title: Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011.
abstract: BACKGROUND
  Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. We analyzed data from population-based infectious disease surveillance for severe acute respiratory illness (SARI) among children <5 years of age in Kibera, a densely populated urban slum in Nairobi, Kenya.
  
  
  METHODS
  Surveillance was conducted among a monthly mean of 5,874 (range = 5,778-6,411) children <5 years old in two contiguous villages in Kibera. Participants had free access to the study clinic and their health events and utilization were noted during biweekly home visits. Patients meeting criteria for SARI (WHO-defined severe or very severe pneumonia, or oxygen saturation <90%) from March 1, 2007-February 28, 2011 had blood cultures processed for bacteria, and naso- and oro- pharyngeal swabs collected for quantitative real-time reverse transcription polymerase chain reaction testing for influenza viruses, parainfluenza viruses (PIV), respiratory syncytial virus (RSV), adenovirus, and human metapneumovirus (hMPV). Swabs collected during January 1, 2009 - February 28, 2010 were also tested for rhinoviruses, enterovirus, parechovirus, Mycoplasma pneumoniae, and Legionella species. Swabs were collected for simultaneous testing from a selected group of control-children visiting the clinic without recent respiratory or diarrheal illnesses.
  
  
  RESULTS
  SARI overall incidence was 12.4 cases/100 person-years of observation (PYO) and 30.4 cases/100 PYO in infants. When comparing detection frequency in swabs from 815 SARI cases and 115 healthy controls, only RSV and influenza A virus were significantly more frequently detected in cases, although similar trends neared statistical significance for PIV, adenovirus and hMPV. The incidence for RSV was 2.8 cases/100 PYO and for influenza A was 1.0 cases/100 PYO. When considering all PIV, the rate was 1.1 case/100 PYO and the rate per 100 PYO for SARI-associated disease was 1.5 for adenovirus and 0.9 for hMPV. RSV and influenza A and B viruses were estimated to account for 16.2% and 6.7% of SARI cases, respectively; when taken together, PIV, adenovirus, and hMPV may account for >20% additional cases.
  
  
  CONCLUSIONS
  Influenza viruses and RSV (and possibly PIV, hMPV and adenoviruses) are important pathogens to consider when developing technologies and formulating strategies to treat and prevent SARI in children.
authors: Robert F
authors: RF
authors: Breiman
authors: Leonard
authors: L
authors: Cosmas
authors: M
authors: M
authors: Njenga
authors: John
authors: J
authors: Williamson
authors: Joshua A
authors: JA
authors: Mott
authors: Mark A
authors: MA
authors: Katz
authors: Dean D
authors: DD
authors: Erdman
authors: Eileen
authors: E
authors: Schneider
authors: M
authors: M
authors: Oberste
authors: John C
authors: JC
authors: Neatherlin
authors: Henry
authors: H
authors: Njuguna
authors: Daniel M
authors: DM
authors: Ondari
authors: Kennedy
authors: K
authors: Odero
authors: George O
authors: GO
authors: Okoth
authors: Beatrice
authors: B
authors: Olack
authors: Newton
authors: N
authors: Wamola
authors: Joel M
authors: JM
authors: Montgomery
authors: Barry S
authors: BS
authors: Fields
authors: Daniel R
authors: DR
authors: Feikin
mesh_terms: D000208:Acute Disease; D000256:Adenoviridae / Q000235:genetics / Q000302:isolation & purification; D000257:Adenoviridae Infections / Q000453:epidemiology / Q000821:virology; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D009980:Influenza A virus / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology; D007630:Kenya / Q000453:epidemiology; D007875:Legionella / Q000302:isolation & purification; D007876:Legionellosis / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D029121:Metapneumovirus / Q000235:genetics / Q000302:isolation & purification; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D009975:Orthomyxoviridae / Q000235:genetics / Q000302:isolation & purification; D010222:Parainfluenza Virus 1, Human / Q000235:genetics / Q000302:isolation & purification; D010223:Parainfluenza Virus 2, Human / Q000235:genetics / Q000302:isolation & purification; D018184:Paramyxoviridae Infections / Q000453:epidemiology / Q000821:virology; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000821:virology; D011019:Pneumonia, Mycoplasma / Q000453:epidemiology* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000821:virology; D011156:Population Density; D011204:Poverty Areas; D060888:Real-Time Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000235:genetics / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology; D010253:Respirovirus Infections / Q000453:epidemiology / Q000821:virology; D012229:Rhinovirus / Q000235:genetics / Q000302:isolation & purification; D019351:Rubulavirus Infections / Q000453:epidemiology / Q000821:virology; D014505:Urban Population / Q000706:statistics & numerical data*