Viral etiology of severe pneumonia among Kenyan infants and children.
BACKGROUND
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.


OBJECTIVE
To determine the viral etiology of severe pneumonia among infants and children at a rural Kenyan hospital using comprehensive and sensitive molecular diagnostic techniques.


METHODS
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.


METHODS
The presence of respiratory viruses and the odds ratio for admission with severe disease.


RESULTS
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]).


CONCLUSIONS
In a sample of Kenyan infants and children admitted with severe pneumonia to a rural hospital, RSV was the predominant viral pathogen.
Berkley
James A
JA
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. jberkley@kilifi.kemri-wellcome.org
Munywoki
Patrick
P
Ngama
Mwanajuma
M
Kazungu
Sidi
S
Abwao
John
J
Bett
Anne
A
Lassauniére
Ria
R
Kresfelder
Tina
T
Cane
Patricia A
PA
Venter
Marietjie
M
Scott
J Anthony G
JA
Nokes
D James
DJ
D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology / Q000821:virology*; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification*