Microorganisms Associated With Pneumonia in Children <5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study

Abstract

Background. Pneumonia, the leading infectious cause of child mortality globally, mainly afflicts developing countries. This prospective observational study aimed to assess the microorganisms associated with pneumonia in children aged <5 years in developing and emerging countries.Methods. A multicenter, case-control study by the GABRIEL (Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries) network was conducted between 2010 and 2014 in Cambodia, China, Haiti, India (2 sites), Madagascar, Mali, Mongolia, and Paraguay. Cases were hospitalized children with radiologically confirmed pneumonia; controls were children from the same setting without any features suggestive of pneumonia. Nasopharyngeal swabs were collected from all subjects; 19 viruses and 5 bacteria were identified by reverse-transcription polymerase chain reaction. Associations between microorganisms and pneumonia were quantified by calculating the adjusted population attributable fraction (aPAF) after multivariate logistic regression analysis adjusted for sex, age, time period, other pathogens, and site.Results. Overall, 888 cases and 870 controls were analyzed; ≥1 microorganism was detected in respiratory samples in 93.0% of cases and 74.4% of controls (P < .001). Streptococcus pneumoniae, Mycoplasma pneumoniae, human metapneumovirus, rhinovirus, respiratory syncytial virus (RSV), parainfluenza virus 1, 3, and 4, and influenza virus A and B were independently associated with pneumonia; aPAF was 42.2% (95% confidence interval [CI], 35.5%-48.2%) for S. pneumoniae, 18.2% (95% CI, 17.4%-19.0%) for RSV, and 11.2% (95% CI, 7.5%-14.7%) for rhinovirus.Conclusions. Streptococcus pneumoniae, RSV, and rhinovirus may be the major microorganisms associated with pneumonia infections in children <5 years of age from developing and emerging countries. Increasing S. pneumoniae vaccination coverage may substantially reduce the burden of pneumonia among children in developing countries. Keywords. pneumonia; child; case-control studies; etiology; developing countries.Pneumonia is the leading infectious cause of child mortality and accounts for 1 million deaths annually, mainly in developing countries [1][2][3]. Implementation of more effective preventive vaccination policies and treatments may reduce pneumonia deaths in children <5 years old in developing countries [4]. However, better knowledge of pneumonia etiology is required. Indeed, vaccination policies should be regularly evaluated in the context of disease epidemiology. In many countries,

Respiratory viruses among children with non-severe community-acquired pneumonia: A prospective cohort study

“…The main limitation of our study is the absence of healthy controls. However, respiratory virus detection has been reported in approximately 50% of asymptomatic subjects in the same age stratum as our cases [14,21]. This, in turn, reinforces the importance of respiratory viruses in children with non-severe CAP, as our detection rate was approximately 90%.…”

“…Notably, the pathogenic role of RV has been recently described in adults with CAP, with a more modest association in older children (5-17 years old) [20]. Additionally, RV was identified as one of the major microorganisms associated with CAP in children < 5 years of age from developing and emerging countries hospitalized with CAP in a multicenter case-control study [21]. The clinical significance of multiple respiratory virus detection causing childhood CAP is not completely clear.…”

Viral and bacterial coinfection among hospitalized children with respiratory tract infections

“…The reported frequency of community-acquired pneumonia due to MP in pediatric patients worldwide varies from 1.5% to 17.6%. [21][22][23] Studies conducted in Latin America report frequencies ranging from 0.74% to 43.8%. [24][25][26] Most of the reports are from a previously healthy pediatric population.…”

Burden of Influenza in Less Than 5-Year-Old Children Admitted to Hospital with Pneumonia in Developing and Emerging Countries: A Descriptive, Multicenter Study

“…8,9 Briefly, incident cases of 2-to 60-month-old children hospitalized with a suspected pneumonia were identified by study clinicians at each participating site and assessed for eligibility. Pneumonia cases were defined by the following criteria: c Cough and/or dyspnea; c tachypnea, as delineated by the WHO (breathing rate ³ 50 cycles per minute in children 2-12 months of age and ³ 40 cycles per minute in children 12-59 months of age) 9 ; c first symptoms appearing within the last 14 days; and c radiological confirmation of pneumonia, as per WHO guidelines, including primary end-point pneumonia or other infiltrates. 10 Patients who met the inclusion criteria and from whom signed informed consent was obtained from their parents or legal guardians were included in the study.…”