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Microorganisms Associated With Pneumonia in Children <5 Years of Age in Developing and Emerging Countries: The
Thomas Bénet1,2, Valentina Sánchez Picot1, Mélina Messaoudi1
1Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1.
Insights
Pneumonia in young children is often caused by Streptococcus pneumoniae, RSV, and rhinovirus in developing nations. Increased vaccination against S. pneumoniae could significantly lower pneumonia rates in these vulnerable populations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Pneumonia is the leading infectious cause of mortality in children globally, disproportionately affecting developing countries.
- This study focuses on identifying key microorganisms responsible for pneumonia in children under five in resource-limited settings.
Purpose of the Study:
- To assess the specific microorganisms associated with childhood pneumonia in developing and emerging countries.
- To quantify the contribution of identified pathogens to the overall pneumonia burden.
Main Methods:
- A multicenter, prospective observational case-control study involving 888 cases and 870 controls of children <5 years old.
- Nasopharyngeal swabs were analyzed using reverse-transcription polymerase chain reaction to detect 19 viruses and 5 bacteria.
- Multivariate logistic regression was employed to calculate the adjusted population attributable fraction (aPAF) for each pathogen.
Main Results:
- Over 93% of pneumonia cases and 74% of controls had at least one detected microorganism.
- Streptococcus pneumoniae, Respiratory Syncytial Virus (RSV), and rhinovirus were independently associated with pneumonia.
- S. pneumoniae accounted for a significant portion of pneumonia cases (aPAF 42.2%), followed by RSV (18.2%) and rhinovirus (11.2%).
Conclusions:
- Streptococcus pneumoniae, RSV, and rhinovirus are identified as major contributors to pneumonia in children <5 in developing and emerging countries.
- Enhancing Streptococcus pneumoniae vaccination coverage presents a critical strategy to reduce the global burden of childhood pneumonia.
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.
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