Viral Etiology of Severe Pneumonia Among Kenyan Infants and Children

TLDR

Pneumonia is the leading cause of childhood death in sub‑Saharan Africa. The study aimed to determine the viral etiology of severe pneumonia among infants and children in a rural Kenyan hospital, providing comparative estimates essential for targeted vaccine development. Participants were children aged 1 day to 12 years from a defined catchment area, admitted with severe or very severe pneumonia, or presenting with mild upper‑respiratory infection or well controls; the study used comprehensive molecular diagnostics to detect respiratory viruses and calculate odds ratios for severe disease. Among 759 sampled children, 56 % had at least one respiratory virus, with RSV in 34 % and other viruses in 29 %; RSV was strongly associated with severe pneumonia (adjusted OR 6.11), whereas other viruses were not linked to severity, making RSV the predominant pathogen.

Abstract

Pneumonia is the leading cause of childhood death in sub-Saharan Africa. Comparative estimates of the contribution of causative pathogens to the burden of disease are essential for targeted vaccine development.To determine the viral etiology of severe pneumonia among infants and children at a rural Kenyan hospital using comprehensive and sensitive molecular diagnostic techniques.Prospective observational and case-control study during 2007 in a rural Kenyan district hospital. Participants were children aged 1 day to 12 years, residing in a systematically enumerated catchment area, and who either were admitted to Kilifi District Hospital meeting World Health Organization clinical criteria for severe pneumonia or very severe pneumonia; (2) presented with mild upper respiratory tract infection but were not admitted; or (3) were well infants and children attending for immunization.The presence of respiratory viruses and the odds ratio for admission with severe disease.Of 922 eligible admitted patients, 759 were sampled (82% [median age, 9 months]). One or more respiratory viruses were detected in 425 of the 759 sampled (56% [95% confidence interval {CI}, 52%-60%]). Respiratory syncytial virus (RSV) was detected in 260 participants (34% [95% CI, 31%-38%]) and other respiratory viruses were detected in 219 participants (29%; 95% CI, 26%-32%), the most common being Human coronavirus 229E (n = 51 [6.7%]), influenza type A (n = 44 [5.8%]), Parainfluenza type 3 (n = 29 [3.8%]), Human adenovirus (n = 29 [3.8%]), and Human metapneumovirus (n = 23 [3.0%]). Compared with well control participants, detection of RSV was associated with severe disease (5% [corrected] in control participants; adjusted odds ratio, 6.11 [95% CI, 1.65-22.6]) while collectively, other respiratory viruses were not associated with severe disease (23% in control participants; adjusted odds ratio, 1.27 [95% CI, 0.64-2.52]).In a sample of Kenyan infants and children admitted with severe pneumonia to a rural hospital, RSV was the predominant viral pathogen.