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

Abstract

Limited information is available on the etiology of acute lower respiratory infection (ALRI) particularly pneumonia in the rural community of developing countries since most etiological studies are carried out in the hospital settings. This study examined the etiology of pneumonia among young children in a rural community of Bangladesh. A cohort of 252 newborns was followed till 24 months of age during 1993-1996. Community health workers (CHWs) identified cases of ALRI during household surveillance and recommended hospitalization. On admission, nasopharyngeal aspirates (NPA) and blood were collected for bacterial and viral identification, and chest x-rays were done. Multiple regression analysis identified factors associated with a viral etiology. Physicians diagnosed 67 pneumonia; 45% of NPA were positive for viral agents of pneumonia, and respiratory syncytial virus (RSV) was predominant (81%); 6 of 48 blood cultures were positive. X-ray was done for 58 cases; 52% had pneumonic consolidation. Of the RSV cases, 33% were found in children without pneumonic consolidation. Children living in a one-room house were 3 times more likely to develop viral pneumonia (odds ratio (OR) = 3.67, CI 1.05-12.83) than children living in a larger house. Counseling on avoiding crowding where a newborn is accommodated might reduce pneumonia incidence.

Efficacy of a Russian-backbone live attenuated influenza vaccine among young children in Bangladesh: a randomised, double-blind, placebo-controlled trial

“…This study corroborates data obtained over many years in urban and rural Bangladesh, which have shown sustained circulation of multiple influenza strains and associated high clinical attack rates 2, 3, 4, 5, 6, 7, 12, 22, 23, 24. Overall, 24·5% of children in our study had laboratory-confirmed influenza illness (any strain) during the course of this trial, including over a third (34·8%) of children at the rural Matlab site.…”

“…These results are reassuring, particularly in combination with a similar lack of wheezing signal in the Senegal study, 18 and support careful assessment of the Russian-backbone LAIV in younger age groups. Previous data from Bangladesh show high attack rates and severe illness in young children3, 4, 5, 7 particularly those younger than 2 years 4, 6…”

“…In Bangladesh, over a decade of surveillance data show that influenza virus circulates during most months of the year and that infection is a frequent cause of febrile illness and lower respiratory tract infections in young children 2, 3, 4, 5, 6, 7. Furthermore, in urban Kamalapur, which has a background clinical pneumonia incidence of 500 cases per 1000 child-years, community-based surveillance identified that 10% of children younger than 5 years with clinical pneumonia are positive for influenza virus 4 .…”

Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008–2010

“…7 National influenza surveillance data from Bangladesh suggest that approximately 67 000 persons are hospitalized annually as a result of influenza virus infection and that the rate of influenza-virus-associated severe acute lower respiratory infection is 1 case per 1000 child-years among children aged < 5 years. [8][9][10] Similar findings have been reported in Guatemala, Kenya, Nicaragua, the Philippines, Thailand and Viet Nam. 7,[11][12][13][14] Although data on the influenza burden are useful to guide investments in influenza prevention and control, these data are not available in many tropical countries in Latin America.…”

Incidence of Respiratory Virus-Associated Pneumonia in Urban Poor Young Children of Dhaka, Bangladesh, 2009–2011

“…Approximately 68% of these deaths occur in the first year of life [5]. Viral pathogens, primarily respiratory syncytial virus (RSV), human parainfluenza viruses (HPIVs), human metapneumovirus (HMPV), influenza A and B viruses and adenoviruses [3], [6], [7], [8], [9], [10], [11] are major contributors to community-acquired pneumonia, especially in the first years of life [4]. There is a growing body of literature describing the etiology and incidence of pneumonia associated with different respiratory viral infections among hospitalized children but less information is available on the community-based incidence of virus specific pneumonia.…”