title: Viral etiology of severe pneumonia among Kenyan infants and children.
abstract: 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.
authors.affiliation: Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. jberkley@kilifi.kemri-wellcome.org
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.forename: Patrick
authors.initials: P
authors.lastname: Munywoki
authors.forename: Mwanajuma
authors.initials: M
authors.lastname: Ngama
authors.forename: Sidi
authors.initials: S
authors.lastname: Kazungu
authors.forename: John
authors.initials: J
authors.lastname: Abwao
authors.forename: Anne
authors.initials: A
authors.lastname: Bett
authors.forename: Ria
authors.initials: R
authors.lastname: Lassauniére
authors.forename: Tina
authors.initials: T
authors.lastname: Kresfelder
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cane
authors.forename: Marietjie
authors.initials: M
authors.lastname: Venter
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
authors.forename: D James
authors.initials: DJ
authors.lastname: Nokes
mesh_terms: 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*