatment were according to IMCI and national guidelines; ambulatory and hospitalised cases were included. Results: Amongst 555 births, 369 child-years of follow-up were accrued with median follow-up of 33 weeks (IQR 19 – 49 weeks). 108 pneumonia episodes occurred in 87 children, an incidence of 0.29 episodes per child-year (e/cy), 95%CI 0.24 – 0.35. First pneumonia events occurred before 14-week vaccination in 45 children (42%); the earliest event occurred at 21 days. There were 43 cases of hospitalised pneumonia, (incidence 0.12 e/cy, 95% CI 0.08 – 0.16) and 65 ambulatory episodes (incidence 0.18 e/cy, 95%CI 0.14 – 0.22). Hospitalised cases were younger than ambulatory cases: median age 13 weeks (IQR 6 – 27), vs 21 weeks, (IQR 12 – 24), p=0.03. Median length of hospitalisation was 3 days, (IQR 2 -5 days). The in-hospital case fatality was 5%; there were no deaths amongst ambulatory cases and no case progressed to require hospitalisation. Conclusion: There was a high incidence of pneumonia and of severe disease despite high PCV coverage in this area Funding: Bill and Melinda Gates Foundation; SA Thoracic society GSK Fellowship; Federation of Infectious Diseases Societies of South Africa
http://dx.doi.org/10.1016/j.ijid.2014.03.1027
http://dx.doi.org/10.1016/j.ijid.2014.03.1028
Type: Poster Presentation
Type: Poster Presentation
Final Abstract Number: 55.001 Session: Pediatric and Perinatal Infections Date: Friday, April 4, 2014 Time: 12:45-14:15 Room: Ballroom
Final Abstract Number: 55.002 Session: Pediatric and Perinatal Infections Date: Friday, April 4, 2014 Time: 12:45-14:15 Room: Ballroom
Etiologic profile of micro-organisms causing severe pneumonia in children under five in India
Incidence and severity of childhood pneumonia in the Drakenstein Child Lung Health Study, a birth cohort in South Africa
R. Das 1,∗ , M. Singh 2 , A. Agarwal 2 , P. Ray 3
D.M. le Roux ∗ , L. Myer, M.P. Nicol, H. Zar
1
University of Cape Town, Cape Town, South Africa
All India Institute of Medical Sciences, Bhubaneswar, India 2 Post Graduate Institute of Medical Education and Research, Chandigarh, India 3 Postgraduate Institute of Medical Education and Research, Chandigarh India, Chandigarh, India
293
Background: Pneumonia is the single largest killer of children under-five worldwide. The disease takes the lives of over 2 million children under the age of five every year - nearly one fourth of these deaths occur in India alone. About half of pneumonia cases in India are caused by bacteria and could be treated with antibiotics. Methods & Materials: This open-label two-arm randomized clinical trial was conducted to determine the differences in failure of treatment with a 7-day course of oral amoxicillin administered for first 48 hours in the hospital followed by 5 days at home in comparison to being administered at home for all 7 days, in children 3 to 59 months old who have WHO defined severe pneumonia. Respiratory syncytial virus (RSV) antigen in nasal washings using ELISA method, and standard microbiological techniques to isolate S. pneumoniae and H. influenzae from baseline nasopharyngeal swabs were carried out. Results: A total of 377 children were included. The samples obtained from the enrolled patients revealed that 36.87% had S. pneumoniae, 16.44% had H. influenza, and 53.31% had RSV colonization. There were no significant differences in rates of isolation between the home and the hospital group (p = 0.53). The rates of isolation of these organisms were not predictive of treatment failure with oral amoxicillin. Conclusion: S. pneumoniae is the most common bacterial cause of severe pneumonia in children under-five in India. Oral amoxicillin given in the home setting is as good when given in hospital setting.
Background: Childhood pneumonia remains the major cause of global under-5 mortality. Conjugate vaccinations against Streptococcus pneumoniae (PCV13)was introduced into the South African primary health care program in 2009, while immunisation against Haemophilus influenzae b has been in place for a decade. This study investigated the incidence and severity of pneumonia in a South African birth cohort with high coverage for these vaccines. Methods & Materials: Active pneumonia case detection was performed from June 2012 to November 2013, in infants enrolled in the Drakenstein Child Lung Health study, a birth cohort study in a peri-urban area of South Africa. Pneumonia case definitions and treatment were according to IMCI and national guidelines; ambulatory and hospitalised cases were included. Results: Amongst 555 births, 369 child-years of follow-up were accrued with median follow-up of 33 weeks (IQR 19 – 49 weeks). 108 pneumonia episodes occurred in 87 children, an incidence of 0.29 episodes per child-year (e/cy), 95%CI 0.24 – 0.35. First pneumonia events occurred before 14-week vaccination in 45 children (42%); the earliest event occurred at 21 days. There were 43 cases of hospitalised pneumonia, (incidence 0.12 e/cy, 95% CI 0.08 – 0.16) and 65 ambulatory episodes (incidence 0.18 e/cy, 95%CI 0.14 – 0.22). Hospitalised cases were younger than ambulatory cases: median age 13 weeks (IQR 6 – 27), vs 21 weeks, (IQR 12 – 24), p=0.03. Median length of hospitalisation was 3 days, (IQR 2 -5 days). The in-hospital case fatality was 5%; there were no deaths amongst ambulatory cases and no case progressed to require hospitalisation. Conclusion: There was a high incidence of pneumonia and of severe disease despite high PCV coverage in this area Funding: Bill and Melinda Gates Foundation; SA Thoracic society GSK Fellowship; Federation of Infectious Diseases Societies of South Africa
http://dx.doi.org/10.1016/j.ijid.2014.03.1027
http://dx.doi.org/10.1016/j.ijid.2014.03.1028