Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges

Papua New Guinea Pneumonia

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Abstract

Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment.

Methods: A prospective case-control study was undertaken, enrolling children

Results: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9-14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2-36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p <0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%.

Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.

Original languageEnglish
Article numberUNSP 5
Number of pages10
JournalPneumonia
Volume9
DOIs
Publication statusPublished - 5 Mar 2017

Cite this

@article{4e912c73d2ac4ad9a47ab4419dfe5ee0,
title = "Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges",
abstract = "Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment.Methods: A prospective case-control study was undertaken, enrolling childrenResults: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6{\%}) with moderate pneumonia, 187 (18.7{\%}) with severe pneumonia and 75 (7.5{\%}) with suspected meningitis, of whom 48 (4.8{\%}) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9-14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2-36.4). Half the cases were admitted to hospital (500/998; 50.1{\%}). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8{\%}). Of cases eligible for follow-up, outcome data was available from 76.7{\%}. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0{\%} and 29.0 to 47.7{\%} in cases and controls (both p <0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5{\%}.Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.",
keywords = "Pneumonia, Meningitis, Papua New Guinea, Streptococcus pneumoniae, Haemophilus influenzae, Vaccination, HAEMOPHILUS-INFLUENZAE, CHILDREN, DIAGNOSIS, BACTERIAL, INFECTIONS, PATHOGENS, ETIOLOGY",
author = "{Papua New Guinea Pneumonia} and Blyth, {Christopher C.} and Rebecca Ford and Joycelyn Sapura and Tonny Kumani and Geraldine Masiria and John Kave and Lapule Yuasi and Andrew Greenhill and Ilomo Hwaihwanje and Amanda Lang and Deborah Lehmann and William Pomat",
year = "2017",
month = "3",
day = "5",
doi = "10.1186/s41479-017-0029-y",
language = "English",
volume = "9",
journal = "Pneumonia",
issn = "2200-6133",
publisher = "GRIFFITH UNIV EPRESS",

}

Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines : study methods and challenges. / Papua New Guinea Pneumonia.

In: Pneumonia, Vol. 9, UNSP 5, 05.03.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines

T2 - study methods and challenges

AU - Papua New Guinea Pneumonia

AU - Blyth, Christopher C.

AU - Ford, Rebecca

AU - Sapura, Joycelyn

AU - Kumani, Tonny

AU - Masiria, Geraldine

AU - Kave, John

AU - Yuasi, Lapule

AU - Greenhill, Andrew

AU - Hwaihwanje, Ilomo

AU - Lang, Amanda

AU - Lehmann, Deborah

AU - Pomat, William

PY - 2017/3/5

Y1 - 2017/3/5

N2 - Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment.Methods: A prospective case-control study was undertaken, enrolling childrenResults: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9-14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2-36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p <0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%.Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.

AB - Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment.Methods: A prospective case-control study was undertaken, enrolling childrenResults: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9-14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2-36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p <0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%.Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.

KW - Pneumonia

KW - Meningitis

KW - Papua New Guinea

KW - Streptococcus pneumoniae

KW - Haemophilus influenzae

KW - Vaccination

KW - HAEMOPHILUS-INFLUENZAE

KW - CHILDREN

KW - DIAGNOSIS

KW - BACTERIAL

KW - INFECTIONS

KW - PATHOGENS

KW - ETIOLOGY

U2 - 10.1186/s41479-017-0029-y

DO - 10.1186/s41479-017-0029-y

M3 - Article

VL - 9

JO - Pneumonia

JF - Pneumonia

SN - 2200-6133

M1 - UNSP 5

ER -