Etiology of acute lower respiratory tract infection in Central Australian Aboriginal children

Abstract

These findings have implications for both standard treatment protocols and vaccine strategies. The high rate of coinfection may make it difficult to develop simple clinical predictors of bacterial infection. In the setting of a developed country with efficient patient evacuation services, management algorithms that focus on disease severity and need for hospital referral will be most useful to health staff in remote communities. Pneumococcal conjugate vaccines will be required to reduce the high attack rate of pneumococcal disease.

Viral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, Bangladesh

“…In this study, 45% of NPA were positive for viral agents. This finding is similar to the results of hospital-based studies on etiology of ALRI in young children in India, Gambia, and Central Australia [6,13,14]. In most etiologic studies in developing countries, the detection of viruses was approximately 30 to 50% [13].…”

“…Studies conducted in the Gambia and in Central Australia on infants and children who were admitted to the hospital with ALRI identified 49% and 48% with respiratory virus and 30% and 6% with bacterial isolations, respectively. RSV was the most common virus and S. pneumonia and H. influenza were most commonly bacteria [5,6]. Most etiological studies on ALRI have been conducted in hospital settings with patients who reported for treatment for respiratory ailments; hence, not much is known about the etiology of ALRI, particularly pneumonia, in rural communities of developing countries.…”

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in Indigenous infants in Australia

“…18 Similarly, rates of pneumonia due to respiratory syncytial virus and influenza virus in this population are high. 5,19,20 While there are no data on its contribution to lower respiratory infection in these children, carriage of non-encapsulated Haemophilus influenzae is as high as 100% by 120 days of age. 21 Data from studies published since this study was conducted suggest that the WHO definition substantially underestimates the vaccine-preventable proportion of pneumonia cases and that additional clinical data such as cross-reactive protein values may be important, [22][23][24] although the latter may be population-dependent.…”

“…Baseline disease incidence was calculated on estimates derived from a study that did not use the WHO definition for radiologically confirmed pneumonia because it was not available at the time. 5 Because of our use of the WHO definition and our decision to evaluate only the first episode, disease incidence in this population was considerably lower than anticipated. Additional analyses evaluating repeated episodes of WHOdefined radiologically diagnosed pneumonia and all-cause acute lower respiratory infection and pneumonia requiring hospitalization have been performed for children from 5 to 23 months of age and have not changed our findings substantially.…”

“…3 On the basis of data from central Australia 5 and taking into account differences in the invasive pneumococcal disease burden between Northern Territory regions, 6 we assumed an incidence of 70 cases per 1000 population per year across the Territory as a whole. If 80% coverage is assumed (on the basis of routine childhood immunization data), 3 birth cohort years before and after the vaccine would provide 80% power (a = 0.05) to detect a 20% reduction in pneumonia incidence.…”