The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal

Abstract

The data on the burden of invasive bacterial infections and pneumonia from this study suggest that vaccines in development against Salmonella Typhi and the pneumococcus have the potential to significantly improve the health of children in Nepal.

Haemophilus influenzae Type b Carriage and Novel Bacterial Population Structure among Children in Urban Kathmandu, Nepal

“…similar to that found in Indonesia where carriage rates were 4.6% (8). In the Indonesian population, a Hib vaccine probe study indicated that the incidence rate of Hib-caused meningitis is Ͼ70/100,000 children under 5 years old (7), a rate 20 times the rate identified from hospital-based microbiological studies in this Nepali population (12). The Hib carriage prevalence in these areas contrasts with populations of notably high disease incidence, including Alaska (28) and the Gambia (1) in their respective prevaccine eras, where a Hib carriage prevalence of 7 to 10% was found and the disease rates were correspondingly Ͼ70/100,000 children (2,28).…”

“…Since April 2005, as part of a microbiological surveillance study, all children admitted to the children's ward of Patan Hospital with suspected invasive bacterial disease or pneumonia have routinely had blood samples and, where appropriate, cerebrospinal fluid (CSF) samples cultured. All pathogens isolated from blood and/or CSF samples were stored at Ϫ70°C (12,38). Hib disease-causing isolates were obtained from this collection for comparison with isolates from children carrying Hib.…”

“…Small studies have previously identified Hib as an important cause of meningitis in Nepal (26,34), and recent studies of children in hospitals in Kathmandu, Nepal, suggest that Hib caused 2 to 8% of the cases of meningitis (12,25). However, the absolute number of cases in the study was small, and there is still uncertainty about the relative importance of Hib in Asia.…”

“…However, the absolute number of cases in the study was small, and there is still uncertainty about the relative importance of Hib in Asia. In urban Nepal, we have previously identified a significant burden of pneumonia in children less than 5 years old admitted to a hospital (12,38). While Hib is likely to be the cause of many of these cases of pneumonia, most children with Hib pneumonia have negative blood cultures, and confirmation is therefore not possible (6).…”

Treatable Bacterial Infections Are Underrecognized Causes of Fever in Ethiopian Children

“…17,18 Similar rates of S. pneumoniae bacteremia were described in other resource-poor settings like Nepal (1%) and Nigeria (2.2%). 19,20 The higher RT-PCR method sensitivity compared with blood culture may explain these differences. The work by Resti and others 21 compared the performance of blood cultures and real-time PCR for the detection of S. pneumoniae bacteremia among children admitted with pneumonia to 83 Italian hospitals.…”