Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border

BMC Infectious Diseases

Francois Nosten²  Luis Ortega⁵  Christina Phares⁵  Carole Deglise³  Naw Cicelia¹  Verena Carrara⁴  Wanitda Watthanaworawit⁴  Claudia Turner²  Paul Turner² 

[1]Shoklo Malaria Research Unit, Mae Sot, Thailand

[2]Centre for Tropical Medicine, University of Oxford, Oxford, UK

[3]Première Urgence–Aide Médicale Internationale, Mae Sot, Thailand

[4]Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand

[5]Centers for Disease Control and Prevention Collaboration, Atlanta, GA, USA

关键词: Virus;    Respiratory;    Influenza;    Refugee;    Pneumonia;   

Others  :  1145763
DOI  :  10.1186/1471-2334-13-434

 received in 2013-01-25, accepted in 2013-08-30,  发布年份 2013

【 摘 要 】

Background

Pneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border.

Methods

Maela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR.

Results

Seven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/−gentamicin in 664/701, 94.7%).

Conclusions

Viral nucleic acid was identified in the nasopharynx in half the patients admitted with clinically diagnosed pneumonia. Development of immunisations targeting common respiratory viruses is likely to reduce the incidence of pneumonia in children living refugee camps and similar settings.

【 授权许可】

   
2013 Turner et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]WHO: The global burden of disease: 2004 update. Geneva: World Health Organisation; 2008.
• [2]UNICEF: Pneumonia: the forgotten killer of children. Geneva: UNICEF/WHO; 2006.
• [3]Mulholland K: Childhood pneumonia mortality–a permanent global emergency. Lancet 2007, 370(9583):285-289.
• [4]Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H: Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008, 86(5):408-416.
• [5]Cashat-Cruz M, Morales-Aguirre JJ, Mendoza-Azpiri M: Respiratory tract infections in children in developing countries. Semin Pediatr Infect Dis 2005, 16(2):84-92.
• [6]Ruuskanen O, Lahti E, Jennings LC, Murdoch DR: Viral pneumonia. Lancet 2011, 377(9773):1264-1275.
• [7]Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O’Brien KL, Roca A, Wright PF, Bruce N, et al.: Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010, 375(9725):1545-1555.
• [8]Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, Simmerman JM, Gordon A, Sato M, Howie S, et al.: Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011, 378(9807):1917-1930.
• [9]Madhi SA, Ludewick H, Abed Y, Klugman KP, Boivin G: Human metapneumovirus-associated lower respiratory tract infections among hospitalized human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected African infants. Clin Infect Dis 2003, 37(12):1705-1710.
• [10]UNHCR: Global trends: refugees, asylum-seekers, returnees, internally displaced and stateless persons. Geneva: United Nations High Commissioner for Refugees; 2011:2012.
• [11]Vathanophas K, Sangchai R, Raktham S, Pariyanonda A, Thangsuvan J, Bunyaratabhandu P, Athipanyakom S, Suwanjutha S, Jayanetra P, Wasi C, et al.: A community-based study of acute respiratory tract infection in Thai children. Rev Infect Dis 1990, 12(Suppl 8):S957-S965.
• [12]Ezard N, Gupta RK: Influenza pandemic plans: what about displaced populations? Lancet Infect Dis 2006, 6(5):256-257.
• [13]CCSDPT: 2006 annual health information report, Thailand-Burma border refugee camps. Bangkok, Thailand: Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT); 2006.
• [14]Turner P, Turner CL, Watthanaworawit W, Carrara VI, Kapella BK, Painter J, Nosten FH: Influenza in refugees on the Thailand-Myanmar border, May-October 2009. Emerg Infect Dis 2010, 16(9):1366-1372.
• [15]WHO: Integrated management of childhood illness handbook. 1st edition. Geneva: World Health Organisation; 2005.
• [16]WHO: Cough or difficulty breathing. In Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. World Health Organisation; 2005:69-108.
• [17]Anonymous: BTS Guidelines for the management of community acquired pneumonia in adults. Thorax 2001, 56(Suppl 4):IV1-64.
• [18]Maertzdorf J, Wang CK, Brown JB, Quinto JD, Chu M, De Graaf M, van den Hoogen BG, Spaete R, Osterhaus AD, Fouchier RA: Real-time reverse transcriptase PCR assay for detection of human metapneumoviruses from all known genetic lineages. J Clin Microbiol 2004, 42(3):981-986.
• [19]Kim C, Ahmed JA, Eidex RB, Nyoka R, Waiboci LW, Erdman D, Tepo A, Mahamud AS, Kabura W, Nguhi M, et al.: Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays. PLoS One 2011, 6(6):e21610.
• [20]Emery SL, Erdman DD, Bowen MD, Newton BR, Winchell JM, Meyer RF, Tong S, Cook BT, Holloway BP, McCaustland KA, et al.: Real-time reverse transcription-polymerase chain reaction assay for SARS-associated coronavirus. Emerg Infect Dis 2004, 10(2):311-316.
• [21]UNHCR: Health information system. http://www.unhcr.org/pages/49c3646ce0.html webcite
• [22]Ahmed JA, Katz MA, Auko E, Njenga MK, Weinberg M, Kapella BK, Burke H, Nyoka R, Gichangi A, Waiboci LW, et al.: Epidemiology of respiratory viral infections in two long-term refugee camps in Kenya, 2007-2010. BMC Infect Dis 2012, 12:7.
• [23]Mathisen M, Strand TA, Sharma BN, Chandyo RK, Valentiner-Branth P, Basnet S, Adhikari RK, Hvidsten D, Shrestha PS, Sommerfelt H: RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study. BMC Med 2009, 7:35.
• [24]Adegbola RA, Falade AG, Sam BE, Aidoo M, Baldeh I, Hazlett D, Whittle H, Greenwood BM, Mulholland EK: The etiology of pneumonia in malnourished and well-nourished Gambian children. Pediatr Infect Dis J 1994, 13(11):975-982.
• [25]Weber MW, Mulholland EK, Greenwood BM: Respiratory syncytial virus infection in tropical and developing countries. Trop Med Int Health 1998, 3(4):268-280.
• [26]Nokes DJ, Ngama M, Bett A, Abwao J, Munywoki P, English M, Scott JA, Cane PA, Medley GF: Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance. Clin Infect Dis 2009, 49(9):1341-1349.
• [27]Berkley JA, Munywoki P, Ngama M, Kazungu S, Abwao J, Bett A, Lassauniere R, Kresfelder T, Cane PA, Venter M, et al.: Viral etiology of severe pneumonia among Kenyan infants and children. JAMA 2010, 303(20):2051-2057.
• [28]Mathisen M, Strand TA, Sharma BN, Chandyo RK, Valentiner-Branth P, Basnet S, Adhikari RK, Hvidsten D, Shrestha PS, Sommerfelt H: Clinical presentation and severity of viral community-acquired pneumonia in young Nepalese children. Pediatr Infect Dis J 2010, 29(1):e1-e6.
• [29]Nokes DJ, Okiro EA, Ngama M, Ochola R, White LJ, Scott PD, English M, Cane PA, Medley GF: Respiratory syncytial virus infection and disease in infants and young children observed from birth in Kilifi district, Kenya. Clin Infect Dis 2008, 46(1):50-57.
• [30]Nokes DJ, Okiro EA, Ngama M, White LJ, Ochola R, Scott PD, Cane PA, Medley GF: Respiratory syncytial virus epidemiology in a birth cohort from Kilifi district, Kenya: infection during the first year of life. J Infect Dis 2004, 190(10):1828-1832.
• [31]Turner C, Turner P, Carrara V, Burgoine K, Tha Ler Htoo S, Watthanaworawit W, Day NP, White NJ, Goldblatt D, Nosten F: High rates of pneumonia in children under two years of age in a South East Asian refugee population. PLoS ONE 2013, 8(1):e54026.
• [32]Turner C, Turner P, Cararra V, Eh Lwe N, Watthanaworawit W, Day NP, White NJ, Goldblatt D, Nosten F: A high burden of respiratory syncytial virus associated pneumonia in children less than two years of age in a South East Asian refugee population. PLoS ONE 2012, 7(11):e50100.
• [33]Simmerman JM, Uyeki TM: The burden of influenza in East and South-East Asia: a review of the English language literature. Influenza Other Respi Viruses 2008, 2(3):81-92.
• [34]Kalu SU, Loeffelholz M, Beck E, Patel JA, Revai K, Fan J, Henrickson KJ, Chonmaitree T: Persistence of adenovirus nucleic acids in nasopharyngeal secretions: a diagnostic conundrum. Pediatr Infect Dis J 2010, 29(8):746-750.
• [35]Thavagnanam S, Christie SN, Doherty GM, Coyle PV, Shields MD, Heaney LG: Respiratory viral infection in lower airways of asymptomatic children. Acta Paediatr 2010, 99(3):394-398.
• [36]Hammitt LL, Kazungu S, Morpeth SC, Gibson DG, Mvera B, Brent AJ, Mwarumba S, Onyango CO, Bett A, Akech DO, et al.: A preliminary study of pneumonia etiology among hospitalized children in Kenya. Clin Infect Dis 2012, 54(Suppl 2):S190-S199.
• [37]Shann F, Hart K, Thomas D: Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull World Health Organ 1984, 62(5):749-753.
• [38]Madhi SA, Klugman KP: A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 2004, 10(8):811-813.
• [39]Hazir T, Nisar YB, Abbasi S, Ashraf YP, Khurshid J, Tariq P, Asghar R, Murtaza A, Masood T, Maqbool S: Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2-59 months: a multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clin Infect Dis 2011, 52(3):293-300.
• [40]Soofi S, Ahmed S, Fox MP, MacLeod WB, Thea DM, Qazi SA, Bhutta ZA: Effectiveness of community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trial. Lancet 2012, 379(9817):729-737.
• [41]Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Laxminarayan R: Antimicrobial resistance in developing countries Part II: strategies for containment. Lancet Infect Dis 2005, 5(9):568-580.
• [42]Garcia-Garcia ML, Calvo C, Pozo F, Villadangos PA, Perez-Brena P, Casas I: Spectrum of respiratory viruses in children with community-acquired pneumonia. Pediatr Infect Dis J 2012, 31(8):808-813.
• [43]Peltola V, Soderlund-Venermo M, Jartti T: Human bocavirus infections. Pediatr Infect Dis J 2013, 32(2):178-179.
• [44]Ayieko P, Akumu AO, Griffiths UK, English M: The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis. Cost Eff Resour Alloc 2009, 7:3.
• [45]Olsen SJ, Laosiritaworn Y, Siasiriwattana S, Chunsuttiwat S, Dowell SF: The incidence of pneumonia in rural Thailand. Int J Infect Dis 2006, 10(6):439-445.
• [46]Nokes JD, Cane PA: New strategies for control of respiratory syncytial virus infection. Curr Opin Infect Dis 2008, 21(6):639-643.
• [47]Nair H, Verma VR, Theodoratou E, Zgaga L, Huda T, Simoes EA, Wright PF, Rudan I, Campbell H: An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children. BMC Publ Health 2011, 11(Suppl 3):S30.