Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in NepalFunding None.
19 April 2017
07 September 2017
11 December 2017 (eFirst)
Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal.
Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation.
Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission.
Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.
- 1 Falade AG, Mulholland EK, Adegbola RA, Greenwood BM. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Ann Trop Paediatr 1997; 17 (04) 315-319
- 2 Liu L, Johnson HL, Cousens S. , et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379 (9832): 2151-2161
- 3 Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002; 2 (01) 25-32
- 4 Adegbola RA. Childhood pneumonia as a global health priority and the strategic interest of the Bill & Melinda Gates Foundation. Clin Infect Dis 2012; 54 (Suppl. 02) S89-S92
- 5 Williams EJ, Thorson S, Maskey M. , et al. Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal. Clin Infect Dis 2009; 48 (Suppl. 02) S114-S122
- 6 Shah AS, Knoll MD, Sharma PR. , et al. Invasive pneumococcal disease in Kanti Children's Hospital, Nepal, as observed by the South Asian Pneumococcal Alliance network. Clin Infect Dis 2009; 48 (Suppl. 02) S123-S128
- 7 Chhetri UD, Shrestha S, Pradhan R. , et al. Clinical profile of invasive pneumococcal diseases in Patan Hospital, Nepal. Kathmandu Univ Med J (KUMJ) 2011; 9 (33) 45-49
- 8 López EL, Glatstein E, Ezcurra GC. , et al. Rapid decrease in rates of hospitalization resulting from invasive pneumococcal disease and community-acquired pneumonia in children aged <60 months after 13-valent pneumococcal conjugate vaccine introduction in Argentina. J Pediatr Infect Dis Soc 2017; DOI: 10.1093/jpids/piw089. [epub ahead of print]
- 9 McCollum ED, Nambiar B, Deula R. , et al. Impact of the 13-valent pneumococcal conjugate vaccine on clinical and hypoxemic childhood pneumonia over three years in central Malawi: an observational study. PLoS One 2017; 12 (01) e0168209
- 10 Pírez MC, Algorta G, Chamorro F. , et al. Changes in hospitalizations for pneumonia after universal vaccination with pneumococcal conjugate vaccines 7/13 valent and haemophilus influenzae type b conjugate vaccine in a Pediatric Referral Hospital in Uruguay. Pediatr Infect Dis J 2014; 33 (07) 753-759
- 11 Lucero MG, Dulalia VE, Nillos LT. , et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev 2009; (04) CD004977
- 12 Paudel KP. PCV 10 introduction in National Immunization Program of Nepal. Pediatr Infect Dis 2016; 8 (02) 67-71
- 13 Müller NL, Franquet T, Lee KS, Silva CIS. , Eds. Imaging of Pulmonary Infections. Philadelphia: Lippincott Williams & Wilkins; 2007
- 14 World Health Organization, ed. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd ed. Geneva, Switzerland: World Health Organization; 2013
- 15 Nair H, Simões EAF, Rudan I. , et al; Severe Acute Lower Respiratory Infections Working Group. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381 (9875): 1380-1390
- 16 le Roux DM, Myer L, Nicol MP, Zar HJ. Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. Lancet Glob Health 2015; 3 (02) e95-e103
- 17 Sgambatti S, Minamisava R, Bierrenbach AL. , et al. Early impact of 10-valent pneumococcal conjugate vaccine in childhood pneumonia hospitalizations using primary data from an active population-based surveillance. Vaccine 2016; 34 (05) 663-670
- 18 Hoo A-F, Dezateux C, Hanrahan JP, Cole TJ, Tepper RS, Stocks J. Sex-specific prediction equations for Vmax(FRC) in infancy: a multicenter collaborative study. Am J Respir Crit Care Med 2002; 165 (08) 1084-1092
- 19 Pandey A. Health care options in childhood ARI before hospital care. Indian J Public Health 2002; 46 (02) 51-56
- 20 Riva E, Salvini F, Garlaschi ML, Radaelli G, Giovannini M. The status of invasive pneumococcal disease among children younger than 5 years of age in north-west Lombardy, Italy. BMC Infect Dis 2012; 12 (01) 106
- 21 Patwari AK, Bisht S, Srinivasan A, Deb M, Chattopadhya D. Aetiology of pneumonia in hospitalized children. J Trop Pediatr 1996; 42 (01) 15-20
- 22 Weinberger DM, Harboe ZB, Viboud C. , et al. Pneumococcal disease seasonality: incidence, severity and the role of influenza activity. Eur Respir J 2014; 43 (03) 833-841
- 23 Khan S, Priti S, Ankit S. Bacteria etiological agents causing lower respiratory tract infections and their resistance patterns. Iran Biomed J 2015; 19 (04) 240-246
- 24 Furer V, Raveh D, Picard E, Goldberg S, Izbicki G. Absence of leukocytosis in bacteraemic pneumococcal pneumonia. Prim Care Respir J 2011; 20 (03) 276-281
- 25 Williams DJ, Hall M, Auger KA. , et al. Association of white blood cell count and C-reactive protein with outcomes in children hospitalized for community-acquired pneumonia. Pediatr Infect Dis J 2015; 34 (07) 792-793
- 26 Flood RG, Badik J, Aronoff SC. The utility of serum C-reactive protein in differentiating bacterial from nonbacterial pneumonia in children: a meta-analysis of 1230 children. Pediatr Infect Dis J 2008; 27 (02) 95-99
- 27 Deva A, Prasad SR, Madappa BP, Junjegowda K, Bachu RPN. Pneumococcal infections at a rural tertiary care hospital: a seven year study on isolation rate, clinical spectrum and antibiogram. J Clin Diagn Res 2014; 8 (02) 50-52
- 28 Addo-Yobo E, Chisaka N, Hassan M. , et al. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet 2004; 364 (9440): 1141-1148
- 29 Loo JD, Conklin L, Fleming-Dutra KE. , et al. Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia. Pediatr Infect Dis J 2014; 33 (Suppl. 02) S140-S151
- 30 van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet 2009; 374 (9700): 1543-1556
- 31 Akata K, Chang B, Yatera K. , et al. The distribution and annual changes in the Streptococcus pneumoniae serotypes in adult Japanese patients with pneumococcal pneumonia from 2011 to 2015. J Infect Chemother 2017; 23 (05) 301-306